GHARP II is a technical support contract with the goal of building national capacity to implement and lead HIV programs. The goal is to reduce HIV transmission, mitigate its impact and strengthen health systems. As such, the projects strategy has been to pilot, develop, and train people on new techniques or skills, but then to turn responsibility for ongoing implementation and monitoring of programs to national stakeholders. The condom promotion aspect will be almost fully transitioned to local distributors for example, and the guidelines and curricula that are developed have been turned over to partners for ongoing implementation (e.g. the parenting manual to the Ministry of Education, the MARPS guidelines to the National program, the nurses leadership and management curricula to the nursing schools). As skills are built within the public and private sector, recipients are engaged in conducting the work, for example, trained participants are then used to assist in planning and conducting additional trainings. The project has comprehensive monitoring and evaluation processes in place. Data is collected and reported on a monthly basis. Programmatic assessments are conducted periodically. Quality assistance visits to NGOs implementing care and support, VCT and MARPs programs are done on a semi-annual basis, while semi-annual assessments are conducted of public sector VCT and PMTCT sites. Coaching, mentoring and supervisory visits and contacts are done monthly and quarterly and program meetings are held for most of the programmatic areas. Follow up data is gathered for training and capacity building sessions and workshops are held to assess the effectiveness of the activity.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Neither3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHVCT Ministry of Health 50000 Technical assistance supportHVOP Ministry of Health 200000 Technical assistance supportMTCT Ministry of Health 50000 Technical assistance supportOHSS Ministry of Health 100000 Capacity Building support for the CCM

GHARP II will continue to work closely with the National HIV/AIDS Program (NAPS) and USAID-funded NGOs to strengthen the quality of services provided and to work towards sustainability. Regular supervisory and quality assurance visits will be conducted to the participating NGOs to ensure adherence to guidelines and standards and to provide mentoring and technical assistance as needed. A series of training sessions will be scheduled to ensure that the care and support staff has the technical and management skills needed for effective implementation of the programs. Once training is offered to the NGOs, they will begin to offer those services or workshops in the community or at the NGOs, and GHARP II will provide assistance as they roll them out to ensure quality. These include palliative care (pain management, wound care and end of life care) coordination, syndromic management for sexually transmitted infections (STIs), and stigma and discrimination. Quarterly feedback meetings will be held with NGOs and Ministry of Health (MOH) treatment site staff to improve coordination in the regions and to encourage networking. During the year, emphasis will be placed on leveraging needed resources to strengthen and expand the existing adult care and support initiatives. GHARP will support the integration of Prevention of Mother to Child Transmission (PMTCT) into care and support and will initiate steps to operationalize and evaluate integration efforts. During the year, emphasis will also be placed on enhancing the network among partners to increase uptake, reduce drop-out rates and strengthen referrals to care and treatment facilities. In so doing, GHARP aims to increase program sustainability, strengthen the health system, and improve care and support outcomes overall. This will also include linking NGOs to resources from other programs and agencies such as Ministry of Agriculture, MLHSSS and private sector organizations and companies such as Food for the Poor. As part of our approach to enhance economic empowerment, eligible clients will be linked to training programs, loans, and will be eligible to access revolving funds at the NGOs. GHARP II will continue to provide technical support to NGOs in implementing these activities, and will continue to look for additional resources for the NGOs. During the year guidelines and standards will be reviewed and updated, including the economic eligibility criteria and the Community-level Home and Palliative Care (CHPC) referral guidelines and support group guidelines.

In FY12, GHARP II will continue to work closely with National AIDS Program (NAPS) and USAID-funded NGOs to strengthen the quality of services provided and to work towards sustainability. To this end, supervisory and quality assurance visits will be conducted to the participating NGOs to ensure adherence to guidelines and standards and to provide mentoring and technical assistance as needed. A series of training sessions will be scheduled to ensure that the care and support staff has the technical and management skills needed for effective implementation of the programs. Once training is offered to the NGOs, they will begin to offer those services or workshops in the community or at the NGOs and GHARP II will provide assistance as they roll them out to ensure quality. These include parenting skills workshop and other activities aimed at strengthening parent/guardian capacity and increasing their participation in the delivery of services. Quarterly feedback meetings are held with NGO and NAPS staff to improve quality of services and promote networking and coordination. During the year, emphasis will be placed on leveraging needed resources to strengthen and expand the existing OVC initiatives. GHARP II will work with the MLHSSS to ensure that child protection is emphasized and to improve the NGOs capacity to provide effective psychosocial support and adherence support to orphans and vulnerable children. Members of these OVC subgroups/those most at risk of HIV infection and infecting others will be informed about HIV/AIDS and equipped to embrace healthy lifestyles. NGOs will continue to be linked with resources from other programs and agencies such as Ministry of Education, MLHSSS, and private sector companies for obtaining school uniforms and other support that is available to HIV-affected older OVC. As part of our approach to enhance economic empowerment, eligible older OVC will be linked to training programs and other educational opportunities to improve their economic standing. During the year GHARP will work with implementing partners to drafted/review /update guidelines and standards, including child protection policies and recording and reporting of cases of abuse. A service providers manual will be adapted within the context of the NPA and SOP and NGOs with follow up training in its use essential for comprehensive care for orphans and other vulnerable children. GHARP will collaborate with MLHSSS, MOH, NAPS and other partners to formalize SOPs for referrals from the respective sites/agencies.

GHARP II will continue to work closely with the monitoring and evaluation (M&E) staff at National AIDS Program (NAPS), the Maternal and Child Health (MCH) Division, the USAID-funded NGOS, and Community Support and Development (CSDS) to improve the quality of reporting and, ultimately, programming. GHARP II will continue to work with CSDS to provide technical assistance to the NGO in data collection and reporting and will participate in data quality assessments and provide on-site training to NGO M&E staff. GHARP II will help organize and conduct the annual NGO M&E workshop. Technical assistance in M&E will also be provided to NAPS and the MCH Division at Ministry of Health (MOH) as needed and as requested. To increase the strategic information available to inform programming, GHARP II will collaborate with NAPS on two national assessments; one on the barriers to condom use among sex workers, and the other on health care workers attitudes towards PLHIV. Both reports will provide key information that has not been previously available, and will be used to strengthen GHARP II programming. Another key contribution to the strategic information available for programming will be the mapping of MARPS hotspots, which will be combined with service delivery sites, condom outlets, and other key social and community services. Once finished, the GIS database will be delivered to NAPS, whose staff will be trained in using, maintaining and updating the database. GHARP II databases on key activities, including people trained during the project on the various program areas, will also be handed over to the national response so they will be aware of and utilize the skills and resources built during GHARP II. Programmatic assessments of the GHARP II service and delivery activity, Positive Health Dignity and Prevention (PHDP), will be conducted and new tools will be implemented and/or strengthened to assist in reporting and to document processes, e.g. to improve referrals, track clients participating in economic development, etc.Quality assurance (QA) is an area of emphasis during this year, with standardized QA tools and processes being developed for all the main technical areas of GHARP II. QA assessments will be conducted semi-annually, and will include record reviews, staff and client interviews, and observation as ways of gathering information on service delivery quality. Once finalized, these tools will be handed over to the NGO and to NAPS so that they can be used to continue to monitor quality improvement.

GHARP II incorporates health system strengthening into all of the technical area activities. Activities outside of those technical areas (PMTCT, VCT, HVOP, HVSI, HBHC, HKID) focus primarily on building the organizational and management capacity of NGOs and selected public sector partners. In the current year, GHARP II will continue to work with the Management and Organizational Sustainability Tool to diagnose areas of strength and weakness within the few remaining NGOs who have not previously conducted this workshop. Action plans will be prioritized and developed, and GHARP II will provide ongoing support and TA to ensure that these are moving forward. GHARP II will continue to follow up with the NGOs and public sector partners who have undergone the MOST in previous years and to provide TA or other support. GHARP II will also continue to provide technical assistance in policy development, assisting partners develop, implement and follow up on policies; this will include assisting GBCHA conduct a policy workshop for their member companies, and providing support for the S&D policy implementation at the MOH. The institutionalization of the leadership and development program will be a key focus for the year. GHARP II will conduct an assessment of the program, identifying graduates and following up with them to gather information about success they have had, as well as how we can improve the program and enhance sustainability. Additional Leadership Development Programs will be offered to MOH staff in selected Administrative Regions and programs (NAPS, TB) to build their planning and management capacity. The LDP Core Group and the regional networks will be convened for their annual meetings, and will be engaged in the process of developing a sustainability plan. GHARP II will also meet with key staff at the MOH to map a way forward to support the Core Group and network as well as to plan for using the trained staff to support the work in the MOH as trainers, mentors and coaches.The adapted nursing school short course will be piloted, and the curricula and student and teacher manuals will be finalized and handed over to the MOH. GHARP II will continue to follow up with the Health Education department to ensure that the curriculum is included into the regular curricula for nurses, and that they budget for the materials and supplies needed. During this process, GHARP II will also supervise nursing tutors in giving the course and will certify those that successfully complete this, thus building a cadre of staff with the skills and experience to deliver the LDP training.NGOs will receive assistance to broaden their financial resources base by going through the Business Planning for Health workshop, where they will learn to identify services they can provide and develop business plans for those services. Following the completion of the program, GHARP II will provide ongoing support and will track the success of the program in improving the financial sustainability of the NGOs. GHARP II will continue to provide technical assistance to NAPS to improve their HR management. TA will be provided in developing a performance management process, which will include an employee satisfaction survey and updating of job descriptions. Once the HS 2020 report is made available, and the MOH decides how to implement, GHARP II will remain available to provide TA as appropriate. TA will also be provided to the Global Fund CCM as well.

GHARP II will continue provide key technical inputs to support the national voluntary counseling and testing (VCT) program and work closely with NAPS to ensure quality in counseling and testing. This will be done through the finalization and implementation of a VCT quality assurance system and efforts to improve the quality of counseling and to improve the referral system to better ensure that HIV+ people enroll at the care and treatment sites. Technical support will be provided to standardize and expand case management of HIV+ people when they reach the VCT setting. Communication is an important and often overlooked area in VCT, although it is the essence of counseling. Training will be provided to counselor testers to improve their communication and counseling skills and thus their ability to support clients with other issues, such as substance abuse, domestic violence, stigma and discrimination, etc. To ensure focus on most at risk populations, GHARP II will provide technical support to the selected VCT sites which include the USAID-funded NGOs. This assistance will help identify effective strategies to reach these populations, get them into appropriate care and treatment or link them to other support as needed. Mobile testing will be conducted with logging and mining enterprises to reach the workforce and the surrounding communities. Innovative efforts to reach men who have sex with men (MSM) and commercial sex workers (CSWs) and to get them into testing will be developed and recommendations made to National AIDS Program (NAPS) regarding how to continue the programs. The selected sites will be visited regularly to assess the quality of services and to provide mentoring and supportive supervision as staff work toward reaching those most at risk. Modifying guidelines on prioritization of retesting MARPS will be done via VCT steering committee meeting. Technical advice and assistance will also be provided in exploring new strategies such as home counseling and testing. In the last year of the project, there will be emphasis on completing and handing over protocols, guidelines and other tools, and transitioning much of the technical and quality assurance support that GHARP II currently provides to the national program. This includes development and implementation of case navigation protocol at VCT sites to address challenges in the weak referral of HIV positive persons from VCT sites into HIV Care and Treatment Sites; and review and update of the VCT National Curriculum to meet international standards by inclusion of PMTCT guidelines.

Significant attention will continue to be placed on providing appropriate services and products to high-risk groups, including men who have sex with (MSM), community sex workers (CSWs), miners and loggers and the communities surrounding mining and logging camps. GHARP II will work with the National HIV/AIDS Program (NAPS) and with the USAID-funded NGOs to refine strategies to reach this population with effective behavior change messages and with referrals for services including counseling and testing. Emphasis will be placed on developing and strengthening linkages to substance use and sexually transmitted infection (STI) screening, sexual and reproductive health services, domestic violence support, and in training prevention staff to effectively provide the needed information and to ensure that the referrals happen. Guidelines for the NGOs implementing the MARPs prevention program will be finalized. GHARP II will continue to promote and develop initiatives to provide alternatives to sex work, such as job readiness training, linking to income generation opportunities in the private and public sector, and referral to micro-enterprise support through Institute of Private Enterprise Development (IPED). Outreach to miners and loggers will be coordinated through the private sector to ensure sustainability and maximize reach at low cost; this will be combined with voluntary counseling and testing (VCT) to provide a greater range of services. Community mobilization sessions will be conducted with NGOs working in the region to develop the local organizational capacity to implement and maintain prevention efforts.Access to condoms is a critical element of HIV prevention program. To this end, the condom distribution program to non-traditional retailers will be continued, but through the private sector. During this year, private sector condom distributors will be brought on board to supply retailers, and technical assistance will be provided to ensure that this is effectively being transitioned.Activities to decrease stigma and discrimination (S&D) in the health sector will continue, with NGO staff taking the lead. They will be trained to conduct sensitization workshops with health facilities in their regions, and then to provide ongoing support with policy development and implementation of plans to decrease stigma and improve access. Technical assistance will be provided to NAPS and the MOH to develop and implement the non-discrimination policy throughout the MOH.All activities are coordinated with NAPS and with civil society stakeholders; during the year the documentation will be consolidated and transitioned to appropriate partners (private sector and NAPS for condom, NAPS for MSM and CSW, private sector for loggers and miners, etc.). GHARP II will continue to refine the pilot of the prevention with positives program, now called the Positive Health, Dignity and Prevention (PHDP) program, as internationally recommended. A PHDP manual has been developed and will be finalized in the 2012 after the development of associated job aids and tools. During the year, programmatic research will be conducted to provide input for improving the program as well as to provide evidence as to the effectiveness of the program.

GHARP II will continue to collaborate with the MCH Division of the MOH to improve quality of PMTCT services. Site visits will be conducted to assess compliance with the national guidelines, and technical assistance and job aids will be shared at those sites to ensure the appropriate knowledge and tools are present. GHARP II will continue to work with the Maternal and Child Health Division to identify problems with drug availability and use in labor and devlivery wards and will identify approaches to address these. Technical assistance will be provided to help diagnose problems with monitoring and evaluation reporting from the sites, and to identify potential solutions. Assistance will be provided to administer MCH supervisory tool at GHARP II-supported sites to improve quality of care at these sites by identifying challenges and issues and providing technical advice to overcome these challenges. Quality assurance tools will be developed and implemented to assess quality of services at the clinics and to monitor improvement. GHARP II will explore ways to strengthen and improve management of the PMTCT sites, including leadership and management training, and ways to improve referrals from the sites to the care and support services and treatment sites post-delivery. A TOT was recently conducted, and during this year GHARP II will work with those individuals to ensure they are using the skills they learned, involve them to a greater extent in monitoring quality of services, providing support to other clinic staff, and also help them build their skills in training, management and in clinical aspects of PMTCT. Collaboration with NAPS, NGOs, and other stakeholders will be strengthening to promote the use of PMTCT services within various communities and regions. The aim of these approaches is to increase program uptake, and assure appropriate follow-up, counseling, and treatment to clients before, during and after pregnancy. Technical assistance will be provided in development/revision of appropriate tools and resources for PMTCT, including posters, job aids, and a pocket card of the PMTCT guidelines, which will build their capacity in developing such materials on their own. GHARP II will also continue to work with the medical and pharmacy councils to provide continuing education credits on managing HIV+ women during pregnancy; this will include identifying and training local clinicians or health workers to deliver the new PMTCT training materials. This would be most pertinent in ensuring that the one-day training focusing on doctors/pharmacists is made available in the various regions of Guyana.