The MSH/BLC project is aligned to contribute towards two Partnership Framework goals: to reduce morbidity and mortality and provide essential support to Basotho people living with or affected by HIV and AIDS through expanding access to high quality treatment, care, and OVC services by 2014; and, the human resource capacity for HIV service delivery is improved and increased in 3 key areas (retention, training and quality improvement) by 2014. The project reaches 47,000 OVC and care givers in five districts (Quthing, Mohale's Hoek, Qacha's Nek, Mokhotlong, and Thaba Tseka). The project goals are: 1) technical and institutional systems strengthened and capacity built in Lesotho; 2) community-based outreach program developed that can provide needed community-based care and support services and effective tracking and referrals to clinical settings for people infected with and affected by HIV/AIDS; 3) a mechanism developed and strengthened for providing needed community-based care for OVC and; 4) national policy and guidelines strengthened for comprehensive community-based care and a supportive environment for OVC affected by HIV/AIDS. The MSH/BLC capacity building and sub-granting strategy is focused on ensuring that program activities are fully owned by local entities. Specifically, BLC supports local community and government structures; Strengthens government systems in leadership and coordination. Vehicle needs Transport and communication between communities is almost exclusively limited to Four-wheel drive vehicle, foot or pony since existing paths are often too narrow or steep for even a motorcycle to pass. For timely and effective implementation and monitoring of the project activities, the BLC project will require robust and reliable four wheel drive vehicle.

MCHIP will continue its successful work to strengthen the CHAL Schools of Nursing capacity to house and educate nursing and midwifery students. Building upon work undertaken in FY13, MCHIP will strengthen education for nursing and midwifery students through increased rural clinical placements; and strengthen the ability of the CHAL Schools of Nursing to train and educate nursing and midwifery students.

MCHIP will continue its ICT component with a focus on improving learning methods (students), teaching methodologies (teachers/educators) as well as systems (performance management, teacher-school communication) to ensure that the CHAL SONs are well-equipped to graduate students better prepared for todays world. MCHIP will continue to work hand-in-hand with the CHAL SONs to expand the rural clinic placement program. As the majority of primary health care is provided in the rural area, it is essential to have newly graduated nurses achieved competencies in order to be the front line worker. New graduates need the competency to assess, diagnose and treat common conditions. Expanding on these rural clinical placements will allow the nursing students at CHAL schools to expand their clinical knowledge by increasing their contact with a variety of clinical experiences and cases as well as exposing them to the rural community health environment that they are likely to be placed in post-graduation.

MCHIP will continue to work closely with CHAL to strengthen the SONs faculty and clinical staff. Nursing faculty are often dependent upon hospital staff for clinical instruction of their students but many of these nurses have not been trained to serve as clinical instructors for the SON. The clinical setting is where nursing students are able to apply and integrate their theory-based knowledge from the classroom into clinical skills in the hospital or community setting. To produce competent, quality graduates, faculty and preceptors must have the tools and skills necessary to implement the competency-based curriculum. Activities will continue to focus on the following key areas: Clinical education: Preceptor development, preceptor TOT development, technical updates, clinical objective tools, clinical quality improvement, and linking didactic to clinical education; Didactic education: Training in effective teaching skills and student performance assessment, development of standards and competencies, and the provision of ongoing supportive supervision; Mentorship: Provision of in-depth supportive supervision of faculty and clinical preceptors; and Clinical site and school collaboration: Support the building of relationships between the schools and clinical sites - a key to the success of good clinical experiences for nursing students.

The project will continue to support the development of an enabling regulatory environment for nursing education through strengthening the Lesotho Nursing Council, focusing on policy/regulatory environment and advocacy issues. Expected results include increased capacity of the LNC to develop and strengthen the regulatory framework of Lesotho; increased capacity of LNC operational procedures, through implementation of the LNC strategic plan and a strengthened LNC board; and increased capacity of the LNCs current registration and licensing processes.

MCHIP will continue to support the MOHSW and the MC Technical Working Group (TWG) to finalize the development of VMMC guidelines, strategy, and training materials for Lesotho, inclusive of EIMC, as part of the MOHSWs larger Prevention Program. As part of this MCHIP introduce and adapt a VMMC operational guide for Lesotho and support the development of framework and service delivery model to scale up adult VMMC.

MCHIPs Lesotho based VMMC Technical Advisor will provide direct support and oversight of MCHIPs activities, with support from Jhpiegos regional and headquarters VMMC technical experts. Geographic coverage will be national as policies and guidelines created are to cover the country. Facilities have not yet been agreed upon with the MOHSW so a clear geographic area for service delivery cannot yet be identified. Quality assurance standards will be developed in accordance with international standards and guidelines and facility staff oriented. A system of provider certification will also be established. Jhpiego will meet with facilities to discuss the project and develop shared expectations and working assumptions in MOUs with the District. MCHIP will procure supplies and equipment necessary for services for agreed upon sites, including devices, surgical instruments, gloves, sutures, local anesthesia, and other consumables. MCHIP will continue to work with communications organizations such as PSI, and together with them as well as the MOHSW and the TWG to develop IEC materials.

Up to three trainings for 16 service providers each are planned. MCHIP will also aim to conduct three five-day MC counseling training course for up 18 participants each. This program builds upon Jhpiegos competency based clinical training approach, and the WHO/UNAIDS/Jhpiego learning package in Male Circumcision under Local Anesthesia, and provides a unique opportunity to early infant circumcision which the MOHSW is strongly in favor of rolling out. MCHIP will provide supportive supervision and follow-up for newly trained MC service providers, health educators and counselors in their workplaces. Upon MOHSW endorsement task sharing and task shifting to scale up VMMC will be piloted.