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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 1 Futures Group, 2 National AIDS & STI Control Program, Kenya dmwai@futuresgroup.com. March 21 st , 2013.

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

Daniel Mwai,1 Irene Mukui,2ArinDutta,1Priya Iyer,1

1Futures Group, 2 National AIDS & STI Control Program, Kenya

dmwai@futuresgroup.com

March 21st , 2013

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

overview
Overview
  • Introduction and research questions
  • Methodology
  • Results and discussion
  • Limitations and conclusion
introduction
Introduction
  • 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 Programmeand 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.
research questions
Research Questions
  • 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 ?
methodology
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)
efficiency of the harmonized training curriculum
Efficiency of the Harmonized training Curriculum
  • 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.
  • 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
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
Limitations
  • Limitations of this analysis include the
    • Lack of a measure of training or mentoring quality
    • The use of data from pilot designs.
conclusion
Conclusion
  • 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.