|Parallel session PS29, Wednesday, May 28 2008, 11:00-12:30, Room 4|
|Chair(s): Alexandra Calmy, Department of Internal Medicine, Division of Infectious Diseases, HIV/AIDS Unit, University Hospitals of Geneva, Switzerland & Anna Mia Ekström, ARVMAC Coordinator, Karolinska Institute, Sweden|
|Handover of HIV Care Activities from MSF-CH Project to the Nylon District Hospital: An Experience from Douala, Cameroon|
|Oumarou Gnigninanjouena, Director, Nylon Hospital, Médecins Sans Frontières, Yaoundé, Cameroon|
|Effects of ARVs on African Health Systems, and Maternal and Child Health|
|Muhamadi Lubega, Medical Superintendent, ARVMAC Research Project, Iganga District Hospital, Uganda|
|Rapid Skill Transfer through Mentoring: A Sustainable Way to Rapidly Address the Shortage of Trained Healthcare Workers in Resource-Limited Settings|
|Marie Charles, International Centre for Equal Healthcare Access, UK|
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Submitted by: Alessandra Sauven (ICVolunteers)
The need for sustainable healthcare for people living with HIV/AIDS has had a huge impact on the health sector. Without adequate support, HIV treatment expansion plans put a great deal of strain upon health systems and can at times lead to an overall lack in quality. Finding ways and mechanisms through which to respond to this challenge is vital to ensure that health systems are able to respond effectively to current needs and demands.
Dr. Gnigninanjouena Oumarou from the Nylon District Hospital, Cameroon, discussed challenges and lessons learned from a project set up between Nylon District Hospital, Douala, and Médecins Sans Frontières (MSF) in 2001. The project initially focused on integrating HIV care into the hospital system and went on to introduce anti-retroviral therapy (ARV) in 2003, along with palliative care at the community level. In response to a significant increase in hospital workload, HIV care was decentralised and a referral and counter-referral system put in place from 2006 onwards between the hospital and other peripheral health institutions in Douala. In 2007, MSF handed activities over to the hospital. Dr. Oumarou highlighted the importance of working in partnership with MSF, Switzerland, and the Ministry of Health to supervise the handover and ensure the transition proceeds effectively. He also stressed the vital role played by formal training to build up clinical skills, counselling performance and managerial capacities prior to this handover period.
Dr. Lubega Muhamadi, Principle Medical Officer/Medical Superintendent of Iganga Hospital, Uganda highlighted some of the challenges associated with expanding and implementing treatment plans and programmes without adequate investment in strengthening weak health systems. In doing so he referred, in particular, to the ARVMAC project, set up to assess the effects of the rapid scale-up of anti-retroviral therapy (ART) for HIV/AIDS on resource-limited health systems, maternal and child morbidity and mortality in three sub-Saharan African countries.
Preliminary observations from Uganda's Iganga hospital, one of ARVMAC's three demographic surveillance sites, suggest that, whilst growing numbers benefit from ARV services, mandatory counselling, optional testing and home-based care, this in turn puts significant pressure on an already overstretched health workforce. Maternal and child healthcare feel the strain in particular as staff attempt to provide sustainable and often necessarily time consuming HIV care to mothers and children, whilst continuing to fulfill their general workload. Dr. Muhamadi stressed the need to consider ways through which to motivate staff to cope with the added workload, whilst enabling them to deliver good quality care. He also highlighted the need for increased personnel, infrastructure, funding and supplies in order to meet the growing needs and pressures placed on hospitals by ART.
Dr. Marie Charles from the International Center for Equal Healthcare Access (ICEHA) spoke of rapid skill transfer as an effective and sustainable means through which to strengthen healthcare systems in developing countries and build capacity. ICEHA provides clinical mentors to Ministries of Health programmes and clinics in the developing world who in turn coach their counterparts on various aspects of HIV-related healthcare, from anti-retroviral therapy to the organisation and management of clinic flow. Projects are initiated by invitation from countries to ICEHA, a factor which as Dr. Charles stressed, is crucial to ensure that projects remain driven by national and local demand as opposed to Western specifications. In particular, she highlighted the importance of working with local partners and communities within national guidelines to adjust programmes to specific local settings.
The session highlighted the need to promote reliable access to sustainable high-quality HIV care, whilst considering new ways through which to strengthen and adapt health systems so as to ensure that new demands and needs are met efficiently and effectively.