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The HIV/AIDS Twinning Center

HIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgJames P. SmithExecutive Director, American International Health AllianceXIX International AIDS Conference 2012 Satellite Session

Institutional Twinning Partnerships as a Mechanism for Health Systems Strengthening and Sustainable Development of Human Resources for Health

Washington, DC

1Description of the HRSA-funded HIV/AIDS Twinning Center Program

Program wide goals and objectives

Review of our Twinning Partnership Methodology and some of the advantages and results of twinning Presentation OverviewHIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgHIV/AIDS Twinning Center www.TwinningAgainstAIDS.org

Before my colleagues describe three examples of how twinning projects are working in the field, I want to provide an overview Tell you a little about the Twinning Center, explain what the twinning methodology is and what it is accomplishing overall in support of system strengthening and human and organizational capacity building.

2The HIV/AIDS Twinning Center The Twinning Center utilizes a volunteer-driven, peer-to-peer twinning methodology refined by AIHA over nearly two decades of implementation in more than 150 partnerships in 33 countries.

Currently, the Twinning Center manages twinning programs in 10 countries:

Botswana * Ethiopia * Kenya Mozambique * Namibia * Nigeria Russia * South Africa * Tanzania * Zambia

35 Active partnerships, including North-South institutional twinning partnerships, South-South partnerships, and triangular partnerships

Volunteer Healthcare Corps (VHC): long-term volunteer programs in Ethiopia, Tanzania, and South Africa, with volunteers also placed at selected partnership sites in Mozambique and Botswana (90+ volunteers; 27,000 professional days of service)

HIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgHIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgFor many of you unfamiliar with AIHA, we are a not-for-profit organization whose mission since our founding in 1992 has been to advance global health by promoting and supporting (in an organized fashion) volunteer driven twinning partnerships between health-related institutions and professionals in the US and overseas.The HIV/AIDS Twinning Center Program was established in 2004 by AIHA with funding from the US Department of Health and Human Services Health Resources and Services Administration.

Like AIHAs predecessor programs funded by the US State Department and USAID to help meet the health system challenges of post-conflict and transitional countries of Central and Eastern Europe and the former Soviet Union -- the Twinning Center focuses on creating voluntary, peer-to-peer, relationships that, in this case, to support PEPFAR objectives to build sustainable institutional and human resource capacity in target countries using the Twinning Methodology;The Twinning Center accomplishes this primarily through institutional Twinning Partnerships - in many cases involving US partner institutions in North-South partnerships but increasingly embracing South-South twinning, enabling leading institutions from one African country to support and mentor counterpart institutions in another.40 institutional twinning partnerships in 10 African countries and the Russian Federation have been developed under the Twinning Center program to date; While 5 have graduated from the program, 35 are currently active of which 9 have significant South-South twinning elements. New twinning partnerships are being established at the rate of approximately five a year. As a complement to our Institutional twinning programs the Twinning Center also supports a Volunteer Healthcare Corps (VHC) which places volunteer professionals on the ground for between 3 and 24 months. To date the VHC has placed over 90 volunteers who have contributed over 75 person-years of professional service.These volunteers provide needed technical assistance, mentor counterpart professionals, serve as role models, and fill key leadership and management gaps during system transition in many instances in support of an institutional twinning partnership but in the case of our program in Ethiopia by by engaging over 60 members of the Ethiopian Diaspora in helping to support broader health system strengthening priorities established by the Ministry.

3 PEPFAR IISYSTEMS STRENGTHENING

Organizational DevelopmentIn-service training

How Twinning Supports PEPFAR

INSTITUTIONAL CAPACITY BUILDINGDEVELOPING HUMAN RESOURCES FOR HEALTHPre-servicetrainingTWINNING PARTNERSHIPSBUILDING SUSTAINABLE PROFESSIONAL RELATIONSHIPSOngoing MentoringFaculty DevelopmentAssociation Building With PEPFAR IIs mandate of systems strengthening to facilitate country ownership, the twinning model is particularly well suited to building the sustainable capacity Twinning is a holistic approach that strengthens capacity of institutions and caregivers at all levels. Our partnerships are supporting PEPFAR II by building institutional capacity, developing human resources for health, and building sustainable professional relationships, And this is largely through faculty development, organizational development, pre- and in-service training for health and allied caregivers, and ongoing mentoring. Partnerships are also focusing on strengthening professions on a national or regional level by building capacity of professional associations. EXAMPLE: In Tanzania, for example, twinning partners are working with TANNA (Tanzania National Nurses Association) and TASWA (Tanzania Social Workers Association).4Technical Areas by CountryHIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgBotswanaCote d'IvoireEthiopiaKenyaMozambiqueNamibiaNigeriaRussiaSouth AfricaTanzaniaZambiaBehavior ChangeXXCare & Treatment (Hospital Systems)XXXXCounseling & TestingXXXHealth Information TechnologyXXXXXHealth Professions Education XXXXXXXXXLab StrengtheningXXMedical TechnologyXXPalliative CareXXXXXPara Social Worker ProgramXXXPrevention through MediaXXProfessional Association DevelopmentXXXXXXXSubstance Abuse / IDUXXTB/HIV CoinfectionXX5Health Professions EducationHIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgBotswana (1)Cote d'Ivoire (0)Ethiopia(5)Kenya (0)Mozambique (4)Namibia(1)Nigeria (1)Russia(2)South Africa (4)Tanzania (3)Zambia (3)MedicineXXXXPharmacyXXNursingXXXXXSocial WorkXXXEmergency MedicineXXClinical Associates (& other physician extenders)XXMedical TechnologyXPara Social WorkersXXXJournalistsXXOther (research, biomedical technology, etc.)X6Key Elements of TwinningInstitution-to-institution pairingPeer-to-peer professional relationshipsEmphasis on professional exchanges and mentoring Volunteer-drivenLeverages private-sector institutional resourcesNon-prescriptive but rigorous approach to collaborative process, work plan development, and outcomesDemand-driven, with significant recipient investment and ownershipSignificant returns to both sidesHIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgSo, when we talk about twinning partnerships, who is pairing up with whom? Or who is marrying whom?

We have instit to instit partnerships, such as the hospital to hospital partnerships, like the Elmhurst to Debre Berhane in Ethiopia, or the medical school to medical school partnerships for the clinical associates in South Africa We have peer to peer partnerships, where these are focused on trainings and assistance provided by individuals to others. For example, the medical technology partnership in Namibia is an example of this. The lab mentors placed in Zambia are another example of this. In Twinning, the emphasis is on professional exchanges and mentoring, and at AIHA, most of our partnerships are volunteer-driven. Our approach is non-prescriptive and demand driven, where the local partner is in the drivers seat.

What weve seen from our approach is that it yields significant returns on both sides.7Twinning ProcessIdentify Country Needs & PrioritiesIdentify the PartnersConduct Initial Assessment VisitExchanges & Work Plan DevelopmentOngoing Capacity BuildingWhere can the twinning approach help achieve national and PEPFAR goals for target areas and/or institutions?What local organization needs technical assistance and what organization(s) possesses the expertise to help and are the best match?Partners meet in host country, begin to build working relationships, conduct site visits, and prepare organizational and needs assessments.Host partner visits resource partners institution and community to learn appropriate new approaches and technologies. Partners jointly develop work plan in keeping with PEPFAR goals and objectives, ensuring maximum coordination with local stakeholders and other implementing organizations.Based on work plan, partners set a timeline and work together to meet objectives, goals, and targets.HIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgSo now youve seen all of the components of a twinning partnership, but how does this really work on the ground?

Over the past two decades, AIHA has fine-tuned the partnership implementation process and, since 2004, has been constantly working to ensure the process for the Twinning Center partnerships is in keeping with PEPFAR objectives and desired outcomes.Step 1 - Determine where the partnership approach can help achieve national and PEPFAR goals.Step 2 - Identify local organization that needs technical assistance and solicit U.S. or South organization with the expertise to help. Sometimes partnerships are pre-made based on existing relationships.Step 3 - Partners meet in host country, begin to build working relationships, conduct site visits, and prepare organizational and needs assessments that help guide workplan development.Step 4 - Host partners visit donor partners institution and community to learn appropriate new approaches and technologies. Partners jointly develop workplan in keeping with COP goals and objectives, ensuring maximum coordination with local stakeholders and other implementing organizations.Step 5 - Based on workplan, partners set a timeline and work together to meet objectives, goals, and targets.

Its important to note that partnerships are often constantly evolving and growing based on ever-changing healthcare needs. In other words, they are highly responsive and dynamic because it is the recipient partners themselves who drive the direction of the partnerships.

8Cumulative Trainings by CountryHIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgFY 2011: 2,371 health professionals trained through partnerships or graduated from Twinning Center-supported pre-service programsMore than 22,000 trained between 2005-2012 across 11 countriesTwinning Center Health & Allied Professionals Trained (2005-2012)9Twinning Gets Results!In a partnership, it is not about you or me it is about us. It takes a bit of time to get to that point, but when you nurture that relationship, sustainability will follow. Donald Simpson, University of ArkansasWith us, there are so many things that have stuck. Our collaboration and the results of this partnership relationship cannot be taken away. Instead, our collaboration is organic and constantly growing in new and exciting directions.Dr. Sylvester Moyo, Polytechnic of Namibia

HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org10HIV/AIDS Twinning Center ~ www.TwinningAgainstAIDS.org

Contact InformationJames P. Smith, Executive DirectorE-mail: jim@aiha.com

Kelly Wolfe, MPH, Med, DirectorHIV/AIDS Twinning CenterE-mail: kwolfe@aiha.com

Kathryn Utan, Communications ManagerE-mail: kutan@aiha.com

American International Health Alliance1250 Eye Street, NW, Suite 350Washington, DC 20005Tel: 202-789-1136

HIV/AIDS Twinning Center www.TwinningAgainstAIDS.orgThank you. 12