PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 RESPONDING TO THE HIV/AIDS EPIDEMIC IN THE CARIBBEAN - TAKING A REGIONAL APPROACH

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Regional Capacity Development Brendan Bain, Shelly Trim, Maxine Ruddock- Small CHART Regional Coordinating Unit and The Caribbean Health Leadership Institute The University of the West Indies

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Purpose of presentation  Regarding the response to the HIV epidemic at national and regional level in the Caribbean To underline the rationale for Capacity Development To acknowledge the organisations that have undertaken Capacity Development To identify successes in the area of capacity development To consider past and present challenges To envision the way ahead

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Capacity building in response to HIV

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  We had (and still have) the second highest HIV prevalence rate in the world after sub-Saharan Africa.  Advanced HIV disease is the leading cause of death among persons aged years in this region. HIV/AIDS in the Caribbean 

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Reported AIDS Incidence in CARICOM Member Countries

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 New AIDS Cases per year per 100,000 population Western Hemisphere ( Source:CAREC ) Latin America North America Caribbean

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Insufficient systematic, region-wide training  CAREC Special Program on STI was doing some training  Few professionals believed that they were prepared/equipped to provide HIV care  Uncoordinated visits by outside speakers  Some professionals attended HIV meetings / conferences / updates outside of the Caribbean

Up to mid-2000, only 25% (approx.) of Jamaican doctors said that they felt “confident enough” to treat persons with AIDS.” Source: Dr Yitades Gebre, Former Director, HIV/STI programme Ministry of Health, Jamaica In one unpublished study Many personal testimonies supported this finding, not just about doctors, but about other groups with responsibility for establishing policies and developing and serving in HIV programmes

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Capacity building in response to HIV

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Regional (Caribbean-based) Organisations  CARICOM/PANCAP  CAREC  Caribbean Cytometry and Analytic Society (CCAS)  Caribbean Assoc. of Pharmacists  CFNI  CHART Network  CHRC  CRN+  CCNAPC  PAHO HIV Caribbean Office (PHCO)  Trans-Caribbean HIV/AIDS Research Initiative (TCHARI)  UWI (CHART,CHLI, DrPH)

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 We have got more than a little bit of help from our friends* * Credit to The Beatles for the lyrics!

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Question  How many organizations based outside of the Caribbean have taken part in HIV- related capacity building in the Caribbean? More than 35

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  GOVERNMENTAL USA: USAID, CDC, HRSA, Dept. of Defence, Peace Corps Germany: GTZ UK: DFID Canada: CIDA Brazil Others  MULTINATIONAL European Union UNAIDS, inclusive of:  PAHO/WHO  UNDP  UNESCO  UNFPA  ILO World Bank Global Fund Others International Organisations (1)

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  International Foundations and NGOs Cicatelli Associates Inc. Clinton Foundation Education Development Center, Inc. (EDC) International Red Cross (IFRC) JHPIEGO Lutheran Medical Center, New York/New Jersey MEASURE/MACRO Partners in Health The Capacity Project International Organisations (2)

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  Foreign Universities Cornell Harvard Howard Johns Hopkins Univ. of Medicine and Dentistry of New Jersey (Francois-Xavier Bagnoud Center) Univ of Pennsylvania  Foreign Universities Univ of Washington (I-TECH) Others  Other Entities Association of Nurses in AIDS Care (ANAC) NASTAD (National Alliance of State and Territorial AIDS Directors) Pharmaceutical firms International Organisations (3)

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 So… Is there a need for better coordination and harmonization of HIV capacity building efforts in the Caribbean?

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Capacity building in response to HIV

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Strengthening a regional approach  Focus: Strengthen regional institutions  Rationale: Strengthen key institutions Strengthen key institutions that cover major parts of the Caribbean; then the benefit would be felt at national level in many countries Utilize economies of scale Utilize economies of scale Build stronger networks Build stronger networks Go for synergistic benefit Go for synergistic benefit from teamwork and sharing

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 S trengthening the I nstitutional R esponse to H IV/ A IDS and S TIs in the C aribbean (SIRHASC)  Period: Dec 2000-Dec 2007  Source: 6.9 M Euro Grant from the European Union  Principal Recipient: CARICOM Secretariat Birth of the PANCAP Coordinating Unit  Sub-recipients: CAREC ; CHRC ; CRN+ ; UNAIDS ; UWI (UWI HARP)

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Question Was the SIRHASC Project a success story?

SIRHASC Graduate Level Scholarship Awards (N=39) NEVIS JAMAICA TRINIDAD & TOBAGO GRENADA BARBADOS ST. LUCIA DOMINICA ST. VINCENT MONTSERRAT BR. VIRGIN IS. ANGUILLA ST. KITTS ANTIGUA BAHAMAS HAITI CAYMAN IS. TURKS & CAICOS IS. CARICOM Countries GUYANA BELIZE ARUBA CURACAO BONAIRE SURINAM CUBA DOM REP

SIRHASC GRADUATE LEVEL SCHOLARSHIPS BY DISCIPLINE Public Sector Mgmt. Nursing Education Medical Microbiology Governance Communication Nutrition Behavioural Sciences Clinical Psychology Counselling Health Economics Public Health Infectious Diseases Education (Health Promotion) PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Sharing ideas with other universities  The University of Technology, Jamaica  University of Guyana Visits by UWI HARP staff UG Faculty participated in:  Training of trainers’ programmes at UWI  UWI HARP Scientific Conferences  Dominican Republic, Suriname

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Recent Initiatives  June 2003: Caribbean HIV/AIDS Regional Training (CHART) Network AApril 2006: Trans-Caribbean HIV/AIDS Research Initiative (TCHARI) SSept. 2006: Master of Education (Health Promotion, focus on HIV), UWI St Augustine SSept. 2007: Caribbean Health Leadership Institute SSept Doctorate in Public Health 2 Virtual Leadership Development Program (OECS)

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Building the Capacity of Health Care Providers: A Pan-Caribbean approach

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 The CHART Network The Caribbean HIV/AIDS Regional Training Network

CHART Map NEVIS JAMAICA TRINIDAD & TOBAGO GRENADA BARBADOS ST. LUCIA DOMINICA ST. VINCENT ST. EUSTATIUS SABA MONTSERRAT BR. VIRGIN IS. ANGUILLA ST. KITTS ANTIGUA BAHAMAS CHART Training Centers CHART Coordinating Center OECS HIV/AIDS Project Unit CARICOM/PANCAP HQ HAITI CAYMAN IS. TURKS & CAICOS IS. CARICOM Countries GUYANA BELIZE ARUBA CURACAO BONAIRE SURINAM BERMUDA CUBA DOM REP

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 A Flexible Model  Training teams work either at CHART Centres or elsewhere  Four training levels  Learning activities at points of delivery of care as much as possible  Trainers are Caribbean nationals and experienced persons from outside of the Caribbean  Learners may sometimes go outside of their own countries

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 On site Training

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Curriculum development

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Numbers and categories of persons who have attended CHART training events

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Challenges - present and future PProgrammatic How to continue capacity building - themes, focus Coordination and harmonization Move training beyond the health sector Staffing and Sustainability OOther Allow/prioritize time to attend training Staff turnover - a frustration, but a reality to be addressed

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Reasons to continue  Changing training needs Leadership and management Surveillance, M&E Caring for children born with HIV who are now adolescents Care and treatment of older persons with HIV HIV and co-morbidities  Integration of HIV into primary health care  Staff turnover  Strengthening pre-service education and training  Training outside of traditional health sector

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 In building capacity… Is it best to take a systems approach?

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 Capacity building: Thinking and acting strategically  Assess human resource needs Other systems needs (equipment, supplies, maintenance, optimal record keeping, communication, procurement) Attrition and Turnover - reasons, reduction, adjustment  Build the work force systematically  Allocate personnel appropriately  Track progress  Measure and evaluate in relation to needs

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  How can we work smarter? Train for effective leadership and teamwork Fill important service gaps Integrate HIV into general health care Practice Continuous Quality Improvement Invest in multisectoral training Activate public:private partnerships Improve grants management Use a business approach Capacity building: Thinking and acting strategically

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 The way ahead  Scale up ‘pre-service’ training  Give certification for in-service training programmes  Coordinate / Harmonize training  Emphasize Quality Improvement through Monitoring & Evaluation with feedback  Implement better HRH tracking systems  Establish written policies and procedures to ensure follow-through

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  Topic-based, clinical training is not enough Need to take a whole systems approach Include training in  Leadership knowledge, skills and attitudes  Specific areas of management  Surveillance  M&E  Research skills  Grants management  Implement business/sustainability plan The way ahead

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  Own - Governments need to own and support/sustain national training  Partner - to plan and execute training and strengthening of services  Support a regional approach for  national benefits The way ahead

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010  One agreed Action Framework that provides the basis for coordinating the work of all partners.  One National Coordinating Authority, with a broad-based multisectoral mandate.  One agreed Monitoring and Evaluation System. The way ahead: Three “Ones” or Four “Ones”?  ? One agreed training/capacity-building system

PANCAP AGM Sonesta Maho Resort, St Maarten Oct 31-Nov 1, 2010 The way ahead

End of Presentation Thank you