The purpose of this cooperative agreement is to provide support and capacity building across a range of key issues in the fight against HIV/AIDS and address key areas of the Botswana PEPFAR Partnership Framework. Capacity building is achieved through training, mentoring and support undertaken in key HIV/AIDS programs, and healthcare management, end of program evaluations assessing, and supply of technical staff to MOH to achieve greater health system strengthening and integration.

Activities undertaken cover the entire country, from the remotest of health posts to hospitals in the capital city. The target population is primarily heath care workers in both the government and private sector health system. In 2012 in-service training to be provided includes technical workshops and will reach a target of 1319 trainees. Activities undertaken for capacity building impact health system strengthening, and the general population receiving services, e.g. mothers and babies benefiting from early infant diagnosis of HIV and improved infant feeding education and support, and the provision of TB/HIV training to private practitioners.

As a local partner, our long term goal is to ensure that a stronger health care system has been developed that can be maintained, updated and managed by the relevant ministries. Given the need for cost efficiency, every effort is made to ensure optimal impact and value for money.

In support of the work undertaken, two all terrain vehicles were purchased under this mechanism in January 2010 and these are in full time use by the field teams.

Private Practitioners TB Training - The Botswana National TB Strategic Plan seeks to involve all health care providers in TB control. The TB private practitioners training activity supports the Botswana National Tuberculosis Control Program's public private mix (PPM) by involving all relevant health care providers in delivering good quality TB services to all sectors of the population. The PPM aims to provide guidelines that will direct how collaboration of the private sector with the public health sector in patient management will be done. It is recognized that training is a key component in achieving the PPM goal to engage all health care providers in TB care and control in order to improve access and ensure compliance with national TB control guidelines. Support will be provided for the participation of private practitioners (medical officer, nurses, pharmacists, and laboratory personnel) to attend training sessions conducted by the MOH in collaboration with their training partners in TB.

The laboratory support activity builds capacity in laboratories throughout Botswana.

Activities will include in-service training to ten laboratory staff from laboratories throughout the country in the fields of bio-safety, tuberculosis, grant protocol writing, laboratory detection, identification and quantification as well the diagnosis of malaria.

The support of a seconded staff member in data management at the TB reference laboratory will be ongoing as well as in-service training to support the Laboratory Information Management System.

A workshop will be supported to provide technical updates and shared experiences in order to increase knowledge and skills of the laboratory network in Botswana.

The overall objective of the two activities in this program area is to support the national health system to become a more efficient and cost effective in delivering needed HIV and other health services. Health services in Botswana are plagued with operational challenges that often can be rectified by facility management and staff without external resources and support. Capacity building in management strives to ensure quality service delivery through improvements in planning, implementation and monitoring across the spectrum of health services in the Botswana health arena and supports Ministry of Health public sector reforms including policy reforms linking areas such as stigma and gender issues to HIV, and ties directly into MOH performance improvement policies.

Sustainable Management Development Program (SMDP):

The above challenges are being addressed through support to the SMDP program. The SMDP program delivers in-service training to public health managers to develop leadership skills and uses process improvement methodologies to improve service delivery. The training is composed of both classroom lecture modules and the implementation of a project in the workplace under the mentorship of the course tutors. Healthcare managers in all areas of the health system geographically and programmatically are targeted ensuring linkages across all services.

The Botswana National HIV/AIDS Strategic Frameworks (NSF) I and II address the ethical, legal and human rights aspects of the HIV epidemic through the Ethics, Law and Human Rights (ELHR) Sector. This sector has been understaffed and underfunded since the beginning of NSF I.

National Aids Coordinating Agency (NACA) Ethics, Law and Human Rights Coordinator:

The above challenge is being addressed by providing a policy advisor to NACA to implement the ELHR sector plans and run the ELHR secretariat of the National Aids Council. This assistance helps to move the Ethics, Law and Human Rights agenda forward in the national response and encompasses policy and legal reform.

National HIV Testing and Counseling (HTC) Workshop

The program objective is to build capacity through targeted training, technical updates and program evaluations in order to increase the knowledge and skills of HIV testing and counseling (HTC) providers and to support greater integration of HTC programs into other prevention programs.

In FY 2012, training will be provided to HTC counselors to share programmatic and procedural updates, improve patients to care and treatment, as well as conduct partner and discordant couples counseling and testing. Further, training will be conducted with HTC counselors and other providers placed at Safe Male Circumcision (SMC) sites to provide pre and post circumcision operative counseling, HIV counseling and testing, post operation follow up, and other SMC training needs. PEPFAR funds will also support the provision of mentoring and support to the SMC counselors through regular counselor supervision and support visits with a view to assuring the quality of counseling services provided and to prevent counselor burnout.

COP 2012 funds will also support the production and printing of information-education-communication (IEC) for the promotion of HTC services and training materials.

Technical updates, training, and shared experience workshops will be conducted throughout Botswana.

Routine HIV Testing (RHT) Evaluation

Additional support will be towards the end of project evaluation of the Routine HIV Testing strengthening project in five University Research Company supported districts. This project which was initially funded in FY 2011. This will be a process evaluation which will assess the RHT Improvement Strategy/Model with the view of informing future efforts, the impact of the project in areas such as increased testing and integration in relation to care and support. It will also serve to guide Ministry of Health on the sustainability and absorption of this program as well as inform them on any challenges relating to policy issues.

Activities in this program area support capacity building and program activities in prevention of mother-to-child transmission of HIV (PMTCT) to healthcare workers of all cadres in all healthcare facilities throughout Botswana. System strengthening is supported in the integration of various services. Program areas covered are early infant diagnosis; follow up of mother child pairs, linkages to care and treatment, sexual reproductive health and family planning, infant and young child feeding practices. Global Health Initiative (GHI) health related wrap around areas encompass gender issues, women focused activities, child survival, and safe motherhood.

Early Infant Diagnosis Training (EID)

The training of clinicians across the country in Dried Blood Spot collection, and in-field mentorship and support to enhance implementation. This training is for use of DBS cards for blood collection and not laboratory analysis. Mentorship of health care workers on Infant and Young Child Feeding practices, Sexual Reproductive Health and the recently introduced triple prophylaxis (universal access to Highly Active Antiretroviral Treatment) for pregnant HIV infected women are being integrated into the EID project. This strategic approach is part of a holistic approach to the PMTCT program. Mentorship and support of PMTCT activities will facilitate a more integrated, coordinated, and comprehensive program that is in line with the strategic plans for PEPFAR and local stakeholders. In future, it is hoped that E- Registers will be introduced into the mentoring and support of the EID program.

Determinants of Malnutrition Study

A community based study to determine the socio-cultural, biological, and behavioral factors associated with infant malnutrition will be conducted in households in study districts as determined by MOH. This study will also have a qualitative component that includes interviews and focus group discussions targeted at mothers with children who have been identified as malnourished. This project supports integration of PMTCT program in areas of gender issues (womens rights and socio-economic status), child survival, and safe parenting.

Sexual Reproductive Health (SRH) integration to HIV/AIDS services

This program seeks to focus on the integration of SRH into HIV services across the healthcare system in Botswana. Activities will include the dissemination of IEC materials to healthcare workers across all the spectrum of health care facilities, mentoring and training of healthcare workers and assistance in setting up of systems to facilitate this integration. The objective is to increase uptake of SRH services among HIV infected women in multiple clinical settings over time as they receive antenatal care, labor and delivery, post partum and HTC and HIV care and treatment.