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Nursing Efficiency and Task-Sharing in Tanzania

I-TECH Tanzania led the development of the task-sharing policy guidelines for Health Sector Services approved in 2016 as well as the policy’s operational plan. While task-sharing is a widely known HIV service delivery efficiency strategy, still there is continues gaps between national strategies and actual implementation at the site-level [1,2].

Continue reading “Nursing Efficiency and Task-Sharing in Tanzania”

Field Epidemiology Training Program (FETP) in Tanzania

A training participant takes part in a handwashing exercise as part of a cholera outbreak investigation.

For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country.

To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and Prevention (CDC) and the Ministry of Health Community, Development, Gender, Elderly and Children in Tanzania, launched a new Intermediate Field Epidemiology Training Program (FETP) for mid-level health professionals.

Continue reading “Field Epidemiology Training Program (FETP) in Tanzania”

Best Practices

To address the UNAIDS Sustainable Development Goals for elimination of HIV/AIDS, tuberculosis, malaria and other diseases by 2030, and the PEPFAR 3.0 goals, I-TECH leverages the technical expertise of its universities and partners, the broad experience of its funders, and best practices from 15 years of implementing programs.

 

Transition & Sustainability

The International Training and Education Center for Health (I-TECH) works in partnership with host country governments, universities, professional associations, non-governmental organizations, private sector groups and funding agencies to strengthen local capacity and build sustainable health systems.

I-TECH follows a partnership model that guides the provision of technical services and technical assistance toward local ownership and sustainability, creating projects and programs that can be readily transitioned into national systems.

Based at the University of Washington, I-TECH draws upon a strong global network of public health professionals. The approach described in this document is customized in each country to respond to local needs and priorities. In addition, each I-TECH country office team aligns the model with the unique Partnership Framework Implementation Plans of the partner host government.

1. IDENTIFY NEEDS in consultation with host country governments

I-TECH works with host country governments to assess existing health systems and identify specific areas where the delivery of health care could be improved. This early collaboration helps to ensure that technical assistance accurately reflects the country’s specific health strategies and priorities.

2. STRUCTURE PARTNERSHIPS that integrate projects into existing systems

In each partnership, I-TECH develops roles, responsibilities, and timelines based on a long-term vision of integrating projects into existing national systems. As part of this vision, I-TECH recognizes and leverages the strengths and resources of national systems, building on and maximizing these efficiencies. The partnerships that emerge are attuned to the needs, realities, and structure of host country systems. Thus, they build and maintain lasting capacity within host country systems, maximize cost-effectiveness, and produce projects that can be more readily scaled up to meet national goals.

3. SECURE TECHNICAL RESOURCES from affiliated universities, partners, and the I-TECH network

As a center based at the University of Washington, I-TECH has direct access to a wide variety of technical specialists. In addition, I-TECH draws upon a robust global network of locally based public health professionals. These specialists provide a wide range of technical expertise to meet project needs.

4. PROVIDE TECHNICAL ASSISTANCE AND SERVICES tailored to actual needs and resources

I-TECH is committed to technical services and technical assistance approaches that build upon and support the existing strengths of local health systems. In addition, I-TECH prioritizes the use of local and regional expertise, an approach that builds the capacity of local experts to meet locally determined needs.

5. MONITOR PERFORMANCE; evaluate achievement of objectives and measure outcomes

I-TECH implements projects within a quality improvement framework designed to track progress in institutional capacity building and guide successful implementation. Using the framework, implementers monitor the progress of each project against specific benchmarks of success; for example, the progressive transfer of skills and capacity to local institutions. This methodology ensures that objectives are met and provides data to adjust approaches as projects evolve.

6. TRANSITION PROJECT into national systems to ensure sustainability

The ultimate goal of I-TECH’s partnership model is to improve health outcomes by strengthening local capacity and building sustainable health systems. I-TECH’s technical services and technical assistance are tailored from the initial planning stage to produce projects that can be successfully absorbed into national systems within mutually determined and realistic timeframes. Recognizing that a successful transition takes time, I-TECH offers transition support in a variety of technical areas including quality improvement and grant management.

Voluntary Medical Male Circumcision

I-TECH has developed extensive capacity and expertise in voluntary medical male circumcision (VMMC) program implementation and management by providing comprehensive VMMC services and/or technical assistance across Southern and Eastern Africa in Botswana, Malawi, Mozambique, Namibia, Tanzania, and Zimbabwe. Technical focus areas include health policy and guideline development, including early-infant male circumcision and piloting and evaluating devices; external and internal quality assurance; demand creation and community mobilization; training; and direct service delivery – all built on a strong foundation of monitoring, evaluation, and learning. Since 2011, I-TECH has directly provided more than 660,000 VMMCs with an adverse event rate of less than 2%.

I-TECH promotes an integrated model, consistent with the Global Health Initiative (GHI) Principles, and supports data-driven program implementation and management. By working closely with the Ministries of Health, local partners, and communities, I-TECH ensures implementations are country-owned and foster strong health systems and sustainable programs.

Program Highlights

Expanding Two-Way Texting for Voluntary Medical Male Circumcision Clients in South Africa
I-TECH, in close partnership with voluntary medical male circumcision (VMMC) implementing partner, the Aurum Institute and technology partner, Medic, is conducting a five-year study funded by the National Institutes of Health to further evidence on the efficiency, safety, and scalability of two-way text-based (2wT) follow-up for VMMC services. 2wT is ...
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Reducing HIV through Voluntary Medical Male Circumcision in Zimbabwe
Since 2013, the ZAZIC Consortium has been implementing Voluntary Medical Male Circumcision (VMMC) as part of a combination HIV prevention package approved by the Ministry of Health and Child Care (MoHCC) in Zimbabwe. Unlike other VMMC programs in the region, the ZAZIC model uses an integrated approach, blending local clinic ...
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Two-Way Texting for Post-Operative VMMC Follow-Up RCT in Zimbabwe
Voluntary medical male circumcision (VMMC) is considered safe and the vast majority of men heal without complication. However, guidelines require multiple follow-up visits, which can burden staff and facilities with clients who are typically healing well. With funding from the National Institutes of Health (NIH), ZAZIC recently conducted a prospective ...
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Increasing VMMC Delivery and Safety in Zimbabwe
Employing modern medical male circumcision within traditional settings may increase patient safety and further male circumcision scale up efforts in Sub-Saharan Africa. ZAZIC established a successful, culturally sensitive, partnership with the VaRemba, an ethnic group in Zimbabwe that practices traditional male circumcision. The VaRemba Camp Collaborative (VCC) was created to ...
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Integrating Research and Practice

Program Highlights

Field Epidemiology Training Program (FETP) in Tanzania
For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country. To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and ...
Read More
Layering Research and Practice in Haiti
The EMR iSanté enables research on population health in Haiti, including the implementation of Option B+. This work was presented at the International AIDS Society Conference in 2015 ...
Read More
Quality Improvement in Ukraine
I-TECH applied the Clinical Assessment for Systems Strengthening (ClASS) methodology and tools to assess over 30 regional and local HIV care sites and facilities since 2014 ...
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Strategic Information in Ukraine
I-TECH in Ukraine has worked to implement the Training System Monitoring and Reporting Tool (TrainSMART) via its partners, supporting adaptation of the tool per partners’ specifications and training stakeholders on its use since 2013 ...
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Nursing/HCW Cadres

World Health Organization guidelines for placing all HIV positive individuals on antiretroviral treatment has intensified the demand for a competent and accessible global health work force that can accommodate 90-90-90 UNAIDS targets for testing, treating, and virally suppressing HIV patients. There is an urgent need to concentrate on effective, differentiated, and cost-efficient service delivery models that embrace high quality patient-centered HIV care as countries adopt and roll out Test and Start. Achieving 90-90-90 will require substantial shifts in how HIV services are staffed and delivered; different solutions, including task sharing, are still needed to reach targets. Over the past decade, a variety of non-physician cadres, such as nurse-midwives, clinical officers, and medical assistants, have contributed to growing evidence of task sharing’s positive contributions to HIV health outcomes in resource-limited settings.

Program Highlights

Clinical Mentoring in Haiti
I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
Read More
Nursing Efficiency and Task-Sharing in Tanzania
I-TECH Tanzania led the development of the task-sharing policy guidelines for Health Sector Services approved in 2016 as well as the policy’s operational plan. While task-sharing is a widely known HIV service delivery efficiency strategy, still there is continues gaps between national strategies and actual implementation at the site-level [1,2] ...
Read More
Using Data to Improve Health Service Delivery in Malawi
The Kuunika Project: Data for Action was a four-year program implemented by a consortium of organizations, including the International Training and Education Center for Health (I-TECH), that began in 2016 to improve healthcare service delivery through the effective use of data. Consortium activities aimed to improve data systems, data use, ...
Read More
Workforce Development in Haiti
It is critical that health care providers receive the necessary training to empower them to improve patient outcomes CHARESS supports both pre-service and in-service training efforts in Haiti. In particular, CHARESS is a key partner of MSPP in maintaining its national clinical guidelines.  ...
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Human Resources for Health

The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated health care workforce, and sustainable systems to educate and train those workers. I-TECH uses a systemic approach to build the skills and knowledge of, and foster attitude changes in, health care staff and those who train and educate them.

The following model outlines I-TECH’s human resources for health-based approach to achieving comprehensive patient-centered care. Each component of the model, including a strong enabling environment, supports an optimized health workforce as the foundation of an effective service delivery system.

Program Highlights

Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania
High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization's (WHO) recommendation to “Treat All," eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) ...
Read More
Building the Capacity of the Health Workforce in India
I-TECH India PL has worked with stakeholders to develop national training curricula for health care staff on delivering HIV care and treatment services. In addition, it has:

  • Planned and implemented training programs for various cadres of clinical and program staff;
  • Participated in medical officer training programs at the national ...
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Clinical Mentoring in Haiti
I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
Read More
Field Epidemiology Training Program (FETP) in Tanzania
For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country. To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and ...
Read More

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Tanzania

I-TECH began its work in Tanzania in 2006 at the request of the Ministry of Health and Social Welfare (MOHSW) and the U.S. Centers for Disease Control and Prevention (CDC). For over a decade, I-TECH has been providing national-level technical assistance to the National AIDS Control Program (NACP); National Tuberculosis and Leprosy Program (NTLP); Prevention and Mother to Child Transmission (PMTCT); Field Epidemiology and Laboratory Program (FELTP); Directorate of Human Resources for Development; Directorate for Nursing and Midwifery; and other departments in the Ministry of Health, Community Development, Gender, Elderly and Children, so as to strengthen health systems in Tanzania and improve the quality of care provided to patients with HIV/AIDS.

I-TECH Tanzania is directly contributing to the UNAIDS 95-95-95 targets through support for implementation of “Treat All” through differentiated HIV service delivery models (SDMs); strengthening of human resources for health and workforce capacity aligned to PEPFAR’s Human Resource for Health Strategy; policy development support; and public health surveillance through strengthening data collection, quality and interpretation at every level of the health system.

Program Highlights

Differentiated HIV Service Delivery Models in Tanzania
In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania ...
Read More
Nursing Efficiency and Task-Sharing in Tanzania
I-TECH Tanzania led the development of the task-sharing policy guidelines for Health Sector Services approved in 2016 as well as the policy’s operational plan. While task-sharing is a widely known HIV service delivery efficiency strategy, still there is continues gaps between national strategies and actual implementation at the site-level [1,2] ...
Read More
Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania
High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization's (WHO) recommendation to “Treat All," eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) ...
Read More
Innovative Training Models in Tanzania
I-TECH Tanzania has implemented many pre- and in-service training initiatives and materials, as well as adopted TrainSMART ...
Read More

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Malawi

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.

Program Highlights

Using Project ECHO in Malawi
The Extension for Community Healthcare Outcomes (ECHO) Project® was developed by the University of New Mexico to improve care for underserved populations using a hub-and-spoke approach of knowledge-sharing by video-conferencing technology. The Lighthouse ECHO project provides a platform for sharing critical, timely, and life-saving information and data with health care ...
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Birth Defects Surveillance in Malawi
Malawi is one of first countries in Southeast Africa to respond to the World Health Organization’s call for robust birth surveillance systems. Routine surveillance is essential for public health monitoring of pregnancy outcomes and birth defects, especially in high-HIV burden settings where women living with HIV initiate the use of ...
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National COVID-19 Emergency Response in Malawi
In collaboration with the Malawi Ministry of Health (MOH) and Centers for the Disease Control and Prevention (CDC), I-TECH has supported the national COVID-19 response in Malawi since March 2020. Technical assistance has focused on laboratory capacity, supporting quality COVID-19 surveillance and data management, and implementing a COVID-19 population-based survey ...
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HIV Recency Surveillance in Malawi
The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection ...
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Cervical Cancer Screening and Treatment Strategy Support in Malawi
Cervical cancer is the leading cause of cancer death among women in Malawi. In response, the Ministry of Health (MOH) in Malawi developed a five-year National Cervical Cancer Control Strategy for 2016-2020. The strategy outlines comprehensive interventions, including the integration of cervical cancer screening services into HIV care. In 2019, ...
Read More
Using Data to Improve Health Service Delivery in Malawi
The Kuunika Project: Data for Action was a four-year program implemented by a consortium of organizations, including the International Training and Education Center for Health (I-TECH), that began in 2016 to improve healthcare service delivery through the effective use of data. Consortium activities aimed to improve data systems, data use, ...
Read More

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