The Capacity Project, implemented by IntraHealth, works to ensure effective and efficient delivery of comprehensive care and treatment for PLHIV in Belize, Costa Rica, El Salvador, Panama and Guatemala. The projects strategic approach includes six interwoven technical strategies to increase access to high quality care for PLHIV:

1. Measure and support improvements in the quality of services provided for care and treatment of people living with HIV/AIDS in health facilities.2. Establish strong referral networks and integrate care and treatment with community-based support to ensure complementary services and promotion of HIV prevention through facility-community partnerships.3. Provide trainings to health service providers in the public and private sector, NGOs and government organizations and civil society.4. Build HRH capacity at both the pre-service and in-service levels through updates of university curricular content & teaching methods and standardization of in-service curricula and methodology for performance-based training.5. Support innovation at the health facility and community level through use of information communications technology, and appropriate training in information systems.6. Promote the institutionalization of standards for quality improvements at national and institutional levels.

Sustainability: Social Security institutions in Costa Rica and Panama, have initiated the institutionalization of the projects Quality Assurance model, through a progressive plan to adopt the model in both outpatients and in-services care. And across the region, governments are adopting the stringent Capacity quality standards. The Capacity benchmarks remain a tool that is used by countries in the region to monitor and improve their hospitals themselves.

The Capacity Project began a pilot Continuum of Care (CoC) project in Guatemala and will continue to expand the work in Guatemala through the Capacity Project and across the region through the Capacity Plus project. The primary purpose of the CoC in Guatemala is to develop systems that provide humane, effective, high-quality comprehensive and continuous care to PLHIVs and their families. The CoC constitutes a package of services for PLHIVs, MARPs and indirectly the general population. These services empower a multi-sectoral local network of community groups to proactively demand high-quality services. A fully developed CoC brings together five major components of a response to HIV: care, treatment, support, counseling/testing (CT), and prevention. The core activities of the CoC strategy include: (a) Training and Supportive Supervision of institutional and community health personnel in ART compliance, home care, stigma and discrimination reduction, and gender dimensions of HIV. (b) Prevention with Positives training that will ensure the systematic application of providing prevention recommendations to HIV-positive clients, assess client adherence to ARVs and other medications, assess clients for signs and symptoms of STIs, integrate RH/FP services including condom counseling and condom provision at every visit, and referals for community-based support. (c) M-health technology (the use of mobile phones to share health information, send prevention messages, follow up with clients, provide text reminders for when it is time to take ARVs and/or other medications or come for medical appointments, and notify members of the hospital-community integration team of upcoming meetings, progress on implementation of activities, and other relevant issues) to improve community-facility partnerships. (d) Referral and counter-referral network to maximize the integration of complementary services, ensure client satisfaction and ARV adherence, and minimize client loss to follow up.

The Capacity Project monitors care and treatment services by establishing a performance information system and using data for decision making. The project works closely with Ministry of Health and other stakeholders to leverage resources for improvements and needed follow-up in hospitals after the assessments.

The Performance Improvement for Quality (PIQ) strategy will build capacity of hospital and MOH/SSI authorities to implement facility performance improvement surveys. This strategy aims to build institutional capacity for a comprehensive HIV/AIDS care and support system that is fully integrated into the overall health system. The project will enable stakeholders and counterparts to dissemination lessons learned, best practices and successful interventions for both advocacy and decision-making purposes. The project will strengthen the presentation and use of information through a series of structured national forums in collaboration with the MOH and other projects and agencies. Because the most sustainable activities are those that possess strong budget forecasts and M&E plans, the project will advocate for the inclusion of performance improvement and monitoring in the annual operational plans and budgets of the MOH/SSI. This inclusion will support country ownership and the implementation of the National HIV/AIDS Strategic Plan and HIV/AIDS Monitoring and Evaluation Plan in each country.

The Performance Improvement for Quality (PIQ) strategy will be implemented in 57 hospitals in 5 countries: Belize, Costa Rica, El Salvador, Guatemala and Panama. Activities will support institutional capacity-building at the national level. PIQ will be implemented through the Ministries of Health (MOH) and Social Security Institutes (SSI) of the focus countries. IntraHealth country representatives will train representatives from the HIV/AIDS Program, MOH/SSI central or regional level, and other hospitals to assess compliance with performance standards using standardized tools.

The Capacity Project will conduct assessments to help hospital authorities and staff address the gaps identified in their hospital performance. They will develop an action plan to remedy the gaps and then support, with technical assistance, the implementation of the interventions in the hospitals. The Capacity Project will develop training and learning interventions to target capacity building in skills and knowledge, one of the primary reasons for the performance gaps. They will facilitate intervention plan follow-up meetings to monitor and motivate progress on implementation of identified interventions, conduct subsequent performance assessments to see percentage change in compliance with standards and repeat any needed trainings.

One of the major challenges facing hospital workers is overcoming barriers to making improvements to health services in a resource-constrained environment. During this year, these gaps assessments and actions plans will raise awareness among MOH/SSI and HIV/AIDS Program stakeholders for the need for the systematization and the institutionalization of the performance standards and methodological process to ensure sustainability of the approach. For activities identified as targeted leveraging, the MOH and other NGOs will provide both technical and financial support.

HRH capacity will be enhanced at both the pre-service and in-service levels through revisions and updates of curricular content and teaching methods at university health and social welfare schools and standardization of in-service curricula and methodology for performance-based training.