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Category: Health Systems Strengthening

HRSA Delegation Witnesses I-TECH’s Vital Work in South Africa

Post categories: Health Systems Strengthening Nursing/HCW Cadres South Africa
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Members of the HRSA delegation and officials from a Department of Correctional Services (DCS) health facility in Witbank, South Africa

In late March, I-TECH South Africa hosted a delegation from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA).

Led by Dr. Mary Wakefield, HRSA Administrator, the delegation also included Ambassador Jimmy Kolker, Assistant Secretary for Global Affairs, U.S. Department of Health and Human Services (HHS); Dr. Austin Demby, Director – PEPFAR, Office of Global Affairs, HHS; and Dr. Jose Rafi Morales, Director HRSA/HAB PEPFAR Global HIV/AIDS Program.

The group was accompanied in-country by Steven T.  Smith, Health Attaché and HHS Regional Representative for Southern Africa;  Dr. Nancy Knight, CDC Country Director; Rehmeth Fakroodeen, CDC HSS lead and HRSA Activity Manager; and the I-TECH Senior Management Team.

The purpose of the visit was to observe the following activities, funded by HRSA through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Training Correctional Health Workers

With 165,000 inmates incarcerated in 237 correctional facilities, South Africa has the fourth-highest global incarceration rate, and the country’s facilities are operating at 137% of intended capacity.[1]Overcrowding leads to insufficient ventilation and poor physical and mental health, all of which fuel the spread of HIV and tuberculosis (TB). HIV prevalence in these facilities is as high as 34.6%,[2] and the reported TB cure rate is less than 40%, compared to 70% in the general population.[3]

Ensuring adequate skills among health care providers in correctional facilities is essential to fight the spread of HIV and other communicable diseases. During its first visit, to a DCS health facility in Witbank, the HRSA delegation witnessed first-hand I-TECH’s work to conduct a situational analysis and support the training of health care workers on the care and management HIV and AIDS, tuberculosis, and sexually transmitted infections (STIs). This work was conducted in two regions: Limpopo, Mpumalanga, and North West (LMN) and KwaZulu-Natal.

Supporting Continuing Professional Development for Nurses

In 2012, the SANC started the process of developing a Continuing Professional Development (CPD) Program for the 262,000 nurses in South Africa[4]; however, due to funding constraints and lack of capacity, I-TECH South Africa was asked to support them in the program’s development. Through the CPD Program, nursing practitioners will be required to attain a minimum number of CPD points as a prerequisite for annual renewal of their license to practice.

The HRSA delegation met with the Chair of the Board of Directors of SANC and its Registrar, as well as representatives from the National Department of Health and academic institutions. Members of the delegation were briefed on achievements to date, which include technical assistance to establish a CPD technical working group and a draft CPD framework for nurses, a situational analysis of feasibility and acceptability of CPD, and a CPD pilot study outline developed for two provinces.

[1] Institute of Medicine. Key Populations, Key Solutions – A Gap Analysis & Recommendations for Key Populations and HIV in South Africa. Accessed 17 March 2013. http://southafrica.iom.int/publication/key-populations-key-solutions-a-gap-analysis-recommendations-for-key-populations-and-hiv-in-sa/

[2] South African Department of Correctional Services. 2007 Prevalence Survey for HIV.

[3]Verbal communication with South African National Department of Correctional Services on 28 March 2013.

[4] South African Nursing Council Licensure Register.

I-TECH Helps to Fight Cervical Cancer in Haiti

Post categories: Haiti Health Systems Strengthening Human Resources for Health Noncommunicable Disease
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I-TECH's Dr. Jean Guy Honoré and nurses assess supplies.

On International Women’s Day, March 8, Radio France Internationale’s Atelier de Medias posted a piece highlighting I-TECH’s work to fight cervical cancer in Haiti. The following is a summary of the post.

According to the World Health Organization (WHO), cervical cancer is ​​the second most common cancer in women worldwide and remains a leading cause of death, with approximately 86% of new cases and deaths occurring in middle- and low-income countries.1 Among women who die from this disease, the percentage of them from developing countries has increased from 80% in 2002 to 88% in 2008, and it may reach 98% by 2030.2

Haiti — a country with limited resources and a population of 10 million — is no exception. Currently, it is estimated that, every year, 568 women are diagnosed with cervical cancer in Haiti, and 353 of them succumb to the cancer.3 According to the WHO, if nothing is done by 2025, there will be an approximately 55% increase in cases of cervical cancer in Haiti.

In answer to this threat, the Haitian Ministry of Public Health and Population (MSPP), through the Direction of Family Health (DSF), launched a Cervical Cancer Prevention program in Haiti. Since 2011, I-TECH — with funding from the U.S. Health Resources and Services Administration through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR — has supported DSF/MSPP in facilitating the training of trainers (ToT) and participating actively in the drafting of standards for screening and treatment of precancerous lesions on the cervix.

In March 2013, I-TECH in collaboration with Dr. Frantz Montès from MSPP and two other Haitian experts, Dr. Christophe Millien and Dr. Eddy Jonas from Partners in Health/Zanmi Lasante, conducted a training in visual inspection with acetic acid (VIA) and cryotherapy for caregivers from these institutions.

This program grew under the leadership of I-TECH’s Technical Director Dr. Jean Guy Honoré. In December 2013, I-TECH began to assist institutions in implementing the program, and in the months that followed, it was launched at six institutions across the country. This has resulted in hundreds of patients screened, several of whom have received cryotherapy and cervical biopsies.

The full text of the article (in French) can be found at http://atelier.rfi.fr/profiles/blogs/halte-au-cancer-du-col-en-ha-ti-i-tech-s-investit.

Sources:

1. Human Papillomavirus and Related Cancers in Haiti. Summary Report 2010. World Health Organization / ICO Information Centre on HPV and Cervical Cancer HPV (HPV Information Centre), 2012. Accessed on May 25, 2014.

2. Strategies for cervical cancer prevention using visual inspection with acetic acid and cryotherapy treatment screening. Report of the PAHO workshop for Latin America and the Caribbean. Guatemala City, June 1-2, 2011. Washington, DC: Pan American Health Organization, 2011.

3. Globocan 2008: Cancer Incidence and Mortality Worldwide. International Agency for Research on Cancer / World Health Organization, 2010.

Launch of HIV Programs in Zimbabwe Hits the Right Note

Post categories: Clinical Mentoring Demand Creation eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention Male Circumcision Monitoring & Evaluation Scott Barnhart Zimbabwe
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Zim_launch

To the brass beats of the Prince Edward School Jazz Band, on Feb. 6, a crowd of approximately 150 government officials, health professionals, and members of the press celebrated the launch of three programs in Zimbabwe, two of which are implemented by I-TECH Zimbabwe and partners. These vital programs aim to build local capacity and provide comprehensive services to prevent and combat HIV/AIDS in the country.

Speaking at the festivities were David Bruce Wharton, U.S. Ambassador to the Republic of Zimbabwe; Dr. Owen Mugurungi, director of the AIDS and TB Unit at the Ministry of Health and Child Care (MOHCC); Dr. King Holmes, Chair of the Department of Global Health at the University of Washington; Dr. Ann Downer, Executive Director of the International Training and Education Center for Health (I-TECH); and Dr. Batsirai Makunike-Chikwinya, Country Director of I-TECH Zimbabwe.

“Preventing the spread of HIV/AIDS is important to all of us, as is providing the best level of care to those living with this disease,” said Amb. Wharton. “Today we celebrate the launch of programs that will help us reach these goals together – programs that were designed together, by dedicated teams of collaborating partners from Zimbabwe and from the United States.”

In this spirit of collaboration, the programs, totaling $65 million over five years, support the Zimbabwe MOHCC with grant funding by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), technical support from the Centers for Disease Control and Prevention, and implementation by local and U.S.-based partners. These partners include I-TECH; Zimbabwe Association of Church-Related Hospitals; Zimbabwe Community Health Intervention Research Project; Compre Health Services; The Newlands Clinic and Newlands Clinic Training Centre; Pangaea Global AIDS Foundation, Zimbabwe; and the University of Zimbabwe-University of California, San Francisco Collaborative Research Programme.

The Training and Mentoring Program seeks to develop and deliver in-service training on antiretroviral therapy, including the medical management of HIV/AIDS, women’s reproductive health, tuberculosis (TB), and TB/HIV co-infection to 8,000 health care workers across the country over five years. A mentorship component will also provide health care workers with access to ongoing learning and feedback on clinical issues. Health workers will receive refresher trainings via distance learning technologies, and the effectiveness of the program will be measured through a training database.

Also celebrated – and accompanied by a ribbon-cutting and presentation of 17 new vehicles – was the launch of the Voluntary Medical Male Circumcision Program. The program, building on work that started last spring, seeks to deliver services to 412,000 men in Zimbabwe between the ages of 15 and 49 years over the next five years. Medical male circumcision has proved very effective in preventing the spread of HIV. Randomized controlled trials in Uganda, Kenya, and South Africa have shown that this intervention reduces the risk of female-to-male sexual transmission of HIV by approximately 60%.

“Together, these two programs will improve the effectiveness and quality of prevention, treatment, and care services for those affected by HIV/AIDS – and create better health systems for all Zimbabweans,” said Dr. Holmes.

New Article Examines Effect of Training Approaches on Malaria Case Management

Post categories: Health Systems Strengthening Human Resources for Health Malaria Uganda
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Martin Mbonye

Martin Mbonye

In Uganda, the country with the world’s highest malaria transmission rate, effective training of frontline health workers is especially critical. A new article reports the positive effects of the Integrated Infectious Disease Capacity Building Evaluation (IDCAP)’s training approaches on malaria case management in the country.

“Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” was lead-authored by Martin K. Mbonye, Msc., a researcher at the Infectious Diseases Institute (IDI) in Kampala, Uganda, and published in open-access journal PLOS ONE on Jan. 8; the full text is available online.

“This project made huge strides toward improving the capacity of health workers,” said Mbonye. “These findings have positive implications for Uganda’s increasing ability to take ownership of its malaria interventions and better fight infectious diseases – which account for the majority of the disease burden in the country.”

The IDCAP provided classroom training, distance learning, and on-site support to mid-level practitioners through two interventions: the Integrated Management of Infectious Disease (IMID) training program and on-site support, which integrated site visits and continuous quality improvement. Building on the work of the Joint Uganda Malaria Program (JUMP), IDCAP tackled a wider scope, including malaria, pneumonia, tuberculosis, HIV, and related infectious diseases. (Read more about the interventions and other results here.)

The evaluators then measured the effects of the interventions and the performance of 36 facilities. The results were promising; the combination of interventions was found to improve emergency triage, assessment and treatment processes, and malaria care, a topic of particular importance in Uganda, where steady temperatures and rainfall enable high levels of malaria transmission year-round.

As the IDCAP’s monitoring and evaluation team specialist, and then as program manager, Mbonye oversaw the project’s data surveillance system. He reported improvements in the use of diagnostic tests for malaria suspects, the prescription of the appropriate antimalarials for patients who were determined to need one, and a reduction in the prescription of antimalarials among patients who tested negative for malaria. This decrease in presumptive diagnosis is an important element in reducing drug stockouts and resistance.

I-TECH was one of four partners in the now-completed IDCAP grant to the Accordia Global Health Foundation, and University of Washington professor Marcia Weaver is the IDCAP principal investigator. This article is one of the first in a series of papers describing the study’s results.

Ensuring Quality for In-Service Trainings

Post categories: Health Systems Strengthening
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More effective, efficient and sustainable health worker in-service training (IST): what have we learned so far?  The IST session in a nutshell from the 3rd Global Forum on Human Resources for Health, Recife, Brazil.

Brazil forumThere are more in-service training programs than ever before with training often representing the lion’s share of investments for strengthening human resources for health (HRH).    An increasing number of reports indicate that  training is rarely evaluated, frequently duplicative and may not be designed to meet needs.  A growing multiplicity of poorly coordinated training providers may overwhelm and weaken training systems rather than strengthen them.

Ensuring that quality of the services delivered by health workers is upheld and continually strengthened is of utmost importance to the Universal Health Coverage agenda. Training is clearly an important contribution towards the development and maintenance of health worker competencies for delivering quality services – but how can we make training more effective, efficient and sustainable?   While evidence is patchy, we have substantial experience and expertise on what practices are essential – such as the practice recommendations summarized in the  USAID PEPFAR-supported Improvement Framework for Health Worker Improvement Framework for Health Worker In-service Training, which we launched at the November 13th IST side session of the 3rd Global Forum on HRH.

We gathered participants from around the world at this side session to harvest and share experiences, strategies and lessons learned.  Sparked by info-rich and stimulating lightning talks that compressed research, evidence-informed frameworks and country experiences into 3 minutes – participants speed networked and brainstormed their way through each theme of the Improvement Framework in a knowledge café.

knowledge cafeSo what did we learn?  We’ve conveniently packaged together the questions we discussed along with some of the main lessons learned here:

1) Strengthening training institutions and systems: how can we strengthen, standardize and institutionalize training systems?

  • In-country linkages between learning systems (pre-service education, CPD) are needed to strengthen and institutionalize training systems.  IST should also be provided by local institutions to increase ownership and sustainability of training.  Standardization of training materials and program can maximize existing resources for training for training and improve training effectiveness and efficiency.  Resource flows require further analysis and improvement with participants recommending that advocacy is needed for training budgets within healthcare systems to support trainees to attend IST programs.

2) Coordination of training: what mechanisms can be used to better coordinate training?  What characteristics are most desirable in a training information/tracking system?

  • We need to stop training the same people over and over again, while others are not trained at all. A system for tracking training courses and participants would not only improve the efficiency, effectiveness and sustainability of training, it would also help to ensure equitable access to training by all health workers.

3) Continuum of learning from pre-service to in-service: What roles can different stakeholders play to ensure continuum of learning between pre-service education and in-service training?

  • Pre-service institutions can be at the heart of a coordinated in-service training structure by offering courses directly or accrediting groups like professional associations to provide training.  This model can help ensure consistency between pre-service and in-service training content and allow for in-service trainings to count towards degree programs offered by pre-service institutions.  This approach requires coordination among key stakeholders such as academicians, associations, regulatory council, and ministry of health.

4) Design and delivery of training:  A review of the literature  suggests  shorter, repeated, simulation-heavy, workplace-based training can be more effective.  Given the current system is geared towards classroom-based, group-based training, how can we implement more effective methodologies?

  • We should prioritize linking any training event to continued health professional development, and look for opportunities to provide workplace-based training using alternative methodologies that supports a continuous quality assurance process.

5) Support for learning: How do we prepare, support and incentivize busy healthcare workers to provide workplace-based mentoring or support to others?

  • It’s interesting to note that during the knowledge café this question did not generate any discussion –  perhaps because addressing support for learning extends well beyond training and education systems, into issues of supervision, job descriptions, working conditions, and other aspects of human resource and facility management.  Nevertheless, all agreed that ensuring an on-the-job environment the enables the learner to utilize new knowledge and skills is essential to translating learning into improved quality of services and health outcomes.

6) Evaluation and improvement of training: How can evaluation of IST outcomes be strengthened to inform improvement in training?  What are some of your successes and some of your needs in identifying results of your training programs?

  • The evaluation-focused group was well-attended, and participants engaged eagerly in identifying themes for discussion around the topic of outcome-level evaluation of trainings.  One of the key issues discussed was that there are multiple factors – barriers and facilitators – influencing the outcomes of training programs, which poses a significant challenge to evaluation.  It was noted that teasing out these factors methodologically, to identify the specific contribution of training towards desired program outcomes, requires significant time, thought, and resources.  Participants in this group were provided CDs containing the Training Evaluation Framework and Tools (TEFT) and a web link (www.go2itech.ort/resources/TEFT) providing resources to help address this challenge.

There’s clearly more than we were able to harvest and digest in a 90 minute session.  We’d like to invite you to join us in sharing your experiences online via the open access wiki we are putting together; this is expected to launch in February 2014.  This wiki will include one page guidance for each recommendation in the Framework including a brief synthesis of the relevant literature, examples of good practice and links to additional resources and tools.  We invite you to enrich this wiki with your examples, lessons learnt and technical resources and join the growing community who are leading change efforts towards more effective, efficient and sustainable training.

Itching to get started?  Click on the links below to have your say and see what others are saying:

  1. How can we strengthen, standardize and institutionalize training systems?
  2. What mechanisms can be used to better coordinate training? What characteristics are most desirable in a training information/tracking system?
  3. What roles can different stakeholders play to ensure continuum of learning between pre-service education and in-service training?
  4. Given the current system is geared towards classroom-based, group-based training, how can we implement more effective methodologies?
  5. How do we prepare, support and incentivize busy healthcare workers to provide workplace-based mentoring or support to others?
  6. How can evaluation of IST outcomes be strengthened to inform improvement in training?  What are some of your successes and some of your needs in identifying results of your training programs?

For more information:

A Global Improvement Framework for Health Worker In-service Training: Guidance for Improved Effectiveness, Efficiency and Sustainability: http://ow.ly/qZAVu

Human Resources for Health Journal Series on Improving the efficiency, effectiveness and sustainability of health worker in-service training: Closing the gaps between evidence, practice and outcomes: http://www.human-resources-health.com/series/IST

Training Evaluation Framework and Tools: https://www.go2itech.org/resources/TEFT

Authors:  R Bailey, CapacityPlus; J Bluestone, Jhpiego; G O’Malley, I-TECH;  C McCarthy, CDC; S Ngobua, CapacityPlus; F Petracca, I-TECH; L Schaefer, USAID; T Wuliji, USAID Applying Sciences to Strengthen and Improve Systems Project (ASSIST),

Five-Year Cooperative Agreement with CDC to Train and Mentor Zimbabwe Medical Staff

Post categories: eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Zimbabwe
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A new award to I-TECH seeks to fight the spread of HIV in Zimbabwe by rapidly scaling up training and mentoring of the country’s medical staff.

I-TECH South Africa Hosts I-TECH’s First Training for Standardized Patients

Post categories: Health Systems Strengthening Monitoring & Evaluation South Africa
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I-TECH South Africa is using Standardized Patients to measure the quality of care for sexually transmitted infections (STIs) for an operations research (OR) study in the Northwest Province. Ten South African actors, five men and five women, will visit 40 clinics before a new STI training program and at two time periods after the training.