For nearly a decade I-TECH has worked in Côte d’Ivoire in collaboration with the US Centers for Disease Control and Prevention to develop and implement an electronic laboratory information system (LIS) in key laboratories. In order to respond to evolving data needs and ensure timely access to quality laboratory data, an electronic LIS requires ongoing development and continuous user training and technical support.
Previously, from 2015-2017 I-TECH worked closely with the Ivorian Ministry of Health and Public Hygiene (MSHP)’s Directorate of Informatics and Sanitary Information (DIIS) to identify, develop and reinforce the capacity of local professionals to lead and conduct LIS training, deployment, and maintenance activities in anticipation of national roll-out of the LIS at 96 general hospital laboratories. As part of this effort, and in collaboration with the DIIS, I-TECH trained users and deployed LIS at 13 national and regional level laboratories. Between 2013 and 2015, the total number of local professionals competent in LIS deployment increased to 24 local LIS support providers, while the number of in-country LIS trainers increased to 27. Within ten months, local IT providers and trainers trained over 75 health care workers to use an LIS and implemented an LIS at 36 laboratories. During supervision visits to 26 laboratories, within 4 to 6 months post-installation, 25 out of 26 (96%) of laboratories were actively using the LIS.
More recently, Côte d’Ivoire International Training and Education for Health (I-TECH CIV), I-TECH’s local partner in Côte d’Ivoire, has started working directly with CDC and DIIS and continued to engage I-TECH computer developers and deployment strategists to continue the progress with LIS.
I-TECH continues to make considerable progress with code base development for OpenELIS. For more information, visit the OpenELIS Global website.
The International AIDS Society (IAS) hosted the 24th International AIDS Conference on 29 July – 2 August 2022 in Montreal, Canada, and virtually. The theme this year was “re-engage and follow the science” to highlight that the HIV and AIDS epidemics are not over and still require significant global support. The conference brings together HIV researchers and experts for presentations and discussions on a wide-range of HIV- and AIDS-related topics.
This year, the International Training and Education Center for Health (I-TECH) and its partner network organizations participated in a number of activities at the IAS International AIDS Conference. Pamela Collins, MD, MPH, I-TECH Executive Director, participated in a pre-conference meeting panel on HIV and non-communicable disease integration hosted by the NCD Alliance. Dr. Collins’ discussion focused on the social stigma related to HIV and mental health conditions, specifically the impact stigma has on care and the role that integration has in addressing stigma.
In addition to the panel, I-TECH representatives also presented posters from programs in Côte d’Ivoire, Tanzania, and Ukraine:
Additionally, representatives from I-TECH’s partner network organizations and the Centers for Disease Control and Prevention (CDC) presented findings from I-TECH-supported programs in India, Malawi, and Zimbabwe:
On 18-19 May 2022, the International Training and Education Center for Health (I-TECH), in collaboration with the Programme National de Lutte Contre le Sida (PNLS; National AIDS Control Program) under the coordination of the General Directorate of Health, hosted its first national HIV prevention, care, and treatment quality improvement (QI) conference in Abidjan, Côte d’Ivoire. The conference brought together over 100 representatives from the Centers for Disease Control and Prevention, United States Agency for International Development, the Human Resources and Services Administration (HRSA), US President’s Emergency Plan for AIDS Relief (PEPFAR), and PEPFAR implementing partners from around the country to agree on a national approach to QI; update the national strategic plan for improving Quality, Health, and Safety; and learn about the unique QI approach being implemented by I-TECH through the Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) program.
“This is an historic workshop. [There have been] many conversations and meetings with the PNLS/Ministry of Health and USG agencies [over the years] to gather all the stakeholders to harmonize QI interventions,” says Dr. Jean T. N’Guessan, QISSEC QI Consultant. “This national QI workshop was a success because the leadership was carried by the PNLS, the national Program to fight AIDS, and supported by I-TECH.”
The goal of the conference was to elevate QI practices on a national level and work with stakeholders to adopt and integrate the QISSEC QI approach into their own HIV prevention, care, and treatment programs to improve HIV services while identifying and addressing gaps in care (e.g., viral load monitoring, antiretroviral therapy uptake).
“In Côte d’Ivoire, all hospitals—both public and private—are required to implement continuous quality improvement for all care and services, which can lead to a one-size-fits-all approach to QI,” explains Dr. Nathalie Krou Danho, I-TECH QISSEC Project Director. “This workshop made it possible for us to identify gaps in national standards for the prevention, care, support, and treatment of HIV infection, while also providing an effective QI framework that helps clarify the roles and responsibilities of the stakeholders implementing QI initiatives across the country.”
QI interventions are often applied unilaterally across all sites regardless of analysis of the sites’ specific needs, but I-TECH’s approach tailors each QI intervention and related activities to the needs of the site according to self-identified gaps by the sites. This approach allows sites to be involved in each step of the process, reinforces skills and knowledge, and ultimately creates a sustainable approach to QI. By using the QISSEC approach, HIV programs around Côte d’Ivoire will be able to align their QI work and substantially improve HIV services, while also fulfilling PEPFAR priorities and targets.
“Since I-TECH’s approach works in collaboration with all levels (national, district, and site) of the health system pyramid, we are able to coach sites to develop a QI plan based on the identified gaps, implement it, as well as monitor and evaluate it,” says Dr. Nathalie Krou Danho. “Through data analysis of MER indicators and SIMS data, the approach takes into account the organizational improvement of the quality and the services offered to the patients.”
The QISSEC project, a five-year cooperative agreement with HRSA under PEPFAR, works with local partners to implement customized site-level QI interventions using patient-centered approaches in clinics to ensure a facility-owned and locally led response to the persistent challenges seen in HIV prevention, care, and treatment programs (e.g., HIV testing, retention, suppression, PrEP, TB prevention) and support Côte d’Ivoire in reaching the UNAIDS 95-95-95 targets. The project has initially been focused on 60 priority sites throughout the country but plans to expand to Abidjan’s 75 high-impact sites next year, bringing the total number of sites to 101.
“The QISSEC project aims to strengthen ownership of continuous QI at all levels of the health system pyramid,” says Dr. Nathalie Krou Danho. “To do this, I-TECH collaborates with all national stakeholders, including PEPFAR implementing partners and civil society organizations who can help motivate beneficiaries to take part in QI efforts and extend its QI approach to the community.”
I-TECH’S WORK IN CÔTE D’IVOIRE IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER 1 U1NOA45176-01-00 THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS, OR THE U.S. GOVERNMENT.
Through a five-year cooperative agreement with the United States (US) Health Resources and Services Administration (HRSA) under the US President’s Emergency Plan for AIDS Relief (PEPFAR), I-TECH implements the Quality Improvement (QI) Solutions for Sustained Epidemic Control (QISSEC) project in Côte d’Ivoire. This project aims to support Côte d’Ivoire in reaching the UNAIDS 95-95-95 Fast-Track Targets, which to date have not been consistently achieved with specific populations faring worse than others.
The QISSEC approach supports Côte d’Ivoire’s National AIDS Program, Côte d’Ivoire’s International Training and Education for Health (I-TECH CIV), and other implementing partners to help close HIV-related service delivery gaps across clinics and communities, aiming to reach the UNAIDS 95-95-95 targets. Focused on 80 priority sites throughout the country, QISSEC works closely with local clinic- and community-based partners to implement customized site-level QI interventions; integrate community or civil society groups into QI approaches; establish national QI learning networks; and disseminate QI successes and lessons learned across the learning networks. Using this patient-centered approach, QISSEC aims to ensure a facility-owned and locally-led response to persistent challenges in patient testing, retention, and suppression.
Operations management, including general operations, finance, and human resources (HR) work, are vital to any organization. They are particularly important in the complex landscape of public health programming, where they form the backbone of life-saving services. The International Training and Education Center for Health (I-TECH) network is grateful for the expertise and leadership of finance, HR, and operations professionals across the globe who keep the organization running smoothly and responsibly. We asked several I-TECH Finance, Operations, and HR Managers to share a little bit about what drives their work, as well as their experiences as leaders within the public health field.
I have been working in the I-TECH Côte d’Ivoire Finance Department for more than 3 years. Prior to I-TECH, I worked on several development projects in Côte d’Ivoire for 14 years.
I am really dedicated to this work.
Since my childhood, I have always had compassion for people in need. I have been affected by the way refugees were struggling for life during the Liberia and Sierra Leone wars. This led me to work with a development non-governmental organization (NGO). Already working in the humanitarian field, I told myself that I could make my modest contribution in a health NGO. I got the opportunity to join I-TECH and have really enjoyed my job since.
Being a leader is not easy. In addition to having a full to-do list, I face many unforeseen circumstances every day. Being competent does not mean knowing everything, but you need to understand each topic well enough to be able to make informed decisions and ask the right questions if information is missing.
I am focusing more and more on building the right team, along with a sustainable human strategy and a culture of innovation. This will be their contribution to I-TECH.
Tannia Toivo HR Manager, I-TECH Namibia
I joined the HR field because of my love of working with and helping people. Naturally, I was drawn to the public health field and specifically to I-TECH because of its work in addressing the challenge we are facing with HIV in Namibia.
I first joined I-TECH Namibia as an HR Officer for a short period in 2012 and 2013. I was very fortunate to join the team again in May 2016 as an HR Manager. It has been so rewarding as I interact with professionals and experts from diverse backgrounds and experiences, therefore learning every day.
Generally, the HR field is woman-dominated, and it is great to see the impact that women have in the corporate world. It is a challenging field that is always growing and changing; requiring one to work very hard and to have strong job knowledge in order to succeed. My work as an HR Manager also means that I am involved in Affirmative Action activities, which place an importance in making sure that women are provided equitable employment, training, and job advancement opportunities amongst others. Through my work, I play a part in empowering other women.
Angela Amondi Operations Lead, I-TECH Kenya
My operations work was initially with general nonprofits, but as I evolved in my field, I began specializing in public health nonprofits.
I have found that being the Operations Lead for the I-TECH Kenya office has been extremely fulfilling. The organization provides professional support and development to help employees learn on the job and enhance their professional skills. A few of my I-TECH career highlights include when I supported the startup for the Kenya office and led the subsequent scale-up when we received additional funding. Within a period of two years, the office grew from having six employees to 17. While leading the operations scale-up, I set up the business operations support and created all operational policies and procedures.
I-TECH practices and emphasizes work/life balance, including having policies that support new mothers and, even before the onset of the COVID-19 pandemic, including telecommuting as part of the organizational policies. These policies have allowed for peace of mind to focus on the work and achieve the objectives at hand.
Gerald Hiwa Finance Manager, I-TECH Malawi
The public health sector needs to be occupied by personnel who have a strong background in finance and can provide strong leadership to oversee financial and grants management. Working in the public health field allows me to answer that call of providing strong leadership so that donors and funders become more confident on how the funds are being utilized and that the intended beneficiaries are benefitting from various health programs.
Analyzing the impact of health interventions compared to the funding investment has been another factor that has enabled me to remain in the public health space for the past 9 years.
My role at I-TECH Malawi as a Finance Manager has been quite educative and impactful. Educative in the sense that I have gained additional knowledge by working with a diverse group of people with different backgrounds. I have also learned to appreciate other people’s perspective regarding work culture. The experience working with I-TECH senior management in Malawi and at headquarters has taught me to focus on the core objective of the various programs and link deliverables to budget monitoring.
My role has been impactful in the sense that I supervise two Finance Officers. Together we have managed to have clean audits with no findings for the past 5 years during annual external audits. Our Finance Department has maintained the first position for three consecutive years during the Global Finance Excellence award, a rating used to gauge policy compliance and accurate financial reporting. My role has had an impact by ensuring that all payments are in compliance with policy and reporting deadlines are met.
I was introduced to finance work within the public health field by accident, you might say. I started work as an accountant at an IT company, where I mostly did bank reconciliations and invoices and also worked with debtors. After 8 years I felt like I was stagnating and not really growing much as a professional; then the opportunity to join I-TECH Namibia presented itself. I saw the job ad in the paper, decided to go for it, applied, and the rest is history…
I have had so many wonderful experiences, including when I went to work in the South African country office’s Finance Department. I was tasked with assisting them to set up their systems and sharing my expertise and experiences. I liked working in a different set-up, learning the different South African cultures, and interacting with new people.
Another favorite experience is working with people from all over the world, networking and learning from their experiences, as well as sharing mine with them. Back home in the Namibian office, I also like that I get to interact with field staff, which is rare; finance people in general tend to be more office-based. But every now and then I go out into the field and conduct fiscal inventory verifications where I get to learn more about the operations in the field and interact with my fellow colleagues.
A highlight in my work was when I acted as Finance Director for over six months. The experience really shaped my career and confidence and challenged me in ways that made me grow as a professional.
Even though the finance field is generally male-dominated (especially here in Namibia), I’m not conscious of being a woman in my position as a Senior Finance Manager. Instead, I see my position as both an opportunity and a challenge; an opportunity to inspire more young women to join the field, and a challenge to demonstrate that women can excel in any field.
On March 13-16, Liz Blanton, Monitoring and Evaluation Advisor at the International Training and Education Center for Health (I-TECH), joined more than a thousand clinicians, funders, academic leaders, government officials, and public health experts for the MetaECHO™ conference in Albuquerque, New Mexico. The University of New Mexico’s Project ECHO® model aims to bring specialized health care and expertise to rural and underserved communities in the U.S. and worldwide.
Blanton presented a poster titled “An Evaluation of Pilot Project ECHO in the Republic of South Sudan and Implications for Implementation in Fragile States.” The evaluation, still in its early stages, will assess the feasibility and acceptability of the model, which is implemented by Columbia University’s ICAP and is the first of its kind in a fragile state.
It will also gauge the impact of the ECHO model – based on telementoring and case presentation from a panel of experts – on providers’ sense of self-efficacy and professional satisfaction, as well as assess outcomes at the facility and systems levels.
“It’s the outcomes piece that really interested people,” said Blanton, pointing out that most of the outcomes studies to date have been fairly small. “It’s something a lot of people at the conference were talking about: how effective is Project ECHO at improving health outcomes?”
In light of this year’s theme of “Infinite Possibilities,” there were also deep discussions about the evolution of the model and how it might be adapted to improve communication between providers and patients, not just among providers. “There were several ‘ECHO Talks’ – TED-style talks – that were really moving,” said Blanton. “Some of the best were by patient advocates,” who highlighted the need for patient-centered care.
A fireside chat with keynote speaker Dr. Don Berwick, President Emeritus and Senior Fellow at the Institute of Healthcare Improvement, underscored the question: how can ECHO teams best deliver what patients need?
Today, Project ECHO operates more than 220 hubs for more than 100 diseases and conditions in 31 countries. The MetaECHO community encompasses all those dedicated to reaching the collective goal of touching 1 billion lives by 2025.
Project ECHO at I-TECH
Several programs at I-TECH utilize the Project ECHO model as a mentoring tool and force multiplier:
The first I-TECH-supported ECHO program in the Caribbean was established in January 2018, with the hub site in Jamaica. In that initial year, 41 ECHO sessions were provided, with participation by nearly 300 health care workers. Topics centered on viral load suppression and also included a series on TB prevention, diagnosis, and treatment in people with HIV; tenofovir toxicity; and HIV and lymphoma. During an I-TECH assessment, it was found that the majority of complicated cases presented during ECHO sessions in the Caribbean involved patients with mental health and substance use disorders that negatively impact their ability to adhere to medication and care. Plans are under way to include a psychiatrist/mental health specialist on the ECHO expert panel, and one Wednesday per month will be focused on HIV/mental health co-morbidities. The Jamaica Ministry of Health has also requested that I-TECH include an additional 20 HIV care and treatment sites, as well as a small group of private practitioners, in the current HIV ECHO program community of practice. In service of this request, I-TECH will support the development of a second ECHO program based in Trinidad, which will be launched this month.
I-TECH is implementing ECHO to build the capacity of laboratory staff and improve the quality of lab services in Côte d’Ivoire. Sessions include up to 17 laboratories and nearly 30 participants apiece; topics have included management of non-conformities in laboratories. laboratory equipment preventive maintenance, best practices in HIV serology, and external quality assurance.
In Malawi, I-TECH supports Project ECHO in partnership with the U.S. Centers for Disease Control and Prevention (CDC), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and Lighthouse Trust. The program has more than 40 participants from five different sites, and case presentation topics have ranged from tuberculosis to HIV encephalitis to Kaposi’s sarcoma. Benefits of the program include not only increased engagement of providers to discuss difficult cases, but also an improved referral system between clinics.
ECHO is installed and supported by I-TECH at 41 sites in Namibia, and monthly participation reaches up to 400 subject matter experts and staff. Dozens of topics were discussed during the pilot period (November 2015 to September 2016) alone – the most widely attended were on HIV disclosure to children, PMTCT Option B+, and presentation of tuberculosis. In an evaluation of the Namibia pilot, nearly 80% of participants cited that access to the expertise of HIV specialists and inter-disciplinary consultation was a major area of need for them and their clinics. Ninety-three percent of the participants reported that the presentations during the pilot ECHO sessions provided them with useful, up-to-date knowledge.
Representatives from the International Training and Education Center for Health (I-TECH) attended the fourth international African Society for Laboratory Medicine (ASLM) conference in Abuja, Nigeria, on 10-13 December 2018.
The theme this year focused on the role of laboratories in preventing and controlling the next pandemic. I-TECH had seven abstracts accepted at the conference that highlighted the laboratory systems strengthening work done by I-TECH in Cambodia, Côte d’Ivoire, and Zambia. The full abstracts presented by I-TECH can be found in the ASLM 2018 Conference Abstracts Conference Book.
Below is a summary of I-TECH presentations:
Siew Kim Ong, I-TECH Cambodia Project Coordinator, was lead author and presenter for the “Improved Laboratory Compliance to Quality Standards in Cambodian Laboratories through On-site Trainings.” This abstract reviewed the effect of training in 12 I-TECH-mentored laboratories in Cambodia on laboratory processes (Page 27).
Nayah Ndefru, I-TECH Seattle Laboratory Strengthening Specialist, presented an abstract titled, “Effectiveness of Using a Mixed Approach of On-site Mentoring and Tele-mentoring for Improving Laboratory Quality Management Systems: Lessons From Cambodia.” The presentation looked at the lessons learned in the implementation of a Quality Management System (QMS) in 12 national hospital laboratories throughout Cambodia and the 2018 pilot approach to addressing the QMS gaps identified in an earlier baseline survey (Page 55).
Larissa Koffi, I-TECH Côte d’Ivoire RTCQI Specialist, presented two posters: One titled, “Analysis of EQA HIV Serology Data in Côte d’Ivoire Reveals Gaps in Quality Testing.” The second poster was “Analysis of HIV Point of Care Testing Sites in Côte d’Ivoire Reveals Gaps in Tester Competence.” The posters displayed the results of a retrospective study that can inform strategies and interventions for improved quality at HIV testing sites (Page 200).
Sylvestre Kone, I-TECH Côte d’Ivoire Laboratory Quality Specialist, presented a poster titled “Improving Quality and Capacity of the Laboratory System in Côte d’Ivoire.” The poster detailed the work the team is doing to train and mentor laboratory staff in hospital laboratories towards achieving international quality standards (Page 242).
Felicity Gopolang, I-TECH Laboratory Mentor Consultant, presented a poster titled, “Implementation of a Professional Development Program in Laboratory Leadership and Quality Management in Zambia from 2016-2018.” The poster outlined the impact of the Program on quality improvement (Page 206).
Pat Sadate-Ngatchou, I-TECH Seattle Senior Laboratory Advisor, was lead author on the poster titled “Improvement of Quality Practices within HIV Point-of-Care testing (POCT) Sites in Côte d’Ivoire Through Implementation of the Rapid Test Continuous Quality Improvement (RTCQI),” which explored the impact of the implementation of RTCQI in POCT site audits (Page 246).
About ASLM The mission of ASLM is to improve clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks. Based on five strategic pillars, ASLM serves the community of laboratory professionals and promotes the value of strong medical laboratories to key stakeholders such as the Ministries of Health, research laboratories, and universities. ASLM is an independent, non-profit organization endorsed by the African Union and headquartered in Addis Ababa, Ethiopia.
The I-TECH Certificate Program in Laboratory Leadership and Management (CPLLM) was a nine-month course that trained laboratory staff in supervisory positions leadership and management skills to make substantive and impactful improvements in laboratory testing quality and operations. The program was developed in 2013 and first piloted in 2014.
The Fifth Annual Global Digital Health Forum was held from 10-11 December in Washington, D.C., attracting more than 300 participants to the FHI 360 Conference Center. At the forum, representatives from the new Digital Initiatives Group at I-TECH (DIGI) and its partner in Haiti, CHARESS, shared knowledge and lessons learned from 15 years of experience implementing digital health solutions worldwide.
“I welcome the messages from donors funding digital health work that they are shepherding a new era through the Digital Investment Principles,” said Joanna Diallo, DIGI Managing Director. “The conference provided DIGI an opportunity to present our contributions to global goods like OpenELIS, OpenMRS, and OpenHIE.”
Diallo moderated a panel titled “Different Labs Need Different Systems: An Exploration of Open Source Laboratory Information Systems Use in Global Health and the Community of Practice that Brings Them Together.” Jan Flowers, DIGI Faculty Co-Lead and Director of Global Health Informatics at the University of Washington Clinical Informatics Research Group, and Casey Iiams-Hauser, Senior Informatics Implementation Specialist with DIGI, were panelists, along with Steven Wanyee of IntelliSOFT, a former member of the I-TECH Kenya team.
The panel highlighted LIS as a critical component of national health information systems (HIS) architecture, exploring a complementary suite of open source LIS that are implemented across low- and middle-income countries, describing the laboratories and use cases each serves.
“The forum is a fantastic opportunity to meet with funders, on-the-ground implementers and technologists to discuss our work and learn about new initiatives and technologies,” said Iiams-Hauser. “We can leverage this knowledge for success both in our existing health information projects and in future partnerships.”
CHARESS HIS Lead Nathaelf Hyppolite participated in a session highlighting the development, implementation, and transition of EMR in developing countries, drawing on I-TECH and CHARESS’s work in Haiti. Participants heard about the benefits of an interoperable EMR: a unified data format, the ability to back up data, and that same data can be used to generate reports via DHIS2 from both the cloud servers and hardware EMR system. Hyppolite also shared the advantages and limitations of transitioning to an OpenMRS and OpenHIE platform, which bring experts together to share knowledge, standards, and best practices, as well as collaborate on technologies.
This focus on community and communication was noted by Diallo and the other participants. “DIGI really appreciated the opportunity to learn more about new standards and technologies, how to best approach digital health governance work, and how a shared language will help us collaborate and work together to ultimately improve health outcomes,” said Diallo.
In 2017, in collaboration with the Côte d’Ivoire Ministry of Health and Public Hygiene (MSHP), the National Public Health Reference Laboratory (LNSP), and a local accreditation organization, the Regional Center for Health Evaluation and Accreditation (CRESAC), I-TECH conducted a baseline assessment of laboratory services at 50 laboratories across Côte d’Ivoire.
The purpose of the joint assessment was to determine the laboratory’s capacity to provide HIV and clinical diagnostic services. More specifically, I-TECH aimed to determine the number of laboratorians and HIV counseling and testing staff trained and certified in HIV testing; the quality and timeliness of HIV and clinical diagnostic tests; and the status of each laboratory in order to prepare them for laboratory accreditation under the SLIPTA (WHO’s Stepwise Laboratory Improvement Process Towards Accreditation) scheme.