The 11 Pacific Island countries and territories (PICT) included in this project have low and generalised HIV-prevalence or, in a few cases, have never recorded any HIV diagnoses. Sexually-transmissible infections (STIs), however, are common, with some countries having relatively high rates of STIs. Rates of HIV testing are low, usually confined to antenatal testing which may or may not have been standardised.
Many PICT have laws criminalising key populations including men who have sex with men (MSM), transgender people and sex workers; and there are few protections against discrimination. At least one country (Palau) is considering a law that would criminalise HIV transmission.
The delivery of medical services varies between PICTs, and is often hampered by vertically-structured services which may be inaccessible to or unwelcoming of members of key at-risk populations. Health care workers report being fatigued from overwork and from the need to respond to international development agency visits. There is a lack of coordination between international agencies and possibly some duplication of effort as a result.
This Pacific Sexual Health Workforce Capacity Building Program is a joint regional capacity building initiative between ASHM and The Oceania Society for Sexual Health and HIV Medicine to provide clinical mentoring, training and resources to health professionals working in HIV, TB and STIs in eleven Global Fund-supported Pacific countries. The project is supported by the Principal recipient of the Global Fund grant, managed by UNDP and jointly implemented by ASHM and OSSHHM, with ASHM acting as the sub-recipient of the grant.
The project was developed to support health care workers in the eleven countries through gaining a deeper understanding of each country’s response to HIV, TB and sexual health, and establishing a pool of ‘Pacific Clinical Mentors’ based in Fiji to deliver training and direct mentorship to health professionals in Pacific countries. Clinical mentoring is a well-established method for supporting the scale-up of HIV clinical services in resource-constrained settings.
The clinical mentoring model is designed to facilitate south-south collaboration between Pacific countries, a paradigm that posits developing countries as agents of action rather than mere participants in a donor-recipient relationship. This approach moves away from the ‘fly-in-fly-out’ approach that characterised earlier models for capacity development, and centralises supporting the expertise and capacity development of each country’s exiting health workforce.
For small Pacific countries with low HIV caseloads, clinical mentoring can help maintain up-to-date knowledge in HIV clinical care, assist local healthcare workers manage more complex cases, and build valuable professional relationships between mentors and mentees as well as between mentees and fellow health professionals in other Pacific countries. In combination with traditional technical training and capacity development workshops, clinical mentoring programs provide an efficient, flexible way to support locally-developed service delivery models while retaining the autonomy of health professionals in each country.
11 Pacific Island countries and territories (PICT):
Cook Islands, Vanuatu, Samoa, Tonga, Niue, Palau, Nauru, FSM, RMI, Tuvalu, Kiribati
April 2017 – January 2018
Establishment of a pool of Pacific Mentors: 7 Fiji-based clinicians with a range of experience in HIV, sexual health and infectious diseases were recruited as Pacific Clinical Mentors, including specialists in paediatrics, obstetrics and tuberculosis, supported by four experienced ASHM mentors.
Country assessments and in-country mentoring: Assessments to each country identified local successes and challenges in HIV, sexual and reproductive health and TB management, as well as knowledge gaps and training and capacity development needs.
Update and development of HIV, STI and SRH resources and tools: New guidelines and flowcharts for management of HIV, HIV/TB and STIs build on existing OSSHHM, ASHM, WHO and CDC guidelines and are tailored to meet local cultural and clinical circumstances.
The Pacific Sexual Health Workforce Capacity Building Program with its established pool of Fiji-based mentors will provide on-going remote mentorship to health care workers in the 11 PICTs to allow them to continue to access assistance on the management of complex cases of HIV and SRH.
Dr Mere Sigawale | Fiji-based Clinical Mentor, HIV & SRH clinician
For any general enquiries relating to this project, please contact:
Michelle O'Connor | ASHM International HIV&SRH Program Adviser
Michelle.OConnor@ashm.org.au | +61 2 8204 0736
OSSHHM is a membership-based professional society representing the interests of health care workers working in the areas of HIV, sexually transmitted infections and sexual health in the smaller PICTs. Established in 2007 and headquartered in Suva, Fiji, OSSHHM has 170 members in 16 Pacific Island Countries and Territories. OSSHHM works to improve access to training in STI/HIV management for public and private sector health care workers while improving the quality of services at local level for key affected populations. For more information visit www.osshhm.org