Managing treatment and prevention programs for sustainability: the Site Capacity Assessment (SCA) tool
J. Donahue1, K. Foreit2, K. Stafford3, M. Oluoch4, L. Burrows5, B. Jefferson5
1Catholic Relief Services, Washington, United States, 2Futures Group, Washington DC, United States, 3University of Maryland, Institute of Human Virology, Baltimore, United States, 4Catholic Relief Services, Nairobi, Kenya, 5Futures Group, Washington, United States
Issues: To move treatment and prevention programs to sustainability, managers need practical tools to identify problems, track progress and effects of assistance and determine when external assistance can be phased out. Tools must be comprehensive (covering all essential areas and functions), feasible (usable by general program officers with minimal disruption to program operations), reliable (high inter-rater agreement), and valid (correctly identifying sustainable areas and areas needing assistance).
Description: AIDSRelief assists approximately 350 treatment and 200 PMTCT sites in ten countries in sub-Saharan Africa and Latin America, ranging from small rural health centers to high volume urban hospitals. Over the next five years, country programs are expected to “graduate” to local management. To better manage the graduation process, AIDSRelief developed and tested a Site Capacity Assessment (SCA) tool covering medical care and treatment, institutional development, pharmacy, laboratory, strategic information and public relations. Five-point scales derived from staff interviews and direct observation assess physical infrastructure, human resources, planning and budgeting, record keeping and reporting, practices, management and supplies. Scores are aggregated along a continuum of sustainability from needing support to sustainable to center of excellence. Local data entry and dashboard analyses are provided for site managers; uploads to central server support cross-site comparisons. SCA was pretested in Zambia and Nigeria with independent raters and achieved high inter-rater agreement. SCA can be administered in 2 days per site with a single rater.
Lessons learned: Assessment items and instructions must be specific and concrete (e.g. all items in a given score level must be satisfied to be rated at that level of capacity). Pilot testing, dialog with program staff and content revisions are essential. For maximum utility, program managers recommended six-monthly assessments.
Next steps: SCA is being scaled up program-wide. Predictive validity will be assessed as sites transition from external assistance.
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