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Lessons learned from nurse capacity-building activities
D. Parham-Hopson1, B. Aranda-Naranjo1, J. Yu-Shears1, C. Hall1, R. Conviser2
1U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, United States, 2Global Health Policy Partners, Missoula, United States
Issues: The
President's Emergency Plan for AIDS Relief (PEPFAR), reauthorized in 2008,
emphasizes strengthening of health care systems and training of 140,000 new
healthcare workers by 2013.
Description: Under PEPFAR, the Health Resources and Services
Administration (HRSA) and its grantees and partners have been building health
care workforce capacity. HRSA's
programs have strengthened the numbers and skills of nurses in sub-Saharan
Africa, India, and the Caribbean. Grantees have pursued clinical goals
like building capacity in prevention, care, and treatment; improving management
of antiretroviral drugs (ARV); expanding programs for prevention of
mother-to-child transmission of HIV; promoting provider-initiated testing and
counseling; and building clinical mentorship programs. Grantees have also
worked to strengthen pre-service training programs as well as the professional
standing and certification of nurses. HRSA-supported activities have
promoted expanded roles for nurses through mentoring and training that
facilitates task shifting; however, some governments have been slow to
recognize nurses' capacity to take over tasks like prescribing ARV.
Lessons learned: Program success is enhanced by respecting local
contexts, promoting community involvement and coordination among cadres of
health care workers, while working to clarify extensions in nurses'
responsibilities. To assure nurses' skills, it is critical to include hands-on
components in training sessions and to follow up those sessions with both
training updates and practical experiences, having mentors and technical
assistance available. Site visits by mentors help to improve both individual
and institutional practices. Including a training of trainer component in
programs creates a national cadre of health care workers who can sustainably
monitor the quality of care. Finally, collaborative efforts with
Ministries of Health (including their national or regional training centers, as
well as state, provincial, or district entities and local universities in some
places) also promote program sustainability.
Next steps: Apply and share
best practices and lessons learned.
Provide funding
for strengthening of nursing schools.
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