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

clinical mentoring at the HC level. WHO and other guidelines related to clinical mentoring forHIV care and provision of ART will be very useful in this regard.b. Clinical mentors are stretched too thin, and the number of mentors is inadequate compared with need. Clinicalmentors have been assigned multiple responsibilities, and have large numbers of clinics to visitevery month in the performance of their duties. It is impossible for a single clinical mentor to doa quality job of addressing all his or her required responsibilities. Given limited time, mentors willneed to assign different priorities to these various tasks. In discussions with HCs, the singlebiggest concern about clinical mentors was that they did not spend enough time at each siteperforming their primary responsibility of clinical mentoring and training.c. Clinical mentors have been difficult to recruit and retain. Because of the overall shortage of physicians inE thiopia, especially those trained in HIV care, physicians who are potential candidates for theclinical mentor program are highly competitive and may also be recruited by private healthfacilities, NGOs, and other external funders. During the team’s meeting with MSH, the currentprocess for providing financial support to mentors was cited as a significant barrier in recruitmentand retention. Without the ability to be financially competitive, clinical mentors will continue tohave turnover, threatening the sustainability of this important component of the ART trainingand supervision process.d. Mentors need access to the latest information on HIV care and treatment. Knowledge about HIV care is arapidly changing and expanding field. Clinical mentors should have the latest information aboutHIV and ART, so they can share this knowledge with HCs. Having ongoing access to the latestknowledge is another way of increasing job satisfaction for clinical mentors who assume thischallenging position. In addition to IMAI, Comprehensive Course, and other classroom training,it is also important for clinical mentors to have ongoing practical clinical experience in managingHIV/AIDS patients.E. Availability of Resources and CommoditiesTo provide quality HIV care, HCs have many resource needs, including better access to drugs, test kits, labreagents, and other supplies; IMAI tools and educational materials; computers and communications equipment;and space.1. Shortage of drugs: At virtually every HC visited by the evaluation team, a shortage of drugs was citedas a significant concern. With support from PE PFAR and other funders, HCs are able to providefree ART to HIV-infected patients who need these drugs. These drugs are provided at ARTdesignatedpharmacies within the HC by trained pharmacy technicians. However, in terms of OIprophylaxis, only cotrimoxazole is covered for free in the ART pharmacy. Other drugs for OIprevention and treatment must be purchased from the general pharmacy (if available) or fromprivate pharmacies in the community. L ack of drugs for STI treatment is another concern. STIsnot only represent a significant health problem in their own right but increase the risk of bothacquiring and transmitting HIV, threatening to undermine HIV prevention efforts at thecommunity level.2. Test kits and lab reagents/supplies: A number of HCs also reported periodic shortages of HIV testkits and other laboratory reagents. The E thiopian protocol is for rapid testing to be done with onerapid test assay and results to be confirmed with a second. In the event of discrepant results onthe first two assays, a third assay (Uni-Gold Recombigen HIV) is used as a “tie breaker.”Although the number of times that the Uni-Gold assay is needed is fairly limited, some HCsMid-term Evaluation of Ethiopia IMAI Program 38