ABSTRACT
Zambia is one of the HIV high burden countries in Sub Saharan Africa. Government of Zambia has been expanding Antiretroviral Therapy (ART) service nationwide at district level. However, it is still hard to access to ART service for PLHIVs who live in rural. In terms of accessibility, the service must be expanded to rural health centre level, but there are many challenges to expand the quality services into such resource limited setting, especially in the shortage of health providers.<br> JICA's “Integrated HIV and AIDS Care Implementation Project at District Level” launched at April 2006 to improve the quality and accessibility of HIV and AIDS care services in rural Zambia. Two districts in rural area, namely Mumbwa and Chongwe, were selected as project sites. The Project introduced the “mobile ART service” at rural health centre level using the existing health system. Mobile ART services enable a rural health centre that cannot offer ART by itself to provide ART services through the human resource and technical support/assistance of the District Hospital. Mumbwa and Chongwe District Health Management Team (DHMT) started mobile ART services in the first Quarter of 2007, therefore access to ART service in districts has been improved and contributed to increase of ART clients and reduce the defaulter rate within first 6 months of treatment. The project also tried to introduce the community involvement to overcome the shortage of human resources. <br> We found that Mobile ART services involving the community are beneficial and effective, and help ART services expansion to rural health facilities where resources are limited, and as close as possible to places where clients live. The strategies we experienced were cited in “the National Mobile HIV Services Guidelines” published by the MoH and will be able to be duplicated in other resource-limited areas of not only Zambia but also other developing countries.
ABSTRACT
<b>Introduction</b><br> Even though many oversea training programs end in developing an action plan from what they learned during the course, follow-up opportunities are quite limited. Group training program on maternal and child health for Francophone African countries are conducted in Japan since 2003, organized by National Center for Global Health and Medicine and funded by Japan International Cooperation Agency. Follow-up activities in Senegal and Benin are reported with lessons learned.<br><b>Methods</b><br> Training organizer team made a semi-structured interview with 11 trainees, 6 superintendents and 4 Japanese advisors, asking “Do trainees implement what they planned at the end of the training course in Japan? If not, what are the difficulties implementing their plans?”Organizer team also provided some interventions to solve the problems they faced.<br><b>Results</b><br> In Senegal, actions were not implemented yet, because plans were shared neither with their superintendents nor with Japanese advisors working with trainees as project counterparts. Organizer team set up a meeting with all stakeholders to clarify the objectives and outcomes of the training course within the concept of the project. This process made the superintendents understand and support the action plans, and facilitated to start implementing them. In Benin, trainees started activities by themselves based on their action plan under a small financial support from a Japanese advisor. It was rather easy, because they were decision makers of a hospital, but they faced difficulties to manage the staff to continue the activities. Organizer team encouraged them to continue the activities during the meeting in the hospital.<br><b>Conclusions</b><br> Appropriate participants can be selected and training could be effective, when cooperation project are well defined and the role of advisors is clear in the follow-up. Involvement of decision makers or superintendents for the selection and follow-up process can be a contributing factor to improve the effectiveness of the training.
ABSTRACT
<b>Purpose</b><br> Every year, a lot of training programs by Japan International Cooperation Agency (JICA) are conducted in Japan. However, the method of monitoring and evaluation of those trainings are not always conducted other than simple questionnaire survey. The purpose of this research is to demonstrate the significance of daily recording and analysis of the trainee’s voice as a way of the improvement of the quality of training.<br> Bureau of International Cooperation in National Center for Global Health and Medicine (NCGM) conducted detailed monitoring and evaluation for “JICA training for Maternal and Child Health in French speaking African countries in 2009” which NCGM itself had planned training curriculum and implemented the training. The key word of this training was “Continuum of care”. At the end of the 5 weeks training, NCGM expected the trainees to obtain comprehensive understanding of continuum of care, especially two different perspectives, which were “the health system” and “the dignity of individual client”.<br><b>Method</b><br> NCGM training team kept recording the trainee’s voice, then analyzed them every day during five weeks’ training. At the end of the training course, the team divided trainee’s voice into several categories, and then analyzed their time-dependent change.<br><b>Results</b><br> The everyday recording and analysis of the trainee’s voice made NCGM training team possible to differentiate the trainee’s fundamental interest and understanding from simple guesses or curiosity. Based on the result of daily analysis, the training team could introduce unscheduled discussion or fine-tuned the contents of lectures for better understanding of trainees. The trainees’ interpretation about “continuum of care” showed obvious change before and after the training. The active learning program by using Laboratory method gave deeper impact on trainees than the expectation of training team. At the end of training course, the trainees formulated concrete and detailed action plans. The purpose of their action plans was to establish the continuum of care from aspects of both “the health system” and “the dignity of individual client” by analyzing the existing stakeholders and institutions, and ensuring a collaborative linkage among them, which were exactly the expected outcome.<br><b>Conclusion</b><br> Daily recording and analysis of the trainee’s voice was effective and useful to monitor the training. The comprehensive analysis at the end of training course revealed the short impact of the training on trainees, which could be used as a self evaluation tool for the training team.<br> NCGM plans to visit the trainees’ workplace in their home countries for middle and long term monitoring and evaluation. The results will be feed backed into the training curriculum of next year.
ABSTRACT
The importance of medical education and technical cooperation with developing countries is emphasized. As an example, we looked at the residency program of the Department of Surgery, Santa Cruz General Hospital. Provision for postgraduate medical education is quite important in developing countries in order to prevent promising young doctors from leaving the country. Moreover, the curriculum for postgraduate education should be developed in accordance with the health situation of the respective countries. Technical cooperation should be carried out with a long-term perspective, focusing on human resource development, in this case the young doctors. From now on, it will not only be technical experts, but also medical education experts that will be needed in developing countries.