Capacity Building: A Key Component of a Strong HIV Program

This post originally appeared on Management Sciences for Health's Global Health Impact Blog.

A team of nurses converse with doctor at JCRC. (Photo: Julius Kasujja)

A team of nurses converse with doctor at JCRC.
(Photo: Julius Kasujja)

Soon after her husband’s death in 1991, Bahati Shellinah tested positive for HIV, but antiretroviral drugs (ARVs) were not yet available. In 2004 she fell ill, but, luckily, this time ARVs were available. Bahati visited the Joint Clinical Research Centre (JCRC) outside of Kampala, Uganda, and she began taking ARVs for the first time.

Thankfully for Bahati, a local service provider was able to start her on treatment, but that is not the case for many people living with HIV, who often find themselves facing long waiting times, overwhelmed staff, medicine stock outs, stigma, and discrimination. No organization is immune to these challenges, and although JCRC was prepared when Bahati returned, they, too, grappled with organizational challenges as they scaled up services between 2003 and 2010. The gaps in management systems put JCRC's eligibility for donor funding at risk, which would mean patients like Bahati would lose access to their essential medicines.

Since October 2013, the USAID-funded Leadership, Management, and Governance (LMG) Project, led by Management Sciences for Health, has partnered with JCRC to build its organizational capacity to manage donor funding, deliver services, and lead Uganda’s response to HIV and AIDS.

The LMG Project identified gaps in some of JCRC’s siloed information management systems and worked with staff to upgrade and integrate software across JCRC’s clinical, financial management, and laboratory services. According to the data JCRC collected before and after the LMG Project’s assistance, the average patient waiting time decreased from more than six hours to less than 20 minutes.

Staying on ARVs can be more difficult than it seems. For Bahati, the treatment's side effects and people discouraging her from taking it were obstacles. For many organizations, management and governance responsibilities such as budgeting, data management, or resource mobilization are significant challenges.

Bahati Shellinah poses with a sign that reads, "An AIDS-free generation starts with me." (Photo: JCRC)

A team of nurses converse with doctor at JCRC.
(Photo: Julius Kasujja)

For that reason, the LMG Project has partnered with governments, networks, and organizations, like JCRC, to create adaptable tools and approaches that can be adopted or implemented independently. JCRC’s improvements in information management, financial management, and governance systems have reinforced USAID’s confidence that they can responsibly manage funds.

Although significant global progress has been made as we near 2020, the date for reaching UNAIDS’ 90-90-90 targets, more work remains to ensure sustainable HIV and AIDS services. We can assist countries in achieving these targets by empowering communities and developing resilient organizations and health systems that persist, just like Bahati did.

When Bahati was diagnosed with HIV, she thought her life would soon be over. Twelve years after her diagnosis, thanks to a functioning and well-managed ARV service provider, Bahati has consistent access to the life-saving drugs she needs and leads a normal, healthy life.

Developing resilient organizations and health systems that can provide for people living with HIV is key component of our contribution to the HIV and AIDS response and a critical factor as we strive to achieve sustainable HIV epidemic control.