HIV/AIDS

HIV is a chronic disease requiring unremitting adherence to medication (antiretroviral therapy or “ART”). As the leading health issue confronting people living with HIV (PLWH), non-adherence costs the healthcare system between $500 and 1,500 per month per patient1, a figure much higher than the cost of non-adherence for other chronic diseases.

Multiple factors contribute to poor adherence in HIV: managing a complex regimen, medication side effects, lack of immediate evident benefit from taking daily medication, and lastly, staying positive and motivated to maintain lifelong adherence. One key challenge to ART adherence is the stigma associated with HIV; this can constrain PLWHs’ support networks and willingness to take medication as directed.

Traditional patient-provider relationships and adherence intervention models rely on face-to-face office visits. Relying on infrequent visits and ‘push education,’ these models neither provide ongoing support for the PLWH nor empower them to take proactive ownership of their adherence goals. Current mobile applications that support ART adherence rely on intrusive push reminders, and do not provide a data feedback loop to the provider.

These apps report struggling effectiveness and low uptake due to PLWH disclosure sensitivity, lack of patient retention in consistent care, and technology-only intervention points. In addition, existing apps have failed to demonstrate sustainable, scalable impact for the provider or patient populations, and linking this impact to tangible benefits within the HIV healthcare industry.

Technology alone cannot solve all of the ‘real and human’ problems that often drive non-adherence in HIV. However, if executed effectively, mobile technology presents a unique opportunity to help transform the traditional patient-provider relationship into an ongoing, confidential, and collaborative relationship as a foundation for increasing ART adherence.
Leveraging mobile technology to create dynamic education opportunities and positive feedback loops can establish the necessary patient empowerment to drive the core behavior change to increase and sustain adherence.

The idea is to invest in agriculture to address malnutrition issues and boost agriculture sector at the same time via public-private partnerships (PPP) between small size farms, the Ministry of Health (MOH), NGOs and the Ministry of Agriculture (MOA).

Microcredit will be offered to farmers who could invest to produce specific local food products and in return they will be obliged to supply a proportion of their production to associated health facilities for the nutrition programs already implemented and intended to pregnant/breastfeeding women and OVC (Orphans and Vulnerable Children). The farmers will also need to reimburse the funds as per microcredits programs.

There are several nutrition programs in Haiti mainly funded by World Food Program (WFP) . Due to the current malnutrition and poverty situation, it is very likely that those programs will run for many years ahead. Nevertheless, currently there is no integrated agro-health and microcredit programs combining efforts from the Ministry of Health (MOH) and Ministry of Agriculture (MOA) in Haiti to impact the agriculture industry and the health systems together. Suggesting a program involving the MOH and MOA via microcredit is a sustainable approach that could benefit two different sectors and reduce the dependence to international funds.

MSH is a renowned organization in Haiti which was able to develop strong relationships with the different stakeholders and the community. Since MSH is directly supporting health facilities handled by NGOs or MOH, MSH’role is also to advocate for public health change policy with strong data evidence to the MOH and other major stakeholders via SDSH and another project of MSH called LMG (Leadership, Management and Governance). Owing to this expertise, MSH teams will be able to implement a new program including a new Minister, the MOA, to ensure the success of Terenfom. Due to the serious economic and sanitary situation, the country will get important funds from international organizations for many years ahead. Funding will not represent the major challenge for the success of this project.

This project is innovative in itself by its new PPP strategy combining microcredit and two different ministries. Though it is very hard to implement new projects in Haiti due to the very complex situation, the abundance of stakeholders and high influence of politics, it is also very important to remain flexible and be able to adjust to the field situation and any possible changes, such as potential natural disasters or politic instability. MSH is present in Haiti for 26 years and has a strong expertise in public health project management in Haiti. The MSH team has developed a high flexibility ensuring the success of the innovative project Terenfom.

Ath Checkpoint is a community based center for voluntary testing and counseling for HIV. Even though it is based on a model established in other european areas, it is an innovative venture in a national level. The profile of Ath Checkpoint is a groundbreaking project in many levels: it addresses issues of smooth access to HIV testing and counseling for targeted key populations. Making such an important service accessible to men who have sex with men is mainly catered by our networking, roots and deep understanding of the needs of that group. Building that structure we cooperated actively with all organisations, groups and prominent activists and professionals from the local LGBT scene. After half a year of operating in Athens, the response to our services have got very positive reviews and we are gradually being established as a complete one-stop structure for HIV health for men who have sex with men

Ath Checkpoint was created on the grounds of lacking of HIV test and counseling services, that are convenient and accessible to people that have tight schedules and feel unwelcome to traditional environments and structures for HIV testing. State structures not only they are addressed to the general public, they also are problematic providing accessible services. There are also some other private initiatives addressed to other key populations like intravenous drug users and migrants. Ath Checkpoint is the first structure that offers services designed according to the needs of modern men who have sex with men

The base of our organizational model is peer-to-peer services with the technical support of the main HIV policy maker in Greece (KEELPNO). Staff is consisted of people from the LGBT community with an activist and/or professional record in the field. Added to this factor, we have designed and customize services adapted to the lifestyle and needs of men who have sex with men of any background. We provide friendly services of testing and counseling, adhering to a model that is: quick, easily accessible, targeted, painless, free of charge, with convenient operating hours. Such innovations are becoming more and more appealing to the LGBT community and men who have sex with men

The challenges in the area of HIV prevention are always on the rise in Greece on the background of the socioeconomic crisis. Traditional structures collapse and we try to cover the needs of this key population. We try to introduce multiple methods of testing (saliva and blood antibodies tests), and we plan to expand our services to full sexual health prevention services, introducing testing for more sexually transmitted infections (hepatitis, syphilis etc.). It is also our aim to inaugurate a second prevention unit to the second largest city of Greece, Thessaloniki. As we hope that we will continue to grow, we plan to open our services to more key populations, targeting to each group's special needs

With a current estimated population of 2.2 million people, a land mass of 825,418sq km and a population density of 2.5/sq km, access to quality and affordable health care services in Namibia is very challenging. The country also operates one of the most expensive health care service delivery model in the world in which government bears the cost of transporting, lodging and feeding a good number of the 87% of its citizens from the remote hinterland settlements that patronize government health facilities. Katutura State and Windhoek Central Hospitals are the flagship public hospitals in Namibia. Both hospitals combined serve 20% of the entire population of the country. The quality of health services is very poor following the surge in the population they serve and many years of poor management and gaps in infrastructural development. Our innovation in both hospitals revolves around a facility led and owned patient centered approach to quality improvement. It involves the use of data to explore the relationship between quality of services (dependent variable) and the application of leading and managing practices, patient perception of quality and the work climate (independent variables). Our holistic and demand driven approach to tackling the pervasive and seemingly intractable poor quality of health services help the facilities apply participatory diagnostic tools that identify the root causes of their poor services delivery and focus improvement actions on critical triggers that create positive ripple effects across the major facility systems and improve access.

Previous attempts at addressing the problem of access to quality of services in both hospitals adopted a vertical approach with emphasis on improving quality of HIV and AIDS/TB services. This approach eventually led to fragmentation of the overall facility systems. We address the problem through a holistic and patient-centered approach. By combining the successful continuous quality improvement program of a local indigenous organization with the equally successful leadership and management development program of Management Sciences for Health, we have developed a Quality Improvement and Leadership Program (QIL). It is implemented in all departments of the hospitals to improve access to better patient safety, quality of care across the facilities and increased patient satisfaction.

It can be successful in any health facility that is looking to institutionalizing continuous quality improvement. Some factors critical to the successful implementation are:
1. Buy-in to the process at the relevant leadership levels - this includes not just the hospital management team and staff, but by the Ministry of Health and other necessary line ministries and departments.
2. Integration of eight leading and managing practices (scanning, focusing, planning, organizing, aligning and mobilizing, implementing, inspiring and monitoring and evaluating) into the continuous quality improvement process
3. Workgroup-centered approach to work - makes it possible for teams to face challenges and achieve their desired improvement goals in conditions as complex as those in health facilities

Any meaningful and successful work with Ministries of Health requires that one constantly innovations in order to address the myriad of obstacles that are bound to emerge. The QIL program design is a broad outline. The real value is in the implementers awareness of the constantly changing landscape and their ability to adapt and improvise to overcome them within the overall framework for achieve the institutionalization of continuous quality improvement. Besides the mandatory reflection and feedback to facilities and Ministry of Health, at the heart of the QIL Program is the use of data for: a. monitoring progress in the achievement of quality improvement by health facilities b. continuous learning and innovation to improve the design of the program itself.

Global Health Corps aims to mobilize a global community of emerging leaders to build the movement for health equity.

Changing the unacceptable status quo of deep health inequities requires a new generation of leaders with diverse skills and backgrounds. Emerging leaders need opportunities to build their skills and a community in which to reflect and innovate.

GHC provides opportunities for young professionals from diverse backgrounds and nationalities, to work on the frontlines of the fight for global health equity in yearlong fellowships. Our fellows have a measurable impact on the health of the communities in which they work, and draw upon their fellowship experience and the GHC alumni network to deepen their impact throughout their career.

The Global Health Corps program consists of three primary components:
• Building partnerships and increasing the impact of great organizations today
• Training and Supporting the leaders of tomorrow
• Building a global community of changemakers

Global Health Corps’ programming and training curriculum is based on a leadership development framework that integrates professional development, intellectual exploration, and interior formation as it relates to conducting service work. Over the course of the fellowship year and following, fellows will be provided opportunities to build their skills and strengths in each of these domains. Through our programming, fellows develop and continually “practice” leadership behaviors and skills that we consider crucial to achieving progress in global health and social change work.

GHC partners with organizations working on healthcare delivery and access. Fellows work with organizations in yearlong positions and make significant and measurable contributions to the organizations and the target population. Each fellowship team is composed of a pair of fellows, one from the country where the partner organization works, partnered with an international fellow. Over the course of the fellowship year, fellows participate in a wide range of activities aimed at increasing their effectiveness as practitioners and their development as leaders. Throughout the year, they receive on-going training, support and mentorship from the GHC team and our network of advisers. Fellows build a set of shared values, commitment and skills that they carry well beyond the fellowship year.

In South Africa, issues of Workplace Health are well-addressed through legislative mechanisms. While it is improving, the monitoring of compliance with legislation has, unfortunately, been weak. At the same time, SA has, since 1994, subscribed to a free market approach to economic policy. The consequent deregulation of aspects of some industries and the lowering of entry barriers in others has seen a proliferation of small and medium enterprises (SMEs), many of whom operate on the margins of the economy. Resource-constrained SMEs often perceive facilitating workers' access to health services as "an unaffordable luxury".

The Siyakhana Health Trust's innovative "SME Project" brings health services to workers in SMEs at a nominal cost to the company, at no cost to the individual, and with minimal disruption to production. Services are extended to family and dependents - these are accessed off-site, but also at no cost to the individual.

What began as an HIV/AIDS voluntary counselling and testing service has evolved into a fully-fledged workplace health service. The resultant service offering is unique in that it supports the government's objectives relating to worker health across multiple legislative, policy, and strategic domains. (These include, among others, the Labour Relations Act, the Occupational Health and Safety Act, the National Strategic Plan on HIV/AIDS and TB, WHO & ILO Health at Work conventions).

Our innovative approach aims to keep healthy workers at work in health-promoting workplaces.

Our innovation model is distinct in 4 ways:
1) To our knowledge, there are no other citizen sector non-profits providing mobile occupational and general health services to SMEs

2) While there are a number of private sector service providers in the field, they tend to focus on either Occupational Health OR Primary Health Care OR HIV/AIDS. Siyakhana, by contrast, offers an holistic set of services ranging from general health screening to occupational health policy planning, on a not-for-profit basis.

3) Most service providers require workers to leave their workplace to attend off-site clinics. Siyakhana's mobile facility takes services to workplaces

4) No other service provider extends services to workers' dependents at no cost to the individual

The operating environment in which Siyakhana has located itself is influenced by a number of "streams", primarily legislative, economic, social, and health. In many ways, Siyakhana operates at the intersection of these "streams". A positive intersection exists right now since there is a growing realisation of the inextricable link between the health of workers, the profitability of the companies they work for, and the strength of the economy. The external environment is increasingly aware of the need for the services we offer.
Success depends on our agility in responding to varied needs of companies. We thus utilise a flexible staffing model that allows us to deploy expertise where and when necessary. Funding security influences the extent to which the innovation can be replicated.

Having utilised a partnership delivery model from the outset has ensured that Siyakhana is always able to source and introduce cutting edge thinking and developments, via our funding and technical partners.
Open engagement with government has also ensured that we have contributed, not only responded, to changes in policy at a national, provincial and regional level.
At times when policies have proven to be a hindrance, rather than a facilitator, to our work, we have worked with communities to access innovative alternative services, such as our network of private sector general practitioners who deliver HIV/AIDS treatment.
Our mobile facility is fitted with state-of-the-art equipment, requiring staff to be up-to-date with the latest screening techniques at all times.

The The HIV/AIDS - Human Trafficking Coalition is an innovative solution because it achieves the following:

- Advances science and technology towards a cure for HIV/AIDS
- Strengthens anti-human trafficking initiatives
- Promotes victims of human trafficking as highly valued Ambassadors, leading the way in scientific advancement
- Creates a platform for victims to share their knowledge/experience
- Creates an extensive global network that supports local partnerships

In communities in Sub-Saharan Africa, even when vaccines are available at much reduced price, they may still not be accessible to the children who need them due not only to economic factors but also cultural and religious factors and lack of information. It is one thing to have buy-in from the government, it is another thing to have buy-in and commitment from the community at all levels. Building TRUST with the communities at the grassroots level is paramount to success.

The solution:
1) reduces the cost of delivering healthcare to low income consumers 2) Addresses the issue of non-availability of skilled doctors in semi-urban / rural areas 3) Provides a safety net for emergencies via insurance 4) Reduces the need for emergency care, through preventive care