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Home » Forums » e-Forum » e-Forum 2008 *closed* » Theme 2: Demand [19 May - 16 June] » Week 1: Capacity necessary for program scale-up
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06-16-2008 6:39 PM

Re: Week 1: Capacity necessary for program scale-up

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Dear members,

Here's a contribution by XAQSOOR from Somalia.

Thank you for your contribution!

Marcela.
e-Forum Facilitator

Dear Marcela,

Thank you for your updates, I really appreciated,

According to my participation with E forum in Globalfund, I would like to crucially propose the systematic initiavive change of social magnititude of the current community poarticipation of TB,HIV/AIDS, AND ,MALARIA present epidemic spreading  comncept s to Africa as well as worldwide.

To verify my concern, I would definitely propose to get experts in Malaria and TB and HIV/Aids Trainers/Consultansts to share more dailogue in their respective communities in Africa.

Local governements have the main intervenytion in developing the  process, Global fund is the key funder of all sectors.

In somalia, fo example, Globalfund with joint implementation preoject called Globalfund HIV/Aids Program in Somalia implemenbted by Oxfam Novib and SOCSIS GF Project in 2005/6, this project produced Local NGOs traiened by Local Consultants taught the main curriculum of Organizational Development as well as HIV/Aids modern practices to strategise the main interventions of the regional bases in somalia, somaliland and putland where tthere are regional adminstrations of HIV/Aids commission: SCAC,PAC,SAC Respectively.

I will make sure that you will understand the somalia case study to my participation of E-forum Globalfund.

Thank you for giving me this opportunity.

Mr. Abdullahi Mohamoud Nur,
Somalia Consultancy Organisation of Reasearch and Empowerment (SCORE)
South-central Somalia
Horn of Africa

06-16-2008 6:27 PM

Re: Week 1: Capacity necessary for program scale-up

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Dear members,

Here's a contribution by May Mahmoud Farag Ahmed from Egypt.

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Marcela.
e-Forum facilitator
- I may find that  the main  challenging factors that  prevent adequate scale up to meet demand is  the lack of management skills , inadequate  skilled manpower , inadequate remuneration,   inappropriate job placing  or use of  inexperienced staff . This  need  capacity building through continous training , ,improved staff skills and appropriate job placing and through  building  professional  management skills and to strengthen both internal and external monitoring  and programs evaluation systems to give a chance for early corrective actions based on the results.

I agree with Louis Meinko that there is a real demand for street children to have access to health services. Global fund should aim to build capacity  and  financially support those  NGO's that focus on providing services and care for street children.

-Global fund should promote actions that strengthen health systems , information particularly those  has an  impact on the quality and accessibility  of health services.
-There is a great need to improve the coordination between  relevant sectors within miniseries and other sectors in terms of capacity building and to promote wider stakeholders and   community participation particularly those aiming at prevention.

- Ensure that adequate procurement , supplies and distribution to health units with focus on marginal or  hard to reach communities.


    May Farag

06-16-2008 6:13 PM

Re: Week 1: Capacity necessary for program scale-up

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Here's a contribution by Bondu Manyeh from Sierra Leone.

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Marcela.
e-Forum facilitator
Hello,
 
Prevention of capacity for adequate scaling up:  People are becoming aware of the disease and it's dangers - yet a lot of work needs to be done because people are still in Denial, coupled with fear of testing to know their status.  People are reluctant to do the Voluntary, Confidential, Counselling and Testing (VCCT), they hope that they are free without having the VCCT done.  They believe that what God has not made them know must remain hidden.
 
2)  Funding could be a problem; most Community Based Organizations which may easily target the interior parts of the country with the realities of the disease through sensitization, do not have proper means of transportation and communication system which are too expensive for them to cover.  Information through the local communities about the pandemic is very much necessary but lacking; if available in some communities, it is not treated seriously. 
 
3)  Treatment centres need to be improved and increased.  This is lacking for a country that is settling from the dust of a brutal war during which hundreds of women and girls were raped and tortured by their captures.  Good education and communication drive needs to be stepped up in all towns and villages.  
 
Peace.
 
Bondu

06-11-2008 1:04 PM



    • bbk.hill
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Re: Week 1: Capacity necessary for program scale-up

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As an independent observer of the Fund funded interventions in South Asia and Africa , I have the following comments: (1) Increasing access to quality diagnostics e.g., microscopy for TB, Malaria is a critical concern. There is an acute shortage of trained technicians. (2) Country Coordination Mechanism is largely elite biased i.e., in all the fund receiving countries the CCM members are mostly either bureaucrats or dominant figures and hence not widely represented by the public. Transparency and Accountability of existing CCMs are questioned on similar grounds. In most of the cases, the moral harzard is about the CCM having a 'group thinking' i.e., collective dennial of failures, exaxerating achievements etc. (3) Incresing access to treatment, i.e. access to drugs is not a problem as long as funds are available. (4) Cultural barriers to access is not that promiment as it is project. This sometimes looks like ' blamming the victims' in order to avaoid supply side failures. The global fund must address these issues which are crucial for sustainable access. Otherwise, all the efforts may drive into just addressing sysmptoms and not the problem. In this reagrd the global fund should: (1) increse investment in health sysetms (Tangible aspects such as infrastructures, diagnostics tools and human resources) rather than focusing on a quick win over MDGs targets. Focus has to be beyond MDGs. Bihita Bidhan Khisa

06-06-2008 4:49 PM

Re: Week 1: Capacity necessary for program scale-up

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Large population movements, especially in the recent past, in countries emerging from strife like South Sudan, make situation very serious with regard to exposure to HIV epidemic; such countries need to be considered for quick- response mechanisms to install prevention, awareness and management strategies. Refugees are returning in great numbers from high HIV-AIDS prevalent countries of asylum. It is necessary that local structures are established and NGOs be given the capacity to respond. At the same time, local infrastructure like road network is being developed at a very rapid rate, influencing population distribution as a result of the growth of satellite towns and market centers along the roads. These are 'hot spots' for the rapid spread of HIV-AIDS. I think organisation coming up with good ideas for intervention before things get out of control, deserve to be given priority. Global Funds funding mechanisms- which are often very weak-in such a case, need to be reconsidered to avoid delays in local capacity building.This will lower the prevalence rate, but if steps are not taken quickly, the situation will become worse and involve far more funding.

06-04-2008 2:29 PM

Re:Week 1: Capacity necessary for program scale-up

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Dear members,

Please find below the contribution from ASHISH SRIVASTAVA from India..

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Alastair
e-Forum Facilitator

 
 
 

Demand in many countries is a comprehensive term which requires analysis of human development,human conditions, prevailing climatic conditions in countries,social,religious & economical status of countries,status of human development in various parts of world.

No.of challenges do exits with above all factors.M.D.G (United nations resolution) has given targets for socio-economical upliftment, environmental sustainability,health infrastructure,living standard, trade in developing & third world countries. In developing & third world countries demand could be identified by functions of public distribution system,efficiency,social approaches, accesssment of essentials of survival,capacity building in pandemic affected countries with access of cheap vaccines,human genome projects, accessment of anti-AIDS drugs,anti- cancer drugs,life saving drugs, diagnostic kits& equipment with removed custom& excise duty. Improved health information system,R&D,surveillance network, investigational modalities,rural professionals,distribution of long term protection vaccines, sanitary  conditions, environmental degradation are major challenges in many countries for effective health infrastructure. In above countries Global-fund& other partners with voluntary & health administrative agencies at national& state level can give collaborative,innovative,cost effective,capacity building support to general development control regulation,awareness of international health regulations,health infrastructure,system,distribution & general health protection measures. 

ashish

06-04-2008 1:52 PM

Re: Week 1: Capacity necessary for program scale-up

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Please find below the contribution from Kizza Paul from Uganda.

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Alastair
e-Forum Facilitator
 

1- Private Sector; Lack of partnership among the private sector organisation to work together. This is because private sectors organisations always work in a competitive environment. The challenges are; how can competing banks work together or soft drink companies sit together for HIV/AIDS and forget about their core competitive elements? Solution;Global fund should strengthen partnership within the private sector other than thinking that it is already existing.

2- Government workers: Governments recruit and pay for workers they can afford according to their national wage bills. They are normally few workers in civil service. These few workers can not support the growing scale of the Global fund programs. Now since the global fund is a project, it should allow paying for additional project staff to scale up the programs.

3- NGOs/CSOs. Information sharing. There is lack of information sharing  among NGOs and between NGOS and Governments. This results into wrong programmatic planning in scaling up.  Global fund should support National M&E plans

Thanks,

Paul

06-04-2008 1:36 PM

Re: Week 1: Capacity necessary for program scale-up

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Dear members,
please find below the contribution from Joel S Amon from Tanzania.
Thank you,
Marcela
e-Forum 2008 facilitator
WHAT FACTORS IN TERMS OF CAPACITY ARE PREVENTING ADEQUATE SCALE-UP TO MEET DEMAND, AND WHAT COULD THE GLOBAL FUND AND/OR ITS PARTNERS DO TO OVERCOME THEM?
 
ANSWER:

1. CHALLENGES WITH HEALTH SYSTEM
As far as the Government has practiced Decentralization by involvement of local Government and it is continuening to inform the Health system as well as the Local Government , few challenges still exists , other wise the system looks functioning well. 

2. CHALLENGES WITH INFRASTRUCTURE
These rescuers a very big challenge towards health service delivery as it is evidenced that more than 60% of health facilities are old and unfit and more than 70% of health facilities have no staff houses.
 
3. MANAGEMENT AND COORDINATOR OF SERVICES
These are some elecuecet of confusion between who should be responsible to appoint manager fro health services in districts. Councils ie Dom’s between the Central Government ie Ministry of health and the local Government ie Ministry of Prime Minister, Regional Administration and Local Government some District /Councils has experienced a collision of these managers.
 
4. AVAILABIRITY OF HEALTH WORKERS
This is a very big challenge, more than 40% of the health facilities especially Dispensary in Rural areas has an acute shortage of health workers in trained evades like Clinical Officers, Clinical Assistants, trained Nurses etc.
 
5. SKILLS OF HEALTH WORKERS
Most of the health workers in rural health facilities despite of the initial training this acquired in their 1st training institution , they doesn’t get more skills as to enable them to perform their duties properly and effectively and therefore needs up dating/up grading their skills.
 
6. MOTIVATION OF HEALTH WORKERS
There are no any clear motivation policy which does exist either from Central Government or Local Government which shows way on how the health workers is to be motivated especially those working in hand to reach areas, Curial pooling of the health workers to cities Municipals and Rural towns depends mostly on this issue. 
 
 7. PROCUREMENT AND DISTRIBUTION SYSTEM
The existing procurement and distribution system of still leaves a room to work on. The Central Government ie Ministry of health has MSD as the only and major procures and distributor of medical equipments and supplies.
Several health facilities through different forums has raised concern bitterly on the poor way MSD functions , these several evidences produced by district /Council health managers on this system showing how poor they perform.
 
   
SUGGESTIONS
In order to achieve an effective scale up to meet demand:-
  1. Global Fund and or other partners through a special programme let them initiate the formulation of special Fund to be directed to NGO District/Councils for Rehabililation/Construction of health facility infrastructures.
  2. Global fund /or other partners , let work hand in hand with the Government by Funding health Institutions as well as re-opening the previously closed Government health institutions so as to see suit /Gain as many health workers as possible to fill the scarcity.
  3. Global Fund and/or other partners through a special programme initiate the formulation of special fund to update/upgrade knowledge and skills to deserved health workers as individuals or groups from advanced institutions if possible up – Country.
  4. Global Fund and/or other partners in hand to hand with the Government let se a clearly motivation policy which is hand to – reach areas oriented.
  5. Global Fund and /or other partners let advice the Government to Co-operate other partners National or International in Medical equipment and supplies procurement and distribution in the Country.
 
 
      THANKS
 
 
 
 
JOEL .S. AMON
KAESO - COORDINATOR

06-04-2008 1:31 PM

Re: Week 1: Capacity necessary for program scale-up

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Dear members,
please find below the contribution from Ravichandran from India.
Thank you,
Marcela
e-Forum 2008 facilitator
The following factors are preventing adequate scale up to meet demand and to undertake to redress the preventing factors.

 
Factors
Redressing ways
1.
Peer educators themselves do not like to use condoms with their regular partner.
1.       Promote fun with condoms and to help them believe that condom use indicates concern for the partner’s health and therefore is a responsible behavior.
2.       IEC materials like condom menu cards, condom playing cards, hand book on ‘A friend who cares’ rotating cube etc need to be distributed among the PEs, so that they could use them to motivate the peer groups.
2.
Peers do not like to practice non penetrative sex
Ø      Train PEs on sex and sexuality
Ø      Special emphasis on types of non-penetrative sex
3.
Peers are not convinced that PEs sharing of the common myths and misconceptions is a fact.
Ø     During Training and monitoring visits, staff needs to build the PEs ability to give logical and scientific explanations with rational examples and reasoning for common myths & misconceptions.
Ø     The FAQ book can be provided to all PEs to enable them to address the myths & misconceptions in a convincing way.
4.
Peer educators who keep IEC materials with them to train peers find it difficult.  This is because of lack of private space and to keep their families away from their life style.
Ø       Should increase awareness of the importance of PE through their campaign, especially through street plays and other similar folk media.  It is important that they do not disclose PEs are those who belong to high-risk behavior groups.
5.
Peers do not inform their PEs about their symptoms.
Ø       Need to inform peers, the benefits of sharing information about their health problems with their PEs especially for availing timely and appropriate health care.
6.
Peers do not like to take treatment from health care providers trained in syndromic case management.
Ø       Inform the groups that PEs will be an effective link to health care providers and so to avoid quality treatment.
7.
PEs are unable to follow-up peers referred
Ø       Discuss with PEs the problems in referral follow up and alternative ways to ensure follow up.
Ø       Do not reprimand PEs for not doing follow up, but instead focus on their problems.
8.
Some health care providers do not cooperate with the PEs when they refer their peers.
Ø       Meet referral doctors at least once a month to know their problems in managing referrals and seek their cooperation and request them to reinforce key messages in a non-stigmatized and non-judgmental manner.
Ø       In case a health care provider is not co-operative, they need to identify other referral doctors.
9.
Some Peers, who are not satisfied with the treatment given by the referred doctors, discourage other peers from seeking treatment from them.
Ø       Explore reasons for such dissatisfaction.  If desired, they need to discuss the issues with the referral doctors and ensure that the peer groups are satisfied with the treatment.
10.
Peers are not confident that the doctors will maintain confidentiality about their symptoms.
Ø       Emphasize the importance and need for confidentiality during their advocacy meeting with the doctors.
11.
PEs find difficulties to motivate their peers to go for their periodic check-up, especially if they are asymptomatic.
Ø       Increase awareness about symptomatic and the importance of periodical checkup. organize periodic screening camps at a place and time most suited to majority of the beneficiaries.
12.
PEs not able to motivate their peers for partner treatment.
Ø       Enhance their awareness programs about the importance of partner treatment.
Ø       Efforts need to be made to help couples, take joint responsibility for each other’s sexual health.  Indicate that the responsibility and concern for his/her well being is most required.
Ø       Provide medication to the partner through the infected person.
13.
Prostituting messages for youth and the unmarried.
Ø       Training need to be imparted on ‘A&B’.
Ø       Developing skills on how to say ‘No’ to peer pressure.
Ø       Information on risk associated with premarital sex thereby emphasizing ‘say not to sex’ before marriage.
Ø       Emphasize on ‘A’ as a 100% risk free practice.
14.
PEs hesitate to keep penis model and condoms at home because of fear of being reprimanded or being identified as having multi partner sex.
Ø       NGOs in consultation with PE, need to find alternative sites to store condoms.
Ø       NGOs can highlight the role and importance of PEs in their mass education programs, especially through street plays and other non-formal modes so that the community is aware of the role of PEs.
Ø       It is not necessary for them to mention that PEs are selected from those who practice high-risk behavior.
15.
Lack of privacy in the field for condom demonstration especially for street based sex workers.
Ø       Identify shops near the PEs work area to sit with one peer at a time and train them in condom use.
Ø       Shops with a fridge or a cabinet in the center with space behind are most convenient ones.
Ø       Identify other sources trees, quite spots at bus stop, public toilets etc.
Ø       Enable PEs to meet either at NGO office or at the drop in center.
16.
Family members of PEs do not allow them to interact with their peers.  This is especially true for adolescents in the urban slums.
Ø       Talk to family members about their social responsibilities and its contribution in collective societal battle against prevention and control of HIV/AIDS.
Ø       Introduce family members to other PEs who have the support of their families so that they learn about their actual roles and responsibilities.
17.
PEs are not able to maintain confidentiality.  Some times they quote other peers as an example to motivate resistant peers.
Ø       Emphasize ethical and legal implications of breaking confidentiality and serve as role models and maintain confidentiality under all circumstances.
 
 

Yours faithfully
(C.RAVICHANDRAN)
Managing Trustee
Mother Therasa Trust