Global health advocates discussed the findings of an ongoing study measuring the effectiveness of infectious disease training programs at a recent briefing hosted by The Accordia Global Health Foundation. The Integrated Infectious Disease Capacity-Building Evaluation (IDCAP) is a three-year program funded by the Bill & Melinda Gates Foundation with the goal of evaluating training programs to build capacity among mid-level health practitioners in sub-Saharan Africa.
According to Dr. Sarah Naikoba, co-principal investigator of IDCAP, there is an estimated shortage of 4 million doctors, nurses, mid-wives, and other health practitioners in sub-Saharan Africa, and with the burden of the HIV/AIDS epidemic, health centers feel the lack of trained professionals even more acutely. Because of unmet needs, there has been a sharp increase in demand for in-service training programs in recent years, including task-shifting programs in which mid-level health care providers are trained to perform jobs typically reserved for physicians.
In 2006, the Infectious Disease Institute (IDI) of Makerere University in Kampala, Uganda found that half of the established positions for healthcare professionals in the country are vacant, while 64 percent of clinicians who were prescribing antiretroviral therapy were not doctors. Too little is known about the impact of training and capacity-building programs on changes in quality of care and patient health outcomes, said Kelly Willis, senior vice president of Accordia.
To evaluate the impact of capacity-building programs, Accordia conducted a randomized trial at 36 health facilities throughout Uganda in partnership with IDI, the Ugandan Ministry of Health, and the International Training and Education Center for Health.
IDCAP developed an on-site training course with an integrated curriculum for infectious disease management for mid-level practitioners, hoping to significantly improve facility performance and patient health outcomes. They then measured the impact of these interventions on clinical performance and health outcomes, and evaluated the cost-effectiveness of the interventions.
The course targeted medical and clinical officers, nurses, nursing assistants, midwives, laboratory personnel, and counselors, among others. Courses were administered by well-trained, multidisciplinary mobile teams once a month for nine months at each site. The program included training on fever and malaria case management, comprehensive HIV/AIDS care, prevention of mother-to-child transmission, pediatric ART, and tuberculosis case management.
Preliminary analysis indicated that the IDCAP training program fostered significant improvements in several areas, including increases in: the percentage of outpatients triaged; the number of malaria suspects given malaria tests and the percentage of patients who tested negative that were treated with antimalarial drugs; and the percentage of TB suspects given an HIV test. IDCAP co-investigator Dr. Marcia Weaver said given the positive outcomes, they’ll continue to do further analysis on the cost-effectiveness of capacity building programs.