Summary

The University of Western Cape is implementing multiple activities aimed at improving human capacity

development to address HIV and AIDS in South Africa.

BACKGROUND

The 2004 report of the Joint Learning Initiative on health human resources states that "after a century of

most spectacular health advances in human history, Human survival gains are being lost because of feeble

national health systems. The HIV and AIDS emergency has undoubtedly contributed to this problem,

particularly in South Africa. The pressure on health care workers is immense and with the crisis of attrition

and out-migration of personnel, systems in South Africa are challenged as never before. This has been

placed in stark relief by the urgent need to respond to HIV and AIDS epidemic, and especially the current

imperative to deliver antiretroviral therapy (ART) to large numbers of sick people who are often living in

areas where health systems have been poorly developed. This project focuses on strengthening and

expanding the development and implementation of comprehensive HIV and AIDS prevention in South Africa

in order to mitigate the impact of the HIV and AIDS epidemic. The emphasis area for these activities is

human capacity development, training, including pre-service and in-service training for nurse midwives.

The primary target groups for these activities include nurse midwives and community healthcare workers in

the public sector. Secondary target groups include HIV positive pregnant women and their infants.

ACTIVITIES AND EXPECTED RESULTS:

There are tw0 0eparate activities in the PMTCT program area.

ACTIVITY 1: Improving the quality of community health worker programs for the delivery

The use of community health workers, such as lay counselors to support the delivery of HIV and AIDS care

in communities is becoming increasingly common in South Africa. The National Department of Health

(NDOH) has introduced a national community health workers policy framework in 2003 which unifies and

regulates initiatives in this regard. This project aims to develop an audit tool to assess the implementation

of CHW programs in the country using PMTCT as an example. The tool will be piloted in one urban and

one rural sub-district and feedback will be disseminated via a workshop to the NDOH and corresponding

PDOHs where the piloting occurred. The project will begin with a series of workshops with policy makers

and program implementers in two provinces, and national experts to define the scope and key components

of the tool. This will be followed by the development of the tool, during which time further consultation with

stakeholders will take place.

ACTIVITY 2: Training nurse mid-wives in community-based PMTCT

Nurses and midwives are a backbone to the health system and are major role players in the delivery of

quality health services, especially in the context of maternal and child health services. With HIV and AIDS

the most common primary cause of maternal ad child deaths in the country, this puts a challenge onto the

already depleting MCH health services and to heath care providers, the midwives. The overall aim of this

project is to build capacity through the training of midwives in the prevention, management and integration

of PMTCT into maternal and child health services in a rural district in the Western Cape. The school of

nursing, UWC, will develop a training program targeting midwives managers/supervisors at health facilities,

qualified midwives at primary health care/community health centers and midwives trainees (within

undergraduate and postgraduate studies). Midwives implementing PMTCT at primary health care will

mentor the midwifery trainees. The midwives managers/supervisors will be responsible for conducting

training and implementing the train-the-trainer skills education program for the MCH facility manager on

integration of PMTCT into MCH services.

The above mentioned activities contribute to the PEPFAR 2-7-10 indicators by ensuring skills development

for community health workers and nurse midwives implementing PMTCT services. The development of

skills for this cadre of health care workers will insure implementation of quality PMTCT services, hence

reducing vertical transmission and pediatric AIDS.

Summary

The University of Western Cape is implementing multiple activities aimed at improving human capacity

development to address HIV and AIDS in South Africa.

BACKGROUND

The 2004 report of the Joint Learning Initiative on health human resources states that "after a century of

most spectacular health advances in human history, Human survival gains are being lost because of feeble

national health systems. The HIV and AIDS emergency has undoubtedly contributed to this problem,

particularly in South Africa. The pressure on health care workers is immense and with the crisis of attrition

and out-migration of personnel, systems in South Africa are challenged as never before. This has been

placed in stark relief by the urgent need to respond to HIV and AIDS epidemic, and especially the current

imperative to deliver antiretroviral therapy (ART) to large numbers of sick people who are often living in

areas where health systems have been poorly developed. This project focuses on strengthening and

expanding the development and implementation of comprehensive HIV and AIDS prevention in South Africa

in order to mitigate the impact of the HIV and AIDS epidemic. The emphasis area for these activities is

human capacity development, training, including pre-service and in-service training. The primary target

groups for these activities includes youth participating in sports, coaches, sports programs, traditional

healers and health care workers.

ACTIVITIES AND EXPECTED RESULTS:

There are 2 separate activities in the other prevention program area. The first activity focuses on the HIV

and AIDS prevention through sports participation, and the second activity focuses building capacity of

health care providers and traditional health practitioners on collaboration for HIV and AIDS prevention.

Activity 1: AIDS prevention through sports participation

Research indicates that sports participation by youth has multiple health benefits. In particular, sports

participation has been associated with lowered multiple risk behaviors and substance abuse. Youth

participate in sports activities through the formal schooling organizations and sports associations. Research

has also indicated that the central role of influence that sports coaches, managers, organizers and mentors

have in the lives of young people engaged in sports. In addition sports are an extremely powerful way for

reaching otherwise marginalized and at risk youth, through engaging them in organizational sports

association and activities. As such, sports are natural points for inclusion of HIV information as a vital add

onto sports programming. This project proposes to develop a workshop manual on Preventing AIDS

through Sports Participation that will use sports metaphors and sports messages interwoven with

established scientific knowledge of HIV and AIDS prevention to constitute unique messages that can be

integrated into sports programs. Sports coaches, mentors, administrators and organizers within designated

regions in the Western Cape Province will be trained to use the curriculum with youth. The curriculum will

equip them to incorporate HIV and AIDS messages into their coaching practices and sports programming.

The manual will effectively be a toolkit that will equip sports teachers, coaches and programs to reach

young people in a language that appeals to the latter and is consistent with a passionate engagement in

sports. Sports coaches and administrators will be identified from the West Coast/Wineland region of the

Western Cape Province. The manual will be piloted with a group of sports coaches in this district.

Thereafter it will be delivered more widely through workshops for coaches, trainers, managers and

programs wider than the West Coast Region.

Activity 2: Training health care providers and traditional health care practitioners:

Traditional healers form the major informal sector of health care providers in South Africa. They have been

formally recognized as part of the primary health care system through the promulgation of the Traditional

Health Practitioners Bill and the establishment of the Interim Traditional Health Practitioners Council and the

Directoate of Traditional Medicine within the National Department of Health (NDOH). Yet in formal health

care planning, traditional health practitioners are generally overlooked. Currently the issue of training in HIV

and AIDS is approached sectorally with the formal and traditional health care setting having little interaction

with each other. Efforts at collaboration between formal health care providers and traditional healers in

relation to cultural meanings and practices related to HIV and AIDS usually view the local healing system as

cultural and the biomedical system as somehow culturally neutral. Furthermore, with the exception of the

African Health Care Systems Research Network and the Nelson Mandela School of Medicine at the

University of Kwa Zulu Natal, collaboration is done on a small scale, and falls outside of the national policy

structure. This activity will draw on already existing collaborations with the South African Herbal Sciences

and Medicines Institute (TICIPS) concerning the anthropology of pharmaceuticals and medicinal plants and

focus in the Western Cape. It will organize workshops and develop training which will combine

understanding of traditional healers and health care workers concerning HIV and AIDS prevention and

highlight the sometimes oppositional cultural perspectives of biomedicine and indigenous healing. The

workshop and training will focus on enhancing closer collaboration, improving health education, counseling

and care. This will enhance the ability of health care workers at national, provincial and district levels to

communicate with and utilize traditional healers and herbalists, who thus will have biomedical and

indigenous knowledge of HIV and AIDS to assist with health education and counseling concerning HIV and

AIDS prevention, and care and support ARV use.

These activities contribute to the PEPFAR 2-7-10 objectives by working with sports coaches and programs

ensure integration of HIV prevention messages wit sports activities and reduce new infections.

Furthermore, by ensuring collaboration between the traditional and biomedical health sectors, communities

will receive the same HIV prevention messages from both sectors. This will ensure that greater numbers of

individuals are reached with HIV prevention messages.

Summary

The University of Western Cape (UWC) is implementing multiple activities aimed at improving human

capacity development to address HIV and AIDS in South Africa.

BACKGROUND

The 2004 report of the Joint Learning Initiative on health human resources states that "after a century of

most spectacular health advances in human history, Human survival gains are being lost because of feeble

national health systems. The HIV and AIDS emergency has undoubtedly contributed to this problem,

particularly in South Africa. The pressure on health care workers is immense and with the crisis of attrition

and out-migration of personnel, systems in South Africa are challenged as never before. This has been

placed in stark relief by the urgent need to respond to HIV and AIDS epidemic, and especially the current

imperative to deliver antiretroviral therapy (ART) to large numbers of sick people who are often living in

areas where health systems have been poorly developed. This project focuses on strengthening and

expanding the development and implementation of comprehensive HIV and AIDS prevention in South Africa

in order to mitigate the impact of the HIV and AIDS epidemic. The emphasis area for these activities is

human capacity development, training, including pre-service and in-service training. The minor emphasis

area is local organization capacity building. Target populations include public and private sector health care

workers and youth attending secondary schools.

ACTIVITIES AND EXPECTED RESULTS:

HIV and AIDS require a comprehensive approach with a view beyond the health system. Consistent with

this approach, the activities in this program area demonstrate a multi sectoral approach to targeting a

variety of health professionals. There are two separate activities in the program area.

Activity 1: A web resource to support TB/HIV Clinicians in South Africa

TB is the most common opportunistic infection and most important cause of death in people infected with

HIV in South Africa. Information for clinical management of multiple drug resistant TB (MDR), and

extensively drug resistant TB (XDR) is changing very quickly and it is difficult for clinicians to access this

information. This project will develop and pilot a remote web-assisted consultation service for TB/HIV will

diagnosis and treatment. This service will build the capacity of clinicians in Southern Africa to provide

optimal TB/HIV care. A specialist consultative service and information of relevance to clinicians necessary

to support accurate TB/HIV diagnosis, treatment and palliative care will be provided as a single web-

accessible system. The system will offer a web-based consultation service to which clinicians can send in

questions on how to manage problem cases and receive responses from recognized experts. The site will

provide links to existing clinical guidelines, a photo library with images of clinical presentations and relevant

data-mined information of the most recent updates from scientific literature. 20 Clinicians from various

service outlets dealing with TB/HIV will be trained in efficient use of the system and will participate in the

pilot. The system will be modified after the pilot and 90 clinicians will be trained in the use of the final

system.

Activity 2: Addressing TB/HIV through the development of health promoting schools

A holistic approach is needed to address TB/HIV effectively. The World Health Organization has noted that

"the school is an extraordinary setting through which to improve the health of student, school personnel,

families and members of the community." The UWC Health Promoting Schools Forum is a partnership

between academics at UWC, the Western Cape Reference Group for Health Promoting Schools, the

Western Cape Department of education (WCED) and the Western Cape Department of Health. This forum

has been active in supporting the development of health promoting schools in the Western Cape. There are

currently 130 health promoting schools in the Western Cape. WCED has identified 21 communities as

being in particular need of multi-sectoral interventions through Western Cape Social Transformation

program. The broad goal of this activity is to reduce the spread of TB/HIV in the school community. The

specific aim of the activity is to build and strengthen human capacity among all in the school community.

The purpose of this activity is to ensure the establishment of health promoting secondary schools, to

facilitate the development of TB/HIV policies in the schools and to facilitate a process of developing healthy

psychosocial and physical environment in the school community, and to improve knowledge in the school

community related to TB/HIV.

These activities contribute to the PEPFAR 2-7-10 targets by building human capacity and ensuring the

delivery of quality HIV/TB services.

Summary

The University of Western Cape (UWC) is implementing multiple activities aimed at improving human

capacity development to address HIV and AIDS in South Africa.

BACKGROUND

The 2004 report of the Joint Learning Initiative on health human resources states that "after a century of

most spectacular health advances in human history, Human survival gains are being lost because of feeble

national health systems. The HIV and AIDS emergency has undoubtedly contributed to this problem,

particularly in South Africa. The pressure on health care workers is immense and with the crisis of attrition

and out-migration of personnel, systems in South Africa are challenged as never before. This has been

placed in stark relief by the urgent need to respond to HIV and AIDS epidemic, and especially the current

imperative to deliver antiretroviral therapy (ART) to large numbers of sick people who are often living in

areas where health systems have been poorly developed. This project focuses on strengthening and

expanding the development and implementation of comprehensive HIV and AIDS prevention in South Africa

in order to mitigate the impact of the HIV and AIDS epidemic. The emphasis area for these activities is

human capacity development, training, including pre-service and in-service training. The minor emphasis

area is local organization capacity building. Target populations include public and private sector health care

workers including human resource managers and HIV program managers.

ACTIVITIES AND EXPECTED RESULTS:

HIV and AIDS require a comprehensive approach with a view beyond the health system. Consistent with

this approach, the activities in this program area demonstrate a multi sectoral approach to targeting a

variety of health professionals. There are two separate activities in the program area.

Activity 1: Provide management and leadership training for new HIV program managers and human

resources managers at the provincial and district level:

This activity aims to strengthen the overall capacity of both human resource managers and HIV project

managers to deal with the ever-increasing challenges faced in their workplace through the provision of a

leadership and management training program. The goal of the project is to improve the skills, knowledge

and competencies of new HIV project managers and human resource managers so that they may be better

equipped to deal with the challenges in their work. The objectives of the project are to provide a training

program that would aim to introduce participants to the concept of "self-management"; provide participants

with an understanding and overview of the management functions of planning, organizing, and leading;

familiarize managers with the concept of innovation and allow them to apply creativity techniques so that

managers may be able to lead projects to meet new innovative ideas and introduce problem solving and

decision making processes and techniques applicable to their work environment. In this activity a training

curriculum approved for continuing education credit through the UWC Division of Lifelong Learning will be

implemented. Twenty new HIV project managers will be trained in public service leadership and

management and ten human resource managers at the provincial and district level will be trained in public

service leadership and management.

Activity 2: Human Resources Information System

UWC's current work with the NDOH has initiated a process of conducting a human resource information

audit in South Africa and developing a framework of national indicators for human resource management,

development and planning. This activity will take this process to the next level by developing a district

based human resource information system (HRIS) for general human resources information, with a specific

focus on HRIS requirements for HIV and AIDS program delivery. Planning and managing programs is often

hampered by the unavailability of reliable human resource information. Yet, developing good health

program information system is a labor intensive and time consuming process and the staff that operates

them must be trained and supported. The aim of the project is to improve the quality of healt care provided

through developing a sustainable, decentralized capacity to operate and maintain integrated district based

HRIS, as well as increasing the use of information by health care providers. This activity will develop a

framework for district-based HRIS for the management and planning of human resources and will also

develop a training program fro the data collectors and information users on the development and use of

human resource information. In addition, a group of data collectors and information users will be trained on

the district based HRIS for piloting.

These activities contribute to the PEPFAR goals by training HIV program manager and developing a district

based HRIS. This will lead to improved human capacity development for the implementation of HIV and

AIDS services