Background: Namibia experiences critical shortages of healthcare workers caring for the 14% of the adult population living with HIV. In 2015, the Namibia Ministry of Health and Social Services (MoHSS) adapted, piloted and evaluated a tele-mentoring platform for case-based learning in virtual communities of practice called Project ECHO^® (Extension for Community Health Outcomes) to address challenges in HIV care. Goals of this first ECHO adaptation in Africa included assessing feasibility and acceptability, strengthening workforce capacity, improving provider satisfaction, and reducing isolation.
Description: Best practices for adapting an evidence-based HIV ECHO program were applied, a 9-month curriculum was developed, and Continuing Professional Development (CPD) accreditation obtained.
A virtual community of practice using weekly video-teleconference sessions with didactic training and patient case presentations was established; participants included national experts, regional clinical mentors, doctors, nurses, pharmacists, laboratorians, and health assistants. Between 50 and 120 individuals participated per session, learning from didactics and de-identified patient case discussions. A mixed-methods assessment of the first 34 sessions included process evaluation, pre/post questionnaires (knowledge, satisfaction, self-efficacy, CPD credits), qualitative interviews, and focus group discussions.
Lessons learned: To optimize ECHO in Namibia, MoHSS adapted a model that included leveraging of centralized and decentralized Ministry leadership and expertise, rotating session facilitation, disseminating new guidelines (e.g. PrEP, community adherence clubs, etc.), and empowering lower-level cadres to differentiate aspects of HIV care that could be task-shifted. Over 50% of participants are nurses. During the pilot, knowledge of clinical HIV improved 17.8% overall and 22.3% for nurses (p< 0.01). Self-reported clinical professional satisfaction increased 30%. Most participants (66%) reported reduced professional isolation, and 57% reported improved access to CPD credits. Following the pilot, increased demand and popularity of ECHO led to expansion from 10 to 23 spoke sites.
Conclusions/Next steps: Namibia''s HIV ECHO improved knowledge and provider satisfaction and has demonstrated the ability to adapt to evolving needs in an African context. MoHSS will increase ECHO to 36 sites and expand focus areas beyond HIV in 2018. This first successful ECHO implementation in Africa encountered minimal barriers and has catalyzed development of several additional ECHO programs across Africa and Central Asia.