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RESPONDING TO THE HIV/AIDS EPIDEMIC IN THE CARIBBEAN - TAKING A REGIONAL APPROACH

RESPONDING TO THE HIV/AIDS EPIDEMIC IN THE CARIBBEAN - TAKING A REGIONAL APPROACH. Regional Capacity Development. Brendan Bain, Shelly Trim, Maxine Ruddock-Small CHART Regional Coordinating Unit and The Caribbean Health Leadership Institute The University of the West Indies.

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RESPONDING TO THE HIV/AIDS EPIDEMIC IN THE CARIBBEAN - TAKING A REGIONAL APPROACH

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  1. RESPONDING TO THE HIV/AIDS EPIDEMIC IN THE CARIBBEAN- TAKING A REGIONAL APPROACH PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  2. Regional Capacity Development Brendan Bain, Shelly Trim, Maxine Ruddock-Small CHART Regional Coordinating Unit and The Caribbean Health Leadership Institute The University of the West Indies PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  3. Purpose of presentation • Regarding the response to the HIV epidemic at national and regional level in the Caribbean • To underline the rationale for Capacity Development • To acknowledge the organisations that have undertaken Capacity Development • To identify successes in the area of capacity development • To consider past and present challenges • To envision the way ahead PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  4. Capacity building in response to HIV Why start? PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  5. HIV/AIDS in the Caribbean • We had (and still have) the second highest HIV prevalence rate in the world after sub-Saharan Africa. • Advanced HIV disease is the leading cause of death among persons aged 15-44 years in this region. PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  6. Reported AIDS Incidence in CARICOM Member Countries 1982-2002 PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  7. New AIDS Cases per year per 100,000 population Western Hemisphere 1990-2000 (Source:CAREC) 35 Caribbean 30 25 20 North America 15 10 Latin America 5 0 2000 90 91 92 93 94 95 96 PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  8. Insufficient systematic, region-wide training • CAREC Special Program on STI was doing some training • Few professionals believed that they were prepared/equipped to provide HIV care • Uncoordinated visits by outside speakers • Some professionals attended HIV meetings / conferences / updates outside of the Caribbean PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  9. In one unpublished study Up to mid-2000, only 25% (approx.) of Jamaican doctors said that they felt “confident enough” to treat persons with AIDS.” Source: Dr Yitades Gebre, Former Director, HIV/STI programme Ministry of Health, Jamaica Many personal testimonies supported this finding, not just about doctors, but about other groups with responsibility for establishing policies and developing and serving in HIV programmes

  10. Capacity building in response to HIV Who has been involved? PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  11. CARICOM/PANCAP CAREC Caribbean Cytometry and Analytic Society (CCAS) Caribbean Assoc. of Pharmacists CFNI CHART Network CHRC CRN+ CCNAPC PAHO HIV Caribbean Office (PHCO) Trans-Caribbean HIV/AIDS Research Initiative (TCHARI) UWI (CHART,CHLI, DrPH) Regional (Caribbean-based) Organisations PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  12. We have got more than a little bit of help from our friends* *Credit to The Beatles for the lyrics! PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  13. How many organizations based outside of the Caribbean have taken part in HIV-related capacity building in the Caribbean? 10-20 21-30 30-35 More than 35 Question PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  14. GOVERNMENTAL USA: USAID, CDC, HRSA, Dept. of Defence, Peace Corps Germany: GTZ UK: DFID Canada: CIDA Brazil Others MULTINATIONAL European Union UNAIDS, inclusive of: PAHO/WHO UNDP UNESCO UNFPA ILO World Bank Global Fund Others International Organisations (1) PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  15. International Organisations (2) • International Foundations and NGOs • Cicatelli Associates Inc. • Clinton Foundation • Education Development Center, Inc. (EDC) • International Red Cross (IFRC) • JHPIEGO • Lutheran Medical Center, New York/New Jersey • MEASURE/MACRO • Partners in Health • The Capacity Project PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  16. Foreign Universities Cornell Harvard Howard Johns Hopkins Univ. of Medicine and Dentistry of New Jersey (Francois-Xavier Bagnoud Center) Univ of Pennsylvania Foreign Universities Univ of Washington (I-TECH) Others Other Entities Association of Nurses in AIDS Care (ANAC) NASTAD (National Alliance of State and Territorial AIDS Directors) Pharmaceutical firms International Organisations (3) PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  17. So… Is there a need for better coordination and harmonization of HIV capacity building efforts in the Caribbean? PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  18. Capacity building in response to HIV A Methodological Approach? PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  19. Strengthening a regional approach • Focus: Strengthen regional institutions • Rationale: • Strengthen key institutions that cover major parts of the Caribbean; then the benefit would be felt at national level in many countries • Utilize economies of scale • Build stronger networks • Go for synergistic benefit from teamwork and sharing PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  20. Strengthening the Institutional Response to HIV/AIDS and STIs in the Caribbean (SIRHASC) • Period: Dec 2000-Dec 2007 • Source: 6.9 M Euro Grant from the European Union • Principal Recipient: CARICOM Secretariat • Birth of the PANCAP Coordinating Unit • Sub-recipients: CAREC ; CHRC ; CRN+ ; UNAIDS ; UWI (UWI HARP) PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  21. Was the SIRHASC Project a success story? Question PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  22. CARICOM Countries SIRHASC Graduate Level Scholarship Awards (N=39) 1 BAHAMAS CUBA TURKS & CAICOS IS. CAYMAN IS. BR. VIRGIN IS. 8 2 ANGUILLA 2 2 ST. KITTS BELIZE 2 DOM REP NEVIS ANTIGUA HAITI JAMAICA MONTSERRAT 2 DOMINICA 2 ST. LUCIA 3 BARBADOS CURACAO ARUBA ST. VINCENT 4 GRENADA 2 BONAIRE TRINIDAD & TOBAGO 9 GUYANA SURINAM

  23. Public Health Public Sector Mgmt. Clinical Psychology Health Economics Medical Microbiology Counselling Education (Health Promotion) Infectious Diseases Governance Behavioural Sciences Communication Nursing Education Nutrition SIRHASC GRADUATE LEVEL SCHOLARSHIPS BY DISCIPLINE PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  24. Sharing ideas with other universities • The University of Technology, Jamaica • University of Guyana • Visits by UWI HARP staff • UG Faculty participated in: • Training of trainers’ programmes at UWI • UWI HARP Scientific Conferences • Dominican Republic, Suriname PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  25. June 2003: Caribbean HIV/AIDS Regional Training (CHART) Network April 2006: Trans-Caribbean HIV/AIDS Research Initiative (TCHARI) Sept. 2006: Master of Education (Health Promotion, focus on HIV), UWI St Augustine Sept. 2007: Caribbean Health Leadership Institute Sept. 2009 - Doctorate in Public Health 2010 - Virtual Leadership Development Program (OECS) Recent Initiatives PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  26. Building the Capacity of Health Care Providers: A Pan-Caribbean approach PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  27. The CHART Network The Caribbean HIV/AIDS Regional Training Network PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  28. BERMUDA CARICOM/PANCAP HQ CHART Coordinating Center CHART Training Centers CARICOM Countries OECS HIV/AIDS Project Unit TURKS & CAICOS IS. CAYMAN IS. BELIZE CURACAO ARUBA BONAIRE GUYANA SURINAM CHART Map BAHAMAS CUBA BR. VIRGIN IS. ANGUILLA ST. KITTS DOM REP NEVIS ANTIGUA HAITI JAMAICA MONTSERRAT SABA DOMINICA ST. EUSTATIUS ST. LUCIA BARBADOS ST. VINCENT GRENADA TRINIDAD & TOBAGO

  29. Training teams work either at CHART Centres or elsewhere Four training levels Learning activities at points of delivery of care as much as possible Trainers are Caribbean nationals and experienced persons from outside of the Caribbean Learners may sometimes go outside of their own countries A Flexible Model PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  30. On site Training PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  31. Curriculum development PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  32. Numbers and categories of persons who have attended CHART training events PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  33. PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  34. Challenges - present and future • Programmatic • How to continue capacity building - themes, focus • Coordination and harmonization • Move training beyond the health sector • Staffing and Sustainability • Other • Allow/prioritize time to attend training • Staff turnover - a frustration, but a reality to be addressed PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  35. The way ahead PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  36. Reasons to continue • Changing training needs • Leadership and management • Surveillance, M&E • Caring for children born with HIV who are now adolescents • Care and treatment of older persons with HIV • HIV and co-morbidities • Integration of HIV into primary health care • Staff turnover • Strengthening pre-service education and training • Training outside of traditional health sector PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  37. In building capacity… Is it best to take a systems approach? PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  38. Capacity building: Thinking and acting strategically • Assess • human resource needs • Other systems needs (equipment, supplies, maintenance, optimal record keeping, communication, procurement) • Attrition and Turnover - reasons, reduction, adjustment • Build the work force systematically • Allocate personnel appropriately • Track progress • Measure and evaluate in relation to needs PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  39. Capacity building: Thinking and acting strategically • How can we work smarter? • Train for effective leadership and teamwork • Fill important service gaps • Integrate HIV into general health care • Practice Continuous Quality Improvement • Invest in multisectoral training • Activate public:private partnerships • Improve grants management • Use a business approach PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  40. The way ahead • Scale up ‘pre-service’ training • Give certification for in-service training programmes • Coordinate / Harmonize training • Emphasize Quality Improvement through Monitoring & Evaluation with feedback • Implement better HRH tracking systems • Establish written policies and procedures to ensure follow-through PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  41. The way ahead • Topic-based, clinical training is not enough • Need to take a whole systems approach • Include training in • Leadership knowledge, skills and attitudes • Specific areas of management • Surveillance • M&E • Research skills • Grants management • Implement business/sustainability plan PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  42. The way ahead • Own - Governments need to own and support/sustain national training • Partner - to plan and execute training and strengthening of services • Support a regional approach for national benefits PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  43. The way ahead: Three “Ones” or Four “Ones”? • One agreed Action Framework that provides the basis for coordinating the work of all partners. • One National Coordinating Authority, with a broad-based multisectoral mandate. • One agreed Monitoring and Evaluation System. • ? One agreed training/capacity-building system PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  44. The way ahead PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

  45. End of Presentation Thank you

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