Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4325
Country/Region: Rwanda
Year: 2007
Main Partner: Catholic Relief Services
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: HHS/HRSA
Total Funding: $621,139

Funding for Care: Adult Care and Support (HBHC): $0

[CONTINUING ACTIVITY FROM FY2006 -- NO NEW FUNDING IN FY2007] This activity is related to activities under ARV Services (4849, 4783), and Basic Health Care (2811).

CRS will continue to provide basic clinical care services to 2,100 existing patients enrolled in care at two sites. Basic healthcare will include OI prophylaxis, diagnosis and treatment, counseling on positive living, including alcohol abuse prevention, nutrition counseling, malaria prevention, and HIV prevention. CRS will assure the clinical management or referral of complicated cases to reference or district hospitals. Nurses at health facilities will be trained and mentored to stage all PLWHA reached through PMTCT, CT or PIT with informed consent. Through the EP OI procurement, CRS will ensure that facilities in the district have a stock of drugs to treat OI, manage ART side effects and provide preventive treatment for medical staff exposed to suspected HIV-contaminated fluids and rape victims.

At the site level, linkages between clinical and community-based services will be assured through placement of social workers and community activities coordinators at health facilities. In cooperation with the CSP, these staff will enhance the quality of community-based care throughout the network by training HBC workers in adherence support and psychosocial counseling. The community activities coordinators will support CSP partners to monitor HBC workers through frequent field visits and joint supervision activities. CRS will help the sites increase the enrollment of women identified in PMTCT and of persons identified through VCT. CRS will coordinate with Title II recipients to address the nutrition needs of HIV-infected patients.

CRS will strengthen the medical record system for each site, and train the DHT to verify data reliability. In addition, CRS will encourage and facilitate the use of routinely collected data for problem solving, quality improvement and program evaluation. This will include providing computer programs to sites for summary reports of their patient-level data and training in interpretation of data for program improvement. CRS will also organize quarterly M&E workshops for staff from CRS-supported sites to enhance the collection and use of data at the site level.

These activities support the EP five-year strategy for palliative care by 1) rapidly expanding the availability of care services towards the goal of three health centers in each district providing basic care and 2) improving linkages between clinical and community care services in the network model, including symptom management, OI care, end-of-life care, and integration of care services with prevention and treatment.

Funding for Treatment: Adult Treatment (HTXS): $621,139

This activity relates to HTXS (7161), HBHC (7160), HVTB (7162), HVAB (8187), OHPS (7218).

In FY 2006, CRS is providing a comprehensive package of ART services at eight sites serving 2,000 patients, including 200 children. The package includes treatment with ARV drugs, routine CD4 follow up, viral load testing for an estimated 400 eligible patients with decreased or stable CD4 after nine months of HAART, management of ARV drug side effects, and patient referrals to community-based care.

In FY 2007, CRS will expand quality clinical services, continue support to the DHTs, increase sustainability through performance-based financing, and strengthen SI at all levels.

With procurement support from PFSCM, CRS will provide ARV drugs, CD4 tests, and viral load tests to all supported sites. In order to ensure continuum of care, HIV case managers at sites will train and supervise community volunteers including CHWs, PLWHA association members, and other caretakers, in collaboration with CHAMP. Increasing pediatric patient enrollment is a major priority for all USG clinical partners in FY 2007. Case managers will ensure referrals of pediatric patients identified from PMTCT programs, PLWHA associations, and malnutrition centers. In addition, adult patients enrolled in care will be encouraged to have their children tested. To expand quality pediatric care, Rwanda's few available pediatricians will mentor other clinical providers, using the Columbia UTAP model developed in FY 2006.

In the context of decentralization, DHTs now play a critical role in the oversight and management of clinical and community service delivery. CRS will strengthen the capacity of eight DHTs to coordinate an effective network of ARV and other HIV/AIDS services. The basic package of financial and technical support includes staff for oversight and implementation, transportation, communication, training of providers, and other support to carry out key responsibilities.

The Rwanda EP will continue a gradual shift in funding from input financing to performance-based financing. Through a strategic mix of input through the district support package and directly to health facilities, and output performance-based financing through the purchase of improved performance for specific HIV indicators, districts will receive the appropriate support to increase autonomy and sustainability.

In addition, CRS will strengthen district and facility level capacity for data collection, reporting and use with focus on ARV drugs management, HIV case management, and improved quality implementation and program evaluation. Sites will generate routine summary reports of patient-level data and will interpret that data to inform their programmatic operations. CRS will also organize periodic M&E workshops for all supported sites to discuss the collection and use of data at the site-level.

This activity supports the EP five-year strategy for national scale-up and sustainability and the Rwandan Government ART decentralization plan and addresses the key legislative issues of gender, stigma and discrimination.

Subpartners Total: $0
Bungwe Health Center: NA
Bushenge Health District: NA
Kibogora Health District: NA
Karangara Health Center: NA