The goal of the Maputo Provincial Health Directorate is to initiate the handover of specific HIV care and treatment activities from international USG partner organizations to provincial governments in Mozambique. This transition needs to occur while sustaining and continuing to scale up care and treatment services for PLHIV without life-threatening disruptions of services. Activities towards achieving this goal will focus on the areas of (1) HIV care, support, and treatment; and (2) human resource capacity and infrastructure development, especially for disease surveillance and training. The key issue that will be adressed by these activities include; Strenghthened DPS capacity to plan, oversee implementation and monitor HIV programs. As a result of increased DPS capacity to supervise and monitor programs, improved performance in TB, Malaria, PMTCT, Counselling and testing, pediatric Care and Treatment, Nutrition services will improve over time. The activities of this implementing mechanism are linked to Partnership Framework (PF) goal 3: Strengthen the Mozambican health system, including human resources for health and social welfare in key areas to support HIV care, prevention and treatment goals, and goal 4: improve access to quality HIV treatment services for adults and children. Geographic coverage is Maputo province and target groups are HIV infected children, women and men, and local government and non government organizations implementing HIV prevention care and treatment programs. The long term gains in cost efficiencies result from the transfer of program funding and implementation from international NGO partner organizations to local organizations which eliminates overhead costs. This shift will also strengthen the local capacity of the GRM to implement.

This is a continuing activity to support provincial level monitoring and evaluation (M&E) and health information systems at the provincial level through direct financing mechanisms between USG and the Provincial Level Health Directorate; this is considered a complementary activity to other provincial level support (M&E technical assistance funded through clinical partners in all 11 provinces) and Central level support (through the Cooperative Agreement with MOH and other technical assistance at the Central level.)

As USG direct support to the provinces is a relatively new approach, in this initial phase, SI funds have been allocated for four provinces ($25,000 per province). Two of these are provinces where CDC has existing funding agreements with the Provincial Level Health Directorate; funding for an additional two provinces is also planned for two provinces where USAID plans to initiate direct funding agreements with the Provincial Level Health Directorates.

This narrative refers to direct support in the province of Maputo.

These funds are to ensure resources for capacity building at the provincial and sub-provincial level in strategic information. These funds will be used to develop, strengthen, and/or implement MOH HIV/AIDS data management and monitoring and evaluation systems by improving data collection, verification, analysis, use, and reporting. This may include strengthening of patient monitoring systems, capacity building in SI related human resources, harmonizing data collection and flow, support for data verification and other supportive supervision activities, and other cross-cutting strengthening SI support identified as a priority by the partner, USG, and MOH. Key measurable outcomes include :

80% of supported districts have data verified in at least one HIV-related service each year by a team from the provincial health directorate and/or supporting technical assistance partners

80% of supported districts in which data verification has occurred

80% of districts in which there was a DPS supervision visit focusing on HMIS/M&E (NEP to NED) at least two times/year

This mechanism will make key contributions to health systems strengthening that include development of sustainable locally maintained health services through: training, supervision and mentoring of health workers in provision of quality HIV care and treatment services; and procurement and logistics management of health related commodities needed for operations of health facilities. Cross cutting programs within this new mechanism include logistics management of commodities that include lab, OI and antiretroviral drugs and medical equipment.

DPS Maputo will continue its support to MOH through an alignment of FY 2012 activities with overall PEPFAR Counseling and Testing goals and strategies, with a focus on provider-initiated HTC.

This activity will be two-fold:

1. Support to MOH and implementing partners in implementation of provider initiatied HTC in ante-natal clinics, outpatient departments, TB clinics, STI services, VMMC settings, medical and surgical wards in hospitals and health centers though supervisory visits and support to interchange of experiences.

2. Support for MoH and implementing partners to expand CT component in clinical setting, through TOT and TOW in CT and M&E

The Provincial Directorate of Health Services (DPS), Maputo province is responsible for all health services in Maputo province including leading and monitoring the implementation of the HIV treatment program.

Priority areas in HIV are increased treatment access; ART retention; ART Quality assurance; program linkages and integration especially with CT, TB, PMTCT, nutrition, and pre-ART services.

The DPS continues to seek programmatic efficiencies through conducting integrated supervisory visits with multi-disciplinary teams.

Maputo DPS is currently conducting a pilot of Community Adherence Support groups (GAAC) in 6 districts. This adherence and retention strategy will be expanded to cover additional districts or the entire province in FY12.

New ART registers and forms that enable longitudinal tracking of patients both on ART and Pre-ART have been developed and planned for dissemination throughout the country. These forms will provide information on retention, loss to follow up in both ART and pre-ART patients even in sites that do not have electronic data systems.

Currently this information is primarily only available from implementing partner supported electronic patient tracking systems.

Funding will support the DPS to undertake the following systems strengthening and capacity building activities:

1) ART training of health care providers in the districts and health facilities

2) Supervision of districts and health facilities and oversee a) process to task shift ART to nurses, and middle-level health providers in the province; b) oversight to the implementation of revised ART guidelines (ART initiation at CD4 threshold of 350 and universal ART for TB coingfected patients) c) quality of ART services including Pre-ART services, nutrition and community facilty linkages for improved retention d) Pediatric treatment scale up through better linkages with PMTCT programs, follow up, diagnosis and managment of HIV exposed infants

3) Participation in key HIV related meetings and conferences for DPS staff

4) English courses for DPS staff to improve ability to manage cooperative agreement requirements

5) Convene provincial HIV meetings to review program data and identify strategies to improve performance where areas of weakness are identified.

6) Strengthen laboratory and drug logistics and commodities systems in Maputo province

The M&E department routinely tracks clinical outcomes that are reported monthly by all the health facilities and districts in the province. These data are reported to the MoH which aggregates all of the national data and posts it on the MoH website.