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Human Resource Sustainability in PEPFAR Programs: Presenting Options

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

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Human Resource Sustainability in PEPFAR Programs: Presenting Options

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  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

  2. 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 • BIPAI’s 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. ICAP’s Paradigm:Clinical 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

  6. Basic Principle This work is highly relational Plop-in strategies cannot work An integrated strategy is necessary

  7. 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 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 Qaukeni – Bizana & Flagstaff sub areas Population 400,000 5 doctors per 100,000 population

  10. 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

  11. 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

  12. Human Capacity Building: ICAP-Nigeria Goal: Increase human resource function and sustainability (task focused): work with State DOH staff

  13. CSM: Outcome Oriented

  14. 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

  16. Long Term Solutions: • Increasing the productive capacity of African medical schools • In Botswana: <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!

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