The Southern Nations Nationalities and Peoples Regional Health Bureau (SNNPRHB) is a local government entity that is responsible for all health care and related activities in the Southern Nations Nationalities and Peoples Region. The SNNPRHB is working on building its administrative and technical capacity to design, implement, oversee, coordinate, monitor and evaluate the delivery of comprehensive HIV prevention, care and treatment services in the administrative region. The SNNPR region covers a total population of over 15 million people and has very diverse ethnic, cultural and language groups within the region. It has a low HIV prevalence rate with an estimated HIV prevalence of 0.8% in 2013 (compared with the national HIV prevalence of 1.3%). However, the urban prevalence is 2.0% in contrast to 0.5% for the rural population. SNNPRHB will work closely with the respective HHS/CDC international technical assistance (TA) partner to strengthen its capacity and the health systems in the administrative region for a purposeful and planned transition of the program activities. The SNNPRHB will work in collaboration with HHS/CDC Ethiopia and the Federal MOH in Ethiopia to achieve its program outcomes. All activities implemented under this program will follow current national policies and guidelines for HIV service delivery. SNNPRHB will work to scale up the program and improve the quality of HIV services in the region. It will document its activities, share best practices and undertake monitoring and evaluation of the program. Through this program, SNNPRHB will support and strengthen the monitoring and evaluation of the program activities and site level data use for program improvement. As a PEPFAR partner, SNNPRHB will work towards the implementation of GHI.

The SNNPRHB will recruit or assign a care and support focal person who will oversee the implementation of care and support related activities and assist with the planned transition of adult care and support activities being implemented by the international implementing partner. In COP 2013, the SNNPRHB will:

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.

Oversee implementation of cervical cancer prevention service at Yirgalem, Wolaita Sodo and Hawassa university hospitals.

In COP 2013, the SNNPRHB 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 SNNPRHB 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 core trainer teams 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, local university staff, and partners to 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 core activities to be undertaken by the SNNPRHB 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. The SNNPRHB will gradually take over the implementation support for pediatric care and support services previously provided by Johns Hopkins University in facilities in the region. In COP 2013, the SNNPRHB will work with its international TA partner to identify other high case load sites and further expand services as appropriate. In COP 2013, the SNNPRHB will:

Support local universities in the region to establish training units and transition in-service training.

Conduct site-level mentoring, minor renovations, and provide IEC materials/job aids and supplies.

Ensure rollout, implementation, and monitoring of a pediatric preventive care package.

Ensure availability of pediatric drug formulations, utilization of cotrimoxazole prophylaxis, TB screening, malaria prevention and treatment (including ITNs), prevention and treatment of diarrhea, linkages to immunization programs, Isoniazid prophylaxis (IPT) for HIV positive children, and promote healthy hygiene and safe water interventions.

Promote interventions for psychosocial care and support for children and adolescents addressing psychological and spiritual needs as well as support for end of life care.

Ensure that sites implement early infant HIV diagnosis in all PMTCT sites using appropriate techniques (e.g., dried blood spot), and all eligible HIV positive children are promptly referred for ART care.

Ensure nutritional counseling/assessments are completed at all entry points targeting pediatric patients and HIV exposed/infected infants through training and site-level mentoring; liaise with partners to ensure availability of supplemental feeding products.

Strengthen internal/external referral linkages to identify and link HIV positive children, orphans and vulnerable children with family, social, and adherence support.

This is a new activity with emphasis on ownership and strengthening the capacity of laboratories to be able to better diagnose, build capacity and sustainability in the region. The laboratory support activities of the Regional Laboratory under SNNPRHB in COP 2013 will include:

Procuring laboratory 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, train laboratory personnel on sample referral, monitor the network performance, as well as procure 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 laboratory 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 laboratories 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.

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 continue to report on PEPFAR indicators for the region and to utilize data at site level and regional level to inform evidence-based planning and quality improvement. The SNNPRHB will manage the transition of key technical and managerial activities away from its international TA partner 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 SNNPRHB will:

Transition key technical and managerial activities away from the international TA partner to the Regional Health Bureau.

Assign M&E/HMIS staff and HIT/Data clerks that will be trained in HMIS and HIV/AIDS data management and take over full responsibilities from existing international TA partners working on this.

Use site level performance data for informed decision making.

Work together with the international TA partner to take over the reporting on PEPFAR performance indicators.

Document its activities, share best practice, undertake monitoring and evaluation of the program and 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 SNNPRHB. 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 SNNPRHB 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 SNNPRHB 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), 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 SNNPRHB will work closely with the USG and other partners to avoid programmatic duplication and to synergize activities for optimal use of resources.

The SNNPRHB blood safety program will implement the following activities in COP 2013:

The SNNPRHB 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 SNNPRHB 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 SNNPRHB has set a target of collecting, testing and distributing 12,000 units of blood in COP 2013.

The SNNPRHB 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 SNNPRHB on blood safety, approximately 50 professionals drawn from the SNNPRHB and 3 blood banks 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, SNNPRHB 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 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 SNNPRHB 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 SNNPRHB 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 SNNPRHB 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 SNNPRHB 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 will 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 region.

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 SNNPRHB, 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 SNNPRHB, to support health facilities 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 SNNPRHB 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 SNNPRHB will 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, HIV testing and counseling (HTC) services in health facilities of SNNPR were supported by JHU TSEHAI. In COP 2013, in collaboration with its international TA partner, some of the HCT program activities will be transitioned to the SNNPRHB. In COP 2013, the SNNPRHB 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 laboratories.

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 the USG international TA partner.

Since 2005, JHU-TSEHAI has been supporting the SNNPRHB to strengthen the 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 SNNPRHB to ensure sustainability and local ownership of the STI/HIV program by the region:

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

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

Strengthen STI screening of PLWHAs at the ART clinics, and providing HCT, family planning, and ANC services in public hospitals and health centers in the region.

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

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

Support the capacity of public health facilities in SNNPR to print and distribute STI job aid materials (national STI guideline, wall chart and flipchart) and IEC/BCC materials on STI/HIV prevention.

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

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

In COP 2013, the SNNPRHB will:

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

Support the roll 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+ 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 with PMTCT programs.

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 SNNPRHB will strengthen its capacity to plan, implement, coordinate and support, monitor and evaluate the provision of comprehensive HIV/AIDS services within the SNNPR region. The activities include developing a costed strategic plan, building human resources capacity through in-service training, retention of trained health providers, site supportive supervision, clinical mentoring, use of site level performance data and quality improvement, strengthening laboratory systems including sample referral, minor renovations, and restoration of basic facility functions. The SNNPRHB will also support the catchment area meetings in the region and work to strengthen the facility ART Multi-Disciplinary Teams. It will work with NEP+ and the PLHIV associations in the administrative region to strengthen and coordinate case management program activities, with the objective of improving ART patient treatment adherence and retention of HIV patients in care and treatment services. The case management activities will also optimize functional linkages between the different services (ex. HTC and ART, TB and ART), and the referral system between different levels of facilities, including available community-based services. SNNPRHB will work with the respective HHS/CDC international TA partner to build its capacity and strengthen the health systems in the administrative region to promote a purposeful and planned transition of PEPFAR funded activities, which will ensure program sustainability and local ownership. SNNPRHB will collaborate with other PEPFAR funded partners and stakeholders for efficient implementation of the HIV program activities in the region.

In COP 13, the core activities to be undertaken by the SNNPRHB 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, SNNPRHB will identify other high case load sites and further expand services as appropriate.

In COP 2013, the SNNPRHB will:

Expand ART uptake by maximizing entry points for children testing via PITC at under-five clinics, pediatric inpatient services, TB clinics, and EPI clinics.

Strengthen family-focused HTC, care and treatment, and linkages to other services.

Expand comprehensive pediatric HIV care and treatment in the private sector.

Strengthen management of HIV-exposed and infected infants and early treatment for HIV infants per national guidelines.

Mentor health care providers to improve service quality and provide onsite updates. .

Provide training on pediatric ART, advanced learning through telemedicine, and case review sessions using local university trainers.

Involve the community in supporting uptake and adherence of HEI and pediatric patients, and link pediatric patients to OVC programs.

Provide supplies, equipment, IEC materials/job aids and minor renovations.

Collaborate with local universities to provide in-service/pre-service training and program supervision.

Implement services for adolescent groups and camps designed to provide psychosocial support; incorporate family-focused elements to increase family involvement in pediatric HIV care and adherence.

Integrate adherence supporters into pediatric ART units to ensure retention, tracking and referral for support services to available community-based organizations.

Continue monitoring and evaluation support to facilities as per national mandated standards.

Ensure utilization of quality improvement tools to identify and respond to gaps.

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

Establish strategies to integrate pediatric HIV services with other MNCH and child survival interventions.