HRSA global HIV/AIDS program work is structured around, but not limited to, the World Health Organization’s six building blocks for a strong and sustainable health system. HRSA’s work is structured around the areas of:
- Service Delivery
- Health Workforce
- Civil Society Organizations/Stigma and Discrimination Efforts
- Health Information Systems
- Access to Essential Medicines
- Health Financing
- Leadership and Governance
Since the first phase of PEPFAR, HRSA worked with implementing partners to establish health facilities that provide HIV/AIDS care and treatment to the most vulnerable in the most difficult to reach and remote locations throughout Africa and Latin America. HRSA continues this work by ensuring that comprehensive treatment is available for people living with HIV and AIDS through:
- developing and establishing national care guidelines,
- organizing and training medical and nursing professionals to coordinate their care and share best practices and lessons learned,
- analyzing different service delivery models to ensure continuity of care, and
- working with Ministries of Health to create benchmarks to ensure accountability of facilities and providers.
HRSA continues to implement best practices in HIV care, treatment and prevention practices, including voluntary medical male circumcision, HIV services for pregnant women, and task shifting.
Along with strong programming, HRSA recognizes that in order to be efficient and sustainable, continuous quality improvement efforts are needed. In its domestic HIV program, HRSA has prioritized assessing quality, as well as its improvement and measurement. HRSA routinely uses this expertise in its global work.
Health Workforce Development
HRSA’s has concentrated efforts in the area of human resources for health, also known as health workforce development. In the Global HIV/AIDS Program, HRSA currently conducts in-service and pre-service training for varying levels of health professionals who range from infectious disease medical doctors to community health workers. Once trained, HRSA works with local institutions and host country governments to incentivize the health workers to stay in-country and at times serve in more rural, difficult-to-staff locations.
Through its Resilient and Responsive Health Systems Initiative, HRSA will enhance this work to repopulate the workforce of countries whose health systems have been depleted by civil war, HIV/AIDS, and other catastrophic health emergencies like Ebola. The interventions will be carefully tailored based on assessments of the resources and needs of each country.
Civil Society Organizations/Stigma and Discrimination Efforts
HRSA has a long history of working with Civil Society Organizations (CSOs) and increasing access to care for vulnerable populations within the United States. These domestic programs have established provisions to prevent discrimination and invest in community-based prevention and public health initiatives. For PEPFAR, HRSA will leverage its domestic expertise for use globally in order to enhance the impact of PEPFAR programs on decreasing stigma and discrimination.
Some examples of activities within this program may include:
- supporting the development of stigma and discrimination measures for PEPFAR programs,
- strengthening systems to develop and support patient rights, privacy, and confidentiality as a means to address stigma and discrimination,
- incorporating stigma and discrimination measures in quality reviews of site and above work, and
- training civil society representatives and U.S. government staff on data use to increase meaningful engagement in program design and oversight.
Health Information Systems
Building on its experience in developing systems, structures, and controls within clinics, HRSA is working with Global Program partners to move information into electronic medical record systems. With the information collected through electronic medical records, or health information systems, HRSA will work with grantees to triangulate, analyze, and interpret data to enhance decisions about programming. This data will also be used to help identify what works and where there are areas for improvement.
Access to Essential Medicines
HRSA meets countries at their level of need. As countries continue to strengthen their health sector, HRSA is expanding its work by developing community-based models of care where medicine can be distributed through community structures or health workers. By leveraging these models and systems, HRSA is able to support PEPFAR’s goal to increase the number of people on treatment by providing multi-month dosing, reducing any breaks in treatment, and freeing up the time of health care workers to address new patients or those with more complex issues.
HRSA works with local partners to develop internal controls and structures to ensure seamless and transparent operations of health services. One example of this is the Resilient and Responsive Health Systems Initiative. In this initiative, HRSA will establish measures for domestic resource mobilizations and local co-financing targeted at the health care workforce. This will expand the risk pool and protect against fiscal fluctuations and unpredictability. That will help ensure the steady supply and retention of health care workers in the public sector.
Leadership and Governance
Intrinsic to health system sustainability is ownership and stewardship, which must be underpinned by a strong leadership and governance structure. HRSA works at various levels in this arena, including the macro level with ministries on national policies to govern accreditation of medical professionals and the micro/ grassroots level through organizing nursing councils to standardize care and share best practices.