Objective 4: Improved human and laboratory resources (Health Systems Strengthening)

Target populations

Indicators

Expected Results

HIV positive and other Health System users.

4.1 Fields in which health, education, and psycho- social health service professionals can access in‐service HIV training through a recognised regional body (# by sector).

By 2014, regionally recognised HIV in‐service training will exist in 6 or more fields with at least one in each of three sectors (illustrative;
to be reviewed based on 2009 CHART offerings)

4.2 Countries with strengthened MARP and PLH groups active in delivery of HIV services and advocacy.

Trained leaders and managers will be encouraging participation by MARP and PLH organisations in planning, delivery, and oversight of HIV services in 10 countries by 2014 (illustrative).

4.3 Countries that have reached targeted proficiency level in lab work.

By 2014, 10 countries will
have at least 60% of laboratories taking corrective actions in response to semi‐annual proficiency testing (illustrative).

Overview of Approach: Health system strengthening (HHS) is a looming need in the Caribbean, closely linked to the needs of the HIV response and potentially involving regional components, for which institutional underpinnings are not yet in place. The development of the Caribbean Public Health Agency (CARPHA), over the next few years may provide an appropriate framework. Meanwhile, this project has identified two areas in which modest efforts can leverage significant effects.

Better human and laboratory resources are important for improving country‐level HIV programmes as well as for strengthening Caribbean health systems. Both are amenable to a regional approach, and regional entities exist that are prepared to carry them out. The two areas selected for strengthening under this grant are:
1) improved access to in‐service training for health service workforce; and
2) better assured access to reliable and affordable public health and medical laboratory services, both in‐country and regional.

Each of these resources will improve health system performance both for HIV patients and for many others. Under two Health Service Strengthening SDAs, the project will foster establishment of standards and quality assurance systems, promote competency based, harmonised training options, and encourage the advent of accreditation/certification for institutions and for practitioners. It will take advantage of two existing frameworks: that of the in‐service HIV training programmes for health workers at the University of the West Indies (UWI) and that of the network of certified med labs around the region that serve HIV programmes among others, facilitating the integration of HIV lab services into basic health care.
The programmes at existing Caribbean HIV AIDS Regional Training Network (CHART), built up during the Round 3 grant by the University of the West Indies and its collaborators will be strengthened in response to regional needs assessments now underway. Under this intervention, some 12,750 health workers of different levels and specialties will receive in‐service training in areas prioritised through that needs assessment.

UWI capacity for leadership and management training will be focused on HIV‐related health and non‐health programmes, especially those representing or working with key vulnerable groups. Some 875 programme leaders will be trained. Higher level management and leadership needs in the region will be addressed by providing partial support to the new Doctorate of Public Health programme at UWI, which will contribute a score of graduates to the region’s health programmes in the last three years of the project. Additional benefits will accrue from the real‐world problem solving in which the doctoral students and their mentors will engage, focusing often on problems identified in the leadership courses. A dozen consulting/problem solving studies will be done yearly as hands‐on learning opportunities that also yield professional level consulting results under the tutelage of the lead professors.

The process established to strengthen regional medical and public health labs by the 2002‐2007 CAREC/EU project will be extended and will serve as a best practice model. It will be carried out by the Caribbean Med Labs Foundation (CMLF), created expressly to continue the work of that project, endorsed by the region’s Ministers of Health, and staffed by the technical and administrative leaders of the EU project. This will be done in partnership with the Caribbean Cytometry and Analytical Society (CCAS), the leading professional society in the field. Emphasis will be on provision of services needed by patients with HIV, focusing on the availability not only of HIV‐specific tests but also of more generally used procedures, like routine blood work (but without which HIV patients could not be properly attended).

By 2014, all 16 countries will have cost‐effective access to timely quality assured lab services at all service levels, both in country and regionally for advanced services. National networks integral to the functioning of the regional network will be established and operational in at least 12 of 16 countries, with appropriate quality assurance and monitoring systems. A total of 50% of the regional and national network labs will be accredited.

A tradition of proficiency testing and other quality assurance measures will be established.

Involvement of PLH and MARP representatives in programme design, implementation, and evaluation will be a crosscutting element in both these HSS interventions, as will the creation and support of skills that permit task shifting.

SDA 4.1 Health Workforce/Human Resources

Activity

Expected Results

4.1.1 Improve access to quality in‐service training for health, education, and psychosocial service workers and volunteers to provide better HIV services to all key vulnerable groups and to support task shifting.

80% of NAPS report adequate access to certified in‐service HIV training for personnel in at least two areas

4.1.2 Build leadership and management skills of NAP coordinators, health service staff, and HIV focal points in health and non‐health ministries, to increase access by vulnerable populations to comprehensive HIV services. [UWI, CCNAPC, EDC]

Competency based programme validated; over 800 leaders trained from 14 countries, with emphasis on evidence based decision making and reaching key vulnerable populations.

SDA 4.2 Service Delivery
[Building on start made under 2002‐2007 CAREC/EU regional laboratory strengthening project, laboratory service delivery will be further enhanced in ways relevant to HIV diagnosis, prevention, treatment, and care, as well as to other health areas. This will improve quality and sustainability of national health system lab services, access to accreditation, and reference laboratory services, as well as blood supply]

Activity

Expected Results

4.2.1 Improve access by countries to high quality, reliable, affordable lab services relevant to HIV, STI, OI, and TB management, including diagnosis, care, monitoring and treatment. [CMLF, CCAS]

Regional proficiency testing programme established to provide at least 2 challenges per year for all 7 regional reference node labs and national network labs for HIV/STI/OI and monitoring of patients on treatment.

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