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Radiating Knowledge Division Health, Education, Social Protection Radiating knowledge How a core of experts based in Croatia is boosting HIV surveillance across Eastern Europe, Central Asia and beyond WHO Collaborating Centre Knowledge Hub for Capacity Development in HIV Surveillance HI IDS Knowledge Hub for Capacity Development in HIV Surveillance Content 1. ACKNOWLEDGEMENTS . 3 2. EXECUTIVE SUMMARY . 4 3. INTRODUCTION . 6 Aims of report . 6 Severe epidemics harming region . 6 Weak surveillance undermines response . 7 4. CAPACITY BUILDING FOR SURVEILLANCE . 9 Tasks, work strategies and structure . 9 Regional Knowledge Hubs . 9 Knowledge Hub for Capacity Development in HIV Surveillance . 9 Capacity development defined . 11 Benefits of a regional approach . 12 Evaluation of capacity development for surveillance . 12 5. RESULTS . 14 Outputs . 14 Outcomes: Case studies . 17 Case study 1: Ukraine . 17 Case study 2: Sub-regional transfer of knowledge in south-east Europe . 19 Case study 3: North Africa and the Middle East . .20 6. LESSONS LEARNT . 23 Further investment would pay major dividends . 24 7. RECOMMENDATIONS . 25 8. REFERENCES . 26 9. ABBREVIATIONS . 27 Annex I: Table 1. Training courses delivered since 2004 . 28 Annex II: Table 2. Numbers per country attending Knowledge Hub training courses . 30 Published by: Responsible: Deutsche Gesellschaft für WHO Collaborating Centre and Knowledge Hub for Capacity Technische Zusammenarbeit (GTZ) GmbH Development in HIV Surveillance Dag-Hammarskjöld-Weg 1-5 Andrija Stamparˇ School of Public Health, School of Medicine 65760 Eschborn. Germany Rockefellerova 4, 10 000 Zagreb, Croatia T +49 (0) 61 96 79-0 T +385 (0) 1 4590 142/147 F +49 (0) 61 96 79-1115 F +385 (0) 1 4684 406 I www.gtz.de I www.surveillancezagreb.org German BACKUP Initiative Strategic Information and Research, HIV/AIDS Department World Health Organization 20, Avenue Appia CH-1211 Geneva 27, Switzerland I www.who.int/hiv 2 1. Acknowledgements This report was written by Ivana Bozˇicˇevi´c, Danijela by our colleagues in Croatia – in particular, Josip Lesˇo, Lucija Zigrovi´ˇ c and Stipe Oresˇkovi´c of the WHO Begovac, of the University Hospital for Infectious Collaborating Centre and Knowledge Hub for Capacity Diseases, Aleksandar Stulhofer,ˇ of the Faculty of Building in HIV Surveillance, at the Andrija Stamparˇ Humanities and Social Sciences, University of Zagreb, School of Public Health, School of Medicine, and Jesus and staff at the Zagreb office of the United Nations Maria Garcia Calleja of the Strategic Information and Development Programme. Research Unit, HIV/AIDS Department, World Health Organization, Geneva. The text was edited by consultants Finally, special thanks to the members of our Advisory James Boothroyd and Jennifer Lee. Board for their valuable guidance in our activities. The authors wish to thank the World Health Organization, the German BACKUP Initiative, Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH and the European Commission for establishing the Knowledge Hub and enabling its work. Also, thanks to all those colleagues who attended our training sessions and those who invited experts from the Hub to work with them in providing technical assistance – your commitment to better HIV surveillance has encouraged and educated us, continuously. We are also grateful for the support and commitment shown Authors: Ivana Bozˇicˇevi´c, Jesus Maria Garcia Calleja, Danijela Lesˇo, Lucija ˇZigrovi´c, Stipe Oresˇkovi´c Edited by: Jim Boothroyd and Jennifer Lee Photographs: Title: Danijela Lesˇo Layout/Print: Nikolai Krasomil, www.design-werk.com Druckerei und Verlag Klaus Koch Eschborn, November 2009 3 2. Executive summary As HIV epidemics in Eastern Europe have evolved, so This publication summarizes recent evaluations of the too has our understanding that this long-term threat to achievements and lessons learnt by an innovative institu- health and development is best tackled by fostering tion at the forefront of a cooperative, regional approach local institutions within region-wide networks commit- to addressing HIV: the Knowledge Hub for Capacity ted to continuous learning, improvement and the streng- Development in HIV Surveillance based at the Andrija thening of technical skills. Underpinning this approach Stamparˇ School of Public Health in Zagreb, Croatia. is the premise that regional advocacy and capacity development are necessary to ensure the introduction This is one of three HIV Knowledge Hubs serving and scaling up of comprehensive HIV services across Eastern Europe and Central Asia that were established in whole regions. It is also widely believed that regional 2003-2004 with the support of the German BACKUP advocacy and capacity development is the best guaran- Initiative, a programme of German Technical tee that resulting services will be well-suited to various Cooperation (GTZ), the World Health Organization socio-political, cultural and epidemiological contexts- Regional Office for Europe, WHO Headquarters and, ultimately, sustainable. (Geneva) and the European Commission (grant for Second Generation Surveillance of HIV/AIDS). The The need for fresh capacity to address HIV is urgent. By other two Hubs support harm reduction (the Eurasian the end of 2007, 1.5 million people [1.1-1.9 million] in Harm Reduction Network (EHRN) based in Vilnius, Eastern Europe and Central Asia were living with HIV, Lithuania) and HIV care and treatment (AIDS Training with an estimated adult prevalence of 0.9% [0.7%- and Education Center in St Petersburg, Russian 1.2%]. Epidemics of HIV are now well-established Federation). The St. Petersburg Hub, which was based throughout both regions, and growing at alarming rates until recently in Kiev, Ukraine, is also supported by the in some countries, particularly among injecting drug American International Health Alliance (AIHA). users, a fast-growing sub-population. Of those living with HIV, 66% are in the Russian Federation and 21% All Knowledge Hubs have four key tasks: to facilitate the are in Ukraine. Increasing numbers of infections due to rapid increase in capacity by providing direct technical unsafe sex practices among heterosexual partners also assistance; to organize training for health-care providers, indicate that growth of the HIV epidemic could con- epidemiologists and managers of health systems; to facili- tinue in all sectors of the population. tate networking among regional consultants (and people living with HIV); and to adapt generic WHO tools and Knowledge hubs aim to fill important gaps in health services by providing a regional pool of expertise, creating a regional community of professionals facing a common epidemic; and providing a basis for training programs that are outside of the usual national programmes. 4 guidelines to the needs of countries and regions. In this The Hub’s regional approach has allowed for comprehen- manner, they aim to fill important gaps in health services sive capacity development specific to each region’s needs. by providing a regional pool of expertise, creating a Training (in workshops, mentorship and follow-up ses- regional community of professionals facing a common sions) is combined with ad hoc and longer-term techni- epidemic; and providing a basis for training programs cal assistance to countries. High-level cooperation and that are outside of the usual national programmes or knowledge sharing among countries with similar HIV sources that might be available. epidemics and health-care systems expedites the adapta- tion of policies and guidelines. Standardized, regionally In 2008, GTZ commissioned an assessment of the per- adapted tools that have proven their value in pilot studies formance of the three Hubs, which focuses primarily on have been developed along with training modules to help their outputs (advocacy work, number of people trained, health managers and service providers use them in their technical assistance provided, etc.) and organizational own countries. This is backed up with technical assistan- structures. It found, for example, that since 2004, the ce from regional experts. Hub had offered 38 training courses, attracting 829 par- ticipants from 60 countries of Eastern Europe, Central Policy-makers in countries that have received training Asia and beyond: Africa, Middle East and south-east and technical assistance see a direct link between the Asia. Seven training modules were translated into Knowledge Hub’s capacity development and the subse- Russian and the first courses in Russian, presented in quent improvement of HIV surveillance. Case studies Russian-speaking countries, were organized in 2009. and structured interviews with these policy-makers also point to a substantial transfer of knowledge in HIV Another evaluation done in 2009, also summarized in surveillance. To sustain this and build on these concrete this document, focuses on (more general) outcomes in an achievements, international donors will now need to attempt to assess how work of the Knowledge Hub in invest in the Zagreb Knowledge Hub over the long-term. Zagreb effected the quality of HIV surveillance in coun- There a variety of ways to do this, but without invest- tries that used its services. ment in such HIV capacity development mechanisms, countries in Eastern Europe, Central Asia and elsewhere may simply not know enough about their growing epide- mics to address them in timely and effective ways. Since 2004, the Hub has offered 38 training courses, attracting 829 participants from 60 countries of Eastern Europe, Central Asia and beyond:
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