1. 5 October, 2010 Making the Most of International Partnerships Clinton Health Access Initiative

2. Agenda Clinton Health Access Initiative Approach Approach in Action: Case Study Lessons Learned

3. Founded in 2002, CHAI has helped governments expand access to healthcare, with an initial focus on AIDS treatment What we strive for… A world in which all individuals have equitable access high-quality health care, enabling them to live healthy and productive lives with dignity and equal opportunity. What we do… We support the rapid expansion of access to high quality, essential healthcare for all who need it by improving the organization of commodity markets and by enabling the effective delivery of health services and efficient management of health systems. How we work… We help governments to optimize the use of available resources to maximize health outcomes.

4. Problem …CHAI’s Response … Pediatric HIV/AIDS Malaria Health Systems Human Resources for Health Value for Money Expand ACT access in the private sector, improve diagnosis, and lay groundwork for elimination Transitioning scale-up responsibility, focus on infants and quality, and prove models to prevent infection Be a hand-in-hand partner in 2-3 countries to plan and implement comprehensive system strengthening 50% of HIV+ children die before the age of two, yet systems continue to focus on treating older children There is a $20B gap in next 5 years from what’s available and needed to keep HIV treatment programs going 50% of external aid is “off budget” from national plans; resources are not optimized to strengthen health systems Malaria kills 1 million children annually because diagnosis and treatment are not reaching patients Africa has 11% of the world’s population, 24% of its disease burden, but just 3% of its healthcare workers Lower commodity prices, improve efficiency of spending, and better align donor funds with national costs Improve capacity, deployment and productivity of health workers to help bridge the human resource gap As the AIDS and global health landscape has evolved, so has CHAI and its approach to pressing global health issues

5. CHAI Zambia HRH follows the government’s leadership to design and implement national HRH programs Support government in analyzing and diagnosing HRH bottlenecks / barriers Holistic approach to addressing the HRH crisis ­ Work with MoH to develop pragmatic, integrated, and comprehensive solutions ­ Support data-driven planning and decision making Help to mobilize resources needed Finance the cost of implementation ­ Assist governments raise large-scale, ongoing funding internally and externally ­ Rationalize the use existing funds – by redeploying or lowering costs Provide light touch operational support to implement MoH-driven interventions Coordinated and sustainable implementation of HRH interventions ­ Follow MoH leadership to un-stick bottlenecks and kick start new initiatives to drive change ­ Integrate core functional systems for ongoing oversight

6. CHAI Zambia HRH takes a holistic approach to HRH with a view across the lifespan of the health workforce CHAI HRH Program Objectives Partner closely with MoH to:System-Level OutcomeHealth Outputs Increase the number of qualified healthcare workers Accelerate production of healthcare workers Strengthen skills of health workforce Increase number of patients seen and treated Provide higher quality of care Optimize the distribution of healthcare workers Improve absorption of healthcare workers into the workforce Improve distribution of health workforce Increase number of patients seen and treated Improve patient access to primary healthcare Maximize the productivity and utility of formal and informal healthcare workers Optimize use of existing health workforce Formalize skills of informal workforce Increase number of patients seen and treated Provide higher quality of care Improve patient access to primary healthcare

7. To implement a comprehensive HRH strategy, MoH has helped CHAI understand the partner landscape across the HRH spectrum Increase the number of qualified healthcare workers Optimize the distribution of healthcare workers Maximize the productivity and utility of healthcare workers MoH: DHRA, DPP, DCCDS, DTSS MoFNP MoE MoSTVT MoWS Cabinet Office Senate (for UNZA programs) General Nursing Council Health Professionals Council of Zambia Other regulatory bodies (Pharmaceutical Regulatory Authority, etc.) TEVETA Health worker unions (ZUNO, etc.) Public and Private Health Training Institutions Health facilities (clinical practice) Faith-based Organizations (CHAZ) Civil Society Organizations Implementing Partners Cooperating Partners MoH: DHRA, DPP MoFNP Public Service Management Division General Nursing Council Health Professionals Council of Zambia Health facilities Faith-based Organizations (CHAZ) Civil Society Organization Implementing Partners Cooperating Partners MoH: DHRA, DPP, DCCDS, DTSS, DPHR MoFNP Public Service Management Division Cabinet Office General Nursing Council Health Professionals Council of Zambia Health worker unions Public and Private Health Training Institutions Health facilities Faith-based Organizations (CHAZ) Civil Society Organization Implementing Partners Cooperating Partners

8. Agenda Clinton Health Access Initiative Approach Approach in Action: Case Study Lessons Learned

9. Case Study: National Training Operation Plan (NTOP) Achieving HRH expansion through training scale-up As training capacity is a significant bottleneck to expanding the health workforce, how will Zambia achieve it’s target to scale-up training output by 70%+ across 39 training institutions (TIs)?  Partner with MoH and regulatory bodies to conduct assessment of the 39 TIs to determine resource requirements ­ Lacked infrastructure and tutors and clinical instructors  Expert interviews for feedback on quality standards  Support MoH to produce and disseminate a 5-year costed scale- up plan ­ Put scale-up infrastructure systems requirements in-place ­ Help implement strategies to address the gaps: D/E tutor and Clinical Instructor Program design  Funding commitment of $26 million from GRZ, partners and Global fund Support government in analyzing and diagnosing HRH bottlenecks / barriers Provide light touch operational support to implement MoH- driven interventions Help to mobilize resources needed Approach

10. Case Study: National Training Operation Plan (NTOP) Partner collaboration in training scale-up Underlying the NTOP is coordination and collaboration with various partners 3 Ministries: MoH, MoE, MoSTVT 2 Primary Regulatory Bodies: GNC, HPCZ Health Students 3 Ministries: MoH, MoE, MoSTVT 2 Primary Regulatory Bodies: GNC, HPCZ Ministry of Works & Supply Infrastructure: Health TIs 3 Ministries: MoH, MoE, MoSTVT 2 Primary Regulatory Bodies: GNC, HPCZ Biomedical Association, CHAZ, School of Medicine, Student Union, TEVETA Training Quality Standards MoFNP Cooperating Partners Financial Commitment

11. Agenda Clinton Health Access Initiative Approach Approach in Action: Case Study Lessons Learned

12. CHAI Zambia HRH: Lessons Learned  National leadership is paramount ­ HRH approach must strengthen national HR systems, address key government priorities, be aligned with national health strategic plans ­ Although a partnership dynamic is established at the outset, the government assumes ownership of process, methodology, data, results and next steps ­ End product is the government’s to use at its discretion  Quantitative analysis informs resource allocation and priority-setting decisions ­ Methodology and data collection process involves MoH and all relevant stakeholders Consensus and buy-in established at the outset ­ Avoid large expenditures on HRH interventions that lack clear understanding of which interventions will have the greatest impact on addressing shortage of workers

13. CHAI Zambia HRH: Lessons Learned Continued  Coordinated support by multiple stakeholders can inform better decisions, allow for improved resource mobilization, and avoid potential bottlenecks  National planning / strategies should be complemented with continued on-the- ground support to ensure implementation follow-through and sustained results ­ Supporting MoH to identify and rapidly remove barriers to implementation and breakdown bottlenecks can often unlock resources and build momentum for further progress Optimize use of resources across partners Avoid doing what others are already doing well ­ Clear means to transition responsibility and funding for the proposed approach to the government and/or other organizations