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Transcript of AIDS 2012 - Turning the Tide Together PEPFAR’s Efforts to Strengthen the Global HIV Healthcare...
PEPFAR
AIDS 2012 - Turning the Tide Together
PEPFAR’s Efforts to Strengthen the Global HIV Healthcare Workforce
Ambassador Eric Goosby, M.D.U.S. Global AIDS Coordinator,
Department of State
Healthcare Worker Shortage & HIV Pandemic
HIV Prevalence (UNAIDS, 2006)
Health Worker : Population Ratio (World Health Organization, 2006)
• PEPFAR I: 2003-2008– Priority: Scaling-up HIV/AIDS treatment, care and prevention– Challenge: Not enough health care workers HIV training – Focus on in-service training to teach HIV skills to existing health
workers, task shifting/task sharing HIV services, and some integration of HIV content into pre-service degree programs
• Task shifting– “Game changer” in scaling-up HIV treatment, care, and
prevention– Support for WHO Task-shifting Guidelines
The President’s Emergency Plan for AIDS Relief (PEPFAR)
• Priority: Health Systems Strengthening – Country ownership and sustainability of HIV programs– Congressional mandate to train and support retention of 140,000 new
health care workers, with an emphasis on doctors, nurses, and midwives
– The Human Resources for Health 2009 inter-agency technical working group strategy involves: “Strengthening regulatory bodies and professional associations”, including nursing organizations
• World AIDS Day 2012– Recognizing critical role of nurses and midwives to meet new targets:
• 6 million on ART• 1.5 million pregnant women on ART• 4.7 million voluntary medical male circumcision
PEPFAR II (2009-2014)
Vision: Appropriate number and distribution of qualified health workers who meet the HIV and other health needs of the population
Goals:• Increase the Density of Health Workforce
– Number– Cadres
• Balance Distribution of Health Workforce– Geographic location – Sector – Gender
• Improve Performance of Health Workforce– Quality– Efficiency
PEPFAR’s HRH Strategy: Vision and Goals
Flow Chart Illustrating Various Points for Policy Intervention in HRH Labour Market
Health Care Education Labor Force Health Care Labor Take-up Rate Participation Force Participation
Rate Rate
High
School
Pool of
Qualified HW
Other
Training
Training
in Health
Non-Health Care
Sector
Health Care
Sector
Un-
employed
Employed
USA, UK
Geographic distribution
Private/Public sector allocation
Absenteeism Skill mix Productivity Quality
MIGRATION
Health Labor Market Dynamics
Adapted from Marko Vujicic, World Bank 2009
PEPFAR’s Human Resources for Health Objectives
1. Strengthen pre-service education institutions2. Ensure quality of in-service and pre-service training and practicing professionals 3. Support the development of new cadres and strengthen the community workforce 4. Improve health worker motivation and productivity and foster
positive workplace environments5. Investigate and apply recruitment and retention strategies 6. Improve HRIS and utilization of data for improved management and planning
New HCW
Students
Teachers and Effective Leadership
Infrastructure
Strengthen pre-service education institutions
Objective 1
Source: ITECH
• MEPI/NEPI• East Africa: multi-country learning
collaborative to strengthen regulatory bodies and professional associations
• Uganda & Tanzania: Evaluating country in-service HIV/AIDS training programs
• Global: twinning partnerships in ten countries in Africa and Russia.
Ensure quality of in-service and pre-service training and practicing professionals
Objective 2
Health Workforce Initiatives
• PEPFAR’s medical and nursing pre-service training initiatives: – Competitive awards to African institutions (MEPI)– Grants to specific countries to identify and support priority
interventions to nursing institutions (NEPI) – Transformative Guidelines (WHO) and related activities
• Objectives of initiative - – Workforce capacity - numbers and quality– Education and training more relevant to country needs – Innovative education models– Research capacity (MEPI)– Evidence based policies and technical materials– Costs of effective strategies
Medical and Nursing Education Partnership Initiative
• PEPFAR initiative under the direction of the Office of the U.S. Global AIDS Coordinator
• PEPFAR Implementing agencies, U.S. Department of Health and Human Services, – Health Resources and Services Administration (HRSA), HIV/AIDS
Bureau– National Institutes of Health (NIH), Fogarty Center– Coordinating Centers
• George Washington University, Wash DC• Columbia University, NY
• Other partners (non-USG):– WHO – Transformative Guidelines – Policy and Technical – CHAI and USAID/Capacity Plus
Directory of Awards Medical Education Partnership Initiative (MEPI) and Nurse Education Partnership Initiative (NEPI)
• Botswana• Ethiopia• Ghana• Kenya• Lesotho (NEPI only)• Malawi (MEPI/NEPI)• Mozambique• Nigeria• South Africa• Tanzania• Uganda• Zimbabwe• Zambia (MEPI/NEPI)
PEPFAR/WHO Collaborative: Transformative Medical Nursing and Midwifery Education
Guidelines
• Purpose: To support the new political and resource commitments by providing sound policy and technical guidance
• Apply to a wide range of providers and promotes the efficient use of providers through task shifting
• Promotes innovation: – interdisciplinary teams – Service networks
• Supports the decentralization of education and training with consideration to rural programs
• Builds on and promotes the use of existing WHO policies
• WHO: Task-shifting guidelines• Mozambique & South Africa:
Development of new cadres • GHWA: Community Health Workers
study• Global: Community Health Worker
Program Assessment and Improvement Matrix (CHW AIM)
Support the development of new cadres and strengthen the community workforce
Objective 3
• Four-year initiative to strengthen nursing and midwifery leadership and regulation in 17 sub-Saharan African countries
• Objectives– Ensure high quality practice standards– Ensure updated regulatory frameworks– Strengthen nursing and midwifery councils– Cultivate African nursing leadership
• Approach – Regional conferences – South-to-south collaboration– Regulation improvement grants– Targeted technical assistance – Evaluation science
African Health Profession Regulatory Collaborative (ARC)
• Zanzibar & Tanzania: Productivity & Work Climate Study
• Niger, Uganda, & Tanzania: HRH Collaboratives
• Swaziland & Uganda: Wellness Centers for health workers
• Rwanda : national performance -based incentive scheme
Improve health worker motivation and productivity and foster positive workplace environments
143
48
29
198
2631
7
61
0
20
40
60
80
100
120
140
160
180
200
Registration & triage Consultation Dispensing TOTAL
Ave
rag
e tim
e (m
inu
tes)
Clinic service
Average Client Waiting Times in Kabuyanda at Baseline and Follow-up
Average waiting time at baseline Average waiting time at follow-up
* The average waiting time for 'Consultation' at follow-up is a weighted average of 'Consultation with nurse' and 'Consultation with clinician'
Figure 1. Uganda Productivity:Average Client Waiting Times in Kabuyanda Baseline and Follow-up
Objective 4
• WHO: Retention recommendations for increasing access to health workers in remote and rural areas
• Mozambique & Swaziland: Retention & Quality of Services study
• Tanzania: Recruiting health students from rural areas
• Global: Developing recommendations for measuring retention in PEPFAR countries
Investigate and apply recruitment and retention strategies
Objective 5
• Global: Implementing iHRIS (open source software) in 14 countries
• Kenya: Public Health HR Information System and Workshop being expanded for use in other countries
• Uganda: Work with MOH & MOF on resource planning
• Global: HRM Rapid Assessment Tool & Curricula development
From: “Zeroing In: AIDS Donors and Africa’s Health Workforce” – Oomman, Wendt, Droggitis. Center for Global Development. August 2010
Improve HRIS and utilization of data for improved management and planning
Objective 6
Expanding the Evidence Base:Research & Innovation
• Tools– HRH Action Framework (http://www.capacityproject.org/framework/)– Rapid Discrete Choice Experiment (DCE) Tool– Employee Engagement Tool– TrainSMART
• Implementation Science– Impact of task-shifting on ART delivery (multi-country)– Effectiveness and attrition of providers in PEPFAR-funded health centers (Ethiopia)– Study on Success Factors for Management Capacity Building Sustainability– Impact of Task Shifting for ART Delivery on Patient and Process Outcomes in Uganda – Nurse-initiated and managed HIV Treatment in Policy, Education, and Practice in 17
African countries – Measuring the Impact of On-Site Mentorship on Nurse and Clinical Officer’s HIV and
TB Care and Competencies– Descriptive Study of Nursing and Midwifery Practice and Education Regulation in
East, Central, and Southern Africa
Considerations Going Forward
• An appropriate balance between ‘quantity and quality’.
• Multi-sectoral approaches, particularly between health and education sectors
• Long term, sustainable changes in areas of recruitment, education/training, and retention.
• The use of evidence-based information with demonstrated effectiveness in LMIC.
• Affordable in LMIC.
For further information, please visit:www.PEPFAR.gov
www.facebook.com/PEPFAR http://twitter.com/USPEPFAR
Thank You