Cross-cutting Capacity Building Needs of Proposed Local Partners Philippe Chiliade, MD,MHA HHS / HRSA Maputo, Mozambique August 12, 2010

Overview HRSA’s transition approach and the ClASS process Basis for the analysis Administrative systems findings Financial systems findings Clinical systems findings What are the next steps?

HRSA’s Transition Approach: Programmatic Process 1. Transition Plan (TP) Preparation Provide guidance on TP development Receive TPs from grantees Confirm in- country CDC concurrence on TPs 2. Transition Plan Reviews Perform Project Officer Review of TPs Conduct Track 1.0 Team Review of TPs Identify key questions and gaps in TPs 3. Transition Plan Coordination Discuss TPs with Grantee and in- country CDC team. Receive updates on country program transition efforts 4. Site and Local Partner Assessments Conduct Site and Local Partner(s) Assessments Technical Assistance 5. Capacity Strengthening Support Manage technical assistance support to Local Partner(s) Monitor program and local partner capacity strengthening

ClASS Process

ClASS Modules Review by technical areas –Administrative systems –Financial systems –Clinical systems

Administrative Module Facility Organizational Structure and Governance Risk Management and Legal HIV Program/Clinic Organization and Management Staffing Personnel Policies, Procedures and Files Collaborations (MOH, donors, other providers) Community Linkages MIS Functions, Maintenance and Security Data Management

Finance Module Financial Management and Oversight Budget Management Financial Policies and Procedures Accounting Systems Chart of Accounts and Data Security Accounts Payable, Receivable and Cash Flow Payroll Internal Controls Purchasing, Inventory, and Travel Charges/Fees and Billing/Collections

Clinical Module Facility Clinical Operations and Management HIV Care & Treatment, PMTCT, Pediatrics,… Medical Records and Information Systems Infection Control and Post Exposure Prophylaxis Quality Improvement Processes Referrals Pharmacy and Dispensing Laboratory and other Diagnostic Services Patient Health Literacy Support

Basis for the Analysis HRSA experience assessing LP between March 2009 and June 2010 ClASS at 12 “proposed” local partners 6 countries (Uganda, Nigeria (2), Botswana, Kenya, Rwanda, Zambia)

ClASS Assessment Administrative Review Findings

Administrative Systems Issues Governance –Conflict of interest Organization Management –Problem solving / Quality improvement Human Resources –Salary and allowance schedules –Job descriptions –Performance evaluations –Employee health screening

ClASS Assessment Financial Review Findings

Financial Systems Issues Financial Management Oversight Grant Management Financial Policies & Procedures Internal Control Accounting System (Payroll) Accounting System (Charts of Accounts)

ClASS Assessment Clinical Review Findings

Clinical Systems Issues Quality Improvement Medical Records and Information Systems Staff Turnover Infection Control Retention Issues (pre-ART > ART) Enrolment of pediatric pts and male pts Integration of Services Access (user fees, transportation costs)

Clinical Systems Issues Referral network Capacity of existing sites Decentralization Identification, Documentation, and Spread of promising practices Task shifting/sharing Limited access to Primary Care Access to 2sd line ART

What are the Next Steps? Detailed debrief at the end of the visit –To CDC in-country –To the grantee –To the local partner(s) ClASS Report Developed with feedback of the stakeholders Grantee to develop a capacity building plan of the local partners