Follow-up after training and supportive supervision

1
Follow-up after training and supportive
supervision

• The IMAI District Coordinator Course

2
Strengthening Health Systems

• District focus Fills gaps and complements
  existing training/modules for specialized
  doctors, higher resource settings for
  home-community
• Builds on and strengthens routine health services
• Focus on building a district system with
• Clinical teams
• Referral, back-referral improved communication

3
(No Transcript)
4
(No Transcript)
5
Individualised care for patients

• A Public Health approach facilitates broad
  coverage and enables the majority to access care
  and ART
• Some patients will develop complex problems and
  need specialist input to their clinical or
  psychosocial management
• Mentoring Specialists in apex or tertiary
  centres linked with district generalist
  clinicians
• Referral complex cases referred upwards for
  specialist care and management
• It is not either specialist services or a public
  health approach it is both together

6
The IMAI district coordinator courseAdministrati
ve and managerial tasks

• Planning for scale up
• Preparing the community
• Establishing collaboration with partners
• Planning capacity building
• Establishing distance communication for clinical
  team support
• Follow-up support and supervision after training
• Medicines, diagnostics and health supplies
• Patient monitoring
• Orienting and optimizing entry points
• Prevention acceleration

7
Preparation before training
Training

• Follow-up after training
• District/regional management-
• supportive supervision to sites
• clinical, drug supply management
• patient monitoring
• Clinical supervision
• Facility accreditation
• Health worker certification
• Team to team exchange
• Other QA methods

8
(No Transcript)
9
Patient Monitoring

• Supportive supervision
• Collection/aggregation of reports

10
National Office
Aggregate data
Regional Office
Aggregate data
District Coordinator
Hospital
Monthly report, cohort analysis
HC
HC
HC
11
(No Transcript)
12
Aim of Clinical Mentorship

• As part of emergency HIV care/ART scale-up,
  mentorship is aimed to
• Support decentralized delivery of HIV care, ART
  and prevention with quality of care at all levels
  
• Build capacity of primary-care providers to
  manage unfamiliar or complicated cases by
  consultation and on-site management where
  appropriate
• Promote and facilitate ongoing learning, skill
  development and quality promotion

13
(No Transcript)
14
(No Transcript)
15
Agreed minimum essential data elements What happens to the data Indicators or other aggregated data
Entry point Why eligible for ART Reasons for Substitution within first-line Switch/Substitution to or within second-line STOP ART Number and weeks of each ART treatment interruption Pregnancy status Start/stop dates of prophylaxis Cotrimoxazole Fluconazole INH TB treatment Adherence on ART Source II. HIV Care, III. ART Summary, IV. Patient Encounter and Family Status Transferred to pre-ART or ART register but used only by clinical team /district ART coordinatornot transferred to quarterly report or cohort analysis Indicators for patient and programme management at the facility/district level Distribution of entry points in patients enrolled in HIV care Why eligible for ART clinical only, CD4 or TLC Distribution of patients not yet on ART by clinical stage Distribution of reasons for substitute, switch, stop to investigate problems whether substitutions and switches are appropriate (use in context reviewing medical officer log) ART treatment interruptions Number/Percentage of patients Number weeks Percentage of pregnant patients linked with PMTCT interventions (or simply use to generate lists to assure linkage) Number on cotrimoxazole, fluconazole, INH prophylaxis at end of quarter (for ordering prophylaxis drugs) Number/Percentage of patients on both TB treatment and ART 3b. patients with good adherence to ART