usaid/ethiopia pepfar mid-term evaluation of the ... - GH Tech

performance at clinics where PMTCT is provided; (4) visit and review performance at TB clinics (forTB-HIV integration); (5) visit and review performance at VCT sites; (6) review intake forms andselect three to five to see if they are filled out properly; (7) conduct case reviews for staff meetings;(8) review registers to see if they are copied correctly and have necessary information; and (9)conduct multidisciplinary team meetings. In addition to these multiple tasks, the mentor indicatedthat he was responsible for covering nine HCs providing ART, as well as four others providingPMTCT and eight others providing TB-HIV services, with visits to each of these sites typically forhalf day per month. Given the need for travel time to different sites, this mentor had a very busyschedule. This mentor’s schedule and multiple responsibilities were very typical. The evaluation teamwas also told that at some HCs the clinical mentors were providing ART treatment services directlyto patients rather than mentoring other staff working at the HC to provide this care. The team wasalso told that there was quite a high turnover of mentors, due to factors including burnout andavailability of other job opportunities. The number of mentors was felt to be inadequate comparedwith the overall need.Supportive supervision to HIV/ ART services was implemented by the Regional/ Zonal/ WoredaHealth Offices and partners (WHO, MSH, ICAP, the Rational Pharmaceutical Management Plusproject) to provide technical and management support on a planned and regular basis. However, insome HCs this supervision was not regular and the frequency was variable (quarterly in somelocations and biannually in the rest). The supervisory team often had other full-time duties, and theteam composition was not consistent in every HC. In some regions, many of the managers originallytrained in the district coordinator’s course were no longer there.In group discussions, all HCs stressed the importance of clinical mentoring and supportivesupervision, and recommended that there be stronger and more regular supervision and mentoring.Staff generally valued the clinical mentor and typically were in favor of more frequent mentoring (atleast twice a month). Some staff wanted mentoring to be supplemented by more case reviews, casebaseddiscussions, and more teaching/training on the latest information concerning HIV/ ART.Some sites mentioned that the catchment area meetings should include more discussion of clinicalissues as well as administrative ones. Pharmacists and pharmacy technicians felt that they were notreceiving sufficient mentoring and supervision, and requested the need and desire for morementoring and supervision by those experienced in this area.G. Impressions of IMAI and Barriers to Care from Group DiscussionsResponses in the group discussions among those who were part of the HIV care team included thefollowing:1. Strengths of IMAI approach:IMAI was considered by HC staff to be a very useful approach to decentralize HIV/ AIDSprevention, care, and treatment to lower-level health facilities and to enhance task shifting fromphysicians to health officers and nurses. Staff felt that it helped build the capacity and confidence ofmid-level health care providers to provide HIV comprehensive services. As for some of itsstrengths, IMAI was seen as:• Providing a vital approach toward integrating HIV/ AIDS services• Facilitating linkages between different services• Simplifying the clinical management of patientsMid-term Evaluation of Ethiopia IMAI Program 28