International cooperative healthcare model for HIV/AIDS services expansion

International Cooperative Healthcare Model

PLEASE WRITE THE SPEAKERS NOTES. I WILL DEVELOP THE 15 SLIDES FROM THOSE NOTES. THE NOTES MUST SUPPORT THE 15 SLIDES. PLEASE USE MY PREVIOUS PAPERS AS RESOURCES IN ADDITION TO THE BOOKS I HAVE ATTACHED. If you are unsure, please contact me.

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

SLIDE

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.

Partners:

Ministry of Health (MoH) in ____ (country or countries)

National Aids Council (NAC)

World Health Organization

Partners in Health

National government ____ (country or countries)

Purpose:

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.

SLIDE 2

Political Will:

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.

SLIDE 3

Program Focus:

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 Care

Clinical ART (antiretroviral therapy)

Monitoring and Evaluation (M&T)

SLIDE 4

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.

SLIDE 5

Capacity Building:

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.

SLIDE 6

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.

SLIDE 7

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.

SLIDE 8

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.

SLIDE 13

The relevance of adherence models to the experiences and lives of PL/HV has been determined to be one of the key markers of successful adherence intervention. As Ware explains, "Models developed for use in a specific sociocultural context cannot simply be assumed to be valid in another. They must be validated and, if necessary, adapted to fit the new settings in which they are applied" (2006: S19). Ware et al. (2006) developed a framework for evaluating whether existing models of adherence have cross-cultural validity. Commonly, barriers to treatment include difficulties with transportation, stock-outs of medication, poverty, and gender inequality, while supports might include treatment partners and access to extended family (Ware, et al., 2006). Assessment of adherence to antiretroviral therapy is emerging in resource-limited settings, but often the assessment strategies are have been developed in resource-rich settings (Oyugi, et al. (2004). Successful adherence assessments, such as structured self-report, 30-day visual analog scale, electronic medication monitoring, and unannounced monthly pill counts (Oyugi, et al., 2004) that require the assistance of in-home visits. The cooperative will employ empirically determined best practices such as focusing on patient psychology through counseling effort to improve the perceptions of PL/HA and to change their behavior. Annual patient care plans will be developed and shared across providers, both national and international, as appropriate, so that measures will occur across time that will facilitate communication.

SLIDE 14

International Cooperative Model. The proposed model relies predominantly on the ground-breaking work of PIH and USAID in Rwanda. Fundamental to the model in South Africa are three elements of reform: Performance-based financing, community-based health insurance, and quality assurance programs. These three components of healthcare reform, coupled with the political will to ensure implementation and sustained effort characterized by fidelity to the model, can result in high performing hospitals and centers. The Global Health Workforce Alliance has extensive reach in Africa and has developed models for capacity development, and on-site skill demonstration and training designed to enhance the transfer of skills.

Data integrity and coordination. While a centralized, web-based data system is important for coordination at the local level, it is essential for international cooperative arrangements. Medical records must be easily transferred and physicians must have opportunity to collaborate and discuss treatment history and plans. Open-source tele-consulting opportunities must become a foundational practice in an international cooperative healthcare initiative. These activities can be well-supported via the Internet, but an adequate technology infrastructure must be established or in place.

Performance-based financing. With its history of bureaucratized healthcare, South Africa is conditioned to expect healthcare funding independent of the efficacy of care patients receive. A robust performance-monitoring system can achieve the motivational reform essential to providing quality care in the facilities in South Africa, and can assist the South African healthcare system to achieve levels of performance that permit more or less seamless cooperation with its partners in the U.S.

SLIDE 15

Conclusion:

A substantial number of within-country models for healthcare reform exist and models for international collaboration have also emerged. Increasingly, there is a focus on capacity-building and reliance on technology to accomplish -- virtually -- what cannot be accomplished in situ. The models that appear to be most effective have achieved high levels of support from the local government, and serve populations who recognize the need for external assistance, so levels of motivation and participation are high. The area of cooperative healthcare is evolving quickly, nourished by an increased awareness that disease does not respect national borders.