Capacity building is a cornerstone of PEPFARs strategic plan for a sustainable response to the HIV/AIDS epidemic in Rwanda. Under this award, Tulane University is mandated to harmonize PEPFAR support to Government of Rwanda (GOR) institutions for capacity building in health care. The purpose of Tulane's award is to support and develop public health capacity within Rwanda by strengthening the institutions in

higher learning responsible for producing the workforce for the health sector. Specifically, this award aims to strengthen local institutions responsible for providing high quality education and training to qualified candidates in the areas of public health, social work, nursing, midwifery, medical education, and human resource management.

This award links directly to the Partnership Framework in that it seeks to strengthen Rwandan institutional and human capacities, produce qualified human resources for health in the quantity that Rwanda needs, and transition to increased country ownership of health programs. . Institutional twinning and technical assistance will be employed to assist Rwandan institutions of higher learning in the health sciences assume primary responsibility for the planning and design, implementation, monitoring and reporting of education and training, research, and community outreach programs as well as for the strategic direction and financial management of their respective institutions. Benchmarks will be established to measure institutional capacity in these areas. As capacity is demonstrated consistently over time, responsibilities will be shifted progressively towards Rwandan ownership. Examples of such benchmarks include evidence of adequate preparation, planning and delivery of educational and training activities via the existence of published academic calendars and summary student course evaluations. Consistently accurate and timely invoicing of research grants and contracts is another benchmark towards financial and managerial capacity.

The geographic coverage of this award is national in scope and targets national level institutions as well as a spectrum of human resources in the health sciences sector from central to district staff level within the MOH, faculty and administrative staff within institutions of higher education, technical staff within national and international NGOs, recent university graduates entering the health sector as young professionals as well as direct service providers of psychosocial support (eg. counselors, nurses, psychologists, and social workers).

This award contributes directly to health systems strengthening in the development of human resources for health via multiple activities including pre and in-service training, management and leadership development, retention, workforce planning and institutional twinning. Additionally, this award supports its Rwandan partner institutions of higher learning via infrastructure support to enhance technology-driven, learning laboratories and establish cutting edge audio-visual conference centers. This award's focus on human resources for health and educational institutional capacity building in will contribute to the sustainability and country ownership of the health system. Developing the health workforce through continuing education and training opportunities and creating a 21st century, high-tech learning environment will provide Rwanda's health system with the tools necessary to function efficiently and effectively with reduced external support.

This award also includes a faculty development component, providing opportunities to qualified professionals at national educational institutions to pursue and complete advanced degrees up to the doctoral level. As Rwandan institutions of higher learning augment their workforce with highly trained professors in health sciences, savings will be incurred as the necessity for external expertise is reduced. The establishment of Internet-capable learning laboratories will provide students and faculty greater access to online resources, reducing the cost of expensive texts. Furthermore, such infrastructure will provide broader access to students unable to attend physically in the classroom via distance offerings.

Monitoring and evaluation plans will be linked to mutually agreed upon annual work-plans detailing the types and sources of information to be provided. Specific benchmarks related to transition of responsibility will be articulated in subcontract agreements between Tulane and its Rwandan partner institutions. Evaluations of the training courses and institutional capacity assessments will inform future activities.

54. United Nations High Commissioner for Refugees

Rwanda is host to approximately 53,000 refugees in three refugee sites around the country. Refugee populations are considered to be at high risk of infectious disease, in particular HIV, as well as SGBV and its associated consequence and psychological distress.

UNHCR has been benefiting from PEPFAR funds since 2007 to implement a comprehensive HIV/ AIDS program in Kiziba refugee site located in Kibuye district/sector. Based on the successes and lessons learnt from the past years of project implementation UNHCR through its partner will continue to strengthen the implementation of HIV/AIDS program in the Kiziba refugee site.

The goal of this program is to ensure that refugees and host communities living with HIV/AIDS have access to HIV information, quality HIV care and treatment services as well as supporting a successful Anti Retroviral Treatment adherence that assures viral suppression. UNHCR will continue to support trainings on a sustainable basis, provision of HIV/AIDS messages, basic care and treatment to HIV, TB and OIs to the greatest number of needy refugee patients and in the hosting community, consistent with PEPFAR strategy and GOR national priorities.

UNHCR will continue to strengthen and support the provision of HIV health care services ranging from prevention, care and treatment to refugees and hosting community.

To achieve these activities, UNHCR will strengthen staff capacity to use new guidelines/standards and protocols adopted by both UNHCR/GOR through conducting trainings, mentoring at different levels of

implementation.

UNHCR is committed to working in close collaboration with the Government of Rwanda, UN agencies and NGOs to strengthen its support to HIV care, support and treatment to refugees and the hosting community.

To ensure monitoring and evaluation of the planned activities, UNHCR will strengthen monitoring and data management systems, for collecting, managing, and analysis of clinical data at the health facility, strengthen feedback mechanism for better performance.

Tulane's activities in FY10 will continue to support the development of institutional and human capacities to increase Rwandan ownership and establish Rwandan leadership in the production of its human resources for health. These activities will include; ongoing delivery of education and training in collaboration with key partner institutions ( National University of Rwanda's School of Public Health (SPH), Faculty of Medicine (FACMED), and Department of Social Sciences (DSS)); building research capacity and improving quality of teaching; needs assessments in collaboration with other donors; strengthening administrative and financial management among partner institutions and; developing new

training courses, revising current curricula in response to recommendations of the needs assessment.

Ongoing delivery of education and training In collaboration with the SPH, Tulane delivers a two-year, MPH day program encompassing four course modules, with candidates drawn primarily from district health teams. Course modules emphasize Rwandan health priorities and programs, including HIV/AIDS, and utilize actual case studies and data sets to support learning. An HIV certificate program is delivered jointly with the SPH entitled Strategic Information in Support of HIV/AIDS Programming. This six week program targets HIV researchers and program managers drawn from MOH units such as CNLS and TRACplus, faculty from institutions of higher learning in the health sciences, other GOR ministries (including Gender), local NGO umbrella organizations including the Rwanda Network for PLHIV (RRP+), other local NGOs and faith-based organizations. The HIV certificate program comprises the following courses: Clinical & Epidemiological Aspects of HIV/AIDS and Opportunistic Infections; Applied Behavioral Research; and Introduction to Monitoring and Evaluation Research of HIV/AIDS Programs. Through COP10 Tulane will support 10 students in pursuing their MPH and 30 in completing the HIV certificate program.

Tulane also supports an on-the-job training program, implemented by the SPH, for young professionals recently graduated from university in a variety of non-health backgrounds: economics, management, law, and social sciences among others. This Rwanda HIV/AIDS Public Interest Fellowship (RHPIF) program combines multiple short-term trainings with placement in a host agency working to combat HIV in Rwanda. Through the two-year fellowship, fellows receive an annual stipend, a personal laptop, and cell phone service, and are closely supervised by a host agency mentor and RHPIF/SPH staff. Training in computing, project management, and grant/ proposal writing is provided at the beginning at the program and then intermittently every six months, culminating in the HIV certificate program entitled Strategic Information in Support of HIV/AIDS Programming described above. Training is delivered by SPH faculty and visiting lecturers from the MOH and Tulane University. As part of COP 10 the program will groom 20 young professionals for careers in HIV/AIDS.

In collaboration with the FACMED, Tulane through its US partner, the University of Colorado Denver, Center for Global Health, is involved in the training of 23 medical post-graduates, including seven in Family and Community Medicine. This four-year, post-graduate program prepares physicians to function with a broad clinical scope at the district and health center levels of care so as to better address the burden of disease existing in Rwanda's rural communities. This program also strengthens the capacity of select district hospitals to function as University teaching institutions appropriate for the training of family medicine physicians and other specialists. Visiting faculty from the University of Colorado have also provided teaching support in critically needed strategic curricular topics not currently provided with existing teaching resources in the FACMED for post-graduate specialist programs.

In collaboration with the DSS, Tulane delivers the PSS graduate certificate program entitled Psychosocial Support to PLHIV to participants drawn from Rwanda's institutions of higher learning who are responsible for training individuals who are providing social work and psychosocial services to community members. Through COP10 the 60 participants will be drawn from university departments of social sciences, local and international NGOs, and government health institutes and departments. The PSS certificate, comprising three modules over the course of a 12 month period, seeks to build foundational knowledge and skills related to psychosocial service delivery in an HIV/AIDS context; train students in supporting treatment adherence using a bio-psychosocial framework to establish continuity of care and coordinated service delivery; and enable students to identify individual and community strengths using a Rwandan socio-cultural context and taking into consideration human resource capacity for service delivery. As part of their training, students form teams and design and deliver their own PSS training to an average 30 district level counselors, sociologists, psychologists and nurses on specialized topics, realizing a cascade effect of the training of trainers methodology. Upon successful completion of the PSS certificate, students receive nine graduate credits from Tulane University's School of Social Work (SSW) to advance their pursuit of higher degrees. From this group another 15 students will be selected to participate in a Training-of-Trainers certificate program in social work and counseling.

Evaluations of these ongoing training activities and the in-depth, nationally conducted needs assessment will inform the continuation and potential need to scale up these training courses in FY10.

Building research capacity and improving quality of teaching Continued technical assistance will be provided to enhance pedagogic, research, and programmatic capacity. On-going activities include Tulane's faculty development initiative to continue strengthening faculties at the SPH and DSS. This initiative will support two select faculty members in the pursuit of doctoral degrees at Tulane or other appropriate institutions to ensure that Rwandan colleagues acquire the necessary qualifications to assume greater responsibility within their academic institutions. Tulane faculty will also co-chair doctoral committees and mentor DSS faculty pursuing a doctoral degrees at NUR.

Needs assessments Tulane will support two key activities to determine training and institutional capacity building needs in the three partner institutions. Initially Tulane will collaborate with four other donors through the National Technical Working Group for Human Resources in an in-depth needs assessment. This assessment is designed to determine the health workforce needs in Rwanda, taking into account the disease burden, existing cadres and ongoing trainings (pre and in-service). Thereafter an analysis of institutional capacity, including 'institutional preparedness to transition' will be conducted.

Strengthening administrative and financial management among partner institutions New activities under COP10 for human resources for health seek to build upon existing capacity strengthening efforts to accelerate transition and to provide partner institutions with foundational infrastructure to support their educational and training efforts. Technical assistance will target institutional management capacity of partner institutions such as SPH, FACMED, and DSS so as to develop appropriate human resource management policies and procedures taking into consideration the challenges of retention of qualified faculty in low paying academic posts. Participatory efforts will engage key stakeholders to identify innovative means of compensating faculty and key staff so as to maintain high quality and performing faculties. Technical assistance will emphasize strengthening financial management systems and reporting especially as it relates to grants and contracts management for both principal investigators and financial and administrative staff. Multiple focused, short-term technical assistance visits targeting appropriate counterparts within each partner institution will be conducted throughout the COP10 year to accelerate the transition of managerial responsibility.

New activities under COP10 will also focus on renovation and infrastructure support to establish technology-enhanced learning laboratories, an audio/visual conference center and a sound studio. A networked, thin-client learning lab for 100 students inclusive of online subscriptions to select medical journals and reference texts and a 50 person audio/video conferencing center will be established at the FACMED. A sound studio to record and review undergraduate students' emerging counseling skills in role play situations will be established at the DSS. (The current undergraduate degree program in social work at the DSS enrolls approximately 260 students.) This renovation will strengthen both institutions' ability to deliver quality education and training programs and produce the human resources for health that Rwanda needs.