Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3142
Country/Region: Haiti
Year: 2009
Main Partner: University of Washington
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/HRSA
Total Funding: $5,250,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $300,000

SUMMARY :

I-TECH will continue to subcontract with the Institut Haitien de Santé Communautaire (INHSAC) and the

François-Xavier Bagnoud Center, UMDNJ (FXB) to develop curricula, clinician support tools and job aids,

and provide training in PMTCT for 200 health workers in Haiti. I-TECH and INHSAC will maintain

collaboration with HIVQUAL to continue to provide leadership on supervision and quality improvement of

PMTCT services, in partnership with the principle service delivery networks in Haiti (MSPP, CRS/AIDS

Relief, GHESKIO, PIH/ZL, and MSH). The Emphasis areas include the following: addressing male norms

and behavior, child survival activities, family planning and safe motherhood. The primary target populations

are as follows: physicians, nurses, auxiliary nurses, community agents including traditional birth attendants,

and trainers from the five national nursing schools and the school of midwifery. Coverage areas of these

activities include all geographic regions receiving PEPFAR support for PMTCT services.

BACKGROUND:

INHSAC is a Haitian non-governmental organization established in 1985 to provide post-graduate training in

public health issues for health care workers (HCW). Under COP06, INHSAC was funded through partner

JHPIEGO to provide initial training in PMTCT for 200 providers from 26 clinic sites. Principle partners in this

effort were Ministry of Health (MSPP) Division of Human Resources (DDRH), MSPP departmental directors,

MSH and CRS/AIDS Relief. Under COP07, INHSAC was funded through I-TECH to provide the 2-week

PMTCT course including a one-week practicum to 55 health care workers from approximately 15 new

VCT/PMTCT/palliative care scale-up sites throughout Haiti. Training participants included physicians,

nurses, and auxiliary nurses from these sites. I-TECH assisted INHSAC to improve the existing curriculum

by adding a practical focus on lessons learned from successful interventions in Haiti including updated

material on infant feeding.

In 2007-08, I-TECH and INHSAC collaborated with HIVQUAL to initiate a quality improvement process

involving key PMTCT delivery sites in Haiti. This process follows the "breakthrough collaborative" model

pioneered by the Institute for Healthcare Improvement (IHI). I-TECH sponsored and facilitated meetings of

the Haiti PMTCT "breakthrough collaborative" to find new ways to address old problems and to share best

practices. The process is one of organizational self-study and learning, where I-TECH and INHSAC

convene leaders from the service networks to learn about the quality improvement (QI) framework, set QI

aims, establish measures to track progress, and select interventions. With coaching from I-TECH

facilitators and their "breakthrough collaborative" peers, the leaders will test the interventions within their

networks through Plan-Do-Study-Act QI cycles, document results, and scale-up successful interventions.

ACTIVITY 1: INHSAC will train 200 HCW in PMTCT by delivering 10 two-week sessions including a one-

week practicum at Hôpital Charles Colimon in Petite Rivière de l'Artibonite. INHSAC will collaborate with I-

TECH and the MOH to prepare the PMTCT curriculum and convene stakeholders for review to validate it as

the national standardized PMTCT curriculum for Haiti.

ACTIVITY 2: INHSAC, with the support of I-TECH, will utilize JHPIEGO resources and partner with the

Ministry of Health to develop a training module on PMTCT for traditional birth attendants (TBA) to be

included in the TBA training package. I-TECH will provide technical assistance on curriculum development,

including instructional design, document production, pilot evaluation, and clinical review. A TOT will be

implemented for 60 nurses and auxiliary nurses who will be responsible to train and supervise the TBA.

ACTIVITY 3: INHSAC will partner with the MOH and other stakeholders to develop a training module on

PMTCT for community health workers (CHW) supporting HIV-infected pregnant women enrolled in PMTCT

programs. The training module will be included in the CHW training package, and a TOT will be

implemented for 50 trainers responsible for the training of CHW involved in PMTCT services. I-TECH will

provide technical assistance on curriculum development, including instructional design, document

production, pilot evaluation, and clinical review.

ACTIVITY 4: FXB will work with two representative PMTCT sites to determine priorities for development of

job aids and support tools to enhance the implementation of national guidelines and to integrate and

coordinate the care of women with care for their infants. Because of the high rate of lost-to-follow up of

infants born to HIV-infected women, an emphasis will be placed on developing tools to support the referral,

follow-up, monitoring and care of these infants. FXB Center staff will then develop and adapt support tools,

potentially including flipcharts on counseling and testing for PMTCT, wall charts of key steps in PMTCT,

algorithms of comprehensive PMTCT services, and pocket cards on antiretroviral drug dosing for mothers

and infants, counseling guidelines on infant feeding, and wall charts on safer delivery practices. These tools

will be tailored to the Haitian clinical setting in accordance with the national guidelines. Draft tools will be

reviewed by the PMTCT working group and the MOH and revised accordingly. This activity will increase the

capacity of physicians, nurses, and counselors to implement and adhere to the national PMTCT guidelines

as the provision of PMTCT services expands throughout the country.

ACTIVITY 5: INHSAC and I-TECH in close collaboration with COAG/MOH will continue implementation of

the Initiative for Improving PMTCT Program Performance in Haiti, a component of the national HIVQUAL

project focused on quality improvement of the national HIV program. Also known as the "breakthrough

collaborative" model pioneered by the Institute for Healthcare Improvement (IHI), INHSAC and I-TECH will

continue to facilitate Collaborative meetings for the teams representing HIVQUAL sites with a PMTCT

program. At each meeting, participants will share their experiences over the past several months in testing

quality improvement strategies, and share their learning about which interventions worked and which

interventions failed. I-TECH will provide a quality improvement specialist who will provide skilled facilitation

as participants analyze the experiences and make decisions about what to do next to reach quality

improvement aims. I-TECH and INHSAC will also assist the participants document their progress in relation

to their established quality measures, and to disseminate information on the results of the process. Ten

PMTCT HIVQUAL sites will participate in the initiative in 2009-2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17228

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17228 9725.08 HHS/Health University of 7698 3142.08 ITECH $300,000

Resources Washington

Services

Administration

9725 9725.07 HHS/Health University of 5151 3142.07 ITECH $250,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Care: Adult Care and Support (HBHC): $300,000

SUMMARY:

I-TECH will continue to develop and update a training package of palliative care, home-based care (HBC),

nutrition services, as well as management and leadership of community-based AIDS Service Organizations

(ASOs). I-TECH will collaborate with the non-governmental training center, Institut Haitien de Santé

Communautaire (INHSAC), to provide training and technical assistance for institutional development of

ASOs in all departments in Haiti.

BACKGROUND:

Since 2004, I-TECH has supported INHSAC to develop an integrated HIV counseling curriculum. I-TECH

has produced a video drama on anti-retroviral therapy (ART) adherence issues (Chans), in partnership with

a local video production company (Agence des Jeunes Producteurs) formed and staffed by people living

with HIV/AIDS (PLWHAs). In 2007, in collaboration with local experts from several partner training

institutions, I-TECH developed and included a module on psychosocial support, case management, and

adherence support strategies within the national the national curriculum on anti-retroviral (ARV)

drugs/opportunistic infections (OI). During 2007-08, I-TECH developed and added modules on nutrition and

palliative care for Version 2 of the national ARV/OI curriculum.

In 2008, INHSAC created a standardized training package on Community Based Care (CBC), for personnel

from ASOs and other community-based organizations (CBOs) in each department. The curriculum

emphasized linkages between clinical and community services for PLWHAs. The training also highlighted

the importance of establishing community service delivery points in which services such as nutrition,

support for transportation fees for medical visits, medication (not covered by the national HIV/AIDS

program), psychosocial support, and scholarships for the HIV-infected or affected children are provided.

The curriculum also highlights the importance of linkages with already existing community organizations

providing complementary services such as clean water, insecticide-treated bed nets, and income generating

activities.

ACTIVITY 1: In 2009, INHSAC will train 150 people delivering community services to PLWHAs on CBC in

six, one-week training sessions. The training will utilize the standardized training package on CBC and

continue to emphasize linkages between local initiatives in a variety of sectors (microfinance, nutrition,

agricultural development, etc) and patient support initiatives. These initiatives are capable of building

programmatic expertise in HIV/AIDS issues across these local networks and advocating for PLWHAs. I-

TECH will provide technical assistance (TA) on curriculum development, including instructional design,

documentation production, and pilot evaluation. This initiative will support HIV/AIDS program expertise

amongst community advocates in other sectors and will support leadership by and advocacy on behalf of

PLWHAs.

ACTIVITY 2: INHSAC will implement supportive supervision sessions for CBC. This activity will examine the

core services provided by the community service delivery points (home visits, referral system, etc) and the

efficiency of this linkage with other ASOs. This activity will involve training a group of approximately 30

trainees in CBC (three per geographic department) who demonstrated excellence and leadership during the

standard training. There will be at least one PLWHA in each group. INHSAC, with the support of I-TECH,

will develop standardized supervision tools to be used during supportive supervision sessions. Following

training as supervisors, these personnel will visit community service delivery points and any other CBOs

that provides services to PLWHAs. They will observe their peers in practice, provide supportive feedback,

and report to INHSAC on their findings using standardized forms. Prior to including candidates in the

supportive supervision training, INHSAC will coordinate with employers to release the relevant personnel for

one-week per quarter to supervise other trainees. INHSAC will provide planning and coordination of

supervision visits, and will provide output-based stipends and travel expenses for the supervisors. INHSAC

will make at least two visits per department to oversee the program and will convene the group on a semi-

annual basis to identify commonly-observed problems and strategies for improvement. This program will

result in at least one supportive supervision encounter per trainee following CBC training.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18950

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18950 18950.08 HHS/Health University of 7698 3142.08 ITECH $450,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $2,000,000

SUMMARY:

I-TECH will provide clinical mentorship training and technical assistance (TA) for high quality HIV care and

treatment across the network of the President's Emergency Plan for AIDS Relief (PEPFAR)-supported

antiretroviral therapy (ART) scale-up sites. I-TECH will support staffing and clinic operating costs at Hôpital

Universitaire Justinien (HUJ) in Cap Haitian.

BACKGROUND:

Since 2004, I-TECH has partnered with the University of Miami (UM) and HUJ to expand HIV clinical adult

care and to serve as a regional center for training and TA in the North Department. Beginning in 2004, I-

TECH contracted with Cornell University to place full-time resident technical advisors at the Haitian Group

for the Study of Kaposi's sarcoma and Opportunistic Infections (GHESKIO), in support of its training and

mobile supervision teams. Beginning in 2005, I-TECH has supported two full-time clinical mentors for the

Hôpital de l'Université d'Etat d'Haïti (HUEH), Haiti's largest facility and primary teaching hospital, to support

antiretroviral (ARV) scale-up. In 2008, I-TECH expanded its team of clinical mentors based at HUEH to a

total of six physician mentors, one psychologist mentor and two nurse mentors. I-TECH's ARV services

extension involves both public and non-governmental organization (NGO) sector facilities, and I-TECH has

collaborated closely with the Ministry of Health (MOH) counterparts in realizing these programs. As of July

2008, at HUEH, I-TECH has supported extension of HIV clinical services to approximately 2200 patients

(with 514 on ART) while also decreasing the number of patients who test positive but do not enroll in care.

At HUJ, I-TECH has supported 1,560 patients (with 946 on ART) through its subcontract with UM. By March

2009, I-TECH will have supported approximately 2940 adult patients in care at HUEH (with 777 patients on

ART) and 2250 adult patients in care at HUJ (with 900 patients on ART).

ACTIVITY 1: I-TECH will continue its contract with UM to extend HIV care and treatment services in the

North Department and to consolidate HUJ as a Regional Center of Excellence for HIV Clinical Training.

Through a subcontract with HUJ to support hospital personnel, supplies, materials, and patient support

services, UM will extend HIV care and treatment to 4000 HIV infected adult patients, with 1200 patients on

ART. UM will provide on-going supervision within the Family Practice Center (FPC) at HUJ, the primary site

for outpatient HIV care, and will provide mentorship and leadership in coordinating program activities within

other units of HUJ, including preventive medicine service (PMS), which is responsible for community-based

care services and ART adherence support. UM will also plan, deliver, monitor, and evaluate HIV clinical

training for health care workers including: 11 family practice residents in a three-year residency program;

five residents (internists/ obstetrics & gynecologist [OBGYN]) through one-month rotations; basic HIV

training for 50 final year nursing students, 35 final-year laboratory technology students, and 80 medical

interns; a one-month rotation in collaboration with I-TECH for 10 generalist physicians enrolled in the HIV

care training program; a basic review course on HIV palliative care training for 10 providers in the North

Department; skills assessments and regular feedback to residents and advanced HIV clinical care trainees;

and an HIV training of trainers course on the National HIV Curriculum for 12 physicians/preceptors. UM will

also collaborate with I-TECH on a joint initiative for advanced HIV/AIDS clinical care training for nurses.

Finally, UM will continue to supervise 10 clinics within the North Department's HIV care referral network.

ACTIVITY 2: I-TECH will continue its contract with Cornell for placement of two resident technical advisors

at GHESKIO, a center responsible for training, on-site TA, and quality assurance (QA) to 14 ARV scale-up

sites in Haiti. One resident technical advisor will split his/her time 50/50 between the National Public Health

Laboratory (NPHL) and GHESKIO focusing on molecular biology and co-management of HIV/tuberculosis

(TB) and HIV/multidrug-resistant (MDR)-TB. The second resident technical advisor will dedicate

approximately 40% of effort to training of physicians from HUEH, and 60% of effort to training biomedical

personnel at GHESKIO. Cornell advisors will reinforce GHESKIO in addressing advanced HIV care issues

(resistance, adherence, chronic illnesses associated with greater survival, integrated care spanning adult,

pediatric and prevention of mother-to-child transmission [PMTCT] services), and in implementing new

laboratory technologies for surveillance of ARV and TB drug resistance in Haiti. Cornell will assist

GHESKIO trainers to improve HIV clinical training courses, will carry out monthly site visits with mobile

supervision teams, and will provide monthly in-service sessions for GHESKIO colleagues. Finally, the

Cornell advisors will provide technical expertise to the MOH in developing national care and treatment

guidelines, protocols, standard operating procedures and training curricula.

ACTIVITY 3: I-TECH will continue to lead improvements in quality of care and access to HIV services at

HUEH, through placement of nine full- and part-time HIV clinical mentors. I-TECH will support HUEH to

expand HIV services reaching 3600 patients in care with 1150 patients on ART. Clinical mentors will

complete patient rounds, chart reviews, and case conferences with residents, interns, and medical students

in the infectious disease unit and the pediatric unit of HUEH, with emphasis on ART management, TB/HIV

co-infection and prevention of opportunistic infections (OIs). I-TECH will also organize a mobile team to

provide clinical mentoring and assistance to remote sites. As part of this new clinical mentoring outreach

program, I-TECH will conduct mentoring of mentors (MOM) to expand the number of clinical mentors

working to improve the quality of services provided at six additional ART sites. I-TECH will establish a warm

line telephone service to provide expert clinical advice on HIV/AIDS management to health care providers

with limited access to on-site expert consultation for HIV/AIDS care and treatment. The warm line will

facilitate technical assistance to providers working in the field, thus nurturing regular communication

between senior mentors and providers.

I-TECH will produce several short trigger video segments on skills for quality clinical mentoring/practicum

training, in conjunction with facilitation materials. The "trigger" methodology presents brief open-ended

videos featuring real clinical scenarios or acted situations, and asks the viewer to respond. Usually

presented in a facilitated context, these videos will allow mentors to present scenarios to mentees, on video,

which are not encountered in their normal clinical rounds, and facilitate teaching by eliciting their reactions

or analysis of the video, and discussing them.

I-TECH will continue to collaborate with the Center for Information and Training in Health Administration

(CIFAS), an MOH training unit co-located at HUEH, to continue to provide three-week theoretical and

practical training sessions using the newly revised national ART curriculum for junior and mid-level

providers from throughout Haiti. These training sessions will be supplemented by I-TECH's global distance

Activity Narrative: learning initiative, which began in 2007 and provides cutting-edge case-based HIV clinical updates through

videoconference technology. To support professional development among lead trainers at HUEH, I-TECH

will sponsor nine people (both I-TECH clinical mentors and HUEH counterparts) to attend the annual I-

TECH Clinical Summit or another external study tour.

Through its partnership with HUEH, I-TECH will implement a six-month competitive advanced fellowship

course on HIV care and treatment for 10 general practitioners currently working at PEPFAR sites. Fellows

will spend mornings on the wards and in outpatient clinics managing HIV infected patients, including

patients with TB/HIV co-infection, and afternoons rotating through other services or in seminars related to

best clinical practice, management and leadership, quality improvement (QI) strategies, and other topics. I-

TECH will support a visit by Haiti staff to the successful I-TECH India/Tambaram Hospital fellowship

program.

ACTIVITY 4: I-TECH will continue its nursing initiative at HUEH, with the goals of enhancing the role of

nurses within the HIV care team through training advanced practice nurses in a 6-week intensive course.

Following training, these HIV-specialist nurses will be capable of providing primary clinical management of

stable HIV patients. I-TECH's two HIV nurse mentors will continue to collaborate with nursing supervisors at

HUEH to deliver theoretical training sessions on HIV patient management, patient education, nutrition, and

other topics and will supervised practical rotations in the HIV outpatient clinic and other services of HUEH.

As a joint initiative at HUEH, HUJ and the Collaborative Agreement Partner of the MOH, Plan National, I-

TECH will support expansion of this training program to reach 90 nurses. Participants will be drawn from

several scale-up sites in Haiti where I-TECH and Plan National mobile clinical mentoring teams have

established relationships for on-site supervision and follow-up technical assistance; at these sites, health

care human resources are lacking and nurses must step into a lead role in managing HIV patients. I-TECH

will fund partner UM to conduct a parallel program at HUJ in Northern Haiti, and will support two annual

exchange visits between leads of the two programs to share experiences and lessons learned. I-TECH

nurses will also continue to work with the leadership at HUEH to evaluate the role of nurses relative to care

protocols and patient flow patterns in order to optimize the level of nurse responsibility and improve patient

care, and will continue to support training of nursing students completing rotations at HUEH.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17232

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17232 5463.08 HHS/Health University of 7698 3142.08 ITECH $2,750,000

Resources Washington

Services

Administration

9343 5463.07 HHS/Health University of 5151 3142.07 ITECH $2,300,000

Resources Washington

Services

Administration

5463 5463.06 HHS/Health University of 3142 3142.06 ITECH $1,505,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* TB

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $1,000,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Orphans and Vulnerable Children (HKID): $350,000

SUMMARY:

In partnership with the non-governmental training center Institut Haitien de Santé Communautaire

(INHSAC), I-TECH will train at least 100 social workers, community health agents, community based

organizations (CBO) and non-governmental organization (NGO) staff, and community leaders from across

Haiti's 10 departments, using the standardized national OVC training package. I-TECH will also enhance

the training package with a drama or set of trigger films and job aids on OVC themes. I-TECH, INHSAC and

the University of Medicine and Dentistry of New Jersey's François-Xavier Bagnoud Center (FXB) will also

provide on-going technical assistance to 10 regional HIV/AIDS service organizations (ASOs) for institutional

development and leadership with respect to OVC services.

BACKGROUND:

In 2008, I-TECH contracted with FXB to develop a standardized orphaned and vulnerable children (OVC)

training package focused on: community mobilization to identify and refer OVC; psychosocial issues for

OVC by age, gender, and caregiver status (covering trauma, grief and loss, and self-esteem issues);

effective programmatic strategies to meet basic OVC needs (food/nutrition, shelter and care, protection,

human rights, health care, education, and economic support); creating effective community linkages with

faith communities, small business/micro-credit, and schools; and empowering caregivers and OVC peer

leaders. FXB and INHSAC collaborated to develop the training package with input and review by a number

of key stakeholders in Haiti including the following: Ministries of Health, Education and Social Affairs, Bethel

Clinic, World Relief, World Concern, Save the Children, Zanmi Lasante, Catholic Relief Services, World

Vision, PLAN Haiti, Family Health International, UNICEF, and Maison Arc-en-Ciel. INHSAC, with support

from FXB and I-TECH, utilized the standardized OVC curriculum to conduct 2 training of trainers (TOT)

sessions for 60 trainers from the above listed agencies and organizations.

ACTIVITY 1: I-TECH will supplement the national standardized OVC training package by producing a

drama or set of trigger films on OVC themes which can be used to shape attitudes and skills among

professional and volunteer "helpers" and caregivers. I-TECH will conduct an assessment to develop a

production plan appropriate to the training needs of the target audience. I-TECH will produce the video in

collaboration with a local video production company, Agence des Jeunes Producteurs, formed and staffed

by a video producer living with HIV/AIDS (PLWHA). AJP helped I-TECH produce the Creole-language ARV

drama Chans, and the stigma and discrmination trigger scenarios. I-TECH will participate in developing

scripts and story boards with stakeholders (including organizations working with OVC), and conduct target

audience focus groups on the final draft scripts or scenarios prior to filming, as well as audience testing the

edited video. This process will ensure that the final videos appropriately emphasize key messages, are

culturally relevant, and are appropriate to the Haitian context. I-TECH will develop a facilitation guide to

accompany the video(s), completing a video-based training module package of approximately 90 minutes

duration (videos and facilitated discussion), suitable for broad dissemination among partners.

ACTIVITY 2: I-TECH will contract with François-Xavier Bagnoud Center, UMDNJ (FXB) to enhance the

basic OVC training package through the development of additional training support tools. These may

include handouts, posters, and support tools that distill the content of the curriculum and serve as an

enduring resource for end users of the training to support day-to-day activities with OVC. The selection of

tools to be developed will be determined through pilot testing and evaluation of the curriculum, followed by a

needs assessment with trainers and end users to determine how best to enhance the learning objectives

and provide ongoing support for trainees. The draft tools will be reviewed by a core group of the already-

established OVC Advisory Group (AG). The finalized tools will be translated into Creole for ease of

distribution and use.

ACTIVITY 3: I-TECH will contract with training partner INHSAC to continue to conduct regional trainings

using the standardized OVC training package, reaching social workers, community health agents, CBO and

NGO staff, community leaders, and OVC and caregiver peer educators in each department. The I-

TECH/FXB OVC training specialist will reinforce the INHSAC training team in planning, delivering, and

evaluating the trainings. Evaluation will include checklists and matrices to support INHSAC in tracking the

roll-out of the OVC curriculum and assessing its effectiveness in preparing community workers for OVC

care. The training team will deliver OVC training using the standardized package reaching at least 100

participants from across Haiti's 10 departments. The training team will also collaborate to provide quarterly

follow-up technical assistance visits to the main regional HIV/AIDS ASO in each department, with coaching

in effective strategies to identify and serve OVC. With other stakeholders, including various Ministries and

UNICEF, I-TECH will co-sponsor an annual conference on OVC issues to share best practices in serving

this population. This strategy will link with I-TECH's efforts in institutional development of community-based

palliative care services. The departmental training sessions, the quarterly coaching visits, and the annual

conference will support departmental ASOs to develop as strong regional organizations with programmatic

expertise in OVC issues, capable of building linkages with caregivers and community groups to nurture the

healthy development, education, economic support, and social support for this most vulnerable population.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17229

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17229 12420.08 HHS/Health University of 7698 3142.08 ITECH $750,000

Resources Washington

Services

Administration

12420 12420.07 HHS/Health University of 5151 3142.07 ITECH $250,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Increasing women's access to income and productive resources

* Increasing women's legal rights

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $300,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

Funding for Testing: HIV Testing and Counseling (HVCT): $700,000

SUMMARY:

I-TECH will maintain a subcontract with the Institut Haitien de Santé Communautaire (INHSAC) to continue

implementing training in voluntary counseling and testing (VCT) (including rapid testing) and psychosocial

support services for 300 health workers throughout Haiti. With technical assistance from I-TECH on tools

and curriculum development, INHSAC will also train and support a network of personnel to provide

supportive supervision to VCT providers.

BACKGROUND:

During 2004 -05, I-TECH supported INHSAC to develop an HIV counseling curriculum covering VCT, anti-

retroviral therapy (ART) adherence, stigma and discrimination, changing male norms and behaviors for risk

reduction, counseling of victims of sexual abuse and violence, couples counseling, and other areas (key

legislative interest areas). In 2004-07, INHSAC completed a training of the trainer (TOT) sessions for its

trainers, and delivered multiple training courses including: 1) a one-week course on pre- and post-test

counseling and rapid HIV testing for health care workers from VCT scale-up sites; 2) a two-week in-depth

course on integrated HIV counseling for counselors, social workers , psychologists, and other personnel

responsible for psychosocial support programs in clinic and community-based settings; and 3) a two-week

preventing mother to child transmission (PMTCT) course for providers at PMTCT scale-up sites. INHSAC

collaborated with the National Public Health Reference Library (LNSP) for experienced laboratory trainers to

deliver the rapid testing portion of training during the one-week VCT courses. In 2008, INHSAC hired a lab

trainer to deliver this portion of the training in order to develop its own capacity to directly provide rapid test

training. As INHSAC assumes responsibility for this portion of training, the LNSP continues to partner with

INHSAC in a quality assurance role. In 2008, INHSAC continued to implement VCT, in-depth counseling,

and PMTCT courses. By March 2009, INHSAC will have initiated a supportive supervision program, to

reinforce counseling skills among past trainees. INHSAC will have developed standardized supervision

tools and implemented a curriculum with 10 supportive supervisors in counseling, covering quality

standards, supervision skills, motivating staff, documenting feedback, handling stress and burn-out, and

other areas.

Activity 1: I-TECH will continue collaborating with INHSAC to plan, deliver, monitor, and evaluate VCT

training, including rapid testing, for 200 health workers in clinic and community-based VCT settings. I-TECH

will support INHSAC to improve the curriculum based on lessons learned from training evaluations and

feedback from previous implementations of the trainings. INHSAC will continue to collaborate with the

Laboratoire National de Santé Publique (LNSP) as it provides quality oversight of rapid testing training and

applies quality assurance/quality control protocols at trainee sites.

Activity 2: INHSAC will provide in-service training (a two-week course) on in-depth psychosocial support to

PLWHA and their families for 100 psychologists, social workers and other key personnel from clinic and

community-based care and treatment programs. This two-week training will be extended to three-weeks

with a one-week practicum at Hôpital de l'Université d'Etat d'Haiti (HUEH). This curriculum includes content

related to U.S. Legislative interest, stigma and discrimination and reducing violence and coercion.

Activity 3: INHSAC will train 50 PLWHA as lay counselors to address ART adherence issues and post-test

counseling; once trained, these lay counselors would be eligible to work as paid staff within Haiti's various

ART programs. I-TECH will provide technical assistance on curriculum development, including instructional

design, document production, pilot evaluation, and clinical review. This activity relates to U.S. Legislative

interest. It will generate income and increase educational access for PLWHA. Recruitment and training of

the lay counselors will be done in close cooperation with the sites in which they will be working.

Activity 4: INHSAC will continue to implement its supportive supervision program for counselors. The

program goal is to involve a group of approximately 30 HIV counseling trainees (three per department), who

demonstrated excellence and leadership during training. Following training as supportive supervisors, these

personnel visit trainee sites, observe their peers in practice, provide supportive feedback, and report to

INHSAC on their finding using standardized forms. Prior to including candidates in the supportive supervisor

training, INHSAC coordinates with employers to release the relevant personnel during one-week per quarter

to provide supportive supervision sessions to other trainees. INHSAC provides planning and coordination of

supportive supervision sessions, and provides output-based stipends and travel expenses for the supportive

supervisors. INHSAC will make at least two site visits per department to oversee the program, and will

convene the group on a semi-annual basis to identify commonly-observed problems and strategies for

improvement. This program will result in at least one supportive supervision session per trainee following

the training.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17231

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17231 12424.08 HHS/Health University of 7698 3142.08 ITECH $900,000

Resources Washington

Services

Administration

12424 12424.07 HHS/Health University of 5151 3142.07 ITECH $400,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $400,000

SUMMARY:

The bulk of I-TECH activities will be continuation of customization and deployment of a laboratory

information system (LIS) within the network of USG-supported ART sites. I-TECH also has a lead role in

promoting training and retention of laboratory professionals through development of pre-service curricula for

medical technologists, supporting in-service training, and a strong collaboration with the Haitian Association

of Laboratory Professionals.

BACKGROUND:

In 2007, I-TECH initiated the process of identifying an appropriate LIS for Haiti. In collaboration with a

laboratory information specialist from CDC Global AIDS Program, I-TECH reviewed with stakeholders the

process of requirements gathering and the LIS selection process following the APHL Guidebook for LIS

Implementation in Resource Poor Settings. In December 2007, I-TECH posted a Request for Information

on limsfinder.com to explore and evaluate commercial and open source LIS options. Criteria for evaluation

included functionality, flexibility and customization to meet Haiti's priority needs, opportunity for local

partnership and capacity development, and cost. A national consensus meeting including representatives of

the NPHL, CDC/Haiti, and I-TECH was held in March 2008. The decision was made to pursue adaptation

of OpenELIS, an open source product that can be customized to meet the unique needs of Haiti's clinical

laboratories and NPHL. OpenELIS has already been implemented in Vietnam using PEPFAR funds.

Beginning in March 2008, I-TECH provided technical assistance to NPHL in collaboration with CDC to

develop, print, and disseminate nationally standardized paper-based tools for laboratory information

management. Such tools are needed to support best practices in management of lab information and to

improve efficiency at sites, which in many cases use improvised hand-written lab order slips, lab results

forms, and results registers/notebooks. I-TECH supported training of laboratory personnel on the use of

these tools. Importantly, these paper tools also lay the foundation for development and roll-out of the

electronic LIS, both by standardizing data management processes among clinical labs prior to adoption of

an electronic system, and informing the OpenELIS development team on how to automate these laboratory

workflows.

By March 2009, I-TECH will have developed a standardized curriculum on LIS, have a pilot-ready version of

the Haitian version of OpenELIS, and support pilot testing of this system in 4 clinical laboratory sites and at

the NPHL. The pilot phase of LIS implementation will include ensuring site readiness through hardware and

software installation, providing user training, incorporating feedback and recommendations for continuous

improvement, and planning for rollout to 10 additional departmental reference hospital sites. I-TECH will

also develop an interface for data exchange between OpenELIS and the national MSPP HIV Electronic

Medical Record (iSanté). I-TECH has worked closely with CDC and MSPP since 2005 to develop and

implement the iSanté system, used by 41 sites with records for approximately 24,200 patients as of July

2008.

I-TECH is committed to supporting laboratory professionals in Haiti. In 2007, I-TECH hosted a 10-week

course through the University of Washington's Laboratory Technologist Training Program for 4 Haitian

laboratory professionals from NPHL to attend training on use and maintenance of the PointCare automated

CD4 analyzer. I-TECH also provided technical assistance to develop and deliver a laboratory equipment

maintenance course to be integrated into the standardized pre-service laboratory curriculum. By March

2009, I-TECH will have sponsored an additional 8 laboratory personnel from Haiti to attend 2 study tours; 1

focused on laboratory management and the other on laboratory equipment maintenance and use.

ACTIVITY 1: I-TECH will continue collaboration with CDC/Haiti, CDC/GAP Atlanta, and Haiti MSPP to

implement OpenELIS in a total of 14 sites by March 2010. I-TECH is diligently working to ensure that at

least 3 clinical labs of the initial 5 pilot sites (4 clinical labs plus NPHL reference lab) will "go live" by March

2009. Adaptation of OpenELIS to meet the specific needs of NPHL will be a critical component of this task.

Among the unique business processes of the NPHL that go beyond requirements for the clinical labs are:

statistical analysis and surveillance, training and resource management, and national level laboratory

reporting. Equally important, I-TECH will design and develop an interface between OpenELIS and iSanté to

enable efficient, electronic data exchange. Another long-term objective will be interfacing the systems with

the national pharmaceutical data management system.

Through on-going partnership with the University of Washington's Clinical Informatics Research Group and

expert consultants, I-TECH will continue to collect and incorporate user feedback from the initial sites to

improve the system for replication throughout Haiti. I-TECH will ensure procurement and installation of

necessary hardware (servers, backup power supplies, local area networks, etc.) for new implementation

sites, in collaboration with CDC's Regional Information Officers (RIOs) and site personnel. I-TECH will

maintain the LIS implementation support of 4 in-country staff members (1 part-time health information

system manager, 1 part-time laboratory advisor, 1 information technology advisor, and 1 full-time LIS

trainer).

In close collaboration with NPHL, I-TECH will develop a training of trainers (TOT) module on OpenELIS

functionality along with a user manual, and provide technical assistance for delivery of this TOT to

departmental level laboratory technologists. These departmental laboratory technologists will be responsible

for the training and oversight of clinical lab technologists on the use of OpenELIS. I-TECH staff will provide

follow-up observation of trainers and further on-site training assistance for successful use of the system.

Training and technical assistance will emphasize use of OpenELIS to improve quality of lab services and to

aid decision-making for lab program management. I-TECH will be responsible for developing and

disseminating SOPs for specimen tracking and results reporting.

ACTIVITY 2: I-TECH will continue to promote the laboratory technician profession in Haiti through a

partnership with the Haitian Association of Laboratory Professionals. I-TECH will provide technical

assistance and funding to the Association to develop and disseminate a quarterly newsletter and to host an

annual conference. The goal of both activities will be to provide scientific updates and to instill a culture of

professional excellence. I-TECH will assist the Association to sponsor an award for professional

Activity Narrative: excellence, with a structured application and selection process. Donations of laboratory equipment will be

made to the 2 national laboratory schools in honor of the awardees.

To ensure achievement of a major aim of the National Lab Strategic Plan, I-TECH will continue to take the

lead in standardizing pre-service curricula for the medical technologist training programs at the 2 public

national laboratory schools in Haiti. The focus has been on establishing a 3 year diploma curriculum, but

the National Plan calls for a transition into a 4 year BS degree program. I-TECH will also support other

partners engaged in delivery of in-service training (eg, assist ASCP with rollout of the Basic Lab Operations

Training to all 10 Departments in Haiti).

ACTIVITY 3: I-TECH has played a key role in supporting the NPHL in establishing its 5 year Lab National

Strategic Plan (2008 - 2013). As of October 2008, endorsement of the lab strategic plan by stakeholders is

in its final stages. Fulfillment of this goal is a major milestone, as it is considered high priority by the

CDC/GAP International Laboratory Branch and the PEPFAR Laboratory Technical Working Group. A

strategy needs to be in place to ensure that elements of the plan are actually implemented according to a

defined timeline. A key component of the National Plan is to develop a rigorous monitoring and evaluation

protocol. I-TECH is uniquely qualified to serve as NPHL's primary partner in coordinating these M&E

activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17233

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17233 3886.08 HHS/Health University of 7698 3142.08 ITECH $535,000

Resources Washington

Services

Administration

9340 3886.07 HHS/Health University of 5151 3142.07 ITECH $544,000

Resources Washington

Services

Administration

3886 3886.06 HHS/Health University of 3142 3142.06 ITECH $1,000,000

Resources Washington

Services

Administration

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $5,400,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

The Health information system in Haiti has reached a turning point whereby sufficient progress has been made with regard to its

HIV/AIDS component to uplift the others. In less than five years the HIV/AIDS information system has gotten off the ground to lay

a foundation, which is now serving as a diving board for a complete overall of the HMIS. Indeed, the dynamic which has played for

the standardization of HIV indicators at the inception of this program is spilling over into other areas. Lessons taken away from the

HIV program are now helping to carry out a similar process for the overall HMIS. Some of the data collection reporting and

monitoring tools developed for this program, such as prenatal and maternity registers are helping to fill existing data gaps in

maternal care. The patient medical record developed for the monitoring of AIDS cases is now being adapted to generate a chart

for the monitoring of pregnant women. The infrastructure developed to support monitoring, reporting and surveillance for HIV are

now being tapped to revitalize the same functions in other areas. The best illustration comes from the fact that the post-disaster-

surveillance system put in place on the heels of the recent hurricanes is being supported by field data personnel and makes use

of IT infrastructure supported by this program. The M&E training curricula supported by this program incorporates notions and

applications that can easily be adapted to other areas; and the training sessions are attended by all types of health workers.

Nonetheless, several pieces remained to be put in place for the system to become fully inclusive, and perform at a level where

quality can be completely guaranteed and where data can be made readily available in desired formats to allow evidence based

decisions across the board. The main challenges lie in the development of capacity to: integrate the HIV system into the overall

HMIS; perform seamless routine data validation; monitor and evaluate effectively various emerging components of the HIV

program such as OVC, nutrition, PMTCT, CBO activities; establish close linkages between community-based and facility based

information systems; facilitate data exchange among the multiple electronic applications developed by the HIV program; expand

surveillance to specific groups such as the MARPS, and pregnant women; map out supply of services .

The plan in FY09 is to leverage existing capacity of the USG team and the partners to take on those challenges and ensure that:

() all facility-based and community-based point of services have access and use the data collection, and reporting tools

countrywide () in service and pre-service training are available to capacitate health professionals to perform their data functions ()

reports and analysis can be generated and data used to inform decision making. The following are specific activities to achieve

those overarching goals. The USG team staff is currently constituted by 1 SI liaison and 5 regional officers detailed to backstop

implementation of SI activities on the field. A new position will be added to assist with M&E activities, surveillance and behavioral

surveys. Tulane University will continue to hold its 101 M&E training sessions and will add this year an intermediate course,

through which it will be possible for trainees to integrate in their practicum M&E studies designed for the program and constitute

the manpower to carry out these studies. ITECH which has developed the Electronic Medical record (EMR) will initiate the

process of adapting it to serve patient data management needs in primary care settings to include both HIV-infected and non HIV-

infected patients. This move is expected to ease up surveillance and seal the integration of HIV into the overall HMIS.

SOLUTIONS, a local firm which has developed the web-based aggregate reporting system (MESI) through which HIV reporting is

being carried out, will work with the three implementers of Electronic medical record on a data exchange program to harness the

massive amount of individual data collected on 73 % of patient in care in the country to generate surveillance data. JSI-

MEASURE will ensure the full scale roll out of the community based information system, which is currently being piloted on a

selected number of sites. NASTAD will continue to provide technical assistance and training for surveillance, case notification,

along with the integration of HIV into the HMIS. SCMS will upgrade its application for drug management to allow the

interconnection with other applications such as the EMR and MESI. It will also complete the development of its Program

management System built with the idea of giving to the USG and Global Funds partners a tool for planning, management and

coordination of their activities. The MOH will continue to ensure the role that it has started to play since last year with regard to

data validation, supply of data collection and reporting tools.

Table 3.3.17:

Funding for Strategic Information (HVSI): $800,000

SUMMARY:

I-TECH will support extension of the MOH electronic medical record (iSanté) system for data management

and reporting on HIV care services, and initiate adaptation of iSanté for primary care. I-TECH will continue

targeted program evaluation on transfer of learning following in-service training of physicians at HUEH, and

on process and outcomes of a curriculum strengthening and faculty development process at the four

national nursing schools. I-TECH will initiate targeted program evaluation on transfer of learning following

pre-service training of psychologists and social workers at FASCH.

BACKGROUND:

Beginning in 2005, I-TECH collaborated with MOH, CDC, and other partners in the development of a

standardized set of paper-based adult and pediatric HIV medical record forms. I-TECH then launched a pilot

version of the electronic medical record (EMR) system, and built in enhancements through successive

release versions. As of July 2008, 41 ART sites in Haiti had begun to use the system, with data for more

than 24,200 patients. The system is designed for flexible use, with ability to use the system via the web or

through hosting on a local server. It includes an automated replication function so data from sites hosting

the system on local servers are replicated to a central back-up server. The central back-up server provides

access to de-identified data for national program reporting. As of July 2008,13 clinics were using the system

through local servers, meaning they could use the system without being dependent on sporadic internet

connections. I-TECH and CDC continue to support further deployment of the system on local servers.

I-TECH has reorganized and improved user interface of iSanté. By March 2009, I-TECH will have identified

methods for data exchange between the EMR and several other information tools in Haiti: a laboratory

information system (LIS) currently under development; the pharmacy information tool supported by Supply

Chain Management Systems (SCMS); and the MESI system for presentation of aggregate health program

data. The interfaces will minimize duplication of effort by site personnel in managing patient information and

reporting.

Since 2005, I-TECH has collaborated extensively with local partners, such as CDC, Institut Haitien

d'Enfance (IHE), and HUEH to provide training on use of the EMR system to clinicians, data clerks and data

managers. I-TECH's HIV clinical mentors train fellow clinicians on the relevance of complete patient data for

quality HIV care, on appropriate use of the medical record, and on how to interact with the EMR system to

obtain summary information useful for patient care. I-TECH's iSanté team provides training to data

management personnel through workshop-based and on-site training, supports configuration and

installation of local servers, and provides other computer maintenance support at sites using the system. I-

TECH has also initiated development of a standardized, national training curriculum on data management

and the EMR system.

With existing I-TECH staff and consultants and in partnership with CDC Regional Information Officers

(RIOs), Tulane UTAP, and others, I-TECH is focusing on reinforcing data quality and data completeness

among users of the system, through system modifications, training and on-site technical assistance. I-TECH

supports data analysis and dissemination of findings on key questions of interest. For example, iSanté is

reporting on quality of care indicators as defined and utilized by MOH and HIVQUAL, and I-TECH is

collaborating with MOH and WHO to analyze early warning indicators for ARV drug resistance.

As of March 2009, iSanté will include VCT and PMTCT modules to support improved continuity of care for

patients identified as HIV positive, as well as more efficient data management and reporting for VCT and

PMTCT programs.

ACTIVITY 1: I-TECH will initiate the process of adapting iSanté to serve patient data management needs in

primary care settings to include both HIV-infected and non HIV-infected patients. This process will begin

with primary care site evaluations to determine the top priority and high impact functions of primary care

data management. Following the assessment, I-TECH will collaborate with key stakeholders within the

MOH and CDC to establish a software development and implementation plan to include primary care

standardized paper form development, pilot testing, evaluation and national validation of the paper forms,

development of a training module on use of the paper forms, and delivery of training at the 10 departmental

level hospitals in conjunction with paper form dissemination. The paper forms will inform development of the

modified primary care version of iSanté, which will be ready for implementation by March 2010.

ACTIVITY 2: I-TECH will engage key stakeholders and provide technical assistance on the development of

a minimum-data-set version of the medical record and EMR application for HIV patient care. This

enhancement will allow decentralized satellite care sites to interact with the national network and patient

data system. I-TECH will work with MSPP and other partners to identify and implement cost-effective

innovative technologies for incorporation of these sites (for example, through off-site data entry, use of

mobile phone technology for relay of data, or use of mobile computers to periodically capture data from

sites). I-TECH will develop training modules on the minimum-data-set version and deliver training for 60

personnel from decentralized care sites.

ACTIVITY 3: In collaboration with HIVQUAL, WHO and MESI, I-TECH will continue to strengthen data

management and data analysis capacity in Haiti. The I-TECH team will assist the MOH to refine protocols

for data quality assurance at site, regional, and national levels and provide technical assistance to the MOH

and key partners such as IHE to apply these protocols. I-TECH will also provide leadership on using iSanté

data for patient- and program-level decision-making, through analysis of patient health outcomes related to

HIV treatment programs. I-TECH will continue to incorporate user feedback from clinicians, administrators,

and other iSanté users to modify system features in iterative design and development cycles.

ACTIVITY 4: Through regular training site visits, the I-TECH team will orient clinic users on new system

features and optimal use of the system at their sites. I-TECH will also continue to collaborate with CDC,

IHE, Tulane University, and other partners to provide training to users at all existing and newly established

iSanté sites. I-TECH will reinforce IT support for the iSanté system including on-site and remote training and

support for hosting the application on local servers, supporting replication of data to the central data

Activity Narrative: repository, executing regular system maintenance functions, and making minor modifications of the EMR

application to meet changing local needs. I-TECH will sponsor and conduct an in-depth workshop at I-

TECH/UW to teach about the iSanté software system, the data model, reporting and data access, and

backup and maintenance procedures (how to rebuild servers, reinstall software reload data from backup,

and other failure recovery strategies).

ACTIVITY 5: I-TECH will complete development of a standardized, national curriculum on data

management and the EMR system, as well as an improved and updated user manual for the system to

support training activities. I-TECH will support adaptation and implementation of the curriculum for pre-

service and in-service training for personnel working in VCT, PMTCT, ARV, and non-ARV (palliative care)

settings, including clinicians, social workers and psychologists, and data management personnel. I-TECH

will support training on the MOH"s National Health Data Management (HSIS) system. I-TECH will develop

and implement a TOT for MOH and partner training staff with the goal of increasing capacity for delivering

high-quality and technically sound training.

ACTIVITY 6: I-TECH will undertake a targeted program evaluation measuring transfer of learning among

residents, junior, and mid-level physicians trained at HUEH. Evaluation of transfer will address whether

learners apply skills to the workplace, measuring training outcomes. Training participants will be contacted 6

-12 months after participating in training. Methods may include observation of providers by trained mentors,

a follow-up survey of trained providers, or patient exit interviews. This will yield valuable information about

the quality of the training program and the conditions necessary for transfer of learning into practice.

ACTIVITY 7: I-TECH will conduct a second targeted program evaluation on the process and outcomes of

the integration of HIV/AIDS into the curriculum of the five national nursing schools (ENI). A standardized

student knowledge assessment based on core competencies and reflective of the new HIV/AIDS content

will be developed and used to collect baseline data from nurses currently completing degrees at the ENI.

During the implementation of new HIV content in the curriculum, I-TECH will work with the ENI faculty and

administration to systematically monitor the changes made to methods, materials, and content, and student

and faculty reactions to these changes. This information will be used to document lessons learned and

recommendations for improvement in the curriculum and teaching. Each cohort of nursing students will be

assessed as they complete the program. Student exam results will be compared over time, and triangulated

with process evaluation data on implementation of the curriculum. I-TECH proposes to conduct follow-up

observational assessments of nursing skills in practice among recent graduates after 2 and 4 years, to

identify outcomes of the initiative.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17234

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17234 3910.08 HHS/Health University of 7698 3142.08 ITECH $700,000

Resources Washington

Services

Administration

9341 3910.07 HHS/Health University of 5151 3142.07 ITECH $550,000

Resources Washington

Services

Administration

3910 3910.06 HHS/Health University of 3142 3142.06 ITECH $360,000

Resources Washington

Services

Administration

Emphasis Areas

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $400,000

SUMMARY:

I-TECH will continue working with Haiti's public-sector schools for health professionals (medicine, nursing,

laboratory, social sciences, pharmacy, and dentistry) to integrate HIV/AIDS-related content into

standardized curricula, to build teaching capacity through faculty development activities, and to develop

standardized student evaluation tools and processes based upon mastery of core competencies. I-TECH

will collaborate with the Université d'Etat d'Haïti to develop and integrate a basic HIV/AIDS course for all

freshmen students. I-TECH will also develop the capacity of the Ministry of Health (MOH) to guide health

worker training programs in HIV care and treatment. Geographic coverage area of this activity includes Port

-au-Prince/West Department, Les Cayes/South Department, and Cap Haitien/North Department.

BACKGROUND:

In 2005-2006, I-TECH launched curriculum development processes with Haiti's professional schools in

nursing, medicine, social sciences, and laboratory. This work involved close collaboration with the MOH. In

2007-2008, I-TECH launched a guide for integration of HIV content into the four-year nursing curriculum,

including competencies, learning objectives, and supporting content. I-TECH held a faculty development

training of trainers (TOT) for first-year nursing school faculty, aiming to support integration of HIV content

and improve faculty teaching skills.

By March 2009, I-TECH will have conducted a TOT for laboratory instructors from the two national

laboratory schools, and implemented a pilot and evaluation of the newly developed first year laboratory

technician curriculum. I-TECH collaborated with the Faculté de Sciences Humaines (FASCH) to incorporate

culturally relevant materials on OVC into the required curriculum for psychology and social work students.

For medical school faculty and students, I-TECH supported the installation of an electronic resource library

at the Faculté de Medecine. I-TECH also implemented a TOT for 80 trainers within the MOH.

In 2007-08, the MOH validated the national ARV/OI curriculum, developed by I-TECH in partnership with

local content experts. I-TECH disseminated the curriculum in print and electronic formats, and carried out a

"Teachback" TOT course for trainers from key HIV clinical training institutions in Haiti. I-TECH also

disseminated several Creole-language training videos in partnership with the MOH, including stigma and

discrimination trigger scenario, and a 40-minute drama on ART (Chans). By March 2009, I-TECH will have

revised the national ART curriculum to include new, updated content, disseminated the revised materials,

and conducted additional TOT; it is anticipated that 300 health care providers from Haiti's 10 departments

will be trained.

The above-mentioned activities are part of I-TECH's global strategy for decentralization of curriculum

development capacity to country offices, health ministries, and other in-country partners. In 2007, I-TECH

hired an in-country training manager to be mentored by the Seattle-based Training Development Team

(TDT) and, in turn, to lead mentoring of I-TECH Haiti curriculum development staff and MOH counterparts.

In 2008, I-TECH hired a curriculum developer and funded INHSAC to hire a curriculum developer to further

transition capacity to Haiti, with technical assistance from the Seattle-based TDT. I-TECH continues to

engage the MOH in the formative development and final validation of all I-TECH training products.

ACTIVITY 1: In partnership with the medicine curriculum working group, I-TECH will finalize the integration

of HIV/AIDS content into the curriculum of at least one nationally recognized school of medicine, and

conduct pilot evaluation of the use of the new content. I-TECH will continue to host quarterly faculty

development workshops and provide continued support for the electronic resource library installed at the

Faculté de Medecine.

ACTIVITY 2: I-TECH and INHSAC will collaborate to continue to provide mentoring of nursing school faculty

through three one-week visits to each of five nursing schools and the national school of midwifery, to assure

successful use of HIV curriculum material as well as teaching and assessment techniques. Additionally,

INHSAC will deliver two faculty development sessions aiming to improve teaching skills of 40 nursing faculty

members. I-TECH will continue to facilitate a working group to develop and validate standard student

evaluation tools and processes, linked to graduation requirements. The evaluation tools will use a

competency-based framework and will be closely tied to learning objectives. I-TECH and INHSAC will

continue the year-by-year integration of HIV content into the nursing school curriculum, and INHSAC will

deliver a TOT for instructors of the third year curriculum. I-TECH will support and evaluate implementation

of the third year nursing curriculum while developing the fourth year curriculum. INHSAC will develop and

deliver two faculty development TOT sessions for third-year nursing faculty.

ACTIVITY 3: I-TECH will collaborate with FASCH to ensure validation and dissemination of the revised

social science curriculum, provide faculty mentoring, and assist to develop and validate student evaluation

tools that include HIV-related competencies. I-TECH will also assist FASCH faculty to continue to revise

content for a university prerequisite social sciences course which addresses: HIV/AIDS transmission,

prevention, stigma, gender, and testing and treatment issues. The goal of this core course is to broaden

access to state of the art HIV/AIDS training resources and to shape the knowledge and attitudes of future

opinion leaders in Haitian society.

ACTIVITY 4: In partnership with the laboratory curriculum working group, I-TECH will evaluate

implementation of the first year basic-level lab curriculum, and finalize a revised, standardized year two

curriculum which harmonizes training programs and student evaluation standards of the two national

laboratory schools for the basic-level laboratory professionals. I-TECH will continue to host quarterly faculty

development workshops to address key competencies for laboratory educators. To facilitate successful

delivery of the new courses added to the laboratory curriculum, I-TECH will provide resources to support

recruitment of teachers for the national laboratory schools.

ACTIVITY 5: In partnership with local universities and teaching institutions, I-TECH will continue to work on

the development of a competitive one-year program for students who have successfully completed the

basic-level laboratory training. This one-year program will be the final year of a new four-year bachelor

degree curriculum for advanced laboratory professionals intended to expand the pool of highly skilled lab

personnel in Haiti. The curriculum will include theoretical and practical components, and will be piloted at

the national laboratory school in Cap Haitien.

Activity Narrative: ACTIVITY 6: I-TECH will convene curriculum working groups in for the pharmacy, dentistry and ethnology

schools to launch the process of integrating HIV content into their programs and support for faculty

development activities, including a TOT to support strong teaching skills.

ACTIVITY 7: I-TECH will continue to provide technical assistance to the Training Cluster within the MOH

Coordination Unit for AIDS/TB/Malaria on developing standardized HIV/AIDS clinical training materials,

TOT, and monitoring and evaluating training. I-TECH will conduct a follow up on the TOT "Teachback" to

ensure the proper utilization of the methodology by the participants and reinforce their capacity through

refresher training if needed.

ACTIVITY 8: I-TECH will initiate training and technical assistance for national roll out of the Training System

Monitoring and Reporting Tool (TrainSMART), I-TECH's open-source, web-based training data collection

system. TrainSMART will allow users, including all PEPFAR-supported training organizations in Haiti, to

accurately track training, trainer and trainee data in a consistent manner. Additionally, TrainSMART has a

reporting module that allows users to run various automatic reports, as well as create and save customized

reports that can be run at any interval. TrainSMART will facilitate planning, monitoring and reporting on

training outputs at the departmental and national levels.

ACTIVITY 9: I-TECH will provide funding and technical assistance to establish a regional HIV clinical

training center (RTC) in the South Department. Following launch of the RTC, I-TECH will provide quarterly

visits to mentor local trainers in delivery of high-quality didactic, skills-building, and clinical practicum

training.

ACTIVITY 10: I-TECH will work with various local medical associations to adapt a curriculum for training

healthcare providers working in the private sector. The goals of delivering this training are to reinforce

capacity within the private sector to provide quality care to HIV patients, and to foster a broader network of

clinicians who have received state of the art training in HIV/AIDS care and treatment.

ACTIVITY 11: In 2008, INHSAC and I-TECH conducted a training needs assessment for Disease Reporting

Officers (DRO) and Site Managers (SM) of ART scale-up sites. Based on this assessment, INHSAC and I-

TECH collaborated to develop a leadership and management curriculum to build DRO and SM capacity in

team building, monitoring and evaluation, budgeting and computer literacy. In 2009, INHSAC will provide

this training for 25 DRO and SM from Haiti's 10 departments.

ACTIVITY 12: I-TECH will continue to disseminate and monitor use of the stigma and discrimination trigger

scenario, including adaptation and implementation of TOT developed by the CHART network on training

using the scenarios. I-TECH will continue to integrate the scenarios into its training curricula and activities,

and will advocate and support their use in MOH and partner training.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17235

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17235 4617.08 HHS/Health University of 7698 3142.08 ITECH $715,000

Resources Washington

Services

Administration

10240 4617.07 HHS/Health University of 5151 3142.07 ITECH $800,000

Resources Washington

Services

Administration

4617 4617.06 HHS/Health University of 3142 3142.06 ITECH $0

Resources Washington

Services

Administration

Table 3.3.18:

Subpartners Total: $0
University of Miami: NA
Rutgers New Jersey Medical School: NA
Cornell University: NA
Cross Cutting Budget Categories and Known Amounts Total: $1,900,000
Human Resources for Health $200,000
Human Resources for Health $1,000,000
Human Resources for Health $300,000
Human Resources for Health $400,000