Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce

Abstract

Background: The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. Methods: MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes. Results: Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2-23.5%) and 22.3% (95% confidence interval 13.2-31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV. Conclusions: Similar to other Project ECHO evaluation results in the United States of America, Namibia's Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.

Reflections on project ECHO: qualitative findings from five different ECHO programs

“…Consistent with prior work, our findings suggest that ECHO participants are motivated by and receive quality continuing education [ 31 , 32 , 34 , 35 , 37 , 38 ] and report changes to their own practice [ 31 , 33 , 35 , 38 ]. Indeed, these outcomes often have been foci of quantitative studies collected by systematic reviews [ 13 , 15 ], but the strength of evidence should be increased.…”

“…Many practitioners joined and valued ECHO because of the networking that it offered; this was not just a matter of accessing expert opinion but was seen, sometimes, as a replacement for traditional gathering places and a means to reduce practitioner isolation. This finding mirrors qualitative ECHO studies emphasizing community of practice and practitioner isolation [ 31–35 ]. It also reflects prior work on andragogical spaces for medical professional identity[ 36 ].…”

What do we mean by individual capacity strengthening for primary health care in low- and middle-income countries? A systematic scoping review to improve conceptual clarity

“…Thirteen studies assessing the domains of self-efficacy or confidence were applied to strengthen leadership, managerial or teaching capacity [39][40][41][42]; working with patients [43][44][45][46]; and for the provision of care, such as treatment for non-communicable disease [47], anti-retroviral therapy [45], and providing mental health care [48][49][50][51], a topic which has become prevalent in more recent years.…”

The COVID-19 pandemic: broad partnerships for the rapid scale up of innovative virtual approaches for capacity building and credible information dissemination in Africa

“…The first ECHO program in Africa was launched in 2015 by the Namibia Ministry of Health and Social Services (MOHSS) with support from the US Centers for Disease Control (US CDC) and the United States President´s Emergency Plan For AIDS Relief-PEPFAR; focused on HIV capacity building, this virtual community of practice has met weekly for nearly five years and engages doctors, nurses and pharmacists at over 50 hospitals and health care centers across Namibia [ 15 ]. Since March 2020, the Namibia MOHSS ECHO network has added COVID-19 training while continuing its HIV capacity building program.…”