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Human Resource Sustainability in PEPFAR Programs: Presenting Options

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Goal is direct immediate provision of life-sustaining, health-restoring care and ... Migration to private practice; No clear 'attraction, development, remuneration, ... – PowerPoint PPT presentation

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Title: Human Resource Sustainability in PEPFAR Programs: Presenting Options


1
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

2
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

3
Medium Term Solutions
  • BCM Inducing local health professionals to
    return to their home countries
  • ICAP Nurse Mentoring Program
  • ICAP Human Capacity Building in Nigeria

4
Reverse Brain Drain
  • Strategies fair wages, suitable work
    environments, opportunities for academic
    enrichment and professional advancement
  • BIPAIs 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

5
ICAPs ParadigmClinical 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

6
Basic Principle
  • This work is highly relational
  • Plop-in strategies cannot work
  • An integrated strategy is necessary

7
Interface Among CSM Levels Relationships
FMOH
8
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)

9
Background Eastern Cape
  • Qaukeni Bizana Flagstaff sub areas
  • Population 400,000
  • 5 doctors per 100,000 population
  • 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

10
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

11
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

12
Human Capacity Building ICAP-Nigeria
  • Goal Increase human resource function and
    sustainability (task focused) work with State
    DOH staff

13
CSM Outcome Oriented
14
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

15
Results
  • Six state workshops held all six states have a
    plan for next steps
  • Will be monitoring this process quantitatively
    and qualitatively

16
Long Term Solutions
  • Increasing the productive capacity of African
    medical schools
  • In Botswana lt 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!
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