Ethiopia HIV/ART Nurse Specialist (HANS) Training Program Evaluation
Background
Ethiopia faces a severe shortage of health care workers, with an estimated 21 nurses and three physicians for every 100,000 people (WHO 2003). I-TECH's HIV/ART Nurse Specialist (HANS) Training Program develops essential skills for nurses, who represent nearly 90% of the health care workforce but are underused in Ethiopia's physician-based medical model of care. The training supports rapid scale-up of HIV care and treatment by enabling nurses to alleviate physician workload, thereby enhancing the ability of physicians to focus on patients with the most complex medical needs.
I-TECH Ethiopia has been providing basic ART and HANS training under its national Nurse Initiative Program. The goal of HANS training is to increase nursing capacity for effective HIV and AIDS care and treatment by training nurses from clinical sites throughout Ethiopia. The HANS training provided by I-TECH is a three-week intensive training program that includes interactive classroom-based training (seven days), a clinical practicum (six days at five hospital sites), onsite clinical mentoring (five days), and ongoing clinical consultation and support.
Methods
Evaluation methods included: pre- and post-tests to assess change in participant knowledge before and after the training; observation-based skills assessments at clinical practicum sites; observation-based skills assessments of participants once they returned to practicing in their own facilities; clinical impact assessments via interviews and direct observation; and in-depth interviews with several HANS nurses.
Findings to Date
HANS training has been effective in enhancing knowledge and skills of nurses in the provision of HIV and AIDS care and treatment. Participants' pre- and post-tests showed a significant increase in knowledge. More importantly, participants demonstrated consistent improvement in performance of key competencies during their clinical practicums. The practicum component, which provided participants with the opportunity to observe, apply, and practice skills and knowledge acquired in the classroom, established a critical link between theory and practice. In addition, standardized observations of HANS-trained nurses at their own work sites indicated that HANS-trained nurses demonstrated all competencies to an acceptable standard or above.
Finally, the number of Ethiopian nurse mentors who were once themselves HANS trainees has increased over time. This reflects the expanded role of nurses as a result of the program, and indicates that one of the intended outcomes of the HANS program—that of building capacity within the Ethiopian health care system to train the nursing workforce in HIV and AIDS specialist care—has been successful.
