Mozambique
Spotlight: Supporting Those Behind The Scenes of the HIV Epidemic
There is no doubt that teaching in any setting can be challenging. However, it can be even more so when you have only two and a half years to prepare young people to join the front line in providing quality health care for more than 22 million people. In Mozambique, the instructors who teach técnicos de medicina geral are used to working with few resources. Until recently, they had to prepare their students, who enter with a 10th grade education, without access to teaching materials or adequate training in HIV content. Yet in order to make a dent in the epidemic, TM graduates must be able to correctly diagnose and treat HIV and other diseases, often with insufficient laboratory services and diagnostic equipment. One of I-TECH’s primary activities in Mozambique is to respond to this challenge by providing training and resources to the faculty of health care worker training institutes. With support from I-TECH, these teachers now have new HIV curricula, materials, and tools—support they can use to prepare and expand Mozambique’s health care workforce.
Overview
I-TECH initiated its activities in Mozambique in December 2005 through an invitation from the US Centers for Disease Control and Prevention Global AIDS Program (CDC GAP). After a preliminary assessment and a series of technical assistance visits, I-TECH opened an office in 2006. I-TECH Mozambique’s main objective is to provide technical support to the Ministry of Health (MISAU) to address the shortage of health care providers in the country. Central to this effort is the training and mentoring of mid-level health care workers, particularly técnicos de medicina geral (TM) (similar to physician assistants), nurses, and agentes de medicina (lower level TMs). I-TECH’s support to the Ministry includes curriculum development; the development of training packages, including job aids and evaluation tools; the training of trainers and mentors; ongoing follow-up support to trainers, mentors, and trainees; and operations research.
BACKGROUND
Mozambique, located in sub-Saharan Africa, is battling a severe, generalized HIV and AIDS epidemic. According to the UNAIDS Report 2008, more than 1.5 million people are infected with HIV, with a national HIV prevalence of 11.5%. Mozambique also suffers high rates of tuberculosis and other respiratory diseases, malaria, and diarrheal diseases including endemic cholera, all of which exacerbate the impact of HIV and AIDS. Mozambique’s response is limited by a shortage of medical doctors in all areas of the country, and particularly in district-level clinics. The World Health Organization (WHO) 2008 Health Profile shows that there are a total of 548 doctors in the country, half of which are in the capital city of Maputo, giving an overall figure of 3 doctors per 100,000 population.
Program Highlights
Pre-Service Training: I-TECH is providing technical assistance to the Ministry’s central level Training Department and its 13 national Health Training Institutes. Three major activities are underway; all support TMs, who are increasingly responsible for the clinical treatment of HIV and AIDS in Mozambique:
- Development and implementation of a four-week, practicum-based course, Evaluation and Management of the HIV+ Patient, for graduating TMs.
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Revision of the 30-month pre-service (undergraduate) curriculum (see “Spotlight”).
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Creation of faculty development courses to improve the skills of training institute faculty in lesson planning, participatory learning methods, student evaluations, and other teaching skills.
Prevention of Mother-to-Child Transmission of HIV (PMTCT). Together with other implementing partners, I-TECH Mozambique supports PMTCT through several activities including the development of the Maes para Maes program, a community support program for HIV-positive mothers. The activities are led by site-based mother educators and facility based maternal and child health nurses. The package consists of an operational guide, manuals, and job aids for the nurses and mother educators.
Positive Prevention. In collaboration with the University of California, San Francisco (UCSF), I-TECH is conducting trainings for Ministry trainers and partner organizations who support clinical facilities to integrate HIV prevention messages and establish referral linkages within and outside of health facilities. The goal is to ensure that all HIV-positive patients are provided with a standardized prevention ‘’package’’ of HIV prevention education, clinical services, and psychosocial support.
Clinical Mentoring in
Adult and Pediatric ART. Based on a clinical assessment of TMs’ performance
in the diagnosis and treatment of HIV and related conditions, I-TECH developed
a national clinical mentoring program for TMs on behalf of the Ministry of
Health. The mentoring program trains Mozambican doctors as clinical mentors, and
assists them to train and support TMs through a two-week practical training.
Afterwards, the doctors provide ongoing mentoring at the TMs’ health centers over
the following six months. As of August 2010, every TM who provides care to people
living with HIV in the country had been trained as part of the program; there
are presently trained TMs and doctor-mentors in every province and district in
the country.
HIV Course for Nurses and Agentes de Medicina. I-TECH and the Ministry are in the last stages of finalizing the course for nurses and agentes de medicina (AMs). The course will prepare all cadres of nurses and agentes for their new task-shifted roles in HIV care, and teaches the importance of identifying opportunistic infections and the signs and symptoms of treatment failure or complications. The three-week course is scheduled to be initiated in 2011 and will eventually cover all nurses and AMs in the country.
Assessments and Evaluations. I-TECH Mozambique has developed assessment procedures to ensure that pre-service and in-service training and curricula are of high quality and rest on a strong evidence base. This includes rigorous needs assessments and training reviews and detailed pilot training evaluations. Additionally, I-TECH has conducted several national assessments on behalf of the Ministry and CDC GAP.
Supporting Mozambique’s Health Workforce. Since 2006, I-TECH has worked closely with the Ministry of Health on an overarching reform of the undergraduate education of TMs. To begin the process, I-TECH analyzed the tasks TMs actually perform, and revised their Scope of Practice to reflect the needs of their patient population and work environment. The existing 30-month course structure was also reorganized to help students apply the knowledge and skills they learn in school to the patient visits they will experience in the workplace.
Partnerships
In addition to the US Centers for Disease Control and Prevention (CDC GAP) and the Mozambican Ministry of Health (MISAU), I-TECH works closely with a number of partner organizations in Mozambique, including Columbia University (ICAP), Family Health International (FHI), CARE, HIVQUAL/HEALTHQUAL, Health Alliance International (HAI), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), FANTA, UNICEF, Population Services International (PSI); the Clinton Foundation, and Jhpiego.
