N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 19354

Continued Associated Activity Information

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

System ID System ID

19354 19354.08 HHS/Centers for National Institute 7991 7991.08 TB Surveillance, $110,000

Disease Control & for Communicable MDR-TB,

Prevention Diseases Infection Control

(MRC?)

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $2,089,923

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Improving Strategic Information (SI) capacity and supporting the delivery of key information products were strongly emphasized in

the recent 2008 Joint Review of the National HIV/AIDS Strategic Plan (2004-2008) and in the draft National Strategic Framework

(NSF) for HIV/AIDS (2009-2013). While some progress has been made over the last year in implementation of both routine and

periodic data collection and use activities, much remains to be done and M&E capacity remains very limited in the country. The

development and maintenance of an evidence base for public health program planning and policy development are mentioned

frequently in national forums, but the institutional culture around its practice remains rudimentary and advocacy for adequate

resource allocation episodic at best.

In 2006, NERCHA launched the Swaziland HIV/AIDS Program Monitoring System (SHAPMoS). SHAPMoS is a major element of

the overall national "M&E Roadmap," and has health sector and non health sector components. A challenge to SHAPMoS

implementation is that it's effectiveness largely hinges on the MIS at the MOHSW, which is severely under-resourced in terms of

trained staff, infrastructure, and technical assistance. PEPFAR has been working with the national Health Information System

Coordinating Committee (HISCC) and USG funded partners to build off existing initiatives (e.g. WHO-Health Metrics Network -

HMN) and inject targeted technical interventions to improve routine systems and bring together the key elements of a functioning

HIS, including survey and surveillance data. A crucial element to this support will be in the area of data synthesis and packaging

of information for use by program managers in the Ministry It is understood that this focus on the principle users of data is

important to ensure adequate MOHSW budget to a sustainable system.

Within the MOHSW, M&E for the Swaziland National AIDS Program (SNAP) has operated largely in isolation of the Health

Statistics Unit, responsible for HMIS; thus, there has been little integration of information systems across health program areas.

Since 2007, with USG assistance, SNAP has been working closely with Health Statistics (HMIS) unit in the MOHSW to build

practical and integrated systems to collect, process, and use data for program improvement and advocacy. Computer networks

have been developed (though not fully implemented yet) to move information among MOHSW program offices and among central

offices , regional offices and the large ARV service sites. The Quarterly (HIV) Service Coverage Reports (QSCR), have provided

local stakeholder groups including NERCHA and the CCM (Country Coordinating Mechanism of the Global Fund) with up-to-date

service statistics, although there remains some data transmission problems that result in occasional delays in report publication.

As well, while data tabulation is now automated, data quality audits and more in-depth analysis of the data are not yet routinized.

The USG remains the main bilateral donor actively supporting SI-related activities in Swaziland and has, since 2005, partnered

with UNAIDS, WHO, UNICEF and especially the World Bank's Global AIDS M&E Team (GAMET) to provide technical assistance,

planning and implementation support to the M&E/HMIS units at NERCHA and MOHSW.

The following summarizes the current status of national SI within PEPFAR SI focus areas:

Sentinel HIV Surveillance. Antenatal clinic-based HIV sentinel surveillance has been supported financially by the MOHSW itself

with WHO technical assistance. PEPFAR staff have provided some limited technical assistance but are challenged to provide

more support due to existing MOHSW methods that contravene accepted international standards concerning extra blood

collection at ANC sites. The 2008 ANC round is currently in the field, with preliminary data available before end 2008.

Population-based Surveys. The final report from the 2007 Swaziland DHS+ (the first survey of its kind in Swaziland) was

published early in 2008, and has been widely regarded as an example of effective collaboration between Swazi Institutions

(Central Statistics and the MOHSW) and USG Technical Assistance. National population-based HIV prevalence rates were

produced as were indicators of HIV/STI risk behaviors and HIV/AIDS program coverage. The USG was the leading donor in

support of the SDHS.

Service Availability Surveys. A Service Availability Mapping (SAM) survey was implemented in FY08 with financial support

through Global Fund and technical inputs from the WHO and USG. Preliminary findings are expected in November 2008.

Other surveys for program improvement . The national Linkages and Referrals Study was conducted in FY08 and preliminary

findings released in September 2008. Substantial financial and technical assistance was provided by USG and MEASURE

Evaluation. Referral directories will be revised based on the study data (see Care section).

Health Management Information Systems. The National TB Control Program (NTCP), supported by PEPFAR staff and URC/HCI,

has made remarkable progress to integrate key HIV/AIDS data (e.g. HIV Testing and Counseling (HTC)) into the TB registers,

computerize the system (ETR.net), and improve data flow between regional and national levels.

The MOHSW Human Resource Information System (HRIS) is supported by PEPFAR through the Southern Africa Human

Capacity Development (SAHCD) Coalition. HRIS Workforce data is used for allocating nurses to facilities and for planning

workforce trainings (See HSS section), although much remains to be done to improve data use by planners at the decentralized

(regional) level.

Other Data Utilization Activities. HIV Estimates and Projections Project (using EPP and SPECTRUM), and a Modes of

Transmission (MOT) study were conducted with findings released in 2008, and are used frequently in national planning and

evaluation exercises. PEPFAR provided technical assistance for both.

Note: Due to USG delays in the M&E program procurement process, PEPFAR Swaziland lacked an M&E implementation partner

to conduct planned capacity building activities for SHAPMoS and the MOHSW, and to build the PEPFAR programmatic database

and implement internal PEPFAR program partner capacity building and data quality assurance activities. Enhance Strategic

Information (ESI, with John Snow Inc as prime partner) was awarded in FY08 and is now available for involvement in these

PEPFAR Swaziland M&E activities.

Due to delays in the protocol review, conducted by in the Swaziland HIV/AIDS Research Committee, the Swazi military sero-

surveillance work was postponed until late 2008/early 2009.

PEPFAR Swaziland will continue to play a leading assistance role in building M&E, surveillance, and HMIS systems. The

following activities and expected results are planned using FY09 funds:

1) A programmatic database will be developed with ESI assistance for the management and analysis of PEPFAR-related data for

use in portfolio review, COP and periodic reporting to National stakeholders, USG agencies and OGAC. As well, ESI will work

with PEPFAR Swaziland to establish an internal data quality assurance system.

2) MEASURE DHS+ and PEPFAR staff will provide technical assistance and USG will provide local costs for the design and early

sampling/listing activities related to the 2010 Swaziland AIDS Indicator Survey (AIS), in collaboration with the Central Statistical

Office (CSO) and the MOHSW. This activity is included in the draft 2009-2013 national HIV/AIDS Strategic Framework, along

with a 2013 SDHS.

3) PEPFAR will, with WHO, UNAIDS and others, support the MOHSW/SNAP, in the design and implementation of epidemiologic

and demographic data use activities to strengthen epidemic tracking, program monitoring, and impact analysis. This support will

be implemented in the context of a PEPFAR-MOHSW cooperative agreement, in turn an important element of the overall

PEPFAR Partnership Compact. Based on a specific request from MOHSW leadership, a PEPFAR epidemiologist/statistician will

be locally employed to work with the MOHSW to build capacity in data utilization.

4) PEPFAR SI staff and ESI will provide direct technical assistance and mentoring to the NERCHA- and MOHSW-sponsored

HIV/AIDS M&E Technical Working Group.

5) ESI will also support training and mentoring for improved data collection and data utilization methods for the MOHSW and

NERCHA's multi-sectoral SHAPMoS. By doing so, the USG also strengthens the program monitoring system for Global Fund

reporting, nested within SHAPMoS. A collaborative agreement with the World Bank's Global AIDS M&E Team (GAMET) is being

developed towards these ends.

6) MEASURE Evaluation will provide technical assistance and limited local costs to support development of referral directories

through analysis of data from a national HIV/AIDS program Linkages and Referral systems study.

7) DOD and partners will provide technical assistance to support collection and analysis of HIV survey data in the military

population.

8) Local HTC partner (PSI) and PMTCT partner (EGPAF) will increase its support to capacity building in HTC- and PMTCT-

related M&E at the MOHSW/SNAP unit to develop high quality information products to monitor and improve programs.

9) PACT, ESI and the USG staff will develop and maintain simple methods for PEPFAR program monitoring, reporting, and

planning purposes. Additionally they will provide training workshops and ongoing support to the USG partners in PEPFAR

strategic information to monitor and improve programs. ESI and the USG SI Liaison will focus on prime partners (including

PACT). PACT, in turn, will focus on its sub-grantees.

10) PEPFAR will continue to provide technical assistance for training and support to ETR.net, the national electronic TB register,

and through URC/HCI, overall support to the improvement and integration of National TB/HIV program data. This PEPFAR

intervention will continue to bolster the NTP and leverage a continuance of Global Fund resources.

11) The Southern Africa Human Capacity Development (SAHCD) Coalition will continue to support for the Human Resource

Information System (HRIS) and will build the capacity of MOHSW and HIV/AIDS implementing organizations to maintain and use

data for decision-making for HR policy formulation and management decisions (see HSS).

12) ICAP and MSH will provide continued support at a national level and at facilities to strengthen M&E systems that monitor ART

program progress, supporting improvements in the management of clinics and of patients. (See ARV Services)

This COP requests funds to support an epidemiologist/statistician, who will work part-time from PEPFAR offices on management

of some PEPFAR SI objectives and part-time with the MOHSW on projects to be written into the USG-MOHSW cooperative

agreement developed in FY09.

Products/Outputs for FY09: Programmatic Database for PEPFAR Swaziland; improved PEPFAR data quality; Swazi personnel

at NERCHA, MOHSW and NGOs trained in data collection, use, and dissemination; improved National HIV/AIDS and TB

Program and GFATM reporting, HIV surveillance data on military, improved use of workforce data for human resource planning,

revised referral directories, in-depth analysis and reports on HIV/AIDS program outcomes and impact, sample frame developed

and survey instruments designed for the 2010 AIDS Indicator Survey.

Table 3.3.17: