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. Clinical team may include nurse and ART Aid at first-level and doctor at second-level Regional Referral Hospital Second-level health workers District Hospital District Hospital District Hospital Health Centre Health Centre Health Centre Health Centre Health Centre Health Centre Health Centre Health Centre Health Centre First-level health workers

4. National, Regional and District ART Management Drugs, diagnostics, commodities, logistics support

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 course:Administrative 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. Community/PLHA/stakeholder/other programme involvement Setting targets and choice of sites for HIV Care/ART IMAI Training by cadre and team On-site visits after training Mentorship Team to team support Choose clinical teams, plan training by cadres Orient and optimize entry points Preparation IMAI training Prevention acceleration Logistics: maintaining the supply of drugs, diagnostics, equipment Establish good communication for clinical team support Patient monitoring system: registers, reports, data use Evaluation

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

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. Regional Referral Hospital Regular mentoring visits provided by experienced clinicians at the regional level Basic administrative subunit: the district Health Centre Regular supportive supervision provided by the existing district management team (e.g. district medical officer, district matron) District Hospital External mentors (e.g. expatriate) paired with local mentors on initial visits if sufficient expertise does not exist at regional level Health Centre Health Centre

14. Sequence of steps in the clinical mentoring visit Observe case management and reinforce skills Review patient monitoring system Clinical case review Clinical team meeting Document the visit