1. Training And Mentoring Clinical Health Workers In Kenya; Efficiency Gained from the Proposed Harmonized HIV Curriculum Daniel Mwai, 1 Irene Mukui, 2 Arin Dutta, 1 Priya Iyer, 1 1 Futures Group, 2 National AIDS & STI Control Program, Kenya dmwai@futuresgroup.com March 21 st, 2013 The Second HIV Capacity Building Partners’ Summit, Birchwood Hotel and Conference Centre Johannesburg, South Africa

2. 1.Introduction and research questions 2. Methodology 3. Results and discussion 4. Limitations and conclusion Overview

3. Introduction and research questions

4.  Kenya have relied on off-site training model to train and nature its health workers for HIV response [1], over time.  The need for HIV training and mentoring for healthcare workers is in the rise, although resources for Hiv response are dwindling.  This calls for adoption and used most efficient and effective(E2) use of resources in HIV response.  Inline with National AIDS & STI Control Programme and partners have proposed a new, harmonized HIV training curriculum.  For the curriculum to be adopted, an understanding of potential benefits was needed, to aid in identifying the efficient model. Introduction

5.  What is the total efficiency gained when comparing the off-site components of the proposed harmonized curriculum and the current program?  What is the unit cost per person per day of different models for ongoing mentoring?  What is the impact of the different mentoring models on the number of missed patient encounters in the HCW’s home facility?  What is the most efficient model of ongoing mentoring ? Research Questions

6. Methodology

7.  In the new training curriculum, HCWs are divided into clusters: clinical, pharmacy, laboratory, nutrition and counseling, and social work.  We focused on the clinical cluster (doctors, clinical officers, nurses).  Efficiency was defined in terms of the relative costs of the placement stage.  We calculated the direct costs of the off-site training component  For monitoring, we estimated time spent away from the HCW’s home facility using current program data for two models:  District Health Mentorship Training (DHMT)  Roving Clinicians Model (RCM) Methodology

8. Results and discussion

9. Figure 2: GFATM Round 10 Proposal and Mukui, I., 2012. Estimates include cost of trainers, venue hire, stationery, per diem, and transport. Figure 3:Source: Authors’ calculations. Efficiency of the Harmonized training Curriculum  The venue for placements hosts group learning and case discussions.  When RTC is a hospital, no venue hire costs are incurred; this reduces the cost per HCW by $11.  When accommodation is not required, the cost is reduced by $75 (see Figure 2).  Off-site training is more efficient under the harmonized curriculum  Evident by reduced number of off-site days  Low cost of offsite training. (see Figure 3)

10. Comparing of Two Ongoing Mentoring Models  Figure 4 compares the unit costs of the DHMT and RCM.  The RCM was less expensive than the DHMT,  Requires only one mentor for many trainees  Re-training cost is spread over more days.  Figure 5 compares the indirect costs.  We assumed mentors would provide services when not engaged in mentoring.  The RCM value would rise if clinicians were roving full time.

11. Limitations and conclusion

12.  Limitations of this analysis include the  Lack of a measure of training or mentoring quality  The use of data from pilot designs. Limitations

13.  The DHMT model provides the best balance of lower cost and less disruption to the health system for ongoing mentoring.  The new harmonized training curriculum and skills-building strategy represent a cost-efficient choice for the Kenyan HIV program. Conclusion

14. www.healthpolicyproject.com Thank You! The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is implemented by Futures Group, in collaboration with CEDPA (CEDPA is now a part of Plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).