Abt Associates has been providing TA to MOH to assess human-resource needs and available capacity in the public and private sectors. The shortage of human resources for health has become critical in Cote d'Ivoire given the prolonged politico-military and economic crisis. Building on FY06 activities and the strong relationship developed between Abt and the MOH, the USG proposes in FY 07 that Abt provide substantial technical assistance, beyond the human resources component to the MOH to complement the new MOH award in support of decentralized, sustainable, quality HIV services.

A key objective is to strengthen the managerial and leadership capacity of health managers and administrators at central, district, and community levels to respond to the HIV/AIDS epidemic. These activities will support USG partners and the government of CI in implementing the EP and contributing to the achievement of national goals. Abt will provide TA to continue national studies on human capacity and the development of a human resource strategy for the health sector. In addition, Abt in collaboration with the MOH with provide TA for coordination, planning, harmonization of M&E tools for health workers performance and resource mobilization activities specifically in 10 districts that are the capitals of their region. This will allow the MOH to evaluate and expand its work nationally to reach all 16 regions by the end of the project. Furthermore, Abt Associates will provide TA to the MOH to build institutional capacity at decentralized levels in key areas such as supervision, HR information systems, planning, policy implementation, coordination and use of data. The MOH and Abt will support training for (1) developing a coordination and planning matrix, (2) holding 3 consensus-building workshops on planning and coordination at central, regional and district levels, (3) building capacity (through a training-of-trainers approach) in planning and management of services in a decentralized system, and (4) developing and piloting tools for monitoring and evaluation tools of health workers performance in selected sites. The MOH will fund the conference logistics, trainers per diems, transport etc. To work in seamless coordination, Abt will fund a senior-level consultant to assist the Ministry of Health in planning and coordinating decentralized HIV activities with a focus on sustainability. Specific activities proposed are: 1. Building and Sustaining Management Competencies of Managers of HIV/AIDS Services in the Public Sector. Drawing on the collective experiences of EP community and service delivery partners, Abt will build and sustain management competencies of 200 managers from PNPEC, DIPE, PNLT and district health teams in HIV/AIDS and other health services. These activities will focus on planning, coordination, strategic thinking and rational use of resources, taking into account existing limitations, e.g. finances, rules and regulations, availability of skilled personnel, etc. Key activities will include (1) conducting a rapid appraisal of HIV/AIDS core competencies among 200 key workers at targeted facilities, (2) adapting the WHO primary health care manager's tool kit, (3) providing on-site training, (4) conducting 5 one-week intensive trainings in management and leadership for 200 persons and (5) facilitating ongoing mentoring and career-development relationships between 50 new and 25 old managers (ratio of 1:2). 2. Development of a Pilot Incentive Scheme for Health Workers in Hard-to-Fill Posts. In collaboration with Abt Associates, the MOH is conducting qualitative and quantitative studies to seek a better understanding of incentives (motivation) to attract health workers to serve in hardship areas. Abt proposes to use evidence from other programs and countries to develop and implement a one-year pilot program to provide incentives to 45 health professionals including doctors, nurses, lab technicians, and pharmacists to work in hardship areas. Key activities will include (1) developing criteria for selecting hardship areas, (2) assessing the type of health workers needed to fill the posts, (3) developing an incentive package for each of the cadres, and (4) developing payment and monitoring mechanisms. Health professionals will be chosen in collaboration with the national government and EP service-delivery partners such as EGPAF, ACONDA, ANADER and CARE. 3. Estimating the Costs of Providing HIV/AIDS Medical Services and Conducting a Sustainability Analysis on Current Interventions. In order to inform the scale-up in the public sector, Abt proposes to conduct a costing exercise to estimate the costs of providing HIV/AIDS medical services. The Abt team is experienced in resource estimation, financial analysis, and the development of innovative tools to support policy-making and program planning for HIV/AIDS interventions worldwide. Abt will apply costing frameworks developed under PHR plus with strategic counsel and consultancy with the MOH to provide quality technical guidance on scale-up and sustainability of HIV/AIDS services. 4. Conducting a Feasibility Study for the Development of a Health Insurance Scheme for

HIV/AIDS. The government of CI, as well as EP and development partners, continues to stress the need to mobilize resources for HIV/AIDS and other health services if the epidemic is to be successfully mitigated. As the country explores financing mechanisms to promote sustainable quality HIV services, both local and national health-insurance schemes have been identified as potential sources of financing. Abt Associates partner will assist the MOH and civil society, to evaluate the feasibility of local health insurance schemes complementing resource allocation by decentralized collectivities to mobilize resources and promote sustainable quality HIV services. 5. Addressing the critical shortage of trained instructors at INFAS.To provide adequate human capacity for the delivery of HIV services at a national level, the number of trained nurses, laboratory technicians and physicians must be expanded. To achieve this goal, the training institution (INFAS) and the medical faculty, need to reinforce their human and institutional capacities. This can be accomplished at INFAS by offering some intermediate courses in pedagogic studies, ensuring a core of qualified trained instructors in nursing studies, coupled with institutional recognition by the Ministry of Higher Education and improvement of the technical platform. In the short term (FY07), Abt proposes to temporarily hire up to 20 retired instructors to provide training support while longer-term strategies are implemented. Abt will complement JHPIEGO's work to integrate HIV curricula and facilitate in-service training for former instructors through innovative North-South collaborations. INFAS is currently exploring distance education with Sherbrook University in Canada. This will also permit the institutions based in the North to reopen and decentralize and decongest Abidjan facilities. The medical faculty at the University of Cocody is also well poised to expand North-South and South-South partnerships. 6. Support and TA for NPI. Aga Khan, a sub partner to Abt, will assist local FBOs/CBOs to learn about and apply for New Partner Initiative grants which are designed to seek out new EP partners with important skills and/or infrastructure but little experience with USG funding, is an opportunity for indigenous community- and faith-based organizations to build management and financial capacity and translate their local organizational capital into effective HIV prevention and care services. Abt HS 20/20 Project will set up a local office in Abidjan to support the implementation of activities. Funding will be used to strengthen the systematic instructional design process to help integrate HIV/AIDS pre-service training for student nurses in three new national nursing schools in the North.