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Reyes, E Michael; Sharma, Anjali; Thomas, Kate K; Kuehn, Chuck; Morales, José Rafael (2014)
Publisher: BioMed Central
Journal: BMC Health Services Research
Languages: English
Types: Article
Subjects: ART, Research Article, wa_110, wa_30, wc_503, Sustainability, wa_525, wa_105, Health Policy, HIV, Technical assistance, Health system strengthening, PEPFAR, Capacity building
Background\ud \ud Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs.\ud \ud Methods\ud \ud Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation.\ud \ud Results\ud \ud Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework.\ud \ud Conclusions\ud \ud A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. El-Sadr WM, Holmes CB, Mugyenyi P, Thirumurthy H, Ellerbrock T, Ferris R, Sanne I, Asiimwe A, Hirnschall G, Nkambule RN, Stabinsky L, Affrunti M, Teaside C, Zulu I, Whiteside A: Scale-up of HIV treatment through PEPFAR: a historic public health achievement. J Acquir Immune Defic Syndr 2012, 60(Suppl 3):S96-S104.
    • 2. Fiscal Year 2012 Country Operational Plan (COP) Guidance. http://www. pepfar.gov/documents/organization/169694.pdf.
    • 3. Using science to save lives: Latest PEPFAR results. http://www.pepfar.gov/ documents/organization/187770.pdf.
    • 4. Fiscal Year 2013 Country Operational Plan (COP) Guidance. http://www. pepfar.gov/documents/organization/198957.pdf.
    • 5. Government Accountability Office (US: President's Emergency Plan for AIDS Relief: Efforts to Align Programs With Partner countries' HIV/AIDS Strategies and Promote Partner Country Ownership. Washington D.C: GAO; 2010. http://www.gao.gov/assets/310/309763.pdf.
    • 6. Institute of Medicine Committee on the Ryan White CARE Act: Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act. Washington, D.C.: The National Academies Press; 2004.
    • 7. Clinical Assessment for Systems Strengthening. www.classtoolkit.org.
    • 8. A Successful Framework for Assuring the Quality and Sustainability of US Government-Supported HIV Care and Treatment Programs in Resource-Limited Settings. http://www.classtoolkit.org/class-monograph.
    • 9. Green J, Thorogood N: Qualitative Methods for Health Research. London: Sage; 2004.
    • 10. Bradley EH, Curry LA, Devers KJ: Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 2007, 42(4):1758-1772.
    • 11. Thomas DR: A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006, 27(2):237-246.
    • 12. Russ-Eft DF: Evaluation in Organizations: A Systematic Approach to Enhancing Learning, Performance, and Change. New York: Basic Books; 2009.
    • 13. Crisp BR, Swerissen H, Duckett SJ: Four approaches to capacity building in health: consequences for measurement and accountability. Health Promot Int 2000, 15:99-107.
    • 14. Perla RJ, Bradbury E, Gunther-Murphy C: Large-scale improvement initiatives in healthcare: a scan of the literature. J Healthc Qual 2013, 35(1):30-40. Epub 2011 Sept 14.
    • 15. Clinical Assessment for Systems Strengthening: ClASS Overview/The Class Process. http://www.classtoolkit.org/overview.
    • 16. Linsk NL, Bruce D, Schechtman B, Warnecke R, Tunney K, Bass M: Development and implementation of a quality improvement program for Ryan White Title I care services using a stakeholder-based model. AIDS Patient Care STDS 2005, 19(3):174-185.
    • 17. Svornos T, Mate KS: Evaluating large-scale health programmes at a district level in resource-limited countries. Bull World Health Organ 2011, 89(11):831-837.
    • 18. Kanki P, Kakkattil P, Simao M: Scaling up HIV treatment and prevention through national responses and innovative leadership. J Acquir Immune Defic Syndr 2012, 60(Suppl 3):S27-S30.
    • 19. Clinical assessment for systems strengthening: assessment preparation document. http://www.classtoolkit.org/tools/assessment-preparationdocuments.
    • 20. Goosby E: The President's emergency plan for AIDS relief: marshalling all tools at our disposal toward an AIDS-free generation. Health Aff 2012, 31(7):1593-1598.
    • 21. Cohen MS, Holmes C, Padian N, Wolf M, Hirnschall G, Lo YR, Goosby E: HIV treatment as prevention: how scientific discovery occurred and translated rapidly into policy for the global response. Health Aff 2012, 31(7):1439-1449.
    • 22. Sharma A, Chiliade P, Reyes EM, Thomas KK, Collens SR, Morales JR: Building sustainable organizational capacity to deliver HIV programs in resourceconstrained settings: stakeholder perspectives. Glob Health Action 2013, 6:22571. http://dx.doi.org/10.3402/gha.v6i0.22571.
    • 23. Merion S, de los Rios Carmenado I, de los Rios Carmenado S: Capacity building in development projects. Procedia - Social Behavior Sciences 2012, 46:960-967.
    • 24. Baser H, Morgan P, Bolger J, Brinkerhoff D, Land A, Taschereau S, Watson D, Zinke J: European Centre for Development Policy Management. Maastricht (The Netherlands): European Centre for Development Policy Management; 2008. Discussion Paper No. 59B.
    • 25. Program UND: A Brief Review of 20 Tools to Assess Capacity. New York: UNDP Capacity Development Group, Bureau of Development Policy; 2005.
    • 26. Johnson K, Hays C, Center H, Daley C: Building capacity and sustainable prevention innovations: a sustainability planning model. Eval Program Plann 2004, 27:135-149.
    • 27. Doherty S, Mayer S: Results of an Inquiry Into Capacity Building Programs for Nonprofit Organizations. Minneapolis: Effective Communities; 2003.
    • 28. Chaudoir S, Dugan A, Barr C: Measuring factors affecting implementation of health innovations: a systematic of structural, organizational, provider, patient and innovation level measures. Implement Sci 2013, 8:22.
    • 29. Subramanian S, Naimoli J, Matsubayashi T, Peters D: Do we have the right models for scaling up health services to achieve the Millennium Development Goals? BMC Health Serv Res 2011, 11:336.
    • 30. World Health Organization: Scaling up Health Service Delivery: From Pilot Innovations to Policies and Programs. Geneva: WHO; 2007.
    • 31. MacLeod P: Clinical Assessment for Systems Strengthening (ClASS) Model and Methodology Review: Findings and Recommendations. Seattle: I-TECH; 2013.
    • 32. Bushe GR: Appreciative Inquiry: Theory and Critique. In The Routledge Companion to Organizational Change. Edited by Boje D, Burnes B, Hassard J. Oxford, UK: Routledge; 2011:87-103.
    • 33. Wandersman A, Chien VH, Katz J: Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement. Am J Community Psychol 2012, 50(3-4):445-459.
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