Transcript Transition Assessment

Clinical Assessment for Systems
Strengthening (ClASS)
HARVARD-BHP ASSESSMENT
Briefing Meeting with Ministry of Health, Ministry of Local
Government, and Harvard-BHP
JOSE “RAFI” MORALES, MD, FACOG
CHIEF MEDICAL OFFICER
January 25, 2010
HRSA, HIV/AIDS BUREAU, GLOBAL HIV/AIDS PROGRAM
Briefing Meeting with
MoH, MLG, Harvard-BHP
AGENDA
1.
2.
3.
4.
Introductions
HRSA’s Role in PEPFAR
ClASS Harvard-BHP Assessment Overview
Discussion
HRSA International HIV/AIDS Portfolio
Care and Treatment
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
No. of Countries
Est. FY09 Funding
Level
Capacity Building/Training
Grantee:
Function
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
* Grantee newly awarded in April, 2009. The grantees projects to work in 6 countries.
HRSA Global HIV/AIDS Program
TRACK 1.0 Care and Treatment
Catholic Relief Services

Works in 10 countries
(187 sites)
Transition to Local Partners:
Completed (FY2009):
 South Africa
Anticipated (FY2010):
 Rwanda
 Zambia
Harvard University

Works in 3 countries
(68 sites)
Transition to Local Partners:
Completed (FY2009):
 None
Anticipated (FY2010):
 Botswana
 Nigeria
Purpose



To provide HRSA with an approach to assess the administrative,
programmatic, and financial capacity of USG-supported
HIV/AIDS programs;
To inform HRSA and relevant partners of existing technical
assistance needs, identify available resources to address these
needs, and enable technical and organizational strengthening at
the international partner, local partner, and clinic site levels.
To facilitate a process for HRSA and relevant partners to
determine readiness and ensure a successful and sustainable
transition of programs to local leadership.
Guiding Principles
High quality services to people infected and
affected with HIV/AIDS
 Systems strengthening through local
capacity development; and
 Increased country ownership through
transition of programs to local leadership

Objectives






Assess the quality of services and care provided to patients;
Ensure that organizational systems, policies, and
procedures are in place to accomplish program goals and
objectives;
Assess the organization’s capacity to provide the funded
services and manage funding;
Identify program strengths and weaknesses and provide
appropriate consultation to enhance their capacity to provide
high quality, cost competitive health care and services;
Specify areas of system strengthening to enable
organizations to sustain their HIV service delivery; and
Identify model programs or program components that can
be replicated in other communities or organizations.
ClASS Harvard/BHP-PEPFAR Assessment
January 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.
Assessment Team
WEEK ONE
WEEK TWO
HRSA LEAD
Rafi Morales, HRSA
Rafi Morales, HRSA
TRAINING
REVIEWER
Anjali Sharma
Anjali Sharma
REVIEW SUPPORT
Christine Lim, HRSA
Philippe Chiliade, HRSA
Christine Lim, HRSA
PROJECT OFFICER
Rodrigo Boccanera, HRSA
Rodrigo Boccanera/HRSA
ADMINISTRATIVE
REVIEWER
N/A
Cheryl Nesbitt
(Team Leader)
FINANCIAL
REVIEWER
N/A
Juanita Farrow
Assessment Schedule: Week One
Date(s)
Sun.
1/24/10
Mon.
1/25/10
Tues.
1/26/10
Wed.
1/27/10
Thurs.
1/28/10
Site/Organization Name
1st HRSA team arrives
Meeting with CDC/Botswana
Meeting Harvard/BHP, MOH & Ministry of Local Government (MLG)
Deborah Retief Memorial Hospital and Lab, Morwa Clinic
Drive to Tsabong
Werda Clinic
IDCC & Laboratory
Time
12:40 PM
8 AM
PM
All day
All day
All day
Fri.
1/29/10
Middlepits Clinic
AM
Bokspit Clinic and Strysendum Health Post
PM
Sat.
1/30/10
Drive to Gaborone
2nd HRSA team/consultant group arrives
All day
TBD
Assessment Schedule: Week Two
Date(s)
Sun.
1/31/10
Mon.
2/1/10
Site/Organization Name
Mokolodi Game Drive , Braai, and Traditional Dance
PM
Meeting with CDC/Botswana
Princess Marina IDCC & Pharmacy
AM
AM
Meeting with BHP & MoH, and MLG
PM
Tues.
2/2/10
BHP
Wed.
2/3/10
BHP
Botswana-Harvard HIV Reference Lab
M&E Unit
BHP
Thurs.
2/4/10
Fri.
2/5/10
Time
All day
PM
All day
PM
All day
Tlokweng Clinic and Site Managers Meeting
AM
Failure Management Workshop/Training
PM
Debrief meeting with CDC/Botswana
AM
Debrief meeting with Harvard/BHP, MOH and MLG
PM
Assessment Components

Briefing and Debriefing meetings (1/25, 2/1, 2/5)





CDC/Botswana
Harvard-BHP
Ministry of Health
Ministry of Local Government
Site and Partner Assessments




Entrance meeting
Facility tour
Information Gathering
 Staff interviews
 Document review
Exit conference
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. This session allows the site to provide an
overview of their history, services provided, and accomplishments achieved,
as well as present any challenges currently being faced.
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.
Debrief Meeting: The site visit team meets with staff from partner
organizations at the completion of all site and/or partner assessments to
discuss cross‐cutting findings.
Assessment Final Report


Key immediate outcome from CLASS assessment
Report development stages:
Conduct the exit conference to share initial findings
 Consolidate findings and recommendations for each
technical area
 Synthesize conclusions across technical areas and form
initial cross-cutting recommendations.
 Validate and finalize findings and recommendations
 Disseminate the final report


Used as a working tool for the project officer/activity
manger to follow progress and manage the program
ClASS Tools

Training Tools:




Interview Guide
Curriculum Review Form
Trainings Tabulation Form
Partner Assessment Tools:


Administrative
Financial
Administrative Module
Training Module
Assessment Components: Training
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
Support from:
To
Through

Core Clinical
Master Trainers:
Six physicians,
two pharmacists,
and four nursemidwives
Site-level
Master
Trainers
Site-level Master
Trainers
HCPs



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


Initial and on-going trainings
Direct supervision and support


Assessment Components: Training
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.
Support from:
Core Lab Master
Trainers
To
Site Lab
Master
Trainers
HCPs







Through
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
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
Staff Interviews at BHP and Sites
Clinical Reviewer
Administrative Reviewer
Finance Reviewer
Principle Investigator (PI), Co-Principal Investigator (Co-PI), Executive Director, Site
Coordinator/Administrator, Site Manager
Core Master Trainers
Site-level Master Trainers
(or those functioning in that
role)
Physicians
Board members
Chief Financial Officer
Human Resource Director
Site Accountants
Program Monitoring Staff
Payroll Staff
Pharmacy Staff
Triage Nurse
Laboratory Staff
Data Entry Staff
M&E Staff
Pharmacy staff
Registration Staff
Management Information
Staff
Grants Management Staff
Other relevant staff
Administrative Support
Registration Staff
Patient Liaison Officer
Document Review: Administrative
Advance Review
On-Site Review
Organization’s statement
Minutes of Board and Board Committee Meetings
Current Organogram
Minutes of staff and management team meetings
Current HIV Program chart
Strategic plan
Organization Operating policies
and procedures
Other relevant committee meeting minutes
Contracts for all HIV service subcontractors
Memorandum of Understanding/Agreement for
Partners and Referral sites
Board By-Laws
Personnel files (employee evaluations, benefits, etc.)
Program Work plan
Description of data collection & information system
Personnel policies and procedures
Staff training manuals and list of trainings staff has
participated in during the last 12 months.
Position descriptions
Staff resumes
Organization QI system documents
Personnel files (1 for each category of staff paid by
PEPFAR
Program monitoring policies and procedures
Program monitoring reports
Document Review: Financial
Advance Review
Current budget for HIV Program.
Position descriptions of financial
management staff including accounting
staff.
Organization chart showing staff
responsible for financial management
functions
Committee structure detailing budget
approval process, review process of
financial statements, and how audit
findings are addressed.
Accounting policies and procedures
Billing and Collection policies, if applicable.
Procurement policies and procedures
Chart of accounts
On-Site Review
Financial Management Policies and Procedures including
applicable organizational, MOH, partner, USG, or
Diocesan sources.
Most recent Management Letter and/or audit
report. Prior period report also desired.
Documentation of reconciliation of checking account (s)
Meeting minutes of Management, Governance or other
Committees responsible for financial management
functions including budget and audit.
Visual review of accounting system including electronic
(Excel or Accounting) software.
Documentation of internal controls and internal quality
assurance provisions.
Payroll records
Petty cash records
Travel expense records
Expenditure reports (monthly or quarterly)
Inventory control systems
Document Review: Training
Advance Review



The Nurse Prescriber and Nurse
Dispenser training curricula (1 month)

Dispensing only curricula (4 days)
Materials for training in Routine HIV
Testing (RHT) and Dried Blood Spot
testing (DBS) for nurses

Training materials on lab data
management, reagent logistics and quality
assurance.
National Ante-Natal Sentinel Surveillance
related testing training materials

PIMS II training manual

AIDS Clinical Care Fundamentals

IRB training materials

Introduction to AIDS Clinical care

MASA & BOASA training materials

Pediatric Newborn and Neonate Care


QAI training manual/curricula?


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Laboratory training manual and
materials to train site-level LMT
Training manuals on CD4, Viral load,
haematology and chemistry
Training materials on LIS

Training materials on drug management
systems and strengthening the
pharmacovigilance program.
Any other training materials not reported
in the 2008-2009 annual report and/or
developed after the submission of the
report.
Document Review: Other
Advance Review
On-Site Review

Follow up support visit reports: CMTs, LMTs

Monitoring and Evaluation plan, Training Outcomes Reports, etc.

Trainee Satisfaction Surveys and Survey Results

List of Clinical and Laboratory Master Trainers

24-hour Phone Line policies and procedures

Rapid HIV counseling and testing policies

Mentoring log

DBS collection procedures

Site support log
Laboratory policies and standard operating procedures for
absolute minimum and basic tests



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Laboratory QA and QC reports.
National HIV Care and Treatment Guidelines (Adult, Pediatrics,
PMTCT, HCT, and etc.)

Site assessments (e.g. for viral loads)

Pre-ClASS Assessment Reports


List of site
Clinical and
Laboratory
Trainings
Telephone logs:
CMTs, LMTs
Off-site and onsite training/retraining logs
Focus for Staff Interviews


Clinical Reviewer Interviews

How patients are offered and provided services

How well services are documented

Flow of services

How services are coordinated between different departments
Administrative Reviewer Interviews



How management establishes and communicates processes, implements and
problem solves when issues arise
Verify that staff know and perform the duties for which they were hired or
assigned in the job description
Finance Reviewer Interviews

Concurrent with the review of the financial system

May include management level staff

May include registration and billing staff
Discussion Points