Integrated Infectious Disease Capacity Building Evaluation (IDCAP)
Context
In Africa, the shortage of well-prepared healthcare workers (HCW) is one of the greatest challenges in countries' efforts to strengthen health systems and expand access to healthcare. In this resource-constrained environment, mid-level practitioners (MLP), clinical officers and nursing cadres, are emerging as the ideal clinicians. MLPs are more widely available than doctors, less likely to migrate, command lower salaries, and have been shown to provide an equivalent quality of care, even for complicated diseases such as HIV.
Training mid-level practitioners to perform tasks conventionally assigned to doctors - such as diagnosis, prescribing and treatment adherence monitoring - can expand the total productivity of formal health systems in resource-limited settings, and could play a vital role in helping sorely strained health workforces better address the needs of their patients.
Realizing the value of MLP, the global health community has greatly expanded training efforts for these providers, who greatly outnumber doctors in Africa. However, little evidence exists on which training and capacity-building approaches produce the greatest impact on quality of care and patient health outcomes. The global health community needs a better understanding of which training approaches yield the best results, cost-effectively.
Overview & Hypotheses
To address these challenges, Accordia Global Health Foundation, with funding from the Bill & Melinda Gates Foundation, launched the Integrated Infectious Disease Capacity Building Evaluation (IDCAP). The purpose of this three-year program was twofold: 1) to respond to the reality of task-shifting by better equipping mid-level practitioners (MLP) to manage infectious diseases, and 2) to advance the global health community’s understanding of which training approaches yield the best and most cost-effective results. IDCAP applied rigorous scientific methods to training and evaluation. The program combined training and capacity building with research and impact evaluation to launch a new and essential discipline: the scientific evaluation of capacity-building programs.
In collaboration with the Ministry of Health, 36 public health facilities distributed throughout 28 districts of Uganda were selected to participate in IDCAP. Each selected site was a health center IV (HCIV) or comparable facility accredited to provide and actively providing antiretroviral therapy (ART), with a working laboratory and at least two MLP actively engaged in patient care.
IDCAP tested three hypotheses:
- IDCAP’s Integrated Management of Infectious Disease training course would improve the clinical competence and practice of mid-level practitioners
- IDCAP’s On-Site Support intervention would significantly improve facility performance and patient health outcomes,
- On-Site Support would be cost-effective.
Accordia led the IDCAP team in strong partnership with the Ugandan Ministry of Health, the Infectious Diseases Institute of Makerere University (IDI), University Research Corporation’s Center for Human Services (URC-CHS), and University of Washington’s International Training and Education Center for Health (I-TECH).
