Brown Bag on Sept. 3rd at 12:00 in Rm 109

Purchasing Mavens:

I am back in the saddle again and Sophia is out on vacation but should be back next week. It was a productive trip and we would like to tell you about it.

Sophia and I would like to show you some pictures and tell you about our trip to Africa for ITECH and we would love to answer any questions.

So, come to our brown bag and get a chance to win a bag of Ethiopian coffee!

Location: Rm 109 Purchasing Bldg.
Date: Thursday, September 3rd
Time: 12:00 to 13:00
Type: Brown Bag

Thanks,

Dennis & Sophia

My Ethiopian Dress (no Sophia's!)

Greetings from Addis Ababa, the capital of Ethiopia! Today is our second last day in Addis. We were supposed to be in Makele yesterday to visit one of the regional sites of the I-TECH Ethiopia. The purpose was to see on hand how the regional office processes its requisitions and send them to the headquarter.

Yesterday, Dennis, Kristen of I-TECH Seattle, Kidist – Operations Director of I-TECH Ethiopia and me were at the airport for our flight to Makele. While we were walking up to the lounge area, Dennis was asking me if I would go shopping in Makele. As usual, he offered to lend me his money if I run out. However, I told him I won’t buy anything as my luggage is packed already. I was even planning of checking my carry on bag. Anyhow, as we were sitting on the bench and we have plenty of time to kill until our flight at 1pm, there were boutiques in front of us. My curiosity of items on display brought me to a store which has beautiful Ethiopian dresses hanging on the stand. One particular off white dress with red piping got my attention. And with the price the sales lady gave me, I couldn’t refuse to try it on. Kidist helped put it on me especially the long scarf that goes with it.

Kristen took a picture of me and gave me her thumbs up. And with the encouragement of the three sales clerks who thought I should get it. They said I should match it with red shoes and told them no problem as I have two pairs of red shoes. The other sales clerk also mentioned about a red purse as well. Again, no problem as I have one to match. To make the story short, I bought the dress at $20 US dollars. However, since our flight and all the flights to Makele were canceled, we were given a refund of 100 Ethiopian Birr. Taken this money into consideration, my Ethiopian dress cost me a little over $10. Isn’t it a great deal!!!

So, my fellow Purchasing Mavens, you will see me with this dress with the scarf properly put on my shoulder on Halloween!

See you all in September!

Sophia

Purchasing Training in Addis Ababa, Ethiopia

Purchasing Mavens:

Sophia and I have conducted our first two days of training. Ethiopia has a strong program in place and already has a Procurement Policy and Procedure Manual created (March, 2009). Muluneh, the Finance Director, and Kidist, the Operations Director, have established a fairly robust process and are well along the way to obtaining the delegation. More on the background later.

Below please find info about the I-TECH Ethiopia program. Our next posting will be written (with pictures) by Sophia.

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I-TECH ETHIOPIA OVERVIEW

In Ethiopia, I-TECH delivers technical assistance that enhances antiretroviral treatment (ART) service delivery and develops human resources in HIV/AIDS care. I-TECH provides an array of technical, clinical, laboratory, and operational support to 38 health care sites in the three northern regions of Amhara, Afar, and Tigray. These regions account for nearly 50% of the national HIV burden. I-TECH implements, together with the Ministry of Health (MOH), eight different programs, both national and regional, to 31 hospitals and five health centers. More than 241 staff facilitate government-sanctioned activities, such as training, capacity building, clinical mentoring, and technical support. To promote this work, I-TECH Ethiopia acts in close partnership with the Regional Health Bureau (RHB) offices of the MOH.

PROJECT HIGHLIGHTS

Field-Based Mentoring Teams.
I-TECH currently has 11 field-based clinical mentoring teams providing technical assistance to its 38 I-TECH-supported sites. The field-based team model allows for expert staff-physician and nurse mentors and ART monitoring and evaluation (M&E) advisors to regularly visit clinical sites to provide intensive site support and clinical mentoring. In addition, I-TECH case managers, lab technicians, and data managers are regionally assigned to work with I-TECH health care facilities and staff at the RHBs. I-TECH provides technical assistance to RHB ART program implementation as well as supports initiatives to build the capacities of Gondar and Mekele universities and teaching hospitals to strengthen local health network systems.

ART Training. I-TECH plays a national leadership role in clinical training and curricula and guideline development. The national ART training curricula guidelines for physicians, nurses, and pharmacists at the hospital level were developed by I-TECH. Further, I-TECH continues to contribute to subsequent ART-related guidelines and protocols, such as those pertaining to sexually transmitted infections (STIs), prevention of mother-to-child transmission of HIV (PMTCT), palliative care, ART standard operating protocol, opportunistic infections, and clinical mentoring.

Case Management. Case management is a job duty within the ART multidisciplinary team that is dedicated to finding solutions for ART patients who are at risk for treatment adherence. The case manager provides a continuum of care that maximizes adherence to treatment and minimizes the number of patients lost to follow-up.

At the request of the Ethiopian Ministry of Health, I-TECH developed a national ART case management model to reduce the load on health care workers by shifting tasks to case managers-individuals, some of whom are persons living with HIV/AIDS, who, though they are not health care professionals, were hired and trained to:

Monitor ART adherence.
Link patients to community resources that ensure a continuum of care; where community resources are constrained, case managers mobilize the community to help meet the patients' needs, including clothing, rent, and food.
Trace lost to follow-up clients on pre-ART and ART services and reduce the number of patients lost to follow-up.
Provide health education and adherence counseling at hospitals and within the community.
Strengthening the Tiered Laboratory System. Effective laboratory services are essential for the prevention, diagnosis, and treatment monitoring of HIV/AIDS programs. Ethiopian laboratories can be a constraining factor for ART scale-up due to a lack of infrastructure and human resources.

I-TECH, partnering with the Ethiopian Health and Nutrition Research Institute (EHNRI) and RHBs, provides technical assistance to regional labs, 38 hospitals, and four health centers' HIV laboratories in the regions of Amhara, Tigray, and Afar. Twenty-five million people live in these three regions where there are approximately 404,000 people infected with HIV/AIDS and approximately 108,000 who need ART.

I-TECH's field-based laboratory support program provides mentoring and laboratory-associated trainings to laboratory and health care professionals. It also helps to upgrade or renovate laboratory set-ups by providing lab essentials, engaging in laboratory-related troubleshooting, offering technical assistance to ART referral linkages, and to the national ART scale-up program.

I-TECH also provides technical assistance to regional rollout programs, such as the external quality assessment and the national early infant diagnosis programs. Moreover, I-TECH, together with EHNRI, the Centers for Disease Control and Prevention (CDC), and Columbia University's International Center for AIDS Care and Treatment Programs (ICAP), assisted in the establishment of modern laboratories in Amhara and Tigray regions. These labs provide DNA-PCR testing for early detection of HIV infection in infants born to HIV-infected mothers, thus allowing significant pediatric health care benefits.

The training on HIV diagnosis contributed to improved access to HIV testing, which significantly increased the number of HIV-tested individuals and also contributed to an increased number of HIV-infected individuals who were able to be enrolled in HIV prevention and care and treatment in the three regions. For example, during June to December 2007—since the I-TECH field-based laboratory support program launched—13,871 HIV patients were enrolled in HIV programs and 10,893 started ART.

FOR THE FUTURE
Prevention with Positives (PWP). The PWP approach refers to interventions that help individuals infected with HIV to develop safer behaviors so that they can protect their partners and/or future children from getting HIV/AIDS and themselves from getting sicker.

Until recently, HIV prevention efforts have primarily focused on individuals not infected with HIV. A recent paradigm shift in prevention has led to more focused attention on prevention among HIV-infected individuals. It has been found that modifications to the risk behaviors of HIV-infected individuals are likely to have larger effects on slowing the spread of HIV than comparable changes in the risk behaviors of individuals not infected with HIV (King-Spooner S. 1999). "Positive prevention" efforts aim to prevent the spread of HIV to sex partners and infants born to HIV-infected mothers, as well as to protect the health of infected individuals. Helping people living with HIV to adopt safer behaviors is an important part of a comprehensive prevention approach.

I-TECH Ethiopia—together with Federal HAPCO and the CDC—is currently developing a PWP training curriculum for clinicians for the CDC Office of the US Global AIDS Coordinator (OGAC). It is envisioned that this curriculum will integrate HIV prevention to clinical care settings, standardize PWP approaches and materials, and thus enable health care providers to give focused prevention messages for people living with HIV/AIDS.

In close collaboration with I-TECH, Federal HAPCO is working on an overall PWP National Strategic Framework through a participatory process that includes community-based organizations of people living with HIV/AIDS (PLWHA), a national PWP program implementation plan is being developed for different contexts, such as health centers, hospitals, PLWHA organizations, and the community.

Next steps for I-TECH Ethiopia include:

Finalizing the training materials and sharing them with partners.
Organizing a pilot PWP training for health care providers.
Organizing a national-level training of trainers (TOT) so that partners can roll out the training.
The material will be adapted and translated for case managers, outreach workers, PLWHA, and community-based organizations.

Purchasing Mavens:

A short blog today. To the left is the So. Africa team.




We flew up to Addis Ababa, Ethiopia from Pretoria, South Africa on Saturday. The flight was non-eventful though I did get to see Lake Victoria and Mount Kilamangero out the window. Pretty cool. Sophia finished the book that she was reading.

We arrived on time but it took us 2 hrs to get through customs in Ethiopia as several flights arrived at the same time and they did not have the staff to process us. Everyone is bushed from a long day and we will work on updating our training materials on Sunday in preparation for Monday.

The BLOG site has been down and we will try and get some pictures later today or tomorrow.

Have a good weekend.

Dennis & Sophia

A beginning in South Africa

Purchasing Mavens:

A note - we will have a team picture tomorrow of our meeting here in South Africa as I have to load it from the camera (hey - I am getting better at all of this file transfer...)

ITECH - South Africa is a smaller operation than Namibia (approximately 12 people in the home office, this does not count those in the field). They have moved to new offices that provides them with room to grow.

OVERVIEW:

Since 2003, I-TECH has been working in SouthAfrica at the request of the National and Provincial Departments of Health (DOH) and the Centers for Disease Control and Prevention’s Global AIDS Program (CDC GAP) South Africa, to help implement the South African government’s Operational Plan for comprehensive HIV and AIDS Care, Management, and Treatment.

I-TECH was initially invited to work in South Africa to develop and implement a national training center initiative, specifically at the Regional Training Centre (RTC) in the Eastern Cape Province. The nine SouthAfrican provincial RTCs, also known as the Health Promotion and Quality Assurance (HPQA) centres, are responsible for training health care workers in the care and treatment of HIV and AIDS as well as sexually transmitted infections (STI), tuberculosis (TB), and other diseases associated with HIV.

I-TECH South Africa currently supports organizational development; monitoring and evaluation; and planning, implementation, and clinical mentoring of HPQA centre staff to support the growth of provincial sites, including the Eastern Cape (consisting of the Eastern Cape's main population areas of Mthatha, East London, and Port Elizabeth); Mpumalanga; and Limpopo.

The I-TECH South Africa office moved to Pretoria in April 2008, though it maintains a small satellite office in East London. This shift in location supports the broadening mandate for I-TECH by CDC GAP South Africa, which is to provide technical assistance and expertise to HPQA centres, where requested.

The primary purpose of our meeting here, for one day, was to meet the team, understand their operation and to discuss their future. Jack Jourden, the Country Director and his team have established a good foundation for growth. Sophia and I
look forward to working with them on their journey towards delegation of authority.

Dennis & Sophia

A successful visit to Namibia

Purchasing Mavens:


Sophia and I have completed the first leg of our purchasing delegation review of three ITECH countries. We have finished our work with ITECH-Namibia. We have created a purchasing review program that is broken into four parts: purchasing training, purchasing forms - examples and local procedure review, an audit of local practices and then policy standardization analysis and discussions. On the left is a picture of those involved in the purchasing training/review here in Windhoek. They have been fantastic hosts and made our time in Windhoek enjoyable and productive.

ITECH-Namibia has done much in the past couple of years to create a procurement system that works well for them. Our review and write-up of purchasing policies and procedures which we will produce in a month will hopefully assist them creating a comprehensive and efficient system, based on written policies, that will enable local personal to make appropriate purchasing decisions while using continuous improvement techniques.

Under the leadership of Deqa Ali - ITECH Country Director, and newly appointed Deputy Directors of Finance and Operations (John and Sean), ITECH Namibia will continue to improve its procurement, purchasing and A/P processes while providing best practices for the ITECH system. This dedicated management team has created a strong environment that values process, standardation and process improvement. We are well on the way to testing a system in early 2010 which will lead to the granting of delegation of authority. This is exciting as their solid knowledge and workings will most certainly help other ITECH operations.

Below are pictures of 1) Sophia presenting thank you presents to Deqa, the ITECH-Namibia Country Director and 2 ) the ITECH Namibia leadership team.














Our next post will be from Pretoria.

Dennis & Sophia

Some time to see the wild life

Purchasing Mavens:

Sophia and I had time before training began last weekend to see some of the wild animals at a local game reserve. I finally figured to upload pictures and have included some below:
The baby rhino stayed close to its mother all the time. The giraffe continually visited a salt lick.

Then there were Sophia's two new friends - the croc and the warthog. Sophia got close to them!

Finally, our tour took us past herds of springbok, oryx and wildabeast.

We even came across a poisonous puffader.

We have been putting in long hours but it was good to have the 1/2 day before training began to catch up on jet lag from the long trip and be outside.

We finish our policy review tomorrow and head to Pretoria.

Dennis