Daniel Mwai, 1 Irene Mukui, 2 Arin Dutta, 1 Priya Iyer, 1

1. Training And Mentoring Clinical Health Workers In Kenya; Efficiency Gained from the Proposed Harmonized HIV Curriculum Daniel Mwai,1 Irene Mukui,2ArinDutta,1Priya Iyer,1 1Futures Group, 2 National AIDS & STI Control Program, Kenya dmwai@futuresgroup.com March 21st , 2013 The Second HIV Capacity Building Partners’ Summit, Birchwood Hotel and Conference Centre Johannesburg, South Africa

2. Overview • Introduction and research questions • Methodology • Results and discussion • Limitations and conclusion

3. Introduction and research questions

4. Introduction • Kenya have relied on off-site training model to train and nature its health workers for HIV response [1], over time. • The need for HIV training and mentoring for healthcare workers is in the rise, although resources for Hiv response are dwindling. • This calls for adoption and used most efficient and effective(E2) use of resources in HIV response. • Inline with National AIDS & STI Control Programmeand partners have proposed a new, harmonized HIV training curriculum. • For the curriculum to be adopted, an understanding of potential benefits was needed, to aid in identifying the efficient model.

5. Research Questions • What is the total efficiency gained when comparing the off-site components of the proposed harmonized curriculum and the current program? • What is the unit cost per person per day of different models for ongoing mentoring? • What is the impact of the different mentoring models on the number of missed patient encounters in the HCW’s home facility? • What is the most efficient model of ongoing mentoring ?

6. Methodology

7. Methodology • In the new training curriculum, HCWs are divided into clusters: clinical, pharmacy, laboratory, nutrition and counseling, and social work. • We focused on the clinical cluster (doctors, clinical officers, nurses). • Efficiency was defined in terms of the relative costs of the placement stage. • We calculated the direct costs of the off-site training component • For monitoring, we estimated time spent away from the HCW’s home facility using current program data for two models: • District Health Mentorship Training (DHMT) • Roving Clinicians Model (RCM)

8. Results and discussion

9. Efficiency of the Harmonized training Curriculum • Figure 2: GFATM Round 10 Proposal and Mukui, I., 2012. Estimates include cost of trainers, venue hire, stationery, per diem, and transport. • Figure 3:Source: Authors’ calculations. • The venue for placements hosts group learning and case discussions. • When RTC is a hospital, no venue hire costs are incurred; this reduces the cost per HCW by $11. • When accommodation is not required, the cost is reduced by $75 (see Figure 2). • Off-site training is more efficient under the harmonized curriculum • Evident by reduced number of off-site days • Low cost of offsite training. (see Figure 3)

10. Comparing of Two Ongoing Mentoring Models • Figure 4 compares the unit costs of the DHMT and RCM. • The RCM was less expensive than the DHMT, • Requires only one mentor for many trainees • Re-training cost is spread over more days. • Figure 5 compares the indirect costs. • We assumed mentors would provide services when not engaged in mentoring. • The RCM value would rise if clinicians were roving full time.

11. Limitations and conclusion

12. Limitations • Limitations of this analysis include the • Lack of a measure of training or mentoring quality • The use of data from pilot designs.

13. Conclusion • The DHMT model provides the best balance of lower cost and less disruption to the health system for ongoing mentoring. • The new harmonized training curriculum and skills-building strategy represent a cost-efficient choice for the Kenyan HIV program.