The District
Mentorship Initiative
in Tanzania
Track 1.0
Annual Meeting
Redempta Mbatia
ICAP Tanzania
August 10th 2010
ICAP Tanzania Program
• ICAP TZ has assisted implementation of prevention, care
and treatment services in 127 sites, and PMTCT
services in 408 sites with a focus on quality services in 4
mainland regions (Pwani, Kagera, Kigoma) and
Zanzibar.
• As of June 2010: 61,807 clients enrolled in care and
30,346 (49%) initiated on ART. 458,728 pregnant women
were tested, counseled with 44,120 provided ARV
prophylaxis
• Important innovations have been initiated e.g. prevention
with positives, male circumcision, prevention and
programs for IDUs, FSWs and MSM
• Partnerships have been established with 25 CHMT,
3 RHMT, and 39 NGOs/FBOs
National (GoT) Context
• Chronic shortage of Human Resources (HR)
• The current GoT supervision approach is largely aimed
at improving staff performance, supply chain, HR &
training gaps and logistics using checklists rather than
providing mentorship and ensuring quality
• Six MOHSW indicators for quality improvement in HIV
prevention, care and treatment have been defined
• National Supportive Supervision and Mentoring
Guidelines developed by MOHSW, ICAP other IPs and
now finalized and being adopted
• ICAP TZ experience expected to inform national roll out
of mentorship
Tanzanian Health System
Ministry of Health and Social Welfare (MoHSW)
Policy Development and National Strategy
Muhimbili National Hospital (MNH)
MoHSW
MNH
Referral
Hospitals (4)
Translation and
Coordination of Policy
Implementation and
Supportive Supervision
Tertiary
Regional Hospitals
(RHMT)
District Hospitals (CHMT)
Secondary
Dispensaries/Health Centre
Primary
Community and Health Post
ICAP-Tanzania
District Mentorship Initiative (DMI)
Goal:
• Ensure sustainability and ownership of HIV
prevention, care and treatment within Tanzania’s
existing decentralized health system
• Build a network of mentors at the District and
Regional level to support lower level centres
• Improve quality through introducing a quality
improvement approach using standards of care
(SOCs)
District Mentoring Initiative
GOAL
OBJECTIVES
• Growth, Quality
and
Sustainability
• Implementing a
Model of Care
• Improving
Quality of Care
• Building
Capacity/Strength
ening Systems
NATIONAL RESOURCE
MATERIALS
ICAP TANZANIA
RESOURCE MATERIAL
• National Quality
Improvement
Framework (TQIF)
for quality
improvement in
health service
provision
• National QI Guidelines
for HIV and AIDS
Services
• National Clinical
Mentoring manual for
HIV/AIDS service
• National Clinical
Mentoring training
curriculum for
HIV/AIDS service
• District Mentoring
Initiative (DMI)
Proposal (in line
with national
guidelines/manuals)
The DMI is fully integrated into the existing health system;
Regional and District Health Management Teams are responsible for site
selection for mentoring activities, to coordinate DMI and to select the
regional and district mentors
Principles of DMI
• Mentorship will not replace traditional ‘support
supervision’ currently being implemented by regional &
district health teams
• District Mentors will not be a new cadre within the health
system
• RHMT and CHMT are the key ‘players’ in the existing
system and must be supported.
– Their role is to coordinate and oversee implementation of DMI in
collaboration with ICAP
• Mentors must meet certain criteria
• Clinical competence (macro skills) and experience
• General mentorship skills (micro/soft skills)
• Willingness and commitment
Methodology
 Orientation to RHMT/CHMTs in the region(s)
 Selection of district mentors by CHMTs based on set
criteria
 Selection by RHMT/CHMTs of sites to receive mentorship
 Assessment of mentors’ skills (ICAP TZ)
 In-depth training of mentors- (6 days)
 Pre-mentorship site activities: sensitization of sites, staff,
and site assessments of the model of care.
 Implementation with ICAP TZ close monitoring
 Assessment at 3-months followed by 6 month evaluation
DMI : The Process
CMS Training of Core ICAP Staff in Uganda
Review MOC and agree on key SOC/indicators
Internal Processes
Adapt i-TECH-NACP Training Materials
2 day workshop to orient RHMT/CHMT and endorsement of the proposal
followed by Mentors Self Assessment
Kagera October 2009
Kigoma May 2010
Pwani July 2010
External
Processes
6 days training for district mentors (DMs) focusing on
mentorship skills and methodologies
Kagera February 2010
Kigoma June 2010
Pwani August 2010
32 mentors (8 districts)
16 mentors (4 districts)
28 mentors (7 districts)
1) DMI implementation started at 2 CTC and 2 PMTCT sites in each district
2) Next step DMI evaluation after 3 months pilot period (between July-Nov 2010):
Assessment on Model of Care (MOC), Standard of Care (SOC) , Routine HIV/AIDS
indicators, DMs reports, mentees and mentors self-assessment reports
After DMI evaluation:
roll out DMI in all
facilities in each
district.
Selection criteria
Site
Mentor
• Expertise and experience in a
specific HIV intervention area
• Approachable and accessible
with good communication skills
• Actively providing HIV/AIDS
interventions
• Been through at least one of
the relevant HIV-related
intervention course
• Understands the
country/district’s health
systems
• Willing and committed
•
•
•
•
High volume site
New site with high volume
Low CD4 testing
High number of Loss to Follow
up (LTFU)
• Poor documentation
• Poor enrolment of patients who
are eligible for ART/ or poor
linkage/referral of PMTCT
clients to C&T
Quality Indicators for
Tanzania*….
• All pregnant HIV+ women should be enrolled into CTC
within one month of first ANC visit.
• All HIV-exposed infants should be started on CTX
prophylaxis at one month of age.
• All patients on ART should return to clinic for follow-up
within one month of starting ART.
• All pre-ART and ART patients should have CD4 testing
every six months.
• All ART and pre-ART patients should be assesses for TB
disease at every visit.
• All ART patient should be assessed for adherence at
every visit.
* Quality indicators basis for the SOCs being measured by
mentors before and after mentorship
Next steps
• Quarterly review, assessment, feedback to region and
MOHSW and evaluation of program at six months
• Sharing of progress to date in annual stakeholder
meetings in Kigoma and Kagera (August 2010)
• Incorporation of DMI into the district council health
comprehensive plans (with funding)
• Increased focus on quality with measurable results(SOCs)
• Growing network of mentors focusing on micro/macro
skills in HIV Care, ART, PMTCT (and potentially beyond)
• In light of transition, pool of mentors to be gradually
increased under RHMT/CHMT management.
Thank you!