Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8719
Country/Region: Haiti
Year: 2009
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $1,900,000

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $300,000

SUMMARY: Management Sciences of Health (MSH), the institutional contractor for USAID's integrated

health services umbrella mechanism, will receive prevention funds to target at-risk adults and youth with

abstinence and be faithful (AB) prevention messages. These targeted efforts will continue to ensure

sustainable interventions for promoting prevention activities through the local non-governmental

organizations (NGOs) that receive funding under MSH's umbrella mechanism. Umbrella mechanisms

provide the administrative structure and management capacity to build strong local institutions and generate

involvement of local NGOs and CBOs through direct technical assistance and funding by the lead partner.

Building on past investments to strengthen the capacity of the network of health NGOs in Haiti, the USG will

provide support to include HIV/AIDS prevention into the provision of a basic package of health services for

vulnerable groups in Haiti. The NGO sub partners form a network of nearly 100 service delivery sites that

provide access to basic health services to nearly 3.2 million people. Another 30 public sector service

delivery sites are supported under this project to assist the MOH in hard-to-reach communities throughout

the country.

BACKGROUND

With last year's successful elections, the new government has signaled a strong desire to improve basic

social services throughout Haiti, including attention to HIV/AIDS prevention. The new government's program

recognizes that in order to respond to basic health needs, more efforts are required to encourage the

involvement of NGOs and the private sector. As a result, the GOH has indicated support for continuing to

forge public private partnerships in the rebuilding of Haiti's health sector and the delivery of basic services.

Many of USAID's existing NGO partners are in a strategic position to better integrate Being Faithful

messages targeted to couples, men engaging in high risk sex with multiple partners, and sexually active

youth between 15-24 years of age. Many of these NGOs already have organized programs through

mother's clubs, father's clubs, youth associations and have expressed interested in incorporating HIV/AIDS

prevention methods. Recent DHS data on HIV prevalence and behavioral determinants point to the need to

target parts of the country with the highest HIV/AIDS prevalence rates, such as Nippes, North and the North

East Regional Departments, the latter on the border with the Dominican Republic, with the most frequently

used border crossing.

ACTIVITIES AND EXPECTED RESULTS

Activity 1: A special focus will be placed on "Being Faithful" interventions which target men where they

commonly congregate, such as brothels, sporting events, pubs, clubs, community and social events. Again,

efforts will be undertaken to target USAID's network of father's clubs, as well as men through male networks

of local celebrities, entertainers, artisans, and transportation networks, Messages targeting these male

groups will reinforce themes of fidelity, partner reduction, avoidance of commercial sex and linkages to

condom outlets. The needs of HIV discordant couples will be addressed through targeted counseling and

education as well as referrals to CT. Counseling and behavior change education on prevention of

transmission for HIV positive persons, "prevention for positive" will be an integral part of all prevention

efforts. Efforts will be made to train male adult leaders and youth, to better target messages to men in

supporting behavior change and reducing the spread of HIV.

Activity 2: Many of these organizations work in socially and politically unstable "hot spots" (areas

inaccessible due to violence and instability in the past few years). Efforts will be made to create synergies

with USAID's education, food security and economic growth initiative to increase prevention messages and

positive behavior change among high risk groups. In light of Haiti's economic instability and the high

numbers of youth engaging in transactional sex for survival, linkages will be made with USAID job creation

program to target 15-24 year olds. Special efforts will be made within this population to increase awareness

of personal risk, reduce the number of sexual partners through be faithful programming, address

transactional sex and the risks involved. Particular focus will be placed on providing women with access to

programs that address violence and sexual coercion. Referrals will be made to urge counseling and testing

and linkages for care and support.

ACTIVITY 3: Support will be given to youth focused NGOs to accelerate abstinence and being faithful

programs for youth, most of them out of school and working in the informal sector. It is anticipated that

these youth will be identified from the existing NGO network receiving funding under MSH, such as youth

groups and clubs, local musician networks, sporting associations, local civic associations and community

groups. Many of these networks are in security "hot spots" (areas inaccessible due to violence and

instability in the past few years) and are targets for USAID's new three-year strategy to support the

Government of Haiti in its rebuilding efforts. It is anticipated that civil society groups will promote youth in

the planning, design and implementation of training and outreach efforts in order to maximize youth

ownership and buy-in. Following training, youth peer educators will conduct outreach activities during

community events such as carnival, World AIDS Day, sporting tournaments, youth camps, music jamborees

and activities frequented by youth. Sexually active youth will be referred to condom outlets, CT, and

linkages to other USAID reproductive health services, including family planning.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19564

Continued Associated Activity Information

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

System ID System ID

19564 19564.08 U.S. Agency for Management 8719 8719.08 Leadership, $1,250,000

International Sciences for Management

Development Health and

Sustainability

Project

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $400,000

SUMMARY: Management Sciences for Health (MSH) was awarded USAID's new basic health services

contract in 2007 for a period of three years, thus allowing them to continue the work of its Non-

governmental Organization (NGO) health service delivery network in prevention education to target groups

at high risk for HIV/AIDS. The NGO sub-partners form a network of nearly 100 service delivery sites that

provide access to basic health services to nearly 3.2 million people. Another 30 public sector service

delivery sites are supported under this project to assist the MOH in hard-to-reach communities throughout

the country. USG will support these civil society NGOs that can be mobilized to quickly launch condom

outlets and other prevention activities in some of the insecure "hot spots" targeting underserved most at risk

population (MARP) groups. Prevention activities will target parts of the country with the highest HIV

prevalence rates and support NGOs and CBOs in the network to target these high risk groups. The 2005

Demographic and Health Survey (DHS) data suggest that while knowledge in ways to prevent HIV

transmission is high—over 90%, condom use is low—30% and accompanied by high risk sexual activity.

Partners will work with marginalized communes, peri-urban areas and secondary cities where major

pockets of high risk activity take place to institute additional condom outlets. Training of network members

will include building skills in risk self assessment, condom negotiation, counseling and testing and linkages

to CT, raising issues related to gender and sexual violence and changing social norms. In 2009, NGO

partners will sharpen the targeting of prevention efforts to five key MARP groups: sexually active youth

aged 15 to 24; couples; men engaging in high risk sex; and migrant/border populations.

BACKGROUND: Historically there have been only a few strong and widely recognized Haitian NGOs with

the managerial and technical capacity to implement effective prevention and behavior change programs

targeting specific high-risk populations. In FY 2006, PEPFAR leveled the playing field by expanding the use

of the USAID umbrella NGO mechanism, the previous MSH contract, to strengthen the capacity of new

smaller, nascent Haitian NGOs, CBOs, Faith-based Organizations (FBOs) and private sector entities to

contribute to prevention efforts for targeted populations that typically engage in high-risk behavior. With the

recent successful elections, the new government has signaled a strong desire to improve basic social

services throughout Haiti, including attention to HIV/AIDS prevention and supporting public private

partnerships in the rebuilding of Haiti's health sector. The condom activities and other prevention efforts in

this activity are in line with this vision. Sub-partner NGOs working under the USAID umbrella mechanism

will target parts of the country with the highest HIV prevalence rates, such as Nippes, the North and the

North East Regional Departments, the latter on the border with the Dominican Republic, with the most

frequently used border crossing.

ACTIVITIES & EXPECTED RESULTS

Activity 1: A special focus will be placed on interventions which target men where they commonly

congregate, such as brothels, sporting events, bars, clubs, community and social events. Special efforts will

be made to reach unemployed young men, street traders, members of the informal sector, and divorced

men. Efforts will be undertaken to target USAID's network of father's clubs, as well as men through male

networks of local celebrities, entertainers, artisans, and transportation networks. Messages targeting these

male groups will reinforce themes of fidelity, partner reduction, avoidance of commercial sex, gender

violence, alcohol and drug use, as well as condom use. The needs of HIV discordant couples will be

addressed through targeted counseling and education as well as referrals to CT services and HIV care and

treatment counseling on prevention of transmission for HIV positive persons, stigma reductions and

"prevention for positive" will be an integral part of all prevention efforts. Linkages will be made with the

USAID-supported social marketing program to increase condom use among MARP groups.

Activity 2: Many of these organizations work in socially and politically unstable "hot spots" (areas

inaccessible due to violence and instability in the past few years). Efforts will be made to create synergies

with USAID's education, food security and economic growth initiative to increase prevention messages and

positive behavior change among high risk groups. In light of Haiti's economic instability and the high

numbers of youth engaging in transactional sex for survival, linkages will be made with USAID job creation

program to target 15-24 year olds. Special efforts will be made to better target 15-24 year olds to increase

awareness of personal risk, reduce the number of sexual partners, address gender and transactional sex

and increase correct condom use. Particular focus will be placed on providing women with access to

programs that address violence and sexual coercion. Referrals will be made to urge counseling and testing

and linkages for care and support.

ACTIVITY 3: MSH will ensure continuous supply of condoms within areas of each department that has

limited condom service delivery available. Based on the results of the situation analysis performed in FY 08,

MSH will work with the 40 community members and organizations that were identified as willing to promote

condom use and manage condom outlets. This initiative will be linked to other PEPFAR partners conducting

social marketing of condoms or free condom distribution and the Ministry of Health (MOH).

New/Continuing Activity: Continuing Activity

Continuing Activity: 19568

Continued Associated Activity Information

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

System ID System ID

19568 19568.08 U.S. Agency for Management 8719 8719.08 Leadership, $500,000

International Sciences for Management

Development Health and

Sustainability

Project

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $250,000

ACTIVITY UNCHANGED

SUMMARY: The Leadership, Management and Sustainability (LMS) Program will receive support from

USAID to work with partners to develop their capacity to serve People Living with HIV/AIDS (PLHWA). LMS

will continue to work with the Maison l'Arc-en-Ciel (MAEC) to expand the number of OVCs and PLWHA

families impacted by MAEC's outreach program to metropolitan Port-au-Prince's children infected/affected

by HIV/AIDS and to build on a model MAEC has begun to develop for community mobilization using a large

group of community-based organizations (CBOs) in the Frères and Croix des Bouquets areas. Through this

support, MAEC will continue to increase its caseload from its present 286 families and 572 children/youth to

367 families and 873 children/youth through identification and referral by MAEC partners such as Cornell-

GHESKIO. MAEC will create support groups of PLWHA and non-infected CBO volunteers for its families in

these two zones. The families will receive tangible services such as health care, training, nutritional

support, and school fees as well as participate in MAEC's peer home visiting program that has had an

important effect on bolstering self-esteem and reviving hope among its families. This support offers MAEC

the opportunity to extend its model into Cité Soleil, probably the neediest area in the exceptionally resource-

poor country. In summary, the MAEC activities consist of two main activities: care and support of OVCs

and their families; and a community-level partnership with international, local, and CBOs to support PLWHA

families while working to prevent HIV infection and reduce stigmatization. LMS will help strengthen the

leadership and management skills of the MAEC support groups and increase the involvement and capacity

of the staff towards a common sustainable goal and lasting impact of the program. This program is funded

through 75% HKID and 25% HBHC funding, and a description of these activities can be found under both

program areas.

In addition, LMS will continue support to FOSREF to provide access to services for sexually transmitted

infections (STIs), HIV/AIDS, and sexual and reproductive health, at the institutional and community levels,

to the youth of Cité Soleil. The program plans to reduce by 50% the HIV prevalence in the population of

Cité Soleil and particularly among the youth in this area. In addition, the program will offer other alternatives

to the youth of Cité Soleil. This program is funded through 50% HVOP, 25% HVCT, 15% HVAB, and 10%

HBHC funding, and a description of this activity can also be found under those program areas.

BACKGROUND: MAEC is a Haitian non-profit NGO that began work in the Port-au-Prince area in July

1996 with the opening of the first residential care and treatment facility in Haiti for children orphaned or

affected by AIDS. MAEC began a non-residential program in 1998 and provided monthly medical visits and

other activities for children as well as a dry food ration for the family and regular home visits by social

workers and auxiliary nurses. The participating families live in some of the most HIV-affected areas of the

country, the metropolitan Port-au-Prince communes of Carrefour, Croix des Bouquets, Cite Soleil, Delmas,

Pétionville (including Frères), Port-au-Prince, and Tabarre. Families living in an impoverished area with at

least one HIV+ child or a child who had lost at least one of his or her parents to the disease were eligible to

receive care. As the program has expanded since 2002, through partnerships with Plan Haiti, FHI, and

UNICEF, MAEC was able to add an outreach center that houses classrooms for children and heads of

families, provides medical and psychological consultations as well as cultural activities, etc. Food is

provided by partners CRS and WFP. Community mobilization activities were added through the use of

elected mothers who were trained and able to provide home visits even during times of instability in the

country.

FOSREF has a mandate from the Ministry of Health and Population (MSPP) to deliver youth-focused sexual

and reproductive health and HIV/AIDS services to youth nationwide. In Haiti, youth, who represent more

than 50% of the population, are the most vulnerable groups for HIV/AIDS and unwanted pregnancies, with a

high incidence of clandestine abortions. In this context, FOSREF has identified key cities in the country

where specific programs for youth must be implemented to meet the unmet needs of young people for

sexual and reproductive health and HIV/AIDS prevention. To date, FOSREF has created and implemented

a network of 15 youth centers in many cities. During the last four years, FOSREF has identified areas in the

marginalized segments of the large cities, particularly in the Metropolitan areas of Port-au-Prince, where

there are no existing youth services. Cité Soleil is one of these areas, representing one of the largest

challenges in terms of unmet needs of youth for sexually transmitted infections, HIV/AIDS, sexual violence,

and other sexual and reproductive health matters. Young people have been victims of gang activities that

have reduced them to an almost hostage-like situation. Based on recent official information from the

Ministry of the Interior, the Director of the National Police, and from the UN Peace Keeping Forces

(MINUSTAH), the security situation in Cité Soleil has improved enough to begin to target services to the

population in this area.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19577

Continued Associated Activity Information

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

System ID System ID

19577 19577.08 U.S. Agency for Management 8719 8719.08 Leadership, $350,000

International Sciences for Management

Development Health and

Sustainability

Project

Table 3.3.08:

Funding for Care: Orphans and Vulnerable Children (HKID): $450,000

SUMMARY: The Leadership, Management and Sustainability (LMS) Program will receive support from

USAID to work with partners to build their capacity to provide services to Orphans and Vulnerable Children.

Specifically, LMS will continue to work with the Maison l'Arc-en-Ciel (MAEC) to expand the number of OVCs

and PLWHA families impacted by MAEC's outreach program to metropolitan Port-au-Prince's children

infected/affected by HIV/AIDS and to build on a model MAEC has begun to develop for community

mobilization using a large group of community-based organizations (CBOs) in the Frères and Croix des

Bouquets areas. Through this support, MAEC will continue to increase its caseload from its present 286

families and 572 children/youth to 367 families and 873 children/youth through identification and referral by

MAEC partners such as Cornell-GHESKIO. MAEC will create support groups of PLWHA and non-infected

CBO volunteers for its families in these two zones. The families will receive tangible services such as

health care, training, nutritional support, and school fees as well as participate in MAEC's peer home visiting

program that has had an important effect on bolstering self-esteem and reviving hope among its families.

This support offers MAEC the opportunity to extend its model into Cite Soleil, probably the neediest area in

the exceptionally resource-poor country. In summary, the MAEC activities consist of two main activities:

care and support of OVCs and their families; and a community-level partnership with international, local,

and CBOs to support PLWHA families while working to prevent HIV infection and reduce stigmatization.

LMS will help strengthen the leadership and management skills of the MAEC support groups and increase

the involvement and capacity of the staff towards a common sustainable goal and lasting impact of the

program. This program is funded through 75% HKID and 25% HBHC funding, and a description of these

activities is included in both program areas.

BACKGROUND: MAEC is a Haitian non-profit NGO that began work in the Port-au-Prince area in July

1996 with the opening of the first residential care and treatment facility in Haiti for children orphaned or

affected by AIDS. MAEC began a non-residential program in 1998 and provided monthly medical visits and

other activities for children as well as a dry food ration for the family and regular home visits by social

workers and auxiliary nurses. The participating families live in some of the most HIV-affected areas of the

country, the metropolitan Port-au-Prince communes of Carrefour, Croix des Bouquets, Cite Soleil, Delmas,

Pétionville (including Frères), Port-au-Prince, and Tabarre. Families living in an impoverished area with at

least one HIV+ child or a child who had lost at least one of his or her parents to the disease were eligible to

receive care. As the program has expanded since 2002, through partnerships with Plan Haiti, FHI, and

UNICEF, MAEC was able to add an outreach center that houses classrooms for children and heads of

families, provides medical and psychological consultations as well as cultural activities, etc. Food is

provided by partners CRS and WFP. Community mobilization activities were added through the use of

elected mothers who were trained and able to provide home visits even during times of instability in the

country.

This activity also relates to activities in Care: Pediatric Care & Support. It has 3 components:

ACTIVITY 1: Care and support of OVCs and their families: MAEC has a comprehensive program for the

communities it serves. Each community forms a coordination committee composed of one Mere Déléguée,

two Youth Peer Educators, two Agents de Liaison, two Agents de Formation, two Agents de Sensibilisation,

and MAEC staff. The Coordination Committee oversees all of the activities in its community as well as

receives, helps to select, and follows community projects designed to improve the conditions of local OVCs.

The project will support an extensive series of educational courses for heads of households (mostly single

mothers) as well as provide key training for children/youth (more than 9 years old) on subjects such as

simple health care, first aid (through the Haitian Red Cross), stigmatization, conflict resolution, and

responsible sexuality. The children's trainings will be interspersed with educational or cultural outings.

Cultural activities are designed to help children deal with their highly stressful living conditions. Many

children work through psychosocial issues during play, and MAEC trains its youth peer educators to lead

the teaching and cultural activity sessions. Les Ateliers Copart has been identified to train MAEC's children

and youth as well as to help them develop puppet and theatrical presentations. The MAEC program also

will provide primary health care through the services of an on-site pediatrician. She will perform routine

health care and will refer to partner Cornell-GHESKIO for ART and partners Grace Children's Hospital and

Hôpital de Nos Petits Frères et Soeurs for hospitalizations. School fees will be paid for primary age

children, and other educational possibilities will be provided for youth who are no longer eligible for primary

school. Psychological support will continue as well as home visits supervised by a full-time nurse

supervisor. Other services will include monthly food distribution; hygiene kits for the families; financial

assistance for burial of deceased children; and support to the peer educators involved in micro-credit

projects to generate income; and distribution of clothes and shoes for the neediest children. This component

of this activity will work to serve 393 male and 367 females OVC

ACTIVITY 2: Community-level partnership with international, local, and community-based organizations

(CBOs) to prevent HIV infection and reduce stigmatization: MAEC will work to demystify HIV in participating

families' environments so that neighbors can once again receive them as members of the community.

Community-level activities are directed by the Coordination Committee, which will oversee the

organization/coordination of home visits; school fees; invitations for the drafting and submission of

community-level projects for the benefit of vulnerable children and youth; selection of promising projects

and their recommendation to MAEC leadership; awarding funds to those projects that are approved by

MAEC; and taking the lead in monitoring and evaluating the projects. MAEC will maintain its strong

partnership with the Ministry of Health and Population (MSPP). All of MAEC's activities fall within the

national strategic plan, particularly the emphasis on reducing the vulnerability of youth to HIV infection

through awareness and reinforcement of responsible sexuality and the reduction of the impact of the

disease through the care and support of PLWHAs and their families, especially OVCs. A number of

MAEC's partners, including, most importantly, its partnerships with a number of CBOs in its catchment

areas, will remain a hallmark of the program. These partnerships will continue to be strengthened and

expanded, especially in Cité Soleil. These CBOs will benefit from sharing experiences with other MAEC

partner CBOs from Croix des Bouquets and Frères. This component of this activity will work to serve 393

males and 367 females OVC

ACTIVITY 3: Leadership Development Programs: Good leadership is more important than ever in the

Activity Narrative: health care environment in Haiti. The rise of HIV/AIDS and other infectious diseases; health reforms such

as decentralization; and uncertainties in donor funding present formidable external challenges to health care

organizations. At the same time, organizations confront low staff morale, staff shortages, weak systems and

processes, difficulty in sustaining high-quality services, and other internal challenges. To address these

challenges, they need managers who can not only manage, but also lead their staff through change. When

organizations invest in leadership development for managers at all levels, they will increase their ability to

adapt to change. Their managers will learn to reinforce leadership values and apply leadership practices

that promote sustainable organizational performance. By practicing both leading and managing, managers

will be better able to achieve results and maintain high-quality services despite the obstacles they face.

LMS will implement Leadership Development Programs (LDP) to help MAEC to develop managers who

lead with a vision of a better future. The program has three major learning objectives: (1) learn the basic

practices of leading and managing so that managers are capable of leading their workgroups to face

challenges and achieve results; (2) create a work climate that supports staff motivation; and (3) create and

sustain teams that are committed to continuously improving client services.

LMS will help develop facilitators for the LDPs who will go on to help teams carry out this process at several

levels and for specific audiences—NGOs, youth, and women. As part of the process, these teams engage

in the program over a period of four to six months. Teams will discuss strategies for—and actively

address—their challenges through all program activities. To help organize and support their work, five kinds

of program activities will be held: (1) Senior Alignment Meetings, an initial meeting which generates

commitment and ownership of the LDP among key organizational stakeholders; (2) LDP Workshops, a

series of workshops comprised of 12 half to full day core sessions during which participants learn core

leading and managing practices and concepts; (3) Local Team Meetings, on-the-job meetings between

workshops in which participants transfer what they learned to the rest of their work team, discuss strategies

to address their challenges, and apply leading and managing practices; (4) Regular Coaching, in which

local health managers support the teams in implementing the tools of the LDP; and Stakeholder Meetings,

in which stakeholders are periodically updated and enlisted as resources to support the teams. This

component of this activity will work to train 50 providers/caregivers in caring for OVC

Monitoring and Evaluation of these activities including data collection, use, quality and feedback will be an

ongoing and focused effort.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19583

Continued Associated Activity Information

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

System ID System ID

19583 19583.08 U.S. Agency for Management 8719 8719.08 Leadership, $600,000

International Sciences for Management

Development Health and

Sustainability

Project

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $350,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $50,000

Water

Table 3.3.13:

Funding for Prevention: HIV Testing and Counseling (HVCT): $300,000

SUMMARY: The Leadership, Management and Sustainability (LMS) Program, through support from

USAID, will provide assistance in capacity building to NGOs. LMS will continue to work with FOSREF to

provide youth access to services for sexually transmitted infections (STIs), HIV/AIDS, and sexual and

reproductive health, at the institutional and community levels, to the youth of Cité Soleil. The program plans

to reduce by 50% the HIV prevalence in the population of Cité Soleil and particularly among the youth in this

area. In addition, the program will offer other alternatives to the youth of Cité Soleil. This program is funded

through 50% HVOP, 25% HVCT, 15% HVAB, and 10% HBHC funding, and a description of this activity can

also be found under those program areas.

BACKGROUND: In Haiti, youth, who represent more than 50% of the population, are the most vulnerable

groups for HIV/AIDS and unwanted pregnancies, with a high incidence of clandestine abortions. FOSREF

has a mandate from the Ministry of Health and Population (MSPP) to deliver youth-focused sexual and

reproductive health and HIV/AIDS services to youth nationwide. In this context, FOSREF has identified key

cities in the country where specific programs for youth must be implemented to meet the unmet needs of

young people for sexual and reproductive health and HIV/AIDS prevention. To date, FOSREF has created

and implemented a network of 15 youth centers in many cities. During the last four years, FOSREF has

identified areas in the marginalized segments of the large cities, particularly in the Metropolitan areas of

Port-au-Prince, where there are no existing youth services. Cité Soleil is one of these areas, representing

one of the largest challenges in terms of unmet needs of youth for sexually transmitted infections,

HIV/AIDS, sexual violence, and other sexual and reproductive health matters. Young people have been

victims of gang activities that have reduced them to an almost hostage-like situation. Based on recent

official information from the Ministry of the Interior, the Director of the National Police, and from the UN

Peace Keeping Forces (MINUSTAH), the security situation in Cité Soleil has improved enough to begin to

target services to the population in this area.

This activity also relates to activities in Care Pediatric Care & Support Health System Strengthening. It has

4 components:

ACTIVITY 1: Behavioral Communication Change with Youth: FOSREF will conduct training of youth peers

and youth facilitators from various community-level groups. These youth will then go on to train youth in

schools and in the community and will provide information and sensitization sessions at the Youth Centers.

They will carry out groups education sessions both at the Youth Centers and out in the community. To

support this work, the project (including the youth) will develop/adapt BCC materials that address HIV

prevention, responsible sexual behaviors, promotion of VCT services, addressing stigma and discrimination,

etc. The project will also use trained youth theater groups to deliver HIV/AIDS promotion messages,

consistent and correct condom use, and promotion of VCT, among other topics. This component of this

activity will work to train 60 individuals in counseling and testing according to national and international

standards.

ACTIVITY 2: Youth Access to Clinical SRH and HIV/AIDS Services: The two Youth Centers in Bois Neuf

and Boston will be staffed with trained providers who will deliver sexual and reproductive health and

HIV/AIDS services to youth from Monday to Saturday. During the first year of the project, all clinical

services will be available in the Boston Center and in Bois Neuf, the community outreach activities will be

implemented during the first year, and the clinical services starting at the beginning of the second year.

Youth will have access to STI diagnosis and treatment services, gynecological exams, sexual violence

management, contraceptive methods, VCT services, and other related services. Services will be supported

by trained youth facilitators who will participate in the VCT as counselors and referral sources. Young

people who test HIV+ will be referred to other specialized centers for their medical follow up and integration

into support groups for PLWHA. At the Youth Center, there will be trained youth facilitators who will be in

charge of organizing the referrals. The points of referrals are other established FOSREF Youth Centers in

the Metropolitan area that offer palliative care as well as other institutions offering ARVs such as Choscal in

Cité Soleil. Both HIV+ and HIV- youth will be integrated into post-test clubs that function as psycho-social

support groups. An outreach network of youth facilitators will organize community activities that promote

the VCT services and other related services among youth. This component of this activity will support two

service outlets to provide counseling and testing according to national and international standards. It will

work to provide to 5,600 individuals counseling and testing for HIV and their test results (excluding TB).

ACTIVITY 3: Social Development Program for Youth: The project's social program is based on a model

used by FOSREF in its "Other Choices Program." These are activities that offer social alternatives to the

youth of Cite Soleil, offering them other socio-economic opportunities through training to decrease their

participation in gang activities. Social Clubs supported by the project will provide possible alternative forms

of income, such as computer skills training, floral art/paper training, dance courses, hair/beauty and skin

care courses, sewing/embroidery classes, theater training, and basic literacy courses. Youth attending the

clubs will build skills, self esteem, self empowerment, and will learn about alternative ways to earn income

rather than engaging in risky behaviors.

ACTIVITY 4: Social Rehabilitation/Re-insertion Programs for High-risk Youth, including Youth-Oriented

Leadership Development Program (YOLDP): This activity will address the needs of the most vulnerable

youth, including street children and gang members, to integrate them in social activities and refer them for

other USG partner vocational training. These youth will receive special short technical training in topics

such as mechanics, handcrafting, masonry, carpentry, and so forth. The project will offer elementary

classes for literacy and support for school reintegration of secondary school youth who have dropped out.

The program will link with rehabilitation programs for young girls, and also with other education and

microfinance programs supported by the USG. Particularly for the youth who were gang members, the

project will adapt a youth-oriented Leadership Development Program, to ensure that these former gang

members have the sense of belonging and importance that will replace what they felt as gang members.

Monitoring and Evaluation of these activities including data collection, use, quality and feedback will be an

ongoing and focused effort.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19586

Continued Associated Activity Information

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

System ID System ID

19586 19586.08 U.S. Agency for Management 8719 8719.08 Leadership, $300,000

International Sciences for Management

Development Health and

Sustainability

Project

Table 3.3.14:

Funding for Health Systems Strengthening (OHSS): $200,000

Development of BCC materials: Following the mapping interventions and the inventory of BCC materials

conducted under COP07, LMS will develop a state of art database IEC materials containing both an

electronic catalog and a hard copy .This database will serve as a national resource for all partners with an

interest in communication materials. This will facilitate the coordination in the development of BCC materials

and the harmonization of prevention, care and support messages.

Management of condoms and family planning commodities: Under PEPFAR, the use of PEPFAR HIV funds

to support the integration of family planning services into HIV services is permitted. LMS will provide

technical assistance for the management of the condoms and other USAID-funded family planning

commodities to support HIV/AIDS activities.LMS will work in collaboration with SCMS, SDSH and other

partners to effectively manage PEPFAR-funded condoms in the USG-supported service delivery sites in

close coordination with USG partners while technical assistance is provided to the MSPP to support efforts

to establish one unique and secure commodities management system for the health sector and activity that

unites all of the LMS Project in Haiti: improving leadership and management capacity across partner

organizations, the Ministry of Health, and LMS project staff

SUMMARY: In COP 08 the Leadership, Management and Sustainability (LMS) Program will continue to

provide institutional capacity building support to selected Government of Haiti units, such as the CNLS, to

increase their abilities to provide nationwide coordination, thereby increasing synergies and effectiveness of

the PEPFAR programs. LMS will develop leadership and management skills at national and departmental

levels. Support will also include strengthening organizational and program management capacity to

efficiently and effectively affect the national response, with particular emphasis on coordination issues.

LMS will provide support in areas of organizational development such as: development and maintenance of

constructive, informed working relationships with all stakeholders, including the USG, their IPs, and other

donor organizations; project management; clarifying roles and responsibilities; monitoring and evaluation;

strategic planning; sound governance; and leadership development. The goal of this technical assistance

and capacity building is an improved organizational structure with a clear mission, more efficient

governance, effective internal and external communication, monitoring and evaluation systems, and

improved management.

With the end of the HCP Project in Haiti, the Leadership, Management and Sustainability (LMS) Program

will continue to be supported by USAID to lead the current program on strengthening departmental-level

capacity to plan, coordinate, and monitor interventions focusing on promoting appropriate behaviors for

HIVAIDS prevention, addressing issues of stigma and discrimination reduction, and community mobilization

for increased demand for and use of HIV/AIDS services. JHU/CCP will continue to provide some technical

assistance to the program through a subcontract with LMS. This program is funded through prevention

funds, and a description of these activities is included under both AB and OP program areas.

BACKGROUND: As part of the development assistance under the USAID Investing in People Objective,

3.1 Health Area, 3.1.1 HIV Program Element, USAID provides technical assistance to the Government of

Haiti to reinforce the national health care delivery system and strengthen the leadership capacity and

systems of the Ministry of Health and Population (MSPP) to better manage the National AIDS Program.

The MSPP Departmental Health Directorates are increasingly taking on responsibilities for planning,

monitoring, and coordinating health care services in their regions.

ACTIVITY 1: Development of BCC materials: Following the mapping interventions and the inventory of

BCC materials conducted under COP07, LMS will develop a state of art database IEC materials containing

both an electronic catalog and a hard copy .This database will serve as a national resource for all partners

with an interest in communication materials. This will facilitate the coordination in the development of BCC

materials and the harmonization of prevention, care and support messages.

ACTIVITY 2: Coordination: LMS will assist the departmental teams to formalize the structures and

mechanisms for coordination. Following the mapping exercise done between September and December

2007 in six departments, LMS will work closely with the departments to put in place a system allowing better

coordination of community mobilization and prevention interventions. LMS also will continue to assist the

MSPP central level in the planning and organization of mapping exercises in the four remaining

departments.

ACTIVITY 3: Planning and Monitoring: LMS will assist the MSPP departmental directorates in the planning

of community interventions and their monitoring. The work will consist of analyzing and disseminating the

results of interventions to the partners in order to make appropriate updates and changes.

ACTIVITY 4: Capacity building: While managing and leading the process of coordination of BCC

interventions, LMS also will reinforce the capacity of the departments, implementing partners, and

providers, through training in leadership and management, BCC, community mobilization and/or

interpersonal communication, depending on the specific needs. To support the capacity building effort and

ensure a coordinated and integrated approach, LMS will develop/adapt tools and support materials for the

management of communication and community mobilization activities.

ACTIVITY 5: Leadership Development Programs: Good leadership is more important than ever in the

health care environment in Haiti. The rise of HIV/AIDS and other infectious diseases; health reforms such

as decentralization; and uncertainties in donor funding present formidable external challenges to health care

organizations. At the same time, organizations confront low staff morale, staff shortages, weak systems and

processes, difficulty in sustaining high-quality services, and other internal challenges. To address these

challenges, they need managers who can not only manage, but also lead their staff through change. When

organizations invest in leadership development for managers at all levels, they will increase their ability to

adapt to change. Their managers will learn to reinforce leadership values and apply leadership practices

that promote sustainable organizational performance. By practicing both leading and managing, managers

will be better able to achieve results and maintain high-quality services despite the obstacles they face.

LMS will implement Leadership Development Programs (LDP) to help Haitian NGOs and the MSPP to

develop managers who lead with a vision of a better future. The program has three major learning

Activity Narrative: objectives: (1) learn the basic practices of leading and managing so that managers are capable of leading

their workgroups to face challenges and achieve results; (2) create a work climate that supports staff

motivation; and (3) create and sustain teams that are committed to continuously improving client services.

LMS will help develop facilitators for the LDPs who will go on to help teams carry out this process at several

levels and for specific audiences—NGOs, MSPP, youth, and women. As part of the process, these teams

engage in the program over a period of four to six months. Teams will discuss strategies for—and actively

address—their challenges through all program activities. To help organize and support their work, five kinds

of program activities will be held: (1) Senior Alignment Meetings, an initial meeting which generates

commitment and ownership of the LDP among key organizational stakeholders; (2) LDP Workshops, a

series of workshops comprised of 12 half to full day core sessions during which participants learn core

leading and managing practices and concepts; (3) Local Team Meetings, on-the-job meetings between

workshops in which participants transfer what they learned to the rest of their work team, discuss strategies

to address their challenges, and apply leading and managing practices; (4) Regular Coaching, in which

local health managers support the teams in implementing the tools of the LDP; and Stakeholder Meetings,

in which stakeholders are periodically updated and enlisted as resources to support the teams.

ACTIVITY 6: Direct support to MSPP Units: As requested, LMS will support technical advisors to specific

MSPP Units to assist in targeted capacity building, planning, monitoring, leadership development, and

improved management.

ACTIVITY 7: Management of condoms and family planning commodities: Under PEPFAR, the use of

PEPFAR HIV funds to support the integration of family planning services into HIV services is permitted.

LMS will provide technical assistance for the management of the condoms to support HIV/AIDS

activities.LMS will work in collaboration with SCMS, SDSH and other partners to effectively manage

PEPFAR-funded condoms and family planning commodities in the USG-supported service delivery sites in

close coordination with USG partners while technical assistance is provided to the MSPP to support efforts

to establish one unique and secure commodities management system for the health sector and activity that

unites all of the LMS Project in Haiti: improving leadership and management capacity across partner

organizations, the Ministry of Health, and LMS project staff .

Monitoring and Evaluation of these activities including data collection, use, quality and feedback will be an

ongoing and focused effort.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19591

Continued Associated Activity Information

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

System ID System ID

19591 19591.08 U.S. Agency for Management 8719 8719.08 Leadership, $550,000

International Sciences for Management

Development Health and

Sustainability

Project

Table 3.3.18:

Subpartners Total: $0
Fondation pour la Sante Reproductrice et l'Education Familiale: NA
Johns Hopkins University: NA
Cross Cutting Budget Categories and Known Amounts Total: $400,000
Human Resources for Health $350,000
Education $50,000