The OSS training of Multi Disciplinary Teams at the health facility will:

1. M. Namaalwa1, S. Naikoba1, T. Kendle2, S. Kinoti3, L. Mpanga-Sebuyira1, K. Willis2, M. Weaver41. Infectious Diseases Institute, Kampala, Uganda; 2. Accordia Global Health Foundation, Washington, D.C. ; 3. University Research Company – Center for Health Services, Washington D.C.; 4. University of Washington; Introduction OSS Participation per Cadre (preliminary results) There is an inadequate healthcare workforce to effectively manage the disease burden in rural health facilities. As a result, mid level practitioners (MLP), i.e. clinical officers and nurses, have traditionally taken on the roles reserved for medical officers, such as managing patients on anti-retroviral therapy (ART), patients having malaria, tuberculosis and other infectious diseases. The MLP are inadequately prepared with the necessary skills and knowledge to perform these tasks. IDCAP offers an Integrated Management of Infectious Diseases training program to MLP and On-Site Support (OSS) to multidisciplinary teams. OSS Results Addressing health workforce crisis in rural health facilities through the Integrated Infectious Disease Capacity Building Evaluation (IDCAP) of midlevel health practitioners in Uganda The OSS package of activities were initiated sequentially over the first three visits. MDTs took place at OSS visits 1-6 B/O sessions took place from OSS visits 3-6. C&M include OSS visits 2-6 Objective Describe IDCAP’s onsite support services (OSS). Challenges Image 2: A breakout session following MDT with enrolled nurses and midwives and nursing assistants at an IDCAP intervention site. • Low staffing levels • Inadequate qualification of deployed staff • Inadequate infrastructure • Interruption of OSS activities • Implementing partners at study sites • Heavy workload at sites • Unforeseen district activities • Inadequate clinical equipment at intervention sites • Failure of site staff to comply with the scheduled visits • Inefficient supply chain management system • Overwhelming numbers of staff attending the sessions • IDCAP worked with district and health facility in-charges to identify staff responsible for the routine care of patients with HIV, tuberculosis, malaria and other infectious diseases. • Mobile teams comprising of a medical officer, clinical • officer, laboratory technologist and district maternal and • child health nurse visit sites once per month for two consecutive days. • Mobile teams were trained in the integrated management of infectious diseases, mentoring, and continuous quality improvement (CQI). • Multi disciplinary site teams at 18 Phase A sites are comprised of medical officers(n=11), clinical officers(n=54), registered nurses (n=53), enrolled nurses and midwives(n=97), lab personnel (n=46), nursing assistants(n=88), and others(n=82) (counselors, dispensers and medical records officers). • Breakout sessions curriculum target 3 groups: 1) clinical officers and registered nurses, 2) enrolled nurses, midwives, and nursing assistants, and 3) laboratory staff. • Selected MLP are offered mentoring, including clinical officers(n=44), registered nurses(n=38), enrolled nurses and midwives(n=27), and lab personnel(n=43) • Staff participating receive a certificate based on • attendance in OSS sessions: • Full attendance of two Integrated Management of Infectious Diseases course trainees at each site • 70% attendance for other clinic staff Method/Design IDCAP OSS Schedule Image 1: A nursing officer presenting a case during an MDT session at an IDCAP intervention site. About IDCAP Accordia’s IDCAP is a 3-year program funded by the Bill and Melinda Gates Foundation with the goal of evaluating the cost-effectiveness of building capacity among mid-level health practitioners in sub-Saharan Africa for the treatment and prevention of infectious diseases. IDCAP will measure the impact of a novel package of classroom training, distance learning, and on-site support services on individual competence, facility performance, and health outcomes in the surrounding communities. Accordia’s IDCAP Partners • The OSS training of Multi Disciplinary Teams at the health facility will: • Improve individual health professionals’ clinical • performance • Improve site performance • Improve patient health outcomes within the facilities’ populations • Ensure effective and cost effective care and integration of infectious diseases services. Hypotheses Lessons Learned • OSS activities: • Encourage team building and enable staff multi-tasking • Motivate and direct entire site team at every stage of patient care and management • Inculcate a spirit of consultation among peers and senior cadres • Facilitate hands on skills building • Enhances interest among lower cadres i.e enrolled nurses/midwives to engage in continuous profession development on site • Participation by cadre higher amongst lower cadres i.e enrolled nurses/midwives • Participation per activity higher in breakout sessions because of the short duration Session 927 Abstract Number: 2449