1 Partnering to Strengthen Local Efforts Can Help Us Get to Six Million on ART Anja Giphart, MD MPH Vice President, Program Implementation Elizabeth Glaser Pediatric AIDS Foundation July 25, 2012

Project HEART Countries and Number of Sites

Project HEART Care and Treatment Results,

Project HEART PMTCT Results ,000 pediatric infections averted

Local Capacity Building Approach #1: District Approach to Expansion of Services

District Approach An effective approach to rapidly scaling-up HIV services while building local financial, technical and management capacity Working “through” the districts: – Districts are responsible and accountable for implementation, quality and scale-up of HIV services in their location – EGPAF provided technical assistance and direct funding via subgrants EGPAF worked with a total of 159 districts across 5 countries In the final project year 96% of subaward funds were awarded to local partners, the majority being districts and community organizations

Tanzania Care and Treatment Scale-up District Approach Expanded in 2007

Directly and Indirectly Supported Care and Treatment Sites, Tanzania N=260 ART results for 5 Regions as of March, 2012 N=6,016N=56,486

Mozambique Subgrant Burn Rates Improvements over Time

Local Capacity Building Approach #2: Decentralizing Training

Traditional In-Service Training COUNTRY NAME Physicians Trained: ART Nurses Trained: ART Other HCW Trained: ART Côte d’Ivoire3,0692, Mozambique South Africa9321,868 Tanzania1,7121,8611,214 Zambia9264,0472,638 TOTAL6,91711,7246,962 Over 25,000 Healthcare Workers Trained in the provision of comprehensive HIV care and treatment

Pre-Service Training in Cote d’Ivoire Medicine 69 doctors trained in care and treatment of HIV/AIDS, TB, and malaria * 12 employed by program site * 14 awaiting assignment as civil servants * 42 writing thesis * 1 working outside CI Pharmacy 25 pharmacists trained in lab and strategic supply management * 4 employed by program site * 19 writing thesis * 2 working outside CI Social work 151 social workers trained to provide support and follow- up to PLWHA * 131 employed as civil servants, mostly in program sites * 20 awaiting assignment 245 health professionals trained,

Pre-Service Training in Mozambique By June 2011, Project HEART supported a total of 9 courses for 259 medical officers, nurses, pharmacy agents, and assistant health officers.

Targeted Mentoring for Pediatric Treatment Case Review of 348 Pediatric Patients in 3 Referral Hospitals in Tanzania Site # of records reviewed # of children on ART # eligible but not on ART % eligible but not on ART Maswa District % Shinyanga Regional % Bukombe District % TOTALS % “Systematic analysis of EID cascade and implementation of specific interventions: Lessons from Tanzania.” Schimana, W et al. IAS, 2011

Targeted mentoring to improve pediatric ART initiation - Tanzania* * Data are from three referral hospitals in Tanzania

Local Capacity Building Approach #3: Transition Services to Local Partners

Two Phases of Project HEART Phase I: Emergency scale-up, Phase II: Sustain & Transition, Two Program Phases

Project HEART Transition Approach Sustainable Health Outcomes: Clients have continuous high quality HIV care and treatment delivered by local partners Health Service Provision (Quality & Access) Management Capacity of Government, NGOs & Private Sector managing health system Client and Community Engagement (active civil society, high demand) Enabling Environment Policies, political stability, human rights, gender equality, etc.

Transition Monitoring Tools Area of Measurement DescriptionMonitoring Tool CapacityAssess existence and scope of organizational systems and processes  H-CAT (for MOH Districts and Regions)  Organizational Capacity and Viability Assessment Tool (OCVAT)  Site Capacity Assessment Tool  Affiliate Accreditation Tool TransitionOutcome indicators demonstrating an incremental increase in responsibility and ownership  Benchmark Matrix  OCVAT  Project workplans & budgets SustainabilityPerformance indicators demonstrating sustained ownership and quality  Benchmark Matrix  Affiliate Accreditation Tool  Project workplans & budgets

Country Transition Approaches Health Systems Strengthening, capacity building and transition to local authorities - 2 Provinces Directly Funded by CDC in Mozambique Transition to Existing NGO – Zambia: CIDRZ – South Africa: McCord Hospital and Health Systems Trust, Aurum Institute Enhanced health systems strengthening and transition to a new independent NGO (EGPAF Affiliate) in – Cote d’Ivoire – Mozambique – Tanzania

Getting to Six Million: Our Future Depends on It

Acknowledgements PEPFAR and the US Government Ministries of Health and the National, Regional and Local Governments in Cote d’Ivoire, Mozambique, South Africa, Tanzania and Zambia International and local partners CDC/Atlanta (from GH, PGO, Budget Office and ADS) CDC in Cote d’Ivoire, Mozambique, South Africa, Tanzania and Zambia EGPAF staff in LA, DC and Cote d’Ivoire, Mozambique, South Africa, Tanzania and Zambia Other Track 1.0 partners for their collaboration The patients, providers and communities for their participation, engagement and courage