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

community outreach services (including computers and telephone lines); data report forms that arenot aligned with register forms; lack of continuous clinical mentoring and supportive supervision;lack of coverage for patient needs such as nutritional and adherence support, social problems, andtransportation; poor infrastructure; inability to ensure confidentiality (for example, because ofinadequate space), which promotes stigma and discrimination; low pay for staff; and HIV/ AIDSrelatedservices that are not prioritized at local and higher levels.3. Suggestions for sustainability of the program:Group respondents made a number of suggestions and recommendations to help facilitatesustainability of the IMAI program. These included the following:• IMAI requires involvement and commitment from all policy and decision makers, includingheads of concerned bodies, managers and all technical staff. RHBs and Zonal/ Woreda HealthOffices should give priority to adopting the IMAI approach to the health system in terms ofplanning, supervision, and budget allocation, so that there is a greater sense of ownership andinvestment.• Trained staff need to transfer their knowledge and skills and share their experience with otherstaff after the training.• Gaps in staff due to high turnover need to be filled.• The selection criteria of staff to be trained from the RHBs should be revised and made morestrict, in order to help reduce turnover of trained staff.• E ffective use of the IMAI guidelines, tools, and standard operation procedures at health facilitiesshould be encouraged. There should be continuous and efficient distribution of updatedguidelines and tools during and after the training programs.• Continuous mentoring and regular supervision at HCs should be increased, by integratingmentoring and supervision in the RHBs and by allocating additional mentors. Internalmentorship should be incorporated into the system.• Donors and funding agencies should support training of more health care providers. Donorsshould also design an exit strategy to allow the HIV care system to become more selfsustainable.• Necessary supplies and commodities need to be available to HCs.• All staff should be trained, and the IMAI approach should be incorporated into in-servicetrainings. More refresher training should be offered for already trained staff, and more trainingshould be offered to the untrained at different levels, including the woreda and facility levels.IMAI training should be introduced at the secondary and health post levels• In the future, when provision of ART becomes more consolidated, HIV treatment should beintegrated with other clinical care services at the HC.Mid-term Evaluation of Ethiopia IMAI Program 30