XVIII International AIDS Conference


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Improving comprehensive HIV care and treatment in Central America by strengthening human resources for health

Y. Villaseñor, M. Eugenia De Leon

IntraHealth International, Guatemala, Guatemala

Issues: Health facilities without supportive supervision or performance monitoring have unidentified and unaddressed gaps or performance issues. The USAID Capacity Project, led by IntraHealth International, assisted ministries of health and Social Security institutions to decentralize HIV care and treatment from tertiary to secondary care levels and implement performance improvement (PI) and supportive supervision for HIV/AIDS and TB services.
Description: Using PI methodology, 35 facilities in six countries conducted baseline assessments and analyzed gaps in actual and desired performance and employed interventions to address the root causes of performance concerns. Action plans were developed for 35 hospitals, and 32 facilities conducted a second assessment after action plan implementation. Of the initial 35 hospitals, 17 had time for a third assessment. Action plans enabled facilities and local authorities to identify solutions and develop resource mobilization processes to close gaps (e.g., medical equipment, construction and infrastructure improvement, human resources).
Lessons learned: PI assessments showed gaps in all HIV/AIDS service delivery areas; the weakest were nutritional care for people living with HIV, infection prevention, stigma and discrimination reduction, and counseling and testing. Through action plans, hospitals averaged a 30% increase in performance standards over baseline; some showed improvements of almost 60%. Adopting a multidisciplinary team approach, reducing the workload of individual practitioners, motivating health workers and implementing award/recognition systems helped hospitals improve HIV care quality.
Supportive supervision and monitoring HIV-related performance led to successes: workforce realignment in El Salvador; safer laundry services in Belize; increased visibility of an HIV clinic in Guatemala; procedures and norms actualization in Costa Rica; and improved hand-washing practices in Panama.
Next steps: Performance improvement continues by systematizing and institutionalizing standards to monitor care services and by health ministries' implementing hospital certification and recognition systems.

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