Building the Capacity of the Health and Social Care System in Case Management

J. Csiszar MD. MSc. MBAIAS Conference

July 2010

“HELP”HIV/AIDS Education in Lithuania Program

Content

• Introduction of Project HOPE

• Background• The Problem• Goal and Objectives• The Uniqueness of our

approach• Results• Conclusion

Introduction of Project HOPE

Since 1958 • Improving health via education training,

targeted humanitarian assistance, health policy research

• Present in 5 continents, 37 countries• Core strengths: Health Professional Education Health of Mother and Children Health Systems & Facilities

Development Infectious Diseases Non -Communicable Diseases

Background

• Turbulent political social and economic environment for transitional countries

• Loss of safe employment, social security and disintegration of safety nets in the society

• Ethnic minorities and other marginalized groups are even more dramatically affected than the mainstream population

• Transparent borders, availability of cheap drugs result in a surge of HIV/AIDS among marginalized groups (ethnic minorities, prisoners, IDU)

• Existing health and social systems cannot successfully cope with the epidemic due to fragmentation and lack of coordination between their services

• Long term commitment to CEE countries in transition

• Several years of successful collaboration with Lithuanian partners on Health Care Management program

• Successful experience withmulti professional team training andnetwork development

The Epidemics in Lithuania

The problem

• Doctor centered care• Complex, fragmented services- difficult to navigate

by the patient• Limited awareness in the health and social sector of

the needs of PWLHA, risk groups, and people with special needs

• Lack of multidisciplinary team culture• Communications, coordination, continuity across

services is poor

Goal: To place the patient in the centre of prevention

and care efforts and design a program that addresses his/her unique - health and social- needs in a comprehensive , holistic fashion.

Objectives

Policy level• Integrated case management model• Regulatory framework • System for supervision, follow up , quality management

Institutional level• Create a network of collaborating institutions• Develop Institutional framework for continuing training (CPD) and supervision• Create a pool of Master Trainers affiliated with the National AIDS Institute• Reduce Stigma in health institutions• Build mechanism for monitoring and follow up of implementation

Provider level• Improve KASP• Reduce stigma and discrimination• Improve multidisciplinary teamwork and coordination• Develop organization, communication and management skills• Facilitate the development of team projects• Improve cost effectiveness of the services by avoiding duplication and waste

The uniqueness of the approach

• Multidisciplinary team training (introductory course)

• Selection of candidates for ToT

• Training of trainers• Cascading the training

throughout the country• Shadow faculty,

mentoring• Locally owned program

Results

Coverage

Results

• 231 participants trained

• 153 organizations represented

• 268522 clients reached annually

Results- 39 team projects developed

Results

Conclusions

• The culture of multidisciplinary teamwork, communication, collaboration and continuity of care is essential to the delivery of value to patients

• Building local training capacity was key to scaling up the effect of our program

• Residential, multidisciplinary team setting to promote the culture of collaboration and networking has proven successful

• Countries with similar background may benefit from replicating this model

Thank you!