Support to National HIV/AIDS Program Management and Sustainability

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity has been updated to reflect August 2008 reprogramming and the inclusion of USG regional

planning activities.

Building Systems Capacity of Regional, Zonal and District Health Offices for HIV/AIDS Program

Management

Summary:

This is a continuing activity from COP08 and reflects the growing complexity required to management the

National HIV/AIDS Response in Ethiopia. This activity is a compilation of two system strengthening

activities which include:

1) Support to Regional Bureaus, Zonal and District Health Offices to plan and manage HIV/AIDS activities

in key prevention, care and treatment areas of identified high prevalence and where a diversity of partners

including PEPFAR, Global Fund and private foundation activities are present ($1,300,000); and

2) Support to Federal Ministry of Health and Regional Health Bureaus in Global Fund technical assistance

($700,000).

Activity 1)

In COP08, funds for this activity have been reprogrammed from CDC to USAID in August 2008. It will

continue in COP09.

There are multiple indigenous, bi-lateral and multi-lateral donors and implementers conducting HIV/AIDS-

related activities at regional and local levels. The combination of partners often presents local authorities

with challenges including coordination, monitoring, oversight and reporting.

This activity will support Regional, Zonal and District Health Offices through engagement, placement of

specialists and training to assist local authorities in planning, coordination and management of the National

HIV/AIDS Response in specific localities where PEPFAR and GFATM resources are being utilized. Initial

plans are to place approximately 30 public health management specialists in Regional and Zonal Health

Offices for a three year term, in addition to minimal equipment grants to support an enabling environment

for planning and coordination in light of chronic under financing of Zonal and District Health Offices.

PEPFAR efforts will integrate with existing MOH planning efforts, strengthening joint planning mechanisms

for regional and sub-regional authorities through the placement of professionals in regional HAPCO/Health

Bureaus as well as at district (woreda) levels to support the planning processes.

In response to the growing complexity of PEPFAR Ethiopia, the USG proposes to place public health and

management specialists at regional and sub-regional HAPCO/Health Offices in all regions, focusing on

regions of high HIV prevalence and density of HIV/AIDS services supported by USG. Specialists, seconded

through LMS would support Regional, Zonal and District level planning activities alongside GOE colleagues

and facilitate engagement with PEPFAR and community partners that may not be fully engaged in these

planning activities.

Despite active decentralization from the Federal government to Regions and ultimately Districts there are

serious capacity constraints that do not permit District Health Offices to adequately coordinate and plan

HIV/AIDS and Health activities. A CDC implementing partner identified several key interventions to be

completed when addressing sub-regional authorities:

Institutionalize sub-regional level comprehensive plans of action by Zonal Health Offices and District

Administrators using participatory processes involving USG and other partners working in the region.

Enhance coordination, management and implementation of regional HAPCO plans, in collaboration with

USG and other partners, to result in more efficient utilization of available resources/funds. Standardized

monitoring and evaluation protocols.

This activity intends to enable Regions, Zones and Districts to enhance their capacity to communicate and

coordinate civil society including PEPFAR partners focusing on joint planning of Plans of Action, routine

communications, standardization of materials and referral and networking between prevention, and care

and treatment providers, as well as between facility and community based partners.

Finally, this activity will support improved internal planning and coordination of activities by PEPFAR

partners ensuring links between the community and facility-based pathways of care across the care

continuum of prevention, care and treatment.

Activity 2)

PEPFAR Ethiopia faces multiple requests for support in the development and review of Ministry of Health

processes and documents. These requests result in USG deploying significant technical specialists 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's USG team and its partners -- particularly individuals with these skill

sets -- make responding to these requests difficult. While PEPFAR has discussed supporting the national

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

HAPCO and Regional Health Bureaus (RHB) has increased as the two programs become more

interdependent.

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

and RHB implementation of GFATM resources, and to provide needed technical support to supplement

Activity Narrative: PEPFAR staff that are frequently called to contribute to MOH and GFATM-related technical processes. The

activity will provide support to national and regional level HAPCOs and health bureaus as GFATM block

grants are received from the Federal government. The Regional Health Bureaus and Regional HAPCOS

continue to experience serious capacity constraints and require leadership and management support.

Additionally, this activity will support GFATM proposal development, management and costing exercises

supporting the national HIV/AIDS effort.

Building upon the approaches and participatory approaches developed by Management Sciences for

Health, the Leadership, Management and Sustainability (LMS) project is a cooperative international

partnership that strengthens the leadership, management and systems of public health administration

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 mobilization and

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

USG support to the Global Fund Country Coordinating Mechanism activities through the World Health

Organization, 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 HIV Donors Forum partners including Italian Cooperation and the Department for International

Development.

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 the CCM and GFATM resource

management by the Principal Recipient);

Program and Financial Management;

Monitoring and Evaluation.

The primary emphasis of this activity will be to strengthen management systems for Ethiopian public sector

and civil society 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. PEPFAR Ethiopia's ability to respond to MOH requests for management and technical

support, particularly related to GFATM and national processes, will be substantially enhanced.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18536

Continued Associated Activity Information

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

System ID System ID

18536 18536.08 U.S. Agency for Management 7613 7613.08 GFATM $2,028,884

International Sciences for Technical

Development Health Support

Table 3.3.18: