This is a continuing activity from FY06. To date, Crown Agents has received 100% of FY06 supplemental funds and is on track according to the original targets and work plan. This activity is linked to Care and Support, antiretroviral drugs (ARVs), ART and laboratory services. Crown Agents will use COP06 funds to support the Federal Ministry of Health (FMOH) in organizing a Steering Committee to coordinate renovation activities, and to begin baseline health center assessments in coordination with the FMOH and other stakeholders, including PEPFAR Ethiopia partners. Support for compilation of all existing assessment information, as well as mapping of renovation plans and resources, will also be carried out under COP06, and twenty health centers will be directly renovated by Crown Agents during this period.

An assessment completed by Family Health International (FHI) in FY 2006 identified infrastructure deficiencies as a major obstacle that impedes sustained progress in achieving ART targets. Staffing and infrastructure at current ART hospitals are among the limiting constraints to increasing ART enrollment. To remedy this constraint, the FMOH has taken several measures, including decentralizing ART services to the health center level. ART services at health centers also require adequate infrastructure to accommodate the sizable increase in ART clients expected at these sites.

Although the Global Fund To Fight AIDS, Tuberculosis, and Malaria (GFATM) supports limited renovation, systematic coordination of this effort with others carrying out renovation in the health sector is lacking. Block grants from the FMOH to Regional Health Bureaus (RHB) have resulted in somewhat sporadic renovation, with limited impact in terms of supporting comprehensive HIV services including ART. Currently, bilateral and multilateral agencies, as well as NGOs, are working independently to renovate health centers. These include the Department for International Development (DfID), the Japanese International Development Agency (JICA), the World Bank, the United Nations Population Fund (UNFPA), Pathfinder International, Management Sciences for Health (MSH), Intrahealth, and the Clinton HIV/AIDS Foundation. Structured coordination is needed between and among these agencies, the FMOH and RHB to rationalize infrastructure improvements at the health center level.

Several PEPFAR Ethiopia partners are included among those institutions currently engaged in renovation activities, and closer coordination of these activities is needed. To date MSH's Rational Pharmaceutical Plus (RPM+) project has renovated the pharmacy stores, dispensing rooms and selected rooms for Prevention of Mother-to-Child Transmission (PMTCT) and Voluntary Counseling and Testing (VCT) rooms at nine health centers, with an additional 73 to be renovated during FY 2006 in coordination with the FMOH and RHBs, supported by Crown Agents. Other key PEPFAR Ethiopia partners involved in renovation include Intrahealth, the Care and Support Contractor to be named supporting health center ART service expansion, and the Regional Procurement Supply Office (RPSO). These partners will coordinate all renovation activities under the umbrella supported by Crown Agents under the direction of the FMOH. While these PEPFAR Ethiopia-funded activities have been actively involved in renovation, none have taken on the critical coordination role that Crown Agents will fill, supporting the GOE to play this role on a long-term basis.

The purpose of this activity is to coordinate the various renovation and construction initiatives supporting improved HIV/AIDS services in Ethiopia and to carry out selected renovations, filling gaps when other funds are not available for this purpose. The objectives of the activity are:

1) Coordination: Support the MOH in developing a coordination and synchronization "hub" with national and bilateral stakeholders for all health center renovations supporting the ART health network. Crown Agents will leverage United States Government (USG) resources with the Government of Ethiopia (GOE), including GFATM and bilateral agency resources, under the technical leadership of the Planning and Programming Department within the FMOH;

2) Renovation: Over three years, provide direct or indirect renovation support at 550 targeted health centers selected to support ART and chronic disease management including antiretroviral therapy.

3) Technical Assistance: In coordination with and supporting the FMOH "hub", provide technical assistance in health center infrastructure improvements, by rapidly assessing and assisting in upgrading health centers to support ART services. These services include ART initiation in selected sites and treatment maintenance in the remaining sites supported by the PEPFAR Ethiopia Care and Support Contractor selected to support health center ART service expansion. This activity will utilize only a small amount of PEPFAR funding, leveraging most resources from the host country (e.g. GFATM), other donors and implementing agencies. Crown Agents' resources targeted for direct renovation will serve as an emergency fund to fill gaps, and will only be used when the need arises to renovate additional health centers for ART services that cannot be covered by other donors or PEPFAR Ethiopia partners.

In close coordination with the FMOH, Crown Agents will continue to provide support for procurement of renovation services, materials and project management services, including support for managing subcontracts with local building supply and service providers and ensuring that these contracts are legally binding and adhered to by all parties. Through close monitoring and quality checks, PEPFAR Ethiopia will support the FMOH to ensure compliance with local (or as required, international) standards, and ensure clear and transparent reporting. Further, Crown Agents will support the FMOH in leveraging resources through a consortium approach to renovation. It will also support the FMOH in providing technical mentorship to partners for standardization and possible franchising of infrastructure renovations, upgrading from health post to health center, strategic planning and renovation management within RHBs. The strengthening of formal communication channels that began in FY06 will continue to ensure that PEPFAR Ethiopia partners, the FMOH, RHBs and any other stakeholders involved in renovations are consulted throughout the life cycle of the project. Crown Agents' experience in this type of renovation project is extensive and includes work in Russia and Pakistan where the organization managed the renovation of 36 health centers. Outside the health sector, Crown Agents has recently managed projects in Iraq (construction of the USAID compound), India (British Council Offices), Afghanistan (various ministerial buildings), and Palestine (refugee camps and police stations).

PLUS UP FUNDING: PEPFAR will fund Crown Agents to support renovation of health centers beginning antiretroviral treatment services through the following activities: 1. Carry out targeted renovation to allow effective/efficient services to be provided, in a safe environment, ensuring quality; 2. Coordinate USG renovation efforts at health center level, renovating 20 additional sites in addition to those originally planned; 3. Support MOH Planning and Program Department in coordinating the diverse existing renovation efforts, standardizing renovation approaches and designs, institutionalizing maintenance packages, and leveraging resources. This will assist the MOH in effectively decentralizing services in a more sustainable manner.