Integrated Infectious Disease Capacity Building Evaluation (IDCAP)

Overview and Objectives

Evaluated a cost-effective method to build capacity among non-physician clinicians in sub-Saharan Africa for the treatment and prevention of infectious diseases. A comprehensive surveillance system of 36 health facilities and their patients measured the impact of a novel package of classroom training, distance learning, and on-site support services on individual competence, facility performance, and health outcomes in the surrounding communities.

Objective #1 – Create an optimal capacity-building program for the integrated care and prevention of infectious disease, built on the hypotheses that a core curriculum focusing on non-physician clinicians (i.e. clinical officers and nursing officers) and complemented by on-site support services for multidisciplinary clinic teams can cost-effectively improve individual and clinic performance. Accordia Global Health Foundation and IDI have six years of experience developing locally relevant curricula for the prevention, care and treatment of infectious disease in Africa. With our key partners, we are building on existing training programs including the WHO’s Integrated Management of Adult Illnesses program, and the substantial expertise of our partners and others, to develop an optimal, integrated package of capacity-building activities for appropriate care and prevention of infectious disease, including two main components:

• Integrated Management of Infectious Disease (IMID) Curriculum – An integrated curriculum for non-physician clinicians – specifically, clinical officers and nursing officers – on the care and prevention of infectious disease and the practice of continuous quality improvement (CQI), delivered at IDI with extensive clinical sessions and designed to prepare the trainees to conduct peer training courses when they return to service.
• On-Site Support (OSS) – CQI activities and a set of responsive Multidisciplinary Team Training (MDT) modules for use at the clinic level for teams of medical officers, clinical officers, nurses and midwives, laboratory technicians and records keepers.

Objective #2 – Evaluate the effectiveness of the Integrated Management of Infectious Diseases (IMID), and the incremental impact and cost-effectiveness of the On-Site Support (OSS), through their staggered introduction across sites and by testing key hypotheses. Two arms of 18 clinics receive randomized and staggered introduction of IMID and OSS. The two arms will be compared to test three hypotheses:

• An integrated IMID course can prepare non-physician clinicians to perform key clinical tasks at acceptable standards of care
• OSS will significantly improve clinic performance and health outcomes
• OSS can be conducted cost-effectively

Achievements

• Completed a baseline assessment, which shows significant deficiencies in infectious diseases care processes and the need for capacity building.
• Established data surveillance systems in all 36 health facilities to collect routine clinical and laboratory data in support of the IDCAP’s performance indicators.
• Implemented On-Site Support (OSS) program in 36 rural health facilities throughout Uganda, training over 700 non-physician clinicians.
• Developed the following training tools:
  • Integrated Management of Infectious Diseases (IMID) core course curriculum
  • Booster courses curricula
  • Distance learning tools
  • Multidisciplinary Training courses (MDT)
  • Clinical Decision Guides
  • A revised outpatient record form (Medical Form 5)
  • Emergency Triage, Assessment and Treatment guidelines and monitoring tools.
• Linked the CQI process to the Ministry of Health institutionalization process to ensure sustainability.
• The impact of IDCAP’s primary interventions on individual competence and facility level performance is currently being analyzed.
• A mortality survey will be conducted in late 2011 to evaluate the health outcomes, with results in early 2012.