Abt Associates will continue work under the Health Systems (HS) 20/20 project to build the capacity of the MOH, NAC, and MMAS. The goal of the project is to strengthen the health system.

Since July 2009, HS 20/20 has provided a Global Fund Coordination Technical Advisor at the Global

Fund Unit of the MOH's Planning and Cooperation Department at the central level to build capacity in coordination and management of Global Fund (GF). This advisor will continue to build MOH's capacity to manage, monitor, and report on Global Fund grants. Particular focus is placed on MOH's internal organizational structure and ability to establish financial monitoring and tracking systems, operating policies and procedures, and human resource needs to manage GF reporting. Managing and improving disbursement requests, progress reports, future applications and grant implementation are critical to ensuring the continuation of GF resources. Geographic focus is MOH central level. This advisor coordinates with the USG team on Global Fund issues and allows the USG to have an insider's perspective of the situation at the MOH. She will coordinate closely with the new USG Global Fund Liaison.

There has also been a HS 20/20 Financial Management Technical Advisor at MOH's Administration and Finance Department (DAF) at the central level since September 2009. This advisor will continue to address challenges related to various aspects of financial reporting and organizational capacity. This will be done through development of increased measures and controls on budget execution and coordination between DAF and other MOH departments. Other areas of focus will be on organizational structure, internal procedures, network structure, staff capacity and communication. The support is intended to improve financial management in general, including of Global Fund.

Financial management TA to NAC will continue, working directly with Financial Management Unit and other management staff at the central level as well as with provincial nuclei of NAC. HS 20/20 will simplify and improve tools used by financial staff, develop relevant financial management procedures, and build capacity for central and provincial staff.

Institutional Development support to NAC will continue in early FY 2010 but will not require FY 2010 funds. NAC was created by a ministerial decree in 2000, which did not provide it with the institutional framework that exists for other Mozambican government institutions. Due to this, NAC' staff have not had access to employment security, accumulation of seniority, retirement, etc. For the past year, HS 20/20 has been working with NAC and the Ministry of Civil Service to provide NAC with a recognized legal status within the framework of government institutions. This work has been completed and is awaiting official approval by NAC, Ministry of Civil Service, and will then be sent to the Council of Ministers; this is expected to be completed by early 2010.

HS 20/20 will provide institutional development support MMAS at the central level to address human resources constraints and strengthen institutional capacity to fill current and future HR gaps. Activities include: developing standard scopes of practice, roles and responsibilities for social worker cadres; identify needs for pre-service and in-service training for social workers; review available training materials;

map local institutions that offer social work programs or have the potential to collaborate in training; provide a strategy report summarizing options to build the pool of qualified social workers and trainers; select strategy and pilot. This activity has a cross-cutting Human Resource for Health (HRH) focus because it addresses the need to strengthen social worker cadres.

Although no further funding in FY 2010 is required for National Health Accounts (NHA), the report will be finalized in late 2009. Dissemination meetings will be held to share the findings with government, donors and other stakeholders.

This project contributes to Partnership Framework Goal 2, Objectives 2.2, as it will build NAC's financial capacity to use state and donor funds effectively; and Goal 3, Objectives 3.1, 3.2, as the project will strengthen MMAS' ability to design and roll out a plan for training social workers, improve MOH's capacity to manage Global Fund and improve financial management.

HS 20/20 is a project that contributes to the overall health system, as it addresses underlying weaknesses in the health system. The support given to government institutions strengthens several areas and the links between them, such as health finance and governance.

HS 20/20 will increase cost-efficiency by relying more on its resident technical advisors rather than travel from headquarter staff. The technical advisors also coordinate regularly to ensure synergies among their work, such as the two advisors at MOH.

HS 20/20's monitoring and evaluation (M&E) plan includes work plans and progress reports to USG, and regular meetings with USG Global Fund task force and other meetings.

With the support of an Institutional Capacity Coordinator the MMAS will address human resource

constraints and strengthen institutional capacity to fill the current and future anticipated gaps in qualified

social workers. Addressing the HR and capacity issues will ultimately increase access to quality care and

support for children and other vulnerable populations infected or affected by HIV. Activities include:

consensus-building among stakeholders, organizing development of standard competencies for social

action workers (SAW), early childhood educators and trainers, assessing current training materials,

articulating different options for training reform, and initiating as appropriate creation and adaptation of

materials. Long-term goals include development of revised training strategies for SAW, early childhood

educators and trainers and strengthening the capacity of MMAS to strategically design, implement,

monitor and disseminate results of activities. Once there is consensus on standardized competencies

and scopes of practice for SAW, the project will identify and follow up with Mozambican institutions as

appropriate for collaboration in ongoing training activities.

This activity will include the Global Fund Coordination TA to MOH's Global Fund Unit, Financial Management TA to MOH's Finance Department, Financial Management TA to NAC, and institutional support to MMAS. The system barrier addressed is weak institutional capacity to plan, budget, manage and coordinate. This activity will continue the long term TA that has already begun within MOH and NAC, and put TA in place for the MMAS activity. The TA work with GOM counterparts, with the aim to gradually transfer skills and ensure that robust systems are in place.

There are linkages across the areas of Service Delivery, Information Systems, Human Resources, Health Finance, Procurement Systems, and Governance. For example, the Global Fund TA works with the different disease programs at MOH, the Planning Department, Finance Department, and Central Medical Stores to ensure that Global Fund activities are better coordinated, implemented, monitored, and reported. There is also intentional spillover in several of the activities; for example the Financial Management TA at MOH is not only for Global Fund, but to improve financial management in general.

Support to MMAS will ensure that social worker cadres are better defined, with benefits to the whole health system.

This activity (technical assistance in management systems) is not captured by new generation indicators. USG is working with the partner to develop work plans and appropriate indicators. After the preliminary work on social worker cadre and curricula development is completed, e.g. in FY 2011, relevant indicators for the MMAS activity may be number of health care workers being supported in a pre-service training institution and number of community health and para-social workers who successfully completed a pre- service training program.