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) is eliminated, and all populations and age groups are linked in one universal policy. This recommendation change erases the distinction between all groups. However, a substantial number of PLHIV still present late to care and have advanced disease, and require interventions that prioritize clinical packages to reduce mortality and morbidity and eventually enable them to become clinically stable [1].
Category: Health Systems Strengthening
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”
Jeff Lane
Jeff Lane, JD, MPH, is an Assistant Professor with the University of Washington Department of Global Health and is an affiliated faculty member with University of Washington’s (UW) International Training and Education Center for Health (I-TECH). From 2010-2015, Jeff worked on the PEPFAR Policy Monitoring Project that built capacity of PEPFAR partner countries to develop and monitor health law and policy reforms critical to HIV/AIDS program scale-up and sustainability. Jeff co-led the South Africa health policy systems strengthening project, which worked with the National Department of Health of South Africa to strengthen its health policy management processes and information systems.
During his career, Jeff has worked to strengthen health policy and regulatory environments in Cambodia, Dominican Republic, Ghana, Haiti, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, the United States, and Zambia. Jeff’s research interests focus on how policy development and implementation impacts public health around the world and specifically on access to essential medicines and health services. Jeff teaches a graduate level course every spring titled Policy Development and Advocacy for Global Health (GH523). Jeff received his Juris Doctorate and Masters of Public Health from UW.
I-TECH Haiti Country Office Becomes an Independent NGO
On June 1, 2018, the University of Washington’s International Training and Education Center for Health (I-TECH) country office in Haiti officially became a local non-governmental organization (NGO). The office will be rebranded as the Centre Haïtien pour le Renforcement du Système de Santé (CHARESS) and will continue to implement programs to improve HIV services via a trained health workforce, robust health information systems (HIS), and clinical mentoring.
CHARESS will be responsible for maintaining, training, and deploying HIS such as iSantéPlus and the Système d’Echange d’Information de Santé d’Haïti (SEDISH), a national health information exchange, across Haiti and ensure the sites receive on-site and remote technical assistance. The team will also oversee clinical mentoring activities at 20 sites and provide technical assistance to the Ministry of Public Health and Population (MSPP) and other implementing partners in Haiti.
“I-TECH has a mission to support sustainable development,” says Scott Barnhart, MD, MPH, Professor in the Department of Global Health and an I-TECH Principal Investigator overseeing programs in Haiti. “The conversion of the I-TECH country office and launch of a fully independent NGO to take up those activities is testament to I-TECH’s commitment to fostering locally owned and led development.”
The announcement of the shift to local ownership comes after two years of strategic planning by key stakeholders and partners to successfully transition I-TECH Haiti’s country office into an independently functioning NGO. As such, CHARESS will aim to allocate more of its funding to program activities, as well as pursue local funding opportunities restricted to Haitian organizations.
“The programs that are shifting to CHARESS have already proved to have had a dramatic impact on the health care landscape in Haiti,” remarked Jean-Guy Honoré, MD, I-TECH Haiti’s Country Director. “Transitioning of the key programs, specifically our HIS work, to a local ownership will allow CHARESS to become a leader in sustainability on the global stage. We are proud of the work that we have accomplished and look forward to the future.”
For 16 years, I-TECH has helped develop strong national health systems in low- to middle-resource countries while promoting the importance of local ownership as a way to sustain those effective health systems. I-TECH will continue to be a close partner in supporting CHARESS and looks forward to continued collaboration.
I-TECH Ukraine Conducts ARVs for Epidemic Control Workshop
In early April, the International Training and Education Center for Health (I-TECH) conducted a five-day workshop on “Antiretroviral Drugs for Epidemic Control” for more than 50 chief doctors and deputy chief doctors from Regional AIDS Centers in Ukraine.
Workshop participants learned about evidence-based, international best clinical practices and the cost-effectiveness of strategies for using antiretroviral therapy (ART) to control HIV epidemics. International keynote speakers included:
- Dr. Jeremy Penner, International Clinical Advisor in Ukraine to I-TECH/University of Washington (UW);
- Dr. Elliot Marseille, Consultant to I-TECH/UW and the Center for Global Surgical Studies at the University of California, San Francisco;
- Dr. Michael Martin, U.S. Centers for Disease Control and Prevention (CDC) Senior Technical Advisor for HIV/AIDS care and treatment in Thailand; and
- Dr. Juliana de Fatima da Silva, Epidemic Intelligence Service Officer at the CDC.
The pool of facilitators also included nine national experts from the Ministry of Health’s Center of Public Health (CPH).
The workshop aimed to support the development of efficient strategies to achieve the UNAIDS 90-90-90 goals: 90% of HIV-positive people know their status, 90% of those are on treatment, and 90% of those are virally suppressed. To this end, the workshop covered national situational analysis, national clinical recommendations, and service delivery models with the highest potential for adaption in country.
Progress on ART optimization in Ukraine was shared, and participants were able to discuss their experiences and ideas for improving HIV-related services. The presentations and group discussions were particularly timely, given the development of complex new HIV clinical guidelines currently under way in Ukraine – they also provided much needed evidence to support this process.
Similar workshops were requested by the CPH and leaders of the Regional AIDS Centers, and I-TECH plans to meet this request by conducting two workshops in June and September 2017.
THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). 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.
Guyana Revamps Its Health Information System with I-TECH Support
The International Training and Education Center for Health (I-TECH) recently partnered with the Ministry of Public Health in Guyana and the U.S. Centers for Disease Control and Prevention (CDC) to launch a new health information system (HIS) that will protect patients’ privacy, maintain confidentiality, and provide security for sensitive data.
In an article in Guyana’s Kaieteur News, Deputy Chief Medical Officer, Dr. Karen Boyle, described how health officials hope to reduce health service quality inequities between coastal regions and other parts of the country as part of the national 2020 plan, in part by reducing waiting time for medical services and improving patient health literacy. Dr. Boyle stated they expect to “improve access to health information” and allow for “shared responsibility” for health care decision-making by providers and patients.
The health information upgrade is also being supported by PAHO (the Pan-American Health Organization), UNAIDS, and local collaborating partners such as the University of Guyana, e-Government, the National Insurance Scheme, and the Government Technical Institute (GTI).
CUGH 2017: Text Messaging and Tablets for Training
On April 6, the International Training and Education Center for Health (I-TECH) headed to the 8th Annual Consortium of Universities for Global Health (CUGH) Conference in Washington, D.C. I-TECH Zimbabwe presented among many colleagues in the University of Washington’s Department of Global Health, including staff of the department’s E-Learning Program (eDGH), which has worked closely with I-TECH on a number of e-learning and blended learning training programs.
This year’s conference theme was “Healthy People, Healthy Ecosystems: Implementation, Leadership & Sustainability in Global Health,” and I-TECH’s entries highlighted its sustainable workforce development work worldwide.
I-TECH Zimbabwe’s Vivian Bertman shared results on the use of text messaging as a low-cost, sustainable platform for building health care worker skills and knowledge to care for children and adolescents with HIV.
The research, titled “Health Worker Text Messaging for Training Peer Support, and Mentoring in Pediatric and Adolescent HIV/AIDS Care: Lessons Learned in Zimbabwe,” assessed the use of WhatsApp in a blended learning program. Participants used the app for peer-to-peer learning and support, generating over 300 entries, continuing discussions after course completion, and creating spin-off groups, including a support group for teens.
Highlighting the flexibility of cost-effective e-learning approaches was an oral presentation by eDGH’s Leslie Wall and Anya Nartker titled “No internet? No problem! Creative approaches to cost-effective e-learning delivery in resource-constrained settings.” The research looked at five tablet-based training programs developed by eDGH, in partnership with I-TECH, and delivered in Namibia, Tanzania, and Zimbabwe.
For participants, time spent off the job decreased from four days to less than one day, and within training programs that used text messaging to keep learners engaged, all participants finished in the time allotted. The team plans to expand learning activities and incorporate additional real-time interactions via text-message-based discussion groups or added face-to-face interactions.
Caitlin O’Brien-Carelli, an MPH graduate from the UW Global Health program, explored additional sustainable training models. O’Brien-Carelli presented her MPH thesis work on behalf of I-TECH: “Training Healthcare Workers on the Use of Electronic Medical Records in HIV Clinics in Kenya: An Evaluation of Three Training Models.”
During I-TECH Kenya’s first years of training health care workers to use the KenyaEMR system, the team adjusted its training from 5 days to 3 days, and moved the training from off-site to on-site, to increase sustainability and maintain effectiveness. Results confirmed that with the adjustments, training quality was maintained, more people in more facilities were trained, and costs were reduced significantly.
Detailing innovations on the operations front, I-TECH HQ Managing Director Rob Lindsley presented at a conference satellite session titled “Global Operations 2017: Tools for Faculty & Administrative Leaders.” Lindsley’s presentation, “It’s About How Hard You Can Get Hit and Keep Moving Forward: Global Support and PLC Registration in India,” outlined I-TECH’s complicated, creative pathway to country office registration in India.
HIV/AIDS Community Mourns the Loss of Samuel Tadesse
On January 25, Ethiopia, and the world, lost a treasured advocate and leader in the fight against HIV/AIDS: Samuel Tadesse.
Samuel, who discovered he was HIV positive in 2004, turned his diagnosis into action, founding the Debre Mitmaq Association at the Tsadkane holy water well. The Association is a partnership between the Orthodox Church and secular efforts to encourage antiretroviral therapy (ART) for those infected. It is a crucial alliance that has resulted in a shelter providing HIV testing, counseling, ART, and care for more than 1,300 people. More than that, it is a community of love, support, and rehabilitation. Read more about Samuel’s work with I-TECH at the Tsadkane holy water well.
Samuel Tadesse — and his enthusiasm, selflessness, and determination — will be greatly missed.
The following video was created by Theo Angell and Maria Gargiulo during a February 2011 visit to the well:
Ethiopia- Debire Mitimak – More than Holy Water from Theo Angell on Vimeo.
Ukraine’s HIV/AIDS Clinics Embrace ClASS Approach
This month, the International Training and Education Center for Health (I-TECH), working with the Ministry of Health (MOH) in Ukraine, sensitized heads and other managers of HIV/AIDS clinics and centers on how to implement continuous quality improvement (CQI) by applying an approach known as the Clinical Assessment for Systems Strengthening, or ClASS, model.
The MOH’s Center of Public Health and I-TECH Ukraine held a two-day ClASS sensitization workshop for HIV clinicians from seven regions of Ukraine that are new to ClASS. The ClASS approach addresses CQI and identifies areas for improvement and assessment as well as detailed follow-up actions.
Presentation of the model was supplemented by reports and success stories shared by teams from Cherkasy, Kyiv, Chernivtsi Oblast, and Kryviy Rig City AIDS Centers, along with other sites that participated in ClASS between 2014 and 2016. The exchange of this experience proved effective in ensuring buy-in from new regions and raised their interest in and excitement about the model and its potential impact.
I-TECH Ukraine Program Director Iryna Yuryeva, who presented the ClASS model, said she was encouraged by the response to the workshop. Perceptions among the new audience shifted “amazingly quickly” she said, “from extreme concern, anxiety, and belief that almost nothing can and should be improved at their health care facilities to sincere and passionate interest and impatient anticipation of ClASS visits in the coming months.”
Participants expressed keen interest in the ClASS approach, which emphasizes team problem-solving and joint identification of ways to improve assessment, develop operational and strategic plans, and seek technical assistance when needed to address gaps. In addition, ClASS could also be helpful for health care facilities preparing for formal accreditation by addressing assessment-based practical recommendations.
The “real-life cases and improvements” reported by the participating clinicians, and their ability to exchange experiences and proactively tackle main areas for improvement, were highlights of the training. This is all part of the ClASS methodology, a process that I-TECH’s Yurveya says demonstrates a “natural and evolutionary continuous quality improvement.”
I-TECH Ukraine will continue to support the MOH by promoting the ClASS approach as part of the CQI process in Ukraine, in particular by conducting additional ClASS trainings in seven new regions in 2017.
THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). 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.
Lab Managers in Zambia Earn Certificate in Leadership and Management
At a December ceremony in Lusaka, Zambia, a group of health laboratory supervisors completed the Certificate Program in Laboratory Leadership and Management, a blended-learning course developed and conducted by faculty and staff the International Training and Education Center for Health (I-TECH) at the University of Washington. The program was implemented in partnership with the American International Health Alliance (AIHA), the U.S. Centers for Disease Control and Prevention, and the Zambian Ministry of Health (MOH).
Effective leadership and management in laboratory settings are critical to providing timely detection, surveillance, and response to infectious diseases. Strengthening these skills has a direct, positive effect on quality of care and the capacity of low-resource countries to reach epidemic control.
The 16 managers, recruited from MOH public health laboratories, participated in nine months of online learning, face-to-face meetings, and mentorship. Courses covered leadership and management skills, and also topics related to implementing diagnostic technology, managing and communicating laboratory information. Participants also designed and implemented a capstone project designed to improve their laboratories’ operations. Online modules were developed with support from the UW Department of Global Health’s E-Learning Program (eDGH).
This certificate program is intended for middle- to senior-level clinical and public health laboratory leaders such as managers and directors, medical technologists, health scientists, and physician scientists interested in improving medical laboratory operations and evidence-based health policymaking. The blended-learning format allows participants to remain employed during their studies.