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Success Story: WhatsApp, a Potential Warmline for Low-Resource Settings

Post categories: eLearning/Distance Learning Health Systems Strengthening Zimbabwe
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A PMTCT Client Retention training includes tablet-based modules.
A PMTCT Client Retention training includes tablet-based self-study modules.

In Zimbabwe, health care workers often need to build confidence and skills in caring for HIV-positive infants and children. The International Training and Education Center for Health (I-TECH) has employed an innovative approach to support these front-line staff – a case-based, self-study PMTCT Client Retention training.

During the introductory session, participants are oriented to the course, given self-study tips, loaned tablets and instructed on their use, and given a pre-course assessment. Participants also attend a half-day classroom session at the beginning and end of the five-week course.

A WhatsApp discussion group is also set up to send messages of motivation and reminders and for participants to share issues during the course. WhatsApp is widely used in Zimbabwe as an inexpensive mobile phone platform to message individuals and groups.

WhatsApp for collaborative problem solving

Elizabeth is a primary care nurse who was among a cohort of 30 participants in one of these trainings, conducted in Mashonaland Central Province. About one week into the course, Elizabeth faced a situation at work where she was confused about how to apply national guidelines to one of her pediatric patient cases. Elizabeth chose to bring the issue to her training cohort. Below is a sample of the discussion that ensued among several members of the group, showing that a number of the cohort were similarly perplexed:

Elizabeth: A woman came to our clinic. She was ill. She wanted to get tested because she was ill for a long time on and off. The woman tested positive. Because she is breastfeeding an 11-month-old baby l commenced her on Option B+. l tested the baby with antibody RDT [rapid diagnostic test] and tested negative. l commenced the baby on cotrimoxazole prophylaxis. The question is: Was it necessary for the baby to be given NVP [nevirapine] prophylaxis since the baby tested negative and is now 11 months OR should l give the baby NVP prophylaxis for 6wks from now????

Elizabeth received a range of responses from her cohort:

  • NVP is only given from birth up to six weeks. Commence mother on Option B+, baby on cotr prophylaxis collect confirmatory DBS [dried blood spots] for the child.
  • I agree with ~nr
  • Cotr prophylaxis and confirmatory DBS only for the baby. Thanks guys.
  • Baby should still get NVP for six wks since still breastfeeding — meaning baby is still exposed.
  • As per NVP shld be given — the first dose at birth, the second dose 48hrs after first dose, then third dose 96hrs after second dose. Prophylaxis shld be given as soon after delivery as possible. When prophylaxis is delayed the less likely that the infection will be prevented.
  • By age of 14 days, infection already would be established in most infants. So l think it’s not necessary to give NVP as prophylaxis.

One member of the cohort was a district nursing officer (DNO). He shared that he had deliberately delayed responding until others had weighed in. He not only gave advice but also encouraged the group to refresh themselves on the resources available on their tablets:

Sorry for a late response. Remember key things in your scenario: mother is positive, baby is breastfeeding and is 11 months. … Infant is still at risk, therefore cotri prophy, infant feeding counselling and a continuation of routine FCH [family and child health] care will help. Then 6wks after stopping breastfeeding conduct rapid HIV test again. If negative stop cotri prophy and continue routine care. If positive CT cotri prophy, initiate ART.

He then referred Elizabeth to an algorithm in the national ART guidelines, which were included for easy reference in an application on the participants’ tablets.

This exchange showed the potential use of WhatsApp for support in clinical decision making, in the absence of a warmline for consultation. Upon returning to the classroom, participants engaged in discussion around the WhatsApp conversations, with particular attention paid to the case that Elizabeth had brought to the group. Other members of the cohort reported that they had watched the exchange with interest though they did not contribute.

The cohort members reported that the case was educational for them, and many of them indicated that they would like to continue their group for ongoing support.

As for Elizabeth’s young client, a rapid test was collected and returned negative. Results of the DNA test are still being awaited by the group with much interest. As one member wrote: “We cannot afford to lose that child, wherever she is. … She is still our child.”

 

E-Learning and Data Quality Improvement Featured at CUGH 2016

Post categories: Caribbean eLearning/Distance Learning Health Information Systems Health Systems Strengthening HIV Care and Treatment Kenya
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Optimized-CUGH banner 2016

The International Training and Education Center for Health (I-TECH) is presenting three posters at the 7th Annual Consortium of Universities for Global Health (CUGH) conference in San Francisco on April 9-11. The theme of this year’s conference is “Bridging to a Sustainable Future in Global Health.”

A critical component in sustainability is the ability to collect accurate and meaningful data through electronic medical records (EMRs) – the subject of two abstracts from the I-TECH Kenya team.

In addition, online learning and electronic learning (e-learning) provides opportunities for health care workers in resource-limited settings to gain critical knowledge and skills while minimizing their need to leave the workplace.

In close partnership with the University of Washington Department of Global Health’s eLearning Initiative (eDGH), I-TECH piloted e-learning modules for KenyaEMR and transitioned the HIV management diploma program at the University of the West Indies into a blended learning program that incorporates online courses.

“Building Human Capacity for Optimal Use of an Electronic Medical Record System in Kenya: Results of a Pilot Evaluation of Two eLearning Modules”

The transcript tab allows learners to read along with the narration.
The transcript tab allows learners to read along with the narration.

Since 2012, the Kenyan Ministry of Health, PEPFAR, and partners have supported implementation of electronic medical record systems (EMRs) at more than 600 public-sector health facilities. The International Training and Education Center for Health (I-TECH) has supported scale-up at more than 300 of these sites.

However, implementation is just part of the story. Successful, sustained use of EMR data depends upon the knowledge and skills of front-line health care workers. To address this need, I-TECH and eDGH developed and piloted two interactive e-learning modules on EMR data quality and EMR data for decision-making.

I-TECH and eDGH found that facility staff were motivated to use EMR e-learning modules and apply what they had learned. Participants found the content relevant to their jobs and cited an interest in additional scenarios and modules. Self-paced e-learning modules were determined to be a viable solution for standardizing sustainable training on EMR systems.

“Institutionalization of a Routine Data Quality Assessment (RDQA) Procedure for Improved Data Quality of Electronic Patient Medical Records in Kenya”

To support progressive EMR data quality improvement, I-TECH developed a Routine Data Quality Assessment (RDQA) standard operating procedure and analysis tool. The RDQA procedure was defined in collaboration with the Kenyan Ministry of Health and integrated within existing policies and procedures.

From 2014 to 2015, 180 baseline and repeat assessments were conducted. I-TECH supported facility personnel to share results during county-level EMR review meetings; these presentations motivated other sites to plan for RDQAs and fostered a culture of ongoing data quality improvement. The RDQA procedure for EMR data has now been institutionalized as a method for progressively improving EMR data quality in Kenya.

“Train, Transfer, and Sustain: Building Capacity for Online Learning at The University of the West Indies Diploma in the Management of HIV Infection Program”

In partnership with the University of the West Indies (UWI), eDGH and I-TECH transitioned a one-year diploma program in the Management of HIV Infection to a blended learning platform that combines online courses with either a clinical practicum or a research project.

The shift in pedagogy, methodologies, and technologies was achieved through a three-phased approach designed to not only train UWI faculty and staff, but also transfer online facilitation skills to them and sustain those skills.

In its second year as a blended learning online program, the diploma program has scaled up to include health care workers from Cayman Islands, Jamaica, and Suriname.

These projects are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA0680, International AIDS Education and Training Center. The content and conclusions of this post are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.

Ukraine Formally Adopts ClASS Methodology

Post categories: Health Systems Strengthening Ukraine
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Anna Shapoval, Country Representative, and Iryna Yuryeva, Senior Training Developer, with the National ClASS Guidelines.
Anna Shapoval, Country Representative, and Iryna Yuryeva, Senior Training Developer, with the National ClASS Guidelines.

On January 26, the Ministry of Health (MOH) of Ukraine formally adopted the national guidelines on Clinical Assessment for Systems Strengthening (ClASS) and approved ClASS as a formally recommended national qualitative methodology/tool. The ClASS Guidelines were developed by a team of 10 experts from the International Training & Education Center for Health (I-TECH) and the Ukrainian Center for Socially Dangerous Diseases of the MOH of Ukraine (UCDC).

The ClASS methodology in Ukraine offers four key modules/tools: Clinical, VCT, Administrative, and Financial. Two additional modules that will help assessing HIV/TB integrated services and HIV labs are in the process of development with input from the national and international experts. They are expected to be formally approved later this year.

“This is a significant accomplishment and the product of a very small team who put tremendous efforts, time, and energy to develop national guidelines in the course of just few months,” says Anna Shapoval, Country Representative for I-TECH Ukraine. “We are extremely proud and humbled by the fact that our joint efforts of promoting ClASS in Ukraine in the past two years are sustained in the form of this publication.”

On February 2-3, I-TECH and UCDC conducted the national dissemination workshop in Kyiv. ClASS Guidelines were presented to the group of the national ClASS reviewers, representatives of the eight Oblast AIDS Centers (OACs) from the regions that participated in the assessment to date, as well as OACs from the three new regions interested in applying ClASS. Along with local partners, I-TECH and UCDC discussed potential benefits that participation in ClASS could offer, just some of which include:

  • A positive platform for mentorship and sharing experience with the national ClASS reviewers, most of whom represent various health facilities and work in various regions of Ukraine;
  • Sound, evidence-based assessment findings, which may be successfully used for development of the strategic and working action plans and for attracting additional financing from budget and off-budget sources, donors including additional technical assistance; and
  • Preparation for accreditation and compulsory certification.

The future plans in regard to ClASS promotion in Ukraine include assessments of additional regions, development of at least two additional modules, training of the second group of the national ClASS reviewers, and applying ClASS toward at least two OAC as part of their preparation for the accreditation or mandatory certification.

Following the workshop, over 100 copies of the publication were immediately sent out to the U.S. Centers for Disease Control and Prevention (CDC) office in Ukraine, other international agencies, the MOH, all Health Departments of all Oblast State Administrations, all Oblast AIDS centers, scientific medical libraries, libraries of the Ukrainian medical universities, and continuous medical education academies.

“These guidelines open new opportunities for applying ClASS methodology and tools in Ukraine in different contexts and, most importantly, upon request from specific health care facilities or regions,” says Ms. Shapoval. “This differentiates ClASS from other top-down evaluations or approaches.

“The level of enthusiasm about ClASS among our national and local partners is inspiring, and with the additional modules on labs and HIV/TB co-infection being finalized and plans to train and certify the new group of national reviewers, we hope I-TECH will continue expanding its work around ClASS in Ukraine in the coming years.”

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

New Evaluation Highlights Benefits of iSanté to Care and Treatment

Post categories: Haiti Health Information Systems Laboratory Systems
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Dr. Regine Juste (left) works on iSanté with Dr. Marinho Elisma, I-TECH Haiti's Lead Clinical Mentor.
Dr. Regine Juste (left) works on iSanté with Dr. Marinho Elisma, I-TECH Haiti’s Lead Clinical Mentor.

For a decade, the iSanté electronic medical record system and OpenELIS lab software, developed by the International Training and Education Center for Health (I-TECH), have allowed health care providers to document HIV patient care and patient care histories.

A recent evaluation, “Report on Best Practices in ‘Point of Care’ Implementation of iSanté and OpenELIS Data Systems,” has expanded the current knowledge of iSanté’s use at point of care (POC) as well as highlighting the benefit of iSanté use to care and treatment.

The evaluation also identifies strengths and challenges in POC use of the iSanté and OpenELIS systems in clinics and hospitals in Haiti, in order to guide improvements in the quality of I-TECH’s technical assistance.

The move to point of care

Until 2012, most sites used iSanté primarily to capture data that providers had recorded on paper forms. In 2012-13, with impetus from the Haitian Ministry of Health and funders, I-TECH supported some iSanté sites to move toward POC implementation.

This involves providers using iSanté during patient visits to enroll patients, review health history, capture clinical assessments and treatment plans, and record drug and laboratory orders.

Evaluation shows positive impact

Through in-depth interviews and focus group discussions with hospital personnel, I-TECH was able to grasp the positive impact of iSanté POC system use has on care and treatment.

Facility personnel at all levels were satisfied with the transition to POC system use. All five sites evaluated reported increases in provider confidence and improved human resource management, citing reduced provider workload and more effective use of provider time.

Personnel also perceived a number of positive effects of system use on productivity and quality of care including benefits to patient experience (reduced wait times) and service quality.

New HIV Training Guide Geared Toward Family Physicians in Ukraine

Post categories: Health Systems Strengthening HIV and STI Prevention Human Resources for Health Ukraine
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Pilot Training Ukraine
Participants, experts, developers, and trainers of the pilot training event that took place in October 2014 at the UFMTC at NMU.

The International Training and Education Center for Health (I-TECH) Ukraine, in close partnership with the Ukrainian Family Medicine Training Center (UFMTC) at Bogomolets National Medical University (NMU), and under the auspices of the Ministry of Health (MoH) of Ukraine, has published a new facilitator guide, Modern Technologies for the Organization of Prevention of HIV/AIDS Transmission and Drug Use: The Role of Family Medicine Based Primary Health Care.

“This publication is a product of creative collaboration by a united team of experts in the areas of family medicine and HIV,” said Olga Vysotska, Director of the UFMTC at NMU. “It is a unique gift to the faculty of all departments at medical schools and colleges all over Ukraine that train medical doctors and nurses.”

The MoH of Ukraine recommends the guide as a tutorial for clinical interns and doctors enrolled in in-service or continuous medical education training programs, as well as for faculty of the Ukrainian medical universities and colleges that train medical doctors and nurses as general practitioners and family doctors.

The goal of the course is to provide participants with skills and knowledge in the early diagnosis, care, social adaptation, treatment, and early prophylaxis of HIV, specifically in combination with drug addiction, tuberculosis, and hepatitis, as well as to form the proper attitudes necessary for family physicians in Ukraine to provide effective services to HIV patients, and patients of at-risk groups.

The guide is based on the results of a pilot training event that took place in October 2014 at the UFMTC at NMU. Dr. Chris Behrens from I-TECH facilitated the event, along with nine leading national experts from NMU, the Ukrainian Center of Diseases Control (UCDC), the Ivano-Frankivsk Oblast Clinical Center for Palliative Care, and the Kiev City AIDS Center.

“It is the first of its kind in Ukraine; no such publications existed prior to this one,” said Dr. Vysotska. “In addition to their work on the most up-to-date clinical content, we really valued the methodological support provided by I-TECH during the training process and development of the guide, as well as the application of contemporary tools and approaches to adult education.”

The key areas covered by the course are:

  • HIV/AIDS epidemiology, both globally and in Ukraine, including the roles of primary health care and family medicine in responding to the HIV/AIDS epidemic
  • Pathophysiology, pathogenesis, and stages of HIV infection, including key diagnostic methods
  • Palliative care for HIV/AIDS patients by family doctors.
  • Antiretroviral therapy (ART)
  • Diagnosis and management of co-infection (HIV/TB/virus, hepatitis B and C) in family practice
  • HIV in pregnant women, including prevention of mother-to-child transmission
  • Management of patients with HIV and drug addiction, including opiate substitution therapy (OST)
  • Post-contact prophylaxis, including universal precautions (international and Ukrainian standards)

“The process of development of this product by a multicultural, multiprofessional team of experts was vibrant, mutually enriching, and very satisfying,” said Anna Shapoval, Country Representative for I-TECH Ukraine. “We are most grateful to the Ministry of Health of Ukraine, HRSA of the US Department of HHS and CDC in Ukraine for their support and guidance through this project and look forward to new initiatives of this kind together with our national partners.”

For more information about the guide, please visit: http://www.ex.ua/618786634523

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Mental Health – A New Challenge for HIV Treatment in Ethiopia

Post categories: Ethiopia Health Systems Strengthening HIV Care and Treatment Mental Health
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I-TECH-supported HIV care and counseling in northern Ethiopia, in 2009. Photo courtesy of Julia Sherburne.

Although HIV patients in Ethiopia have greater access to antiretroviral therapy (ART) than they did a decade ago, ensuring that patients adhere to a full course of ART is still a major challenge. In response, in 2008, the International Training and Education Center for Health (I-TECH) launched a landmark HIV/AIDS Case Management program in several of the country’s regions where HIV prevalence was high.

This project was supported by the U.S. President’s Plan for AIDS Relief (PEPFAR), through the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).

The goals of the project are to help control the HIV epidemic in Ethiopia, minimize transmission of HIV, and help HIV patients lead healthy lives. The project actively targets and engages patients considered to be likely non-adherents by assessing clinical, nutritional, domestic, and economic indicators. Those at risk of non-adherence are transferred to I-TECH-trained case managers located within ART clinics.

“ART taken for life is a challenge, but missing a few pills can cause a rapid decline in the health of a patient suffering from HIV. A discontinued course of ART will create a resistant strain of HIV that is much more difficult to treat,” says Misti McDowell, former Country Director for I-TECH Ethiopia.

Poor adherence can also mean high risk of transmission in the patient’s community. The Case Management program helps mitigate that risk.

A new screening tool

I-TECH quickly realized that many patients attending adherence counseling sessions were suffering from mental health issues, including depression, anxiety, and substance abuse. It was also understood that many health workers did not have the competencies or skills to adequately engage in conversation with patients about their mental and emotional welfare.

I-TECH formulated a mental-health screening tool for all ART patients to better assist patients with ART adherence and mental health issues.

“Many HIV patients in Ethiopia become overwhelmed by depression, and commit suicide. The mental health component to our work has helped to prevent these outcomes, and manage mental health issues related to HIV diagnosis,” says Dr. Manuel Kassaye, I-TECH’s Care and Treatment Programs Director.

Shared experiences can save lives

In Ethiopia, there are currently only 42 working psychiatrists catering to the needs of an estimated population of 93 million. “The country is in need of a strategy to deliver mental health services to people,” says Dr. Manuel. I-TECH-trained adherence case managers, working in partnership with hospital clinicians, have directly helped to address mental health issues related to HIV in Ethiopia.

The majority of case managers selected and trained by I-TECH have themselves been diagnosed with HIV, ensuring empathic relationships with their patients.

“To be a good adherence support worker, I believe it is necessary to have HIV,” says Mulugojam Yilikal, who was trained as a support worker by I-TECH in 2008. “The case worker will have enough experience to empathize with the patient, to help guide them through their mental and emotional issues.”

She adds that patients feel secure and comfortable talking to people who also have HIV. “By opening up and talking freely with us, it benefits their mental health, and their adherence to taking their medication.”

Mulugojam’s brother tragically committed suicide in 2007, after struggling to come to terms with his HIV diagnosis. “I know that if this support and counseling service [had been] available to my brother, he would have been saved from killing himself,” she says. “If a patient confides to a support worker that they want to take their own life, they can be prevented [from doing so] through counseling.”

Genet Behre, 30, is married and has a 5-year-old son. She discovered her HIV status during a pregnancy check-up in 2009. She immediately started taking ART and reluctantly disclosed the news to her husband—who subsequently left her. Once disclosure is made, there usually follows a period of emotional and mental distress that often leads to household dysfunction. “It was a terrible time when I first found out,” says Genet. “I was very distressed, and came into conflict with family and friends.”

After being screened for mental health, Genet was offered counseling and medical treatment for her depression and anxiety. “After six months, I had stopped fighting with my family,” she says. “My life is now stable again, my home life is peaceful, and I have an income selling injera. The counseling and medical support I receive has helped me to live like ordinary people, and not fear for the future.”

After counseling, new hope

A peer support group has been set up by I-TECH, in which patients have a platform to confide in others and speak openly without fear of being judged. Here, people are encouraged to share personal experiences and coping strategies. The group focuses on helping patients cope with the stigma associated with HIV, and overcome any barriers to ART adherence, including social and economic problems.

Zenabe Teklu, 35, silently sits with her I-TECH trained case manager at Gondar Hospital. Although she barely speaks, she is evidently happy to be in the reassuring company of her mentor. Zenabe had two children who both tragically died within six months of being born. After the departure of her husband in 2007, her mental health started to deteriorate. Then, after developing physical sores in 2007, she was tested for HIV, and promptly joined I-TECH’s case support program. However, between 2007 and 2013, she continued to suffer strong symptoms of mental disturbance and suicidal tendencies.

In 2013, I-TECH introduced the mental health screening service at Gondar Hospital. Up to this point, Zenabe was mistakenly told that her depression and suicidal thoughts were symptoms of ART medication. Zenabe started receiving the correct medication and counseling shortly after hospital staff members had completed I-TECH training in mental health screening.

Zenabe, who currently works as a cotton weaver, is happy to have turned a huge corner in her life with the support of I-TECH: “My life is stable compared to how I was before. I no longer feel full of anger and depression. I have experienced a lot of trauma, but the support I get from my case managers helps me to live a normal life”.

I-TECH Shares Research at CUGH 2015

Post categories: Haiti Health Information Systems Health Systems Strengthening Kenya Malawi Male Circumcision Nursing/HCW Cadres Quality Improvement
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CUGH 2015

On March 26-28, Boston University will host the Sixth Annual Consortium of Universities for Global Health (CUGH) Conference.

The theme of this year’s conference is “Mobilizing Research for Global Health,” and featured speakers include Olusoji Adeyi, Director, Health, Nutrition and Population, World Bank; Paul Farmer, Co-Founder, Partners in Health; and Stephen Morrison, Vice President, Center for Strategic and International Studies.

Staff members from the International Training and Education Center for Health (I-TECH) will attend to present research on several topics:

Malawi

  • Quality improvement practices decrease adverse event rates in a surgical male circumcision program in Malawi
    Kohler PK, Chilongozi DA, Namate D, Barr BA, Msungama W, Phiri O, Tenthani L, Chalulu K, Perdue T, Barnhart S, Krieger JN
  • Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi
    Holman J, Muyaso M, Msiska G, Namate D, Wasili R

Haiti

  • An assessment of data quality in Haiti’s multi-site electronic medical record system
    Puttkammer N, Baseman JG, Devine EB, Hyppolite N, France G, Honoré JG, Matheson AI, Zeliadt S, Yuhas K, Sherr K, Cadet JR, G. Zamor, Barnhart S

Kenya

  • Evolution of the KenyaEMR training program: Towards efficiency and quality in scale-up
    Atelu C, Antilla J, Muthee V, Puttkammer N

About CUGH

Founded by leading North American university global health programs, CUGH aims to:

  • Define the field and discipline of global health;
  • Standardize required curricula and competencies for global health;
  • Define criteria and conditions for student and faculty field placements in host institutions;
  • Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.

CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.

 

MOU Signed with the Ukrainian Centre for Socially Dangerous Disease Control

Post categories: Health Information Systems Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Ukraine
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From L to R: Igor Kuzin, Head of the National M&E Center at UCDC; Dr. Natalia Nizova, Director of UCDC; Matt Heffron, I-TECH Informatics Implementation Specialist; Anna Shapoval, I-TECH Ukraine Country Director; and Mykhailo Rabinchuk, PR and Event Manager at UCDC.

From L to R: Igor Kuzin, Head of the National M&E Center at UCDC; Dr. Natalia Nizova, Director of UCDC; Matt Heffron, I-TECH Informatics Implementation Specialist; Anna Shapoval, I-TECH Ukraine Country Director; and Mykhailo Rabinchuk, PR and Event Manager at UCDC.

On March 11, the University of Washington Department of Global Health (DGH) signed a Memorandum of Understanding (MOU) with the Ukrainian Centre for Socially Dangerous Disease Control of the Ministry of Health of Ukraine (UCDC).

This landmark event consolidated cooperation between the International Education and Training Center for Health (I-TECH) — a DGH center — and UCDC. This partnership started in 2013 with the launch of the I-TECH-developed Clinical Assessment for Systems Strengthening (ClASS) tool within a project to build clinical and managerial capacity of HIV/AIDS services in Ukraine.

All parties expressed confidence that this MOU would help foster relationships and the development of possible collaborative projects in capacity building, monitoring and evaluation, and research aimed at quality improvement of health care services in Ukraine.

“I-TECH is very excited about this new development in our collaboration with UCDC,” said Anna Shapoval, Country Director of I-TECH Ukraine. “The MOU will help to formalize, fortify, and, hopefully, expand our partnership with the UCDC in the coming year and beyond —  in particular in the area of health systems strengthening through development of human resources for health and supporting strategic information systems.”

Faculty Partnerships with University of Namibia Lead to Strengthened School of Public Health

Post categories: eLearning/Distance Learning Health Systems Strengthening Human Resources for Health Leadership & Management Namibia Nursing/HCW Cadres
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UNAM School of Nursing Science and Public Health

UNAM School of Nursing Science and Public Health

Despite a decrease in the estimated annual HIV/AIDS incidence since 2001, HIV/AIDS remains a significant source of morbidity and mortality in Namibia.[1]

In 2008, the International Training and Education Center for Health (I-TECH) at the University of Washington (UW) was invited to conduct a rapid assessment of the University of Namibia (UNAM) master’s degree program in public health, with the goal of identifying ways to strengthen UNAM’s School of Nursing Science and Public Health. Dr. Virginia Gonzales, Senior Lecturer in the UW’s Department of Global Health and Senior Technical Specialist with I-TECH, led that study along with Lee Pyne-Mercier, UW Affiliate Instructor and former I-TECH Country Program Manager.

New award based on study findings

Recommendations included the suggestion that UNAM attract lecturers from outside the university to strengthen teaching in subjects such as research methods, epidemiology, and biostatistics. Based on these and other findings from the assessment, UNAM and UW/I-TECH submitted a joint application to the US Centers for Disease Control and Prevention (CDC) and were awarded a five-year cooperative agreement in 2010, with Dr. Ann Downer, Executive Director of I-TECH, serving as principal investigator.

The goal of the agreement was to improve and enhance the UNAM School of Nursing Science and Public Health. Objectives for this project included:

  • Plan for sustainability and transfer of resources to UNAM.
  • Strengthen professional development and faculty support at UNAM.
  • Strengthen content and delivery of the MPH program at UNAM.
  • Improve research capacity and output of lecturers and students at UNAM.
  • Strengthen institutional capacity and infrastructure for teaching public health at UNAM.

With this new award, I-TECH/UW and UNAM embarked upon a series of faculty partnerships. The group also began to explore how to separate the UNAM School of Nursing Science and Public Health into two programs, creating both a School of Nursing and a School of Public Health. The UNAM Senate issued a proclamation in 2014 that this would occur.

“The focus of curriculum [in the new School of Public Health] will be needs-driven,” says Dr. Käthe Hofnie Hoëbes, Associate Dean of the UNAM School of Nursing Science and Public Health, “and it will support new job growth in Namibia, as it promotes the creation of new cadres of public health specialization.”

From partnership comes growth

Retreat with UW and UNAM faculty, 2009

Retreat with UW and UNAM faculty, 2009

The CDC award has now come to an end; however, through this project, UW and UNAM created 16 strong faculty partnerships, all determined by the priorities of the UNAM faculty through a Public Health Working Group (PHWG).

“The benefit of working with the PHWG was one of the key takeaways from this project,” says Dr. Gonzales. “It ensured that UNAM was in the position to offer continual input, guide project activities, and truly lead the project.”

The faculty partnerships occurred in health policy, bioethics, nutrition, research, environmental health, and epidemiology, linking interested faculty at UW and UNAM. Through these relationships, UW faculty visited the main UNAM campus in Windhoek to facilitate workshops and review curriculum, and the UNAM faculty visited UW to observe classes and work on curriculum revision.

As a result of the trust among faculty at both universities, partnerships evolved in unexpected areas as well, including social work, nursing, medicine, pharmacy, teaching technologies, and with the Namibian Ministry of Health and Social Services’ (MOHSS) Primary Health Care Program.

“Working in partnership was a cross fertilizing, fulfilling and enriching exercise for all of us who were involved,” says Magdaleena Nghatanga, former Director of the Directorate of Primary Health Care, MOHSS. “Across the ocean we shared experiences and professional expertise. Utilizing technology such as Skype, Dropbox, and e-learning helped the team in developing and revising the curriculum, as well as in building and improving teaching at the university level. As a result, the Primary Health Care Program and curriculum were revised and updated, and the students were thrilled with the new lectures.”

Outcomes echo throughout the country

Leaders in Health--Namibia! working group, 2010

Leaders in Health–Namibia! working group, 2010

The collaboration also focused attention on teaching skills, and evaluations of faculty by students at UNAM improved considerably. In addition, UNAM graduates reported improved skills and knowledge in HIV/AIDS, nutrition, health policy, epidimiology, and research and increased knowledge of and interest in public health. Thesis supervisors at UNAM reported greater skills in supervision and student mentoring, and UNAM lecturers reported increased knowledge, skills, and confidence in teaching course materials.[2]

The workshops offered on learning theory and teaching skills were later scaled to all of UNAM, including remote campuses. Several faculty also participated in the Leaders in Health – Namibia! (LIH) program that was designed by I-TECH/UW in collaboration with the MOHSS in order to strengthen the health care delivery system in Namibia through effective mentoring of health leaders and managers. The UNAM faculty who participated in LIH later improved course content on leadership and management at UNAM by using material and content from LIH.

“This partnership has yielded benefits on many fronts,” says Dean Hofnie Hoëbes. “Lines of collaboration have been initiated with other world-class universities, and technical support was provided for the roadmap for establishing a standalone School of Public Health. This will benefit the nation as a whole by supporting public health care in the country and preparing a larger, professional workforce with specialized skills to address shortages in public health practitioners in Namibia.”

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[1] Namibia Global Health Initiative, 2011-2015/16.

[2] University of Namibia and I-TECH Namibia. Evaluation of the Impact of the UNAM/I-TECH Collaboration upon the Master of Public Health Program, 2009-2012. 2013.

Tablets Help Tanzanian Health Care Workers Upgrade Skills

Post categories: eLearning/Distance Learning Health Systems Strengthening Tanzania
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Students in Kilosa, Tanzania, try out the new tablet app.

Students in Kilosa, Tanzania, try out the new tablet app.

In November 2014, the Tanzania Ministry of Health and Social Welfare (MOHSW) launched a program that allows practicing Clinical Assistants to upgrade to the level of Clinical Officer — the first MOHSW distance learning program in Tanzania to use tablet computers to deliver medical course material.

The International Training and Education Center for Health (I-TECH) and the University of Washington Department of Global Health’s e-learning group (eDGH) collaborated with the MOHSW on the In-Service Programme for Ordinary Diploma in Clinical Medicine, a blended distance learning program.

Credential upgrades expand the range of health care services that these practitioners can provide, including care and treatment of HIV and AIDS. They are also expected to have a positive impact on retention of healthcare workers. The use of tablet technology makes these upgrades more convenient and accessible.

“Working students need learning that will not take them off their workstations for relatively long periods of time,” says Dr. Fabian Mghanga, Principal of Mtwara Clinical Officers Training Center. “Being appropriate to their situation and context, this tablet e-learning [program] provides answers to their demands.”

Support for this project was provided through the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR) by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA). Programmatic oversight was provided by the U.S. Centers for Disease Control and Prevention (CDC) in Tanzania.

A comprehensive educational experience

Sixty-five students have enrolled in the inaugural cohort.

Sixty-five students have enrolled in the inaugural cohort.

I-TECH has worked with the MOHSW since 2010 to redesign the Clinical Officer upgrading program to align with current clinical guidelines and competency-based training approaches. Sixty-five students, based at health facilities throughout the country, have enrolled in the inaugural cohort, at three Clinical Officer Training Centers based in Kilosa, Mafinga, and Mtwara. Scale-up to additional training centers is planned for next year.

The new two-year Clinical Officer upgrading program incorporates three modalities: self-paced learning using interactive e-learning materials on tablet computers, face-to-face classroom activities and instruction, and hands-on practical training in clinical settings.

Upon completion of all course requirements, students will earn a Diploma in Clinical Medicine after achieving a passing mark on the National Qualifying Examination.

An app for self-directed learning

Learning materials for the In-Service Programme for Ordinary Diploma in Clinical Medicine.

Learning materials for the In-Service Programme for Ordinary Diploma in Clinical Medicine.

I-TECH and eDGH instructional designers and e-learning specialists collaborated with the MOHSW to design a digital textbook application for the Android platform. Students will complete e-learning modules using this app during self-study periods.

The app is designed to enhance self-directed learning by embedding interactive quizzes, anatomy tutorials, and other learning exercises into the course text. It also includes full-color photos and videos that are not available in the traditional residential training program.

MOHSW and training center representatives designed the course schedule and clinical rotation plan, provided clinical review, app testing, and assisted in the design of learning exercises.

“This modality of learning is quite amazing,” says Dr. Mghanga. “Our students can learn almost anything, wherever they are, at their own time and pace, yet feel they are no less [informed] than the on-campus students.”

Preparing for sustainability

In preparation for the official launch, I-TECH officially handed over all teaching and learning materials, including a donation of 73 tablet computers, to the Human Resource Development Department of the MOHSW. Tablets were distributed to students and faculty at each participating training institution.

I-TECH and the MOHSW conducted a faculty orientation to prepare principals and instructors at each training institution to successfully facilitate a distance learning program. In turn, training center faculty conducted student orientations at each site during the first face-to-face session.

In the coming weeks, the MOHSW and I-TECH will orient distance education mentors based near students’ homes, who will support students during practical rotations.

I-TECH will evaluate the first year of course implementation, and results will inform future scale-up and transition planning with the MOHSW to help ensure a sustainable program. To further support sustainability, the MOHSW has established a revolving fund to purchase tablets for future student cohorts.