In FY13, ASSIST will continue to: 1) Scale up and strengthen provision of integrated TB/HIV including MDR-TB care and treatment services to PHC clinics and communities; 2) Institutionalize Quality Improvement/Quality Assurance for TB/HIV services; 3) Strengthen the capacity of MOH Tuberculosis Control and AIDS programs to lead and manage roll out of TB/HIV care and treatment services; 4) Contribute to health systems strengthening; 5) Conduct operational research to inform current practices; 6) Strengthen community participation in the provision of TB/HIV and MDR-TB care and treatment; and 7) Knowledge management, monitoring and evaluation and project administration. The project will work in all four regions to support 30 more TB diagnostic units and 60 primary health clinics initiating TB treatment integrated with HIV care. The project will work with the following target populations: general population at risk for TB and HIV; people living with HIV; pediatric TB and HIV patients; members of the military and armed services; inmates and prison service members in 4 main prisons (one per region); and employees of large scale corporate organizations at risk for TB/HIV co-infections. In a bid to increase efficiency, the project will reallocate workloads and technical support from focusing on specific technical areas to provide support in all technical areas to reduce redundancy to ensure maximum output and accountability. ASSIST will continue to work collaboratively with PEPFAR and other donors to maximize technical support, increase efficiency and reduce cost from duplication. ASSISTsupports the MOH to develop and use evidence-based policy guidelines and capacity building strategies that promote ownership.

" ASSISTs primary target populations include adults, children, PLHIV and high risk groups for MDR-TB. ASSISTalso covers health care workers, the general public and policy makers. ASSIST will build on its successes in order to address gaps/bottlenecks for achievement of national and PEPFAR targets, and implement new activities that address new national and international priorities. In FY13 ASSIST aims to: scale up and strengthen provision of integrated TB/HIV including MDR-TB care and treatment services to PHC clinics and communities; institutionalize Quality Improvement/Quality Assurance for TB/HIV services at national and health facility levels; strengthen the capacity of MOH Tuberculosis Control and AIDS programs to lead and manage roll out of TB/HIV care and treatment services; contribute to health systems strengthening; conduct operational research to inform current practices; strengthen the programmatic and clinical MDR-TB management; and improve TB/HIV knowledge management, monitoring and evaluation. ASSIST will continue to: strengthen TB screening and diagnosis in all HIV clinics as well as the military and correctional services; engage CBOs to advocate and/or provide TB/HIV care like patient support, provision of community DOTs both for drug sensitive and drug resistant TB; collaborate with CMS, MSH and CHAI in forecasting and quantification of both 1st and 2nd line anti-TB drugs; scale up the provision of TB diagnostic and treatment services in primary health clinics in the regions supported; and collaborate with business societies and the public service commission to continue providing resources for information dissemination and education among their employees.

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n a more recent report by Abt Associates, an assessment of the MOH/HR Unit was conducted to ascertain the skills required to implement the HRH Strategic Plan. The Training Office is one of the functional areas within the MOH/HR that was assessed in terms of functions and responsibilities. Currently, a Training Officer (TO) second by the MOPS and a nurse are responsible who has been seconded to the unit are managing the training function for the entire MOH to address in-service training needs for a workforce of about 3,000+ health workers . Swaziland is a high prevalence HIV/AIDS and the TB/HIV co-infection rate very high. This scenario poses challenges for the Training Office because of the varied needs of the health workers with the complexities with TB/HIV co-infection. The report has identified these areas of support for the Training Office: strengthening coordination of in-service trainings; developing evidence informed and needs based training plan; ensuring quality of in-service trainings. These 3 areas are technical and broad and require expertise in training and development in the health.

The current barriers in IST that contribute to it not function include are largely related to poor coordination amongst providers a fragmented training system with MOPS responsible in defining training priorities for the entire civil service and MOH not having a role in influencing this process, duplication of training, poor quality training because there is not system currently to evaluate training courses offered, and poor linkages between IST, on-the-job-training and supportive supervision. There is no follow-up system once an individual has completed training and no training database and selection of trainees.

PEPFAR partners are also contributing largely to these barriers where partners are targeting the same health care workers from facilities for different training that maybe overlapping in content; the training is not informed by any needs assessment but project driven to address technical skills that are not vetoed by the TO because the is no technical capacity to assess the training; training has become an easy way to increase the burn rate by partners; the same type of training by each partner without an evaluation of the use by the participants in improving health care delivery; there is no accreditation system in Swaziland to evaluate training and partners are making the determination on who and what they train.

Through URC/ASSIST, technical support will be provided to the TO in developing systems for managing IST in the MOH that will include a framework for all training programs that will offered and also provide guidance to in-service training program providers and the MOH TO in defining key practices, training programs structure, processes and outcomes. This framework will help focal persons and departmental heads to plan and improve coordination in terms of format, training approaches, participant selection, engaging supervisors and managers in defining their departmental training needs, defining the relevant learning methods and approaches to enhance the skills of the health workforce, and follow-up after the training to assess impact.