Mid-<strong>term</strong> Evaluation <strong>of</strong> Ethiopia IMAI Programiv
EXECUTIVE SUMMARYThis assessment represented a <strong>mid</strong>-<strong>term</strong> project <strong>evaluation</strong> <strong>of</strong> <strong>the</strong> Integrated Management <strong>of</strong>Adolescent and Adult Illness (IMAI) Project, which has been implemented in nine regions and twocity administrations <strong>of</strong> E thiopia since 2005. The IMAI Project has <strong>the</strong> overall goal <strong>of</strong> reducing <strong>the</strong>transmission and impact <strong>of</strong> HIV/ AIDS by streng<strong>the</strong>ning treatment and care services, with <strong>the</strong>objective <strong>of</strong> utilizing IMAI to build <strong>the</strong> capacity for decentralized antiretroviral <strong>the</strong>rapy (ART)services, including chronic disease management, within <strong>the</strong> ART network. The overall objective <strong>of</strong>this <strong>evaluation</strong> was to evaluate IMAI implementation (including successes and challenges) and <strong>the</strong>contribution <strong>of</strong> IMAI to <strong>the</strong> efficiency <strong>of</strong> HIV/ AIDS clinical teams at <strong>the</strong> health center (HC) level.Based on <strong>the</strong> Scope <strong>of</strong> Work, review <strong>of</strong> key background documents, initial discussions with staff <strong>of</strong><strong>the</strong> U.S. Agency for International Development (USAID), and priorities articulated during <strong>the</strong>sediscussions, <strong>the</strong> team focused on seven primary areas related to IMAI at <strong>the</strong> HC level:• Integration <strong>of</strong> services within HCs, including integration <strong>of</strong> HIV prevention and care witho<strong>the</strong>r clinical services, such as tuberculosis (TB) care, sexually transmitted infection (STI)care, and care for pregnant women• The Health Network Model, focusing on <strong>the</strong> establishment <strong>of</strong> effective linkages with highermedical levels (particularly local hospitals) and <strong>the</strong> community (home care, outreach, ando<strong>the</strong>r activities)• Training, including <strong>the</strong> most recent National Comprehensive HIV Care and TreatmentCourse, previous IMAI training, and o<strong>the</strong>r HIV-related training• Supportive supervision and mentoring, with a particular focus on <strong>the</strong> roles and contributions<strong>of</strong> <strong>the</strong> clinical mentors working with specific HCs and HIV care staff• Staffing and provision <strong>of</strong> decentralized care, including issues related to task shifting, andhuman resource issues imposed by attrition and o<strong>the</strong>r challenges• Data management, including <strong>the</strong> ability <strong>of</strong> <strong>the</strong> HCs to collect, analyze, and evaluate relevantdata for monitoring and <strong>evaluation</strong> purposes• Overall quality <strong>of</strong> HIV/ ART care at <strong>the</strong> HC level, with an assessment <strong>of</strong> both benefits andchallenges related to <strong>the</strong> IMAI Project and recommendations for improvementAs part <strong>of</strong> this assessment, <strong>the</strong> team visited 20 HCs throughout E thiopia selected by USAID andlocated in <strong>the</strong> Amhara, Harari, Oromia, and Tigray regions, <strong>the</strong> Sou<strong>the</strong>rn Nations and NationalitiesPeoples Region, and <strong>the</strong> city administrations <strong>of</strong> Addis Ababa and Dire Dawa. Several structuredsurvey instruments were developed to collect both quantitative and qualitative data. Theseinstruments collected information on HIV services <strong>of</strong>fered after IMAI was introduced; <strong>the</strong> level <strong>of</strong>integration <strong>of</strong> HIV services within <strong>the</strong> HC; linkages with <strong>the</strong> referral hospital and <strong>the</strong> community;mechanisms <strong>of</strong> supportive supervision and mentoring; essential laboratory tests; <strong>the</strong> number <strong>of</strong> stafftrained in IMAI (previous and current training versions); <strong>the</strong> attrition rate at each health facilityamong those trained; <strong>the</strong> number <strong>of</strong> clients seen for counseling and testing, prevention <strong>of</strong> mo<strong>the</strong>rto-childtransmission (PMTCT), HIV care, and receipt <strong>of</strong> ART; outcomes <strong>of</strong> patients on ART,including loss to follow-up; and organization and utilization <strong>of</strong> <strong>the</strong> monitoring system. Observationswere made <strong>of</strong> clinical management <strong>of</strong> HIV patients at each HC in order to help assess <strong>the</strong> quality <strong>of</strong>HIV/ AIDS treatment services. Finally, a focused group discussion among those trained in IMAIasked participants for <strong>the</strong>ir opinion and understanding <strong>of</strong> <strong>the</strong> IMAI approach; <strong>the</strong>ir <strong>evaluation</strong> <strong>of</strong> <strong>the</strong>Mid-<strong>term</strong> Evaluation <strong>of</strong> Ethiopia IMAI Program 1
Change language