Jhpiego's overall goal is to support the HIV response in Mozambique with prevention (counseling and testing, infection prevention control, male circumcision and prevention of mother to child transmission and gender-based violence), care and treatment (HIV/TB integration, site enhancement and biosafety), and health systems strengthening (pre-service education, training and support, and information systems). Activities contribute to GOM objectives and USG priorities in the Partnership Framework and Global Health Initiative strategy. Alignment with USG priorities includes preventing new HIV infections, reducing TB and strengthening health system components. Activities are planned for national scale-up with implementation from central to local levels, including Gaza, Maputo, Maputo City, Sofala Manica and Inhambane Provinces. Target populations include persons at behavioral risk for HIV in the general population, healthcare workers, community health workers, and PLHIV. Jhpiego is using costing and expenditure data from 2011 to direct activities. Key efficiency strategies include reducing the investment in renovations of clinics for male circumcision and focusing community testing efforts in high prevalence areas to be more cost efficient. Jhpiegos work in health system strengthening focuses on task-shifting, increased production, and ensuring competency, support and retention of healthcare workers. Capacity building is achieved with sub-contracts to local organizations for HIV testing. A monitoring and evaluation plan exists, capturing data on all PEPFAR and MOH indicators. These data are used to inform and modify program activities. Pipeline was not an issue for this partner. Jhpiego will purchase two vehicles to support male circumcision activities.

In FY12, Jhpiego will continue to provide technical support to implement the National Plan for Infection Control for TB (IC/TB), including development of IC/TB plans in selected sites (after the assessment), training, supervision and follow-up to monitor and improve compliance with IC/TB standards in the different areas. To decrease TB transmission at selected facilities, including Machava General Hospital, Jhpiego will support minor renovations, and procure and distribute basic equipment and supplies to improve mechanical ventilation. For personal protection Jhpiego will also procure surgical masks and N95. Additionally in FY12, Jhpiego will develop, print and disseminate IEC materials and support the participation of two MOH staff members in international IC/TB trainings and conferences.As part of the TB/HIV Technical Working Group, Jhpiego will continue to participate and collaborate with partners to define and develop policies and guidelines, and monitor progress in the implementation of IC/TB related activities. Finally Jhpiego will assist the MoH in the development of the protocol to implement a National Surveillance of TB disease among health workers or to determine household transmission of TB (particularly MDR-TB) after treatment is started.

JHPIEGO supports Ministry of Health (MOH) priorities outlined in the Human Resources National Development Plan (2008-2015). In FY12 Jhpiego will continue to support the following activities:1) Development of HRIS to allow for more efficient tracking and planning of human resources.2) Finalization of the General Nursing and MCH curricula. The implementation of the revised Nursing curriculum (MCH and general nurses) will start in all health training institutions where MCH and general nursing courses are carried out. Supportive supervison and on-site technical assistance for all IdFs implementing the revised curicula will be provided with focus on the new ones, or ones implementing more critical semesters (eg: III and IV semester where there are nore clinical skills and decision making).3) Implementation of the Standard-based Management (SBM-R) approach. Emphasis will be given to recognize improvements based on compliance with the pre-determined educational standards. All training institutes should be perfoning up to 70% of the standards or higher. Supportive supervison and on-site technical assistance will be provided as well as documentation the improment process and main results in case study/report.4) Institutionalization of the training and monitoring system for in-service training (SIFo) at the national level, and support the implementation of the preservice information system at the 13 MOH training institutions. Jhpiego will provide technical support through training, supportive supervision, and acquisition of equipment and internet access (where needed).5) SIFln implementation and proper use in all training institutes, to include training, supervision, and monitoring activities in all IdFs. Provide support for a help desk system for SIFln and provide additional HR as needed.6) Implementation of the Model In-Patient Ward methodology at the current 42 sites, and expand to at least 20 new sites. This initiative is also based on the SBM-R approach and will also implement a package of incentives to recognize achievements. Provide technical support to the current and new sites including training, and supportive supervision as well as reprodution of materials, videos, posters, manuals, and checklists to facilitate on-site training and supervision.7) Short-term technical assistance (TA) to the HR Directorate to look at financial and non-financial incentives for health care workers including a performance-based financing model. Provide support to finalize the retention/atraction national strategy asa needed and provide technical assistance for the development of insentives packages based on incentives studies using the Discreet Choice Experiment Methodology.8) Performance-based Continuous Education linked with standards and training packages.Additionally, this IM receives Central GBVI funds.

Ongoing HIV transmission in sub Saharan Africa necessitates vigorous prevention efforts, which is why the compelling evidence of the effectiveness of medical male circumcision (MC) as an HIV prevention intervention has been met with increasing support from in Mozmabique. Following Jhpiegos successful completion of a demonstration project in 2009-2010, the MOH has accepted MC as an effective HIV prevention strategy and is one component of a comprehensive prevention package in communities with high rates of HIV infection and low rates of circumcision of men. Thus, this intervention is being implemented and scaled-up in communities with high rates of HIV infection and low rates of circumcision of men.Jhpiego currently provides MC services in seven sites, including one military facility, in Maputo City, Maputo, Gaza, Manica and Sofala Provinces. An additional three sites are being prepared with the goal of initiating service delivery in the spring of 2012. Jhpiego is working in coordination with the MOH, NAC, USG and other key partners to support a gradual implementation of safe MC/minor surgery services. Activities include providing surgical equipment/supplies, training, development of educational materials, and ensuring that appropriate quality assurance mechanisms are in place. MC services are not a stand-alone intervention, but part of a comprehensive prevention strategy, which includes: 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.In FY12, Jhpiego will continue its support to the implementation and expansion of safe and integrated MC/minor surgery services in existing military and public facilities (10 in total). With these funds, Jhpiego will fund an additional three sites in the five provinces). Funding will also support mobile services (the actual mobile units are being procured by SCMS). In addition Jhpiego will provide technical assistance to implement operations research to assess and analyze specific elements of the provision of MC services in Mozambique, and advocacy with MOH and community leaders.

The goal of the injection safety program is to reduce the risk of transmission of HIV and other blood borne pathogens through biomedical procedures, at health facilities. Since 2004, Jhpiego has provided technical assistance to MOH to improve compliance with standards and implementation infection prevention and control (IPC) practices in hospitals using Standards-Based Management and Recognition approach, periodic measurement and rewarding of good performance, to promote implementation of informative infection prevention and control practicesIn FY12 in alignment with PEPFAR goals, JHPIEGO will continue to provide technical support to the MOH, in particular DNAM and the nursing department, in the expansion and monitoring and evaluation of the IPC efforts, including adequate sharps and other infectious waste disposal, PEP scale-up and M&E. Jhpiego will continue to support MOH on improvement of waste management systems: dissemination and monitoring implementation of the National waste management plan. In FY12 Jhpiego will support PEPFAR clinical partners in piloting a model waste management using autoclaves in 6 selected facilities in Zambezia, Sofala and Gaza, which are the PEPFAR focus provinces, and Maputo Province. Jhpiego will be responsible for the procurement and purchase of equipment and supplies, supervision of program implementation, in close coordination with CDC Mozambique and with the support of CDC HQ the International Medical Waste Program Manager.Key activities include 1) training for health workers and ancillary staff, reproduction and dissemination of materials, including job aids and IPC pocket manuals; 2) Support to clinical partners in the implementation of program activities through, training, supportive supervision, development and use of monitoring and evaluation tools; 3) procurement and distribution of selected personal protective equipment (PPE) (e.g., respirators, non-sterile exam gloves, face shields, surgical masks, aprons, etc.); 4) improvement of infectious waste systems disposal including dissemination of policies and strategies; 5)support for the implementation of PEP (including PEP in instances of sexual assault) with training, creation of job aids, and monitoring and evaluation; 6) organization of national coordination meeting on IPC.Jhpiego will provide USG clinical partners with technical assistance and guidance in FY12 to mainstream IPC activities while providing technical assistance to DPS/DDS to improve management of stock levels and resupply of necessary items through existing MOH channels.

JHPIEGO will continue its support to MOH through an alignment of FY12 activities with overall PEPFAR counseling and testing (CT) goals and strategies, with a focus on strengthened linkages to other services by the provision of CT services in the community (CCT) and in health care facilities (provider initiated testing and counseling or PITC). Through mobile and outreach as well as home-based CCT JHPIEGOs local partners will target populations less likely to access facility based health services with a special focus on men, adolescent girls, partners of PLHIV and couples in communities with high populations density and high prevalence as well as low numbers of people previously tested. Emphasis will be given to referral systems especially for CT clients with TB symptoms to contribute to early TB case finding in the community. JHPIEGO will also be instrumental in the regional CT campaigns planned for FY12 as through their partners mobile as well as home-based CCT demand creation activities will be carried out in the two of the three focus provinces (Gaza, and Sofala). The target population for the regional campaigns will be mainly partners of PLHIV, couples and men, as these particular groups have had low coverage in years past. In the PITC component, Jhpiego will provide technical assistance to the MOH and clinical partners to develop and implement a strategy to improve coverage and quality of PITC for inpatient and outpatient services including blood banks, based on the results from the PITC assessment (AVALIATIP).

Quality assurance is a priority and JHPIEGO will continue implementing the SBMR approach to ensure that each counselor performs at or above the quality standards. The standards evaluation is implemented through peer supervision among counselors. Additionally, all of JHPIEGOs partners counselors will participate in a training designed by the National Health Institute to improve the quality of HIV rapid diagnostic testing.

Whereas in previous years, counselors simply gave referral slips to HIV positive clients, with FY12 funds, JHPIEGOs counselors will have a stronger role supporting newly diagnosed clients by personally introducing them to existing peer educator/peer navigator/case manager volunteers who will navigate or escort clients to enroll or register for follow up services, including positive prevention or the new MOH pre-ART service delivery package and support groups. For those newly diagnosed who do not enroll in HIV care and treatment services, CT counselors will continue using the door to door approach to re-visit already diagnosed HIV positive to monitor their enrollment and adherence to recommended treatment and care through the positive prevention or pre-ART support groups. HIV negative clients will be encouraged to bring their partners in for testing and reduce their risk through condom use and partner reduction. Where available, counselors will refer HIV negative men to medical male circumcision services.

JHPIEGO will work closely with the USG and partner Strategic information teams to develop and utilize instruments to document and measure CT service uptake as well as service-to-service and facility-to-community linkages to ensure follow-up, retention and adherence of clients diagnosed with HIV. Additionally, this IM receives Central GBVI funds.

In FY12, Jhpiego's MTCT priority is to support the MoH to address the gaps in training materials for MNCH service providers as a result recent policy developments, including revised WHO guidelines for PMTCT were adopted and the authorization of task shifting for MCH nurses to prescribe ART. The main activities will include the revision of the curricula and teaching methodology, development of didactic materials, and tutoring of faculty and clinical preceptors.In FY12, JHPIEGO will: 1) support pre-service training through the revision of MNCH training curricula to include new guidelines on ARV prophylaxis and infant feeding nutrition (Option A); 2) support the roll out of in-service training of Option A through curriculum and training material development; 3) Develop a curriculum for provision of ART by MNCH nurses; and 4) Reproduce training materials related to provision of ART by MNCH nurses.