1. Nancy Fitch, EGPAF Mozambique CD TRACK 1.0 Annual Meeting Tanzania, August 200 9 EGPAF Project HEART: Transition Plans to Build a Sustainable Future: Opportunities, Risks and Challenges

2. Changing PEPFAR Context PEPFAR 1 – ART scale-up success, yet new cases exceeding scale-up PEPFAR 2: Global Health Strategy – Strengthen health systems – Integration with maternal-child health, PHC with greater decentralization – Best practices….. high quality, cost-effective – Move from “Emergency” to “Sustainability” Development assistance – Paris Declaration – Align with national health policies, foster country ownership and harmonize with other donors Flat-line budget – “Treatment mortgage” and impact on scale-up 2

3. Global Health Initiatives and Health System Strengthening Ultimate goal: strengthened country health system that effectively provides quality HIV PCT – Local NGO critical intermediary step to assure quality HIV services and support system strengthening Conceptual framework of health systems: Governance Financing Health Work Force Health Information system Supply Management systems 3

4. Global Health Initiatives and Health System Strengthening GHI bring HSS direction, scale, speed, increased resources Identify HSS targets and indicators Promote country capacity for strong national planning processes to align GHI resources. Promote meaningful role for civil society in governance and delivery of health services Improve evidence-based decision making of host governments to generate and use knowledge. 4

5. TRANSITION Plan Fully Consistent with EGPAF MISSION EGPAF’s mission “to eradicate pediatrics HIV/AIDS” and strategic plan are consistent with building capacity in host countries and with local organizations that over time lead to long-term sustainability PY 06 program and three year action plan aggressively place transition as priority 5

6. EGPAF Transition Planning Key Guiding Principles USG/EGPAF activities will be well-integrated with national HIV plans MOH/In-country /partners/stakeholders to be fully involved in defining sustainability and transition Leadership development, administration and management capacity building, and quality/continuity of services essential Clients, particularly PLWHA, key stakeholders Community engagement/advocacy and favorable external environment are key Prevention of new infections, especially vertical, is a priority 6

7. 7 GOAL All affected children and adults in service areas utilize high quality HIV prevention, care, and treatment services provided by local partners or host government EXPECTED OUTCOMES 1.An expanded number of clients have uninterrupted use of sustainable and high quality HIV care and treatment services; and 2.Capacity and leadership to plan, manage, implement, and monitor quality service delivery is transitioned to local organizations. RESULT 1: Expanded access to sustainable, high quality clinical service provision is strengthened RESULT 2: Client/community/stakeholder capacity is strengthened for awareness, treatment support and social audit RESULT3: Management capacity and viability of managing leader/ partner(s) organization(s) is strengthened Cross-cutting Underpinning: Favorable Environment

8. EGPAF Project HEART Global - Country Roles Joint Global-Country Leadership Team: Leadership strategy Define standards of excellence for governance (quality mgmt), financing, human resources, clinical information/M&E, etc. Global: Provide TA in needed cross-country gaps. Develop “toolkit” from experiences and best practices Build capacity of and devolve responsibility to local NGO(s) in specific functions, such as C&G, audit, competitive proposal writing. Country: Support quality, affordable PCT services Intense capacity development of national NGO, and host government service delivery components, in collaboration with host counterparts for transition. 8

9. 9 OBJECTIVE 1: To improve capacity at government level to carry out selected activities of Project HEART/Tanzania Level 1: Build capacity at national MOHSW level 1 Continue to participate in several Technical Working Groups and chair the pediatric TWG. XXXXXX Level 2: Build capacity at regional MOHSW level 5 Quarterly joint supportive supervision visits and systems to selected districts. XXXXXX Level 3: Build capacity at district MOHSW level 12 Address the human resource constrains by  Human resource assessment at sites, districts and develop HR plan.  Exploring possibilities to hire staff for existing open positions with the districts council budget, and  Discussing the constant rotation of trained staff. X XXXX OBJECTIVE 2: To improve capacity of existing NGOs to carry out selected activities of Project HEART/Tanzania 15 Detailed organizational capacity assessment of TPHA and PAT including medical/technical capacity and operational capacity. X OBJECTIVE 3: Establish a new NGO and build capacity to take over remaining activities of Project HEART/Tanzania 19 Develop criteria to select board members for the new NGO X 23 Develop plan for the NGO to develop technical and operational capacity over the next four years XXX OBJECTIVE 4: Ensure HIV services are uninterrupted in EGPAF assigned regions and transition plan is implemented according to plan 25 Participate in CDC lead stakeholder meetings XXXXX 26 Develop clear benchmarks in collaboration with CDC Tanzania and EGPAF global, MOHSW and other key stakeholders to monitor progress XX

10. EGPAF Mozambique Rapidly invest in development of local NGO to: Assure and support quality, affordable PCT service delivery via partnership with provinces and districts Assure financial management, mgmt and technical capacity building, governance (quality) Partner with District/Provincial Health Directorates, Direct financing via sub-grants to implement services and assure quality Joint planning and budgeting Capacity building of national and provincial health boards Provide evidence from decentralized services to guide national health policy and to strengthen health systems of governance, financing, human resources, information, supply management. 10

11. EGPAF Tanzania Goal: Districts will provide high quality HIV PCT services for all affected children and adults in Kilimanjaro, Arusha, Tabora, Shinyanga, Mtwara and Lindi regions EGPAF will continue to strengthen capacity through subgrants, TA, capacity building at: 1.Government (MOH, regional and district) 2.Existing NGOs: Pediatric Association and Tanzania Public Health Association 3.New local NGO to assume responsibilities. 11

12. EGPAF Cote d’Ivoire Become national NGO (program currently 100% national staff) Provide funding, financial oversight and technical and managerial TA to support: – District Mgmt teams – Sites – MOH – NGOs Fund services via intermediary of Health Service Payment Authority Fund private sites via PBF 12

13. EGPAF South Africa Support to the SA national CCMT programme: – Facility (PHC, CHC, Hospital) – District Health Department – Provincial Health Department – National Department of Health Strengthen DOH provincial and district level to guide and direct service delivery – Graduate mature service facilities – Transfer seconded staff to DOH payroll – Refocus skill development from individual facilities to district and provincial teams – Empower and train managers/providers to ensure quality service delivery – Build/strengthen quality service systems at provincial and district levels 13

14. EGPAF South Africa Development of new payment mechanism to allow direct funding to provincial/district health levels: – National District Health Care Financing body – Private company acting as clear house for donor funds – Via existing or local NGO Transition McCord Hospital and AIDS Health Foundation to direct USG or alternative funding as local organizations. 14

15. EGPAF Zambia EGPAF’s key partner has been the UAB/CIDRZ who has worked with MOH systems and local organizations in such areas as strategic planning, human resources development, quality assurance/improvement, supply chain management, and laboratory support. Prevalence much higher in urban areas (23%) than rural (10) 15

16. EGPAF ZAMBIA 1.Prepare CIDRZ (Centre for Infectious Disease Research in Zambia) to become a national NGO to manage financing and provide technical assistance to Lusaka and four Provincial Health Offices supporting district level HIV service delivery 2.Strengthen the management and system capabilities for the delivery of quality HIV prevention, care and treatment services for Lusaka DHMT and Province; 3.Strengthen the management and technical capacity of a local NGO--Africa Directions—to provide voluntary counseling and testing and support group activities. 16