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

k. Standardization of HIV courses and training materials besides those offered as part of the IMAI program shouldbe encouraged. Although the IMAI/Comprehensive Course training is now standardized with anational curriculum, there is a wide range of non-IMAI HIV training courses offered by differentpartners, including training on C&T, PMTCT, and STI management. Uniformity in these othercourses should be encouraged, so that all training is consistent with the latest clinical informationand with national guidelines. There should be agreement on a core of basic information that allsuch training programs would include.l. Training is an ongoing activity that should be continually reinforced. Training does not conclude with takinga single comprehensive course but rather represents an ongoing activity. Instruction from theclinical mentor is one way for this activity to take place. Additional opportunities are through casediscussions and case presentations, such as those that may take place during multidisciplinaryteam meetings or catchment area meetings. In addition, those in the HC who have already beentrained should share their knowledge and experience with other HC staff to help promotediffusion of knowledge within the HC.3. Clinical Mentoring and Supervisiona. Although eventually the HIV care system should be self-sustainable, at present clinical mentors are still needed.The health care system cannot rely on mentors forever to support HIV care and treatment,especially given the overall shortage of physicians in E thiopia and the need for physicians in otherclinical capacities. However, during the critical phase of rapid scale-up and decentralization ofHIV care, the evaluation team does not believe that capacity exists at the local level for HIV careand treatment to be sustainable without the assistance of clinical mentors. Despite the initialcomprehensive training that health workers received, additional supervision and mentoring arerequired to gain greater familiarity and practical experience with how to apply knowledge learnedin the training and manage the many practical and sometimes complex issues related to ART andother HIV care.b. During the scale-up phase, the clinical mentoring system should be strengthened, with greater numbers of clinicalmentors, more resources, and decreased workloads. As noted, clinical mentors have a great number oftasks to accomplish, especially given the large number of sites they are responsible for overseeing.Not only does this mean that clinical mentors cannot adequately fulfill the tasks to which theyhave been assigned, but it also increases the risk of burnout and staff turnover. The fact that MSHis not able to pay salaries to clinical mentors that are competitive with other external funders is amajor challenge to the sustainability of clinical mentors. Not having sufficient numbers of clinicalmentors who can devote sufficient time at sites threatens the entire Health Network Model andthe ability to provide decentralized ART and HIV care at the HC level. During the phase of rapidART scale-up, the evaluation team recommends that additional mentors be hired and thatdiscussions be held with MSH to develop ways to pay clinical mentors more competitive salaries.Other measures to encourage retention and promote staff satisfaction are suggested below.c. The primary function of the clinical mentor should be mentoring and training. Clinical mentoring should focus onproblem-based clinical issues. The evaluation team found that clinical mentors are assignedresponsibilities including review of records and other supervisory activities. Although some ofthese may need to be performed by the mentor, their primary job should be observing, teaching,and mentoring clinicians (especially health officers and nurses) who are providing HIV/ ART careat the HC level. As indicated elsewhere, there are serious concerns about the skills of manyclinicians to provide this care, including the ability of local clinicians to identify and managecommon clinical problems. The clinical mentor is critical in this regard and needs to haveMid-term Evaluation of Ethiopia IMAI Program 48