The International Training and Education Center for Health (I-TECH) has broad expertise in strengthening health care regulatory systems in low- and middle-income countries. I-TECH’s approach to regulatory strengthening emphasizes the importance of sustainability and country ownership, by working with ministries of health, health professional councils, and health professional associations to:
- Conduct sound situational analyses and needs assessments;
- Develop standard operating procedures to efficiently operationalize and scale key regulatory activities;
- Develop regulatory information management systems;
- Develop standards to establish consistent expectations for high quality health services; and
- Develop continuing professional development frameworks and guidelines.
The Frontline Field Epidemiology Training Program (Frontline FETP) enhances the capacity of HIV and AIDS surveillance and strengthens health systems. The program contributes to a sustainable response to HIV by training health professionals in basic field epidemiology that can support responsiveness to HIV surveillance needs. Continue reading “Field Epidemiology Training Program in Malawi”
I-TECH continues to focus efforts on the improvement of data quality and use of data to improve clinical decision making. I-TECH works at the site level to build awareness and buy-in for data quality and use among site-level management and health care workers.
On-site I-TECH Monitoring and Evaluation (M&E) Officers and Program Assistants monitor completeness and accuracy of service delivery documentation from the point of patient encounter to the point of final data capture in Ministry of Health and Social Services electronic databases. M&E Officers promote the use of data by clinicians and facility management for systems improvement and performance enhancement.
I-TECH supported the Ministry of Health and Social Services in 2017 and 2018 in the development and dissemination of the national Cervical Cancer Prevention Guidelines including algorithms for screening, referral, and post cryotherapy instrument disinfection, and monitoring and evaluation tools. Continue reading “Cervical Cancer Screening and Treatment in Namibia”
I-TECH in Namibia spearheaded use of distance learning for HIV care and treatment through the establishment of a digital video conferencing network to link Windhoek with training sites and hospitals throughout the country starting in 2008. Building off that foundation, Namibia became the first country in Africa to implement the Project ECHO model, a tele-health platform started at the University of New Mexico, whereby clinicians in remote areas connect with rotating subject matter experts and clinicians a robust virtual community of practice to build health care worker capacity, support peer-to-peer cross-facility learning and reduce feelings of professional isolation.
Continue reading “Training through Distance Learning in Namibia using the Project ECHO Model”
I-TECH assists the Ministry of Health and Social Services with the expansion and provision of voluntary medical male circumcision (VMMC) as an HIV prevention option. This support started in 2008 with the development of national guidelines and training materials, followed by national trainings of health care workers. In 2015, this support expanded to include direct service delivery in the Oshana and Zambezi regions, as well as Karas region from 2017 onward. Since 2016, I-TECH has also supported demand creation with a network of community-based mobilizers and recruiters using a human-centered design approach to actively engage communities and stakeholders to increase the number of men voluntarily electing medical circumcision. The program has performed over 36,000 VMMCs in Namibia.
I-TECH has trained physicians, nurses, and community counselors to ensure that adequate skills and experience are in place to deliver safe, high-quality male circumcision services.
I-TECH works to strengthen the quality of pediatric HIV care and treatment in Namibia through the development of a “model” pediatric HIV clinic and supporting decentralization of quality pediatric care to other facilities. In collaboration with the Ministry of Health and Social Services, I-TECH developed an innovative, structured, culturally-relevant intervention to help guide health care workers and caregivers of HIV-positive children through the process of disclosing a child’s HIV-positive status to the child.
An evaluation of the disclosure program showed that it increased health care worker and caregiver confidence and communication in pediatric disclosure, as well as demonstrating improved viral suppression, adherence, and HIV knowledge among pediatric patients. I-TECH clinicians have also worked at the site level to support the development, implementation, and monitoring of strategies to improve adolescent HIV services and transition of adolescents from pediatric to adult care.
In accordance with the HIV Care Continuum, I-TECH supports direct HIV care and treatment service delivery as well as on-site clinical mentoring and technical assistance in 81 facilities in five regions of Namibia. I-TECH supports key evidence-based strategies such as provider-initiated HIV counseling and testing, eMTCT, and decentralization of ART services to the clinic.
In collaboration with the MoHSS, I-TECH is implementing “Treatment for All” guidelines (December 2016), an HIV care and treatment approach that initiates patients on lifelong antiretroviral therapy as soon as they test HIV-positive. I-TECH has developed an interactive education and counseling intervention, ARVs and Healthy Me, for health care workers to support HIV-positive patients in attaining good adherence and engagement in care.
To improve the quality of data for use in clinical decision-making, I-TECH actively participates in national technical working groups and advisory committees, and conducts rigorous monitoring and evaluation (M&E) to build awareness and buy-in for data quality and date use among site-level managers and health care workers.
I-TECH has worked for almost twenty years to support health systems strengthening and the national response to the HIV epidemic in Malawi through significant contributions to the development of a robust health care workforce that provides high-quality HIV prevention, care, and treatment services.
In Malawi, I-TECH works through the secondment of well-qualified, experienced technical advisors (TAs) in the Ministry of Health (MOH) and other institutions to provide technical assistance for development and implementation of the national strategic plan led by the Government of Malawi (GOM). I-TECH TAs play an important role in ensuring timely national HIV/TB response by supporting prevention and control across the HIV care continuum. Additionally, I-TECH TAs support and facilitate surveillance and M&E for HIV/TB programs. This assistance enables the MOH to collect and manage up-to-date data to inform evidence-based decision-making by GOM and partners.
I-TECH technical assistance to Malawi MOH also covers the implementation of national surveillance systems to improve the generation of high-quality epidemiological data. Surveillance TAs work together with their GOM counterparts to improve storage and transportation conditions for lab samples, train staff in analysis of surveillance samples, and increase the functionality of surveillance systems to generate reliable and accurate data. The principal surveillance projects I-TECH TAs support in Malawi are Birth Defects Surveillance and HIV Recent Infection Surveillance. Most recently, I-TECH TAs have been placed at Public Health Institute of Malawi (PHIM) to support GOM with its emergency response to the COVID-19 pandemic.
Departments and units supported by I-TECH TAs include the National Tuberculosis Control Programme, Department of HIV and AIDS, Supply Chain of HIV Commodities, Monitoring and Evaluation of HIV Program Diagnostics, Reproductive Health Department, PHIM, National HIV Reference Laboratory, and the National Registration Bureau. I-TECH TAs also support clinical mentoring and M&E at Lighthouse Trust, a Center of Excellence for HIV care that was established in 2001.
I-TECH has worked in Namibia since 2004 to support a robust and sustainable health care system, and to address key health challenges including high HIV prevalence and a critical shortage of skilled health care workers.
Based in the capital city, Windhoek, I-TECH in Namibia has a long history of successfully supporting the Ministry of Health and Social Services (MoHSS); the Ministry of Education, Arts, and Culture; the University of Namibia; and the Ministry of Defence/Namibia Defence Force with programs to improve the prevention, care, and treatment of HIV. I-TECH’s flagship work in Namibia included the training of physicians, pharmacists, nurses, and community counselors in a wide range of subjects including sexually transmitted infections, tuberculosis, and pediatrics. In 2015, the program has expanded its focus to include direct service delivery across the HIV clinical continuum including multiple prevention programs such as DREAMS, pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision (VMMC).
Successes include the establishment of nurse-initiated and managed ART services, support of the use of distance learning technologies (digital video conferencing, Project ECHO) to train Namibia’s dispersed health workforce, and delivery of VMMC services aimed at keeping boys and men HIV-negative. In 2017, I-TECH began implementing HIV prevention activities aimed at keeping adolescent girls and young women HIV-negative, including through the provision of PrEP.
I-TECH has also implemented a successful national survey focusing on the health and wellness of adolescents and young adults in Namibia in partnership with the Ministry of Gender Equality and Child Welfare, UNICEF, MoHSS, Namibia Statistics Agency, and the U.S Centers for Disease Control and Prevention.