International Programs

World Map


In 2004 and 2005, Dr Barker was awarded a Kenan Fellowship to take sabbatical leave for 12 months to improve delivery of HIV care in his home country of South Africa. Building on earlier work of the Institute for Healthcare Improvement (IHI), he established a series of demonstration projects in the country to show that highly active antiretroviral therapy could be rapidly delivered to all who needed it within a short period of time. South Africa is the epicenter of the global HIV pandemic, with 5 million of its 45 million population infected with the virus, more than any other nation on earth. 



Nearly 15 years ago, US and European clinicians showed that an effective cocktail of antiretroviral drugs could stop the deadly virus in its tracks and allow infected patients to live a prolonged, near normal life. Despite this knowledge, pitifully few efforts were made to intervene and life expectancy continues to plummet across sub Saharan Africa. Life expectancy in Swaziland, a country just north of South Africa is now half of what it was just 10 years ago. A child born today in Swaziland can expect to live 35 years -- as long as an English infant born in medieval times. Currently, only about 25% of all who need ARVs in South Africa have access to this treatment, and the program to prevent perinatal infection in that country is largely ineffective.


SA Map

Using systems improvement methods developed by IHI, Dr Barker leads projects that are supporting HIV care in 5 of South Africa's 9 provinces with 2 clear objectives in mind--demonstrate that it is possible to rapidly increase access to antiretroviral care for all who need it, and to dramatically decrease transmission of HIV from mother to child.

The approach is simple and effective…learning collaboratives have adapted and applied systems thinking and rapid cycle change, often with dramatic effect in a short period of time. 



Across South Africa, UNC/IHI supported projects have dramatically improved access to care by engaging all health facilities in a district or subdistrict, without reliance on additional resources.

Compared to all South African programs, which are stalled at providing 20-25% of the annual need for HAART, UNC/IHI supported projects have rapidly expanded access and 2 of the projects have recently provided nearly 100% of the projected need for HAART.

In a major expansion of the South African work, Dr Barker is collaborating with the University of Kwazulu-Natal in a major new 5-year scale-up project, funded by the CDC, to reduce mother-to-child transmission of HIV in all 300 clinics and hospitals over 3 Districts. The project will assist front-line clinicians to reliably implement health care protocols for HIV positive pregnant mothers that could reduce mother-to-child transmission of HIV by 20,000 cases each year – the “20,000+ Campaign.”