Our Work in the Ivory Coast
The Abt Associates-led PSP-One project has two PEPFAR-funded activities in Cote d’Ivoire: one focusing on private-sector human resources in health (HRH) and the scale-up of HIV services, the other on public-private partnerships and HIV/AIDS in the workplace. Both capture equally important aspects of HIV/AIDS prevention and treatment by addressing different challenges facing Cote d’Ivoire.
Background:
Until 1999, Cote d’Ivoire was one of the foremost up and coming African countries; with a strong economy and stable government, it was a model for the region. Ever since, Cote d’Ivoire has struggled with multiple coups and civil war that have hindered it growth and exacerbated ethnic strife.
Not only has the country suffered economically and politically, its population’s health has been devastated by AIDS. According to a 2004 UNAIDS report, Cote d’Ivoire’s HIV/AIDS prevalence rate was 7 percent, one of the highest in West Africa. Each year, 54,000 children are born to HIV-infected mothers, and many of them, about 33 percent, will contract the virus as a result of insufficient prevention-of-mother-to-child care.
Private Sector HRH and HIV/AIDS Service Scale-up:
PSP-One conducted an assessment of private sector HRH in Cote d’Ivoire as a companion survey to a public sector HRH assessment completed by the PHRplus project. The survey provided policy makers with a comprehensive analysis of the country’s HRH, their current ability to provide HIV/AIDS and other basic health services, and the potential ways to expand capacity. Employing such a holistic approach allows policy makers to create a national human resources policy that recognizes the important contributions of both sectors in the provision of HIV/AIDS and other basic health services.
PSP-One developed and applied multiple survey instruments specific to Cote d’Ivoire to assess the various facets of HRH by examining private health facilities and training institutions and interviewing private healthcare workers. Data collectors surveyed over 250 private healthcare facilities to determine the number and type of healthcare workers, retention and attrition rates, the types of services provided (including HIV/AIDS, TB, malaria, maternal and child health, and family planning), and the facility’s capacity to see and treat patients.
Just as important to the present and future of health services in Cote d’Ivoire are the attitudes of current health workers. In addition to obtaining quantitative information on the facilities, PSP-One interviewed private healthcare workers to better understand their motivation for working in the private sector, sector preference for employment, what incentives were of greatest import, and reasons to leave or remain with an employer.
The final survey was used to assess doctor, pharmacist, midwife/nurse, and lab technician training institutions. The questionnaire examined the presence or lack of HIV/AIDS training in the curricula, the number and types of instructors, teacher/student ratio, number of graduates, employment preference, and percentage hired after graduation by type of organization (ex. public, for- and not-for-profit). Improving training for future healthcare workers is the first step in improving the health sector as a whole and thus, the health of Ivorians.
All three of these surveys are interrelated, as they address the multi-tiered nature of the health sector and the need for improvements at each level in order to improve the health situation in Cote d’Ivoire and make an appreciable impact on its HIV/AIDS pandemic. PSP-One, using the findings from the private sector assessment, has developed a report outlining the current state of the healthcare workforce and made recommendations to strengthen the private sector and scale-up HIV/AIDS service provision.
Public Private Partnerships to Address HIV/AIDS in the Workplace:
As mentioned earlier, HIV/AIDS impacts a significant portion of the Ivorian population. In the workplace, its effects are even more detrimental–it is the leading cause of death among Ivorian workers. Besides the apparent and grave social ramifications of familial grief and needless death, this reality is also injurious to the economy. These are the same people that “support extended families and local economies, produce goods, provide services and generate tax revenue” and are vital to the future of the country.
Following an announcement made by the Government of Cote d’Ivoire to increase the number of public and private organizations offering HIV/AIDS programs in the workplace, and a situational analysis completed by Family Health International (FHI) in 2005 that illustrated the potential impact workplace programs could have on combating HIV/AIDS, workplace programs are being given the appreciation they deserve.
The government of Cote d’Ivoire, recognizing the benefit of public-private partnerships in workplace programs, is working with PSP-One to amplify their impact. The project provides technical assistance to various government Ministries, including the Ministry of Public Works for Employment and Administrative Reform, the Ministry of Education, and the Ministry of Health and Public Hygiene, to aid in the development and implementation of workplace programs for their employees and to strengthen such programs across the public and private sectors.
In the past, one of the hindrances to these types of programs has been the lack of coordination and information sharing. Recognizing this as an area for improvement, PSP-One is working towards the creation of national standards and models for workplace HIV/AIDS initiatives and harmonizing existing programs by organizing and supporting the dissemination of information and best practices.
Additionally, PSP-One is creating awareness of HIV/AIDS within the workplace to address stigma, discrimination, and gender-related issues and making efforts to link workplace programs to services for abstinence and prevention, orphans and vulnerable children, behavior change and palliative care.
