Beginning this month, I-TECH is inaugurating a new series of free online e-learning modules designed to advance the knowledge and skills of clinicians practicing in resource-limited settings.

The I-TECH Clinical Education Modules are a free online training resource for clinicians.

The I-TECH Clinical Education Modules are short, self-contained e-learning modules that will be released on the third Tuesday of each month, and be available online for at least one year after their release. The modules are designed to be appropriate both for self-study and for use as the centerpiece of an hour-long classroom training, and can be downloaded in advance for use in settings where internet bandwidth is limited or sporadic.

Each module consists of:

• An expert lecture, illustrated by images and graphics
• A short interactive online quiz to reinforce the key learning points, and
• A PDF learning guide to help structure an effective classroom session or accommodate self-study

“Across I-TECH’s global work, we have seen that many clinicians lack access to ongoing professional development, and the kind of cutting-edge lectures we take for granted in American research universities,” says Dr. Chris Behrens, who serves as the series’ medical editor. “These modules will makes that kind of expert presentation available online, for free, in a format targeted specifically to the experience and needs of clinicians working in resource-constrained settings.”

The first module, a 38-minute presentation by Dr. Chris Behrens called HIV/TB Co-Infection: Initial Management, is focused on the implications of recent research studies on the topic of when to initiate HIV antiretroviral therapy in TB co-infected patients.

You can access that module, and learn about the topics of upcoming modules, by visiting the I-TECH E-Learning Library.

In Namibia, I-TECH has been involved in supporting the Ministry of Health and Social Services (MOHSS) to scale up medical male circumcision (MC), which has been shown to lower the risk of HIV infection among men by 60%. To support health care workers to safely and effectively perform the procedure, I-TECH has assisted the MOHSS to produce a new MC training video. Recently, two members of the I-TECH Namibia team who participated in the production of the videos, Eva-Liisa Kafidi and Justin Nyatondo, kindly agreed to share a little more about the videos and the MC program.

Male circumcision is an approach to HIV prevention that I-TECH is involved with in several countries. Can you tell readers a little more about the history of the program in Namibia?

The four new training videos are being distributed on a DVD in Namibia.

Certainly. In March 2007, the World Health Organization and UNAIDS issued policy and program recommendations on male circumcision for the prevention of HIV infection. These emphasized that safe MC services should be scaled up as a priority intervention in settings with heterosexual epidemics characterized by high HIV prevalence and low levels of MC. Namibia is one of the 14 southern and eastern African countries identified as priority areas for this recommendation.

In response, the Government of the Republic of Namibia, through the MOHSS, widened the scope of its HIV prevention package to include the provision of safe, affordable, and accessible MC services. To provide some background: According to a 2008 assessment, Namibia had a low MC prevalence rate of 21%, which requires a rapid scale up of MC services to achieve at least 80% coverage by 2025 to attain the desired public health impact.

What role has I-TECH played?

Video screen shot, "Sterile Surgical Gloves."

I-TECH has been involved with the male circumcision program from 2009, when Namibia started rolling out MC services to health facilities. Of course, the rollout requires adequate training for providers, and I-TECH has been involved with this important step. After an initial pilot training by Jhpiego, I-TECH Namibia, in collaboration with the MOHSS, adapted that curriculum for doctors and nurses, making it particularly tailored to the Namibian context.

In addition, I-TECH supported the MOHSS to develop and pilot MC curriculums for community counselors and an MC curriculum for managers. The three curricula are now used in the training of physicians and nurses, community counselors, and facility managers. In addition, I-TECH supported the MOHSS to conduct a training of trainers course for potential MC trainers.

I-TECH provides technical guidance to support the implementation of safe and effective male circumcision services through regular visits to MC sites, and by certifying that providers are able to perform key procedures. I-TECH trainers also carry out regular onsite mentoring visits for providers who have demonstrated some proficiency with the procedure, and has designed the standardized tools used to assess MC providers.

Can you talk a little bit about the new MC training video?

Safe hand washing procedure is a key skill covered in the new video series. (Video screen shot, "Surgical Hand Scrub")

Yes! The MOHSS has set a goal of circumcising 450,000 men by 2015. To increase the number of MC providers and meet this goal, I-TECH supports MOHSS to conduct a two-week training course, Male Circumcision under Local Anesthesia, on a regular basis. The participants, who are nurses and doctors, are equipped with the knowledge, skills, and competence required to implement the program. The course encompasses two components: didactic [classroom based] sessions during the first week, followed by practical sessions with real patients at the National Referral Hospital (Windhoek Central Hospital) during week two. In addition, community counselors are trained to provide specific counseling on male circumcision before the procedure. To date, nine trainings have been conducted and more than 9,000 men have been circumcised.

Safety is an important element of the training. Key skills and safety procedures to minimize the risk of complications, such as infection, are therefore emphasized throughout. To further support this goal, the MC curriculum also includes a series of videos. These four videos cover the following topics:

1. Surgical hand scrubbing
2. How to put on sterile surgical gloves (correctly!)
3. Instrument processing (decontamination and cleaning)
4. Instruments and supplies required for adult male circumcision

The videos are shown to participants in the classroom, after which they are asked to demonstrate the same skills in simulated sessions and during practice when managing actual patients (under supervision) in week two.

A nurse demonstrates one step in the safe processing of surgical instruments. (Video screen shot, "Instrument Processing.")

MOHSS drafted the video scripts based on its on-the-ground experience, with close collaboration and technical assistance from I-TECH. Namibia is also the leading implentor of partial task-shifting in MC service delivery, and therefore trains nurses to conduct the procedure under the supervision of doctors. Reflecting this major policy shift in Namibia, the actors in the videos are all nurses from the MOHSS.

Thank you! Is there anything more you’d like to add?

I-TECH is delighted to be involved in this prevention program. The videos will allow us to maintain a consistent message on infection prevention to circumcision providers in Namibia!

Learn more about I-TECH’s work in Namibia.

I-TECH is pleased to announce a new publication in the Malaria Journal. The article, “Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda” is by lead author Allen Namagembe of the Infectious Diseases Institute in Uganda, and includes contributions from co-authors from I-TECH (Marcia Weaver, PhD), Accordia Global Health Foundation, the Uganda Malaria Surveillance Program (UMSP), and the University of California, San Francisco.

Lead author Allen Namagembe

Increasingly, global and local leaders are placing an emphasis on evaluating the meaningful health outcomes of  interventions. This includes training interventions designed to prepare health care workers to respond to the priority issues they encounter every day. In the new article, the authors discuss their evaluation of the effect of a clinical and laboratory skills course, the Integrated Management of Malaria, in Uganda. The course was provided to health care workers at nine health facilities that were Ugandan Ministry of Health malaria sentinel sites: sites where UMSP was conducting surveillance activities.

The results showed that the team-based training program was associated with significant improvements in skills, and that these improvements were lasting: most persisted for a year after the six-day course. As a joint program, the effects of the course can’t be distinguished from UMSP activities, but the evaluation conclusions do lend support to long-term, ongoing capacity building and surveillance interventions.

“One important aspect of this study was the use of a longer, one year follow-up,” said I-TECH’s Marcia Weaver. “I-TECH and other programs are working toward evaluations that examine outcomes over a longer time period, and this study is a good example of that approach.” Weaver also expressed great appreciation for every member of the team. “It was a pleasure to work with this group of dedicated partners,” she said.

If, like many members of the global health community, you recognize an increasing need for qualified health care workers worldwide, I-TECH’s most recent publication, The I-TECH Approach to Strengthening Pre-Service Health Training Institutions (PDF), may be of interest to you. By way of introduction, I-TECH has invited Stacey Lissit, I-TECH’s Director of Training, to briefly discuss the evolution of the organization’s work in this arena.

In my eight years at I-TECH, I’ve witnessed remarkable growth and expansion in our activities in support of pre-service educational institutions and systems. Much of this growth has occurred within a very short time frame. A few years ago, I-TECH was just venturing into the pre-service field. Today, we have pre-service activities in nearly all of our partner countries worldwide, and pre-service has joined in-service training as the focus of our activities supporting health workforce development.

In Mozambique, an instructor speaks to young técnicos de medicina, a key mid-level cadre of health care workers. I-TECH has worked closely with the Ministry of Health (MISAU) to revise the curriculum for the cadre and support faculty at local training institutions.

This growth in pre-service training has paralleled the path along which global HIV care and treatment programs have evolved. Initially, global donors, including the President’s Emergency Plan for AIDS Relief (PEPFAR) staged an emergency response to the HIV pandemic, dedicating resources toward direct service provision in care and treatment. As this response continued to mature, however, it became clear that weaknesses within national health systems were creating barriers to sustainable, effective, and efficient delivery of services. In response, donors and leaders increased their emphasis on strengthening national health systems. The evolution of focus in the pre-service sector mirrored this shift within health services delivery. In the context of the emergency response, many leaders recognized relatively early that any sustainable care and treatment program would require health care workers to graduate from their institutions with the knowledge and skills to care for and treat people living with HIV and AIDS. Thus, early work with pre-service training institutions focused on integrating HIV clinical knowledge and skills into the curricula for cadres at all levels, and on training faculty to deliver this content.

It quickly became clear, however, that integrating new content into a weak infrastructure would not lead to effective education. Schools could benefit from strengthening curricula, improving classroom and clinical teaching methodologies, reducing class sizes, hiring additional tutors, upgrading facilities, and stocking libraries with updated materials. Students and teachers could learn better in less crowded teaching and housing facilities, and with more reliable Internet access. In short, training institutions, like the national health systems in which they were embedded, would benefit from comprehensive systems strengthening. 

As PEPFAR and other global leaders began to focus on health systems strengthening, “Health Workforce,” one of the six building blocks of the World Health Organization’s Framework for strengthening health systems, drew greater attention. Global data supported this focus, demonstrating then (as now) that health care worker shortages challenge the ability of all health care systems to improve health outcomes.

I-TECH responded. Drawing on our academic roots in two teaching institutions (the University of Washington and the University of California, San Francisco) and our extensive experience collaborating with local organizations, we expanded our work from integrating HIV and AIDS content into pre-service programs to revising the full curricula. And we went from training faculty in content and methods for delivering HIV material to broader efforts in faculty development, including strengthening clinical teaching and student assessment. The I-TECH approach expanded to include comprehensive efforts to ensure that all aspects of our partner training institutions were functioning effectively in order to ensure delivery of high quality education.

So what does it take to produce a doctor, nurse, or clinical officer who is equipped to effectively meet the health needs of her community? I-TECH believes that, among other factors, it takes

• an evidence-based curriculum that addresses priority health conditions;
• adequate numbers of well-trained, motivated faculty;
• clinical sites with enough patients to support student learning (but not so many that the site is overwhelmed and staff have no time for student teaching);
• resources and equipment–for example, well-stocked skills labs, gloves, computers, and adequate classroom and dormitory space.

I-TECH's formalized approach to pre-service developed through years of experience, and recognizes that training institutions rely on a wide network of regulatory bodies, ministries, professional associations, and other stakeholders.

In addition, we’ve seen over and over again that pre-service institutions don’t exist in a vacuum. Professional regulatory bodies, ministries of education and health, professional associations, and communities all support training institutions, and in some cases we must put our focus there.

Ultimately, our goal is to sustainably increase the number of well-trained health care graduates in each of our partner countries. As an organization, we’ve arrived at a formalized approach to achieving this organically: through on-the-ground experience, flexibility, and the constant commitment, dedication, and support of our local institutional partners.

To learn more about our approach to building pre-service capacity with local training institutions and systems worldwide, and read a few specific examples, I invite you to peruse our new project profile, The I-TECH Approach to Strengthening Pre-Service Health Training Institutions (PDF, 2.5MB).

(Left to right) Dr. Namate, Dr. Bateganya, and Mr. Samute.

The I-TECH Malawi office is pleased to announce the signing of a new memorandum of understanding with the Malawi Ministry of Health. The memorandum affirms that, as part of its broad and expanding work in the country, I-TECH Malawi will continue its close, valued partnership with the Ministry.

I-TECH is thankful for this show of confidence. The growing Malawi team is eager to respond to the Ministry’s call to action and to collaborate with local partners to achieve national health goals.

(Left to right) Mr. Njati, Dr. Bateganya, and Mr. Samute.

Present to sign were Mr. Willie Samute, the Principal Secretary of the Malawi Ministry of Health, and Dr. Moses Bateganya, I-TECH Malawi Country Director. They were observed by Mr. Hetherwick Njati, Director of Planning and Policy Development in the Ministry of Health, and Dr. Dorothy Namate, the Global Fund Coordinator seconded by I-TECH.

Learn more about I-TECH’s work in Malawi.

I-TECH partnerships draw on the dedication of local governments, health care workers, communities, and institutions around the globe.

1. Our Partners: I-TECH has worked in collaboration with the Health Resources and Services Administration, the US Centers for Disease Control and Prevention, local ministries of health, and other partners for 10 years in order to strengthen health systems in resource-constrained countries. Following our Partnership Model, I-TECH guides every project toward the goal of local ownership, sustainability, and transition into national systems. Partners are the key to making that work.

2. Our Vision: “I-TECH envisions a world in which all people have access to high quality, compassionate, and equitable health care.”  We put our vision statement in front of us every day in order to face complex conditions with an attitude of hope. We have seen progress toward achieving this vision in the past decade, although much work remains to be done.

3. Our Staff: From just a handful of full-time employees in 2002, I-TECH has now grown into a worldwide team of committed, compassionate, and skilled staff, based in more than a dozen countries. We honor one another, our partners, and the I-TECH operating principles that define our ideal organizational culture. Every member of our team contributes to our success.

Partnership is essential to achieving national care and prevention goals, strengthening infrastructure, and preparing new generations of health care workers.

4. Health Systems Strengthening: We appreciate more than ever the ability of a strong health system to deliver high quality care to people who need it most. Strong systems rely upon the development of trained health care workers, provider networks, and infrastructure. That is why we focus on strengthening all levels of a health system.

5. Public Sector Programming: Based at two public universities in the United States (the University of Washington and the University of California, San Francisco), our primary work is to partner with local governments in resource-constrained settings to strengthen national health care and higher education systems. We believe deeply in the model of working with government to strengthen systems that are transparent and accountable to the people they serve.

Innovative methodologies, information technology, and scholarly research inform and improve I-TECH efforts.

6. Innovation: We draw upon innovative methodologies, information technology, and scholarly research to inform and improve our work. From the TrainSMART electronic database to the iSanté electronic medical record system to effective clinical mentoring programs, I-TECH develops and tests new ideas for improving health systems worldwide.

7. Theory into Practice: As a university-based organization that implements programs in multiple countries, we draw upon the intellectual resources of our US and partner universities as we translate knowledge into evidence-based, effective, and well-designed programs on the ground.

The Everyday Leadership website offers more than 300 videos with insights from global leaders at every level.

8. Feedback: We recognize that effective programming requires feedback for continuous program improvement.  In collaboration with our partners, I-TECH monitors and evaluates program outcomes in order to provide strategic information and quality feedback for program improvement.

Together, I-TECH and partners are working toward a brighter future.

9. Everyday Leadership: I-TECH’s Everyday Leadership project and leadership training activities are built upon our belief that good leadership and management can be learned and must be taught alongside other technical competencies as essential components of health systems strengthening. We believe that leadership can and should occur at any level of our organization.

10. The Future. The future may be uncertain, but our dedication to quality health care is not. Our experience in the important work of health systems strengthening; our respect for our partners, our clients, and ourselves; and our continued commitment to improving the health of our communities worldwide will continue to guide us as we move forward into our second decade.

Recently, several I-TECH staff members returned from a visit to China, where they led two very successful trainings with local professionals. The first was a pilot training, in Beijing, on qualitative research methods. The second brought I-TECH’s leadership and management training to an engaged group of leaders in Chengdu.

“[I have] had similar trainings before, but the concepts were abstract,” said one enthusiastic participant. “These ideas were more clear to me.”

Elaine J. Douglas, I-TECH senior technical specialist and lead facilitator for the leadership and management training, echoed this enthusiasm. “Being in China was a privilege, and the workshops went very well,” she said. “The participants for both workshops were very skilled and engaged; they kept us on our toes with excellent questions and a strong desire to learn more and integrate new concepts and approaches into their work and lives.”

I-TECH's TB prevention efforts include trainings that prepare health care workers to implement prevention activities in their facilities. Here, a group of trainees in Ethiopia gather for a photo.

World Tuberculosis Day falls on 24 March each year. This year, as always, I-TECH would like to recognize and thank the health care workers, clients, and partners worldwide who are drawing attention to this disease and working to prevent and treat it.

I-TECH works with local partners to strengthen the prevention and treatment of tuberculosis (TB) by implementing trainings that help health care workers recognize TB in their clients, improve care and treatment for TB and TB/HIV coinfection, and prevent the spread of illness in health care facilities. Laboratory training and improvements are making accurate and reliable testing for TB more widely available. Infrastructure improvements are making it easier for facilities to separate patients with TB and multi-drug resistant TB from other clients, limiting new infections.

I-TECH’s prevention and continuous quality improvement efforts include the free, easy-to use TB Prevention Toolkit, designed in collaboration with the Curry International Tuberculosis Center to help facility level administrators and health care workers implement TB infection prevention and control measures.

One of several posters created for World Tuberculosis Day 2012; visit stoptb.org to create your own.

More: Posters, History

This year, the website of the Stop TB Partnership is featuring a poster-creation website to commemorate the day; visit the site to create a custom “Stop TB” promotional poster and learn more about the partnership’s key treatment and prevention goals.

From the site:

World TB Day, falling on March 24th each year, is designed to build public awareness that tuberculosis today remains an epidemic in much of the world, causing the deaths of several million people each year, mostly in developing countries. It commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. At the time of Koch’s announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch’s discovery opened the way towards diagnosing and curing TB. 

“Smile and be proud—” say posters and billboards in Botswana “—you’ve made the decision of your life.” It’s a direct invitation to something the Botswana Ministry of Health wants all Batswana thinking about, talking about, and participating in: safe male circumcision, or “SMC”.

Welcoming faces during the event at Maun General Clinic.

Together, I-TECH and the Ministry of Health (MOH) are working to scale up SMC in Botswana as an important component of the national HIV prevention effort. They have an ambitious goal, too: by the year 2016, the MOH would like 470,000 HIV-negative men and boys in Botswana (birth to 49 years of age) to be circumcised.

Recently the poster, along with several others like it, found a new home at Maun General Clinic, in northern Botswana. On a sunny afternoon, representatives from the MOH, I-TECH, and local and national partners gathered in Maun to formally celebrate the arrival and establishment of a new SMC medical team at the facility.

The team’s new place at the clinic is part of an I-TECH commitment to employ and place two teams of SMC professionals in densely-populated areas. Each team is comprised of a medical officer, five nurses, one auxiliary, and a site administrator, and is supported by three counselors. Together, they will provide onsite and outreach SMC services to eligible clients and work closely with the facility management, district health management teams, the MOH, and other collaborating partners.

Promotional posters and other materials urge all Batswana to become involved in SMC efforts.

The choice to use this team of professionals is a part of a formalized approach to SMC adopted by the MOH from the World Health Organization. Called the Model for Optimizing Volume and Efficiency (“MOVE”), the approach involves using medical teams with high nurse-to-doctor ratios, allowing for task sharing between nurses and physicians. It’s an efficient and safe methodology that decreases client waiting time, shortens SMC procedure time, and increases the number of procedures physicians can perform without compromising quality.

In the coming months, as the team begins providing services to the region, I-TECH will continue to support them, providing close mentoring from master trainers.

 Find out more about I-TECH’s work in Botswana.

The new telemedicine center at Mekelle University College of Medicine and Health Sciences.

At a medical university in northern Ethiopia, fifteen students are gathered in a small alcove just off the main road, crowded around a single piece of paper. They’ve just gotten the results of a major exam, and their excited jostling would be familiar to any student.

In Ethiopia, however, as in many resource-limited settings, these students, when they graduate, will be crucial to national efforts to provide quality health care–and there aren’t likely to be enough of them.

Once they’ve joined the workforce, many will also find that they’re isolated from the work of their local and global peers, and that to pursue professional development, they have to travel long distances and take time away from their jobs.

In response to these challenges, I-TECH Ethiopia, in collaboration with university and national leaders, has intensified efforts to remove educational barriers through distance learning (DL) and telemedicine technologies. As a key component of this work, I-TECH and partners recently inaugurated a new university-based DL and telemedicine center at the Mekelle University College of Medicine and Health Sciences. A similar center is also under construction at Bahir Dar University.

The new centers leverage distance learning technology to respond to the need for training of key health cadres in Ethiopia.

The new centers will leverage distance learning technology to respond to the increasingly urgent need for pre-service and in-service training for key health cadres in Ethiopia. Despite growth and improvements, Ethiopia’s few medical and health sciences colleges graduate only several hundred health practitioners every year; too few to meet growing demand. In addition, staff turnover at facilities, coupled with a shortage of professors, exacts a toll on graduation rates and the quality of education. Now, using a high-definition video conferencing system, the centers can broadcast coursework, seminars, and expert medical consultation, potentially reaching a greater number of students and health care workers.

Recently, local leaders and partners gathered in Mekelle for a ribbon-cutting ceremony to inaugurate the university’s new facility. During a short introduction, Bill Graham, I-TECH Ethiopia’s country director, warmly acknowledged the support of the Federal Ministry of Health, the Regional Health Bureau, and leaders at Mekelle University. He emphasized the important role distance learning can play in strengthening Ethiopia’s national health system, and thanked university leaders for their dedication to finding innovative approaches to pre-service and in-service training.

“This new endeavor  . . .  has the potential to improve the capacity of Ethiopian health professionals to manage and implement health services,” said Mr. Graham. “I believe it will support new strides in our work to lessen the burdens of maternal and newborn deaths and infectious diseases; equally important is its enormous contribution to improving the quality of medical and health sciences education in Ethiopia.”

In addition to extending their educational reach, telemedicine and distance learning promise exciting improvements for Ethiopian medical schools. They provide a way for leaders to “virtually” bring experts (and expertise) from around the world to their own locations, overcoming the considerable limitation and expense of travel. Similarly, schools can use these tools to share their own expertise more widely, reaching out to their respective regional hospitals and institutions to share knowledge, standardize protocol, and discuss lessons learned.

New technologies also have the potential to support and enhance training. For example, live operating room practicums at Mekelle are often chaotic and crowded–overburdening staff and creating stressful sessions. Using live video streaming technology, instructors can instead broadcast procedures from the operation room to one or more classrooms, taking students out of the operating room, easing the burden on physicians, and creating a better learning experience.

Next Steps

The benefits of distance learning and telemedicine, especially in resource-constrained settings, have been well-documented. For this reason, the Federal Ministry of Health and the Regional Health Bureau have endorsed these methodologies as one way to improve health care nationwide, and are working with medical schools throughout the country on new distance learning centers and programs. I-TECH will be providing technical assistance to support these locally-initiated projects.

Read more about I-TECH Ethiopia’s work to strengthen national health systems.