Although LMS-AIDS Care & Treatment (ACT) is primarily a service delivery project, from the beginning it has included capacity building of government health systems by improving health workers’ HIV/AIDS/TB technical skills and strengthening the supporting systems for service delivery in Nigeria.  The approach has been to build a government-led partnership with LMS-ACT playing a supporting role.  Although this inevitably requires patience, it increases ownership, effectiveness, quality and sustainability of health care services in the long run.
 
LMS-ACT is involved with services through the provision of crucial supplies for HIV treatment such as laboratory equipment, ARV drugs and reagents.  LMS-ACT builds the capacity of the health facility staff, thus promoting ownership and sustainability of services.  To date LMS-ACT has trained over 1,300 healthcare workers in HIV/AIDS and TB technical trainings in the areas of PMTCT – Preventing Mother to Child Transmission; TB/HIV – Including Palliative Care; HCT – HIV/AIDS Counseling and Testing; ART- Adult Care and Treatment, Pediatric Care and Treatment (includes Palliative Care); LAB- Laboratory best practices; OVC- Orphans and Vulnerable Children; Strategic Information; and Supply Chain Management Systems.

In addition to working to build the clinical skills of the health care workers who are providing the services, a large part of LMS-ACT success has come as a result of focusing on building capacity in leadership and management by working with government and health care leaders at all levels including Federal, State, Local, and Community.  The LMS-ACT Leadership and Management trainings are designed to inspire a desire for change and improvement by creating a paradigm shift in thinking, and they allow leaders at all levels to see challenges as opportunities, rather than merely accepting current systems in their broken state.

---

 

---

When working with State and Local governments, LMS-ACT establishes a partnership relationship from the beginning with the government taking the lead, and MSH offering support.  LMS-ACT signs a Letter of Implementation with the State MOH, as well as with the local government authority’s health facility, documenting each organization’s role.  While LMS-ACT provides the training, ARV drugs, and laboratory equipment, the government leaders are expected to take on full ownership of the project by providing qualified staff, adequate facility space (including renovations when needed), necessary equipment such as generators and fuel, and medical equipment such as weighing scales, and thermometers.  

At the health care facility level, in addition to improving leadership by inspiring the desire for change, LMS-ACT also provides management tools and assists with the implementation of systems to help facilitate these changes.  LMS-ACT has provided: printed job aid charts at all sites for easy reference, and improved quality of services; patient flow charts to help facilities in managing increased patient load, as well as reducing patient time; on-the-job training and mentoring; training for health care staff to do quality improvement audits, including the use of a checklist.

LMS-ACT works to strengthen the health care facility coordination systems by establishing groups that come together to trouble shoot, find a shared voice, and solve problems to improve health care services.  Groups that have been established include Patient Care Teams, which are made up of health care workers; Project Management Committees, focusing on hospital leadership; Support Groups Meetings, which bring together HIV Counseling and Testing (HCT) Patients; and Network Meetings, a forum for Community Leaders to find a common voice.

LMS-ACT established state-level meetings between the Implementing Partners to promote coordination between the different organizations working in each state.  These meetings provide a forum for the state government to coordinate with each Implementing Partner and ensure their assistance is best supporting the state needs.  

LMS-ACT has incorporated the MSH and LMS principles of leadership, management, capacity building and sustainability in all areas of its program implementation, while building the technical capabilities of local health care providers and providing essential drugs and equipment for HIV/AIDS and TB services.  Now that strong technical knowledge has been well established in many of the facilities of all six states where LMS-ACT works, the project looks forward to increasingly using the Leadership and Management trainings at all levels as a way to improve health services even further.

What we have achieved is through MSH.  But whatever knowledge we have will remain there.  Anywhere, I can handle patients with HIV, I thank God for that knowledge.
~ Hajiya Medinat Adakeke, Chief Nursing Officer, Lakoja, Kogi State.