The goal of this program is to build leadership and management capacities among senior and middle- level public health managers in the country. This will be done through a Fellowship program for graduates of the University with a Masters degree and a coaching and mentoring program for existing managers at District level.

Malawi has major shortages of key human resources especially in leadership positions to manage an increasingly complex national HIV/AIDS program. Most of the program is managed by expatriate Technical Assistance (TA) staff with time-limited appointments. The TA system has not been successful in building the required local capacity and is expensive. Programs also tend to collapse when their tenure ends.

Malawi decentralized its health delivery system and transferred powers, functions and decision-making responsibilities to the district level in a sweeping manner with substantial independence of the central level. The aim of decentralization of the health sector is to improve efficiency in the use of resources and delivery of health services. However, the decentralized health sector faces challenges due to inadequate leadership and management skills among public health managers across all levels as identified in the MOH Plan of Work (2004 - 2010).

The Leadership and Management Development Program is intended to train the next generation of leaders and is implemented by the University of Malawi, College of Medicine (CoM) in collaboration with Ministry of Health (MOH). Having a well trained cadre of mid-level managers would not only support the efficient delivery of Health care services for HIV/AIDS prevention, treatment, and support services, it would help strengthen the health care delivery services in general as decentralization unfolds. The program supports the Malawi National Action Framework (NAF) Objective 2.1: To improve the capacity of the health care system to manage HIV and related disease diseases and Goal IV of the Partnership Framework on cross-cutting systems strengthening - "To provide targeted, discrete systems strengthening in 5 key areas (laboratory services, health information systems, human resources, procurement and supply chain management, and health finance) to support the Prevention, Treatment,

Care and Support goals". Ultimately, the program will strengthen the health system and ensure sustainability through local ownership and capacity to manage the national response to HIV and AIDS.

The program's initiative of coaching and mentoring of local Malawian public health managers will improve leadership and management capacity and therefore contribute to health systems strengthening. The local Malawian health managers will sustain and own the national response to HIV and AIDS and the general health system as desired by PEFAR (Partnership Framework, page 3, First Paragraph).

The Fellowship for leadership in HIV prevention, treatment, care and support Program In September 2008, the COM, in collaboration with the MOH with support from CDC/PEPFAR, established the Fellowship Program for Leadership in HIV and AIDS Services. The program offers opportunities and provides financial and mentoring support to local Malawian individuals who have a Masters degree and have the potential to take up leadership positions in HIV and AIDS services in the public sector and NGOs. The health professionals are linked with the University system and field experience with US government (USG) partners and the MOH on HIV and AIDS for two years. After successful completion of the fellowship, fellows will be absorbed and retained within the public sector and in NGOs such as Christian Health Association of Malawi (CHAM). The first intake of four (4) fellows will be in January 2010.

The Management development for District-Level Public Health Managers Along side the Fellowship Program for Leadership in HIV and AIDS services, the CoM is implementing management capacity building program for middle level public health managers who are already appointed and are serving in leadership and managerial positions in the District Health Management Teams (DHMTs), supervisory Health Support Zone offices and other senior managerial positions in the health sector. The Health Managers while in their workplaces participate in management and leadership classroom / workshop trainings and are mentored through support visits to ensure that they apply the skills they acquired in workshops. Even though the program focuses on MOH and NGOs working in HIV and AIDS others would benefit from this program.

With FY2008 funding from PEPFAR, the program established the National Steering Committee (NSC) to oversee and provide guidance to activities. The NSC guides the programs by identifying priority areas and reviews the performance of the administrative structure. The Committee is co-chaired by the MOH and COM, and comprises of members from key stakeholders in the national response to HIV and AIDS from the academic institutions, private sector and development partners. The NSC promotes linkages and collaboration among stakeholders and is strategic platform for building sustainability of the programs.

The quality of the operations of the programs will be achieved through use of independent external

examiners to review the courses and the standards of the program and outputs. The fellowship program will increase the number of new eligible local Malawian candidates for management and leadership positions in the national response to HIV and AIDS within a medium to a long term future. The Management capacity building program creates strategic local health officials/managers who are empowered with better management and decision-making skills, and creativity and innovation in problem- solving. These officials, in turn, optimize the functionality of the decentralized Malawi health system. This contributes immensely to Malawian ownership as well as ensures the long term sustainability of HIV and AIDS programs as well as the entire health service delivery system.

Budget Summary PFIP Year 1 Funding - $253,205 PFIP Year 2 Funding - $800,000

PFIP Year 1 Funding - $253,205 PFIP Year 2 Funding - $800,000

With PFIP year 1 funds we expect to implement the following activities:

• Promote linkage and collaboration among the stakeholders and HIV service organizations • Strengthen the capacity of the College of Medicine • Train DHMTs, and: • Enhance sharing experiences in HIV and AIDS management, organizational leadership and service delivery management.

These activities will be continued in PFIP year 2.

Budget Code - OHSS Management and Leadership Development for District Level Managers

$253,205 - Year 1

Activity 1: Promote linkage and collaboration among the stakeholders and HIV service organizations

The program will facilitate two meetings of the National Steering Committee; the first meeting will approve the first 10 DHMTS that will be enrolled in the training program. The second meeting will review the progress being achieved and the performance of the CoM. The meetings will also review policies and operating standards that guide the management of the mentorship schemes. The committee will also review the composition of its members to increase the number of stakeholders to be involved.

Activity 2: Train and mentor 10 District Health Management Teams The goal of training for DHMTs is to improve the effectiveness of public health programs in Malawi by empowering District Health officials with better leadership, 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. To accomplish this activity, the program will collaborate with the Department of Planning and Policy Development in MOH to identify 2 out of 5 Health Support Zones from where 10 out of a total of 28 DHMTs (40 managers) will be enrolled in the training program.

The program will evaluate the management capacity building program that has been implemented by MOH with support from CDC from November 2007 to December 2008. The lessons learnt from this program will feed into the development of the College of Medicine coordinated program. Furthermore, the

program will assess specific training needs among the participating DHMTs in order to develop appropriate training modules. The program will receive technical assistance from CDC-Sustainable Management Development Program (SMDP) in evaluation of the previous program, conducting training needs assessment and developing training curriculum and modules.

Activity 3: Strengthen the capacity of the College of Medicine The program will recruit a full time Training Facilitator to increase the capacity of the college's existing faculty on Heath Management. The program will also recruit four part-time trainers and mentors from a pool of active graduates of the Management for International Public Health (MIPH) course conducted by CDC-SMDP in collaboration with Emory University in Atlanta, USA.

The program will conduct a study tour to Botswana to learn from experiences of a similar program to help with improvements to the Malawi program. The program will sponsor one Malawian candidate to attend the MIPH course to be held in South Africa to increase the number of possible facilitators and mentors for district health managers.

Activity 4: Enhance sharing experiences in HIV and AIDS management, organizational leadership and service delivery management

The Program Director will present abstracts at the CDC-SMDP biennial conference and the HIV implementers' meetings to share experiences with others.

Budget Code - OHSS - Management and Leadership Development for District Level Managers $400,000 - Year 2

With PFIP year 2 funds, we expect to continue implementing the following activities:

• Promote linkage and collaboration among the stakeholders and HIV service organizations. • Train and mentor District Health Management Teams and: • Enhance sharing experiences in HIV and AIDS management, organizational leadership and service delivery management.

Activity 1: Continuing with governance of the scheme and promote linkage and collaboration among the stakeholders and HIV service organizations

The program will convene four meetings of the National Steering Committee to approve the second cohort of 10 DHMTS for enrollment in the training program and to review the progress achieved by the program. The meetings will also review policies and operating standards that guide the management of the mentorship schemes. The committee will also review the composition of its members to increase the number of stakeholders to be involved.

Activity 2: Train and mentor 18 District Health Management Teams

In collaboration with the Department of Planning and Policy Development in MOH, the program will scale- up and enroll the remaining 18 DHMTs (90 managers) from 3 Health Support Zones to cover the entire public health sector with the program. The program will use experiences and lessons learnt in year one of implementation to review the training modules.

Activity 3: Enhance sharing experiences in HIV and AIDS management, organizational leadership and service delivery management

The program sponsor one presenter to the HIV and AIDS implementers' meeting to share experiences with others

Budget Code - OHSS Fellowship for Leadership in HIV and AIDS Prevention, Treatment, Care and Support Services $400,000 - Year 2

Activity 4: Build fellows' competencies in managing HIV and AIDS services The program will scale up and increase the intake of fellows from 4 in year 1 to 6 fellows in year 2. The program will review curriculum and training modules for the Fellowship program, conduct short courses and provide on-the-job coaching and mentoring.

Activity 5: Enhance sharing experiences in HIV and AIDS management, organizational leadership and service delivery management

The program will hold an annual dissemination and review meeting to share experiences of the Fellowship Program with key stakeholders in the national response to HIV and AIDS.