This implementing mechanism is unchanged from last year. University Research CO., LLC (URC) Overall Goals and HIV-Specific Objectives

URC has worked for over 40 years to help clients use scientific methods and research findings to improve program management and outcomes and to achieve organizational and behavioral change. URC has worked with the Royal Cambodian Government's (RCG) Ministry of Health (MOH) since 2003 to strengthen the public health system's capacity to deliver high quality health services in the areas of HIV/AIDS, maternal, neonatal and child health and nutrition, reproductive health, and infectious diseases.

With FY10 PEPFAR dollars, URC will continue its Health System Strengthening (HSS) work in integrating HIS systems and working to increase links and referrals between HIV/AIDS services and other related services (FP, MNCHN, etc.). URC will expand its HSS work by piloting mechanisms to include HIV-affected or at-risk populations in the RCG's Health Equity Fund (HEF) system of Social Health Protection (inclusion is currently based solely on income). URC will also include HIV/AIDS services in the results-based financing (RBF) approach that it is piloting in three Provinces in Cambodia. Furthermore, building on past successes in health sector technical assistance, URC is expanding its HIV technical focus to include services for orphans and vulnerable children (OVC) through a sub-contract with the local NGO New Hope for Cambodian Children (NHCC). This direct support for OVC is linked to the HEF work, as it will look to define OVC as a HEF-eligible population based on risk status rather than income.

Target Populations In the area of HSS, URC's target population includes health workers in public facilities in the 10 Provinces supported by the USG and the population using these health facilities. An estimated 200 Entertainment Workers will become HEF beneficiaries in Poipet, as well as an estimated 2,000 HIV-affected family members in Phnom Penh. In OVC care, URC will inherit an existing cohort of beneficiaries served by NHCC. 500 children will receive OVC services with another 1,000 family members included in the family-based approach to OVC services. Geographic coverage URC will work in 11 Provinces implementing existing strategies (HIS integration, PMTCT/ANC integration), but focus the new initiatives (hospital service integration and internal referrals, HEF beneficiary definitions, RBF) in four of those Provinces (Banteay Meanchey, Battambang, Pursat, and Phnom Penh/Kandal).

Making the Most of HIV Resources URC applies funding from the World Bank, the Asian Development Bank, and the Health Sector Support Project 2 (pooled donor funds) for its work with health equity funds, which provide health protection and subsidies to the poor. The results based financing work is closely integrated with an Annual Operating Plan process that is funded by a Global Fund Rd. 5 grant. As a leader in strengthening RGC capacity in MNCHN and RH/FP, URC is uniquely qualified to place its HIV systems strengthening work within a supportive network of health wrap-around services. Its HIV funds also improve existing MNCHN and RH/FP programs by paying for training to providers on referrals for HIV-specific needs.

Cross-cutting Areas As part of its HIV programs, URC supports the cross-cutting areas of gender and human resources for health. URC subcontractor NHCC works to ensure significant male (husband) participation in their OVC work, and their family-based approach has been successful at keeping families intact. URC's training programs will reach approximately 200 people. URC's PEPFAR funds will also address many of this year's priority issues including all of the health wrap-arounds by working to link patients accessing hospital-based HIV services to RH/FP and MNCHN services.

Enhancing Sustainability Improving administrative, managerial and financial sustainability has been at the core of URC's work in Cambodia over the past seven years. URC's model of partnership with the MoH public health service delivery network enhances both its programs' sustainability and the RGC's capacity to provide high-quality health care for the Cambodian people. URC's strategies for creating a sustainable program, rooted in host country leadership are as follows:

Build upon its partnership with the MoH to strengthen health systems at all levels (National Centers, Tertiary Hospitals, Referral Hospitals, District Hospitals, and both Operating District and Provincial health management units). Use its work pioneering social health protection services to link to other relevant government ministries and councils (Council of Ministers, Council of Administrative Reform, Ministry of Labor, Ministry of Social Affairs) URC is a leader in the coordination of social health protection mechanisms and service delivery integration. Partners include WHO, UNICEF, UNFPA, GTZ, etc. URC is the only "project" to be regularly invited to the RGC's monthly Donor Coordination meetings. Continued training of health care workers to add to Cambodia's cadre of trained, local health care staff. Working with sub-grantees to enhance their capability to find additional funding sources and properly monitor and manage existing resources.

M&E FHC will ensure proper M&E of PEPFAR old and next generation indicators for HSS and OVC. As URC regularly collects program data, and is the RGC's lead partner in HIS development, it routinely uses HIS and non-HIS information to inform and shape ongoing project design and implementation. Its monitoring and evaluation plan will thus be programmatically relevant and based upon ongoing inputs. It will utilize staff expertise for data collection and data-driven interventions.

This is a new activity. URC will work with OVC in two ways: through a contract with a local NGO, New Hope for Cambodian Children (NHCC) whose mission is to work with NGOs and the Royal Government of Cambodia to assist children living with HIV/AIDS and their families; and 2) through the creation of a new type of Health Equity Fund (HEF) beneficiary, HIV/AIDS orphans and their families, that will permit existing HEFs supported by URC with non-PEFAR funding to pay for transport and food for OVCs receiving HIV/AIDS care from RGC health facilities. HIV/AIDS care is offered free by the facilities, but by paying for transport and food costs, the HEFs will lower the financial barriers to access these "free" services.

The NHCC project has five components:

1. Social support to Pediatric Programs in Phnom Penh: NHCC provides transportation expenses so that children can access pediatric ARV clinics for OI and ART care. The program also gives support to families to provide for the nutrition needs of children on ARVs and pays school fees so that OVCs can continue their education.

2. The NHCC Transitional House: NHCC has learned that when HIV positive children are very sick, their families frequently have trouble taking care of them, have trouble getting them to scheduled medical appointments, and lack the resources to provide the 24-hour care necessary to keep them alive. The transitional house, staffed by a small team of full-time care providers who live in the facility, provides a place where very sick children who need intensive care can come and be restored to health. When they recover their health, these children return to their families.

3. Support to the pediatric ARV clinic at Chey Chumneas Referral Hospital home-based care (HBC) program: This is the principal ART hospital in southern Phnom Penh and many of their patients are very poor. NHCC field workers provide direct HBC to pediatric HIV/AIDS patients at the Chey Chumneas Referral Hospital and provide technical assistance to the hospital on how to manage the hospital's HBC program.

4. The Early Childhood Development Day Care Center: This center provides day care and support so that men and women with HIV/AIDS will not have to abandon their children in order to work. The center provides a safe place for working mothers/fathers to leave their children while they work. The center also provides a safe place and loving environment for the children and provides nutritious meals to the children. An NHCC staff doctor attends to any medical needs of these children.

5. The HIV widows' income generation project: This project aims to provide income generation for a small number of HIV-positive mothers who do not have another job by giving them a job making baby quilts to sell. They are paid a monthly salary, and the quilts are sold both in Cambodia and abroad. The project currently recoups about 80% of its costs through the sales of quilts; the goal is to make it fully self-sustaining. While the mothers work, their children are at the day care center described in point four.

This program has been designed in an integrated manner with the intention of trying to provide the best care possible to OVC within the context of their families and the context of the Cambodian health care system, which is often fragmented and diffuse. URC proposes to expand an existing social health protection mechanism, health equity funds (HEF), to cover OVC. HEFs can be thought of as a simpler, Cambodian version of Medicaid. The HEF patient record system assigns a unique patient identifier to track benefits and payments; it can be applied to OVCs, which will lead the RGC to change the definition of beneficiaries to cover a vulnerable group, parallel to the current beneficiary group (those living in poverty). This will provide insight into the full range of services that OVC and their families are (or are not) accessing, which will surpass anything that can be currently collected outside of specific surveys.

This activity is unchanged from last year.