Support, Capacity building and sustainability. Group (2)

Transcription

1 Support, Capacity building and sustainability Group (2)

2 Cadres summary Many different cadres Support by both Government and NGOs Within & outside country, different model, different scope of work, different training curriculums, different expectation, different payment/incentive scheme; different supervision mechanism Training is not regulated nor standardized Coverage of CHW/CHV widely varies

3 Cadres Elementary Polyvalent agent (APE) All of them screening for TB, support to treatment CHV Activist Traditional leader Cough officer- helping health facility, screening, providing HE for coughing All of them screening for TB, contact tracing, collecting of sputum, support to treatment and receive training by NGO Support materials, bicycle Public/NGO/CSO Public NGOs Country Mozambique Mozambique

4 Cadres Public/NGO/ CSO Country CHV (cadre health post) NGO/CSO Indonesia Cadre PPTI (to find the case and to support treatment) PETA (to support MDR-TB cases) AISYIYAH is PR Cadre AISYIYAH (community cadre) To find the case, to support treatment and advocacy (IEC) NGO Patient organization FBO Indonesia Indonesia Indonesia Community Nurse Public Indonesia

5 Cadres CHW called CHEW to link dispensary (PHC) with community CHEW junior conduct community program, active case finding including house to house Community health ward support TBA Community health nurse - TBA (formally got training provided by Government) School of health technology CHV recruited by NGO/CBO. NGO/CBO organized training for specific purpose Treatment supporter Sputum transporter Contact tracer Public/NG O/CSO Public & NGOs Country Nigeria Nigeria

6 Cadres CHW formally trained by Gov through NGOs pick from community based on capacity, experience, people with history of TB, CHW & Sputum fixer are provided incentive and bicycle, raincoat, M&E tools Sputum fixer supplement to CHW, means when CHW find presumptive TB cases, sputum fixer go out and collect the sputum, send to nearby lab Supervision by NTP, curriculum by NTP, training provided by NGO Community volunteers All CHW are trained by Gove, NTP, but supported by NGOs. Regarding sustainability, Gov expecting to pay salary for CHW. Now, developing plan for this. Public/NG O/CSO Public & NGOs NGOs Country Tanzania

7 Cadres CHW service provided CHV given training, no formal, curriculum developed by Gov, 3 days training (paid depends on policy) (20 USD/month) - incentive CHEW identify from community, required basic education, 1 week training provided by Government, paid by Government (in the future) Cough monitor is CHV, adopted by certain organization, stipend varies from org to org (some 50 USD/month) Public/NG O/CSO NGO Public NGO Country Kenya Kenya Kenya Kenya

8 Cadres Midwives - Screening of TB patients and provision of drugs - Daily DOT for MDR-TB patients from their coverage area - Contact tracing, initial home visit - Health talk at RHC Public Health Supervisor - Support to other BHS at community level Community Health Volunteer -health talk, health education at community, Identify and refer presumptive TB cases, sputum transportation, contact tracing, follow up for miss dose cases & LTF cases, DOT provision MDR-TB treatment supporter (MDR-TB volunteer) -Daily provision for evening DOT -Side effect monitoring -Health education and counseling -MDR-TB contact tracing - Support to patient Public/ NGO Public Public NGOs NGOs Country

9 CHW Training Duration Guideline Facilitator Frequency Country 2 weeks training on TB Government Government (NTP) CHV 1 week NGO Government (NTP) Prn (as required) Prn (as required) CHV 3 days NTP, CSO NTP, CSO Based on need CHV 1-3 days National Programme CHW Up to 2 weeks for TB National Programme NGO Prn (as required) Mozambique Mozambique Indonesia Nigeria Government Once Nigeria CHW 1-2 weeks Gov Partners Once, but regular supervision by NTP Tanzania

10 Training Duration Guideline Facilitator Frequency Country CHW 5 days NGO NGO Depend on NGO CHV 2 weeks, for TB 3 days Gov Gov Once, refresher training if needs CHW 3 days NTP & WHO NTP Usually once per 2 years CHV 3 days NTP & WHO NTP, NGOs Annually and on job training when required DRC Kenya

11 Support & incentive to CHW/CHV Pay for performance, CHW/CHV are provided targets to be performed. CHVs are paid based on activity they conducted. This can lead to demotivated CSS block fund mostly for TB and HV. PR CSO manage fund. No standardized payment of NGOs. Baseline survey is done, they claimed for minimum wage of country. Recognition and certification is suggested. No standardized payment. Now, focusing, % of minimal wage Not paid by Government. Paid by USAID, GF and CTB. No standardize payment of NGOs. Tanzania, Indonesia Nigeria Kenya Mozambique DRC

12 Challenges Guideline is not in local language Lack of materials (job-aid as well as training materials) Different language (so, translated to local language during training) No standardize curriculum Qualification of CHV is very wide, ability are very varies (some kind of standardization require) Issue of linkage to health facilities Need to update GL to cover all intervention areas (TB, MDR-TB, TB/HIV) Different nature of diseases may hinder integration of services at community level without substantial training Country Most Mozambique & Nigeria Mozambique,, DRC Nigeria, DRC Kenya, Tanzania, Tanzania

13 Recommendation for sustainability Review the incentive system for both CHW & CHV Incubate into the Government system and Supervise & support by Government Integrate several community health interventions (HIV, TB, malaria, etc) Standardize the training curriculum and localized the language Coordinate with Donors and partners to make sure CHW are integrated and paid for these CHWs. For all CHW, Nigeria, Kenya and Tanzania, there is active consideration by Government to pay salary for sustainability Include CHW payment, training and support system into country strategic plan and all provincial and district plan

14 THANK YOU