With funds reprogrammed in April 2009, the TBD partner will help build capacity at the national health-

worker training institute (INFAS) by renovating and equipping laboratory training space for hematology,

biochemistry, microbiology, and immunology laboratories to accommodate twice the current number of

students (currently 120). In addition, an old amphitheater will be renovated and equipped to meet current

national security guidelines and safe training conditions.

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $7,028,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Background

Strategic information is a fundamental priority of the PEPFAR portfolio in Cote d'Ivoire. The USG team recognizes the impact of

good data management and the critical need to improve the sustainability of all HIV programs by developing monitoring and

evaluation (M&E) strategic and operational plans, designing national databases with stakeholder input, standardizing and

strengthening data collection and surveillance, and improving data quality and data use for decision-making.

Cote d'Ivoire's progress toward one national M&E system is coordinated by the Ministry for the Fight Against AIDS (MLS) through

its Department of Planning, Monitoring, and Evaluation. The MLS is charged with determining the country's HIV M&E vision and

designing strategic plans to achieve this vision. Operational HIV M&E tasks are shared by the ministries directly involved in the

response to HIV/AIDS. The MLS collects data and develops the M&E plan for community interventions. In the Ministry of Health

(MOH), the Department of Information, Planning, and Evaluation (DIPE) is responsible for HIV/AIDS data in the health sector and

the Public Health Pharmacy (PSP) directs drug and commodities forecasting, tracking, and management. The Ministry of Family,

Women, and Social Affairs (MFFAS), through its National OVC Program (PNOEV), collects data and develops the M&E

operational plan related to OVC activities. The Ministry of Education (MEN) contributes significantly to targets for prevention of

sexual transmission.

USG support is designed to build an effective, sustainable national SI infrastructure by strengthening capacities at the local,

district, regional, and central levels. Two principal PEPFAR prime partners - Measure Evaluation and CDC/Retro-CI - directly

support the government of Cote d'Ivoire (GOCI) to carry out SI-related activities. CDC/Retro-CI has been providing surveillance

and health management information systems (HMIS) technical assistance since 1988. In FY09, PEPFAR will ask CDC/Retro-CI to

concentrate on collecting, verifying, and analyzing data from: 1) routine HIV program monitoring, 2) surveys and surveillance, 3)

national and sub-national HIV databases, 4) supportive supervision and data auditing, and 5) HIV program evaluation and

research. Measure Evaluation will concentrate its technical assistance on human capacity, partnerships and planning, including:

1) organizational structures with HIV M&E functions, 2) human capacity for HIV M&E, 3) partnerships to plan, coordinate, and

manage the HIV M&E system, 4) national multi-sectoral HIV M&E planning, 5) an annual costed national HIV M&E work plan, and

6) advocacy, communications, and culture for HIV M&E. The dissemination and use of data from the M&E system to guide policy

formulation and program planning and improvement are considered cross-cutting, and data and data analysis will be shared

appropriately among HIV/AIDS stakeholders.

The USG also will provide technical assistance to build the data-management capacities of NGO/CBO/FBO partners and of key

government agencies active in the HIV/AIDS response.

FY08 Response

In FY08, PEPFAR is continuing the progressive transfer of capacity to the national government at both central and decentralized

levels. Support to the ministries is being expanded to broaden the national impact at all facility- and community-based HIV/AIDS

services. Through its partners, the USG is focusing on the following strategic priority areas:

JSI/TASC 3 and Retro-CI have developed and executed a six-month project to deploy harmonized national M&E paper tools. This

portion of the national information system is being interfaced with existing information systems. Measure is working with PEPFAR

care and treatment partner ACONDA to deploy the electronic version of this paper tool (currently called SIGVIH). These activities

are intended to contribute to the building of a secure national HIV data repository that respects WHO privacy and confidentiality

guidelines and will be a one-stop provider of HIV/AIDS data at the individual and aggregate levels.

The MOH is coordinating implementation of a longitudinal HIV-positive patient monitoring system. The PSP, in partnership with

SCMS, is putting in place a system to improve commodities forecasting, tracking, and management. This system will be

interoperable with the national longitudinal patient monitoring system.

The MLS, with support from SCMS, has conducted the pilot phase of a data transmission project using PDAs, designed to help

develop functional local M&E units that can capture data related to activities at the community level. The MLS has been awarded

a new PEPFAR-funded cooperative agreement with the CDC that will allow the MLS to:

• Collaborate with other relevant ministries to create a national repository to store and manage data/information.

• Contribute to key preliminary milestones of a national data repository, such as the standardization of indicators and data

collection tools, creation of a data confidentiality policy, and creation of a unique national identification number for all health

services users.

• Disseminate HIV/AIDS data/information via the following activities: 1) Creation of a national clearinghouse of documents, tools,

and other HIV/AIDS resources for use by all stakeholders, including the general public, government agencies, NGOs, and

international partners. Promotion of this resource should include community and local stakeholders. 2) Redesign of the existing

MLS Web site with a particular focus on ease of use and the provision of up-to-date national HIV/AIDS statistics, reports, and links

to key international HIV/AIDS documents, guidelines, and other data.

All USG-funded partners are reporting their quarterly program results to the PEPFAR strategic information team and are

responding to ad hoc requests for program data. To help build and strengthen one national M&E system, all USG-funded partners

are participating in quarterly SI meetings and are implementing decisions made during these meetings.

FY09 Priorities

FY09 priorities were determined during consultations over three months by a committee consisting of the USG team, its two

principal SI partners, and GOCI representatives. The World Bank's Organizing Framework for a Functional National HIV

Monitoring and Evaluation System was used to assess the country's progress toward developing one national M&E system.

Based on the national M&E plan, the committee chose the following four priorities for FY09:

1) The USG will support the development of Cote d'Ivoire's human capacity for HIV M&E. The number of M&E staff will be

increased through a fellowship program that will target new graduates in statistics, public health, epidemiology, and related fields.

After completing the program, fellows will be capable of working as M&E officers for HIV programs. In addition, short- and long-

term training will be provided to current M&E officers. PEPFAR also plans to support the definition of M&E core competencies for

HIV/AIDS programs in Cote d'Ivoire.

2) The USG will support the development of partnerships to plan, coordinate, and manage the HIV M&E system in Cote d'Ivoire.

National SI technical working groups (TWGs) will be revitalized. Lessons learned from the HMIS TWG, which is working well, will

be applied to the M&E TWG and the Surveys and Surveillance TWG. The PEPFAR quarterly SI meeting, which provides a routine

communication platform to facilitate exchange of information among stakeholders, will be co-organized with the Department of

Planning, Monitoring, Evaluation within the MLS. The objective is to transition effective management of this communication

platform to the GOCI by 2010. In addition, all PEPFAR partners will be supported in working toward the development of M&E

capacity, accountability, and responsibilities of sub-partners, health facilities, communities, and other operational units indirectly

receiving USG funds.

3) The USG will support the continued development of national and sub-national HIV databases. A common strategy will be used

for all database development. When possible, an Ivorian organization will be chosen to develop the database. Otherwise, an

international information technology company or university will be chosen as a contractor through a competitive process and will

be requested to partner with a local public or private institution and to design and implement a clear plan to transfer activities to a

national organization. The objective is that databases will be maintained and governed by Ivoirians no later than two years after

their deployment. The targeted databases for FY09 are the HIV patient monitoring system (SIGVIH), the all-patient monitoring

system (SIGVISION), the community information system (MRS with PDA), the laboratory information system, and the orphans

and vulnerable children information system. The USG will also support the development of a national HIV data security and

confidentiality policy.

4) The USG will conduct supportive supervision and data auditing. GOCI staff assigned to health data management at the district

level (CSE) will be trained in HIV data-quality assurance. PEPFAR will provide incentives to the CSE, such as per diems for

supervision and reimbursement for data transmission. In the MOH, the DIPE will be supported to organize a national task force

that will report national HIV data quarterly. This support will be performance-based. The USG will also support the development

and implementation of a national health user identification number in order to mitigate the high level of duplication noted in

reports.

Pending OGAC approval, PEPFAR Cote d'Ivoire is also planning to strengthen its evidence base for decision-making through a

significant public health evaluation (PHE) portfolio in the program areas of ARV treatment, PMTCT, and CT. EGPAF will continue

two country-specific evaluations begun with FY08 funding, assessing 1) the effectiveness of its HIV/AIDS care and treatment

program and 2) the quality of infant feeding and nutrition counseling and practices at PMTCT sites. A third country-specific PHE

proposed for FY09 will evaluate care and treatment of patients with HIV-2 infection and will serve to create a research platform for

further clinical, immunological, and virological studies of HIV-2-infected patients. The findings of this PHE will have implications for

all countries with HIV-2 infection, in particular in West Africa, and will provide data for the WHO to draft evidence-based guidelines

for HIV-2-infected patients.

PEPFAR CI also plans to participate in three inter-country PHEs: an evaluation of interventions to reduce early mortality among

patients initiating ART, an evaluation of PMTCT program models designed to improve engagement and retention of clients and

maximize PMTCT program impact, and an evaluation of three models of HIV counseling and testing in outpatient departments to

determine the most effective model for increasing testing uptake, identifying HIV infection early, and ensuring linkages to care and

treatment services.

Sustainability

The USG continues to promote sustainability by building the capacity of Ivoirian government agencies and indigenous

organizations to mobilize resources and implement evidence-based programs, including capacity to collect, process, analyze, and

use data effectively. The USG is transferring technical, financial, programmatic, and M&E skills from international organizations to

local CBO/NGO/FBOs and ministries to manage activities and to be accountable for achieving and documenting results. Through

training, infrastructure strengthening, and advocacy in support of decentralized SI capacity, the USG is supporting the

development of sustainable data-management systems for the delivery of quality HIV/AIDS prevention, care, and treatment.

Table 3.3.17: