Low coverage and uptake of PMTCT services limit Ivorian women's access to lifesaving services. Recent

government data indicate that reasons for low coverage and uptake include:

• PMTCT services are concentrated in the southern part of the country and not widely available elsewhere.

• Acceptance of HIV testing is fairly low in sites that have not yet implemented routine provider-initiated

testing.

• Most health-care facilities still use laboratory-based HIV tests, and many women are unwilling to wait or

return for their results.

• PMTCT and CT services are not integrated into clinical-care services

JHPIEGO's involvement in PMTCT services in Cote d'Ivoire has focused primarily on building capacity in

pre-service education (integrating PMTCT, CT, and ARV modules into teaching institution curricula) and

providing technical assistance in PMTCT training. JHPIEGO also monitors the quality and performance of

PMTCT services provided by the 19 EGPAF pilot sites using the Standards Based Management and

Recognition (SBM-R) system. (A report on the first round of follow-up visits to all 19 sites is being finalized).

Achievements include:

• Development and validation of performance standards for PMTCT

• Training of 20 national trainers and 15 advanced trainers in PMTCT

• Training of SBM-R performance facilitators on PMTCT performance standards

In FY07, JHPIEGO is providing technical assistance for both pre-service and in-service education activities

and is working to improve the quality and performance of PMTCT services through the SBM-R approach as

services are scaled up (see the narrative on JHPIEGO's SBM-R work in the Strategic Information section).

The SBM-R approach can help identify performance gaps and barriers in the provision of PMTCT services

at the site level and can inform attempts to overcome them. JHPIEGO will continue to work closely with the

National HIV/AIDS Care and Treatment Program (PNPEC) and implementing partners to identify

appropriate interventions to correct existing performance gaps.

In FY08, JHPIEGO will provide technical assistance to the Ministry and Health and PNPEC to support scale

-up of PMTCT services, epecially on issues related to the new national PMTCT guidelines and protocols,

including:

• Revising and adapting the national training curriculum for PMTCT. JHPIEGO provided technical

assistance in the development of the first curriculum in 2004. The revised curriculum will include an

overview of services that can be integrated into other HIV services, clinical staging and CD4 count

evaluation, and indicators for cotrimoxazole prophylaxis.

• Revising and adapting the performance standards for PMTCT to comply with the government's new

national policies and guidelines.

• Revising the PMTCT training manual

To increase uptake of PMTCT services, JHPIEGO will build the capacity of service providers to provide

integrated services at hospitals and health-care centers. The integration of reproductive health and family

planning into PMTCT services will provide HIV-positive pregnant women with counseling about postpartum

family planning and access to family-planning methods. CT services can also be integrated into postpartum

and/or well-baby care, avoiding missed opportunities for testing women and children during key clinic visits.

This initiative will be conducted in the same sites in which the SBM-R approach is being pilot-tested. Using

integration curricula developed in other countries, JHPIEGO will train 100 service providers from the 19

SBM-R pilot sites to provide family-planning services to HIV-positive clients. The program will also support

several outlets to provide counseling and testing, especially for women attending mother-child health and

family-planning services, as well as family-planning services for CT clients.

To enhance referrals and linkages between services, providers will be trained and oriented on integrating

family planning and CT services. Linkages will be strengthened by frequent discussions with hospital health

management teams to ensure that opportunities are not missed and that waiting times for referred patients

are kept to a minimum. Referral slips will be introduced to capture the number of clients referred for family

planning, CT, and ARV services.

Special attention will be given to ensure that HIV-positive pregnant women who need ART are referred to

appropriate ART clinics or hospitals. JHPIEGO will work closely with the PNPEC, EGPAF, ACONDA, and

ICAP-CU to develop clear referral guidelines and protocols for all ART sites.

JHPIEGO will also work closely with the PNPEC, PEPFAR partners, and SCMS to strengthen service-

delivery systems. This is strongly linked to SBM-R activities and includes ensuring that family-planning

commodities and other supplies from the MOH and other stakeholders are available at service-provision

sites, especially at mother-child health and CT sites. Integrated service-provision registers will be used at

sites during the pilot phase of the program. All logistics and arrangements will be supported by other

PEPFAR partners; JHPIEGO will provide the materials and technical assistance.

JHPIEGO will report to the USG strategic information team quarterly program results and ad hoc requested

program data. To help build a unified national M&E system, JHPIEGO will participate in quarterly SI

meetings and will implement decisions taken during these meetings.

Despite efforts by PEPFAR, other donors, and their partners to prioritize and support counseling and testing

(CT) as an essential technical area in the fight against HIV/AIDS, only 7% of Ivorian women receive CT

during routine antenatal visits (AIS, 2005). Reasons for the low coverage or uptake of CT services include

the fact that most HIV testing services in Cote d'Ivoire are not integrated into clinical care sites and services;

CT is still offered mostly on an "opt-in" basis and can only be performed by professional clinicians. Although

the current national standard testing algorithm in Cote d'Ivoire includes rapid testing, most hospitals and

other health-care facilities predominantly use laboratory-based HIV tests.

To date, JHPIEGO's involvement in CT services in Cote d'Ivoire has focused mostly on providing technical

assistance in CT training and building the capacity of CARE International's local CBO/FBO sub-partners to

provide quality CT services. JHPIEGO provides follow-up and monitors the quality and performance of

PMTCT services under the 19 pilot Standards-Based Management and Recognitin (SBM-R) sites supported

by EGPAF, using performance standards that include a CT component. Key achievements to date include:

• Development and validation of performance standards for CT in the context of PMTCT

• Training of SBM-R performance facilitators on PMTCT performance standards, including a CT component

• Training 20 national trainers and 15 advanced trainers in CT

• Conducting two training of trainers for 20 trainers in CT under the CARA project supported by CARE

International

• Follow-up and supervision of 40 CT trainers and 15 advanced trainers to further develop and enhance

their skills

In FY07, JHPIEGO continues to support CARE International's CT efforts and the SBM-R program to

strengthen provision of quality PMTCT services through follow-up and supervision visits and collection of

data on performance standards achieved to document effectiveness in improving outcomes. These data will

help identify gaps in current provision of PMTCT services and will guide interventions to improve quality,

accessibility, and acceptability of these services.

In FY08, JHPIEGO will work closely with the National HIV Counseling and Testing Technical Committee,

the Ministry of Health, the Ministry of HIV/AIDS, and other relevant government bodies and stakeholders to

accomplish the updating, development, or adaptation of identified training materials, job aids, and

supervision tools, including for provider-initiated CT (PICT), couples CT, community-based, and classic CT,

in accordance with revised national HIV/AIDS service-delivery guidelines. In addition, JHPIEGO will conduct

training for appropriate service providers in these areas and develop trainers who will work with PEPFAR

partners to support the scaling up of CT service delivery in accordance with the expected new rapid-testing

algorithm. All training materials will include a module that defines district- and national-level referral

systems, detailing linkages of CT services to care and treatment. JHPIEGO will also develop performance

standards for various levels of CT to improve the quality of service provision. These activities will be

coordinated with key partners and national programs and will contribute to the national goal of reaching

100% of patients in all clinical settings and extending services to the community level, as supported by

PEPFAR implementing partners.

1. Learning Resource Package and Human Capacity Development

All materials development will be performed in the context of the already-planned instructional design

workshops for advanced trainers. As the last step in the process for advanced trainers to become master

trainers, instructional design workshops will simultaneously provide the opportunity to develop the required

standardized learning resource packages. JHPIEGO will also print and distribute the developed job aids.

Using these materials, JHPIEGO will coordinate with PEPFAR partners and national stakeholders to

conduct training in provider-initiated, couples, community-based, and classic CT for 500 service providers

and 50 trainers, according to their identified needs. All logistics and arrangements will be supported by the

coordinating PEPFAR partners; JHPIEGO will provide the materials and technical assistance.

2. Adapt existing CT performance standards for various levels of CT services to improve the quality of

service provision

In coordination with PEPFAR partners and national stakeholders, JHPIEGO will adapt CT performance

standards for the provision of stand-alone CT services, community-based CT services, and other levels as

needed. JHPIEGO's technical team will work closely with the National HIV/AIDS Care and Treatment

Program (PNPEC), Alliance Cote d'Ivoire, and other key stakeholders to provide guidance and support to at

least 10 CT sites supported by Alliance to ensure that these standards are implemented. These

performance standards will strengthen internal and external supervision while providing a sustainable

measure of quality assurance. All logistics and arrangements will be supported by Alliance; JHPIEGO will

provide the materials and technical assistance.

3. Strengthen referral systems between CT services and care and treatment

In order to enhance referrals and linkages between services, providers will be trained using the module

defining district- and national-level referral systems and detailing linkages of CT services to care and

treatment. These linkages will be strengthened by developing referral protocols and having continuous

discussions with hospital health management teams to ensure that there are no missed opportunities and

that waiting times for referred patients are kept to a minimum. Referral slips will be introduced to capture

number of clients referred for care and treatment. JHPIEGO will also work with site coordinators to map

services and resources available both within the facility and in the nearby community, and will produce

simple directories. These directories will be used to support intra-facility and external referral systems to

ensure continuity of care for those who test positive, including PMTCT services, infant follow-up, and

access to ART services.

An evaluation of the initial phase is expected in FY09 to determine the relative impact of the different

models in terms of uptake of testing and referrals to care and treatment services. The results of the

evaluation will help guide program planning during the expansion phase of the comprehensive CT program.

Since 2002, the Ivorian NGO ACONDA has provided innovative, comprehensive, family-based care

services in support of Ministry of Health PMTCT and HIV treatment programs. ACONDA defines a holistic

approach to care and seeks to provide a complete and integrated package of quality services that includes

prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART,

OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum

of care through links with local PLWHA and community organizations. After working as a treatment sub-

partner to EGPAF (Project HEART), ACONDA in September 2006 graduated to become an EP prime

partner providing comprehensive family care and treatment and PMTCT services. In FY08, ACONDA will

initiate about 5,000 people on ART to reach a total of 20,000 patients, including at least 2,000 (10%)

children, at 90 sites, including 16 sites to be added in FY08.

The USG country team believes that ACONDA, an important new prime partner that is undergoing

enormous and rapid growth, needs strong technical assistance in organizational capacity development to

achieve its objectives and create sustainable systems. Therefore, the EP in FY08 will fund an AIDSTAR

technical-assistance provider to be responsible for providing necessary capacity-development assistance

and training to improve ACONDA's performance and competitiveness and help the organization move

toward achieving sustainability.

The TA provider will design and implement capacity-building interventions, including but not limited to:

• Provision of technical assistance and training in organizational development (technical capacities, good

governance, procurement and human-resource management systems), based on a needs assessment

• Provision of technical assistance and training to improve financial management, based on the results of an

ongoing pre-audit assessment

• Identification of management and financial costing tools and provision of training in their application

• Identification of other appropriate mechanisms for leveraging corporate competencies and incorporating

them into the program for funding during subsequent years.

To help meet Government's need to assess and build human capacity in support of quality HIV service

delivery in Côte d'Ivoire, JHPIEGO, with the support from CDC, developed a Training Information

Monitoring System (TIMS©) to track training events, participants and trainer development in the area of HIV

in Côte d'Ivoire (including VCT, PMTCT and Care and Treatment but applicable to a broader range of

activities).

A Microsoft Access™ database application, TIMS© allows senior and mid-level program managers to

monitor a range of training activities and track results from a variety of perspectives. It is designed to be part

of an organization's training information system, replacing paper-based reporting and aggregation with a

computer database. Ministries of health, national training programs and nongovernmental organizations can

use TIMS© to supplement service information for policy decisions on training, retraining and provider

deployment.

To date the following has been achieved with the TIMS© program:

1. Adaptation and customization of TIMS© to the Ivorian context

2. Translation of TIMS© into French

3. Training of two DIPE data managers in TIMS© database system

4. Stakeholders meeting in September 2006 to review and finalize data collection forms and endorse the

use of TIMS©

5. Recruitment and training of local data entry clerk (seconded to DIPE) in data collection, entry and

analysis of TIMS© data

6. Workshop to train PEPFAR implementing partners and government officials on the application and use of

TIMS©.

7. Consultative meeting to outline role of key point persons identified to oversee TIMS© at partner

organizations and to develop a data collection system to provide data centrally to DIPE

8. Collection, entry and analysis of TIMS© data for generation of monthly and quarterly reports for partners

and other stakeholders

Efforts are currently underway to accelerate and maximize the use of TIMS© in-country by PEPFAR

implementing partners and other partner organizations. To date a total of 10 PEPFAR implementing

partners, 4 donors, and 13 departments within the Ministry of Health and Public Hygiene, the Ministry of

HIV/AIDS, the Ministry of Education and the Ministry of Family and Social Affairs report into TIMS©. A total

of 250 service providers who have received training in HIV/AIDS have been entered into the TIMS©

database.

DIPE data managers are working closely with the JHPIEGO Country Team and the local IT expert to:

1. Ensure that the data collection system developed with partners is in place

2. Follow-up and review data quality and determine if data collection forms are being filled out correctly by

partners

3. Data entry and analysis is being effectively carried out

4. Generate monthly and quarterly reports to disseminate to partners and other stakeholders ( a first run of

reports should be available at the end of July 2007)

Once the number of trainees entered into the database reaches 300 entries, the data entry clerk will clean

the data to ensure that there are no errors or duplication. A copy of the database file will also be sent to

JHPIEGO/Baltimore for review. Key technical staff that supervise and manage JHPIEGO's TIMS©

programs will check the data to ensure that it is being entered and analyzed correctly. Systematic cleaning

and verification of Cote d'Ivoire data will be conducted periodically.

Several follow-up meetings will be organized during FY07 to make specific recommendations for

generating standard monthly and/or quarterly reports; to ensure that partners needing TIMS© data have

access to it; to discuss how the data can be used to inform program planning with partners; and to promote

wider use of the database. These meetings will also be used as a forum to problem-solve any obstacles

regarding TIMS© implementation and data-sharing.

During the most recent follow-up meetings held in August 2007 to solicit feedback on the implementation of

TIMS© to date, several recommendations were made to ensure the inclusion and use of TIMS© among

partners. These included:

• Adding the completion of TIMS© forms to all training agendas i.e. making sure TIMS© is a mandatory

component of every training event;

• Including the collection and submission of completed TIMS© forms to DIPE in all trainers' terms of

reference; and

• Developing certificates of attendance to certify that trainees have participated in and completed training

courses. (Based on discussions held with PNPEC, DFR and DIPE, a consensus was reached that

certificates would be developed, printed and signed by the NGOs or PEPFAR partners organizing and

conducting the trainings).

In FY08, TIMS© data collection, entry and analysis activities will continue and will be expanded to include

additional partners reporting to TIMS© (25). The TIMS© database will also be expanded to include other

domains of health (TB, malaria etc). Existing TIMS© forms will be revised to include these new areas,

Efforts will also be made to link TIMS© to other existing training databases in order to integrate training data

files and to provide comprehensive training information for Cote d'Ivoire. Once a sufficient about of data has

been entered into the TIMS© database, data files can be linked with other data sources such as

government service delivery databases, human resource information systems and geographic information

systems (GIS), giving the flexibility to use TIMS© data beyond training monitoring.

The information collected through TIMS will be used by DFR, PNPEC, DIPE and PEPFAR partners to

monitor trainings and keep track of trainees based on their competencies and skills. It will also be used to

inform program planning at both the organizational and national levels.

Activity Narrative: In addition to the above, the feasibility of introducing a web-based version of TIMS© that is currently being

pilot-tested in Mozambique and Ethiopia will be presented to CDC, PNPEC, the relevant Ministries and

PEPFAR partners. Once pilot-tested, scaled-up and integrated, the web-based system will allow partners to

enter data directly into TIMS©, and track customized training information (by using the customizable fields

available in the database) to inform strategic decision-making and program planning and to meet program

needs at the organizational-level.

Meetings will be held with Abt Associates, CDC, PNPEC, other PEPFAR implementing partners and

relevant Ministries in FY07 to discuss the additional role and use of TIMS© in gathering follow up data on

trained providers. Preliminary results from a program implemented in Ethiopia that followed-up 659 trained

providers provided detailed information on attrition by cadre and training content that is now being

expanded to include selected partner follow up data both at hospital and health center level. This type of

follow-up can result in very interesting data as to health provider longevity in public sector HIV service

delivery sites.

If endorsed and funded by CDC, during FY08, JHPIEGO will work closely with Abt Associates, DIPE, and

other relevant Ministries to develop a joint program for gathering key follow-up data on trained providers in

Cote d'Ivoire. The follow-up information will supplement and add to the work that is currently being carried

out by Abt Associates with the MOHPH in the area of human resources and capacity building.

With USG funding since 2004, JHPIEGO provides technical and logistical assistance to build human

capacity in support of quality HIV service delivery in Côte d'Ivoire. Working in collaboration with the Ministry

of Health (MOH), its National HIV/AIDS Care and Treatment Program (PNPEC), and PEPFAR

implementing partners, JHPIEGO has provided technical support to strengthen and scale up in-service

training by building national pools of trainers and of master/advanced trainers with expertise in HIV/AIDS.

Part of a larger strategy to build organizational capacity rather than simply individual capacity,

master/advanced trainers are able to train and supervise other trainers. Achievements include:

• Development of national pools of trainers in PMTCT (20), CT (20), and medical management of people

living with HIV/AIDS (20 trained in ART).

• Development of a national pool of advanced trainers (15).

• Follow-up, supervision, and mentoring of JHPIEGO-trained trainers conducting PEPFAR partners'

trainings.

• Tracking of service providers and trainers trained in HIV/AIDS-related services through the Training

Information Monitoring System (TIMS). TIMS collects a wide variety of data related to HIV/AIDS trainings,

including background information and skills of service providers trained, the content and number of training

workshops carried out by partners, the qualifications and skills of trainers, and the geographic location of

service providers and trainers.

Trainers from the national pool have provided trainings for a number of PEPFAR partners, including FHI,

EGPAF, ACONDA, the National OVC Program, and ANADER, as well as other partners in-country

(UNICEF).

With FY07 funds, and in collaboration with the MOH, PNPEC, WHO, and PEPFAR implementing partners,

JHPIEGO is continuing the process of follow-up, supervision, and mentoring of JHPIEGO-trained trainers as

well as data collection on training through TIMS. Twenty more advanced trainers are being trained.

In FY08, JHPIEGO will provide technical support to the MOH and PNPEC to continue to build human

capacity and increase the pool of national trainers in Abidjan and 10 health districts. This will help address

concerns that the pool of national trainers is insufficient to meet partners' training needs and that a majority

of national trainers are Abidjan-based and not accessible at regional levels. With FY08 funding, JHPIEGO

will:

• Reinforce human capacity at the national level by training 25 more advanced trainers, increasing the

number of advanced trainers from 35 (as of FY07) to 60.

• Conduct five clinical training skills trainings (in PMTCT, CT, ART, OVC, and laboratory skills (CD4 count

and HIV testing)) to increase the national pool of trainers from 60 to 160. JHPIEGO will ensure that these

trainings include trainers from the 10 health districts (40 regional trainers).

• Monitor new trainers as they lead training sessions to provide feedback on training techniques.

All logistics and arrangements will be supported by the PEPFAR coordinating partners; JHPIEGO will

provide the materials and technical assistance.

Building on current work to strengthen both pre-service and in-service HIV/AIDS training, JHPIEGO will

explore the feasibility of introducing innovative learning approaches and media to continually update the

skills and knowledge of faculty, students, clinical preceptors, and already-deployed service providers to

ensure quality HIV/AIDS-related services.

As a first step, JHPIEGO will conduct a basic needs assessment to determine perceived needs of the three

key teaching institutions (UFR, INFAS, and INFS), affiliated hospitals, the MOH, and Ministry of the Fight

Against AIDS (MLS). The assessment will explore the continuing-education interests and needs of faculty,

students, preceptors, service providers and other stakeholders and government representatives, including

where they currently get their HIV/AIDS information and updates; their access to computers, e-mails, and

the Internet; and their comfort levels with using computers and software programs. Findings will be shared

with the MOH, PNPEC, and USG team and used to develop a continuing-education strategy and

interventions for Cote d'Ivoire.

To respond to the immediate need to provide faculty, students, preceptors, and service providers with the

most up-to-date information on HIV/AIDS, JHPIEGO will collaborate with the MOH to produce a periodic

newsletter on HIV/AIDS, to include case studies, new developments, research findings, innovative

programs, best practices, and lessons learned. The newsletter will be developed and disseminated on a

quarterly basis and will include contributions from other PEPFAR partners, providers, and faculty members.

In FY08, JHPIEGO will also explore the feasibility of developing and implementing an HIV/AIDS-specific

electronic learning management system (LMS) for Cote d'Ivoire that involves adapting approved HIV/AIDS

training packages (on ART, CT, PMTCT, and others to be determined) into a modular electronic training

format. LMS programs can be implemented at teaching institutions so that teaching faculty can use them as

a resource for teaching students, and they can be installed at the hospital level to support providers

(JHPIEGO is currently implementing a similar program in Ethiopia).

If determined to be feasible, a pilot LMS program will be designed to focus on pre-service education and/or

in-service training in Cote d'Ivoire. A non-Internet-based LMS in HIV/AIDS content will be developed,

reflecting a variety of learning methodologies. The process includes mapping content and designing and

recording lectures, games, video demonstrations, and other interactive learning methods to technical

content. The LMS program will be installed and field-tested at the three teaching institutions in Abidjan. Key

faculty at the three institutions will be selected as core champions of the program and will be trained on

using the LMS. They will also be oriented on methods of incorporating use of the LMS into HIV/AIDS

teaching sessions.

To ensure the functional ability and appropriate implementation of the LMS, JHPIEGO will procure essential

IT equipment and provide IT-specific technical assistance to maintain the LMS program at the three

institutions. JHPIEGO will work with Abt Associates to identify appropriate partners to help with the

proposed plans for strengthening these institutions.

Activity Narrative: JHPIEGO will monitor the implementation of the LMS pilot program and document the practices of

instructors incorporating the LMS into their HIV/AIDS teaching practices, their interest in expanding

electronic learning for HIV/AIDS teaching, and the use of the LMS by faculty, students, and others.

A stakeholders meeting will be held after three to six months to review the pilot program and determine

whether it should be expanded to the in-service level at a first cohort of hospitals.

JHPIEGO will implement an M&E plan tracking project-specific, PEPFAR, and national indicators and will

report to the USG strategic information team quarterly program results and ad hoc requested program data.

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

implement decisions taken during these meetings.

Although attempts have been made to improve pre-service education in Cote d'Ivoire, most teaching

institutions use out-of-date teaching methodologies and curricula. Faculty have little access to up-to-date

information, and there is a disconnect between didactic and practical learning, especially in the case of

medical and nursing students. A lack of agility in systems to update curricula in response to changing

national health-care needs is a problem that has resulted in inadequate levels of teaching and learning in

critical "newer" health domains such as HIV/AIDS, TB, and malaria.

With USG support, JHPIEGO has been working in Cote d'Ivoire since 2004 to strengthen pre-service

education and integrate HIV/AIDS into the curricula of three key teaching institutions: UFR-SMA (for

physicians), INFAS (for nurses and other health agents), and INFS (for social workers). These efforts are

expected to have a substantial downstream benefit as medical, nursing, and paramedical students graduate

with the skills to immediately support HIV service delivery. By ensuring that medical and nursing students

possess basic knowledge and skills in HIV/AIDS, strengthened pre-service education (i.e. training in which

essential HIV/AIDS content has been integrated) has the potential to reduce the need for in-service training,

thus saving the country valuable resources currently spent on in-service training.

Achievements to date include:

• Development and validation of comprehensive training materials for PMTCT, CT, and HIV treatment based

on national and international standards and materials and adapted to the Côte d'Ivoire context;

• Integration of HIV modules in training curricula of the three teaching institutions;

• Formation of advisory groups to coordinate the pre-service strengthening process;

• Training of a critical mass of teachers (100) from these teaching institutions in adult training techniques

and in use of standardized modules for PMTCT, CT, and ART to strengthen their teaching methodologies in

classroom settings;

• Training of a pool of advanced trainers (20) affiliated with the teaching institutions in effective teaching

skills to strengthen their ability to conduct competency-based training for their peers (other faculty).

With FY07 funds, and in collaboration with the Ministry of Health, the Ministry of Education, WHO, and

implementing partners, JHPIEGO is in the process of:

• Reinforcing the three teaching institutions' capacity to acquire effective teaching skills by training:

60 additional faculty in HIV/AIDS content, including staff from INFAS in Bouake and Korhogo

20 additional advanced trainers (added to the 20 trained in FY06);

• Conducting follow-up visits to observe and mentor faculty as they teach in classroom settings and/or follow

-up and monitor their students;

• Supporting faculty who are advanced trainers to train their peers in effective teaching skills;

• Working closely with the National HIV/AIDS Care and Treatment Program (PNPEC) and EGPAF to begin

identifying and selecting 10 clinical training sites for competency-based training for students.

With FY08 funds, JHPIEGO will build on FY07 interventions and expand its pre-service education activities

to regional teaching institutions (UFR-Bouake, INFAS-Bouake, and INFAS-Korhogo). Based on action plans

developed by each teaching institution during an effective teaching skills workshop in April 2007, the

following activities were determined as key additional steps needed to strengthen pre-service education and

to fully integrate HIV/AIDS into curricula for medical, nursing, and social work students:

1. Developing a critical mass of highly skilled trainers (master trainers and advanced trainers) among faculty

from the three teaching institutions in Abidjan to build institutional capacity and promote ongoing curricula

revisions using adult learning techniques;

• Instructional design training (20 participants) for faculty who participated in effective teaching skills training

to become master trainers. This is the final step in JHPIEGO's mastery approach and is essential for

developing master trainers and for building the capacity of the teaching institutions to develop their own

courses and competency-based learning resource packages;

• A second effective teaching skills workshop to increase the pool of advanced trainers from 20 to 40. This

is particularly important for UFR, since it has a total of 300 faculty that need to be trained in HIV/AIDS and

only 10 UFR faculty participated in the first workshop;

• Two clinical training skills courses (40 participants total) with emphasis on coaching and demonstration

skills for preceptors from the newly identified practical training sites.

2. Decentralizing the pre-service training approach to regional faculty in Bouake and Korhogo teaching

institutions. (This is a continuation activity initiated in FY07).

• Conduct two clinical training skills trainings for UFR (20 participants) and INFAS (20 participants) faculty in

regional teaching institutions (Bouake and Korhogo) to expand their pool of trainers;

• Include regional faculty in all advanced training activities (e.g. the effective teaching skills workshop

mentioned above) to increase the pool of advanced regional trainers.

3. Conducting follow-up visits to supervise and mentor newly trained faculty to ensure that HIV/AIDS is fully

integrated in curricula.

• Develop structured observation tools for follow-up visits to evaluate the effectiveness and quality of

trainings;

• Conduct follow-up visits to classrooms to observe the skills of trained faculty while they are teaching. In

particular, JHPIEGO staff will monitor the cascade training conducted by newly trained faculty who

participated in the effective teaching skills training (advance trainers) as they train and mentor their faculty

peers. This will ensure the quality of teaching skills among faculty and the implementation of pre-service

curriculum changes;

• Conduct follow-up visits to faculty from Abidjan and from regional teaching institutions (Bouake and

Korhogo) in conjunction with advanced trainers from the teaching institutions. This will allow master and

advance trainers to build their supervision skills and strengthen UFR and INFAS capacities to monitor their

own faculty, promoting sustainability;

• Follow-up visits to the training sites while newly trained preceptors are training and coaching students and

while master trainers coach preceptors.

Activity Narrative:

4. Strengthening/upgrading skills-based labs at UFR and INFAS through the provision of anatomical models

and other materials to strengthen the practical training and decision-making skills of students.

• Provide materials for four skill labs and the 10 new clinical training sites.

Materials include job aids, laminated learning guides for students to practice while they are role-playing,

basic infection-prevention (IP) materials to simulate IP practices, and anatomical models (e.g. the Zoë

model) to improve PMTCT services, since service providers are required to perform clean and safe

deliveries.

5. Establishing 10 model clinical training sites for competency-based training for teaching institutions. (This

is a continuation activity initiated in FY07.)

• Identify 10 model sites in collaboration with the PNPEC, UFR, INFAS, INFS, EGPAF, and ACONDA;

• Upgrade training competencies of preceptors (four preceptors per site) at selected model clinical training

sites;

• Follow-up visits to mentor trained preceptors at selected sites and to provide technical updates on

HIV/AIDS;

• Provide necessary equipment, materials, and supplies to strengthen the 10 sites.

JHPIEGO will work closely with the dean of the faculty of medicine, the directors of both INFAS and INFS,

the Department of Training and Research (DFR), and other relevant ministries and PEPFAR partners

(including Abt Associates) to ensure that all of its pre-service activities are integrated and linked to Cote

d'Ivoire's National Human Resources Strategy and complement other in-country human development

capacity efforts and interventions. JHPIEGO will work with Abt Associates and the PNPEC to ensure that

the model sites are in MOH pilot districts and among those receiving support to develop micro-plans.

JHPIEGO will implement an M&E plan tracking project-specific, PEPFAR, and national indicators and will

report to the USG strategic information team quarterly program results and ad hoc requested program data.

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

implement decisions taken during these meetings.

The Alliance Nationale Contre le VIH/SIDA (ANS-CI) is a national umbrella NGO that manages sub-grants

and provides financial and technical assistance to sub-grantees. ANS-CI was established in 2005 with the

support of the International HIV/AIDS Alliance and the EP in order to serve as the linking organization

between donors/partners and civil-society organizations working at the community level.

The USG country team believes that ANS-CI needs strong technical assistance in organizational capacity

development to achieve its objectives and create sustainable systems. Therefore, the EP in FY08 will fund

an AIDSTAR technical-assistance provider to be responsible for providing necessary capacity-development

assistance and training to improve ANS-CI's performance and competitiveness and help the organization

move toward achieving sustainability.

The TA provider will design and implement capacity-building interventions, including but not limited to:

• Provision of technical assistance and training in organizational development (technical capacities, good

governance, procurement and human-resource management systems), based on a needs assessment

• Provision of technical assistance and training to improve financial management, based on the results of an

ongoing pre-audit assessment

• Identification of management and financial costing tools and provision of training in their application

• Identification of other appropriate mechanisms for leveraging corporate competencies and incorporating

them into the program for funding during subsequent years.