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Human Resource Sustainability in PEPFAR Programs: Presenting Options. Robin Flam MD DrPH Director, Clinical Unit International Center for AIDS Care and Treatment Programs (ICAP) Columbia University Mailman School of Public Health Meg Ferris, PhD, MPH

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human resource sustainability in pepfar programs presenting options

Human Resource Sustainability in PEPFAR Programs: Presenting Options

Robin Flam MD DrPH

Director, Clinical Unit

International Center for AIDS Care and Treatment Programs (ICAP)

Columbia University

Mailman School of Public Health

Meg Ferris, PhD, MPH

Vice President for International Fellowships

Baylor International Pediatric AIDS Initiative

Baylor College of Medicine

short term solution the pediatric aids corps
Short Term Solution: The Pediatric AIDS Corps
  • Goal is direct immediate provision of life-sustaining, health-restoring care and treatment (26,000 currently)
  • 94 physicians recruited since 2006; roughly 60 in Africa at any time
  • PAC doctors also train hundreds of local health professionals both through didactic teaching and side-by-side mentoring
medium term solutions
Medium Term Solutions
  • BCM: Inducing local health professionals to return to their home countries
  • ICAP: Nurse Mentoring Program
  • ICAP: Human Capacity Building in Nigeria
reverse brain drain
“Reverse” Brain Drain
  • Strategies: fair wages, suitable work environments, opportunities for academic enrichment and professional advancement
  • BIPAI’s Clinical Centers of Excellence and Pediatric AIDS Corps program are designed to have a multiplier effect on local health professional capacity, both through training and by reversing brain drain
icap s paradigm clinical systems mentorship csm
ICAP’s Paradigm:Clinical Systems Mentorship (CSM)

CSM is the name of an integrated methodology developed by ICAP

broadens the principles of clinical mentorship to the context of public health programming and health systems strengthening.

The goal of the CSM methodology is to

Implement high quality programs

Build capacity to sustain these programs

HR sustainability is fundamental to this

basic principle
Basic Principle

This work is highly relational

Plop-in strategies cannot work

An integrated strategy is necessary

task shifting icap south africa
Task Shifting: ICAP-South Africa

ICAP Nurse Mentoring Program

Goal: Redirect tasks from doctors to nurses; create enhanced opportunity for nurses by developing a cadre called Nurse Mentors (cadre focused)

background eastern cape
Background: Eastern Cape

Population 6.9 million

61.2% rural

10.1 doctors per 100,000 population

102 professional nurses per 100,000 population

Total population HIV prevalence 10.9%

Using ASSA 2003 modelling it is estimated that 69,000 patients require ART per year

Qaukeni – Bizana & Flagstaff sub areas

Population 400,000

5 doctors per 100,000 population

nurse mentoring program
Nurse Mentoring Program

Relieve the scarcest cadre, and utilize the most available

Doctor to Nurse task shifting

Enhance competencies of, and empower nurses; create career ladder

Create a network for nursing support

Training, Mentoring for NMs

Orientation and involvement of DOH management staff and faculty from schools of nursing

results
Results

Nurse Mentors are Site Support Team Coordinators

On-site nurses appreciate mentoring by fellow nurses

There has been formal recognition of mentorship training as post-basic certificate

There is new legislation around ART Rx by nurses

Nursing schools implementing mentoring programs focusing on HIV in pre- & post-service; our nurse mentors will be among the trainers

human capacity building icap nigeria
Human Capacity Building: ICAP-Nigeria

Goal: Increase human resource function and sustainability (task focused): work with State DOH staff

cross training
Cross Training
  • Corps of State-based mentors identified by ICAP staff
  • Intensive workshops held in each state
    • Process emphasized and practiced: moving from supervision to mentorship
    • Next steps collaboratively developed
      • Adding CSM process and cross training pieces to start-up and refresher trainings of clinic staff; co-facilitation
      • State/ICAP Co-mentoring visits
        • Decreasing in frequency over time
      • Step-down workshops to Clinic Managers/Leaders
      • Intermittent intensives for State Corps
      • State-wide workshops, CMEs, other conferences as above co-developed and co-facilitated by ICAP and State
results1
Results

Six state workshops held; all six states have a plan for next steps

Will be monitoring this process quantitatively and qualitatively

long term solutions
Long Term Solutions:
  • Increasing the productive capacity of African medical schools
  • In Botswana: <10% of physicians are citizens; 0 citizen doctors in district clinics and primary hospitals; Migration to private practice; No clear “attraction, development, remuneration, retention” strategy
  • New medical school founded in Botswana in 2006
  • Important development, but it takes time!