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Resources: Cooperative Delivery Model and Annotated Bibliography assignments; course readings
Address potential challenges to your model in the presentation and the feasibility of using your model as a pilot program that could be expanded to other countries, thereby creating a global service network.
Format any citations and references in your presentation consistent with APA guidelines.
International cooperative healthcare model
Healthcare cooperatives involve many different types of organizations: Nonprofit agencies, Non-governmental organizations (NGO), commercial companies, and government, depending on the political jurisdiction. The cooperative can take many different forms, including purchased or shared services, worker-owned or patient-owned organizations, community owned organizations, or jointly owned organizations that are some combination of these forms. A range of services may be provided through a healthcare cooperative that includes the providing primary and acute care, health insurance, and a range of social care programs, such as those that provide community healthcare workers or daily living support.
Ministry of Health (MoH) in ____ (country or countries)
National Aids Council (NAC)
World Health Organization
Partners in Health
National government ____ (country or countries)
The cooperative works to strengthen and expand HIV / AIDS services in the provinces of ____ (country or countries). The cooperative assist with the implementation of policies set by the MoH. The cooperative is involved at all stages, from program planning through implementation, and finally monitoring. Direct and indirect support is to be provided to the health centers in the provinces and to the local and regional health management teams at the health centers.
Best practices have shown that in order to be successful, an international healthcare cooperative must have the support of the country's government and of the NGOs, communities, and healthcare staff. A top-down approach is necessary because of the many changes that are needed in standard operating procedures. Visible and vocal support from the government leaders wiiill encourage people to make changes and to align themselves with the goals of the cooperative.
Systems and Structures:
The cooperative will make a concerted effort not to create parallel systems or structures. A fundamental goal is to support and make use of existing policies, regulations, and guidelines. However, an important part of the cooperative model is to carry out a situational analysis that seeks to determine whether existing regulations and practices are beneficial to patient outcomes -- and to weed out and replace, if necessary, any dysfunctional components. At both the district and local levels, new programs will be integrated and old programs will be improved.
The cooperative will targeted several programs for improvement, making the services more robust, increasing the scope, and initiating new programs where indicated. The programs that are currently designated for emphasis by the cooperative are:
Counseling and Testing (CT)
Prevention of Mother-to-Child Transmission (PMTCT)
Clinical ART (antiretroviral therapy)
Monitoring and Evaluation (M&T)
Technical and Management Strategies
A three-pronged approach will be used for program development, implementation, and monitoring. The strategies are rooted in simple, time-tested techniques.
Audits. Program audits will be established and data will become the basis for both monitoring and compensation. Data clerks will be hired and trained in local and district facilities. Program audits will be designed to improve quality and fidelity to the model. The audits will cover the collection, storage, utilization, and analysis of the data, thereby increasing the appreciation of healthcare staff for the use of data as a management and quality tool. To further instill the importance of data, provincial staff will be charged with auditing data from a different province. In addition, all provincial and local data will be susceptible to an audit by head office staff.
Decentralization. Implementation and authority will be linked at the provincial level, as programs have been decentralized. Healthcare will be pushed more into the realm of the local facilities in order to address issues of the distribution of care, reduce patient travel time, and ensure local knowledge is leveraged. Provincial healthcare program managers will receive assistance from local managers to provide laboratory and pharmacy services, clinical care, prevention of mother-to-child transmission, and monitoring and evaluation.
Provincial healthcare managers will provide training and technical assistance to local healthcare managers and staff. In turn, the provincial healthcare managers will receive training in their specialty from the central office. In order to address issues with the potential for long-term impact, the cooperative shall ensure that official agreement fare obtained from the regional and local healthcare authorities. Agreements are to be obtained whenever renovations of infrastructure are planned, and when essential medical and laboratory equipment costing over a certain limit are to be purchased. Written contracts will delineate the supports and services to be provided by the cooperative, and these contracts -- which are technically recipient agreements -- will be authorized and co-signed by officials of the cooperative and hospital board of directors and healthcare center officials.
Staff Recruitment and Training:
Accessing funding for advanced training in healthcare policy and practice, the cooperative will develop fellowships or work with existing fellowships, such as the Harkness Fellowship in Health Care Policy and Practice. The fellowships provide opportunity for healthcare practitioners and healthcare policy researchers to travel to the U.S. For a year, during which time they will conduct research study that is geared toward policy. This will enable close-up experience with international models of healthcare delivery and the opportunity to work with leading experts in the areas of healthcare policy and medicine. Following completion of the fellowships, participants are expected to assume high-profile positions in their native countries.
Disused buildings will be targeted for renovation by the cooperative in order to create ART centers with adequate storage for antiretroviral drugs and diagnostic equipment, materials, and supplies. A comprehensive system of HIV/AID care will be provided, a key element of which is the recruitment and training of community healthcare specialists. The community healthcare specialists will conduct home visits to monitor adherence to therapy and to provide supplies of medications in the appropriate containers. The community healthcare workers will also function as patient advocates for PL/HA. The renovations will also serve to boost staff moral and improve the overall environments in which people provide and receive healthcare.
HIV / AIDS Program Enhancement
Because efficient and accurate laboratory work is integral to the successful treatment of HIV / AIDS, the cooperative will ensure that sophisticated laboratory set-ups are established in local and regional health care centers. The goals of the cooperative include ensuring that same-day HIV test results are established. This goal will be supported through the use of motorcycles with attached coolers for the transport of lab samples and results. Concomitantly, the process of collecting lab samples will be enhanced by removing barriers to testing that have resulted from the need for patients to travel long distances to clinics for evaluation -- returning to the clinics for test results and subsequently for treatment. The cooperative has an associated goal of improving receptivity and acceptance of HIV testing -- community healthcare workers are expected to play an important role in the achievement of this goal.
The cooperative will ensure that parents can access HIV testing and treatment at the same facility as their children. This will prevent the expenditure of time and energy traveling to different clinics -- which may be far apart -- on the same day. The cooperative will establish a polymerase chain reaction (PCR) laboratory for testing children who are 18 months old or less. The PCR blood samples will be drawn in the local healthcare facilities and transported to labs with testing facilities. For children under 18 months who will be tested, dried blood -- spot samples will be sent to -- and results returned from -- the hospital via expedited postal services. In most rural areas of the country, a shortage of qualified healthcare workers indicates that it is essential to increase the uptake of diagnostic testing and greatly expand treatment services. The cooperative will work continuously to identify innovative practices that address these issues. For instance, outreach to PL/HA volunteers will be employed to identify, recruit, and train community healthcare specialists who will be tasked with providing treatment adherence support and counseling support to others PL/HA.
The cooperative recognizes the importance of bringing HIV treatment and prevention services into the local centers and communities. Stable and collaborative relationships with the government and the MoH are crucial if this is to occur, be sustainable, and remain focused on speedy implementation of the programs. The provision of services within the country can occur despite weak infrastructure and shortages of trained healthcare staff. National, regional, and local partnerships are essential for attaining…