This is a continuing activity to enhance transition to local partners. The Dire-Dawa City Administration Health Bureau (DDAHB) was previously a sub-grantee under Columbia University ICAP (CU ICAP) to build its capacity to implement HIV/AIDS activities. The DDAHB is a government institution and oversees all public sector health care within Dire Dawa city and surrounding rural areas with a total population of 341,834. The goal of the DDAHB HIV/AIDS program is to prevent new HIV infections by increasing access to and improving the quality of a comprehensive package of HIV/AIDS services both hospital and health center-based. The program will be linked with community-level activities. Additional funding will be leveraged from other sources. The program will be coordinated with other USG partner activities to minimize cost and reduce duplication of effort. With COP2012/2013 funding, it is anticipated that one vehicle will be purchased at a cost of US$55,000 for the life of this mechanism for the purpose of coordinating facility-level HIV services in the region. The DDAHB 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 DDHAB program supports the GOEs national effort to address the Human Resources for Health (HRH) issues in Ethiopia. DDAHB 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 support DDAHBs capacity to implement these activities solely by itself in the long-term.

The Dire Dawa City Administration 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 being implemented by the international TA partner. In COP 2013, the DDCAHB will undertake the following activities:

Strengthen the intra-facility and two way referrals and linkages between health facilities and the community.

Coordinate and harmonize work with community-based organizations (CBOs) working on HIV/AIDS care and support services, and facilitate their involvement in health facilities multi-disciplinary team and catchment area meetings; 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; 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 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 services for PLHIV, and improve access to pain medication for PLHIV, including morphine.

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

Refer and link HIV positive women for cervical cancer prevention services

In COP 2013, DDCARHB 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 DDCARHB 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 13, the core activities of the Dire Dawa City Administration Health Bureau will be to 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 Dire Dawa City Administration Health Bureau, in collaboration with CU ICAP, will support pediatric services across hospitals and health centers in Dire Dawa. These services and activities will include the initial site-level assessment, training of the multidisciplinary teams, clinical mentoring, data collection and reporting, renovations and supportive supervision. In COP 2013, the DDCAHB 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.

Distribute developed pediatric health care 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.

This is a new activity that will emphasize local ownership and strengthening the ability of laboratories to support improved diagnosis, capacity building, and sustainability of laboratory activities in the Dire Dawa City Administration of Ethiopia. In COP 2013, the DDCAHB laboratory support activities will include:

Procuring lab safety materials and auxiliary equipment to support the laboratory quality improvement / accreditation process.

Selection of laboratories to be enrolled in SLIPTA as well as mentoring of laboratories that are already participating in the SLIPTA process.

Conducting training on Laboratory Quality management(LQM), laboratory leadership and management, HIV rapid testing, laboratory safety and security, and ART monitoring, in collaboration with Universities and partners.

Establishing equipment maintenance capacity through employment / training of equipment maintenance technicians / engineers, and also procurement of maintenance tool kits and calibration equipments.

Establishing an equipment maintenance workshop at a minimum, at the regional laboratory level, with the capacity to maintain auxiliary equipments, and to perform basic calibration and preventive maintenance for larger equipment.

Strengthening the Regional EQAS (REQAS) program and increasing coverage of health facilities which are participating in REQAS.

Planning and organizing regional laboratory program review meetings and follow-up activities.

Collaborating with EHNRI and other partners to establish data management capacity (data base) for major laboratory program areas such as training, sample referral network, EQA, SLIPTA and equipment maintenance.

Collaborating with EHNRI, the postal service and partners to strengthen sample referral networks, training laboratory personnel on sample referral, monitoring the network performance, as well as procuring sample transportation and storage materials.

Strengthening the microbiology laboratory service at the regional laboratory to support referral testing, disease surveillance, and outbreak investigations in the region.

Strengthening / establishing a regional lab technical working group that plans, prioritizes, undertakes and follows up on the performance of laboratory related activities in the region.

Developing / customizing laboratory related SOPs and, guidelines /manuals for labs in the region.

Strengthening the capacity of laboratories in the region (regional, sub-regional, hospital and health center) through training, guidance, procurement of auxiliary lab equipment, and mentorship in collaboration with partners.

The DDCAHB is a local government institution responsible for all health care services in the Dire Dawa City Administration. In COP 2013, the partner will support and strengthen monitoring and evaluation of the HIV program activities in order to be able to report on PEPFAR indicators for the region and to utilize data at the site and regional levels to inform evidence-based planning and quality improvement. The partner will manage the smooth transition of key technical and managerial activities away from ICAP to the DDCAHB. 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 the capacity to report on PEPFAR performance indicators. In COP 2013, the partner will:

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

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 actitivies 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.

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, DDCAHB 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, implementation guidelines, disseminate policy documents, best practices, and evaluation findings. The Dire Dawa City Administration Health Bureau will work closely with the USG and other partners to avoid programmatic duplication and to synergize activities for optimal use of resources.

The Dire Dawa City Administration Health Bureau blood safety program will implement the following activities in COP 2013:

The Dire Dawa City Administration Health Bureau will manage and coordinate collection and testing of blood from voluntary non remunerated donors through a stationary collection site and a mobile outreach team. One mobile team will be established under the regional blood bank. The Dire Dawa City Administration Health Bureau will assist the blood bank in setting up mechanisms for pre and post donation counseling, donors test result notification for transfusions, transmissible infections (TTIs), and referral to health facilities for those who require clinical care. To meet the need for safe blood in the rapidly expanding health care facilities in the region, the DDCAHB has set a target of collecting, testing and distributing 4000 units of blood in COP 2013.

The DDCAHB will coordinate and facilitate training of hospital clinical staff on appropriate clinical use of blood to ensure the safety of the recipients and reduce poor transfusion practices. At least one clinician from each transfusion hospital will receive a TOT training on the clinical use of blood from WHO to cascade the training to clinical staff working in each transfusion hospital in the region. To build the capacity of the DDCAHBon blood safety, approximately 20 professionals drawn from the DDCAHB and the blood bank will be trained on blood bank management, donor recruitment, blood testing, and processing by WHO and the FMOH/NBTS.

Recruitment of blood donors is an important component of transfusion services. Therefore, the DDCAHB will assist the blood bank in the region to create public awareness around blood donation and community mobilization, development, dissemination, and utilization of communication materials. This will also include the use of different communication channels such as print and electronic media for blood donor education, mobilization, recruitment, and retention. It will also assist with the establishment of community blood donors clubs with the support of the existing regional blood bank.

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

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

The DDCAHB 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 the blood bank and hospitals in the region to establish haemovigilance and a review system, in addition to supporting the establishment of transfusion committees in all transfusion hospitals in The Dire Dawa administrative area.

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 the DDCAHB, 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 DDCAHB, to support health facilities under DDCAHB 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 DDCAHB 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 Dire Dawa City Administration Health Bureau 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, ICAP supported HIV testing and counseling (HTC) services in the health facilities of the Dire Dawa region. In COP 2013, some activities of the HCT program will be transitioned to the DDCAHB. In COP 2013, the DDCAHB 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 national and regional levels and provide technical and logistic support to sites implementing HTC services.

Work in close collaboration with CU ICAP.

Dire-Dawa RHB will be provided with technical support by ICAP to carry out these activities.

The Dire Dawa Administrative Region has a population of 342,827, and HIV prevalence of 4.3%. Since 2005, CU ICAP has been supporting the DDCAHB to strengthen STI services and program activities in all public health facilities in Dire Dawa .

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

Strengthening the capacity of HCWs in Dire Dawa to diagnose and treat STIs/HIV. Health care providers from public health hospitals and health centers in Dire Dawa 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 Dire Dawa. 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 in Dire Dawa.

Strengthen condom demonstrations and access at the public health facilities in Dire Dawa, 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 Dire Dawa.

Support the capacity of public health facilities in Dire Dawato 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).

The Dire Dawa City Administration Health Bureau (DDCAHB) will work closely with the respective CDC/PEPFAR international partner to build its capacity, and will gradually transition PMTCT activities to strengthen ownership and ensure sustainability of the program. It will enhance the capacity of Zonal/Woreda Health Offices to support transitioning of PMTCT services effectively.

In COP13, DDCAHB will:

Support the transition of PMTCT services to public hospitals and health centers in the Dire Dawa City Administration.

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 mother 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 also promote integration of FP and HIV services.

Support Integration of TB Screening with PMTCT program

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

Support 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.

The DDHAB HIV/AIDS activities initially implemented through a sub-grant with Columbia University ICAP are continuing under the primary direction of the DDHAB. Columbia University ICAP will continue to provide technical assistance as the DDHAB fully assumes the role of lead implementer. DDHAB currently provides ART to ~4,000 patients at 11 sites. Under COP2012, specific activities to be implemented directly by the DDHAB 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 the Dire Dawa area; strengthen catchment area meetings; improve functioning of multi-disciplinary ART teams within care and treatment facilities; implement quality improvement activities; and improve use of site-level data. The DDHAB will conduct regular on-site supportive supervision to monitor service delivery at health facilities and improve functioning of health network and referral systems. Quarterly review meetings will be led by the DDHAB to discuss issues and identify solutions. The DDHAB will provide minor renovations, furnishings, maintenance, and restoration within health facilities. The DDHAB will support GOE efforts to address HRH issues in Ethiopia by supporting and coordinating HIV in-service training of different cadres of health providers and strengthen on-site mentoring. The DDAHB 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 organizations implementing HIV/AIDS care and support activities.

In COP 13, the core activities by Dire Dawa City Administration Health Bureau will be to build its managerial and technical capacity to take over the pediatric care and treatment program in preparation for a full transition of the support by 2015. Under COP 2013, Dire Dawa City Administration Health Bureau 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 DDCAHB 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 for OVC.