Preparing for the Future of HIV/AIDS in Africa A Shared Responsibility (2011) / Chapter Skim
Currently Skimming:
5 Strategies to Build Capacity for Prevention, Treatment, and Care of HIV/AIDS in Africa
5 Strategies to Build Capacity for Prevention, Treatment, and Care of HIV/AIDS in Africa
Pages 106-147
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 106... ...
They can accomplish this by employing appropriate staffing models to optimize impact and utilizing the capacity of local institutions. • The United States and other donor countries can play a role in building institutional and human resource capacity to prepare for the long-term burden of HIV/AIDS in Africa by supporting partnerships at all levels, as well as other capacity-building programs.
|
From page 107... ...
In addition to health workers being compensated insufficiently and asked to work under harsh conditions with few supplies and little support, an extreme imbalance exists in the distribution of credentialed health professionals among regions and countries (and by geographic location within the same country)
|
From page 108... ...
Any sustainable solution to Africa's health problems will require a stable cadre of medical officers, nurses, clinical officers,3 dentists, and allied health workers -- not only as clinicians, but also as teachers, managers, and leaders. A 2005 analysis of the human resource requirements of the U.S.
|
From page 109... ...
. The training of the necessary cadre of health workers, prepared and supported to confront their countries' health issues, is a key challenge that all African nations must face (SAMSS, 2010)
|
From page 110... ...
. STRATEGIES TO BUILD CAPACITY FOR PREVENTION, TREATMENT, AND CARE OF HIV/AIDS IN AFRICA Governments and nongovernmental organizations in the United States and other donor countries and within Africa can help build capacity for prevention, treatment, and care of HIV/AIDS in Africa.
|
From page 111... ...
Successful capacity building supports national health plans and health system development and is fundamentally based in and guided and led by host country partners -- particularly since government capacity is itself crucial to the future course of the African HIV/AIDS epidemic. Promising Strategies for Highly Affected Nations in Africa: Making the Most of Existing Capacities Governments and nongovernmental organizations within Africa can build additional capacity for prevention, treatment, and care of HIV/AIDS by making
|
From page 112... ...
This section highlights promising strategies that can be used to this end. These strategies fall into two broad categories: employing appropriate staffing models to optimize impact and utilizing the capacity of local institutions.
|
From page 113... ...
. The committee identified a number of strategies that could be implemented to achieve this goal: use of management and support staff, task sharing, harnessing of the informal health sector, use of modern information technology, analytic planning for the health workforce, and investment in women as health workers.
|
From page 114... ...
Task sharing Sharing of roles and responsibilities is not a new concept in the provision of health care; realignment of roles and responsibilities has been a long-standing response to changing health care needs, particularly in emergency situations or underserved areas.5 As a result of the HIV/AIDS crisis, the concept has reemerged with increased urgency. One term used to describe shared or realigned responsibilities is "task shifting." WHO defines task shifting as 5 In fact, what is sometimes understood as realignment of roles is actually formal recognition of the contributions of health workers that have previously been "invisible." For example, midwives were important providers of obstetrical services even before physician involvement in obstetrical care, but may now be seen as having "inherited" this responsibility from physicians as their roles have become more prominent.
|
From page 115... ...
. The delegation of the health care responsibilities of nurses, physicians, clinical officers, dentists, and other health professionals to others, including community health workers, has been effective in addressing the severe human resource shortages in many African countries (Buchan and Poz, 2003; Glenngård and Anell, 2003; Morris et al., 2009)
|
From page 116... ...
Depending on the type of degree and the specific country, the amount of training required can vary. For example, in South Africa it takes 4 years to train nursing or midwife students, 2 years to train pupil nurses, and 1 year to train pupil nursing auxiliaries (South African Nursing Council, 2010)
|
From page 117... ...
Where formal health care facilities are not easily accessed, this group of informal health workers is the first and most important point of call for people in search of health services (Omaswa, 2006)
|
From page 118... ...
Informal health workers are found in every health system, and the impact of their role increases as the strength of the formal sector weakens. Unlinked health care providers -- such as those providing home-based care, informal drug vendors, and traditional healers -- play important roles in some communities and deserve to be acknowledged, encouraged, and supported (Omaswa, 2006)
|
From page 119... ...
Additionally, the private sector and the academic and medical communities should be brought to the table. Begun in 2002 as a project to track the supply and deployment of Kenya's nursing workforce, the Kenya Health Workforce Information System (KHWIS)
|
From page 120... ...
. Investment in women as health workers Investing in the training and education of women as health workers can have both direct and indirect positive impacts on HIV/AIDS.
|
From page 121... ...
The capacity of these local resources -- including South−South partnerships and regional collaborations, African science academies, national public health institutes, and health resource partner institutions -- should be recognized and exploited. South−South partnerships and regional collaborations with universities and other training programs South−South partnerships and regional collaborations can be a highly effective model for diffusing successful practices.
|
From page 122... ...
. African science academies can therefore offer
|
From page 123... ...
played a timely and important role in informing South African policy. ASSAf published the report when the South African Ministry of Health was taking nonscientific positions.
|
From page 124... ...
NPHIs are particularly beneficial in low-resource countries, where they pro vide public health professionals with a group of technically oriented colleagues and a prestigious career path, helping to stem the tide of experts leaving government service for higher-paying jobs with international nongovernmental organizations. NPHIs in low-resource countries also encourage governments to set science-based public health priorities and policies, better integrate and leverage funds from numerous vertical programs, and plan strategically and systematically for future human resource and infrastructure needs (IANPHI, 2010; IOM, 2009)
|
From page 125... ...
At the regional level, networks of such groups already exist. For example, Equinet supports country networks of communitybased health care providers, while the African Health Systems Governance Network, created in 2009 and based at the African Center for Global Health and Social Transformation (ACHEST)
|
From page 126... ...
In 2007, for example, PEPFAR -- through CDC and Becton, Dickinson and Company (BD) , a leading global medical technology company with laboratory expertise -- launched a 5-year public−private partnership to improve overall laboratory systems and services in African countries severely affected by HIV/AIDS and TB (CDC, 2010)
|
From page 127... ...
With help from Pfizer and others, IDI has achieved the goal of building capacity in Africa for the delivery of sustainable, highquality prevention and care for HIV/AIDS and related infectious diseases through training and research. Since 2001, IDI has trained more than 3,500 health care providers from 27 African countries, currently providing care to approximately 10,000 patients, and has helped build research capacity in the region by pairing promising new investigators with established researchers from North America and Europe through mentoring arrangements and fellowships (Pfizer Inc., 2010)
|
From page 128... ...
With close to 80 percent of their patient populations being civilians, these military facilities are an important component of their respective national health care systems (U.S. Military HIV Research Program, 2010)
|
From page 129... ...
Linkages were established with local clinical experts, as well as with health training institutions and organizations. Relation ships with South African government health and social services agencies were strengthened (Stark, 2010; Stark et al., 2010)
|
From page 130... ...
7 broke ground for the establishment of large-scale twinning relationships aimed at building sustainable institutional and human resource capacity in nations with limited resources. AIHA was initially established by a consortium of major health care provider associations and professional medical education organizations to help the nations of the former Soviet Union build much-needed health system capacity (AIHA, 2010a)
|
From page 131... ...
10 I-TECH serves many countries in Africa, including Botswana, Ethiopia, Kenya, Malawi, Mo zambique, Namibia, Tanzania, South Africa, and Uganda. It receives funding from HRSA, USAID, the U.S.
|
From page 132... ...
132 PREPARING FOR THE FUTURE OF HIV/AIDS IN AFRICA TABLE 5-3 I-TECH's Principal Programs Program Activities Services Provided • I-TECH clinical mentors who help partners develop Health System Strengthening of Strengthening clinical care and goals and test new methods of care • Quality improvement programs to strengthen treatment systems systems of care • Electronic medical record systems Strengthening of • Training management systems health information • Remote clinical diagnostic systems systems • Up-to-date materials and supplies Strengthening of • Laboratory information systems laboratory systems • Training and support for new diagnostics • Services to strengthen educational institutions that Strengthening of training and coordinate, design, deliver, monitor, and evaluate education systems courses, degree programs, and workshops on infectious diseases • Collaborative programs with the ministry of health Health Workforce Health care worker Development education systems and ministry of education • Reform of educational degree programs • Integration of evidence-based information on infectious diseases into existing courses • Faculty development training Training development • Interactive training for diverse cadres of health care providers and educators • Multimedia resources • Distance learning for environments with limited Distance learning technology and low bandwidth • Learning opportunities that allow students to remain on the job • A venue for health care workers to practice Clinical mentoring hands-on skills with oversight by an experienced provider • Research designs and methods for resource-limited Operations Research Monitoring and and Evaluation evaluation settings • Operations research to inform every phase of programming, starting with assessments before an intervention begins
|
From page 133... ...
. Additional government capacity-building programs include the Humphrey Fellowship Program and the Fogarty Fellowship Program.
|
From page 134... ...
Among these benefits are increased program effectiveness and the opportunity to network and participate in the global health movement. Increased program effectiveness The accomplishments of I-TECH's HIV/ART Nurse Specialist (HANS)
|
From page 135... ...
. In 2008, the Consortium of Universities on Global Health created a formal alliance to build collaborations and foster the exchange of knowledge and experience among interdisciplinary university global health programs, working across education, research, and service (CUGH, 2010)
|
From page 136... ...
Financing WHO estimated that it would cost $254.8 billion in training and recurrent salary costs over 10 years to eliminate the global human resource gap (of 4.3 million health workers)
|
From page 137... ...
. Several twinning projects (including projects in Botswana, Zambia, and Ethiopia)
|
From page 138... ...
private companies, academic institutions, foundations, and civil society organizations, should establish national databases and information sys tems for health care worker statistics, as well as bolster the analytic capacity of national planners for determining human resource needs. • ecommendation 5-1b: African governments and institutions should R create staffing models to optimize the impact of the health care work
|
From page 139... ...
African govern ments and international donors should recognize, invest in, strengthen, and utilize currently existing capacity within African institutions and networks to provide local solutions for responding to the HIV/AIDS epidemic. This capacity includes South−South and regional partnerships, universities, African science academies, national public health institutes, and other net works within Africa.
|
From page 140... ...
• ecommendation 5-4b: Innovative North−South and South−South R partnerships that build human resources for health should be devel oped. In North−South partnerships, African counterparts should take the lead in developing and controlling the partnership agenda.
|
From page 141... ...
Washington, DC: Accordia Global Health Foundation. AIHA (American International Health Alliance)
|
From page 142... ...
2009. The impact of HIV scale-up on the role of nurses in South Africa: Time for a new approach.
|
From page 143... ...
Humphrey Fellowship Program. http://humphreyfellowship.org/page/97565/index.v3page;jsessionid=2nd 9knmmkdl00 (accessed August 13, 2010)
|
From page 144... ...
2006. Informal health workers -- To be encouraged or condemned?
|
From page 145... ...
Pretoria, South Africa: South African Department of Health. http://www.doh.gov.za/docs/misc/aids.pdf (accessed September 24, 2010)
|
From page 146... ...
2008b. Task force on human resources for health financing: Global health workforce alli ance.
|
From page 147... ...
http://www.who.int/eht/eHealthHCD/en/index.html (accessed August 5, 2010)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.