Revitalizing CommunityBased Health Care Systems in Tanzania: Integrated Prevention, Care And Treatme

1
Revitalizing Community-Based Health Care Systems
in Tanzania Integrated Prevention, Care And
Treatment Services

• J. Killewo,
• School of Public Health and Social Sciences,
  MUHAS
• C. Maternowska,
• UCSF/ICRH-Kenya
• M. Gross,
• Pangaea Global AIDS Foundation

2
Tanzania the Public Health Context

• Lack of access to health care services
• Weakened health care infrastructure
• Dwindling health care workforce
• Escalating HIV/AIDS epidemic
• Generalized poverty

3
Tanzania the Public Health Context

• In most rural areas poor transportation
  infrastructure, and shortage of healthcare
  workers and medicines, limit health care access
  for most vulnerable

4
Tanzanias Public Health Challenge

• To provide innovative solutions to HIV/AIDS
  prevention, care and treatment that support the
  MOHs strategic plans
• Integrating HIV/AIDS prevention and care within a
  strengthened primary health care delivery system
• Improving community-based prevention
• Increasing ARV adherence and referrals
• Decongesting high-level tertiary care
• Upgrading the health care workforce
• Investment at the community level to meet demands
  of remote and rural populations

5
Formative Research Understanding the Challenge
(2005-2007)

• Archival research Community Healthcare Workers
  and stakeholder interviews
• Field-based research Mifundi District, Iringa
  Region Kyela District, Mbyea Region
• Workforce gap analysis to identify revitalized
  CHW role
• Ethnographic study of PHC issues to identify
  local community needs

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Findings Archival Research

• CHWs faced numerous problems
• Volunteer positions, inadequate village support
• Low level training, not well integrated into the
  national health care delivery system
• Lack of supervision
• Shortage of drugs
• Lack of transport

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Findings Workforce Gap Analysis

• Poor coordination with multiple NGOs, CBOS, etc

• Shortages of equipment and supplies
• High patient volumes ? overworked staff poor
  quality care
• Unmet patient expectations
• Long distances to health facilities lead to poor
  adherence

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Findings Ethnographic Study

• Access to health care facilities limited by costs
  (insurance system ineffective, transport, etc)
• Lack of medications
• Quality of care problematic
• no confidentiality/stigma
• provider/client rapport generally poor
• no linkages between community hospital

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Developing Health Care Leadership the Youth of
Tanzania

• Given the TZ health care crisishuman resource
  and infrastructurehow can we
• promote HIV Prevention/treatment?
• revitalize the CHW cadre?
• strengthen the health system?
• reach the rural and remote?
• A simple intervention placing young Tanzanians
  at the centre of improving community-based HIV
  prevention, care and treatment
• The Youth Health Corps

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YHC Programme

• Operates on several levels
• Provides economic opportunities and HIV
  prevention for YHC members
• Improves access to prevention and treatment at
  the community level
• Strengthens the community level health dispensary
  to provide quality health services

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Scope of Work for YHC

• Provide HIV prevention, education and support
  services within the context of integrated primary
  health care
• Provide rapid HIV testing and/or referrals to HIV
  VCT
• Offer coordinated referrals for treatment and
  community support services
• Link HIV positive participants with HIV care and
  treatment services at community health
  dispensaries and/or at district level as
  appropriate
• Serve as patient and community advocates

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Implementation of Youth Health Corps

• Selection criteria
• Young adults 18-26
• Minimum Form IV
• Locally identified and recommended
• Train/employ YHC as paramedic CHWs
• Facility level inputs at health dispensary level
  improved diagnostics, staff training, support
  for adequate drug coverage
• Supervise YHC by clinicians at local health
  facilities
• Establish a TAG review findings, changes and
  guide the process (NACP, MOH, MUHAS, etc)

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Implementation and Evaluation of Youth Health
Corps

• The proposed stages of implementing and testing
  YHC model will be evaluated in collaboration with
  the MOH
• Demonstration Project (PEPFAR-Funded, launch in
  October 2008)
• Large scale RCT at regional level
• Develop scale-up plan and exit strategy and
  handover to MOH
• Evaluation will include feasibility impact on
  household/community, health system and youth
  corps members cost-effectiveness

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Intended Impacts of Youth Health Corps
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Youth Health Corps Generating Future Healthcare
Leaders

• YHC members will be nationally recognized and
  certified by IAHS/MUHAS
• YHC members will train and serve for 2 years
  maximummaking way for new YHC members
• At completion YHC members will be linked to
  employment education in clinical medicine and
  the allied health sciences
• Successful YHC members will receive an
  incentive-based cash bonus to allay educational
  costs

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Acknowledgements

• Ministry of Health and Social Welfare
• Curriculum Development Committee Members
• National Institutes of Health (NICHD)