Training and mentoring clinical health workers in Kenya Efficiency gained from the Proposed Harmonized HIV Curriculum

1. Training And Mentoring
Clinical Health Workers In
Kenya; Efficiency Gained from
the Proposed Harmonized HIV
Curriculum
March 21st , 2013
Daniel Mwai,1 Irene Mukui,2
Arin Dutta,1 Priya Iyer,1
1Futures Group, 2 National AIDS & STI Control
Program, Kenya
dmwai@futuresgroup.com
The Second HIV Capacity Building Partners’ Summit, Birchwood Hotel and Conference Centre
Johannesburg, South Africa

2. Overview
1. Introduction and research questions
2. Methodology
3. Results and discussion
4. Limitations and conclusion

3. Introduction and research
questions

4. Introduction
 Kenya have relied on off-site training model to train and nature its
health workers for HIV response [1], over time.
 The need for HIV training and mentoring for healthcare workers
is in the rise, although resources for Hiv response are dwindling.
 This calls for adoption and used most efficient and effective(E2)
use of resources in HIV response.
 Inline with National AIDS & STI Control Programme and partners
have proposed a new, harmonized HIV training curriculum.
 For the curriculum to be adopted, an understanding of potential
benefits was needed, to aid in identifying the efficient model.

5. Research Questions
 What is the total efficiency gained when comparing the off-site
components of the proposed harmonized curriculum and the
current program?
 What is the unit cost per person per day of different models for
ongoing mentoring?
 What is the impact of the different mentoring models on the
number of missed patient encounters in the HCW’s home
facility?
 What is the most efficient model of ongoing mentoring ?

6. Methodology

7. Methodology
 In the new training curriculum, HCWs are divided into clusters:
clinical, pharmacy, laboratory, nutrition and counseling, and social
work.
 We focused on the clinical cluster (doctors, clinical officers, nurses).
 Efficiency was defined in terms of the relative costs of the
placement stage.
 We calculated the direct costs of the off-site training component
 For monitoring, we estimated time spent away from the HCW’s
home facility using current program data for two models:
 District Health Mentorship Training (DHMT)
 Roving Clinicians Model (RCM)

8. Results and discussion

9. Efficiency of the Harmonized
training Curriculum
 The venue for placements hosts group
learning and case discussions.
 When RTC is a hospital, no venue hire
costs are incurred; this reduces the cost
per HCW by $11.
 When accommodation is not required, the
cost is reduced by $75 (see Figure 2).
 Off-site training is more efficient under
the harmonized curriculum
 Evident by reduced number of off-site
days
 Low cost of offsite training. (see Figure 3)
Figure 2: GFATM Round 10 Proposal and Mukui, I., 2012. Estimates include cost of trainers, venue hire, stationery, per diem, and transport.
Figure 3:Source: Authors’ calculations.

10. Comparing of Two Ongoing
Mentoring Models
 Figure 4 compares the unit costs of the
DHMT and RCM.
 The RCM was less expensive than the
DHMT,
 Requires only one mentor for many trainees
 Re-training cost is spread over more days.
 Figure 5 compares the indirect costs.
 We assumed mentors would provide
services when not engaged in mentoring.
 The RCM value would rise if clinicians were
roving full time.

11. Limitations and conclusion

12. Limitations
 Limitations of this analysis include the
 Lack of a measure of training or mentoring quality
 The use of data from pilot designs.

13. Conclusion
 The DHMT model provides the best balance of lower cost and less
disruption to the health system for ongoing mentoring.
 The new harmonized training curriculum and skills-building strategy
represent a cost-efficient choice for the Kenyan HIV program.

14. Thank You!
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