“…Health system barriers in Malawi and other African countries include chronic, severe shortages of essential resources for prevention such as gloves and disinfectant, staff shortages of trained personnel, and lack of adequate staff training and supervision (Ansa, Udoma, Umoh, & Anah, 2002;Garbus, 2003;Chelenyane & Endacott, 2006;Mbanya et al, 2001;Reis et al, 2005;Sadoh et al, 2006;Walusimbi & Okonsky, 2004). Staff shortages have been exacerbated by out-migration of trained health workers to more affluent countries (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004) and by premature health worker deaths caused by AIDS.…”