Human Resource Sustainability in PEPFAR Programs: Presenting Options

1
Human Resource Sustainability in PEPFAR Programs
Presenting Options

• Robin Flam MD DrPH
• Director, Clinical Unit
• International Center for AIDS Care and Treatment
  Programs (ICAP)
• Columbia University
• Mailman School of Public Health
• Meg Ferris, PhD, MPH
• Vice President for International Fellowships
• Baylor International Pediatric AIDS Initiative
• Baylor College of Medicine

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Short Term Solution The Pediatric AIDS Corps

• Goal is direct immediate provision of
  life-sustaining, health-restoring care and
  treatment (26,000 currently)
• 94 physicians recruited since 2006 roughly 60 in
  Africa at any time
• PAC doctors also train hundreds of local health
  professionals both through didactic teaching and
  side-by-side mentoring

3
Medium Term Solutions

• BCM Inducing local health professionals to
  return to their home countries
• ICAP Nurse Mentoring Program
• ICAP Human Capacity Building in Nigeria

4
Reverse Brain Drain

• Strategies fair wages, suitable work
  environments, opportunities for academic
  enrichment and professional advancement
• BIPAIs Clinical Centers of Excellence and
  Pediatric AIDS Corps program are designed to have
  a multiplier effect on local health professional
  capacity, both through training and by reversing
  brain drain

5
ICAPs ParadigmClinical Systems Mentorship (CSM)

• CSM is the name of an integrated methodology
  developed by ICAP
• broadens the principles of clinical mentorship to
  the context of public health programming and
  health systems strengthening.
• The goal of the CSM methodology is to
• Implement high quality programs
• Build capacity to sustain these programs
• HR sustainability is fundamental to this

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Basic Principle

• This work is highly relational
• Plop-in strategies cannot work
• An integrated strategy is necessary

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Interface Among CSM Levels Relationships
FMOH
8
Task Shifting ICAP-South Africa

• ICAP Nurse Mentoring Program
• Goal Redirect tasks from doctors to nurses
  create enhanced opportunity for nurses by
  developing a cadre called Nurse Mentors (cadre
  focused)

9
Background Eastern Cape

• Qaukeni Bizana Flagstaff sub areas
• Population 400,000
• 5 doctors per 100,000 population

• Population 6.9 million
• 61.2 rural
• 10.1 doctors per 100,000 population
• 102 professional nurses per 100,000 population
• Total population HIV prevalence 10.9
• Using ASSA 2003 modelling it is estimated that
  69,000 patients require ART per year

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Nurse Mentoring Program

• Relieve the scarcest cadre, and utilize the most
  available
• Doctor to Nurse task shifting
• Enhance competencies of, and empower nurses
  create career ladder
• Create a network for nursing support
• Training, Mentoring for NMs
• Orientation and involvement of DOH management
  staff and faculty from schools of nursing

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Results

• Nurse Mentors are Site Support Team Coordinators
• On-site nurses appreciate mentoring by fellow
  nurses
• There has been formal recognition of mentorship
  training as post-basic certificate
• There is new legislation around ART Rx by nurses
• Nursing schools implementing mentoring programs
  focusing on HIV in pre- post-service our nurse
  mentors will be among the trainers

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Human Capacity Building ICAP-Nigeria

• Goal Increase human resource function and
  sustainability (task focused) work with State
  DOH staff

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CSM Outcome Oriented
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Cross Training

• Corps of State-based mentors identified by ICAP
  staff
• Intensive workshops held in each state
• Process emphasized and practiced moving from
  supervision to mentorship
• Next steps collaboratively developed
• Adding CSM process and cross training pieces to
  start-up and refresher trainings of clinic staff
  co-facilitation
• State/ICAP Co-mentoring visits
• Decreasing in frequency over time
• Step-down workshops to Clinic Managers/Leaders
• Intermittent intensives for State Corps
• State-wide workshops, CMEs, other conferences as
  above co-developed and co-facilitated by ICAP and
  State

15
Results

• Six state workshops held all six states have a
  plan for next steps
• Will be monitoring this process quantitatively
  and qualitatively

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Long Term Solutions

• Increasing the productive capacity of African
  medical schools
• In Botswana lt 10 of physicians are citizens 0
  citizen doctors in district clinics and primary
  hospitals Migration to private practice No
  clear attraction, development, remuneration,
  retention strategy
• New medical school founded in Botswana in 2006
• Important development, but it takes time!