Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8784
Country/Region: Mozambique
Year: 2009
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $7,471,890

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

(1) HIV and malaria in pregnancy component reprogrammed to JHPIEGO in FY08; no new funding for FY09

(2) Central level support component to be reprogrammed for implementation in FY09

-- Acticity unchanged from FY08 --

This activity is composed of two distinct pieces: the first focusing on HIV and malaria in pregnancy

[$135,000], and the second focusing on central-level support for PMTCT policy development, including

mother support groups and integration with child health [$203,000].

HIV and malaria in pregnancy

It is well-known that malaria and HIV are devastating global health problems. Less is known about the

interaction of the diseases or treatment choices for co-infected individuals; however, the current information

reveals a very serious public health problem given the wide geographic overlap of the diseases in sub-

Saharan Africa. HIV and malaria are highly endemic in Mozambique. HIV prevalence is 16.2%, and more

than 90% of the population is exposed to malaria. Malaria is the largest single cause of mortality in

hospitals: it is responsible for over 40% of outpatient visits and for 30% of recorded hospital deaths. The

population is thus not only at severe risk of ill-effects of each disease, but for co-infection by both of them.

Pregnant women are especially vulnerable to these diseases. Malaria during pregnancy increases the risk

of maternal anemia, spontaneous abortion, still birth, low birth weight, and neonatal death. It is responsible

for the death of approximately 10,000 African women and 200,000 infants each year.

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: A) 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; B) Complete analysis of

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

guidelines for malaria, HIV/AIDS, and reproductive health; D) 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.

The activity described so far will provide a foundation for future revision of training materials and service

delivery guidelines beyond the PMTCT setting, with latest evidence relating to the interaction between HIV

& Malaria.

Central-level PMTCT support

This is a new activity designed to strengthen national PMTCT leadership and guidance by creating

opportunities with a TBD partner with central-level influence and experience in Mozambique, such as

UNICEF or other potential applicants. The TBD partner will be in a unique position to influence MOH policy

at central level, including finalization of outstanding PMTCT norms and standards, as well as a systematic

approach to integrating PMTCT and child health (IMCI) activities, thereby creating a stronger link between

PMTCT and child survival efforts.

Key activities will include A) Support for central-level finalization and dissemination of PMTCT norms and

standards; B) Support coordination of PMTCT and child health integration, including IMCI; C) Collaborate

with I-TECH in development and implementation of mother support groups for PMTCT. Coordination

between stakeholders started in FY07 with planning for a support group assessment activity, and FY08

activities will include development of a standard model, pilot phase, and implementation.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19729

Continued Associated Activity Information

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

System ID System ID

19729 19729.08 HHS/Centers for JHPIEGO 8784 8784.08 $135,000

Disease Control &

Prevention

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $0

ACTIVITY UNCHANGED FROM FY2008 - NO NEW FUNDING IN FY09

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15684

Continued Associated Activity Information

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

System ID System ID

15684 15684.08 HHS/Centers for JHPIEGO 8784 8784.08 $370,000

Disease Control &

Prevention

Table 3.3.02:

Funding for Biomedical Prevention: Injection Safety (HMIN): $1,349,390

This RFA was developed to ensure continuation of support for activities that began under the University

Technical Assistance Program (UTAP) Cooperative Agreement (CoAg) to support a broad range and

expansion of prevention and care services and activities in Mozambique. Working with the Ministry of

Health (MOH) and other local partners, the agreement is designed to build on and strengthen multiple

PEPFAR activity service areas, specifically counseling and testing, infection prevention and control

(including tuberculosis), male circumcision, cervical cancer prevention, gender issues, human capacity

development, prevention of mother-to-child transmission, malaria and other linkages areas. Within this RFA,

the specific Infection Prevention and Control area activities where Fiscal Year (FY) 09 funding is being

requested include: Infection Prevention and Control (IPC) and improvement of waste management systems

at major US goverment supported hospitals where Anti-Retroviral Treatment (ART) services are provided.

MOH, with technical assistance from JHPIEGO, has been implementing a nationwide Standards-Based

Management and Recognition approach (SBM-R) to improve Infection Prevention and Control (IPC)

practice from 2004-2008 in major USG supported hospitals providing ART services and serving as referral

units for HIV/AIDS services throughout the country. Using the SBM-R approach, health staff across different

services areas including ART, PMTCT, CT, laboratories, blood banks etc. identify and correct IPC activities

to increase safety and prevent HIV transmission for both patients and health providers. In many instances,

hospital teams have been able to also mobilize additional provincial level MOH resources to support and

further strengthen IPC efforts in their facilities, thus leveraging support already provided by PEPFAR. The

program has been expanded from 6 hospitals in 2004 to 43 hospitals in 2008.

In 2009, the objective is to continue to support the MOH efforts through a TBD partner, in further

consolidation of the IPC program and expansion to a total of 53 hospitals throughout the country.

Also this effort will continue to support the improvement of waste management systems (procurement and

installation of hospital incinerators, training and supervision of waste separation and safe disposal, in

particular for ART sites with larger number of patients and thus large amounts of contaminated waste)

started in 2006. By 2008, six hospitals have improved their waste management system and health staff

have already been trained and supervised on the operation and maintenance of the system. In 2009,

additional hospitals will be included in the program. MOH has already selected two hospitals from the

northern region of the country. The improvement of the waste management system will reduce the risk of

HIV medical transmission and will contribute to safe and high quality of services being available at those

selected hospitals.

Activities will:

(a) Strengthen and institutionalize the IPC program in hospitals;

(b) Utilize the surveillance system created to measure the impact of the improved IPC program;

(c) Decrease the risk of medical transmission of HIV/AIDS; and

(d) Improve waste management systems in new hospitals

Main activities proposed include:

1. Conduct Training of Trainers (TOT) in IPC for 20 new IPC trainees for the 10 new facilities;

2. Conduct three SBM-R training courses for 80 new health workers;

3. Conduct IPC training for 100 health workers;

4. Support and monitor IPC activities in 53 hospitals;

5. Support external assessment to verify hospitals' compliance with the IPC standards conducted in

hospitals

6. Monitor the surveillance system to measure the impact of the improved IPC practices;

7. Procurement and installation of incinerators in up to two new hospitals;

8. Train hospital staff to operate and maintain each system; and

9. Monitor operation of systems to ensure proper functioning.

Product/Deliverables

- One TOT course on IPC activities

- Four courses on SBM-R for new health workers

- Five courses on IPC activities

- 15 Supervision visits to verify hospital compliance with IPC standards

- Two trainings for health staff responsible for the waste management system

- Two incinerators installed in hospitals selected

New/Continuing Activity: New Activity

Continuing Activity:

Continued Associated Activity Information

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

System ID System ID

15775 5177.08 HHS/Centers for JHPIEGO 8784 8784.08 $900,000

Disease Control &

Prevention

8516 5177.07 HHS/Centers for JHPIEGO 4870 3566.07 UTAP $720,900

Disease Control &

Prevention

5177 5177.06 HHS/Centers for JHPIEGO 3566 3566.06 UTAP $825,000

Disease Control &

Prevention

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.05:

Funding for Biomedical Prevention: Injection Safety (HMIN): $0

ACTIVITY UNCHANGED FROM FY2008 - NO NEW FUNDING IN FY09

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

New/Continuing Activity: Continuing Activity

Continuing Activity: 15775

Continued Associated Activity Information

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

System ID System ID

15775 5177.08 HHS/Centers for JHPIEGO 8784 8784.08 $900,000

Disease Control &

Prevention

8516 5177.07 HHS/Centers for JHPIEGO 4870 3566.07 UTAP $720,900

Disease Control &

Prevention

5177 5177.06 HHS/Centers for JHPIEGO 3566 3566.06 UTAP $825,000

Disease Control &

Prevention

Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision

Total Planned Funding for Program Budget Code: $2,000,000

Total Planned Funding for Program Budget Code: $0

Table 3.3.07:

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $1,600,000

Ongoing HIV transmission in sub Saharan Africa necessitates vigorous prevention efforts, which is why the

compelling evidence of effectiveness of male circumcision (MC) as an HIV prevention intervention has been

met with great excitement. Three randomized clinical trials conducted in Kenya, South Africa and Uganda

demonstrated that circumcision of HIV uninfected men provided between 50-60% protection against HIV

acquisition. Thus, this intervention is being considered for implementation and scale-up in communities with

high rates of HIV infection and low rates of circumcision of men globally.

In Mozambique, the Ministry of Health (MOH) recently granted approval for a MC demonstration project in

four sites, including one military facility. In FY09, JHPIEGO will work with the MOH, NAC, CDC, DOD and

other key partners to develop new communication tools and materials, services, and prevention messages

for MC. Objectives will be to: develop materials on MC informed consent, post-operative care, and risk

reduction counseling; train supervisors, trainers, and counselors on MC in each of the four sites; implement

safe MC services in selected sites; support and monitor the implementation of the activities at the selected

sites; 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; design a strategy to promote MC

among non-infected men; and implement a QA/M&E system for MC efforts as part of the overall strategy to

support a safe, effective, and scalable approach to expansion of MC services in Mozambique. Outcomes

will include increased number of skilled providers providing safe MC, strengthened health care facilities to

provide safe MC services, and increased demand for and access to safe MC services.

Male circumcision services will not be a stand alone intervention, but part of a comprehensive prevention

strategy, which incudes: the provision of HIV testing and counseling services; treatment for STIs; the

promotion of safer sex practices; the provision of male and female condoms and promotion of their correct

and consistent use; and linkages and referrals to prevention interventions and other social support services.

An additional emphasis will be on appropriate counseling of men and their sexual partners to prevent them

from developing a false sense of security and engaging in high-risk behaviors that could undermine the

partial protection provided by male circumcision. Appropriate communication tools and messages will

highlight accurate information regarding the protective effect of male circumcision, need for continued use of

other preventive behaviors (e.g. condom use), risks and benefits of the procedure, appropriate post-

operative wound management and the need to abstain from sex until certified complete incision healing.

The provision of accurate information regarding these important facts will be needed in order to achieve

successful and safe scale-up of male circumcision.

As part of FY09 funding, JHPIEGO partner will also develop and implement quality assurance measures

and an M&E system for MC efforts as part of the overall strategy to support a safe, effective, and scalable

approach to expansion of MC services in Mozambique. Additionally, adverse events and post-operative

complications will be monitored and tracked. To assist with future scale-up of male circumcision throughout

the country, JHPIEGO will regularly share M&E reports and lessons learned MOH, NAC, CDC, DOD and

other partners.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.07:

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $250,000

Ongoing HIV transmission in sub Saharan Africa necessitates vigorous prevention efforts, which is why the

effectiveness of male circumcision (MC) as an HIV prevention intervention has been met with great

excitement. Three randomized clinical trials conducted in Kenya, South Africa and Uganda demonstrated

that MC of HIV uninfected men provided between 50-60% protection against HIV acquisition. Thus, this

intervention is being considered for implementation and scale-up globally in communities with high rates of

HIV infection and low rates of circumcision of men.

In Mozambique, USG partners have provided technical guidance to the Ministry of Health (MOH) and the

National AIDS Council (NAC) since late 2006 to plan and prepare a situational assessment for overall minor

surgical capacity, including the expansion of safe MC services for prevention of HIV transmission.

In preparation for future expansion, the WHO and UNAIDS developed toolkit, guidelines and the training

materials needed to train or re-train surgical providers on how to perform MC following the standradized

procedures have been translated to Portuguese using FY08 funds. With this accomplished, adaptation

could take place as soon as the assessment is completed and MOH approves preparation of pilot sites.

Activities in FY09 will build upon this ongoing work and the results of the situational assessment. The TBD

partner will work with the MOH, NAC, CDC and other key partners to: 1) develop or identify communication

tools and materials; 2) initiate safe MC services in four to five selected pilot sites; 3) develop systems to

support quality assurance and monitoring of MC service delivery; and 4) provide capacity building and

technical assistance to governmental bodies.

Based on the findings from situational assessment as well as available literature, appropriate

communication tools and educational materials will be developed with other USG partners and the technical

working group. The TBD partner will ensure that key messages provide accurate information regarding

protective effect of MC, need for continued use of other preventive behaviors (e.g. condom use), risks and

benefits of procedure, appropriate post-operative wound management and need to abstain from sex until

certified complete incision healing. Educational material will be reviewed by technical working groups for

linguistic and cultural appropriateness. Provider educational materials will also be identified that provide

similar information on the procedure as well as detailed information of operative and post-operative care.

Safe MC service provision for HIV-negative men requires appropriate site preparation and training of

providers on how to safely perform this surgical technique as well as how to monitor patients post

operatively is necessary to minimize complications. Partner activities will include:

Introductory meetings and onsite orientation workshops;

Site strengthening in preparation for service delivery;

South-to-south exchanges to support training of trainers;

Provider training for teams in each region (south, central and north), with follow-on counseling-specific

training as necessary; and

Onsite supportive supervision at select sites within each region where MC services are delivered.

Male circumcision services will not be a stand alone intervention, but part of a comprehensive prevention

strategy, which incudes: the provision of HIV testing and counseling services; treatment for STIs; the

promotion of safer sex practices; the provision of male and female condoms and promotion of their correct

and consistent use; and linkages and referrals to prevention interventions and other social support services.

An additional emphasis will be on appropriate counseling of men and their sexual partners to prevent them

from developing a false sense of security and engaging in high-risk behaviors that could undermine the

partial protection provided by male circumcision.

As part of FY09 funding, the TBD partner will also develop and implement quality assurance measures and

an M&E system for MC efforts as part of the overall strategy to support a safe, effective, and scalable

approach to expansion of MC services in Mozambique. Potential outcomes will include increased number

of skilled providers providing safe MC, strengthened health care facilities to provide safe MC services, and

increased demand for and access to safe MC services. Additionally, adverse events and post-operative

complications will be monitored and tracked. To assist with future scale-up of male circumcision throughout

the country, the TBD partner will regularly share M&E reports and lessons learned MOH and NAC.

Finally, the partner funded to conduct this activity will continue technical assistance and capacity building for

MOH, NAC, and stakeholders in the area of MC. The proposed funding will support a series of workshops

and capacity building events that will assist to (a) continuously update 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; (d) support the in-country MC working group, chaired by MOH staff, with participation from

NAC and other stakeholders (including WHO, UNAIDS, UNICEF, and USG and its partners) as needed and

(e) develop appropriate MC policy, as needed.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.07:

Funding for Care: Adult Care and Support (HBHC): $0

ACTIVITY UNCHANGED FROM FY2008 - NO NEW FUNDING IN FY09

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13206

Continued Associated Activity Information

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

System ID System ID

13206 8570.08 HHS/Centers for JHPIEGO 8784 8784.08 $100,000

Disease Control &

Prevention

8570 8570.07 HHS/Centers for To Be Determined 4879 3640.07 TBD

Disease Control & Cooperative

Prevention Agreement

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $0

ACTIVITY UNCHANGED FROM FY2008 - NO NEW FUNDING IN FY09

FY08: 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

USGsupported

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

Activity Narrative: 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

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

New/Continuing Activity: Continuing Activity

Continuing Activity: 13208

Continued Associated Activity Information

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

System ID System ID

13208 8547.08 HHS/Centers for JHPIEGO 8784 8784.08 $1,047,000

Disease Control &

Prevention

8547 8547.07 HHS/Centers for To Be Determined 4879 3640.07 TBD

Disease Control & Cooperative

Prevention Agreement

Table 3.3.09:

Funding for Care: TB/HIV (HVTB): $0

Continuing Activity: (No new funds for FY09)

JHPIEGO is working with the MoH since May 2008 in the area of Infection Control with the objective to

decrease the transmission of TB to patients, health care workers and the community.

The activities that have been implemented are:

1. A consultant has been indentified to work as a focal person for I Control.

2. Undergoing development of 5-year national plan for TB Infection Control in health care settings.

3. A protocol and tool to conduct a national rapid assessment on IC for TB in selected facilities have been

developed

4. A rapid assessment has been conducted in Machava General Hospital, Infulene Psychiatric Hospital. A

draft report and of recommendations regarding the possibility to move the TB reference hospital from

Machava to Infulene have been produced.

5. A chapter on Infection Control measures for the MOH Manual on Management of the MDR- TB has bee

written

6. Working with FHI to improve the translated version of the Infection Control Guidelines which will be soon

submitted adoption.

7. Collaboration with MoH and CDC to conduct the first training on Infection Control as pilot and ToT to

representatives of all the 11 provinces.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15774

Continued Associated Activity Information

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

System ID System ID

15774 15774.08 HHS/Centers for JHPIEGO 8784 8784.08 $450,000

Disease Control &

Prevention

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Care: TB/HIV (HVTB): $250,000

This is a new activity.

The prevention of TB nosocomial infection in Mozambique constitutes a challenge due to the high

prevalence of HIV and TB. Most of admitted patients are HIV-positive and are immuno- compromised and

therefore susceptible to Mycobacterium infection.

The Ministry of Health has requested the integration of the prevention of TB transmission in health care

settings as part of the national Infection Prevention and Control (IPC) plan with the aim to decrease the risk

of infection transmission of Infection to clients, providers and the community.

To better control TB nosocomial transmission in health care settings, there is need to adhere to three types

of preventive measures: administrative, environmental control and protection of health workers.

This activity is related to TB/HIV - ICAP, Vanderbilt University, CARE international and EGPAF, and has

several different components of continuing activities with emphasis on TB Infection Control. The goal of this

activity is to prevent the transmission of TB in health facilities. Activities will be implemented through a

Cooperative Agreement to a "To Be Determined" Partner. This TBD partner will support the Ministry of

Health to implement its TB Infection control plan in collaboration with other PEPFAR partners working in the

area of TB/HIV collaborative activities. FY2009 funding will support the following activities:

1. To support the development and implementation of infection control plan for each hospital.

2. Development of guidelines and protocols to help in recognition, separation, provision of services,

investigation for TB and referral of patients with suspect or confirmed TB disease.

3. Sensitization and training of all staff working in health facilities to understand the importance of Infection

Control and the risk of transmission to h.care workers and other staff .

4. Educate patients by providing them with basic information on TB (transmission, risks of transmission,

symptoms, diagnosis, treatment) and cough etiquette.

5. Support the improvement of natural ventilation and appropriate mechanical ventilation.

6. Support the implementation of voluntary counselling and testing for HIV and screening for TB to all staff.

7. Conduct regular supportive supervision and evaluation of the implementation of the infection control plan.

8. Assist the MoH in setting up a surveillance of nosocomial infections starting in provincial hospitals and

some district/rural hospitals.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $1,061,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The partner will be changed: TBD.

Continuing Activity:

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

Community Based CT. The major activity is to provide continuity to current partner's support for

implementation of this strategy newly accepted by the Ministry of Health to increase the number of

Mozambicans who know their HIV status.

The national CT expansion strategy has undergone major changes since 2005, which aside from greater

emphasis on expansion of Provider Initiated CT (PICT) in clinical settings, includes the "Counseling and

Testing in Health" (CTH) approach being introduced to include health promotion and prevention activities

aimed at increasing the number of people who access health services. This health promotion package

proposes continuation and expansion of HIV counseling and testing as well as the inclusion of Tuberculosis

(TB), Sexually Transmitted Infections (STIs) and hypertension screening and referrals where necessary,

counseling on malaria prevention, environmental health education, and sexual reproductive health

orientation - especially in relation to early pregnancy diagnosis and promotion of institutional delivery.

Partners have supported the MOH and National AIDS Council (NAC) in the establishment of the first

community-based CT (CCT) services in Mozambique since 2006. The Community CT strategy follows the

same approach of the facility-based CT in Health. The pilot program implemented with the support of

JHPIEGO in 2007 and 2008 took place in five provinces of Mozambique with strong support from

international and national NGOs, and Faith Based Organizations (FBOs) testing different models such as:

CT services delivered at non-traditional locations (e.g. churches and mosques); 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. A significant

result of this initiative is women and children accessing CT and being referred for treatment and care

through home-based CT. The expansion of CCT activities has been approved by the Minister of Health at

the end of 2007 ensuring direct MOH and NAC involvement, coordination, and quality assurance.

Efforts for FY09 increase the participation of national civil society organizations in the implementation of

Community based CT.

Objectives:

1. Increase the number of Mozambicans who know their HIV status

2. Expand community CT activities in terms of numbers of implementing NGOs and numbers of clients

served

A. Measurable Outcomes

• NGO staff and volunteers trained in community CT

• NGOs providing integrated community CT increased

• Number of individuals counseled and tested at the community level increased

• Number of individuals referred to care and treatment as a result of integrated community CT services

increased

Main activities

• Perform supportive supervision for community CT

• Monitor and evaluate expansion of community CT

• Provide sub-grants to approximately ten local NGOs for the implementation of community CT activities

• Support the MOH on the creation of minimum standards for CT in community settings

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.

New/Continuing Activity: New Activity

Continuing Activity:

Continued Associated Activity Information

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

System ID System ID

13207 8568.08 HHS/Centers for JHPIEGO 8784 8784.08 $1,405,000

Disease Control &

Prevention

8568 8568.07 HHS/Centers for To Be Determined 4879 3640.07 TBD

Disease Control & Cooperative

Prevention Agreement

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Prevention: HIV Testing and Counseling (HVCT): $150,000

ACTIVITY UNCHANGED FROM FYO8 BUT NARRATIVE HAS BEEN MODIFIED IN THE FOLLOWING

WAYS:

This is a continued activity to establish and enhance CT service provision in existing youth programs in

Mozambique through a TBD partner.

In many developing countries, youth encounter significant barriers to receiving sexual and reproductive

health (SRH) services and to obtaining effective, modern contraception and condoms to protect against

sexually transmitted infections (STIs), including HIV. According to UNAIDS, two-thirds of all young people

living with HIV/AIDS in the world live in sub-Saharan Africa. Young people frequently lack access to SRH

information or even services specifically addressed to them that emphasize STI/HIV prevention, as well as

the life skills needed to protect themselves. Social norms - such as gender imbalance, sexual exploitation,

alcohol use, and lack of sexual negotiation skills increase young people's vulnerability to HIV/AIDS. In many

areas of Mozambique, high HIV prevalence seems to be associated with a low median age at sexual debut

among female youth, low levels of condom use, a low level of of HIV knowledge and high levels of young

women engaged in intergenerational sexual relations. These risk factors underscore the need for integrated

and confidential family planning (FP)/SRH and Counseling and Testing (CT) for HIV services specifically

targeting vulnerable youth.

Scaling up CT services into existing FP/SRH youth health services can draw a range of clients that do not

access CT sites for the general population due to lack of information and access, fear of stigma, and

because they may as well perceive themselves as at "low risk" for HIV.

HIV CT is a good time for young people to think about other issues related to sexual behaviors, including

the prevention of other STIs and unintended pregnancy. Although a few counseling sessions are usually not

enough to affect long-term behavior change, HIV counseling can be a crucial first step. Comprehensive HIV

CT services and appropriate follow-up referrals have the potential to: increase general awareness of

HIV/AIDS; increase clients' understanding that they are vulnerable; encourage both HIV-positive and HIV-

negative youth to adopt safer behaviors, such as abstinence, faithfulness, and condom use as appropriate;

encourage HIV-positive youth to seek proper care and, when necessary and available, appropriate

treatment; reduce the likelihood of unintended pregnancy by providing information about contraception and

referrals as needed; encourage young people to seek other medical and support services, as needed; and

introduce other life skills, such as thinking critically and improving assertiveness. Additionally, youth friendly

CT services have proven successful in reaching more young men with prevention strategies, and

encouraging male involvement and access to FP/SRH services while increasing the predominantly female

clients' access to HIV testing and services.

The TBD partner will provide comprehensive CT services that are able to effectively attract young people,

meet their needs comfortably and responsively, and succeed in retaining these young clients for continuing

care. Basic components will include specially trained providers, privacy, confidentiality, and accessibility.

The intent is to increase access to affordable CT services and useful information while minimizing the

embarrassment of being seen at clinics, fear that confidentiality will not be honored, and concern that staff

members will be

hostile and judgmental.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15931

Continued Associated Activity Information

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

System ID System ID

15931 15931.08 HHS/Centers for To Be Determined 6412 3640.08 TBD

Disease Control & Cooperative

Prevention Agreement

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Prevention: HIV Testing and Counseling (HVCT): $200,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

THIS ACTIVITY IS A CONTINUATION FROM FY2008 (Activity ID 15780.08). HOWEVER, FUNDING MAY

GO TO A NEW PARTNER TBD.

Federal University of Rio de Janeiro has been providing technical assistance (TA) for the Mozambican

Counseling and Testing (CT) Program since FY05. Main focus of activities has been in the strengthening of

CT program training and monitoring through the development and improvement of CT training materials and

supervision tools. This activity is a continuation of South-to-South collaboration with Brazilian experts to

support and provide TA to the Mozambican National Counseling and Testing Program.

FY2009 funds, administered through Brazilian Partner, TBD, will support a full time position for a Brazilian

HIV/AIDS, CT and training expert to provide technical assistance and build capacity within the Mozambican

National Counseling and Testing Program aiming at increased access to and improving quality of CT

services. The CT Program Support Officer will assist in all matters related to the development and

strengthening of the CT Program of the Ministry of Health in Mozambique. Specifically, the CT Program

Support Officer will work to strengthen MOH CT Program staff capacity to expand CT in the CT in Health

Units (UATS). The key objectives of this position are as follow:

Build the capacity and provide support to the MOH team responsible for managing and implementing CT

activities. This will be done in close collaboration with CDC to foster national counseling and testing goals

supported by the USG in Mozambique.

Provide technical assistance to ensure that CT activities are based on the latest relevant science and that

scientific knowledge is translated into programs guidelines and activities.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.14:

Funding for Health Systems Strengthening (OHSS): $2,500,000

This is a new activity.

This RFA was developed to further advance activities that began under the University Technical Assistance

Program cooperative agreement to support a broad expansion of prevention, care and treatment services

and practices in hospitals and clinics in Mozambique. Working with the Ministry of Health and other local

partners, the agreement is designed to strengthen multiple PEPFAR activity service areas, specifically

counseling and testing, infection prevention and control, male circumcision, cervical cancer prevention,

gender issues, human capacity development, malaria, tuberculosis, laboratory biosafety, and anti-retroviral

treatment site infrastructure. Within this RFA, the specific Systems Strengthening area activities include:

workplace safety, gender isues, pre-service, training information systems, human resources for health

systems development and quality assurance.

The Training Department of the National Directorate for Human Resources on the MOH has been

implementing a nationwide quality assurance program for health training institutions starting in 2007. This

program consisted of several interventions: 1) Introduction of training information and monitoring systems at

pre-service institutions in FY08; 2) Introducing the Standards-Based Management and Recognition

approach (SBM-R) to improve teaching quality. This approach consists of 4 standards areas: classroom

and humanistic laboratory, institution management, practical rotation, and infrastructure. Using these

standards, training institution staff identify and correct performance gaps and mobilize resources for quality

improvements. One element of this overall approach was the successful piloting at the Central Hospital in

Maputo of in-ward training model (practical demonstration) for nurses. As a result of this pilot, resources,

tools, and equipment needed for practical demonstrations for students were put into place. 3) Previous year

funds were used to design a task analysis PHE for three cadres of health care providers: nurses (general

and maternal-child health) and clinical officers. There was an expert consultation in July regarding the

assessment tool proposed to capture information. The assessment will be conducted and results analyzed

before the end of calendar year 2008. 4) Developing tools for supervision and updating regulations for

training institutions have been underway for the last two years. Two PEPFAR partners have been involved

in the implementation of this plan through three Technical Advisors (who work closely with the Training

Department), technical assistance and funding for activities. 5) Adapting training materials for use by lower

level cadres of auxillary health care workers. 6) Per a reprogramming request, supporting the Human

Resources Dept at the MOH as they finalize the Human Resources for Health strategic plan and as they

present the plan to donors, international community and other Ministries in Mozambique

FY 09 activities will include:

Continued activities supporting the workplace safety in the form implementation of the workplace safety

program through training, supervision and dissemination activities. This would include standardizing the

use of PEP (post exposure prophylaxis).

Continued support of training information management system development through the expansion of the in

-service training information system using a web-based model and assessment and initial design of the

training information system for pre-service institutions . Funds would be used to support a comprehensive

assessment of needs and capacities at pre-service institutions in order to design a training information

system that captures the information identified as most important to institutions that prepare the majority of

the health care providers in Mozambique.

In FY 09, based on the results of in-ward training model (practical demonstration), this activity would be to

additional hospitals as the request of the Ministry of Health.

Based on the of the results of the task analysis for nurses and clinical officers, FY 09 funds will be used to

revise the curriculums of the cadres identified as priority cadres including recommendations around

teaching approaches, teaching aids and needed equipment.

Based on the results of FY 08 piloting of in-service training materials for auxillary health care workers, the

curriculum will be finalized and national roll-out of the training will occur as a result of support from FY 09

funds.

In FY 08, initial work was done on developing a system for providing PEP to victims of sexual violence in

Sofala province. This included development of training materials for health care providers. In FY 09, the

work will expand to include training a wider auidence, developing a suitable supervision model and

designing a recordkeeping system.

Using FY 08 funds, a two page summary document was developed from the HRH strategy that was used by

the President and Minister of Health in high level international meetings. Following this document

development, a 10-15 page summary document is being developed to explain the salient elements of the

HRH plan to donors and across Ministries the the GMZ. In FY 09, funds will be used to explore how the

HRH strategy can be operationalized and to engage with the Human Resources Dept and others at the

MOH on the usefulness of the current HRIS exploring options for resolving current problems with the HRIS

system.

Deliverables: expanded workplace safety system at the MOH; expanded in-service training information

system and design for pre-service training information system; expand in-ward training model to other

hospitals; HRIS assessed; pre-service curricula changes indentified and initial work on making changes

done; support for operationalizating the HRH strategy

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Reducing violence and coercion

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $1,700,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $111,500

This is a new activity.

ISCISA is a higher level training institution that has provided health training courses for the Ministry of

Health since 2004. Graduates obtain bachelor degree in diverse health areas, such as General, Maternal,

Child Nursing, Administration and Hospital management, Psychology, Occupational Therapy and

Laboratory and Biomedical Technology. This training institution is regulated by the Ministry of Education

and abides by national health policy and World Health Organization principles. ISCISA shares a campus

with the Health Sciences Institute of Maputo, but has their own faculty and can provide accommodations for

students when necessary. In 2008, ISCISA recieved approval to run a 4-year public health course.

Beginning in 2009, this public health course will start with trainees from throughout the country who will be

admitted through a selection process. Curriculum for this course has been developed with support of Lisboa

Tropical Medicine and Hygiene Institute, WHO and UNICEF. There is an emphasis on field work with 58%

of the training focused on hands on learning where students will accomplish practical tasks. It is envisioned

that the graduates of this course will manage health programs and health services in the National Health

Service. Given that this program is in a start-up phase, it is not clear what specific support will be needed

although the ISCISA Director has officially requested PEPFAR support in general. Tentative areas for

support discussed include equipment, furniture, and training material. If individual scholarships are included

as part of the PEPFAR support, scholarships criteria developed by the USG would be used.

PEPFAR funds for 2009 will be available to develop new activities that are supported via a TBD partner with

the goal of supporting the implementation of the public health course in ISCISA. Specific activities to be

supported by PEPFAR are still under discussion with the course coordinator pending other sources of

support.

Product/Deliverables:

To be decided

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $55,750

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 $55,750

Water

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $0

ACTIVITY UNCHANGED FROM FY2008 - NO NEW FUNDING IN FY09

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

Activity Narrative: • 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

preservice

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

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.

Activity Narrative: 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

New/Continuing Activity: Continuing Activity

Continuing Activity: 19730

Continued Associated Activity Information

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

System ID System ID

19730 19730.08 HHS/Centers for JHPIEGO 8784 8784.08 $2,350,000

Disease Control &

Prevention

Table 3.3.18:

Cross Cutting Budget Categories and Known Amounts Total: $2,211,500
Human Resources for Health $400,000
Human Resources for Health $1,700,000
Human Resources for Health $55,750
Education $55,750