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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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Health Systems Strengthening

HRSA GAP’s training and technical assistance is building and strengthening care programs so that affected countries can maintain programs over time and deliver quality HIV/AIDS care. Outlined below, the focus is on training people, building infrastructures such as clinic monitoring, health information systems, and medical and nursing education.

Training Health Care Workforce

Training activities comprise the largest portion of HRSA’s work to strengthen health care systems, and include training for health care providers, pre-service students, faculty, and administrators. By supporting this work across a global network of projects in more than a dozen countries, efficiencies and synergies in the work are created.  HRSA supports education and training in over 25 countries and has trained thousands of health care workers.  Ministries of Health in host countries help design and implement training, which helps them build capacity to sustain training systems.

Nurses have been trained to deliver and monitor antiretroviral therapy in support of “task shifting,” thus allowing nurses to take on larger clinical roles given the limited pool of clinicians.

Training programs have been designed and implemented with local staff to help ensure that they are linguistically and culturally sensitive and focused.   The majority of training staff—85 percent under the largest training project—are local hires.

Building Infrastructure

Clinical mentors and mentor teams are improving the way services are delivered. Mentors use tools, algorithms, and guidelines to help providers improve the care they deliver.

Clinic operations are being strengthened across Africa and Haiti through a module called ClASS, Clinical Assessment System Strengthening.  ClASS is an assessment and technical assistance framework to use in monitoring and enhancing service delivery.  It is based upon a similar resource developed in the 1990s for use by clinics funded under the Ryan White HIV/AIDS Program in the U.S. 

HRSA has supported development and sharing of evaluation and monitoring tools to improve the delivery of care. 

Health information systems have been developed to improve monitoring and tracking of delivery of HIV care. HRSA has funded the implementation and enhancement of a number of health information systems.  Among these is CAREWare, which is also used extensively in its domestic programs. 

Additional health information systems that have been developed include nationally standardized paper tools (for clinical information, laboratory data, and supply management) as well as electronic health information systems that have enabled some facilities to move beyond paper-based systems.

HRSA has also supported the development of resources to enhance such operations as finance and accounting, grants management, and compliance.

Enhancing Quality of Care

A quality management process has been introduced in 11 countries.  National committees oversee quality improvement and peer learning.  Results can now be reliably verified as performance measures are met in select countries.  At a minimum, these measures are drawn from national HIV/AIDS guidelines.  Countries are encouraged to add indicators of importance to them, like patient waiting times.


photo of laboratory

Training Resources

HRSA supports I-TECH, an online database of over 1,200 HIV/AIDS training materials (from 300+ organizations, in multiple languages).  Within the mix are over 100 originally-developed products, many adapted from HRSA’s domestic programs and other leaders in the field.  Resources are tailored to target countries, following quality standards for curriculum development.  Local curriculum developers have been put in place in multiple locations. Topics cover the basics of HIV/AIDS and treatment strategies; evaluation, monitoring and recordkeeping; and leadership.  Materials target nurses, physicians, and lay workers.

ClASS, Clinical Assessment System Strengthening

ClASS is a continuous quality improvement tool to use in monitoring and enhancing service delivery.  It is based upon a similar resource developed in the 1990s for use by clinics funded under the Ryan White HIV/AIDS Program in the U.S.