1. AIDS 2012 - Turning the Tide Together PEPFAR’s Efforts to Strengthen the Global HIV Healthcare Workforce Ambassador Eric Goosby, M.D. U.S. Global AIDS Coordinator, Department of State

2. Healthcare Worker Shortage & HIV Pandemic HIV Prevalence (UNAIDS, 2006) Health Worker : Population Ratio (World Health Organization, 2006)

3. PEPFAR I: 2003-2008 – Priority: Scaling-up HIV/AIDS treatment, care and prevention – Challenge: Not enough health care workers HIV training – Focus on in-service training to teach HIV skills to existing health workers, task shifting/task sharing HIV services, and some integration of HIV content into pre-service degree programs Task shifting – “Game changer” in scaling-up HIV treatment, care, and prevention – Support for WHO Task-shifting Guidelines The President’s Emergency Plan for AIDS Relief (PEPFAR)

4. Priority: Health Systems Strengthening – Country ownership and sustainability of HIV programs – Congressional mandate to train and support retention of 140,000 new health care workers, with an emphasis on doctors, nurses, and midwives – The Human Resources for Health 2009 inter-agency technical working group strategy involves: “Strengthening regulatory bodies and professional associations”, including nursing organizations World AIDS Day 2012 – Recognizing critical role of nurses and midwives to meet new targets: 6 million on ART 1.5 million pregnant women on ART 4.7 million voluntary medical male circumcision PEPFAR II (2009-2014)

5. Vision: Appropriate number and distribution of qualified health workers who meet the HIV and other health needs of the population Goals: Increase the Density of Health Workforce – Number – Cadres Balance Distribution of Health Workforce – Geographic location – Sector – Gender Improve Performance of Health Workforce – Quality – Efficiency PEPFAR’s HRH Strategy: Vision and Goals

6. Health Labor Market Dynamics Adapted from Marko Vujicic, World Bank 2009

7. PEPFAR’s Human Resources for Health Objectives 1. Strengthen pre-service education institutions 2. Ensure quality of in-service and pre-service training and practicing professionals 3. Support the development of new cadres and strengthen the community workforce 4.Improve health worker motivation and productivity and foster positive workplace environments 5.Investigate and apply recruitment and retention strategies 6. Improve HRIS and utilization of data for improved management and planning

8. New HCW Students Teachers and Effective Leadership Infrastructure Strengthen pre-service education institutions Objective 1 Source: ITECH

9. MEPI/NEPI East Africa: multi-country learning collaborative to strengthen regulatory bodies and professional associations Uganda & Tanzania: Evaluating country in-service HIV/AIDS training programs Global: twinning partnerships in ten countries in Africa and Russia. Ensure quality of in- service and pre-service training and practicing professionals Objective 2

10. Health Workforce Initiatives PEPFAR’s medical and nursing pre-service training initiatives: – Competitive awards to African institutions (MEPI) – Grants to specific countries to identify and support priority interventions to nursing institutions (NEPI) – Transformative Guidelines (WHO) and related activities Objectives of initiative - – Workforce capacity - numbers and quality – Education and training more relevant to country needs – Innovative education models – Research capacity (MEPI) – Evidence based policies and technical materials – Costs of effective strategies

11. Medical and Nursing Education Partnership Initiative PEPFAR initiative under the direction of the Office of the U.S. Global AIDS Coordinator PEPFAR Implementing agencies, U.S. Department of Health and Human Services, – Health Resources and Services Administration (HRSA), HIV/AIDS Bureau – National Institutes of Health (NIH), Fogarty Center – Coordinating Centers George Washington University, Wash DC Columbia University, NY Other partners (non-USG): – WHO – Transformative Guidelines – Policy and Technical – CHAI and USAID/Capacity Plus

12. Directory of Awards Medical Education Partnership Initiative (MEPI) and Nurse Education Partnership Initiative (NEPI) Botswana Ethiopia Ghana Kenya Lesotho (NEPI only) Malawi (MEPI/NEPI) Mozambique Nigeria South Africa Tanzania Uganda Zimbabwe Zambia (MEPI/NEPI)

13. PEPFAR/WHO Collaborative: Transformative Medical Nursing and Midwifery Education Guidelines Purpose: To support the new political and resource commitments by providing sound policy and technical guidance Apply to a wide range of providers and promotes the efficient use of providers through task shifting Promotes innovation: – interdisciplinary teams – Service networks Supports the decentralization of education and training with consideration to rural programs Builds on and promotes the use of existing WHO policies

14. WHO: Task-shifting guidelines Mozambique & South Africa: Development of new cadres GHWA: Community Health Workers study Global: Community Health Worker Program Assessment and Improvement Matrix (CHW AIM) Support the development of new cadres and strengthen the community workforce Objective 3

15. Four-year initiative to strengthen nursing and midwifery leadership and regulation in 17 sub-Saharan African countries Objectives – Ensure high quality practice standards – Ensure updated regulatory frameworks – Strengthen nursing and midwifery councils – Cultivate African nursing leadership Approach – Regional conferences – South-to-south collaboration – Regulation improvement grants – Targeted technical assistance – Evaluation science African Health Profession Regulatory Collaborative (ARC)

16. Zanzibar & Tanzania: Productivity & Work Climate Study Niger, Uganda, & Tanzania: HRH Collaboratives Swaziland & Uganda: Wellness Centers for health workers Rwanda : national performance - based incentive scheme Improve health worker motivation and productivity and foster positive workplace environments Figure 1. Uganda Productivity: Average Client Waiting Times in Kabuyanda Baseline and Follow-up Objective 4

17. WHO: Retention recommendations for increasing access to health workers in remote and rural areas Mozambique & Swaziland: Retention & Quality of Services study Tanzania: Recruiting health students from rural areas Global: Developing recommendations for measuring retention in PEPFAR countries Investigate and apply recruitment and retention strategies Objective 5

18. Global: Implementing iHRIS (open source software) in 14 countries Kenya: Public Health HR Information System and Workshop being expanded for use in other countries Uganda: Work with MOH & MOF on resource planning Global: HRM Rapid Assessment Tool & Curricula development From: “Zeroing In: AIDS Donors and Africa’s Health Workforce” – Oomman, Wendt, Droggitis. Center for Global Development. August 2010 Improve HRIS and utilization of data for improved management and planning Objective 6

19. Expanding the Evidence Base: Research & Innovation Tools – HRH Action Framework (http://www.capacityproject.org/framework/) – Rapid Discrete Choice Experiment (DCE) Tool – Employee Engagement Tool – TrainSMART Implementation Science – Impact of task-shifting on ART delivery (multi-country) – Effectiveness and attrition of providers in PEPFAR-funded health centers (Ethiopia) – Study on Success Factors for Management Capacity Building Sustainability – Impact of Task Shifting for ART Delivery on Patient and Process Outcomes in Uganda – Nurse-initiated and managed HIV Treatment in Policy, Education, and Practice in 17 African countries – Measuring the Impact of On-Site Mentorship on Nurse and Clinical Officer’s HIV and TB Care and Competencies – Descriptive Study of Nursing and Midwifery Practice and Education Regulation in East, Central, and Southern Africa

20. Considerations Going Forward An appropriate balance between ‘quantity and quality’. Multi-sectoral approaches, particularly between health and education sectors Long term, sustainable changes in areas of recruitment, education/training, and retention. The use of evidence-based information with demonstrated effectiveness in LMIC. Affordable in LMIC.

21. For further information, please visit: www.PEPFAR.gov www.facebook.com/PEPFAR http://twitter.com/USPEPFAR Thank You