P0102 University of Medicine and Dentistry of New Jersey.

This activity is has USG Team Botswana Internal Reference Number P0102. This activity links to the following: P0101 & P0104 & P0105 & P0106 & P0107 & T1114 & X1301 & X1411 & X1412

The Francois Xavier Bagnoud Center (FXBC) is a leader in PMTCT and delivery of comprehensive, family-centered HIV healthcare services to vulnerable populations. The FXBC's clinical leadership has developed a model approach to PMTCT and HIV care and shares this expertise to build sustainable capacity through training and technical assistance for healthcare providers locally, nationally and in resource-constrained settings worldwide. Throughout 2005 and 2006 fiscal years, the FXBC has collaborated with HHS/CDC/BOTUSA and the MOH to develop the Botswana Training Package (BTP), which is a standardized, evidence-based national curriculum. The BTP was developed through a process of harmonization with the WHO/HHS-CDC PMTCT Generic Training Package, by adapting the CDC Testing and Counseling for PMTCT Support Tools and including separate modules on caring for health workers, stigma and discrimination, postnatal treatment and care, routine HIV testing and team building. Materials on adult learning strategies have been developed and integrated into the BTP and supplemental training document. The FXBC has facilitated two BTP trainer orientations and institutionalized a monitoring and evaluation (M&E) system to follow the progress of in-service trainings and refresher courses.

To build PMTCT training into pre-service curricula, the FXBC has collaborated with the Institute of Health Sciences (IHS) and the University of Botswana (UB). With technical assistance from the FXBC, IHS midwifery faculty is working on incorporation of the BTP into the pre-service curriculum. FXBC is disseminating a listserv on PMTCT and HIV/AIDS-related information of interest to southern Africa, and has developed on-campus HIV/AIDS research corners, faculty and student exchange and research collaborations. Finally, the FXBC developed and provided trainings to MOH (the PMTCT Unit) and IHS staff members on topics related to: family planning and HIV-infected women, team building, report writing, etc.

The FXBC will be responsible for activities in support of PMTCT. The goal of the FXB Center technical assistance activity is to support in-service PMTCT trainings and refresher trainings.

The following objectives relate to the above-stated goal and will be the responsibility of the FXBC during fiscal year (FY) 07: 1.1 - Support in-service PMTCT training focusing on district-level staff; 1.2 - Provide support for national PMTCT Unit capacity development; 1.3 - Disseminate information on PMTCT/HIV to health workers in Southern Africa Region.

In reference to specific deliverables over the course of FY 07, the FXBC will be responsible for the following deliverables:

1 - Training of headquarter staff on the use of the training database and assistance in operationalizing it nationally; 2 - Report analyzing use of training tools; 3 - Training on report writing; 4 - Training on project management; 5- Infant feeding manual; 6 - Southern Africa listserv mailing; 7- Evaluation report on listserv; 8- Database maintenance.

The following target will be achieved at the conclusion of the FXBC's activities for FY 07: 81 health workers trained in the provision of PMTCT services according to national and international standards. The FXBC work plan for FY 07 calls for work at various locations throughout Botswana in collaboration with HHS/CDC/BOTUSA, the MOH, academic institutions (IHS and UB), and other local partners.

07-X1411: UMDNJ- François-Xavier Bagnoud Center.

This activity has USG Team Botswana Internal Reference Number X1411. This activity links to the following: C0617 & P0102 & X1401 & X1406 & X1412 & X1415 & X1490.

The impact of HIV/AIDS on Botswana's healthcare system, coupled with health workforce shortages, has created substantial increases in the physical and emotional demands faced by health workers. Throughout the epidemic, health workers have been in the forefront of care and prevention activities, managing greatly increased numbers of severely ill patients and assuming new responsibilities for PMTCT services and more recently, antiretroviral (ARV) treatment. At the same time, it has become more difficult to respond to the demands of work, since many health workers themselves are HIV infected or are personally affected through ill family members or friends. Though in the forefront of the epidemic, many health workers are the last to seek treatment and care services and are both victims and perpetrators of stigma and discrimination.

GOB seeks to ensure that the present and future health workforce is able to cope with the demands of the epidemic and effectively perform its duties. To achieve this aim, the MOH, with EP support in 2005, implemented a needs assessment to obtain input from health workers in order to inform and guide the development of a National Wellness for Health Workers Programme. The study objectives were: •To determine the magnitude, sources and indicators of stress among health workers. •To identify strategies used by health workers to cope with work-related stress. •To determine counseling and psychosocial support needs of health workers. •To ascertain health worker preferences for delivery of psychosocial support services. •To make recommendations to the Ministry of Health on the establishment of a National Wellness for Health Workers Programme. In late 2006, the FXBC, a leader in PMTCT and comprehensive, family-centered HIV healthcare services to vulnerable populations, was tasked by the MOH and BOTUSA to assist in this process. Specifically, the FXBC reviewed and entered data collected for the caregiver needs assessment; completed a comprehensive analysis of data from written needs assessment survey; identified and developed additional theoretical perspectives to understand caregiver needs and guide development of a National Care for Caregivers Programme; conducted consultations in April 2006, which included interviews and site visits to inform and validate needs assessment survey data; presented initial draft report to the reference group and received comments and feedback; further developed a proposed strategy for National Care for Caregivers Program including minimum package of services using input from needs assessment data and stakeholders; and submitted a comprehensive final report of the Botswana National Wellness for Health Workers Needs Assessment for review and approval.

The findings of the report clearly substantiate the need for a National Wellness for Health Workers Program in Botswana but also identify challenges that must be addressed to ensure that such an initiative is effective and accessible. The goal of the National Wellness Program is to provide services and support opportunities to enhance the well-being and job satisfaction of health workers in order to improve their emotional and physical health, prevent burnout, enhance staff retention, and have a positive impact on patient care. This program is expected to increase health worker knowledge of HIV/AIDS, improve access to services and reduce stigma and discrimination.

Initial discussions identified components to address health worker needs that can build upon and complement existing resources and services and also address gaps. Improving access to, and uptake of, health services for health workers was identified as an immediate target for the program. To improve workers' health and help them better manage work-related stress, a minimum package of Wellness for Health Workers services was proposed. These services should be accessible to both professional and non-professional staff.

The minimum package of services proposed is: 1.Health services for staff that incorporate wellness (physical and emotional) services and workplace safety 2.Stress management programs, e.g., workshops, social and emotional support committees

3.Networking opportunities, e.g., support groups, resources for rest/tea breaks at work, recreation, e.g., choir, football, social celebrations 4.Training and staff development, e.g., workplace safety, team building, supervisory training and support 5.Health worker recognition/appreciation With this in mind, the goal of the FXBC TA in Botswana in FY 07 for this activity is to support the development and implementation of the MOH Wellness for Health Workers initiative.

In FY 07 FXBC will provide technical assistance to the MOH's DHAPC for the Wellness for Health Workers program implementation. Specifically, the FXBC will work closely with the Care for the Caregiver Coordinator and the national steering committee for the program to develop the following: a monitoring and evaluation plan (including indicators), marketing plan (including a brochure), and training modules in stress management, team building, public relations and change management.

07-X1412: UMDNJ-HIV/AIDS Pre-service training.

This activity has USG Team Botswana Internal Reference Number X1412. This activity links to the following: P0102 & X1401 & X1411 & X1415 & X1490.

Since 2003, the FXBC has collaborated with the MOH and the Institute of Health Sciences (IHS) to provide technical assistance around pre-service and in-service PMTCT and HIV/AIDS training. The ongoing partnership with IHS aims to ensure high-quality pre-service training in HIV/AIDS by providing faculty with cutting-edge HIV/AIDS-related information, incorporating this information into curricula and making HIV/AIDS-related resources and information available to students. Over the past few years, FXBC has assisted with the incorporation of PMTCT into the midwifery curriculum, updated faculty annually on PMTCT and HIV, provided HIV-related resources to faculty and established resource corners in two institutes for students and staff. The IHS consists of eight health training institutes, with over 500 students and eight programs through 10 departments. A basic diploma is offered for the following five subject areas: general nursing, medical laboratory technology, pharmacy technology, dental therapy and environmental health. Graduate level studies are offered for midwifery, family nurse practice and nurse anesthesia. The IHS has between 60 and 70 staff members, most of whom have master's degrees, and is managed by the MOH. UMDNJ consists of eight (8) schools in addition to Newark's University Hospital and the University Behavioral HealthCare Center. In addition to its academic departments and schools, UMDNJ consists of various research- and practice-oriented institutes and centers. Once such center is the FXBC, established in 1990. The FXBC is a leader in addressing global health concerns, including HIV and AIDS, and has a well-established history of bringing together academic and research expertise to build the partnerships needed to address complex and changing family health issues worldwide. Collaboration is an essential component of the FXBC's success as well as the success of its partners. Fostering these relationships provides both parties with invaluable learning experiences that offer new pathways of development and growth. The ongoing partnership between the IHS and the FXBC has identified an opportunity for the expansion of collaborative efforts. Further advancing the development of faculty and students at the two institutions would ultimately result in enhancement of both academic environments. In order to achieve this goal, FXBC will strengthen the relationship by establishing a more formal twinning partnership, in conjunction with relevant schools (e.g. School of Nursing) within UMDNJ. Focus Area #1: Faculty and Student Development To enhance the skills of graduating students in HIV/AIDS prevention and care, the FXBC will assist the IHS in delineating HIV/AIDS competencies required for each of the program offered. This will lay the foundation of appropriate development of HIV/AIDS-related courses and curricula. In 2007, FXBC will develop HIV/AIDS competencies for nursing and health education.

The FXBC will partner with IHS to establish faculty growth and development initiatives. This partnership will include a faculty-exchange program between the two institutions and allow faculty members to teach a semester in their partner institutions. This will benefit both UMDNJ and IHS by opening up new possibilities for academic growth, including access to UMDNJ long-distance courses for IHS faculty.

The FXBC staff holding academic appointments will also co-teach together with an IHS faculty member a course to students from IHS, thereby facilitating student and faculty growth and development. This course will be taught in Botswana. This will benefit students as they broaden their horizons to the possibilities of research and academic opportunities in the health professions.

The FXBC will expand the HIV/AIDS resource corners to 5 additional IHS libraries in order to expand to all eight locations, and will monitor their usefulness.

The FXBC will offer two update workshops on HIV/AIDS geared to the needs of IHS faculty. These training workshops will be selected based upon the results of a previously conducted need assessment of IHS faculty.

Focus Area #2: Skills development: Program evaluation and assessment

In order to enhance the scope of health-related evaluation, assessment and research activities at UMDNJ and IHS, the FXBC proposes to facilitate a researcher partnership program, through which individual faculty members from one institution will be given an opportunity to link with their counterparts at the other institution who share the same professional interest. It is anticipated that joint research activities will be geared towards practical/operational research areas that will result in enhancing the local capacity for effective healthcare provision. Negotiation of nature and scope of any joint research activities will remain the responsibility of individual researchers. The FXBC's responsibility will include facilitating negotiations between potential partners, while securing funding and clearance for various research projects will be the responsibility of individual faculty members. To facilitate the highest quality of any joint activities, IHS will be able to access to UMDNJ's online research tools.