NOTE: In April 2009 reprogramming, FY09 funds made available for development of a Partnership

Framework are being allocated to Abt Associates to support financial (including National Health Accounts)

and human-resources analyses to lay the groundwork for framework strategic planning. Strong health

systems are essential for achieving improved health outcomes. Abt Associates Inc.'s Health Systems 20/20

(HS 20/20) project provides a comprehensive approach to health-system strengthening by focusing on the

financing, operational, governance, and human-resource constraints that impede access to and use of

quality health care. These four core components are addressed together to provide sustainable,

comprehensive improvements to national health systems.

Abt Associates works closely with the Ministry of Health (MOH) and associated directorates to ensure that

capacities are built at all levels of the health system. This includes technical assistance for institutional,

organizational, and financial capacity-building activities that seek to devise a health system capable of

sustaining itself with minimal external support. At the central and provincial levels, efforts include developing

champions (technical leaders) who can lead health systems after project completion. At the organizational

level, Abt Associates works directly with key directorates to support leadership and the management of

critical health systems activities. At the individual level, Abt Associates provides training on leadership and

management in a decentralized system (173 people trained so far).

With FY09 funding, Abt Associates will continue and build on these activities through:

- Technical assistance to scale up the government's human resource information system (HRIS) and

improve records archiving systems at the Directorate of Human Resources (DRH).

- Institutionalization of essential management skills in a decentralized health system.

- Technical and infrastructure support to the national health worker training institute (INFAS).

- Technical assistance to improve human resources (HR) management practices.

- Design and pilot task-shifting approaches.

- Support to strengthen the capacity of the Ministry for the Fight Against AIDS (MLS) to sustainably

coordinate the national HIV/AIDS response.

- Support for the decentralization unit of the MOH, in collaboration with the National HIV/AIDS Care and

Treatment Program (PNPEC).

- Pilot an incentives scheme for health workers in hard-to-fill posts.

Activities will complement efforts to support decentralized, sustainable, and quality HIV service provision.

Efforts will be made to address gender issues and to increase women's access to knowledge-building

activities. In addition to a six-member staff, the project will support a senior-level consultant at the MOH and

a senior-level consultant at the MLS, whose role will be to assist the ministries in planning and coordinating

HIV/AIDS activities with a focus on sustainability at central and decentralized levels.

Specific FY09 activities include:

1. Provide technical assistance to scale up the government's HRIS and improve records archiving systems

at the DRH.

As the Government of Cote d'Ivoire extends implementation of its human resource management software,

GESPER, across ministries and parastatals, Abt Associates has begun collaborating with the DRH and the

Ministry of Finance (MOF) to support implementation of the RHIS at the MOH. Activities with FY08 funds

include: 1) development of a detailed GESPER implementation support plan, starting with rehabilitation

work and provision of equipment at the central level (desks, storage space, computer equipment); 2)

training of DRH staff on GESPER; 3) training of trainers to develop a cadre of master trainers; 4)

deployment of the GESPER application in five health districts; 5) technical support to the DRH to develop

standard operating procedures for use of the GESPER application; 6) technical assistance to develop

information products with human resource (HR) data; and 7) training of 20 persons in the use of the

application at central and decentralized levels.

With FY09 funding, Abt Associates will extend the HRIS to 30 districts and five regions. This will require: 1)

providing basic information and communication technology (ICT) infrastructure to the new districts; 2)

training users on the application; 3) working with the DRH to develop information products and to begin to

use available data for workforce planning, performance management, and budgeting; and 4) working with

the developers of the GESPER system to develop additional functionality to enhance the application, with a

focus on data transfer from the decentralized to the central level.

Abt Associates will provide infrastructure support to the DRH to improve its records archiving system. This

will include light rehabilitation of records rooms or leasing of off-site storage space, purchase of IT

infrastructure to scan and digitally store HR records, and purchase and training of DRH staff on records

archiving software.

2. Address the critical shortage of instructors at INFAS

The number of trained nurses, laboratory technicians, and physicians must be increased to support the

delivery and scale-up of HIV/AIDS services. To achieve this goal, the National Institute of Health Worker

Training (INFAS) and its medical faculty are strengthening their human and institutional capacities. With

FY09 funds, Abt Associates will provide salary support for 35 instructors at INFAS and implement activities

to strengthen the organizational capacity and training curricula.

3. Provide resources for health worker education

Training a new generation of health workers requires that training institutes to be up-to-date with emerging

issues in HIV/AIDS patient management. The current reference library at INFAS has suffered from years of

under-investment and does not stock journals or reference books on HIV/AIDS management, nor does it

have a basic ICT infrastructure. Abt Associates will collaborate with organizations such as the Widernet

Digital Libraries, the ACM Sigmund Anthology, the Open Africa JSTOR Archive, and the FreeForAll

Consortium to avail state-of-the-art e-library materials, including electronic medical journals, textbooks, and

Activity Narrative: training software. Deliverables resulting from this activity will include: 1) providing reference materials to

INFAS satellite campus libraries and to the medical school (UFR( library 2) providing basic infrastructure

support to INFAS and UFR libraries (computers, connectivity, printers, etc.)

4. Pilot an incentives scheme for health workers in hard-to-fill posts

In collaboration with Abt Associates, the MOH is conducting qualitative and quantitative studies to better

understand incentives (motivation) required to attract health workers to serve in hardship areas. In FY07,

Abt Associates developed a pilot program to provide incentives to 45 doctors, nurses, lab technicians, and

pharmacists to work in hardship areas. Criteria for selecting hardship areas were developed; the cadre of

health workers needed to fill the posts was assessed; and an incentive package was developed.

Implementation of the scheme was delayed, however. Abt Associates will pilot the scheme in FY09. Results

of the pilot will inform policy and help the MOH determine the feasibility of scaling the scheme to other

districts.

5. Provide technical assistance to improve HR management practices.

One of the core functions of the DRH is effective HR management. Abt Associates proposes a two-year

activity to assist the DRH to develop and implement a performance management system. This will involve

development of job descriptions and annual individual performance plans, monitoring of progress in

implementing the plans, coaching to improve job performance, and performance appraisal. Job descriptions

and performance appraisals will be linked to the HR information system that is currently being developed. In

the first year of this effort, Abt Associates will: 1) work with the DRH to develop a system to update job

descriptions; 2) develop a performance management system; 3) train MOH staff on the performance

management system; and 4) roll out the system in three initial districts.

6. Design and pilot task-shifting approaches.

With technical assistance from Abt Associates and in collaboration with INFAS, the DRH will begin to

address the HR shortage in selected categories of staff, particularly laboratory technicians and HIV testing

counselors. A task-shifting pilot will be implemented in two districts covering at least 10 facilities. The DRH

will identify the needs, develop policy and curricula, and provide monitoring and evaluation. INFAS will

provide in-service training to the personnel concerned.

7. Strengthen MLS capacity to sustainably coordinate the HIV response.

The mission of the MLS is to coordinate a comprehensive and effective multi-sector and decentralized

national response to HIV/AIDS. A range of challenges, including the prolonged socio-political crisis,

insufficient resources (both financial and technical), and frequent turnover at the highest levels, have

impeded the ministry's capacity to fulfill its mandate.

The second phase of the PEPFAR program attaches significant importance to sustainability through

strengthening of national health systems. In this spirit, the MLS was awarded a five-year cooperative

agreement designed to strengthen its capacity to coordinate the response to HIV and to centralize

organization and coordination of multi-sector HIV/AIDS data. By the end of the project, it is expected that

the MLS will be able to play its coordination role, including fully engaging with the private and NGO sectors,

with minimal external technical assistance.

Abt Associates has expertise and experience in strengthening national coordination and developing

partnerships with the private sector. The project has collaborated with countries to strengthen the capacity

of Global Fund CCMs and has collaborated with corporations to build sustainable HIV workplace and social

responsibility programs.

With FY09 funding, as part of a two- to three-year activity, Abt Associates will:

1) Support a long-term (embedded) technical adviser who will work with the MLS to improve its capacity to

regularly organize quarterly donor forums. This will involve developing terms of reference for the donor

coordination group, organizing regular quarterly meetings, planning quarterly field visits to monitor

implementation, and identifying and documenting policy issues and challenges.

2) Assist the MLS to develop a strategy for mobilizing private-sector involvement in national response to

HIV/AIDS.

7. Provide technical assistance to the Department of Decentralization within the Ministry of Health

In 2003, the Ivorian Government passed a law that devolved responsibility for various sectors from the

central government to local government authorities. Management of health services became the

responsibility of regional and local councils. Operationalization of this decentralization has been hindered by

an inadequate understanding of roles and poor collaboration. As HIV services are scaled up, the capacity of

local and regional authorities to provide management and oversight of care and treatment programs will are

increasingly important. Abt Associates collaborate with the decentralization unit of the MOH (SASED),

which has developed a three-pronged approach involving regional, district, and local health authorities.

With FY09 funding, Abt Associates will provide technical assistance to support the SASED in : 1)

conducting an analysis of decentralization and the management of social services by decentralized entities;

2) develop a framework for collaboration between the MOH and decentralized units; 3) develop a curriculum

for training MOH staff on the implications of decentralization for priority health programs; and 4) collaborate

with 10 districts and two regions to elaborate costed health development plans. Funds for the SASED's

implementation of these activities are requested in the MOH COP09 submission.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15086

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15086 9925.08 U.S. Agency for Abt Associates 7037 5321.08 ABT Associates $1,910,000

International 20: 20 GHS-A-

Development 00-06-00010-00

9925 9925.07 U.S. Agency for Abt Associates 5320 5320.07 Private Sector $250,000

International Partnership One

Development (PSP One)

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $1,500,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: