HARVARD-BHP ASSESSMENT

JOSE “RAFI” MORALES, MD, FACOGCHIEF MEDICAL OFFICER

Clinical Assessment for Systems Clinical Assessment for Systems Strengthening (ClASS) Strengthening (ClASS)

HRSA, HIV/AIDS BUREAU, GLOBAL HIV/AIDS PROGRAMJanuary 26, 2010

Entrance Meeting

Entrance Meeting

AGENDA

1. Introductions

2. Who is HRSA?

3. HRSA’s Role in PEPFAR

4. Assessment Overview

5. Today’s schedule

6. Questions and Answers

HHS/HRSA

Funding Flow

Funding Flow

Funding Flow

HRSA Global HIV/AIDS Portfolio

Grantee: No. of Countries No. of Sites Cum. No. of Individuals on ART

Est. FY09 Funding Level

Catholic Relief Services 10 187 192,400 $134.9 million

Harvard University 3 68 106,500 $58.8 million

Care and Treatment

Grantee: Function No. of Countries Est. FY09 Funding Level

University of Washington (I-TECH) • training • capacity building

14 $48.5 million

American International Health Alliance (Twinning Center)

• twinning partnerships• Mentoring/volunteering

11 $10.6 million

Columbia University (ICAP Nurse Capacity Initiative)

• nursing capacity building 3* $0.89 million

NY AIDS Institute (International HIVQUAL)

• quality improvement 8 $2.1 million

NPI Grantees (5 grantees) • local partner capacity development

5 $4.9 million

Capacity Building/Training

* Grantee newly awarded in April, 2009. The grantees projects to work in 6 countries.

HRSA Global HIV/AIDS ProgramTRACK 1.0 Care and Treatment

Catholic Relief Services

Works in 10 countries (187 sites)

Transition to Local Partners:Completed (FY2009):

South AfricaAnticipated (FY2010):

Rwanda Zambia

Harvard University

Works in 3 countries (68 sites)

Transition to Local Partners:Completed (FY2009):

NoneAnticipated (FY2010):

Botswana Nigeria

Clinical Assessment for Systems Strengthening (ClASS)

Harvard/BHP-PEPFAR AssessmentJanuary 25-February 5, 2010

Purpose

The purpose of the ClASS Harvard-BHP assessment is to conduct a comprehensive review of BHP’s organizational, programmatic, administrative & financial systems capacity to ensure readiness to become a directly funded USG partner.

The assessment methodology has been developed in collaboration with Harvard, BHP, and CDC/Botswana.

WEEK ONEWEEK ONE

HRSA LEAD Rafi Morales, HRSA

TRAINING REVIEWER

Anjali Sharma

REVIEW SUPPORT Christine Lim, HRSA

PROJECT OFFICER Rodrigo Boccanera, HRSA

ADMINISTRATIVE REVIEWER

N/A

FINANCIAL REVIEWER

N/A

Assessment Team

Date(s) Site/Organization Name Time

Mon. 1/25/10

Meeting with CDC/Botswana 8 AM

Meeting Harvard/BHP, MOH & Ministry of Local Government (MLG)

PM

Tues. 1/26/10 Deborah Retief Memorial Hospital and Lab, Morwa Clinic All day

Wed. 1/27/10

Drive to TsabongAll day

Werda ClinicThurs.

1/28/10 IDCC & Laboratory All day

Fri. 1/29/10

Middlepits Clinic AM

Bokspit Clinic and Strysendum Health Post PM

Assessment Schedule: Week One

Date(s) Site/Organization Name Time

Mon. 2/1/10

Meeting with CDC/Botswana AM

Princess Marina IDCC & Pharmacy AM

Meeting with BHP & MoH, and MLG PM

Tues. 2/2/10

BHP All day

Botswana-Harvard HIV Reference Lab PM

Wed. 2/3/10

BHP All day

M&E Unit PM

Thurs. 2/4/10

BHP All day

Tlokweng Clinic and Site Managers Meeting AM

Failure Management Workshop/Training PM

Fri. 2/5/10

Debrief meeting with CDC/Botswana AM

Debrief meeting with Harvard/BHP, MOH and MLG PM

Assessment Schedule: Week Two

Site Assessment Components

Entrance meeting: The assessments begin with an opportunity for the team to meet with the organization’s leadership, HIV clinical and laboratory Master Trainer Corps, and other key staff.

Facility tour (as appropriate): The team tours the facility to gain the perspective of the impact of clinical and laboratory training on quality of care and support to decentralization.

Information gathering: Team members conduct staff interviews and request follow up documents to clarify or confirm information ‐collected.

Exit Conference: At the end of the site visit, the team meets with the organization’s leadership to share findings of the assessment, including strengths and areas for improvement.

Assessment Components: Training

Support from: To Through

Core Clinical Master Trainers:Six physicians, two pharmacists, and four nurse-midwives

Site-level Master

Trainers

Assessment of site-specific training and support needs

Immediate on-site practical support Identification of site-level Physician and

Nurse Master Trainers On-site follow-up support Support and evaluation visit Telephone site support

Site-level Master Trainers

HCPs Initial and on-going trainings Direct supervision and support

Clinical Master Trainer/ARV Site Support Component (CMT): Goal: Further develop and expand a sustainable training capacity in clinical care and treatment of HIV/AIDS patients that provides on-going training and mentoring to ARV sites

Assessment Components: Training

Support from: To Through

Core Lab Master Trainers

Site Lab Master

Trainers

Assessment of site-specific needs Centralized training and mentoring in CD4,

Viral Load, Chemistry, Hematology, and other lab testing

On-going site support Periodic follow-up support and evaluation

visits Telephone site support

HCPs

Provide on-site training and mentoring in labs Evaluate Site Master Trainers in established

labs and Nurses for Rapid HIV Testing and Dry Blood Spot

Laboratory Master Trainer/ARV Site Support Program (LMT): Goal: Support the establishment of decentralized laboratories with CD4 and viral load testing capability by developing a sustainable training program in these tests at the local level.

Proposed Schedule

Staff Interviews

Executive Director Clinic Director Site Manager Core Master Trainers Physicians Nurses Pharmacy Staff Laboratory Staff Other relevant staff

On-Site Review

List of site Clinical and Laboratory Trainings Telephone logs: CMTs, LMTs Mentoring log Site support log Off-site and on-site training/re-training logs Other relevant documents

Questions & Answers