The Botswana Civil Society Strengthening Program, titled Maatla, which means strength in Setswana, was designed to significantly and sustainably strengthen the capacity of civil society organizations (CSO) in Botswana to deliver HIV/AIDS and related health services. Implemented by FHI360, the project is strengthening the quality and reach of CSO HIV/AIDS services at a national level by strengthening management systems of four key NGO networks (Botswana Network of AIDS Service Organizations (BONASO), Botswana Network of People Living with HIV/AIDS (BONEPWA+), Botswana Council of Non-Governmental Organizations (BOCONGO) and Botswana Christian AIDS Intervention Program (BOCAIP)) and their members and affiliates. Beginning in year three, USAID will provide direct grants to two of these organizations (BONEPWA+ and BOCAIP) to continue service delivery, while Maatla continues to build their overall management capacity. In four focus districts (Ngamiland, Okavango, Ghanzi and Chobe) the Maatla program will support district-level CSO coalitions and district-level government structures to develop and implement HIV/AIDS activities that are based on evidence and effectively engage with and mobilize communities across the district to improve service delivery for target populations.

The Maatla project will contribute towards the Global Health Initiative goals by engaging with and building the capacity of local actors to ensure country-owned programming which is sustainable beyond the life of the project. FHI360 will work intensively with BONASO and BOCONGO to transition ownership of capacity building efforts to them.

FHI 360 will collaborate with the USAID-funded OVC and Gender project being implemented by Project Concern International (PCI) and its partners to strengthen the capacity of CSOs in Botswana to deliver services targeting OVC. CSOs serving OVC are constantly challenged by the multi-dimensional needs of this population and by the complex set of interventions and services needed to improve their quality of life. The Maatla program will collaborate with PCI to enhance the capacity of CSOs to identify, reach and support particular groups of marginalized, highly vulnerable children, and to ensure implementation of national guidelines for OVC care. Maatla will contribute towards achieving the PEPFAR OVC goals by building capacity within local communities to respond to the needs of OVC.

Working in its four focus districts (Ngamiland, Okavango, Ghanzi and Chobe), FHI 360 will use the outcomes of its capacity assessments to determine the level of technical competence amongst CSOs in providing comprehensive quality care to vulnerable children and their families. FHI 360 will work with PCI to develop comprehensive capacity building plans tailored to the specific needs of CSOs implementing OVC programs which are in-line with national standards and protocols. Working at the national level with the NGO networks, and at the district level through CSO coalitions and local government structures, FHI 360 will support the dissemination and implementation of key national documents, such as the Guidelines on the Care of OVC and the Manual on Providing Psychosocial Support to OVC. Use of the newly developed PEPFAR Transition Toolkit for HIV positive Adolescents will also aid in systematizing services for this population.

The Maatla program will also collaborate with PCI to strengthen the capacity of CSOs in the targeted districts to provide quality early childhood care and education services, as established in the Early Childhood Care and Education Policy of 2001. Specific activities will include: cascading dissemination of protocols designed to guide the provision of early childhood services; strengthening the capacity of CSOs to mobilize their communities and increase awareness and demand among families; and, supporting CSOs to leverage resources to help sustain early childhood services.

The program will also work with key government and CSO stakeholders to establish the new structures stipulated in the Childrens Act: the Village Child Protection Committees (VCPC), the Childrens Consultative Forum, the Childrens Council, and the Childrens Courts. The establishment of the VCPCs will be prioritized, since they are an essential structure for improving the identification and support of OVC within their communities and for monitoring their well-being. The program will strengthen the ability of CSOs to support the VCPCs and ensure they fulfill their roles and responsibilities in accordance with the Act.

FHI 360 will strengthen the capacity of CSOs in Botswana to deliver tuberculosis (TB) and HIV-related services at community level. Community-based TB services delivered through CSOs have the potential to contribute towards the goals of the MOH National TB Control Program (NTCP) Strategic Plan by improving TB diagnosis, improving treatment outcomes, and increasing access to and demand for HIV-related treatment, care and support.

FHI 360 will work in its four focus districts (Ngamiland, Okavango, Chobe and Ghanzi) with district health services and CSOs to increase community involvement in TB case finding, treatment and prevention. FHI 360 will improve community-based direct observation of treatment (DOT) by working with local NTCP staff and leaders of CSOs to form DOT teams or strengthen them where they exist. Training will utilize tools developed by the World Health Organization (WHO) and the Botswana MOH. FHI 360 will also establish and strengthen referral networks to help community-based DOT volunteers ensure suspected TB cases reach a TB diagnostic center.

FHI 360 will support the TB Advocacy, Communication and Social Mobilization Strategy (ACSM) by enhancing the capacity of NTCP staff, local health centers and CBOs at the district level in using cross-cutting strategic behavioral communication (SBC). SBC will be used to raise awareness about the major challenges which are unique to the targeted, remote districts where the Maatla program is being implemented, and to increase TB awareness, reduce stigma, facilitate risk assessment for case detection and referral, increase treatment literacy and adherence, and foster family and community support.

In order to address the specific needs of high-risk groups, FHI 360 will build the skills of local partners to capitalize on existing entry points where TB education, detection, sputum collection and referrals can be integrated. Specific activities will include: training staff and supervisors working with OVC in targeted regions to recognize children and youth with symptoms of pulmonary or extra-pulmonary TB; clarifying or establishing local referral networks for TB diagnosis and treatment, and communicating with local HIV/ART clinics and OVC organizations; providing training or refresher training for CSO staff implementing behavior change interventions reaching out to vulnerable women, mobile men, and at-risk youth; an, supporting TB/HIV coordination teams at district level to identify TB/HIV co-infection services and possible gaps in supported health facilities.

Civil society organizations (CSO) in Botswana have the potential to play an important role in the national HIV response. However, the countrys civil society is small and faces multiple challenges including lack of long-term funding, lack of systems and structures, and low technical capacity. Maatla will build upon previous capacity building efforts to ensure that the CSOs in Botswana are better able to deliver HIV/AIDS and related health services, and to ensure that capacity building continues beyond the life of the project. Project activities are aligned to the national Civil Society Capacity Building Framework that was finalized in 2011.

The Maatla team will focus national-level capacity building on four NGO networks that have mandates as leaders of the civil society response to HIV/AIDS--BONASO, BONEPWA+, BOCAIP and BOCONGO. Support will include not only training, but also long-term mentoring, coaching, twinning and secondments. BOCCIM is providing on-going support for partnerships between CSOs and the private sector for targeted mentoring in specific skill areas. WUSC has placed one volunteer Organizational Development (OD) Adviser in each organization to facilitate and coordinate OD efforts. The Maatla program will support BONASO and BOCONGO to sustain capacity building of CSOs over the long term by engaging them in the strategic management of the Maatla project, supporting them to access funding for their members and affiliates, and by gradually transitioning the capacity building implementation role from FHI 360 to the networks themselves.

The Maatla program will build upon and adapt the CSO coalition model used by NCONGO to strengthen the district HIV/AIDS and health responses. NCONGOs model includes formal capacity building for CSOs in Ngamiland and Okavango Districts, as well as joint planning and program implementation. NCONGO will implement capacity building activities at its Learning and Innovation Site in Maun (LISN) using different modalities, including training, coaching through one-on-one, or small group site visits, as well as community-based training, roundtables and CSO forums. NCONGO will collaborate with BOCCIM to support twinning and mentoring with local businesses through the BOCCIM business councils at district level, and with BOCONGO non-health sector NGOs. Capacity building of local government will be implemented by FHI 360s core partner NASTAD, and will entail in-service training for district staff, to be followed-up with one-on-one situational coaching and mentorship. NASTAD will promote and strengthen linkages between the CSO coalitions, DHMTs, DACs, and DMSACs through its interactions.

HIV counseling and testing (HCT) plays an instrumental role in the Botswana NSF II 2010-2016. Two priority areas are Preventing New Infections and Scaling-Up Treatment, Care and Support. Both require accessible, high quality HCT, which cannot be delivered by the Government of Botswana (GOB) alone. The Maatla program will enhance the capacity of CSOs to: create awareness of and demand for and referral to HCT; strengthen the human resources needed to provide HCT; and, enhance the quality of HCT service delivery.

FHI 360 and its partners will collaborate with Tebelopele in four focus districts (Ngamiland, Okavango, Ghanzi and Chobe) to ensure that HCT is promoted by CSOs and is delivered to required national standards. The Maatla team will ensure district-based CSOs are competent in planning, implementing, monitoring and evaluating community mobilization activities and, as needed, serving as satellite sites for Tebelopele. The selected CSOs will be given training and on-going technical support to achieve these required standards, as well as measurable operational and programmatic targets that will contribute to reaching district-defined HCT goals.

Through the establishment of and support to district-based CSO coalitions, as well as linkages with the BONEPWA+ centers of excellence, Maatla will support the design of community education and mobilization strategies to increase HCT for specific populations. This will include infants, through greater access to early infant diagnosis (EID), adolescents, and orphans and vulnerable children (OVC).

FHI 360 and its partner NASTAD will work with the DMSACs and DACs in planning service delivery to ensure that CSO promotion and referral for HCT reaches the least covered geographic areas and most at-risk populations (MARP), including women and girls, their partners and other men. These groups are under-represented according to HCT statistics in the focus districts. FHI 360 will offer district-level referral network training to support referral networks including regular meetings, service directories, referral forms, and focal persons.

Civil society organizations (CSO) play a fundamental role in HIV/AIDS prevention programming in Botswana. However, the National Strategic Framework II-- 2010-2016 (NSF II) identified a number of gaps including insufficient targeting of services, poor community engagement, limitations in the generation and use of data, and insufficient implementation capacity in communities.

Using its prevention readiness assessment with the four national NGO Networks, the Maatla Project is developing and implementing a targeted plan of action with each. The prevention readiness assessment determines the NGOs: understanding of the drivers of HIV transmission for specific target groups; appreciation of specific entry points for combination prevention activities that are targeting specific audiences, including most-at-risk populations (MARP); and knowledge and use of evidence-based behavioral, biomedical, and structural prevention strategies, policies and priorities. The Maatla program is focusing on the national NGOs to increase use of evidence-based interventions amongst their members and affiliates, while drawing upon existing materials and resources such as the materials used in the FHI 360 Basha Lesedi project, the Johns Hopkins University Go Girls! initiative, and the RTI HIV Prevention Project for MARP.

The NSF II specifically highlights that previous prevention strategies in Botswana have overlooked the prevention aspects of care and support for people living with HIV (PLWHA). The Maatla program is working with BONEPWA+, CDC and the Ministry of Health (MOH) to develop a strategic plan to roll out the Positive Health, Dignity and Prevention (PHDP) programa comprehensive package services that includes: risk reduction, identification of discordant couples and partner disclosure, partner testing, adherence counseling, reproductive health services including STI screening, TB screening, referral for cervical cancer screening for HIV positive women as well as legal and religious referrals. With continuing management support from Maatla, USAID plans to provide direct funding to BONEPWA+ in early in FY 2013, to expand the PHDP program to several BONEPWA+ support groups in hard-to-reach areas.

At the district level, Maatla will work with the CSO coalitions and local government structures to ensure that all entry points for multi-sectoral prevention programming are clearly identified, and services and referrals, especially for MARP, are well defined and operational. FHI 360 will provide focused technical assistance, training, and coaching to individual CSOs based on the outcomes of the technical capacity assessments. Maatla project core partner NASTAD will build the capacity of the District Multi-Sectoral AIDS Committees (DMSAC) and District AIDS Coordinators (DAC) to lead the planning and coordination of the multi-sectoral district prevention responses through one-to-one coaching and mentoring.