Summary

This USG-supported activity through CDC's Sustainable Management Development Program (SMDP) will

train District Health Managers build management capacity for the Ministry of Health (MoH) zonal support

offices, and the Malawi Institute of Management (MIM).

Background

Following the enactment of the Local Government Act in 1998, the MoH accelerated its pace and the

manner of decentralizing its decision making and functions to the district level. To move towards this goal

the Ministry abolished its regional offices in 1999. Effectively, district health service functions are under the

management of District Health Management Teams (DHMTs). Decentralization has transferred powers,

functions and decision-making to the district level in a radical manner with substantial independence of the

central level. However, these District level authorities are still within the public administration and operate

within the context of ultimate central control through policy cohesion, regulatory systems and monitoring

together with central planning control and allocation of resources.

Decentralization of health management is increasingly recognized internationally as a prerequisite for

efficient and effective management and planning in addition to enhancing local participation. The system is

also considered as a strategy for improving the performance of the civil service as well as having the

potential to reducing number of staff and costs by making more efficient use of the remaining staff. The

functions in the health sector have been devolved based on the assumption that the system has the

potential to achieving increased equity in terms of access and coverage, improved efficiency in the use of

resources and delivery of health services, enhanced accountability, improved quality of care as well as

improved health outcomes. Management of HIV/AIDS programs at district level stands to gain in terms of

efficiency and effective use of resources by devolving functions to the assemblies (districts).

The DHMTs develop plans and budgets at district level using the "District Implementation Plans" (DIPs), a

process that the MoH, through its Department of Planning and Policy Development with assistance from

Management Sciences for Health (MSH), partners of the Sector Wide Approach (SWAp) Common Fund

and technical assistance provided by Overseas Development Institute fellowship, has developed. On an on

going basis, the ministry provides guidelines and orientation to DHMTs for every annual circle.

A meeting of the Management Training stakeholders was held in May 2006. The meeting recommended

that DHMTs needed additional training in health sector planning and budgeting. In response to this need,

USG supported a training needs assessment, with collaborative input from MSH in November 2006. The

training needs assessment confirmed the stakeholders view and revealed that knowledge, skills and

performance gaps in public health program management existed among DHMTs. Furthermore, MoH and

MSH officials were in agreement with the view that DHMTs need a wider and complete understanding of

public program management if they are to meaningfully fulfill their role of managing functions of the health

sector at district level in addition to the DIP guidelines and orientation sessions that are provided to them.

Activity 1:Training District Health Managers

The Emergency Plan (EP) seeks to assist the Malawi Government achieve its goal by training district-level

decision-makers to plan and manage public health programs more effectively using SMDP management

training tool called, Healthy Plan-it. The training for DHMTs will improve the effectiveness of public health

programs in Malawi by empowering District Health officials with better management and decision-making

skills and stimulating creativity and innovation in problem-solving. The training will build the skills of local

public health managers to prioritize, plan, organize, monitor, and evaluate the use of organizational

resources (time, personnel and money) to prevent or control diseases, disabilities and premature mortality.

In FY 2007, 30 district health personnel (all being members of DHMTs) from 15 district hospitals across the

country were trained and assisted with local public health prioritization, planning, organizing, monitoring,

and evaluating the use of organizational resources (time, personnel and money) to prevent or control

diseases, disabilities and premature mortality. All the 15 teams were followed up and mentored in the

application of the skills. The DHMTs are keen in using the management skills that they obtained from the

training. In FY 2008, the project will train and mentor 26 district health personnel from the remaining 13

DHMTs.

Activity 2: Build Management Capacity of the MoH Zonal Support Offices and Malawi Institute of

Management

To enhance the in-country management training capacity, the program trained two locals (a faculty member

of the Malawi Institute of Management (MIM) and one Ministry of Health Zonal Support Officer) in training of

trainers in FY 2006. In FY 2007, the program will train one staff member from Central Office of the

Department of Planning and Policy Development in Ministry of Health. These trainings last for 6-weeks in

Management for International Public Health (MIPH) and are offered each fall in Atlanta by the CDC in

collaboration with the Emory University Rollins School of Public Health. The course trains participants in a

broad variety of public health management skills, including practical exercises and innovative training

techniques, and provides them with fully-developed training materials for participants to use in their own

country training programs. The two locals that were trained in FY 2006 facilitated the training and mentoring

of DHMTs in FY 2007 with technical support and guidance from SMDP who provided quality assurance of

the training and mentoring processes.

Plans to establish MIM as a local faculty and institutional home for Healthy Plan-it training will be

discontinued in FY 2008. This decision was made due to poor management of logistics of the training

program in FY 2007 by MIM. Instead, the program will begin to build the capacity of both the Ministry

Central Office and Zonal Support Offices to lead the processes of training needs assessment, conducting

trainings and providing follow-up, mentoring and supervisory visits to district hospitals.

CDC-SMDP will continue to provide technical support to MoH in conducting in-country training needs

assessments, developing locally appropriate curriculum, planning in-country workshops, and supervising

applied management learning projects that provide a practicum for trainees.

Activity Narrative:

The program will continue to work with key stakeholders and the donor community to ensure the long-term

sustainability of the program and address issues such as local funding for recurrent costs, integrating the

program with MoH SWAp work plans, and evaluating impact. It will also ensure that past experiences shape

the manner in which future activities of the program are managed.

This narrative describes the CDC Malawi M and S needs for both GHAI and Global AIDS Program (GAP)

funds. The CDC Malawi M and S budget, including GHAI and GAP funding, has been vetted through the

interagency decision making process and agreed to as presented in the FY 2008 COP submission.

Malawi is not a PEPFAR focus country but Malawi receives significant resources from the Global Fund for

AIDS, TB and Malaria (GFATM). Because of the very limited human and technical capacity to implement

programs in Malawi, the GFATM depends on the USG to complement their efforts by providing critical

technical staff to assist with program design and implementation. The USG Malawi team's M and S goals

reflect a strategic approach to both addressing the needs of the GFATM programs and that of the programs

directly supported by the USG. The M and S plan for the HHS/CDC office in Malawi, is designed to have

sufficient staff during the FY 2008 period and beyond, to provide appropriate technical and programmatic

oversight and assistance to all implementing partners in Malawi. The CDC M and S budget in FY 2008

COP supports the USG interagency team process of providing technical assistance and monitoring of

PEPFAR activities across a significant array of implementing partners in Malawi. CDC has seven

cooperative agreements supporting a broad range of implementing partner activities including GFATM

activities in nine program areas. Upcoming RFA awards will add two new partners in calendar year 2008.

To achieve the goals of effective technical assistance to the Government of Malawi and its' implementing

partners, the CDC GAP Office in Malawi had planned for fifteen positions in FY 2008. This is an increase of

one technical position (Medical Officer) over the previous year. Two technical positions were originally

planned for in 2008 however limits in our budget did not permit the addition of the second position, a

Laboratory Specialist. If funding is available and the entire PEPFAR USG team is in concurrence we will be

able to fill this position in FY 2009.

The FY 2008 COPHHS/CDC staffing plan includes four USDH that are comprised of the Chief of Party,

Deputy Director, Medical Officer, and Epidemiologist. No new USDH positions are sought in COP 2008.

The current HHS/CDC staffing plan also includes two non PSC contractor positions; a Monitoring and

Evaluation Officer and a Counseling and Testing Specialist (both supported through Comforce) and one

ASPH fellow. We are currently converting both our Comforce non PSC contractors to US PSC positions in

FY 2008. Additionally we have eight FSNs which include a Program Management officer, an Administrative

Officer, two IT support staff, three drivers and one custodian.

M and S costs are inclusive of rent for offices, utilities, office operational costs, M and S specific equipment,

travel for M and S staff, training for M and S staff, residential leases and post allowance for the 2 USDH M

and S positions, and increased communications costs related to enhancement of office communications

and connectivity. This FY 2008 COP submission does not include HQ TA support in keeping with FY 2008

COP guidance that this will be funded through the Headquarters Operational Plan process.

ICASS charges of $366,000 and CSCS charges $178,525 are budgeted separately in their own activities

with the prime partner listed as State as required by FY 2008 COP guidance.