Abt Associates has been providing technical assistance to the Ministry of Health (MOH) to strengthen the

national health system's capacity to deliver HIV/AIDS services. Building on previous activities and strong

relationships developed with the MOH and the USG/CI, Abt proposes to provide substantial technical

assistance to build the institutional capacities of the MOH, Ministry of the Fight Against AIDS (MLS), MOH's

Department of Human Resources (DRH), National Training Institute for Health Agents (INFAS), Department

of Training and Research (DFR), and National HIV/AIDS Care and Treatment Program (PENPEC). The

main purpose of FY08 activities is to continue strengthening the managerial and leadership capacities of

program managers, administrators, and policy-makers at central, district, and community levels to respond

to the HIV/AIDS epidemic. These activities will support USG partners and the Ivorian government in

achieving PEPFAR and national objectives.

The following eight activities are targeted for central and decentralized levels:

Strengthening the DRH's Institutional Capacity to Manage Human Resources for Health (HRH). The DHR

faces many challenges, including inadequate capacity to provide sustained supervision and management of

HR, a weak HRH information system, and limited infrastructure. Abt will address these challenges by:

1. Conducting a rapid participatory institutional review of the DRH to look at issues such as personnel,

infrastructure, and roles and responsibilities as they relate to and support HRH. The review will ensure the

DRH's ownership of results by including its viewpoint, vision, and input on strategies for improving its

performance.

2. Identifying and interviewing key stakeholders, such as donors and coordinating bodies (e.g. the Global

Fund Country Coordinating Mechanism) to better understand how they articulate their plans, problems, and

strategies vis-à-vis the DRH.

3. Preparing a summary report outlining challenges and opportunities and making recommendations for

future steps.

4. Creating an action plan to align and strengthen HRH at all levels of HIV/AIDS care. The plan will facilitate

resource mobilization to operationalize the HR Strategic Plan.

Building the DRH's Sustainable Policy Capacity. DHR staff will need to learn new skills to implement

existing policies and mobilize resources to hire, train, and retain human resources at all levels of care. Abt

will strengthen policy skills and expertise by integrating the concept of policy champions. Efforts to build in-

country capacity will focus on identifying and strengthening policy skills among 30 policy champions, 20

regional-level managers, and 10 central-level policy specialists. Policy champions will be trained in three

key policy areas: policy review, policy development, and policy evaluation. At the end of this intervention,

trained champions will be able to develop and implement strategies to advocate and to mobilize resources

at national, regional, and sub-regional levels.

Developing a Computerized Human Resource Information System. Abt will support DRH efforts to develop

an information system capable of providing up-to-date HR data. The Human Resource Information System

(HRIS) will monitor HR needs to support the sustained delivery of quality HIV/AIDS services. The project will

interface with JHPIEGO's Training Information Management System (TIMS). The HRIS will monitor

employment, skill levels, distribution, and staffing needs in the health sector. Abt will support the DRH to

develop, test, and install HRIS electronic and paper-based systems in 30 facilities with high HIV/AIDS

patient volume in five regions. The components installed at health centers will operate and generate

required reports using only paper-based tools. Those installed at provincial and district hospitals will be

computer-supported to ease the burden of reporting.

Building MOH Capacity to Coordinate and Plan HIV/AIDS Services at Regional and District Levels. Abt will

work with the MOH to develop and implement a minimum package of health management systems and

competencies for HIV/AIDS service delivery in the public sector. Using findings from the recent HIV/AIDS

service provision assessment (SPA), the team will assist regional and 19 district teams in developing

HIV/AIDS scale-up plans to address specific local needs. Key activities will include (1) mapping district-level

HIV/AIDS service provision data, (2) providing on-site training to review and revise training management

competencies, (3) assisting management teams to use strategic information and SPA data to develop

decentralized district-level targets and strategies, (4) facilitating presentation of each district's management

strategy to the MOH, and (5) distributing district management plans to health facilities in each district.

Building Long-Term Institutional Capacity of District Health Institutions to Deliver HIV/AIDS and Other

Priority Services. As the health sector moves forward with administrative and financial decentralization,

regional and peripheral institutions urgently need capacity building to assume their new roles. Abt, in

consultation with the National Public Health Institute (INSP) and Department of Training and Research

(DFR), will build management capacity of district health institutions to deliver HIV/AIDS and other priority

health services. The project will collaborate with the PNPEC to align this activity with the development of

micro-plans for the districts. Key activities will include (1) developing the minimum package of capacity-

building activities for district managers, coordinators, and local government officials, (2) developing criteria

for identifying pilot districts, (3) identifying key staff to participate in off- and on-site intensive training, and

(4) provide long-term mentoring to pilot districts. Abt will sign a sub-agreement with the INSP and DFR to

undertake this activity. Activities will include quality control and M&E to ensure optimum integration of all

HIV/AIDS interventions by the INSP and DRF.

Strengthening a New Generation of Faculty at INFAS Nursing Schools. This activity will build on the recent

HR assessment and HR policy strategy to strengthen the production of quality nurses and laboratory

technicians. INFAS has requested assistance from Abt to strengthen a new generation of faculty at its three

training institutions in Abidjan, Bouake, and Korhogo. Abt will collaborate with the Ministry of Education

(MEN), DFR, JHPIEGO, and other key partners to train 10 master trainers/site preceptors and upgrade the

skills of 60 nursing faculty to a higher level of training. Abt will focus on strengthening instructional design,

while JHPIEGO will focus on effective teaching and course evaluations. To implement this activity, Abt will

identify and train a core team of trainers in new instructional-design techniques focusing on emerging issues

in capacity building. Master trainers will conduct four intensive in-service training sessions with about 15

participants for two weeks. This will also ensure the institutionalization and long-term sustainability of faculty

training at INFAS. Abt will offer targeted mentoring support to 60 new instructors on-site and at the three

INFAS sites. Training will include updating the teaching environment and incorporating new technology

within each institution.

Activity Narrative: Matching Pre-Service Training With Real-World Skill Needs of INFAS and UFR Graduates. The INFAS and

UFR have solicited further assistance from Abt to conduct a rapid appraisal of nurse and physician core

skills needed in the changing environment. In the past three years, JHPIEGO has assisted the INFAS to

integrate HIV/AIDS in existing curricula. In FY08, Abt will collaborate with the DFR and JHPIEGO to conduct

a rapid appraisal of nursing skills. Abt will apply state-of-the-art tools to interview current and would-be

employers to understand core skills required for nurses and lab technicians to work effectively in the health

sector. Key activities will include 1) review of the core curriculum in collaboration, (2) building consensus

with key stakeholders on the assessment approach, (3) conducting targeted interviews with current and

would-be employers on core skills, (4) analyzing and disseminating the findings to all key stakeholders.

Findings from this assessment will assist JHPIEGO and other partners in updating pre-service clinical

training at the INFAS and UFR.

Strengthening the INFAS Reference Library. Training a new generation of nurses and lab technicians

requires INFAS to be up to date with emerging issues in HIV/AIDS patient management. Abt will facilitate

twinning of the INFAS with the George Mason School of Nursing to strengthen the INFAS reference library.

George Mason will assist the INFAS with print and electronic reference materials, while Abt will identify and

print publicly available reference documents from key institutions such as WHO, CDC, UNAIDS, USAID,

FHI, etc. The project will provide four desktop computers and printers to facilitate student access to

electronic documents.

Conducting a Comprehensive National Health Systems Assessment. The MOH believes that a

comprehensive health system assessment is needed to give an overview of the health system's

functionality. In collaboration with MOH, Abt proposes to diagnose the system's performance by identifying

strengths and weakness and developing practical strategies and recommendations based on an

understanding of priorities and programming gaps in Cote d'Ivoire. The project will gather information on

key health system functions, including governance, health financing, health service delivery, human

resources, pharmaceutical management, and health information systems.

To help build a unified national M&E system, Abt will participate in quarterly SI meetings and will implement

decisions taken during these meetings.