Training And Mentoring Clinical Health Workers In Kenya; Efficiency Gained from the Proposed Harmonized HIV Curriculum

Daniel Mwai,1 Irene Mukui,2 Arin Dutta,1 Priya Iyer,1 1Futures Group, 2 National AIDS & STI

Control Program, Kenyadmwai@futuresgroup.com

March 21st , 2013

The Second HIV Capacity Building Partners’ Summit, Birchwood Hotel and Conference Centre Johannesburg, South Africa

1. Introduction and research questions

2. Methodology

3. Results and discussion

4. Limitations and conclusion

Overview

Introduction and research questions

Kenya have relied on off-site training model to train and nature its health workers for HIV response [1], over time.

The need for HIV training and mentoring for healthcare workers is in the rise, although resources for Hiv response are dwindling.

This calls for adoption and used most efficient and effective(E2) use of resources in HIV response.

Inline with National AIDS & STI Control Programme and partners have proposed a new, harmonized HIV training curriculum.

For the curriculum to be adopted, an understanding of potential benefits was needed, to aid in identifying the efficient model.

Introduction

What is the total efficiency gained when comparing the off-site components of the proposed harmonized curriculum and the current program?

What is the unit cost per person per day of different models for ongoing mentoring?

What is the impact of the different mentoring models on the number of missed patient encounters in the HCW’s home facility?

What is the most efficient model of ongoing mentoring ?

Research Questions

Methodology

In the new training curriculum, HCWs are divided into clusters: clinical, pharmacy, laboratory, nutrition and counseling, and social work.

We focused on the clinical cluster (doctors, clinical officers, nurses).

Efficiency was defined in terms of the relative costs of the placement stage.

We calculated the direct costs of the off-site training component

For monitoring, we estimated time spent away from the HCW’s home facility using current program data for two models: District Health Mentorship Training (DHMT) Roving Clinicians Model (RCM)

Methodology

Results and discussion

Figure 2: GFATM Round 10 Proposal and Mukui, I., 2012. Estimates include cost of trainers, venue hire, stationery, per diem, and transport.Figure 3:Source: Authors’ calculations.

Efficiency of the Harmonized training Curriculum

The venue for placements hosts group learning and case discussions. When RTC is a hospital, no venue hire

costs are incurred; this reduces the cost per HCW by $11.

When accommodation is not required, the cost is reduced by $75 (see Figure 2).

Off-site training is more efficient under the harmonized curriculum Evident by reduced number of off-site

days Low cost of offsite training. (see Figure 3)

Comparing of Two Ongoing Mentoring Models

Figure 4 compares the unit costs of the DHMT and RCM. The RCM was less expensive than the

DHMT, Requires only one mentor for many trainees Re-training cost is spread over more days.

Figure 5 compares the indirect costs. We assumed mentors would provide

services when not engaged in mentoring. The RCM value would rise if clinicians were

roving full time.

Limitations and conclusion

Limitations of this analysis include the

Lack of a measure of training or mentoring quality

The use of data from pilot designs.

Limitations

The DHMT model provides the best balance of lower cost and less disruption to the health system for ongoing mentoring.

The new harmonized training curriculum and skills-building strategy represent a cost-efficient choice for the Kenyan HIV program.

Conclusion

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Thank You!

The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is implemented by Futures Group, in collaboration with CEDPA (CEDPA is now a part of Plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).