Global Fund To Fight AIDS, Tuberculosis and Malaria and MOH Management Support and Capacity

Building

This is a new activity. During FY07, it has become clear that one of the major bottlenecks for strengthening

the HIV/AIDS response in Ethiopia is low personnel levels and management challenges at the country's

HIV/AIDS Prevention and Control Offices (HAPCOs), at both national and regional levels. During FY07,

PEPFAR Ethiopia was faced with repeated major requests to support Global Fund To Fight AIDS,

Tuberculosis and Malaria (GFATM) activities in coordinating with PEPFAR, as well as repeated requests to

provide substantial technical inputs for Ministry of Health processes and documents in collaboration with

GFATM resources. These requests resulted in USG deploying significant levels of human and technical

resources to respond appropriately, many requiring specialized knowledge of GFATM processes, as well as

of management strengthening and HIV/AIDS and systems strengthening technical abilities. Relatively low

staffing levels of PEPFAR/Ethiopia partners -- particularly individuals with these skill sets -- made response

to these requests difficult. They are expected to continue in FY08. While PEPFAR is supporting the

national HAPCO with placement of a GFATM -PEPFAR Liaison Officer, the need for technical assistance to

HAPCO and Regional Health Bureaus (RHB) and increased technical support for PEPFAR is substantial.

The main focus of this activity is to ensure that PEPFAR has sufficient capacity to adequately support MOH

and RHB efforts using GFATM resources, and to provide needed technical support to supplement PEPFAR

staff that are frequently called to contribute to GFATM-related technical processes. The activity will also

provide support to national and regional level HAPCOs and health bureaus, which continue to experience

challenges requiring management TA. Additionally, this activity will support GFATM proposal development,

management and costing exercises supporting the national HIV/AIDS effort.

Building upon the approaches and participatory products developed under the former USG Management &

Leadership Project, the new Leadership, Management and Sustainability (LMS) project is a cooperative

international partnership that strengthens leadership, management and systems of programs and

organizations to improve their health outcomes. Without effective management and leadership, the delivery

of quality health services and achievement of sustainability is compromised. The purpose of the LMS

project is to support the USG and host country organizations by providing technical assistance, approaches

and strategies to strengthen institutional capacity to lead and manage HIV/AIDS and other health programs

and related social sector programs in the public, private, and NGO sectors. This activity will allow PEPFAR

to access expertise to support GFATM activities ranging from proposal development to grant

implementation.

This activity is linked to other donor and partner resources to promote the effective implementation of

GFATM resources, critical for achievement of PEPFAR goals. Close integration with the Sustainable

Management Development and Support to the Global Fund Country Coordinating Mechanism activities (ID

10540, ID 10411) as well as other PEPFAR management support partners at regional and national levels,

will be an important feature of this activity. Other linkages include GFATM, the Clinton HIV AIDS Initiative,

and the World Health Organization (WHO).

Assistance will be outcome-oriented, and should strengthen local capacity. Activities will focus on

alleviating specific bottlenecks that are causing under-performance, including inadequate or poor

performance in the following areas:

• Governance and Leadership (including aspects of the functioning of CCM);

• Program and Financial Management;

• Monitoring and Evaluation.

The primary emphasis of this activity will be to ensure robust management systems for Ethiopian public

sector HIV/AIDS program implementation. Capacity of Ethiopian organizations such as the federal and

regional HAPCOs will be strengthened to ensure the effectiveness of a coordinated HIV/AIDS programming.

Supporting these efforts, LMS will also collaborate with PEPFAR's National Association of State and

Territorial AIDS Directors (NASTAD) activity to support and intensify regional and woreda level planning,

creating important interagency synergies. As a result of these multiple efforts, PEPFAR Ethiopia's ability to

respond to MOH requests for management and technical support, particularly related to GFATM and

national processes, as well as its ability to coordinate PEPFAR partners' activities across the continuum of

HIV prevention, care and treatment, will be substantially enhanced. It is expected that facility-community

linkages will also be enhanced, resulting in a more effective and fully functional health network.

As part of PEPFAR's overall systems strengthening effort to support improved program management and

use of HIV funding, additional resources will be added to LMS to complement existing PEPFAR activities

supporting the national Health Management Information System (HMIS) implementation This decision

came as a result of PEPFAR Strategic Information Interagency Technical Working Group analysis, in

conjunction with the Government of Ethiopia Ministry of Health, which identified existing critical gaps and

potential areas for increased support.

LMS has access to substantial HMIS expertise which can provide important complementary synergies with

existing PEPFAR partners supporting HMIS, beginning to address some of the clear gaps in the national

scale-up. The activity diversifies PEPFAR technical assistance resources, permitting access not only to

LMS but to additional U.S. Government (USG) wrap-around resources at health center, health post and

community levels. It will strengthen the nascent HMIS system at these levels, where all data is generated,

thus promoting more informed data-driven decisions.

The LMIS activities will primarily focus on HMIS support to primary health care facilities (health centers,

health posts) and associated administrative levels, as well as community level activities. Specific activities

include: 1) support to expansion of pre-service training for health information technicians, 2) in-service

training for existing health facility and community level staff, 3) supportive supervision, and 4) site-level

training on data quality and use as well as capacity building for woreda and facility level staff on data-use for

decision making.

All activities will be planned in close consultation with all involved stakeholders, principally the MOH and

PEPFAR partners (including Tulane University) as well as other development partners that are closely

Activity Narrative: engaged in the HMIS reform and the roll-out of the new system. No overlap of activities will occur.