Implementing Enhanced Packages of Care Summation, Challenges and Next Steps

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Implementing Enhanced Packages of
CareSummation, Challenges and Next Steps
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Key Lessons Learned

• Need to identify a strategic approach for the
• delivery of the minimum package of care.
• Steps include
• Needs Assessment
• Definition of minimum care package
• Use of ICAPs service delivery approach
  multidisciplinary, continuity, family focused,
  comprehensive

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Key Issues Lessons learned

• One Stop Services model for TB/HIV integration in
  Rwanda
• Building capacities of national staff and state
  programs
• Improving quality of TB/HIV integration across
  Rwandan sites
• Adoption of ICAP model for TB/HIV Integration as
  national model by TB/HIV national WG

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Key IssuesLessons Learned Nigeria

• Minimum Care Package defined by OGAC
• Standardized by the USG team through the COP
  guidelines
• Adapted by ICAP and sites based on local context
  bringing about package gaps
• Package gaps with no funding led to innovations
  to address challenges e.g. nutritional gaps
  filled through food banks, communal farming

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Key Issues Lessons Learned Tanzania

• Pain Management
• Recent pilot in one district in Dar es Salaam
  successfully integrated palliative care into the
  District team responsibility
• New Area but intense need to institute and
  rapidly scale up in-country

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Challenges

• How do we define and fund a minimum care
  package?
• How do we measure delivered care in terms of
  quantity and quality?
• How do we determine what needs to be added on and
  when?
• How do we scale up linkages between facility
  based and community based activities to ensure
  and enhance continuity?
• When can we graduate a site to function
  independently?

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• National policy on palliative care
• Technical skills in managing HIV patients with KS
  and with general pain issues
• Increase access to drugs for OIs, pain management
• Decentralizing availability of pain management as
  whole
• Expand type of provider able to prescribe
• Decentralizing oncology services

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Moving beyond the challenges

• Define minimum package of care
• Identify windows of opportunities for innovations
  and leveraging resources
• Put in place a systematic approach to ensure mode
  of delivery fits the ICAP model
• Multidisciplinary
• Continuity
• Family focused
• Comprehensive

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Moving beyond the challenges2

• Maximize coverage
• Enhance quality
• Build capacity
• Ultimate goal, graduate sites to stand alone

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High quality program
SOC readiness
Implementing the model of care
Building capacity
Enhancing quality
Site Independence
Site Start-up
Goal 3 Build capacity to promote program
sustainability and independence
Goal 1 Define care package Identify mode of
delivery
Goal 2 Define care package Identify mode of
delivery
Time
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Conclusion

• Care lays the foundation for ART
• Enhanced Package of care delivered at the right
  time using the right approach promotes retention
  and adherence
• Care must focus on the vulnerable populations
  especially pregnant women and children
• Need to begin to think of a paradigm shift
  creating seamless linkages and devolution of
  services from facilities to communities