1. Health Systems Sustainability: Perspectives from AIDSRelief Pat Bass and Dr. Herby Derenoncourt Track 1.0 Implementers Meeting Dar Es Salaam August 4 th – 6 th 2009 Providing Treatment, Restoring Hope

2. Stronger systems Principles: 1.Since 2004, AIDSRelief strives to adhere to the principle of the “Three ones” adopted by most of the countries. 2.AR functions within the Government framework 3.AR implementation plan targets priorities set by Government as steward of the health system

3. WHO Six Health Systems Blocks

4. HSS Framework WHO 1.Service Delivery 2.Health Workforce 3.Health Information System 4.Supply Chain 5.Health System Financing 6.Leadership and Governance - Stewardship AIDSRelief 1.ART Service Delivery 2.Human Resource Development 3.Strategic Information 4.Supply Chain 5.Finance, Compliance 6.Transition to LPs - Stewardship

5. Human Resource Development Financial Management Clinical Human Capacity Strategic Information

6. Human Resource Development General Goals: Increase specific technical skills Support conducive working environments Task shifting Foster involvement of PWLHAs What we do: 1.Each CM brings expertise & provides training to promote local expertise that is sustainable 2.On site Mentoring, preceptorship, training events / programs, exchange visits 3.Provide resources for staffing 4.Support development of site level policies & procedures (SOPs)

7. Financial Management What we do: Increase development of Budgeting, Financial Management &Property Management skills for partners. Train in systems to promote accountability. Train in installation and using accounting software such as Pastel, Peachtree, QuickBooks etc. Develop skills in management of receivables (debtors) and payables (creditors). Train in exchange rate management and managing exchange losses. Train in donor grant management

8. Clinical Human Capacity Development Evolution 2004/05 – Transitioned from US based faculty engaged on a per country basis to in country full time (ex-pats) faculty and care delivery experts 2006 – Local leads identified and given additional training (Physician exchange at IHV, lab exchange, CBTS exchange, CQI TOT) 2007 -Identified highly motivated clinicians and supported their preparation and application to US residencies and fellowships with a commitment to return to their home country upon completion 2008 Transition of US faculty out of countries began Leadership transitioned to Local National

9. Examples of AIDSRelief HRD Activities Zambia Residency Program - AIDSRelief / UMSOM partnership with University of Zambia Teaching Hospital and Nursing Council Develops national expertise Assures future training Develops evidence based local response Pediatric Counseling at country level (Kenya, Zambia, Nigeria, Tanzania) – health professionals in conjunction with ANECCA (ANNECA Pediatric Counseling Training Materials) Training of nurses embracing needs of task shifting Ongoing discussions for HIV Residency in Haiti

10. Strategic Information 2004 – developed job descriptions to hire in-country Strategic information Advisors-requirements M&E experience and computer skills; many were clinicians or had public health credentials (sustainable in-country teams) Through an inclusive process developed training modules, SOP’s, relevant TA to focus on enhanced skill sets (goal to change data culture to information usage) 2005 – developed IQSolutions based on team input that a system needed to be robust, flexible, open-source and user- friendly 2006- decentralized to regional support with HQ TA and program review defined by scope of work for country 2007 – present- focusing on PMMS and DDIU to address gaps and barriers in program and operations, planning and decision making

11. AIDSRelief Data Systems: IQStrategy Sound products based on experience in the field Best Practices Positive outcomes

13. Health supply: Before & After

14. Drug Store: Before & After

15. TRUCK FOR MEDS

16. CHAN Cold Room

17. Thank You