Enhancing and Maintaining the Competence of the Healthcare Workforce in Africa

The Training Programme at IDI, provides training and capacity development to enhance and maintain the competence of the healthcare workforce in Africa, for the prevention and management of HIV and other infectious diseases, with the aim of strengthening health systems in Africa. 

This year July 2015–June 2016, IDI conducted trainings in the areas of HIV, laboratory management, pathogens of securityconcern (PSCs), biosafety & biosecurity, research, and systems strengthening for local and international trainees, using face-to-face and online methods of training. IDI received Ministry of Health (MoH) approval to provide continuing professional development activities to Ugandan healthcare workers and as such, all its trainees who are entered into a database that is periodically sent to MoH, have their annual practicing licenses renewed by the MoH regulatory councils to which they are affiliated. 

IDI training courses are facilitated by seasoned national and international trainers. The quality of courses has been maintained over the years, through the continuous review and updating of content. Besides offering mentorship to its alumni, IDI also provides distance post-training support through the Advanced Treatment Information Centre (ATIC). 

IDI’s capacity building activities are needs-driven, hands-on and are aligned to national and international policy guidelines. Various partners including the MoH, the World Health Organisation (WHO), IDI internal projects, the US Centers for Disease Control and Prevention (CDC) Uganda and Atlanta, the United States Agency for International Development (USAID) through Cardno Emerging Markets, U.S. Defense Threat Reduction Agency (DTRA) through the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Janssen Global Public Health through the Johnson & Johnson Corporate Citizenship Trust , Jhpiego and Africa Capacity Alliance (ACA) have played a pivotal role in the implementation of this year’s activities. 

The Training Programme has also provided technical assistance to the Ministries of Health in Uganda and Kenya in the management of laboratory services, HIV and diseases caused by PSCs.

Building Capacity for the Management of Pathogens of Security Concern

In collaboration with USAMRIID and the Ministries of Health of Uganda and Kenya, IDI has continued to strengthen the ability of public health systems in East Africa to prevent and manage illnesses caused by PSCs. IDI conducted service provider training in PSCs such as Ebola, for clinicians in Uganda and Kenya. In addition, there was post-training follow-up of alumni through onsite and distance learning methods.

As of June 2016, a total of 378 clinicians (178 Ugandans, 179 Kenyans and 21 Tanzanians) had been trained; 134 (52 Kenyans and 82 Ugandans) have so far been followed up, and have displayed evidence of improved prepared- ness for the detection and management of PSCs. The programme has had a significant practical impact: six alumni participated as frontline clinicians and epidemiologists during the massive Ebola outbreak in West Africa which occurred in 2014; three of them have been incorporated into the WHO West African regional team of experts assigned to spearhead the rebuilding of the health care system following this outbreak. In Uganda, graduates of the EDP course applied the knowledge and skills acquired to detect and manage in a timely manner outbreaks of plague in Koboko (October 2015) and yellow fever in Kabale (March 2016). 

IDI, in collaboration with WALIMU (a Ugandan non-government organization with expertise on building capacity for Ebola case management), WHO and Uganda MoH trained another 442 health workers including clinicians, burial team members and hygienists on Ebola management and infection prevention and control. 

Global Health Security Agenda (GHSA) Project 

In October 2015, IDI was awarded a five-year grant by CDC to implement the Global Health Security Partner Engagement Project: Expanding Efforts and Strategies to Protect and Improve Public Health Globally. The project aims to strengthen Uganda’s ability to prevent and detect emerging infectious diseases, with a focus on : biosafety and biosecurity, infection prevention and control, surveillance and prevention of antimicrobial resistance, antimicrobial stewardship, strengthening of laboratory systems and acute febrile illness.  

The GHSA project complements efforts of the USAMRIID/IDI-led East African clinician training programme on PSCs; and trains lab staff from facilities where clinicians are targeted by the PSC training on biosafety & biosecurity. This development creates opportunities for the establishment of teams (comprising clinician and lab staff) that are capable of initiating and sustaining comprehensive activities aimed at early detection and providing the first line of response to outbreaks as the MoH mobilizes for a centralized national response. The achievements so far include: 

•Completion of a baseline assessment in project-supported districts to elucidate strengths and gaps related to implementation lab system strengthening, antimicrobial resistance and biosafety; 

•Establishment of strategic partnerships with key GHSA stakeholders such as: Epidemic Surveillance Division (ESD-MoH); the Biosafety and Biosecurity Technical Working Group; WHO; CDC; Global Health Security Agency; Uganda National Council for Science and Technology; Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity; International Development Research Centre; health facilities; Department of Medical Microbiology at the Makerere University College of Health Sciences; and Uganda Biosafety and Biosecurity Association;

•Development of a National Biosafety & Biosecurity curriculum;

•Organization of a training of trainers (ToT) course in leadership & management, basic and lab tracks of Biosafety and Biosecurity; and 

•Provision of technical assistance in various key GHSA priority areas to the Central Public Health Laboratory, Uganda National Health Laboratory Services, Regional Referral Hospitals, and in Kisenyi and Kiruddu health centres in Kampala.

Testing Innovative Models of Capacity Building

During the year, IDI completed and disseminated findings for two pilot studies that evaluated the effectiveness of innovative approaches to build capacity for HIV management - the Mentors Study and the Low Dose-High Frequency (LDHF) Project. These two approaches: yield higher numbers of trained healthcare workers per facility, minimize service disruption, provide more opportunities for practical clinical case management, and have limited information given to trainees over a long period of time as opposed to traditional didactic classroom approaches.

a)The Low Dose-High Frequency (LDHF) Project 

The LDHF Project was a six-month capacity building multi-centre evaluation study funded by the Barr Foundation through Jhpiego) at IDI, alongside other study centres which included Mildmay Uganda and the Association of Obstetricians and Gynaecologists of Uganda. The project was implemented in the four districts of Kiboga, Kyankwanzi, Hoima, and Kibaale and aimed at evaluating the feasibility of building capacity for pediatric HIV/TB management using multiple onsite mentorships (high frequency), covering limited course content per mentorship visit (low dose), as opposed to traditional methods. There was significant improvement in both knowledge and skills among the healthcare workers trained using the LDHF approach compared to the traditional training which showed improvement only in knowledge.

b)MENTORS Project:

The MENTORS Project was a CDC-funded capacity building operational research study whose overall aim was to determine the effectiveness of using on-site clinical mentorship to improve the clinical knowledge, competence, and practice of mid-level practitioners in the management of HIV and TB; through a cluster randomized controlled trial that was conducted at ten level IV health facilities in rural areas of Uganda. IDI in collaboration with the Accordia Global Health Foundation, successfully completed this study with findings showing an improvement in knowledge and skills in the intervention sites compared with the control sites which received routine MoH-supported comprehensive HIV care support and mentorship.  During the intervention phase, four mid-level practitioners at each of the five control sites received the routine MoH comprehensive HIV care support and mentorship while four mid-level practitioners at each of the five intervention sites received individual on-site clinical mentorship on HIV and TB care for eight hours a week, every six weeks, over a nine-month period on top of what the ones in the control sites are receiving.Results of these two studies highlighted the competitive advantage of innovation over traditional approaches.

Upgrade of the IDI Distance Learning Platform: Collaborations to Enhance Distance Learning 

Through the capacity building demonstration project funded by Janssen Global Public Health through the Johnson & Johnson Corporate Citizenship Trust., IDI in collaboration with the Ugandan Academy for Health Innovation and Impact has further enhanced its capacity to deliver quality eLearning opportunities to health workers. The IDI’s online education platform was upgraded into a clinical training website (https://elearning.idi.co.ug/), which now hosts free online educational resources including case studies and treatment guidelines. The case studies depict real-life HIV/AIDS and TB patient case management scenarios that have been presented at IDI case conferences and switch meetings. Through these open access resources, we are able to share with health workers the expert knowledge that is exchanged at these IDI fora, to improve their capacity in patient management for HIV, TB, non-communicable diseases (NCDs) and other health conditions. These cases are presented in interactive formats that engage users and have also been fitted with quizzes that learners can take to test their knowledge in the subjects covered in the respective case studies. By June 2016, the open access resources had been accessed by 454 users worldwide.