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Integration of HIV services: Lessons Learned from HIV/AIDS Program
Sustainability Analysis Tool (HAPSAT)
Itamar Katz PhD, MPhilAbt Associates, Health Systems 20/20, Bethesda, United
States
Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
Background
Substantial HIV funding Frequently weak health systems Health workers, systems and structures dedicated solely HIV Rapid scale-up
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Issues
Separation of HIV services from those of sexual and reproductive health, antenatal care and maternal and child health
Expensive health information, supply management systems
Underutilized health workers
3Steven John
HAPSAT
HAPSAT is an HIV/AIDS Program Sustainability Analysis Tool
Provides recommendations on enhancing the sustainability of the HIV responses
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Questions HAPSAT addresses
Sustainability of HIV programs in limited-resource settings:
What should be prioritized?
How should additional resources be mobilized?
What efficiency measures should be applied?
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Average time for ART and HCT services per patient per year
Assumption: additional 40% of patient visit time for time spent beyond face-to-face visit (e.g. record review), based on interviews
Source: Wong, Katz et al, 2012
Standard FTE patient load for ART and HCT services
Service Delivery type Work day hours Patient coverage per year
ART
MD/HO-led with Nurse team
6 hours 1,000 patients (MD/HO and Nurse)*Nurse with leftover time, equal to 371 ART patients
4 hours 667 patients (MD/HO and Nurse)*Nurse with leftover time, equal to 371 ART patients
Nurse-led6 hours 623 patients (Nurse)
4 hours 416 patients (Nurse)
HCTSeen by one HW
6 hours 3,408 patients
4 hours 2,272 patients
Calculate labor imbalances by comparing table with actual FTE patient loads
Source: Wong, Katz et al, 2012
Governance
Integration should be considered where efficiency gains can be achieved, as long as the quality of services maintained or improved Frequently dependent on the governance of the programs
Steven John
Integration of social services
Much of behavioral prevention and support for PLHIV and OVC through donor-funded NGOs
In Guyana, several NGOs have had to cease providing HIV services
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Sustaining NGO’s HIV interventions
Government funding of NGOs Innovative funding mechanisms
(fundraising, sponsorships, becoming for-profit)
Integration into public social services: Integrate NGO work Might not reach
marginal populations Integrate into curriculums: work safety,
teachers, health workers, etc.
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Lessons learned
Integration should be promoted where efficiency gains can be achieved, as long as the quality of services maintained or improved
Integration should be applied on both medical and social HIV services
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Email:[email protected][email protected]
Visit:www.hs2020.org/hapsat: Country reports, the tool and document on target setting
Thank you
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