This is a continuing activity. The Oromia Regional Health Bureau (ORHB) was previously a sub-grantee under Columbia University ICAP (CU ICAP) to build its capacity to plan, implement, coordinate, and monitor HIV/AIDS activities and is now a prime partner. The ORHB is a government institution and oversees all public sector health care within the Oromia region (population 29 million). ANC HIV prevalence was 1.7% in 2009 and the number of PLHA last estimated at 80,000. The goal of the ORHB HIV/AIDS program is to prevent new HIV infections by increasing access to and improving quality of a comprehensive package of HIV/AIDS services within the region. The program will be linked with community-level activities. ORHB will leverage funding from other sources and activities will be coordinated with other stakeholder activities to maximize cost and reduce duplication of effort. With COP2011 funding, one vehicle was purchased at a cost of US $40,487 and under COP2012 additional vehicles will be rented for the purpose of coordinating and monitoring activities and services. The ORHB program supports the goals of the GOE's National Strategic Plan (SPMII) and is aligned with the goals of the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. In addition, the ORHB program supports the GOEs national efforts to address the Human Resources for Health (HRH) issues in Ethiopia. ORHB has in place a system to routinely monitor and regularly report on program performance. Additional technical assistance will be provided by Columbia University-ICAP to further support ORHBs capacity to implement these activities solely by itself in the long-term.

The Oromia Regional Health Bureau will recruit or assign a care and support focal person who will oversee the implementation of care and support related activities, and take over the adult care and support activities currently being implemented by the CU-ICAP. In COP 2013, the ORHB will:

Strengthen the intra-facility and two-way referrals and linkages between health facilities and community-based organizations for care and support services.

Harmonize work with community-based organizations (CBOs) like OSSA, support involvement of CBOs in health facilities multi-disciplinary team and catchment area meetings, and use CBOs and urban health extension workers to trace and link lost to follow-up PLHIV.

Intensify prescription of co-trimoxazole prophylactic therapy (CPT) for eligible PLHIV, and consider CPT as one of the quality monitoring indicators, and review its performance regularly.

Provide nutritional assessment and counseling services and provide nutritional support to those malnourished PLHIV in collaboration with partners working on nutritional support.

Integrate mental health services into the chronic care unit or link PLHIV who need mental health service to psychiatric clinics.

Strengthen PwP prevention messages and services.

Strengthen pain assessment and management service for PLHIV and also improve their access to pain medication, including morphine.

Ensure training, distribution and utilization of basic preventive care package components.

Oversee implementation of the cervical cancer prevention services at Asela University, Nekemt, and Bishoftu hospitals

In COP 2013, the ORHB will strengthen its capacity to support and monitor TB/HIV program and service integration in a sustainable manner through training and integrated mentorship activities and ensuring quality of TB/HIV care.

In COP 2013 the ORHB will:

Develop a costed strategic plan for TB/HIV program support as part of the comprehensive HIV/AIDS program plan.

Strengthen TB and HIV control program coordination and integration at regional and sub-regional health care structure levels.

Undertake assessment of the TB and TB/HIV program to identify key program gaps and focus areas for the regional TB control program.

Strengthen TB program management and human resource capacity at regional and sub-regional levels through training of TB and TB/HIV control program staff.

Undertake regular supportive supervision and review meetings to monitor the TB/HIV programs.

Organize a pool of a core team of trainers for comprehensive TB-Leprosy, TB/HIV and MDR-TB training at the regional level.

Organize regional TOTs and in-service trainings on comprehensive TB, TB/HIV TOTs in collaboration with local universities and partners.

Organize mentorship teams composed of RHB, health facility and local university staff; in collaboration with partners, undertake mentorship of the comprehensive TB and TB/HIV control programs in health facilities in the region

Undertake TB and TB/HIV related program evaluations.

Strengthen TB diagnostic services and EQA in collaboration with EHNRI, regional laboratories, and partners.

Strengthen patient referral networks across TB/HIV delivery sites; print and distribute TB/HIV guidance documents and job aids.

Support TB and TB/HIV Advocacy Communication and Social Mobilization (ACSM) activities

In COP 2013, the Oromia RHB (ORHB) will support the pediatric care and support services across hospitals and health centers previously supported by CU ICAP in the region. While implementing the activities in collaboration with CU ICAP and the international TA partner, ORHB will gain experience in order to completely take over site level support in the Oromia region by 2015. In COP 2013, the ORHB will:

Support the development of guidelines, training curricula and standard operating procedures at the national level.

Strengthen EID service delivery as well as the intra-facility linkages required to test and identify HIV positive children, and expand the service to all PMTCT sites.

Ensure all HIV exposed and infected children/adolescents receive caring and consistent psychosocial support services, including HIV status disclosure, adherence counseling and bereavement care.

Provide on-site implementation assistance, including staff support, implementation of referral systems, and support for monthly pediatric HIV/AIDS team meetings.

Provide training in pediatric care and pediatric preventive care package support.

Provide clinical mentoring and supervision to work towards a multidisciplinary approach for care of HIV exposed and infected children, and improve quality of care.

Develop and distribute pediatric provider job aids and patient education materials related to pediatric care and support.

Integrate child survival interventions such as immunization, safe water and hygiene, micronutrient supplement, growth monitoring, and improved infant and young child feeding.

Support nutrition assessments and counseling as a routine clinical activity and coordinate with USG and other partners for provision of food products.

Promote interventions to ensure provision of appropriate pain management for infants and children.

Link families with community-based resources after discharge.

Coordinate with other partners to support safe water interventions like point of use water treatment by disinfectant and general personal and environmental hygiene.

In COP 2013, Oromia RHB/ Regional laboratory will closely work with ICAP-Ethiopiato facilitate the transition of laboratory program activities in the region. The Oromia RHB/Regional laboratory will:

Conduct baseline assessment of laboratories to be enrolled in SLIPTA, participate in SLIPTA training and mentor participating laboratories.

Procure ancillary laboratory equipment and safety materials to support laboratory accreditation through SLIPTA.

Collaborate with Adama, Haramaya, and Jimma Universities and CU ICAP to conduct training on laboratory quality management systems, laboratory management, HIV rapid testing, safety, and ART monitoring

Establish central equipment maintenance capacity through employment of equipment maintenance engineers, training of the maintenance engineers, and procurement of preventive maintenance tool kits and calibration equipments. The workshop will have the capacity to maintain ancillary equipment and conduct calibration and preventive maintenance for larger equipment.

Strengthen the Regional EQAS program and increase coverage of facilities in the region. The regional laboratory will implement process improvement informed by REQAS performance. The regional laboratory will procure equipment and supplies required for regional EQAS.

Organize regional laboratory program review meetings.

Collaborate with EHNRI to establish data management capacity (Data base) for major laboratory program areas such as training, sample referral networks, EQA, SLIPTA ,and equipment maintenance.

Closely work with EHNRI, the postal service, and CU ICAP to strengthen sample referral networks. The Oromia Regional Laboratory will train laboratory personnel on sample referral networks, and monitor network performance. The regional laboratory will procure sample transportation and storage materials to strengthen the sample referral network.

Strengthen the microbiology laboratory servicesat the regional laboratory to support referral testing, disease surveillance, and outbreak investigations in the region.

Strengthen laboratory monitoring of patients, including sample referral.

The Oromia Regional Health Bureau (ORHB) is a local government institution and is directly funded by PEPFAR to implement HIV program activities. In COP 2013, in the SI program area, the partner will support and strengthen monitoring and evaluation of the HIV program activities to be able to report on PEPFAR indicators for the region and to utilize data at the siteand regional levels to inform evidence-based planning and quality improvement. The partner will manage the smooth transition of key technical and managerial activities from CU ICAP to the Regional Health Bureau (RHB). Technical and management support includes, but is not limited to, on-site mentoring and supportive supervision, coordination of in-service training through collaboration with local universities, and implementation of a monitoring system that will result in capacity to report on PEPFAR performance indicators. In COP 2013, the ORHB will:

Facilitate a smooth transition of key technical and managerial activities to the ORHB.

Ensure M&E/HMIS staff and HIT/Data clerks will be trained on HMIS and HIV/AIDS data management, and take over full responsibility for this activity from the existing international TA partner working on this.

Use site level performance data for informed decision making.

Work together with the international TA partner to ensure a smooth transition of responsibility for the activities in order to continue reporting on PEPFAR performance indicators.

Document its activities, share best practices, undertake monitoring and evaluation of the program, and provide site supportive supervision.

Conduct regular regional review meetings.

Collaborate with the international TA partner and local universities to strengthen the M&E unit of the RHB through SI specific in-service trainings.

Implement Quality Improvement (QI) activities for HIV services and site level data use using standard tools and procedures.

This is a new activity to be implemented by regional health bureaus.

Health system strengthening remains a priority for the Government of Ethiopia (GOE) and all stakeholders in the health sector as weaknesses in the health system are critical barriers to achieving country capacity to sustain the response to HIV/AIDS over time. The goal of this program is to build the technical and managerial capacity of the regional health bureaus to successfully transition technical and management support for the implementation of comprehensive HIV prevention, care, and treatment services. In particular, this program will be geared toward supporting the implementation of strategic objective 5 (improve quality of health care), strategic objective 6 (enhance harmonization and alignment), and strategic objective 13 (improve human capital and leadership) of the GOEs Health Sector Development Program IV (HSDP IV).

In COP 2013, the ORHB will work closely with local universities to coordinate the implementation of pre- and in-service training, support the deployment and implementation of human resources information system (HRIS) at the RHB, support and coordinate the implementation of hospital reform and quality improvement programs, conduct regional joint supportive supervision with implementing partners, support regular health sector review meetings, disseminate policy documents, implementation guidelines, best practices, and evaluation findings. The ORHB will work closely with the USG and other partners to avoid programmatic duplication and to enhance synergy for optimal use of resources.

The Oromia Region Health Bureau blood safety program will implement the following activities under COP 2013:

The Oromia Region Health Bureau will manage and coordinate collection and testing of blood from voluntary non remunerated donors through static collection sites and mobile teams. Seven mobile teams will be established under the seven regional blood banks. The RHB will assist blood banks in setting up mechanisms for pre and post donation counseling, donors test result notification for transfusion transmissible infections (TTIs), and referral to health facilities for those who require clinical care. To meet the safe blood need of the rapidly expanding health care facilities in the region, the regional health bureau has set a target of collecting, testing and distributing 28000 units of blood in COP 2013.

The RHB will coordinate and facilitate training of hospital clinical staff on appropriate clinical use of blood, to ensure safety of the recipients and reduce unnecessary transfusion practices. At least one clinician from each transfusion hospital will receive a TOT training on clinical use of blood from WHO to cascade the training to clinical staff working in each transfusion hospital in the region. To build regional capacity on blood safety, about 110 professionals drawn from the RHB and 7 blood banks will be trained on blood bank management, donor recruitment, blood testing and processing by WHO and the FMOH/NBTS, in COP 2013.

Recruitment of blood donors is an important component of transfusion service. Therefore the RHB will assist the blood banks in the region in creating public awareness on blood donation and community mobilization, development, dissemination, and utilization of communication materials, including the use of different communication channels such as print and electronic media for blood donors education, mobilization, recruitment and retention. The RHB will also assist with establishinga community blood donors clubs under the auspices of each regional blood bank.

In collaboration with WHO, the RHB will roll out quality management systems to blood banks in the region and assist blood banks and hospitals in setting up a mechanism and systems for M&E of the regional blood safety program.

The RHB will also assist blood banks and hospitals to set up and maintain a cold chain system for proper storage and transportation of blood and blood products. The RHB will therefore assist with the effort to furnish the blood banks and hospitals with appropriate cold chain equipment to ensure correct temperatures for storage and during transportation of blood.

The RHB will support the establishment of blood bank hospital linkages by mapping all facilities within a 100 kilometer radius that are eligible to provide blood transfusion services and also assist blood banks and hospitals in the region to establish haemovigilance and a look back system, In addition, the establishment of transfusion committees in all transfusion hospitals in the Oromia region will be supported by the RHB.

Medical Injection/Infection Prevention (IP) procedures are important components for providing quality health care services and to prevent the transmission of HIV and other diseases. The international TA partner has been implementing various activities in health facilities under the management of theORHB, which includes technical support through training, provision of basic IP/personal safety equipment, ISS, and clinical mentoring.

In COP 2013, some of the IP and patient safety activities will be transitioned to the ORHB, to support health facilities under ORHB focusing on building IP management capacity through providing trainings, printing and distribution of IPPS guidelines, integrating injection safety and waste management practices into all OPD/IPDs in the facilities, and procuring and distributing selected standard IP commodities.

The ORHB will work closely with the health facilities under its management, other implementing agencies, and the IP committee in all health facilities, to build capacity through mentoring of clinical staff and waste handlers, ISS, and providing IP support materials. This support will include assistance with planning for cost effective, appropriate, and environmentally friendly waste management techniques at the facility level. The ORHB will also assist the health facilities to continue work on ventilation of TB wards and complete the MDR/XDR TB prevention activities. It will also assist with implementation of a continuous quality improvement assessment on the injection safety activities and closely monitor Infection Prevention and waste management activities at the facility level to identify and close gaps in collaboration with the IP committees at health facilities.

In the past, CU ICAP has supported HIV testing and counseling (HTC) services in health facilities of the Oromia region. In COP 2013, some activities of HCT program will be transitioned to the Oromia RHB. In COP 2013, the Oromia RHB HCT program will:

Support the implementation of VCT services including couples/partner and family testing and counseling, and routine HIV testing at point-of-care (POC) in all health care facilities where the service is provided.

Strengthen pediatric PITC in all entry points at all health facilities including in pediatric inpatient facilities, under five outpatient departments, therapeutic feeding units, and immunization outlets.

Work with partners to implement index case testing in hospitals and health centers.

Build human resource capacity through onsite training of health care workers on couples and individual HTC and PITC.

Strengthen systems through regular mentorship and supportive supervision to ensure quality HTC service delivery.

Support HIV rapid testing and quality assurance through regular supervision of labs.

Develop SOPs for HTC activities.

Establish stronger HTC related partnerships at the national and regional levels and provide technical and logistic support to sites implementing HTC services.

Work in close collaboration with CU ICAP.

The RHB will be provided with technical support by ICAP to carry out these activities.

The Oromia Region has a population of 27,158, 471, and an HIV prevalence of 1.3%

Since 2005, CU ICAP has been supporting the Oromia Regional Health Bureau to strengthen STI services and program activities in all the hospitals in the region.

In COP 2013, the following STI program support activities will be transitioned to the ORHB to ensure sustainability and local ownership of the STI/HIV program by the GOE:

Strengthening the capacity of HCWs in Oromia to diagnose and treat STIs/HIV. Health care providers from public health hospitals and health centers in Oromia will be trained on syndromic management of STIs.

Improving the linkage of STI/HIV / AIDS services through provision of PICT for STI clients at public hospitals and health centers in Oromia. At least 80 percent of STI patients will be tested for HIV and linked to care and treatment services.

Strengthen STI screening for PLWHAs at ART clinics, and also HCT, family planning, and ANC clients in public hospitals and health centers Oromia.

Strengthen condom demonstrations and access at the public health facilities in Oromia, particularly for STI patients and PLWHAs at the ART clinics.

Strengthen risk reduction counseling and health education for STI patients at the public health facilities in Oromia.

Support the capacity of public health facilities in Oromja to print and distribute STI job aid materials, (national STI guidelines, wall charts, and flipcharts)and IEC/BCC materials on STI/HIV prevention.

Improve access to prepackaged STI treatment kits in the public health hospitals and health centers in the region in collaboration with other partners(PFSA &PSI).

In COP 2013, the Oromia RHB will work with the respective CDC/PEPFAR international implementing partner to build its capacity, and will gradually transition PMTCT activities to strengthen local ownership and ensure sustainability of the program. It will enhance capacity of Zonal/Woreda Health Offices to support an effective transition of PMTCT services.

In COP 2013, Oromia RHB will:

Support the transition of TA for PMTCT services provided by the US-based partner to public hospitals and health centers in the Oromia region.

Support rolling out of Option B+ through training and mentoring of health care providers at facilities providing PMTCT services.

Conduct site supportive supervision, use site level performance data and implement quality improvement approaches to improve retention of HIV positive mothers and HEIs in care services.

Strengthen the capacity of Case Mangers and MSGs to improve retention of HIV+ women and family members in care and treatment services.

Support implementation of the updated PMTCT monitoring system in line with the Option B+ strategy.

Support training on safe pregnancy and FP counseling and promote integration of FP and HIV services.

Support Integration of TB Screening within the PMTCT program.

Scale-up couples counseling and partner testing, facilitate male friendly services, and establish a monitoring system related to these services.

Provide minor renovations, refurbishment, and repairs of ANC, labor and delivery rooms, and maternity wards.

Improve the referral system to ensure continuum of PMTCT care.

Support the catchment area meetings and conduct regular regional review meetings.

ORHB HIV/AIDS activities initially implemented through a sub-grant with CU ICAP are now continuing under the primary direction of the ORHB. ORHB currently oversees 224 ART sites which manage ~53,000 patients on ART. CU ICAP will continue to provide technical assistance as the ORHB assumes the lead implementer role. ORHB efforts will focus on strengthening regional and woreda health planning, coordination of HIV/AIDS activities in the Oromia region and management oversight of comprehensive HIV prevention, treatment, and care and support services. The ORHB will implement capacity building activities at different levels for sustainable HIV/AIDS service delivery. Specific activities to be implemented directly by the ORHB include improving the health network and referral system within the public sector health care system to ensure efficient delivery of the continuum of HIV care and treatment services to PLHIV in its area; strengthen catchment area meetings; establish and support full functioning ART multi-disciplinary teams in all ART delivery sites in the region; implement quality improvement activities; and improve use of site-level data. The ORHB will strengthen clinical and system mentoring and site supportive supervision activities in the region and conduct periodic evaluations to monitor service delivery at health facilities. Regional review meetings will be led by the ORHB to discuss issues and identify solutions. The ORHB will provide minor renovations, furnishings, maintenance, and restoration within health facilities. The ORHB will address HRH issues by supporting and coordinating HIV in-service training of different cadres of health providers and strengthen on-site mentoring. The ORHB will work closely with NEP+ in implementing case management to improve ART adherence and retention of HIV patients in care and treatment services, as well as strengthen linkages among facilities and with community-based organization efforts related to HIV/AIDS care and support.

In COP 2013, the Oromia Regional Health Bureau (ORHB), will build its managerial and technical capacity to manage the pediatric care and treatment program in preparation for a full transition of the support by 2015. In COP 2013, the Oromia Regional Health Bureau (ORHB) will collaborate with CU ICAP to support implementation of pediatric care and treatment services at existing facilities and initiate the service at all sites providing adult ART services.

In COP 2013, the ORHB will:

Provide technical support in the areas of family-centered HIV care and treatment, and work with the national ART Program to strengthen the growing Ethiopian pediatric HIV program.

Conduct integrated regular mentoring, supportive supervision & review meetings with stakeholders.

Use IEC/BCC materials in local languages to enhance public awareness of pediatric HIV care and treatment services.

Provide technical support with an emphasis on integrating pediatric HIV with child survival interventions, family-centered HIV care and treatment, and strengthen appropriate retention mechanisms.

Emphasize increased pediatric ART service uptake at all sites through improved entry points for children.

Expand its experience in assessing and improving quality of service to all supported facilities in collaboration with CU-ICAP.

Expand case management services to pre-ART and pediatric wards to decrease dropout rates.

Provide on-site assistance to improve medical record keeping, referral linkages, and patient follow-up.

Provide ART training in collaboration with local universities based on national guidelines.

Strengthen linkages with community support services, particularly OVC.