PEPFAR’s Efforts to Strengthen the Global HIV Healthcare Workforce
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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. Health Worker : P opulation R atio (World Health Organization, 2006). HIV Prevalence

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PEPFAR’s Efforts to Strengthen the Global HIV Healthcare Workforce Ambassador Eric Goosby , M.D.

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Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

  • 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

Healthcare Worker Shortage & HIV Pandemic

Health Worker : Population Ratio

(World Health Organization, 2006)

HIV Prevalence

(UNAIDS, 2006)


The president s emergency plan for aids relief pepfar

The President’s Emergency Plan for AIDS Relief (PEPFAR)

  • 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


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

PEPFAR II (2009-2014)

  • 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 s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

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


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Health Labor Market Dynamics

Adapted from Marko Vujicic, World Bank 2009


Pepfar s human resources for health objectives

PEPFAR’s Human Resources for Health Objectives

  • Strengthen pre-service education institutions

  • Ensure quality of in-service and pre-service training and

    practicing professionals

    3. Support the development of new cadres and strengthen the

    community workforce

  • Improve health worker motivation and productivity and foster positive workplace environments

  • Investigate and apply recruitment and retention

    strategies

    6. Improve HRIS and utilization of data for improved

    management and planning


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Objective 1

Strengthen pre-service education institutions

Source: ITECH


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Objective 2

Ensure quality of in-service and pre-service training and practicing professionals

  • 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.


Health workforce i nitiatives

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

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


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

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

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


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Objective 3

Support the development of new cadres and strengthen the community workforce

  • 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)


African health profession regulatory collaborative arc

African Health Profession Regulatory Collaborative (ARC)

  • 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


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Objective 4

Improve health worker motivation and productivity and foster positive workplace environments

  • Zanzibar & Tanzania: Productivity & Work Climate Study

  • Niger, Uganda, & Tanzania: HRH Collaboratives

  • Swaziland & Uganda: Wellness Centers for health workers

  • Rwanda : national performance -based incentive scheme

Figure 1. Uganda Productivity:

Average Client Waiting Times in Kabuyanda Baseline and Follow-up


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Objective 5

Investigate and apply recruitment and retention strategies

  • 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


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Objective 6

Improve HRIS and utilization of data for improved management and planning

  • 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


Expanding the evidence base research innovation

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

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.


Pepfar s efforts to strengthen the global hiv healthcare workforce ambassador eric goosby m d

Thank You

For further information, please visit:

www.PEPFAR.gov

www.facebook.com/PEPFAR

http://twitter.com/USPEPFAR


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