Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8784
Country/Region: Mozambique
Year: 2008
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $7,187,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $135,000

This activity, which is new in the PMTCT program area, represents initial steps for strengthening the

linkages between HIV and malaria prevention, diagnosis and treatment services. Experience from this

activity can be used to create the foundation for improved linkages between HIV and malaria components.

Objectives: A) Strengthen the linkages between HIV and malaria prevention, diagnosis and treatment

services; B) Improve coordination of PMTCT and malaria mitigation activities.

Main Activities will be: (1) Complete HIV and malaria health services assessment, including documentation

of current malaria and HIV prevention, diagnosis and treatment services conducted in PMTCT settings in

selected provinces, with additional focus on linkages between services; (2) Complete analysis of

assessment findings, develop and disseminate recommendations; (3) Develop updated service delivery

guidelines for malaria, HIV/AIDS, and reproductive health; (4) Based upon results of assessment, create

plan for next steps for development/adaptation and pilot test of materials and recommendations for

strengthening of linkages between malaria and HIV prevention, diagnosis and treatment services.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $370,000

Randomized, controlled trials have now confirmed that male circumcision (MC) reduces the likelihood of

female to male HIV transmission by approximately 60%. MC is, however, only partially protective; men will

need to take other steps, such as abstinence, partner reduction and/or condom use, in order to protect

themselves and their partners against HIV infection.

While MC is a promising intervention that could potentially prevent millions of new HIV infections, it is

important to keep in mind that it is a surgical procedure; and as such, it has risks and benefits. Safe MC

services require well-trained healthcare providers, appropriate infection prevention and control practices,

and sufficient equipment and supplies. In addition to the surgical procedure, other essential elements of MC

services that must be taken into account include informed consent, post-operative care and risk reduction

counseling including the promotion of abstinence, partner reduction being faithful, and a minimum package

of other male reproductive health services, such as sexually transmitted infections (STI) treatment, condom

distribution, and HIV counseling and testing.

Since late 2006, JHPIEGO, a partner of the Forte Saúde Project (funded by USAID), has been working in

close partnership with USAID, CDC, WHO, UNAIDS, PSI, among others, to provide technical guidance to

the Ministry of Health (MOH) and the National AIDS Commission (NAC) to plan and prepare a situational

assessment to identify the MOH capacity for expanding safe MC services for prevention of HIV

transmission.

This proposed activity will build upon the current work and the results of the situational assessment, and

while a new activity under A&B, is linked to MC funding under C&OP and CT. The purpose is to provide

technical assistance to the MOH and NAC to develop and implement a comprehensive educational package

to promote other important HIV prevention strategies such as abstinence and be faithful (A&B).

Objectives of this activity will be to: (a) promote A&B as a key complementary strategy for MC for HIV

prevention; (b) develop and implement a comprehensive educational package to promote A&B; and (c) train

counselors on the new educational package for individual and group counseling.

Main activities will be to:

(a) Develop, field-test, and finalize a comprehensive educational package for individual and group

counseling for use consultation rooms, waiting rooms and at the community level.

(b) Train 50 counselors on MC and on how to use the educational package.

(c) Support and monitor the implementation of the activities at the selected sites (up to 6 sites) where an

expected 30,000 clients or individuals will be counseled in A&B as a complementary strategy for MC.

Funding for Biomedical Prevention: Injection Safety (HMIN): $900,000

Since 2004, the MOH, with TA from JHPIEGO, has been implementing a Standards-Based Management

and Recognition approach (SBM-R) to improve IPC practices in hospitals. A comprehensive set of

performance standards were developed covering 9 direct services: sterilization, operating rooms, TB,

emergency departments, inpatient services (medical, surgical, and pediatric wards), dental department,

blood bank, clinical laboratories, and post-mortem care; and 5 support services: administration, health

education, kitchen, laundry and waste management. Using the standards, workers identify and correct

performance gaps, mobilizing resources for Infection Prevention and Control (IPC). The program expanded

from 6 hospitals in 2004 to 13 in 2005, to 23 in 2006, and to 33 (including the Military Hospital in Maputo) in

2007. Compliance with standards ranged from 12 to 45% at baseline and from 52 to 93% in the latest

internal assessments of 2007.

The purpose of activities proposed for 2008 is to continue the support to the MOH for the expansion to a

total of 43 hospitals, and institutionalization of the IPC efforts in health facilities throughout the country.

Key objectives of this activity are to (a) strengthen, expand, and institutionalize the IPC initiative in hospitals;

(b) create a simple surveillance system to measure the impact of the improved IPC practices; and (c)

decrease the risk of medical transmission of HIV/AIDS and of nosocomial TB.

Main activities are to assist the MOH IPC program to:

(a) Develop a system to estimate, order and control the IPC materials and supplies

(b) Conduct one Training of Trainers (TOT) in IPC for 20 new IPC trainers for the 10 new facilities

(c) Conduct three IPC training courses for 100 healthcare workers

(d) Conduct SBM-R training for 90 healthcare workers already involved in IPC activities

(e) Support and monitor IPC training activities in 43 hospitals

(f) Support recognition activities for high performing hospitals in IPC

(g) Develop a simple surveillance system to measure the impact of the improved IPC practices

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $380,000

This program area is comprised of two separate components: (a) Condom use as part of a Male

Circumcision (MC) intervention package, and (b) workplace safety and health including Post-Exposure

Prophylaxis (PEP) for occupational HIV exposures

Proposed funding amount for condom use as part of the MC intervention package: $180,000

Randomized, controlled trials have now confirmed that male circumcision (MC) reduces the likelihood of

female to male HIV transmission by approximately 60%. MC is, however, only partially protective; men will

need to take other steps, such as abstinence, partner reduction and/or condom use, in order to protect

themselves and their partners against HIV infection.

In addition to the surgical procedure, other essential elements of MC services that must be taken into

account include informed consent, post-operative care and risk reduction counseling including the

promotion of abstinence, partner reduction being faithful, and a minimum package of other male

reproductive health services, such as sexually transmitted infections (STI) treatment, condom distribution

and use, and HIV counseling and testing. The promotion of condom use is particularly important to be

emphasized for men that are known to be at higher risk for HIV such as men with multiple partners, men

who have sex with men, military populations, truck drivers, miners, etc.

Since late 2006, JHPIEGO, a partner of the Forte Saúde Project (funded by USAID), has been working in

close partnership with USAID, CDC, WHO, UNAIDS, PSI, among others, to provide technical guidance to

the Ministry of Health (MOH) and the National AIDS Commission (NAC) to plan and prepare a situational

assessment to identify the MOH capacity for expanding safe MC services for prevention of HIV

transmission.

This component will build upon the current work and the results of the situational assessment. It is linked

with MC activities described under A&B, CT, OPSS, and SI parts of the COP08. The purpose is to provide

technical assistance to the MOH, NAC, and stakeholders to identify and work with men at higher risk to

contract HIV and design effective prevention strategies to address it.

Objectives are to, as part of a comprehensive package of MC interventions: (a) Identify men at higher risk of

contracting HIV; (b) design a strategy to promote condom use among the identified population and MC

among non-infected men; and (c) develop educational materials to promote condom use and MC.

Main activities will include to: (a) Develop, field-test and finalize educational materials for individual and

group counseling for use in consultation rooms, waiting rooms and at the community level; (b) train 25

counselors on how to use the educational package within intervention targeting men with risk behaviors and

promoting condom use and MC; (c) support implementation in up to 4 selected sites, reaching an estimated

10,000 clients/individuals counseled in condom use as a complementary strategy for MC; and (d) monitor

the implementation of the activities at the 4 selected sites.

Proposed funding for the second component of this activity is ongoing- Workplace Safety and Health

including Post-Exposure Prophylaxis (PEP) for Occupational HIV Exposures: $200,000

The rapid expansion of the provision of ART and other HIV-related health services is creating a severe

strain on the health human resources situation of Mozambique. The Ministry of Health is trying to cope with

this situation by quickly increasing the production of some critical cadres of health personnel. Additional

support will be needed, however, to ensure: that these new workers acquire the necessary competencies to

perform upon graduation; that they are properly deployed and incorporated in the health system; and that

retention and support strategies, including the protection of the health workforce, are in place to enable their

effective and sustained performance.

The purpose of this component is to support the MOH to continue the implementation of workplace safety

guidelines including the PEP for occupational injuries as a prevention measure for healthcare workers.

Key activity under this component will be to provide training and support for the implementation of the

workplace safety and health guidelines, including PEP, in up to 13 sites in order to achieve gradual

implementation of the workplace safety and health guidelines, including HIV post-exposure prophylaxis in all

central and provincial hospitals.

Funding for Care: Adult Care and Support (HBHC): $100,000

Continuing Activity:

Various activities related to technical support of MISAU, MMAS and CNCS in systems strengthening

(coordination and referral systems, materials development, M&E, supervision tools, policy development

etc). Includes support of OMM care, support and training

This is a new activity.

Gender-based violence (GBV) is an urgent public health problem worldwide, particularly in the context of

the HIV/AIDS epidemic. WHO (2002) reports that between 10 and 69% of women experience physical

abuse at the hands of a male partner at least once in their lives. When combined with a woman's increased

vulnerability to sexually-transmitted diseases including HIV in any given heterosexual encounter, violence

and other gender-related norms guiding male and female behavior greatly exacerbate the situation.

Since 2006, JHPIEGO has been providing technical assistance to the MOH to update and disseminate PEP

guidelines for HIV occupational exposures; and it is now expanding these guidelines to other vulnerable

groups such as victims of gender-based violence. Particularly in countries such as Mozambique, with an

estimated HIV prevalence of 16.2% and with the main mode of transmission being heterosexual

intercourse, and where women suffer a generally lower status of development than men, gender-based

violence and gender norms that influence women's vulnerability to HIV must be incorporated into the

context of existing HIV programs.

The purpose of this activity is to support the MOH to rapidly address the needs of gender-based violence

clients within the health care service delivery system and to ensure linkages between different levels of

interventions.

Objectives:

1. Provide support to the MOH to expand the concept of gender "mainstreaming" into health care service

delivery, through integration of gender-based violence components into existing HIV programs and

strengthening linkages to services for victims of gender-based violence

Measurable Outcomes:

• Assessment conducted of availability, suitability and coverage of local programs to which victims of gender

-based violence can be referred

• Findings of assessment and corresponding recommendations for strengthening of programs for victims of

gender-based violence disseminated

Main Activities:

• Conduct assessment to determine availability, suitability and coverage of local programs to which victims

of gender-based violence can be referred, and to determine culturally appropriate and relevant interventions

and messages to address gender issues (in Maputo City, Zambezia and Sofala provinces)

This activity sheet is also linked to activity sheets 8587, 8631 and 8637.

This activity is a continuation of South-to-South collaboration with Brazilian experts to support and provide

short-term technical assistance (TA) to the Mozambican National STI (Sexually Transmitted Infections) and

HIV/AIDS Program.

A technical expert for HIV/STI training from Brazil will provide short-term technical assistance for the

validation of the STI training roll-out to HIV/AIDS treatment service sites. In addition, the Brazilian expert will

assist the Ministry of Health (MoH) STI/HIV/AIDS program staff and staff from the MoH training institutes to

review of HIV/STI pre-service training materials, to ensure that HIV counseling and testing, partner

notification and STI treatment for HIV-positive clients are incorporated in pre-service training curricula.

Funding for Care: TB/HIV (HVTB): $450,000

According to WHO, about a third of the people living with HIV/AIDS (PLWHA) worldwide at the end of 2001

are co-infected with TB. The majority of these people are in low-resources countries such as Mozambique.

Because up to half of PLWHA develop tuberculosis and tuberculosis is known to have an adverse effect on

HIV progression, tuberculosis care and prevention should be priority concerns of HIV/AIDS programs; and

HIV/AIDS prevention and care should likewise be priority concerns of TB programs.

Prevention and care interventions should be integrated to tackle tuberculosis among HIV-infected people.

Joint TB/HIV interventions seek to 1) prevent HIV infection, 2) prevent TB, 3) provide care for PLWHA and

4) provide care for people with TB.

The purpose of these activities is to strengthen and expand interventions for HIV care, such as treatment of

other opportunistic infections, and ART for TB patients co-infected with HIV in hospital settings, and

increase the capacity of hospital staff to provide comprehensive care for TB patients. All activities will be

coordinated with the Counseling and Testing efforts supported by the Ministry of Health, and linkages within

the appropriate CT referral systems will be emphasized.

These activities are new and are directly linked to JHPIEGO's Infection Prevention and Control activities.

Objectives:

1. Improve access to HIV treatment for TB patients

2. Improve management of HIV/TB patients in in-patient wards in 10 hospitals

3. Minimize nosocomial TB infection among HIV+ patients and healthcare workers

Measurable Outcomes:

• WHO Manual on Tuberclosis Care with TB-HIV Co-Management, Integrated Management of Adolescent

and Adult Illness (IMAI) translated and adapted for Mozambique

• Training materials for HIV/TB management in in-patient wards developed based on the IMAI WHO Manual

• 20 TB supervisors trained as trainers in HIV/TB management using the materials developed

• 50 healthcare workers updated in HIV/TB management using the materials developed

• WHO Operational Manual translated and adapted for Mozambique

• Training materials developed based on the WHO Operational Manual

• 20 TB supervisors trained using the materials developed

• TB respirators selected and purchased for up to 10 sites (pending funding availability)

• Training on use of TB respirators conducted for supervisors and providers (pending funding availability)

Main Activities:

• Translate and adapt the WHO Manual on Tuberclosis Care with TB-HIV Co-Management, Integrated

Management of Adolescent and Adult Illness (IMAI)

• Develop training materials for HIV/TB management in in-patient wards based on the WHO manual

• Train 20 TB supervisors in HIV/TB management

• Train 50 healthcare workers from 10 hospitals in HIV/TB management

• Translate and adapt the WHO Operational Manual

• Develop training materials based on the WHO manual

• Train 20 TB superviros using the materials developed

• Select and purchase TB respirators for up to 10 sites (pending funding availability)

• Train supervisors and providers to use the respirators (pending funding availability)

Funding for Prevention: HIV Testing and Counseling (HVCT): $1,405,000

This activity sheet describes one activity for a TBD partner to continue support and technical assistance

(TA) for CT in clinical and community settings. The major activity is to identify a TBD and provide continuity

to JHPIEGO's current support for implementation of two strategies to increase the number of Mozambicans

who know their HIV status:

(1) Counseling and Testing (CT) in clinical settings, also known as provider-initiated counseling and testing

(PICT) is a key strategy for identifying HIV-infected persons in hospital settings, such as TB clinics and

inpatient wards (adults and pediatric). In these settings many patients who test positive have advanced HIV

disease and thus are already treatment-eligible, making this an effective strategy to refer HIV-infected

person for care and treatment services.

During 2006, JHPIEGO finalized the training materials, initiated the training activities for the integrated HIV

counseling and testing in the community and in clinical settings, and successfully started the implementation

of integrated counseling and testing activities.

In 2008, support for the implementation of the integrated CT in clinical settings and PICT will continue with

monitoring of the roll-out and training in TB service settings on one hand, and strong emphasis support to

the MOH for the establishment and roll-out of PICT in hospitals especially in-patient wards, that do not

benefit from NGO support for CT service delivery, on the other hand. Results expected in 2008 include 200

healthcare workers trained in clinical CT; 100 health facilities or departments/units providing PICT services;

100,000 individuals counseled and tested in clinical settings; and 50,000 individuals referred into care and

treatment as a result of PICT.

(2) Since 2005, JHPIEGO is working closely with the Ministry of Health (MOH), National AIDS Commission

(NAC), local and international NGOs and FBOs to implement integrated Community-based CT (CCT).

Working with couples and families, this initiative, is increasing the number of women and children accessing

CT and being referred for treatment and care. The CCT is assessing four different models of community-

based CT service provision: "classic" VCT services at non-traditional locations, such as churches and

mosques; satellite CT services at fixed locations (i.e. mobile CT teams providing services at health facilities

where CT services are not yet available on a daily basis); CT campaigns at markets and other non-

traditional locations; and home-based (door-to-door) CT services.

Efforts in the current year of 2007 include the evaluation of the pilot initiative on integrated counseling and

testing in the community and its expansion according to the results of the evaluation. In 2008 the expansion

will include new geographic coverage with current partners as well as new areas and partners such as

World Vision, Samaritan's Purse, HAI, among others. Results expected for CCT in 2008 are: 80 NGO staff

and volunteers trained in CCT;

5 National NGOs/CBOs enabled to start provision of CCT; 60,000 individuals counseled and tested at the

community level: and 30,000 individuals referred to care and treatment as a result of integrated community

CT services.

(3) In conjunction with support for CCT, support for CT in the workplace will be expanded, upon the MOH's

request, and include the establishment of CT services at 11 MOH training institutes where future health

cadres are being trained. At the same time pre-service training curricula will be revised to ensure systematic

and adequate CT training of future health cadres at those training institutes. Results expected in 2008

include: 20 teaching institutions staff trained in CT; 11 training institutions offering CT for their students;

10,000 students counseled and tested in the teaching institutions; and CT training modules adapted for pre-

service institutions.

(4) As part of a comprehensive package of Male Circumcision (MC) activities described also under A&B,

C&OP and SI part of COP08, CT materials will be developed/adapted for comprehensive and integrated

counseling on MC within male reproductive health services.

(5) In addition to the activities mentioned above, technical assistance to the MOH will be continued to

rapidly identify and address the needs of gender-based violence clients within PMTCT and CT services

using Mozambique-specific screening tools and materials for the identification of women that access HIV

testing services and as a result are at risk of sexual and/or domestic violence.

Objectives are to identify women that access HIV testing services and as a result are at risk of sexual

and/or domestic violence; and to propose strategies to address these needs. A strategy to address gender-

based violence clients within PMTCT and CT services will be developed and implemented at 6 selected

health facilities with up to 40 health care workers trained on how to implement the screening tools and

support women at risk of sexual and/or domestic violence

The proposed funding breakdown for the above described activities is: PICT and CCT $925,000; CT

services at training institutions $200,000; CT modules in the pre-service curricula $150,000; CT materials

for comprehensive male RH services including MC $50,000; and gender activity with screening tools to

assess women at risk of sexual and/or domestic violence $80,000.

Funding for Treatment: Adult Treatment (HTXS): $1,047,000

Continuing Activity with updated Narrative

This program area is comprised of two separate components: Continuation of support for ART site

infrastructure (supported by FY06 Plus Up funds and FY07 funds) and support for a new gender activity.

ART Site Infrastructure: $950,000

One of the major barriers identified by the hospitals to improving infection prevention and control practices

to decrease the medical transmission of blood borne diseases, such as HIV/AIDS, is the lack of adequate

proper instrument processing and infectious waste disposal. Proper isolation systems to prevent nosocomial

transmission of Tuberculosis (TB) are also needed. Lack of appropriate equipment and inadequate physical

structure are among the main causes of these gaps in most of the hospitals. Since 2006, JHPIEGO has

been providing technical assistance to improve sterilization systems and waste management in USG-

supported ART treatment sites, including provision of incinerators.

The purpose of the program area is to continue to support the improvement of instrument processing,

proper isolation systems, and waste management in USG-supported ART treatment sites, to be selected in

coordination with the Ministry of Health and USG.

These activities are continuing and will be complementary to those occurring in FY07.

Objectives are to: (a) Implement instrument processing and sterilization systems in treatment sites; (b)

implement waste management through provision of incinerators in treatment sites; and (c) improve isolation

measures to minimize nosocomial TB infection among HIV infected patients and healthcare workers

Main Activities will be to: (1) Support and improve central sterilization units in at least two selected USG

supported ART facilities, including provision of equipment and rehabilitation; (2) Select and purchase

incinerators for up to four USG supported ART sites; and (3) Design plans for the rehabilitation of isolation

units for infectious TB patients (Maputo, Sofala and Zambezia provinces).

Gender: $97,000

Gender-based violence (GBV) is an urgent public health problem worldwide, particularly in the context of

the HIV/AIDS epidemic. WHO (2002) reports that between 10 and 69% of women experience physical

abuse at the hands of a male partner at least once in their lives. When combined with a woman's increased

vulnerability to sexually-transmitted diseases including HIV in any given heterosexual encounter, violence

and other gender-related norms guiding male and female behavior greatly exacerbate the situation.

Since 2006, JHPIEGO has been providing technical assistance to the MOH to update and disseminate PEP

guidelines for HIV occupational exposures; and it is now expanding these guidelines to other vulnerable

groups such as victims of gender-based violence. Particularly in countries such as Mozambique, with an

estimated HIV prevalence of 16.2% and with the main mode of transmission being heterosexual

intercourse, and where women suffer a generally lower status of development than men, gender-based

violence and gender norms that influence women's vulnerability to HIV must be incorporated into the

context of existing HIV programs.

The purpose of this program area is to support the MOH to rapidly incorporate and address the needs of

gender-based violence clients within the health care service delivery system and to ensure linkages

between different levels of interventions.

Key objective of this activity is to provide support to the MOH to expand the concept of gender

"mainstreaming" into health care service delivery, through integration of gender-based violence components

into existing HIV programs and strengthening linkages to services for victims of gender-based violence,

beginning with the review, and updating of current policy and materials.

Main Activities will be to: (1) Conduct a desk review of current policy and materials to determine

appropriateness and coverage of issues relating to identification of, and support and referral for, victims of

gender-based violence; (2) Disseminate and utilize findings in desk review, create recommendations for

updating of policy and guidelines; and (3) Update service delivery guidelines for HIV accordingly, to

incorporate gender-based violence issues.

FY07 Narrative: This activity is linked to Activity 8593 in ARV Treatment Services. Proposed funding would

cover some activities initiated in FY06 and currently supported through a sub-agreement of EGPAF with

Vanderbilt University as well as new activities described below.

Zambezia province is the most populated of Mozambique's 11 provinces and also has the most number of

PLWHAs (est: 211,703). The provincial staff working in Zambezia are also said to face one of the biggest

challenges in delivering quality health services owing to deficient infrastructure and human resources even

by Mozambican standards.

The USG, with its new provinicial focus strategy, will identify one or two implementing treatment partners to

support ongoing ARV treatment activities in Zambezia at 3 existing facilities and to expand services to 6

new sites, thereby reaching 1040 persons on ARV in 9 sites total. Support to these sites will include

infrastructure development through renovation of treatment sites, recruitment and training of staff in the

provision of quality HIV care and treatments service, and provision of clinical advisors for supervision and

mentoring of clinic staff. In addition to offering ARV treatment services, the partner(s) will support training

and human capacity development and also assist in improving the health information system and routine

program monitoring at the MoH Provincial Health Office.

In addition to site-level support for ARV service delivery, funding will be provided for pre-service training of

nurses, medical technicians, laboratory assistants and pharmacy assistants in Zambezia Province to build

human capacity necessary for the scale up of ARV treatment and related HIV services in the province. The

partner(s) will also be expected to develop formal links with community-based groups in Zambezia to

provide adherence and psychosocial support. Finally, communication radios will be procured to improve

communication between provincial and district hospitals with smaller health centres that provide follow up

Activity Narrative: care for patients receiving care and treatment services and that function as down referral sites.

Funding for Strategic Information (HVSI): $50,000

April08 Reprogramming Change: Developing a QA/M&E system for male circumcision efforts ($50,000)

This activity is related to activities 15684.08, 15736.08, and 9064.08, as part of the overall strategy to

support a safe, effective, and scalable approach to expansion of male circumcision services in

Mozambique. In addition to the surgical procedure, other essential elements of MC services that must be

taken into account include informed consent, post-operative care and risk reduction counseling, and a

minimum package of other male reproductive health services, such as sexually transmitted infections

treatment, condom distribution, and HIV counseling and testing. To ensure that all these elements are in

place it is important to establish a QA mechanism to monitor and ensure safe MC services.

Funding for Health Systems Strengthening (OHSS): $2,350,000

Reprogramming August08: Support the use and distribution of the Ministry of Health's Human Resources

plan by summarizing the strategy, developing a document that can be distributed widely, printing that

document and supporting a 1 day workshop for donors, Ministry of Health and implementing partners.

All activities listed under TBD are being reprogrammed as is in this request except for the $258,151 to

support a training center.

Continuing Activity:

The rapid expansion of the provision of ART and other HIV-related health services is creating a severe

strain on the health human resources situation of Mozambique. The Ministry of Health is trying to cope with

this situation by drastically increasing the production of some critical cadres of health personnel. Additional

support will be needed, however, to ensure: that these new workers acquire the necessary competencies to

perform upon graduation; that they are properly deployed and incorporated in the health system; and that

retention and support strategies, including the protection of the health workforce, are in place to enable their

effective and sustained performance.

The purpose of this program area is to support the MOH to rapidly and effectively expand, deploy, and

support its health workforce in order to provide HIV-related and other priority health services. The following

activities are being proposed to support the MOH in accomplishing this purpose:

Objectives:

1. Develop and support the implementation of a nation-wide training information system for pre-service

education to track the production and deployment of human resources. This will be based on the current

Training, Information and Monitoring System being implemented for in-service training

2. Strengthen pre-service education for laboratory technicians in coordination with the American Association

of Public Health Laboratories (AAPHL)

Measurable Outcomes:

• Web-based training information system for pre-service education developed and tested in two provinces

• Pre-service training materials for laboratory technicians developed, including reference manual, trainer

notes, student learning materials and guidelines according to standards in coordination with the AAPHL

Main Activities:

• Develop and test a web-based training information system for pre-service education

• Provide technical support regarding the training methodology of the pre-service curriculum for laboratory

technicians in coordination with the AAPHL, who will provide technical content for the curriculum materials

The following activities are continuing and will complement ongoing FY07 activities.

Main Activities:

• Conduct assessment to compare competencies that nurses learned at the training institutions vs what they

currently perform at their workplace, and recommend most appropriate and cost-effective options for

nursing education

• Develop and implement in up to 13 sites a set of performance standards for nursing pre-service education

that can be adapted for different cadres

• Train teams of 5 members (teachers and clinical preceptors) from 13 teaching sites on the performance

improvement process

• Pilot a clinical teaching model where nursing students are closely supervised and mentored at the ward

level in provincial hospitals• Implement in-service training for ancillary workers

• Provide training and support to provincial staff in up to 13 sites for the implementation of the web-based

training and information system

• Develop master guidelines to guide the development and implementation of interventions to improve pre-

service training

Continuation of support for Gender plus up activities ($310,000)

These activities support the plus up activity around developing a system for providing PEP to women who

have been sexually abused in Sofala province. Specifically these activities focus on implementing PEP

guidelines, training of health care providers on how to serve the needs of gender based violence victims

and materials development.

Continuation of support for Male Circumcision ($50,000):

Activities proposed for continuation also include capacity building for the Ministry of Health (MOH), the

National AIDS Council (NAC), and stakeholders in the area of Male Circumcision. As described in other

sections of the COP08 (A&B, C&OP, CT and SI), a comprehensive intervention package will be developed

based on a situational assessment to identify the country's capacity for expanding safe MC services for

prevention of HIV transmission supported through USG FY06/07 funds.

The proposed funding will support a series of workshops and capacity building events that will assist to (a)

continuously up-date government staff and stakeholders on progress of MC activities in-country as well as

internationally/regionally; (b) ensure that data from the assessment are shared with all relevant government

entities and stakeholders, and that a participatory process is in place to ensure a constructive debate

around the results, recommendations and joint planning for the development of the intervention plan and

package; (c) support translation of key MC documents to Portuguese; and (d) support the in-country MC

working group, chaired by MOH staff, with participation from NAC and other stakeholders (including WHO,

UNAIDS, JHPIEGO, DCI, PSI, UNICEF, USG and others) as needed.

NEW Activity: ($258,151)

In an August 22nd meeting with HHS Secretary Leavitt, Mozambique's Minister of Health Garrido identified

the overall shortage of human resources as his number one operational constraint for improving health care

delivery. In their meeting it was proposed that a Lower Level Health Care Worker Training Center be

established in Mozambique to provide Portuguese-language instruction for participants from Lusophone

Africa. These health workers could be prepared through courses lasting only six months or less. Such

Activity Narrative: training could begin with basic technical skills that can serve in a variety of health care settings.

In initial discussions among USG officials following the meeting with the Minister of Health, an existing

facility was considered. On the outskirts of Maputo, there is a training center, the Centro Regional de

Desenvolvimento Sanitario (CRDS), which was developed by the Mozambican Ministry of Health and The

World Health Organization (WHO). The center has classrooms and recently renovated lodging and dining

facilities for participants. Few technical faculty are assigned to the facility; however, there are maintenance

staff. To date, this facility has been under-utilized but could be an ideal location for hosting training for local

Mozambicans and those from other African Lusophone countries. If the emphasis of training were on

gaining technical skills such as laboratory equipment repair, there would be a need to outfit the center with

needed equipment.

Identifying Portuguese-speaking trainers with the needed technical expertise would be important. Drawing

on expertise within each Lusophone country in Africa and partnering with Brazil to provide trainers and other

support for this center would strengthen the effectiveness and sustainability of the center. The proposed

next steps in exploring this idea are to:

1. Share concept paper with Ministry of Health officials in Mozambique.

2. Through a consensus process, revise the concept paper with MOH in Mozambique.

3. Conduct an asset mapping of resources (i.e., training expertise, training or conference center locations,

technical expertise) within each Lusophone country that could be drawn on in developing this training

endeavor.

4. Share concept paper with MOH in Brazil, Angola, Guinea Biseau and Cape Verde to gauge interest level.

5. Assess training needs in participating Lusophone countries.

6. Develop an advisory entity consisting of representatives from key stakeholders.

Deliverables/benchmarks:

• Web-based information system for in-service training available at provincial sites

• Web-based training information management system for pre-service developed

• Training methodologies used in pre-service curriculum for laboratory technicians

• Nursing training institution assessment focusing on what nurses learn in pre-service and what they use in

practice

• Cost effective options for nursing education

• Performance standards for nursing pre-service

• Nursing faculty trained on performance improvement process

• Ward level clinical teaching model at provincial hospitals

• Master guidelines to guide development and implementation of interventions to improve pre-service

education.

Deliverables/benchmarks (gender)

• PEP guidelines implemented

• Health care providers trained around gender based violence

• Materials development.

Deliverables/benchmarks: (male circumcision)

• Assessment data widely shared

• Participatory process around data interpretation

• Translate materials

Deliverable/benchmark: (training center)

• Concept paper for a Lusophone training center

• Asset map of Lusophone countries

• Training needs of each participant country

• Advisory board of key stakeholders