Not required

In FY 2007, $60,000 of funds planned in mini-COP 07 to be programmed for SCMS were erroneously

obligated to EHSP to purchase testkits.

OHPS - Other Policy and Systems Strengthening

Program Area Code: 14

Word Count: 8,362

Overview:

Six years out from 40 years of civil strife, Angola is making the transition from emergency health services to

health development. Containing and reducing the current low-level HIV epidemic are essential to that effort.

This calls for a policy framework and management systems to deliver quality services in national prevention,

treatment and care in a sustainable way. Accordingly, system strengthening is the Ministry of Health's top

priority. The health system has a large pool of basic health workers, but their technical capacity is low. The

chief policies and systems that need definition and upgrading are information, planning, human resources

and drug management. A reliable information system will give the data needed for sound plans;

appropriately trained personnel and good drug management are the basis for delivering services effectively,

resulting in positive health impact.

Activities respond to concrete needs identified by the Ministry of Health to build capacity. The Ministry's low

management capacity and program deficiencies across the board call for a cross-cutting approach by the

USG that realizes economies of scale by working with one principal implementing partner to strengthen

systems to support HIV/AIDS, malaria, family planning and other priority health programs. The approach

also supports policy formulation at the national level and system strengthening at the national and local

levels. USG assistance is noteworthy for capacity-building at the base, within the context of decentralized

development that meets concrete, identified needs and translates into measurable impact. A systems

approach that guards against the duplication of effort that stove-piped programs often produce and a

decentralized approach that reaches up via enhanced capacity from the local level offer the best chance for

sustainability in the Angolan context of drastic systemic needs emanating from decades of war and a legacy

of centralized planning.

Leveraging and Coordination

The USG coordinates it assistance with WHO, UNICEF, UNDP, the European Commission and the World

Bank, all of which join the USG as key members of national committees that help guide policy development

and implementation. WHO is taking a lead in advising on public health legislation. The USG complements

European Commission work to establish a new health management information system by strengthening

health information systems at the municipal level. The USG is working closely with the UN to establish a

Technical Advisory Committee, which, together with Spanish foreign assistance and other international

agencies, will support the National AIDS Institute as the in-country coordinating body for HIV/AIDS. This

proposed advisory committee will conduct assessments and provide recommendations on protocols and

guidelines the government plans to implement. The USG, German and British foreign assistance agencies

are members of the donor-led Global Implementation Support Team (GIST) to address GFATM program

weaknesses and transparency concerns.

In policy and system strengthening, USAID's Essential Health Services Project (EHS) leverages resources

and creates synergies with USAID projects in decentralization and civil society strengthening, the former

working with local governments and citizens and the latter working with non-governmental organizations.

These projects promote leadership roles for women. Essential Health Services has been refined over

recent months to focus tightly on the USG's priority areas of HIV/AIDS, malaria and family planning and is

now under new leadership by a former female Minister of Health from Latin America. This project is the

vehicle for the clinical aspects of PMTCT and VCT, as well as almost all activities in health systems

strengthening.

Current USG Support

The National AIDS Institute (INLS) began to standardize its policies, procedures and protocols and asked

EHS for support. During FY07, the USAID-funded Essential Health Services trained 46 of 99 master

trainers in modules on HIV/AIDS and on HIV/AIDS integration with related areas, particularly tuberculosis;

schooled 18 health professionals in data collection, management and analysis; and trained 69 community

volunteers in two provinces on HIV/AIDS prevention. The USG is helping the Global Fund strengthen

management of the Angola Country Coordinating Mechanism, found ineligible in October 2006 on grounds

of lack of "leadership, communication and the structure of the Secretariat." This finding prevented Angola

from proceeding to Phase 2 of the grant. Our assistance provided a clear structure to the CCM and helped

institute a functional Secretariat that oversees the day-to-day activities of the CCM and enabled Angola to

submit a subsequent proposal for funding to combat malaria.

USG FY08 Support

USG activities in FY08 are:

1) Policy Making:

• Standardize national HIV policies, procedures and protocols to reflect the latest scientific evidence and

international consensus (INLS with EHS).

• Update protocols and manuals on counseling and testing, PMTCT, blood safety and behavior change, with

an aim toward equalizing gender imbalances, training and supervision (EHS).

• Revise current policies that seek to reduce stigma and discrimination (EHS).

• Policy benchmarks for FY 08 include expansion of categories of personnel that can perform rapid HIV

testing; adoption of a differential treatment regime for PMTCT, based on local capacity and local

epidemiological profile, to scale up those services; and strengthening of linkages between HIV and family

planning services (ICAP).

2) Information:

• Strengthen health management information systems to improve municipal-level planning that responds to

concrete health needs and ongoing municipal decentralization (EHS).

• Adapt the European Commission training model in budgeting and planning to the municipal level (EHS).

• Utilize small amount of PEPFAR funding to complement larger investments from USAID's municipal

development and civil society strengthening programs, which collect and analyze information for

Activity Narrative: development planning (Municipal Development Program with CARE, Civil Society Strengthening Program

with World Learning and EHS).

• Incorporate appropriate HIV/AIDS and tuberculosis reporting and analysis into the national information

system (EHS).

3) Planning:

• Assess needs and capacity for training and clinical care (I-Tech).

• Assist local organizations with development of sound grant proposals for behavior change in HIV (EHS).

• Foster community input, with emphasis on women, into HIV/AIDS programming, bringing local health

services and their target populations closer together (EHS).

• Support implementation of a national communications strategy (EHS).

4) Capacity-Building:

• Train personnel for voluntary counseling and testing centers, with an emphasis on women and youth-

friendliness and prevention education (EHS).

• Drawing on the training-of-trainers approach, build capacity at the local level by training 1,224 health

workers and 1,260 community members in HIV/AIDS in 11 targeted municipalities (EHS).

• Train health officials in epidemiological surveillance and in monitoring and evaluation of HIV/AIDS

programs (EHS).

• Develop supervision tools to measure performance (EHS).

• Design workforce training systems (EHS).

5) Drug Management:

• Strengthen systems to forecast needs, procure drugs and ensure their timely and reliable supply

throughout the health network (EHS).

• Upgrade integrated logistics systems and supply chains that encompass HIV/AIDS test kits, STI diagnostic

materials, anti-retrovirals, and drugs to fight opportunistic infections by complementing PMI funds, resulting

in fewer stock-outs (EHS).

• Leverage GDA support from private firms like Odebrecht, tapping their warehousing and distribution

resources to facilitate flow of condoms and prevention education to civil society (Business Coalition against

AIDS, through GDA with Odebrecht).

6) Other:

• Responding to a request from the Angolan government, assist in the conceptualization and drafting of the

HIV/AIDS proposal for Round 8 of the Global Fund (USAID).

• Provide technical assistance to enable the Ministry of Health to become the Principal Recipient for the

Global Fund Round 7 malaria grant (USAID)