In line with the GHI principles of encouraging country ownership and systems strengthening and the Partnership Framework goal of strengthening capacity, the Strengthening Angolan Systems for Health (SASH) project will build capacity within Angolan institutions, rather than to directly provide services. The goal of SASH is to increase the availability and use of high quality services in family planning, malaria, and HIV/AIDS. To achieve this, SASH applies an integrated health systems approach in which higher quality health care services are achieved through more effective management especially in health information and human resources for health, and institutionalized, standards-based quality improvement at the sub-national level (provincial, municipal, health facility). SASH will also focus on expanding and improving access to VCT and the availability of PMTCT to ensure all Angolans are born HIV free. Consistent with the Angolan Governments Revitalization of Municipal Health Services Strategy, SASHs efforts focus on institutional capacity building at the sub-national levels in the provinces of Luanda and Huambo. The project will use a minimum set of standards to be met in order to graduate a province and a methodology to measure that progress. Because central level health information system (HIS), leadership and governance are essential to effective and high quality service delivery at the local level, the program provides specialized technical assistance to support MOH implementation of the National HIS Strategic Plan. Monitoring and evaluation will also support consolidation of national systems to create one system for all areas.

In its National Health System Revitalization Plan, the GRA has demonstrated its commitment to decentralization and integration of service delivery and greater involvement of both civil society and the private sector. However, capacity to implement the plan at the municipal level is lacking. To build sustainable capacity within Provincial Health Departments (DPS), Municipal Health Departments (RMS) to develop, implement, and monitor provincial and municipal health plans, the project will introduce an approach that draws on organizational development and leadership and management best practices, with an aim to decrease project assistance over time as DPS and RMS units demonstrate improved competencies and capacities to achieve the following results:.

Strengthening the routine health information system (RHIS) and building capacity in quality collection, analysis, dissemination, and use of health information at the DPS, RMS, and health facility levels for program planning and management; andSupporting DPS, RMS, and service delivery units to design and adopt a routine quality improvement approach in support of standards-based practices at health facilities which may include limited support to specialized clinical training.

Under HSS, SASH will work in:Strengthening linkages between DPS, RMS and the MOF to ensure that all municipal healthSupporting DPS and RMS to ensure effective financial management of annual health plansThe Monitoring and Evaluation of Health Plans. SASH will work one-on-one with each municipality to conduct monthly reviews of plan implementation and take corrective action when required.

Under HR, SASH will work in:

Build Sustainable Capacity in Human Resources for Health.Conduct an HR Senior Leadership Development Program (LDP) to identify and address bottlenecks in the effective recruitment, hiring, deployment, promotion and transfer of staffStrengthen the capacity of DPS and RMS to support the health workforce through supervision

Under the Routine quality improvement approach, SASH will work with the MOH in the following:Approval of Quality standards in FP/Malaria/PMTCT and VCTService delivery readiness assessment results and dissemination,Trends in key performance indicatorsClient satisfaction

HTC is the gateway to HIV prevention, care, and treatment services, and some of the most effective prevention interventions rely on knowledge of HIV serostatus. While access to HTC services in Angola has improved, much work remains to be done. USAID will support expansion of provider-initiated testing and counseling in all municipalities in the two target provinces, Luanda and Huambo. As USAIDs other HIV activities will generate increased demand for HTC services from a variety of user groups, including youth, men, and MARPs, this program will help the provinces prepare for and respond to these needs. HTC services and client-provider interactions must be non-discriminatory and user-friendly for all client groups. Linking HTC with other clinical services (i.e. treatment of sexually transmitted infections, family planning, tuberculosis care, etc.) can increase access for youth, men, and MARPs. Strengthened referral/counter-referral, supervision, patient records, and quality improvement processes are needed to ensure effective HTC service delivery according to established standards.

Activities include: conducting a baseline survey and mapping exercise of current HTC services and referral networks available at each MOH health care facility in target municipalities; collaborating with USAIDs community-based HIV prevention programs to identify strategies to make clinic-based HTC more user-friendly, accessible, and responsive to the needs of key populations (youth, men, MARPs) who might not otherwise utilize these services; supporting development and implementation of a practical, costed HTC scale up plan for each targeted province to ensure adequate service coverage in every municipality; strengthening current quality improvement practices within each target province to achieve quantifiable increased access to and quality of HTC services.

With COP 12 funding, this projects plans to continue to support the GRA-led expansion of PMTCT services. The aim is to achieve 100% coverage of ANC in both Luanda and Huambo provinces. Increased emphasis will be placed on quality monitoring and follow-up of HIV-positive pregnant women and exposed newborns, increased supervision and in-service training. SASH will work closely with the Global Fund Round 10 grant for scale-up and country ownership of PMTCT services, contributing to the opportunity for national level impact.

PEPFAR PMTCT programs continue to help countries adapt WHO guidelines with a focus on scale-up, taking into account costs and other country-specific implementation practicalities. Key elements of quality PMTCT programs include: developing scale-up plans; promoting provider-initiated testing and counseling; linking PMTCT with antenatal and family planning services; correct assessment, treatment, and follow up of HIV-positive women; effective use of quality improvement processes to optimize PMTCT services; proper administration of anti-retrovirals at delivery; improved counseling to support effective infant feeding and nutrition practices; and prompt, accurate infant HIV diagnosis.

The SASH program will provide technical assistance to help expand access to a fuller range of quality PMTCT services in all municipalities in Luanda and Huambo provinces. Improved coordination, including effective referral/counter-referral processes linking maternity hospitals, health centers, and health posts is essential. Activities include: conducting a baseline survey and mapping exercise of the continuum of PMTCT services available at each MOH health care facility, including referral networks, in each of the target municipalities; collaborating with the National Institute for the Fight Against AIDS (INLS) to review and update the current PMTCT training program, including national PMTCT standards, training curricula and materials, job aids, and training delivery approaches to ensure compliance with international guidelines.

Some of the activities planned for FY 2012 will include:Participation in the INLS-organized 10-day Training of trainers (TOT) on PMTCT Task ShiftingSupport the INLS in the planning and conduction of a 15-day PMTCT TOT for municipal teams;Supporting development and implementation of a practical, costed PMTCT scale up plan for each targeted province to ensure adequate service coverage in every municipality; and strengthening current quality improvement practices within each target municipality to achieve quantifiable increased access to and quality of PMTCT services.