The purpose is to provide technical assistance and financial support to address specific constraints hampering the health system. The mechanism focuses in four objectives: Increase health governance effectiveness through improved planning management and budget execution; Improve health financing to ensure rational allocation and spending of resources; increase sustainable operations capacity by improving skills, knowledge and tools in finance, governance to improve service delivery at all levels; and, improve HR management and retention through strengthening institutional capacity to distribute, retain and train heath managers, community health workers (APEs), social and para-social workers. The TBD will contribute to PFIPs Goals II & III by improving GOM capacity to effectively utilize available resources and increasing the number of social workers. The activity also supports the GHI focus areas I and II. The TBD will build governance and financial management capacity of local institutions, enabling them to receive direct USG funds in the coming years, reduce transaction costs over time, and efficiencies across the USG portfolio in Mozambique. Giving its focus on TA to central level, and without specific targets it was not part of the recent expenditure analysis and moved from a global to a local AA over FY11-12. The mechanism focuses mainly on systems strengthening through capacity building (CB).This mechanism contributes to the PEPFAR capacity building framework and approach to country ownership, as it aims to build GOM capacity and strengthens weaknesses in the HS. FY 2012 funding include 2.5 mil in pipeline and 1 mil from other program areas. Deductions were also take to fund ARVs. Vehicle purchases are currently TBD until an award is made.

TBD Health Systems 20/20, in collaboration with local entities, is currentlyclassifying and costing community-based care services across a wide range of civil society and NGO providers. As part of this activity, the Project will assist the MOH, donors, and the provider organizations themselves to use the costing information for planning and resource allocation decisions . By supporting Mozambican-led data collection and analysis, Health Systems 20/20 plays an important role in promoting and ensuring the development of evidence-based, appropriately-costed health and related plans in the future.

TBD Health Systems 20/20, in collaboration with local entities, is currently classifying and costing community-based care services across a wide range of civil society and NGO providers. As part of this activity, the Project will assist the MOH , donors, and the provider organizations themselves to use the costing information for planning and resource allocation decisions . By supporting Mozambican-led data collection and analysis, Health Systems 20/20 plays an important role in promoting and ensuring the development of evidence-based, appropriately-costed health and related plans in the future.

There is currently no functional program or strategy to form and train social welfare technical staff and early childhood educators (Técnicos de Acção Social and Educadores de Infância). In collaboration with MMAS, TBD Health Systems 20/20 is updating standards, scopes, and competency-based curricula for these cadres of workers.In addition, technical working groups have been formed to focus specifically on strengthening the social welfare programs. By facilitating institutional capacity building and fostering human resource development, project efforts ultimately ensure greater access to social assistance and support by vulnerable groups.After completing a training of trainers for course facilitators, the project will support implementation of the updated competency-based curricula through an initial course conducted in Maputo through the existing Ministry of Health Instituto de Ciencias de Saude de Maputo (ICSM) in line with the goals listed in the MMAS Human Resource Development Plan. The project will support MMAS to explore and implement decentralized training strategies and leverage existing institutions at the provincial level. Simultaneously, TBD Health Systems 20/20 will work with MMAS to plan and advocate for additional resource streams, including from the GRM and donors, to sustain training opportunities. As part of this support, TBD Health Systems 20/20 will strengthen capacity within MMAS to interpret and employ available costing information linked to services within their mandate such as community-based care services which are currently being costed. Available costing information will be leveraged to improve advocacy, planning and resource allocation decisions within MMAS. It is critical that MMAS demonstrate their capacity to manage, implement and monitor sustained,high-quality training approaches to advocate to and convince the GRM and stakeholders to increase funding to strengthen the social welfare workforce in Mozambique.

The recent commitment by the Government of the Republic of Mozambique (GRM) to revitalize the APE program provides an opportunity to increase access to essential health services while freeing up facility-based clinical staff to deliver services that require more technical expertise. The GRMs ambitious strategy aims to scale up the APE program to eventually have 18 APEs per district (3,600 nationally). Implementation of the revitalization of the APE strategy was launched in 2010 with the first round of 179 APEs selected, trained and stationed in 8 districts. The second round is scheduled to happen in late 2011. Given the low health worker density in Mozambique, APEs are instrumental in providing health promotion and key curative functions at community level, and are the link between communities and facilities. This IM will provide technical assistance to the Ministry of Health to manage, finance and coordinate the APE program at a national level. Although progress has been made, the system to support and supervise APEs and to forge linkages with the formal health service delivery system is not yet fully implemented nor harmonized across partners. USAID will transition technical assistance from current provider to this project focused on the central level management of the APE program in the Ministry of Health (MOH). A major management challenge is the lack of a single funding source for APE operations (e.g. recurrent expenses for APE subsidies, kits, and other items).

This is a centrally focused activity with some outreach to certain projects with decentralized Global Fund funded activities and the pilots in provinces for performance-based financing.

TBD Health Systems 20/20 will strengthen the linkages between planning, budgeting and financial management by supporting the DPC (Direcção de Nacional Planificação e Cooperação). National health budgeting and planning in Mozambique are extremely challenging, with varying capacity at the provincial and district levels. Provincial health services and programs are financed by disparate sources (the donor balkanization of the health sector), most of which are never included in the official budget or into the national treasury account. Health Systems 20/20 will assist the Planning Department to improve standard operating procedures and more comprehensive and consistent use of standard tools for the cycle of planning, budgeting and reporting. Moreover, budgeting and financial management cycles will be strengthened through existing linkages with DAF (Direcçãode Administração e Finanças). TBD Health Systems 20/20 will work with the Planning Department to institutionalize the preparation of NHA and use the results for health financing planning and policy. One strategy being implemented with Health Systems 20/20 assistance is to set up unique accounts in the national accounting system (e-SISTAFE), enforce internal controls, and strengthen the organizational structure at DAF and the Central Medical Stores (CMAM) by clarifying and documenting roles and responsibilities. In order to bring more donors into the national system, TBD Health Systems 20/20 is also supporting the development of an External Funds Unit to specialize in the management of vertical funding projects, focused on the sectors largest single donor, the Global Fund. A Health Sector Review (HSR) with health financing as a major focus.

The Ministry of Health is in the process of finalizing the first sector-wide M&E plan. To date, M&E has been isolated in the various disease departments, with the most developed M&E capacity and systems for those diseases with significant funding (e.g. HIV). In 2010 the Ministry reviewed a new approach to health system M&E and in early 2011 created a cross-cutting M&E Department.

The Global Fund represents an important source of such funding, but grant disbursements to the MOH were suspended due incomplete or inadequate reporting. USAID, through Health Systems 20/20, has sought to address these bottlenecks to facilitate access to diversified funding streams and ensure regular non-USG contributions to Mozambican health efforts. The IM will enhance transparency, accountability, decentralization, and efficiency within the DPC and paves the way for GRM to meet Global Fund requirements. Health Systems 20/20 will work with other health projects focused on the sub-national level to Provincial Health Directorates (DPS) to receive, manage and report on external grants through the e-SISTAFE system and the national treasury account (CUT). TBD Health Systems 20/20 will seek collaboration with other provincial-level projects to prepare the DPS to plan and implement Global Fund and other donor activities and manage the accompanying funding. Health Systems 20/20 will support the new civil society principal and sub-recipients (SR) of Global Funds Round 9 grants.