In Vietnam the higher levels in the health care system are mandated to provide technical assistance (TA) and training to lower levels of the health care system. However, onsite TA is resource intensive, making it difficult for the limited numbers of technical experts in specialty centers to provide support to healthcare workers (HCW) throughout the country. In addition, the traditional focus on HCW clinical knowledge and skills does not address the need to strengthen the capacity to systematically monitor and improve systems-level gaps that threaten quality.
To address these challenges, HAIVN has developed a model of TA for Vietnam based on a project developed by the University of New Mexico Health Sciences Center (UNMHSC) Department of Internal Medicine. The project, called the Extension for Community Healthcare Outcomes (ECHO) or Project ECHO, was developed as an innovative approach to improve access to high quality clinical care for complex chronic diseases among rural and underserved populations through capacity building of primary care physicians (PCPs) and other local healthcare workers. ECHO utilizes videoconferencing telehealth technology to bring together multiple community-based PCPs with interdisciplinary specialists from the academic medical center for the purposes of co-management of the PCP’s patients. The model builds knowledge and capacity through three main routes: (1) longitudinal co-management of patients with specialists and case-based learning, (2) opportunities to learn from other community-based PCPs working in similar settings, and (3) short didactic presentations on topics relevant to the case discussions.
Recognizing the potential benefit of the ECHO model in the Vietnam context, HAIVN has adapted the model for specialty centers in Vietnam’s to provide training, mentoring, and technical assistance to HIV care providers in their region. As in ECHO, E-mentoring aims to build health worker capacity through case-based learning, peer-to-peer learning, and short targeted didactic presentations. E-mentoring simulates the traditional one-on-one mentoring experience, but replaces the on-site face-to-face interaction with communication through larger group videoconferencing. Analogous to distance learning, where didactic training is provided over the internet, e-mentoring has many advantages compared to traditional mentoring including lower cost, reduced time away from work for both mentor and mentee, and reduction of professional isolation for those working in distant areas. In addition, the approach allows for providers from multiple locations to connect simultaneously with a central team of experts allowing for experience sharing and peer-to-peer learning between clinical sites.
E-mentoring requires the formation of a network of participating clinical sites connected to a central ‘hub’ institution where expertise and potential mentors are located. Participating sites are expected to prepare clinical case studies for discussion according to a standardized template. Training and mentoring are then provided by designated mentors and coaches from the central institution following Vietnam guidelines and international norms. In addition to clinical care, e-mentoring programs can also focus on providing coaching in quality improvement activities. In these programs, participating sites will also present ongoing quality improvement projects and share lessons learned, successes, and challenges with the network.
Currently HAIVN is supporting the implementation of e-mentoring for HIV care and treatment at the Hospital for Tropical Diseases and the Pediatric Hospital #1 in HCMC, the National Hospital for Tropical Diseases and the National Pediatric Hospital in Hanoi, and the Provincial AIDS Committees in HCMC and Son La Provinces.