How can HIV professionals around How can HIV professionals around the World contribute to the World contribute to sustainable E2 sustainable E2 workwork??

IAS members’ point-of-view as captured in the E2 country consultation meeting held in

Uganda Nov 27-28th 2011

Dr. Mudiope Peter

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Need for sustainable E2 workNeed for sustainable E2 work

o Effectiveness and Efficiency (E2) in country programmes is vital to global efforts to continue to attract funding and leverage that funding to effectively respond to HIV/AIDS epidemic

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Why do IAS professionals need to Why do IAS professionals need to be involved in be involved in E2 work E2 work

On going discussion on E2On going discussion on E2

HIV professionals are HIV professionals are often left outoften left out

Front line HIV services Front line HIV services providersproviders

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3. Country pilot consultation in Uganda

2. IAS member survey on E2

1. Focus Group discussions with HIV professionals at IAS 2011 in Rome

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Where do we gain efficiency?Where do we gain efficiency?

o Greatest efficiency still lies in preventing HIV/AIDS (all 1o , 2o & 3o prevention) (Dr.Dr. Alex Coutinho, Executive Director, IDI)

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Where do we lose EWhere do we lose E22 o Regular stock-out of medicines including ARTo High rates of attrition from careo Low provider client ratio o Non affordability of laboratory monitoring of patients

in care

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Where do we lose EWhere do we lose E22 cont’ cont’o Low staff remuneration Vs work load leads to de-

motivation of staff

o Challenges of ownership- poor coordination of services provision

o Poor or lack of evidence based decisions

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Results –Online survey Results –Online survey Why lack of E2 in HIV programmes?Why lack of E2 in HIV programmes?Functionality of health systems,

Weak collaboration and engagement of partners,

Wrong priorities

Lack of resources

Others; stigma, laws/policies, loss to follow up & poor adherence04/22/23 8

Results –Results –Online survey Online survey Consultation by National programmeConsultation by National programme

50% of members had ever been consulted

Concern of the contribution not being taken seriously

Only 17% of members consulted had their input translated into concrete national plans

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ResultsResults ––Suggestions to improve E2Suggestions to improve E2Strengthen national health systems

Govt ownership

Team work

Evidence based implementation strategies-M&E

Increased funding

Transparency and accountability04/22/23 10

Results –Results –Country Pilot: suggested Country Pilot: suggested ways to achieve E2 @ inter/nationalways to achieve E2 @ inter/nationalCountry ownership

Equitable resource distribution

Strengthening of health systems

Others -Mutual accountability - Efficient & HRD logistical systems, -Sustainable funding04/22/23 11

Prevention of new infectionsMinimization of loss to follow up on ARTBetter staff remuneration and motivation, Task shiftingOperational researchIntegration of services

Results –Results –Country Pilot: suggested Country Pilot: suggested ways to achieve E2 @ Districtways to achieve E2 @ District

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Results –Results –FGD: Suggestions for E2 FGD: Suggestions for E2 improvement improvement

5 key themes; Structural and Systemic IssuesGovernance, leadership and strategic processAdministrative ProcessTechnical ProcessesClient factors

HIV professionals & other stakeholders are jointparticipants in defining, problem solving and implementing the E2 activities

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Suggested way forward at health Suggested way forward at health facility levelfacility levelo Rationalization of clinic appointments

o Task shifting

o Collaboration with other vertical programmes

o Rationalizing ART monitoring and holding decision support meetings that minimizes the reliance on the unaffordable viral load

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Suggested way forward at health Suggested way forward at health facility levelfacility level

o Reducing loss to follow upo Training health workers ?on job verses offsiteo Continued coordinated engagement and

strengthening of all stakeholders( health professionals, NGOs, MARPS, patients, media & communities)

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o HIV professional should be engaged to share best experiences

o Offer TA in relevant field of expertise to inform national HIV care programmes

o Research and Knowledge translation for evidence based policy

Suggested way forward- inter/national Suggested way forward- inter/national levellevel

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Suggested way forward- inter/ Suggested way forward- inter/ national level cont’national level cont’

o Continued coordinated engagement of all stakeholders( govts, HIV professionals, Donors, MARPS, patients, media & communities)

o Media support, for accurate evidence reporting to the public

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Thank you Thank you for listeningfor listening

Discussion!Discussion!

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