The goal of the Academy for Educational Development's (AED) Capable Partners Program (CAP) is to strengthen the technical and institutional capacity of Mozambican organizations to deliver HIV prevention, care and treatment activities, thereby moving towards "Mozambicanization" of the response to HIV. In July 2009, USG signed a new cooperative agreement with AED for CAP II, which expands upon the first three years of CAP and establishes an Umbrella Grants Mechanism (UGM) component to increase the number of Mozambican sub-partners in USG's portfolio and build their capacity to become prime partners.

CAP will work with organizations with varying capacity building needs, grouping them into two tracks: 1) Organizations with some experience managing projects and funds and interested in growing. These organizations require intensive capacity building to become sustainable. Grants will be up to $150,000. AED will reach out to other USG-supported local organizations, e.g. Quick Impact Program grantees, with capacity-building and networking to enable them to graduate into the CAP program. 2) Organizations with more experience managing larger sums of funds, more established financial systems, and/or more effective programs. They do not require the same intensive capacity building as the first group, but still need support to become prime partners of major donors. Some will be groomed to become umbrella grant organizations, with grants up to $1,000,000; they will be supported to master sub- grant management and capacity-building of sub-partners.

CAP relates to Partnership Framework (PF) Objective 1.1, as it strengthens civil society's capacity to implement prevention; Objectives 2.3 and 2.4, as it builds the capacity of sub-partners such as MONASO, a local network of AIDS organizations, in coordination, financial and program management; Objective 3.1, as sub-partner ANEMO increases human resources for health by training home based care workers; Objectives 5.1, 5.3, 5.4, as it strengthens sub-partners' capacity to support community-facility linkages, use advocacy skills and provide services to people living with HIV (PLHIV) and orphans and vulnerable children (OVC). CAP addresses the overall PF goal of sustainability by investing in the human capital of its own staff, building the capacity of Mozambican professionals and organizations; working with promising local organizations to take over CAP's role in capacity-building and grant-making; and helping organizations become more financially and institutionally sustainable.

AED has sub-partners in Maputo, Sofala, Zambezia, Nampula provinces. It has opened small offices in Sofala, Nampula, and Zambezia, and will open one in Manica. This allows CAP to provide regular service

to a growing number of partners without added travel costs, contributing to cost-efficiency. New organizations joining CAP require intensive capacity building at the start. Over time, their efficiency improves and their capacity building needs become less intensive, reducing the demand on CAP's staff. This will result in improved cost effectiveness over time.

To avoid duplicating costs of developing educational materials for prevention activities, CAP collaborates with other USG partners to make professional tools and training available to partners.

Program beneficiaries include CAP partner organizations (staff and members of local organizations) and people served by partners.

AED's key contribution to health systems strengthening is strengthening the role of civil society and communities in the health system. Overall the capacity of civil society organizations will be increased to contribute to the health system and be valued partners that offer their services, experience and ideas. These activities cut across the health system building blocks, but are especially relevant to leadership/governance.

Human resources for health is a cross-cutting area that builds the capacity of community health workers, e.g. OVC and home based care service providers.

The results of the project will be: 1. Increased capacity of Mozambican organizations to develop and manage effective programs that improve the quality and coverage of HIV prevention, treatment and care services 2. Sub-partners expand HIV prevention behaviors among most-at-risk groups 3. Sub-partners increase the numbers of youth, young adults and adults in sexual relationships avoiding high risk behaviors that make them vulnerable to HIV infection 4. Sub-partners increase the number of OVC receiving quality, comprehensive care in their respective target areas 5. Sub-partners increase the quality and coverage of home-based health care to PLHIV and their families 6. Increased coverage of quality treatment and follow-up services for PLHIV

CAP's monitoring and evaluation (M&E) system includes relevant next generation indicators and other indicators reported to USG. It measures the quality of interventions implemented by both CAP and its sub-partners. Results are reported semi-annually and annually. CAP works with sub-partners to develop M&E plans specific to their activities, and builds their capacity to monitor, evaluate, and adjust their interventions. A mix of data collection tools capture quantitative and qualitative data: routine monitoring processes, baseline and follow-up surveys, participant surveys, focus groups, the Participatory

Organizational Analysis Process, community mapping, observation and story collection.

AED will continue sub-granting to the National Nursing Association, ANEMO, and building its organizational capacity. ANEMO will continue training of home based care (HBC) trainers mainly in the southern and central regions (the majority of PLHIV are in these regions) on the four priority services identified by the MOH (psychosocial support, nutrition counseling, positive living, treatment adherence) and on building referral systems between health facilities, families of PLHIV, care and support services, OVC, and HIV prevention activities.

ANEMO will provide accreditation for HBC trainers who have been trained but not accredited, and in- service training for accredited HBC trainers to include: care of skin conditions, pain management, HIV prevention, psychosocial support, nutrition counseling, positive living, treatment adherence and stigma. ANEMO will direct community based organizations (CBO) and nongovernmental organizations (NGO) to clinics in their catchment area to improve the continuum of care.

The activity targets staff of CBOs and NGOs who manage HBC programs. As the national association mandated by MOH to provide HBC training of trainers, ANEMO supports USG and non-USG-supported organizations wanting to train staff as HBC trainers.

To address client retention and referrals, ANEMO trains in the use of HBC evaluation/intake form to establish the level of care needed and received. This is used to develop personal care plans for each client and helps ensure consistent services and improve follow-up and adherence. ANEMO Master Trainers encourage trainers to review care plans with HBC workers every 4-6 months.

ANEMO facilitates linkages between the clinic and the NGO/CBO by mentoring trainers. ANEMO Master trainers promote functional bi-directional referrals between community and clinic but ANEMO does not provide HBC services directly.

The activity will improve the monitoring, supervision and quality of HBC training and services provided. A study will be conducted at the start of the sub-award to ascertain the level of care currently provided, and a mid-term and final evaluation will determine impact and quality. ANEMO coordinates with MOH to monitor and improve quality of care provided by local organizations.

This activity will increase the number of orphans and vulnerable children (OVC) receiving quality care. It will focus on the priority actions of (1) household strengthening and (2) improving the quality of service delivery. AED will provide grants and capacity building to local organizations implementing OVC activities. These sub-partners will employ strategies including coordinated community efforts to support OVC such as mobilizing community leadership and engaging with the National Social Work Institute, Ministry of Youth, and OVC in identifying priority households to receive services; providing job skills and access to school materials and uniforms; and improved use of the child status index to monitor the situation of each child; promoting a family-centered approach; and training OVC service providers and leaders in interventions to reduce sexual exploitation of OVC.

A key strategy will be expanding a program for OVC economic empowerment and employability, Programa Para o Futuro (PPF). PPF helps older OVC gain a complex mix of skills, knowledge, attitudes and behaviors to adopt safe behaviors, improve their health and create quality livelihoods. PPF will be implemented by sub-partner Association for Community Development (ADC), and will be able to be

replicated by other local NGOs. PPF's target population is older OVC, 60% of whom will be female.

Target population will be local organizations serving OVC, and the OVC served. OVC reached will include children from ages of 0-17 of both genders but with a focus on the girl child. Geographic focus will be national but with a focus in Nampula, and Sofala for PPF.

CAP partners will address one or more of the seven OVC service areas: food/nutrition, education, health, psychosocial support, economic strengthening, and protection.

A challenge, not unique to CAP, is defining and measuring quality. Successes include working with Rede Came to train local organizations in OVC advocacy, child rights, and prevention of and responding to sexual exploitation of OVC. The PPF pilot has already started in Beira, and ADC has been one of CAP's strongest partners. Partner organizations in Nampula have established links with various community actors to improve coordination of OVC work.

The AED will provide institutional strengthening and grant support to local organizations to become leading organizations in civil society and to develop and manage effective HIV programs. The CAP's systematic approach to working with these organizations has proven effective; as they mature in their project and basic financial management abilities, their attention is shifting to organizational issues such as fundraising, policy setting, advocacy, networking, external relations, and leadership and governance.

Activities will focus on identifying and assessing new partner organizations; conducting participatory organizational assessments with each partner; providing tailored, intensive institutional capacity-building for implementation of activities and long-term sustainability of the program; creating fora for leveraging new knowledge and expertise among partners; increasing capacity of local professionals to respond to organizational development needs of local organizations.

This activity addresses the system barrier of a weak civil society, which contributes to weak participation in the health system. Civil society organizations will be strengthened to play a leading role in the HIV response - as service providers and advocates - thus strengthening the health system. These community-based organizations are well-placed to design relevant HIV activities and ensure that the voices of people living with and affected by HIV are heard.

This activity links to the capacity-building that AED will provide in the areas of prevention, care and treatment. Sub-partners will receive a mix of technical and organizational capacity-building to meet their identified needs. There is also an intentional spill-over effect since partners will not only have increased capacity to carry out HIV work but to be strong civil society actors in general, thus impacting other areas of health and policy-making.

The relevant human resources for health indicator is the number of community health and social workers who successfully completed a pre-service training program, as CAP partners will train various types of community workers, such as home-based care workers and peer educators.

Academy for Educational Development (AED) provides grants and capacity building to local organizations to design, implement and adapt evidence-based and audience appropriate HIV prevention programs in Sofala, Maputo, Nampula and Zambezia Provinces. The sub-partners target youth aged 15- 35, with communication and negotiation skills within couples, young men and women, girls at risk of sexual exploitation in schools, teachers and school management, to discurouage "grades for sex" and families. Interventions use evidence-based methodology (e.g. from Engender Health/Promundo, Africa Transformation) including facilitated small group discussions, peer education, theater, videos, etc. Interventions target gender norms, the institutions that influence social norms (schools, churches, community leaders), in reducing multiple concurrent partnerships, cross-generational and transactional sex. The target groups are equipped with the understanding, skills and motivation to recognize and avoid high risk behaviors that make them vulnerable to HIV infection. AED mentors local organizations to ensure that community outreach and interpersonal communication interventions, such as drama discussion groups and counseling, are engaging and effective.

All interventions are designed based on a communications strategy informed by formative research with target populations. All messages are monitored for appropriateness with periodic testing. AED conducts monthly monitoring/coaching visits at the start of any new intervention for 3-6 months and quarterly thereafter. AED will provide support to sub-partners in monitoring the effectiveness of the communications strategy and in improving their skills in interpersonal communications. AED also conducts baseline, midterm and end of project surveys.

AED promotes linkages with and referrals to counseling and testing facilities. Faciltiators will be provided with training on stigma and discrimination. In many cases, partners are integrating HIV prevention with

populations with whom they already have a relationship - farmer associations, churches, associations of professors and educators. Vulnerable children are also being educated about reducing sexual exploitation.

AED supports local organizations to expand HIV prevention programs for MARP mostly in Maputo and Zambezia provinces. Sub-grants enable organizations to use innovative approaches to engage the harder to reach populations and strengthen links to other preventive activities. AED will strengthen the capacity of local organizations to develop and implement evidence-based, audience-appropriate packages of minimum services for MARPs, e.g. adult miners, truck drivers, sex workers, military and drug addicts, all primarily over 15 years old. AED partners also work with adults who engage in multiple concurrent partnerships or transactional sex, with interventions focused on small group discussions.

AED will support local partners to ensure that community outreach and interpersonal communication interventions, e.g. discussion groups and peer education, are engaging and effective. Counseling for improved condom education and consistent use, especially by individuals and couples at increased risk of HIV, will be strengthened. Interventions for MARPs include peer education and small facilitated discussion groups with a minimum of 4 sessions. Discussion topics are locally adapted and tailored to the population. For drug addicts and sex workers, the organizations offer complementary activities (e.g. vocational training, therapeutic activities). For miners, interventions take place on the long bus trip from the border to home. The package of interventions also includes activities that reach those who influence the target group: families (in the case of miners and drug users), clients (sex workers) to educate them about risks and how to support positive behaviors. Interventions include linkages to other services, e.g. CT, referral for STIs, condom use education, and social rehabilitation.

All interventions are designed informed by formative research with the target populations. Messages are monitored for appropriateness with periodic testing. AED conducts monthly monitoring/coaching visits at the start of any new intervention for 3-6 months, and quarterly thereafter. AED will support monitoring the effectiveness of the communications strategy and improving skills in interpersonal communications.