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Public Health
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October 2004 - Public Health Strengthening in Guyana - Project Update
SUMMARY:
At the successful, for CSIH, outcome of a competitive bid, the contribution agreement (CA) for the Design phase of the Project was signed January 18, 2002. CSIH developed the Project Implementation Plan (PIP); the final version was approved by the Ministry of Health, Guyana, in the Fall 2002 and accepted by CIDA in January 2003. An extension to the Design phase and a Transition phase was allocated to CSIH by CIDA due to the many changes in Project Officers and incurred delays.
The Amendment to the CA for the start up of the four-year Implementation phase was signed at CSIH, June 3, 2003. The MOU with the Government of Guyana was signed in Georgetown June 9th 2003. The First Year Workplan (covering the period June 2003 to March 2004) was approved at the PSC meeting July 24th 2003.
An inception mission, 13 expert team missions, four study tours (2 in Canada, one in Trinidad and one in Jamaica) were carried out. The Workplan for the Project Year 2 (April 2004 to March 31, 2005) was drafted and presented for approval at the PSC Meeting (May 24, 2004). A comparative report, requesting to clarify the implication of changes to the HIS component due to the MOH switch from Linux to Microsoft operating system, was delivered to CIDA and MOH. CIDA has approved the Second Year Workplan, MOH’s is pending for mid October.
PROJECT ACTIVITIES:
- Management: Project Ottawa and field office are staffed, operationalised and functioning as expected. The First Workplan and the Annual Workplan Update were submitted respectively to the PSC at meetings in July 2003 and May 24, 2004. Quarterly PIC meetings held in Guyana. Narrative and financial reports were submitted to CIDA.
- Missions: An inception and twelve experts team missions held.
- Training: Two study tours for 8 health HIV and TB professionals to Canada. Technical training for the Chief Microbiology Technologist GPHC, at CAREC and PH facilities in Trinidad. Practical training for STI nurse study coordinator in Jamaica. Students training at UG, and continuous mentoring of health professionals and CE held with all level of health professionals in 3 project regions. Training workshop for all health professionals involved in the STI study. Twelve health professionals were sponsored to attend a “Multidisciplinary approached to ARV” workshop in Jamaica.
- Guidelines and Manuals: STI and HIV National Guidelines drafted; National TB Manual and technical protocols developed, including TB Lab manual; “Nursing Guidelines for Care in the Home & Community: Especially in Relation to HIV/AIDS, TB and Palliative Care in Guyana” finalized; STI laboratory manual delivered. Protocol for establishing STI pathogens baseline for Guyana finalized, submitted for IRB review at CAREC and, approved.
- Curricula development with UG: STI/HIV modules; TB modules and Public Health core course for all students.
- Database development: Clinical and PHC database designed, installed at two sites and being piloted.
- Procurement: A dedicated vehicle for the TB Program; eighteen motorbikes for TB DOTS workers; capital laboratory equipment and lab reagents for over $59,000; computers and networking equipment the GUM , Chest and a PHC Clinics. Project vehicle procured and driver hired.
- Local Subcontractors: An additional NAPS expert and officer in place; ten DOTS workers and an administrative assistant for the NTP in place and; a System administrator for the HIS.
- Communication strategy: the Project website is regularly updated; the printed Project brochure is being distributed; several press releases and two Project posters prepared; Project participation at the World AIDS day in Guyana, PANCAP annual exhibit, the CHC exhibit and GYEXPO in Guyana; TV and radio interviews held and presentations made at both CCIH and Stop TB conferences in Ottawa.
FOR THE PERIOD APRIL TO OCTOBER 2004
Activities for this period focused on: 1- finalizing the STI baselines pathogens study Protocol; 2- procurement/installation requirements for laboratory equipment for TB and STIs; 3- training for HIV, TB and STI; 4- further refining of procedures manuals and Guidelines; 5-HIS component re-design.
Project team members/consultants carried out ten missions to meet and work with our local partners. Technical training for the Chief Microbiology Technologist GPHC, at CAREC and PH facilities in Trinidad was organized. The STI study coordinator was trained at a Public health facility in Jamaica. Twelve health professionals were sponsored to attend the ”Multidisciplinary approach to ARV” workshop in Jamaica organized by CHART.
CME and CE sessions held with various health professional associations (Medical Laboratory technicians, Pharmacists, Nurses, and Doctors) were very well received. Lectures on STIs, TB, HIV and microbiology were provided to Medical and Health Science Students. A Public Health core course for all Health Science students was developed, submitted to UG Board and approved to start January 2005. The course will also be offered to the general public in the summer 2005.
STI Baselines Pathogens Study: The nurse coordinator for the study was trained at a Public health facility in Jamaica. The official launching of the STI study was celebrated in July. A ten-day STI workshop for all participants from the six sites and three regions was delivered by CSIH and local experts. In addition, technologists were trained in collaboration with CAREC. Procedure binders were prepared, questionnaires printed and trial runs instituted. Review of all sites was completed during the September mission, recommendations and additional mentoring provided. Study scheduled to start the end of October, 2004.
Draft of STI guidelines provided to local partners for input.
Patients’ and health professionals’ satisfaction surveys were designed, delivered, and analyzed resulting in recommendations to improve service delivery at the GUM clinic. Training was provided. Inclusion of scheduling software is now planned with the IT component. Recommendations to improve service delivery have been implemented by the new Director of GUM, Dr. Singh including regular staff meetings, and a team building retreat/conference (Saturday October 9th) facilitated by Project expert. Grief /stress management workshop was provided in house.
HIV/AIDS component. Twelve health professionals were sponsored to attend the 3-day First CHART Caribbean Regional Training on the Clinical Management of HIV/AIDS: A Multidisciplinary Team Approach, in Jamaica. Upon their return their contributed along with PIC members to the review of the first draft of the National guidelines for HIV/AIDS in a one day workshop held by the project and, facilitated by PAHO.
Donor coordination activities continued to grow exponentially, especially with regards to HIV/AIDS. Success was achieved as collaboration with the CDC team on HIV ARV treatment guidelines was ensured and a mixed working group constituted. Three meetings of the working group were held and the National ARV guidelines are in their final draft. They will be published with CDC funding. Operational guidelines are being prepared as Annex.
TB Component: based on the success of the implementation of DOTS strategy in the Capital region 4, official Launching and expansion of the DOTS program to region 10 was feted, additional DOTS workers were hired and supplied with means of transportation, and the regional nurse coordinator was trained. DOTS in Georgetown prison reviewed. In Georgetown, the Chest Society, a national NGO, was re-activated and first inaugural meeting was held. Fluorescent microscopy procurement and training was provided for the Central laboratory. Mentoring for TB culture was provided on site and cultures initiated during the September mission.
Tuberculosis Laboratory Manual – completed with the exception of INH protocol. During the September mission, INH drug resistance testing, planned initially to be done at CAREC, was also initiated and will result in long-term cost-savings and increased local capacity.
TB Manual revised and finalized by Dr. Persaud and Dr. Hershfield. Final version will be ready for printing by PAHO, by the end of October 2004
The three-day First National Tuberculosis Conference, organized in collaboration with MOH and the Guyana Chest Society to review NTP plan 2000-2005, Project’s contribution and prepare the next five year plan was a success. Proceeding from the conference will be completed by October 19th 2004.
Co-infection (TB-HIV) guidelines were finalized at sessions at the TB conference and additional HIV/TB departments meetings.
Health Information System: the initial plan, which relied on a Linux-based server, was reviewed and scaled down, in light of MOH’s directive that all information systems are to be built on Microsoft operational systems. An exhaustive comparative (original versus current plan) report was delivered to CIDA and MOH. Stand-alone networks with databases replicated on key workstations are being developed at three selected sites: GUM clinic, Chest clinic and one PHC clinic. Required networking, electrical work and procurement were completed. The database is now installed and being piloted at GUM and Chest clinic Staff training initiated. Security access levels were discussed and will be finalized pending local feed back.
2 RHO from regions 6 and 10 are enrolled in one- year Masters training for Public Health at UWI, Jamaica for the 2004-2005 program.
Community Development and Health Component: the “Nursing Guidelines for Care in the Home and the Community especially in relation to STI/HIV and TB and Palliative Care” manual are being finalized after CIDA’ s review. A contingent of Nurse Trainers was identified and two of the training modules (Adult Learning/ Teaching Skills and Infection Control) pilot tested in the three Project regions.
At HQ, a graduate student in Healthcare Administration started residency for four month with the Project.
The Project secured a NetCorps intern who started assignment September 30th for six months in Guyana. Her main responsibilities include personnel training on HIS and eliciting feedback to improve and customize system