This activity continues a twinning partnership between the African Palliative Care Association (APCA) in

Uganda and Hope Worldwide Cote d'Ivoire (HWCI) designed to strengthen quality HIV-related palliative

care services in Cote d'Ivoire.

Palliative care is a relatively new and less developed form of health care in Cote d'Ivoire. In order to begin

partnership activities, the American International Health Alliance (AIHA) Twinning Center facilitated an

assessment exchange by APCA partners in April 2007 to visit and assess HWCI, meet with local

stakeholders, and discuss focus areas for the partnership.

HWCI was established in 1991 in order to bridge the gap in service provision, especially in rural areas, to

reduce the impact of HIV/AIDS in Cote d'Ivoire. With a current staff of 15 full-time employees and a number

of volunteers, HWCI has established partnerships with USAID, CDC, Tulane University, Coca-Cola Africa

Foundation, the United Nations Development Program (UNDP), and the Global Fund and has been

instrumental in the formation of the National Palliative Care Steering Committee in Cote d'Ivoire.

Through partnerships with organizations including the National HIV/AIDS Care and Treatment Program

(PNPEC), the UNDP, the Ministry of Health, and the university hospital system, HWCI opened the Centre

D'Assistance Socio-Medicale (CASM), a clinic providing outpatient medical assistance to thousands of AIDS

patients in Abidjan and the Grand Bassam regions. Begun in the South, the program is extending

geographically and in program breadth, with PEPFAR funding. Services provided to clients/patients include

community education on HIV/AIDS, CT, OVC services, and the provision of ART.

After the initial assessment, AIHA facilitated the development of a partnership work plan and budget that

identify specific activities the partners will undertake together in FY07 and FY08:

1. Strengthen HWCI's technical capacity in palliative care. In FY07, APCA is developing a technical

assistance plan to be implemented over the course of the partnership to improve HWW's capacity, including

training the 15 full-time staff who are involved in palliative care service delivery and relevant community

volunteers in technical service-delivery skills.

In FY08, APCA will review the competencies and skills of HWCI and provide assistance in the development

of job descriptions and other systems and the development and implementation of a holistic palliative care

package, including training in fund raising to finance such a package. The partners will work closely with the

Ministry of Health and other stakeholders to ensure that the palliative care package and all technical

trainings comply with Cote d'Ivoire's national palliative care guidelines.

2. Facilitate a country-specific advocacy program for palliative care. In FY07, the partners are working to

identify stakeholders to establish a National Advocacy Task Force (NATF) with the aim of advocating for the

availability of appropriate palliative care drugs. The task force will review the advocacy work plans

developed by six West African countries at APCA's palliative care conference in Ghana in April 2007 and

identify key areas to address in a similar national plan in Cote d'Ivoire. The task force will comprise palliative

care stakeholders from the MOH, the National HIV/AIDS Care and Treatment Program (PNPEC), and other

relevant organizations.

In FY08, the partners will continue to work closely with the NATF in developing an advocacy implementation

plan for Cote d'Ivoire, conducting a national workshop to build consensus on the availability of drugs, and

conducting advocacy activities with relevant stakeholders with the intent to develop a National Commission

for Palliative Care in Cote d'Ivoire. The commission will ensure the sustainability of partnership activities, as

it will continue to advocate for palliative care services after the completion of the partnership.

3. Support the scaling up of palliative care through training. In FY07, the partners are working to identify

target groups of providers of palliative care services, including both medical and non-medical services

based at the facility, community, and home levels. Based on an assessment of their capacities and needs,

and in coordination with the PNPEC in support of Cote d'Ivoire's National Palliative Care Guidelines, the

partners are developing training modules focusing on direct skills related to the delivery of quality palliative

care services, including modules on living positively with HIV and income-generation activities for people

living with HIV.

In FY08, after the training has been conducted, the partners will review and revise the training and training

materials with the intent to roll out the trainings nationally. The partners will also compile a document of best

practices and lessons learned in the field in the delivery of quality palliative care services, to be

disseminated to all palliative care stakeholders. This activity will ensure the development of a national

strategy on palliative care trainings approved by all stakeholders and in compliance with national guidelines.

4. Strengthen the quality of palliative care services through the development and implementation of

palliative care standards. In collaboration with the PNPEC, MOH, and other stakeholders, the partners are

conducting a review of existing palliative care standards, frameworks, and national M&E tools and

indicators, and they will provide recommendations for strengthening palliative care standards within the

national guidelines in FY07. The partners and stakeholders are working together to revise the guidelines in

a participatory approach using evidence-based best practices and lessons learned from APCA's experience

revising national palliative care guidelines in other African countries.

In FY08, the partners will work with the National Advocacy Task Force to implement the revised National

Palliative Care Guidelines. The partners will conduct trainings with all stakeholders on the application of

palliative care standards and the new guidelines to ensure their proper implementation. The partners will

also conduct a quality-of-care assessment of palliative care services based on APCA's palliative care

outcome scale. This assessment will help the partners evaluate the implementation of the new guidelines.

Recommendations will be made to the NATF based on the assessment.

5. Strengthen networks and linkages to improve the provision of palliative care through the development of

a holistic palliative care package to be implemented throughout Cote d'Ivoire. In FY08, the partners will

focus activities on establishing linkages with other programs, including facility- and community-based home-

based care centers, OVC programs, counseling and testing centers, PMTCT programs, ARV treatment

services, nutritional support programs, TB screening and treatment services, and associations of people

Activity Narrative: living with HIV/AIDS, including the national network RIP+. Partners will conduct a mapping exercise of

community-based organizations working within these domains and the types of services they provide.

Based on the mapping, the partners will review and strengthen the referral systems among organizations

(both up- and down-referral systems), including the development of M&E tools for monitoring referrals. All

stakeholders will be invited to a national workshop to work together in establishing a national referral system

for community-based projects that ensures that PLWHA have access to the entire continuum of care

available.

In collaboration with the NATF, the partners will also work to establish a task group that will support national

advocacy campaigns in communities throughout the country. In addition, the partners will work with all

stakeholders to develop and implement a holistic palliative care package that includes nutritional support

programs, prevention programs, testing services, and ART monitoring for PLWHA. The partners will work

closely with the MOH and other stakeholders to ensure that the palliative care package is in compliance

with the National Palliative Care Guidelines and will serve as a model for palliative care service delivery

throughout the country. The partners will conduct training and mentoring visits to facilitate the

implementation of the holistic care package throughout Cote d'Ivoire in coordination with the referral

networks.

6. Increase the use of evidence-based practices by establishing a Learning Resource Center for palliative

care. In consultation with HWCI and the PNPEC, a Learning Resource Center will be established in FY08

that will provide Internet connectivity and computer training to palliative care stakeholders and increase the

use of evidence-based best practices in palliative care. AIHA has already established a LRC with APCA in

Uganda, so this will increase communication between partners and contribute to sustainability. The LRC will

also serve as a clearinghouse for palliative care resources, information lists, tools, etc. that can be easily

accessed and disseminated to other care associations.

This activity continues a twinning partnership between three organizations providing counseling and testing

(CT) services in Cote d'Ivoire and the Liverpool VCT (LVCT) in Nairobi, Kenya to support quality-assured

scale-up of comprehensive CT services through technical assistance to local partners and other CT

stakeholders for training, supervision, evaluation, policy and standards development, accreditation, and

quality assurance. Twinning activities began in April 2007 with the first exchange visit from LVCT to Cote

d'Ivoire to meet with local stakeholders and potential partners. Based on recommendations from the USG

team in Cote d'Ivoire and in collaboration with AIHA, LVCT visited three CT sites (Port-Bouet, Lumiere

Action, and AIBEF). The aim was to introduce the partners and to conduct an organizational assessment of

the host institutions. After the assessment, it was decided that representatives from all three host

organizations would form a technical working group to serve as the local partner. This multi-disciplinary

team will participate in all partnership activities with LVCT and coordinate the dissemination and replication

of results throughout their respective organizations and to other key stakeholders.

On the second exchange trip in October 2007, Ivorian partners will visit Kenya to tour facilities, learn about

LVCT's services and resources, and develop a joint partnership work plan and budget identifying specific

activities the partners will undertake together. Thereafter, AIHA will issue a sub-grant award to LVCT to

manage this partnership. These funds will be used to support all partnership activities. Overall, partnership

funds will be used to support exchange visits and pay for materials and supplies for the activities the

partners elect to undertake (e.g. training, joint materials development, etc.). A small portion of the funds will

be used to cover administrative costs incurred by partners to manage the partnership, including fiscal and

M&E reporting as required by AIHA and PEPFAR.

Although specific partnership activities will be finalized during work-plan development by all partners, AIHA,

and USG/Cote d'Ivoire stakeholders, initial focus areas for this partnership are the following:

1. To strengthen the technical capacity of the three CT centers in delivering quality CT services. In FY07,

LVCT is working to build the overall capacity of the three selected CT centers to be model centers in the

delivery of quality CT services and provide training to other CT organizations in the country. LVCT will

conduct an overall assessment of the three CT centers and develop a technical assistance plan to be

implemented over the course of the partnership focusing on quality assurance and systems strengthening.

In FY08, LVCT will continue with the implementation of the technical assistance plan. Assistance will be

provided through technical training, partnership exchanges, and on-site mentoring visits focusing on topics

such as the implementation of quality-assurance measures, the development of M&E systems for all levels

of service delivery, and the integration of supportive counseling and supervision into current services.

2. To participate in revising the National Guidelines on Counseling and Testing to include the simplified

algorithm for rapid testing expected to be adopted within the year. In FY07, partners are collaborating with

national and local CT stakeholders, including the Ministry of Health and representatives from CT centers, to

organize a national workshop on CT services in Cote d'Ivoire. During the workshop, participants will develop

standard operating policies and procedures for the national implementation of a new algorithm strategy for

rapid testing within all CT centers and other institutions providing CT or CT-related services. The workshop

will focus on establishing linkages and a referral network among service providers for the delivery of quality

CT services.

In FY08, the partners will work, in collaboration with stakeholders from the national workshop, to implement

the new algorithm approach on the national level, including training staff on new strategies and related M&E

materials. The three local CT centers will serve as coordinating mechanisms as the program is implemented

through the district-approach model, involving local stakeholders in supervisory roles. Emphasis will be

placed on coordination of activities and the establishment of linkages and networks among CT centers and

other CT service providers.

3. To integrate quality CT services into the continuum of HIV care and support. In FY07, partners are

developing training modules to be used to train and coach providers on the delivery of quality CT services,

in coordination with the new standard operating procedures for CT being developed by partners through the

stakeholders' workshop. The partners will conduct an assessment of the quality of existing CT services and

identify areas in need of technical assistance. Based on the gaps identified in the assessment, the trainings

will focus on improving the quality of CT services, including the integration of couples counseling and

prevention strategies for people living with HIV/AIDS, and ways to integrate CT services into existing project

interventions.

In FY08, partners will work to expand and roll out this training model in targeted districts. The trainings will

increase knowledge and skills of providers to deliver quality CT services, as well as focusing on establishing

linkages and networks among service providers in various types of institutions, including regional and

district hospitals, ANC clinics and PMTCT programs, TB clinics and TB/HIV programs, OVC-support

organizations, palliative care providers (including facility-, community-, ad home-based care projects), and

other related organizations. Participants will learn how to incorporate CT services into their existing

structures and work together to provide a continuum of care through referrals and multi-organization patient-

monitoring strategies.