Annual Report. Strengthening Institutional Capacity for Nurses Training On HIV/AIDS in India (GFATM 7) (October September 10)

Transcription

1 Annual Report Strengthening Institutional Capacity for Nurses Training On HIV/AIDS in India (GFATM 7) (October September 10) Annual Report

2 Annual Report

3 Contents Highlights 4 Introduction 5 Activities till September Quarter 1 ( October December 2009) 1.1 Training of GFATM staff on Computerized Management 7 Information system 1.2 Drafting of Supportive Supervision Plan Baseline study Institutional Assessment and refurbishment Distribution of Library Books and Teaching aids 9 2. Quarter 2 ( January March 2010) 2.1 Launch of the Computerized Management Information system National Consensus Workshop Upgradation workshop for Trainers Tally Workshop for Finance Staff Regional Cross Learning Workshops Orientation Workshop for New SSRs Quarter 3 ( April June 2010) 3.1 Project Steering Committee Meetings Quarter 4 (July 2010 September 2010) 4.1 Regional Meeting on Implementing the Global Fund New Funding 13 Architecture & Gender Equality Strategy 4.2 Quarterly Newsletter Financial Updates 14 Annual Report

4 Highlights GFATM Round 7 Training of Nurses on HIV/AIDS & ART The overall implementation of the training courses has been very satisfactory with almost all institutions getting a very good feedback score from the participants on all round performance. The average pre training score was 56.5% and the average post training score was found to be 78%. The analysis of the Feedback Form show that most trainers continued to be appreciated by the participants for their knowledge, technique and skills, and have given them quite high ratings( an average of 4/5). This shows the enthusiasm and confidence levels of the trainers who have continued to maintain high standards of training even after continuously conducting training courses month after month for the last two years. Motivation continues to be is high among trainers and participants, as a majority of the institutions continued to attract participants from among staff nurses across the districts from all health facilities. The attrition of trainers has been negligible except a few instances where trained have migrated for better opportunities abroad. Some new institutions joined the project and some other started their trainings in the 2 nd year of implementation. They are- o o o o o o Symbiosis College of Nursing, Pune CON, Lady Hardinge Medical College, New Delhi CON, PGI, Chandigarh CON, Berhampur, Orissa CON, BHU, Varanasi CON, NIMHANS, Bangalore A total of 40 institutions were sanctioned funds for the refurbishment of their classrooms, library and other areas. Annual Report

5 Introduction GFATM Round 7 Training of Nurses on HIV/AIDS & ART HIV/AIDS in India and the National AIDS Control Program Based on various studies and independent assessments, it is seen that the National AIDS Control Program is progressing steadily towards the objective of halting and reversing the HIV epidemic in India over the period NACO estimates show that there are 22.7 lakh People living with HIV/AIDS in India by the end of 2008 with an estimated adult HIV prevalence of 0.29 percent Declining trends are noted in high prevalence states indicating possible impact of sustained programme interventions. Even the prevalence among pregnant women in the age group of years, (which is considered proxy for incidence/new infections in general population,) is showing a declining trend. The primary drivers of HIV epidemic in India are unprotected paid sex/commercial female sex work, unprotected sex between men and injecting drug use. It is estimated that there are 12.6 lakh Female Sex Workers, 3.5 lakh Men who have Sex with Men with high risk and 1.9 lakh Injecting Drug Users in India. Though sex workers account for 0.5 percent of adult female population, they account for seven percent of HIV infected females. NACP-III is based on the experiences and lessons drawn from NACP-I and II, and is built upon their strengths. Its priorities and thrust areas are drawn up accordingly and include a comprehensive multi-sectoral approach. Considering that more than 99 percent of the population in the country is free from infection, NACP-III places the highest priority on preventive efforts, while, at the same time, seeking to integrate prevention with care, support and treatment. Sub-populations that have the highest risk of exposure to HIV receive the highest priority in the intervention programmes. These would include sex workers, MSM and IDU. Second high priority in the intervention programmes is accorded to long-distance truckers, prisoners, migrants (including refugees) and street children. NACP-III ensures that all persons who need treatment would have access to prophylaxis and management of opportunistic infections. People who need access to ART are provided with first line ARV drugs. Prevention needs of children are addressed through universal provision of Prevention of Parent to Child Transmission (PPTCT) services. Children who are infected are assured access to paediatric ART. The program is also committed to address the needs of persons infected and affected by HIV, especially children. This is being done through the sectors and agencies involved in child protection and welfare. In mitigating the impact of HIV, support is also drawn from welfare agencies providing nutritional support, opportunities for income generation and other welfare services. Care, support and treatment also includes community care centres to provide psycho-social support, outreach services, referrals and palliative care. Mainstreaming and partnerships are the key approaches to facilitate multi-sectoral response, engaging a wide range of stakeholders. Private sector, civil society organisations, networks of people living with HIV/AIDS and government departments, all have a crucial role in prevention, care, support, treatment and service delivery. Annual Report

6 The Global Fund GFATM Round 7 Training of Nurses on HIV/AIDS & ART The Global Fund for AIDS, Malaria and Tuberculosis (GFATM) set up in 2002, is a unique global public/private partnership dedicated to prevent and treat HIV/AIDS, Tuberculosis and Malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. Global Fund financing is enabling countries to strengthen health systems by, for example, making improvements to infrastructure and providing training to those who deliver services. The Global Fund remains committed to working in partnership to scale up the fight against the diseases and to realize its vision a world free of the burden of AIDS, TB and Malaria. There have been 9 rounds of funding by the GFATM for control of AIDS, Malaria and Tuberculosis to various countries including India. The GFATM Round 7 for India provides funding for the training of nurses and strengthening institutional capacity of nursing institutions in India. The GFATM 7 Nurses training project aims at the strengthening and capacity building of 55 nursing training institutes and training 90,000 nurses in India, on HIV/AIDS and ART within a period of 5 years ( ). It will be implemented by Indian Nursing Council (INC) in coordination with the National AIDS Control Organization (NACO) with the support of the management agency, Futures Group International Pvt. Ltd. and Catholic Bishops Conference of India (CBCI). A total number of 55 Nursing Training Institutes have been identified from all over the country for this purpose. The Indian Nursing Council is the Principal Recipient (PR) and 5 of the 55 nursing training institutes are the Sub Recipients (SRs) and are also the Regional Resource Centers. Their task is to conduct the trainings of the master trainers and monitor the other 50 nursing training institutes who are the Sub Sub Recipients (SSRs). The Futures Group and the CBCI are the additional SRs, who support the Indian Nursing Council in implementing the programme. Annual Report

7 Activities for the period October 2009 to September 2010 The Nurses training within the GFATM project continued its progress in the 2 nd year of implementation and successfully achieved all its phase 1 targets within the timeline. All 55 nurse training institutes ( SRs and SSRs) regularly conducted the 5 day training programs in their respective institutions as per the pre-determined quarterly training calendar. The Traiing of Trainers courses were conducted at the 5 regional SRs. During this period, total of around 37,000 staff nurses from across the states were trained in addition to the 9220 nurses trained in the 1 st year bringing up a total of 46,036 nurses trained so far in the 1 st phase of the project. Besides, 179 more trainers were trained during this period to reach to a target of 584 trainers. A select number of 25 trainers were upgraded to master trainers reaching a target of 105 master trainers. The quarter wise activities for the period is discussed below. 1. Quarter 1 (September 09 December 09) 1.1 Training of GFATM staff on Computerized Management Information system A two day Regional training workshop on M&E and MIS was conducted by Futures Group for the West and South zone institutions. All Principals and other GFATM staff (Coordinators, Data entry operators (DEO) and finance staff of all west zone institutions were invited to Mumbai and all aspects of the GFATM project was discussed. Hands-on training was provided to DEOs and coordinators on data entry and maintenance of the web-based MIS. Two more similar trainings were organized for South Zone institutions in Chennai and Hyderabad. The revised Operations manual and the financial guidelines were distributed to all participants. A database of all GFATM staff was developed and made available on the MIS website. 1.2 Drafting of Supportive Supervision Plan Supportive Supervision can be defined as monitoring, guidance and feedback on professional & educational matters to promote enhanced patient care. It deals with technical issues e.g. skills & knowledge. It is aimed at motivating & supporting Health Care Providers to improve their work performance.. Supportive Supervision under the GFATM project is envisaged as a follow up and supplement to the 5 day classroom training. A draft Supportive Supervision guideline and plan has been developed by the Futures Group in consultation with Nursing Experts from INC. A meeting of the State Nursing councils was organized in Delhi and this draft was shared with the participants. Based on their feedback the draft was further revised and after additional feedback from all 55 institutions under the project and other nursing experts, this plan will be finalized and ready for implementation towards the end of Phase 1 of the project. The 5 SRs are being promoted as Regional Resource Centers. The mentoring plan will be implemented under the Annual Report

8 responsibility of these Regional centers. A 2-3 day visit will be made by selected trainers who will become the mentors for the region and will be mentoring trained staff nurses from all tertiary, district and sub-district hospitals in their designated districts. 1.3 Baseline study A major outcome of the nurses training is to improve the prevention and treatment services provided in the various ART centers, PPTCT centers and the ICTCs across the country. This indicator is required to be measured through a series of studies on the PLHA satisfaction levels, starting with a baseline study. A baseline study has been previously conducted by NACO on the satisfaction of PLHAs at the ART center. However, this did not explicitly cover the role and involvement of the nurses in these centers. In this regard, the Futures Group conducted a baseline study on the nurses knowledge and involvement in provision of HIV/AIDS prevention, care and treatment services. The objective of this study was to understand their knowledge and skills, related to the care of HIV/AIDS patients, their attitudes and perception towards them, practice of using Universal Standard Precautions while taking care of HIV/AIDS patient, their training and development needs in order, for them, to be able to provide the comprehensive care to the PLHAs. As a part of this study, 150 randomly selected nurses, working at medical colleges/tertiary and district hospitals/art centers/phcs at 10 category A districts from the five zones, (identified by NACO, GOI), were interviewed with the help of semi structured questionnaires. Standard software has been used to for data entry and some findings from the study are provided below. Study findings 1. Number of years of experience in providing care to PLHAs No experience >12 Base: All Nurses (N=146) Annual Report

9 2. Number of PLHA handled in last 3 months >40 Base: Nurses who have been providing care to PLHA (N=87) 1.4 Institutional Assessment and refurbishment Based on submitted estimates for refurbishment of the Nurse training institutes, the Challenge Fund Committee at INC, approved the refurbishment plans for 6 more institutes in addition to the 3 already approved in the previous quarter. The refurbishment includes, renovation of existing classroom into a State-of-the-art training hall equipped with the latest audio-visual gadgets, renovation and refurbishment of limited capacity boarding facility for trainees and comfortable seating and furniture for conducting the 5 day training programs. In the 1 st phase, a total of 40 institutions have been provided funds for the refurbishment of their training classrooms, library, hotels and other relevant facilities. 1.5 Distribution of Library Books and Teaching aids A select set of books and other publications on HIV/AIDS prevention and treatment and other diseases for the nursing professionals were printed and provided to all 55 nursing institutions within this project. These included latest treatment and prevention guidelines of NACO, WHO publications and other related publications of the Indian Nursing Council. Besides, teaching aids, such as wooden penis models for condom demonstration, female reproductive organs, simulators etc. These aids have greatly facilitated and improved the trainings. 2. Quarter 2 (January 2010 March 2010) 2.1 Launch of the Computerized Management Information system The Futures Group supported the Indian Nursing Council in developing the Training Management Information System (TMIS) for the GFATM project. The web based TMIS was formally launched by Mr. Dileep Kumar, President INC during a Consensus Workshop of all 55 Principals and Coordinators in Kochi on the 13 th -14 th February The MIS includes all details about the training program, such as, the details of all 55 institutes. Training calendar, database of nurses and trainers trained including details about their present work, a feedback from all trainees etc. This MIS is available for all to view from the Indian Nursing Council website at Annual Report

10 GFATM Round 7 Training of Nurses on HIV/AIDS & ART All data into the MIS get entered by the designated data entry operators positioned in each of the 55 institutes within a week after completion of the training program. In addition, a centrally positioned Help desk is available to support data management and data analysis. Data analysis provides information of all trained staff nurses district wise and institution-wise. Launch of the TMIS by the President INC The TMIS Home page 2.2 National Consensus Workshop The 2 nd National Consensus workshop for Principals and Training Coordinators of all 55 institutes was organized at Kochi in Kerala on the 13 th and 14 th February The good practices and issues related to the GFATM training program was discussed among all the staff. Recommendations provided by the institutions were taken into consideration for further improvement of the training courses. Of particular concern, was the problems faced by the institutions in getting staff nurses deputed for the training from the hospitals, especially understaffed hospitals. All institutions were requested to organize sensitization workshops for all Nursing Superintendents within their state. For the first time a grading system for performance was developed and shared with the institutions. This takes into account quantitative and qualitative indicators which provide a ranking for intuitions and individual trainers separately. Annual Report

11 2.3 Upgradation workshop for Trainers Consensus Meeting in Kochi The Master trainers for the GFATM project are senior faculty of the different nursing colleges and schools and with some experience of teaching and working with HIV/AIDS patients. These master trainers were the first groups who underwent training within this project. They were provided with a mandate of training both other trainers and staff nurses. The 1 st 3 batches of TOTs had provided 90 master trainers. In order to achieve the target of 110 Master trainers for the project, 30 top trainers from all regions were invited for a selection workshop to test their knowledge and skills as trainers and upgrade them as Master Trainers. Of these, 25 trainers were successfully identified and selected as Master Trainers to increase the pool of Master trainers to 115. Condom Demonstration among trainers during upgradation workshop 2.4 Tally Workshop for Finance Staff A workshop for Finance Officers and DEO cum accountants of the SR and SSRs of the North Zone was organized in Behror, Rajasthan on the 26 th and 27 th March 2010 to orient them on the use of the Tally software. This software is used for accounting purposes and offers extremely high reliability data. During the workshop, the participants were provided two days hand on training on Tally 9.2. On day 1, all the participants were briefed about the benefits about Tally 9.2, how to operate the accounting software and also how the same can be integrated with the GFATM project to provide timely and fool proof quarterly statement of expenditure to INC. On day 2, the participants were provided a worksheet based on the possible expenses incurred for the project and all were trained on entering the same in the software to provide the hands on training. Annual Report

12 2.5 Regional Cross Learning Workshops Sharing of experiences is one way of updating the knowledge of the trainers across the regions. Periodic Cross Learning workshop on a regional basis has been planned within the GFATM Nurses training project. As the name suggests these Cross learning workshop are designed with the primary objective of all trainers sharing their experiences with their fellow trainers from other institutions and improving upon their training skills and knowledge of the subject. The first such workshop was conducted in this quarter for the East and North- East Zones in Puri, Orissa on the 13 th and 14 th March 2010, and around 50 trainers participated in this two-day program.. Apart from experiences from individual trainers, the draft mentoring plan and the use of better communication in training programs were also highlighted. Participants provided feedback on the technical content and the curriculum and suggestions for improvement of the training programs in future. Representatives of the local PLHIV network shared their views on the care and support services being provide to them and also the discussed the enhanced role of the nurses in addressing stigma and discrimination in health care facilities and in counseling services. Separate Regional Cross learning workshops for other zones were similarly organized for the trainers. The West zone workshop was organized in Mumbai on the 24 th and 25 th April, North Zone in Lucknow on 7 th and 8 th August and for South Zone in Manipal on the 4 th and 5 th September North Zone Regional Cross Learning Workshop, Lucknow Annual Report

13 2.6 Orientation Workshop for New SSRs As per discussion with NACO, a revision of SSRs was done to accommodate institutions in the high HIV prevalent districts. The new SSRs that were identified are College of Nursing,, Symbiosis, Pune, College of Nursing, NIMHANS, Bangalore, and College of Nursing, LHMC, New Delhi. These three institutions together with three other SSRs, which had not started their training programs, were invited for an orientation program to INC, New Delhi on the 26 th February All details of the project were shared and discussed with the Principals and their staff. 3. Quarter 3 (April 2010 June 2010) 3.1 Project Steering Committee Meetings The 2 nd Project Steering Committee meeting was held at NACO on the 30 th April Mr. K. Chandramouli, Secretary and DG, NACO. Apart from the Nurses training project, the training of Counselors and Link workers on HIV/AIDS prevention and care was also discussed in the meeting as part of Round 7 project. An update on the progress of the Nurses training was presented by Mrs. K. Bharati, Asst. Secy and INC and Project Director, GFATM. The nurses posted at the 24X7 PHCs needed more training on counseling and additional inputs would be sought from the Counseling experts, while revising the curriculum in the 2 nd phase. It was also decided to position these trained nurses in ART centers on rotation basis. The 3 rd Project Steering Committee Meeting was similarly organized in NACO on the 6 th September In this meeting, the training of nurses at the 24X7 PHCs was further discussed. It was realized that a majority of the nurses posted in these PHCs are Auxiliary Nurse Midwives (ANMs). It was decided to develop a separate curriculum for the training of around 5000 ANMs as identified by NACO who are positioned in select PHCs. A Technical group comprising of INC team, NACO and TISS would deliberate and develop a separate curriculum for the ANMs. This activity would be taken up in the 2 nd phase of the project. 4. Quarter 4 ( July 2010 September 2010) 4.1 Regional Meeting on Implementing the Global Fund New Funding Architecture & Gender Equality Strategy The above meeting was organized by the Global Fund in Pattaya from the 27 th June to 1 st July in Pattaya, Thailand. A team from INC and Futures Group participated in the meeting. The new funding architecture and Gender issues were discussed. Annual Report

14 4.2 Quarterly News letters Three issues of the quarterly newsletter were developed and printed and 20,000 copies were widely distributed to all Nursing schools and colleges across the country, hospitals, NACO, SACS and other International agencies. These newsletters have been very much appreciated and it has become a good platform for nurses to submit articles of interest and feedback on the training programs on HIV/AIDS. Financial Updates The INC has developed comprehensive financial guidelines for the implementation and monitoring of the GFATM project. INC provides budget allocations and actionable targets and expected deliverables before the beginning of each quarter in respect of each Regional Resource Centre (SR) and in respect of each Nursing Training Institution (SSR). The quarterly budget and actionable targets are being conveyed to each Sub Recipient (for the Sub recipient and also for the Sub-sub Recipients) before the beginning of the quarter. Each Implementing Agency, viz. the Regional Resource Centres (Sub-Recipients) and the Nursing Training Institution (Sub-sub Recipients) prepare a quarterly action plan indicating, inter-alia, the physical targets and budgetary estimates in accordance with the approved budgetary allocation by INC as per pattern of assistance under the Programme covering all aspects of the project activities for the quarter. The implementing agencies ensure that there are no deviations from the budget allocations and/ or actionable targets and expected deliverables provided by the INC while preparing the quarterly action plans. Should there be any need for a deviation for any reason; prior approval is to be obtained from INC before including any deviation in the annual action plans. As part of periodical reporting mechanism for financial management and project management and for submission of financial and programmatic information to Global Fund through the quarterly Performance Update and Disbursement Request, all SRs and all SSRs are required to submit quarterly financial and programmatic reports to Indian Nursing Council. The Sub-sub Recipients are required to submit these reports to their Sub Recipients (with a copy to INC), who will consolidate the reports at the Regional level and submit the same to Indian Nursing Council. The quarterly reports are to reach INC by 8th of the months after the end of the quarter. The SOE in Report III (programmatic and financial information on trainings) is to be submitted immediately after the conclusion of each training program. Summary of Expenditure from October 2009 to September 2010 Comparative position of budget allocation and expenditure incurred up to 30th September 2010 was as under: Implemeting Agency Budget allocation Million USD Expenditure Million USD Indian Nursing council (Principal Recipient) Disbursement to Sub recipients Total Annual Report

15 Variation from budget allocation is mainly on account of purchase of equipment after September 2009 and training of more local in-service nurses entailing less expenditure on travel and accommodation. There was also delay in appointment of staff in some Institutions. Annual Report

16 55 Nursing Institutions implementing the Training project Annual Report