SUMMARY:

The Quality Monitoring and Assessment Program (QMAP) is a new activity for FY 2008, and was added in

response to the additional funding made available to South Africa for this fiscal year. The purpose of the

activity is to assess performance in adherence to USG and agency-specific policies and guidance;

administrative and financial practices and procedures; evidence-based sound clinical care and

management; evidence-based, sound interventions at the community level; and the policy and practice of

partners in providing support services through on-site visits and consultation. The QMAP is not an individual

partner quality improvement program. These on site monitoring assessments will provide Activity Managers

(AM) with information to identify challenges to partner implementation and ensure that PEPFAR funds are

maximized in promoting evidence-based and quality programming under each program area. Since 2004,

the South Africa PEPFAR team has experienced rapid growth of the HIV and AIDS prevention, care and

treatment programs from over $8 million in FY 2005 to an anticipation of almost $600 million in FY 2008.

Management and Staffing has not proportionately increased in an effort to apply the bulk of funds into

program areas. AMs from the larger agencies (USAID and CDC) have responsibility for upwards of 25

partners and fiduciary responsibility for as much as $15 million. Given the increase in resources, the ratio of

staff to partners or dollars will grow in FY 2008 despite new recruitment. The PEPFAR Task Force and

partners utilize several approaches that aim to monitor partner performance. Quarterly and bi-yearly reports

with follow-up; interim progress reports; partner meetings; and requested budget draw-downs are examples

that are currently in use. On-site visits to partners and subs funded through PEPFAR are rare due to the

heavy and growing workload of AM. In FY 2008, the PEPFAR Task Force agreed to prioritize site visits for

the purpose of monitoring quality and assessing performance. This activity is considered an essential

aspect of strategy development under the PEPFAR reauthorization.

The following activities are to be included:

ACTIVITY 1: Establishment of a QMAP Leadership Team to determine the goals and objectives of the

program

The team membership should consist of South Africa Government (SAG) and appropriate Agency

representatives (technical leads and/or AM). A contractor will be named to carry out the tasks. The

leadership team will collaboratively develop the goals and objectives for the QMAP in each technical and

administrative area. The scope of work for the contract will be developed and bid in limited competition so

as to restrict competition to include only bidders from South Africa-based organizations.

ACTIVITY 2: Review of existing tools

In conjunction with the SAG, USG and PEPFAR partners will carry out a review of currently existing

assessment and performance monitoring tools for healthcare settings. Current PEPFAR partners and

international agencies have developed, piloted, and implemented assessment and monitoring tools that

may be modified for this program. It is important to evaluate those already existing tools to minimize

duplication of effort. Appropriate tools developed by other countries will be included in this review. In

addition, in conjunction with the SAG, PEPFAR will develop new tools to monitor performance in any areas

where appropriate tools have not yet been developed.

ACTIVITY 3: Site visits

After development and validation of the QMAP tools, the QMAP Leadership Team will collaboratively

develop a calendar to visit sites of PEPFAR partners. The intent is to conduct site visits and implement the

QMAP for 70% of partners in the first year. A partner review may include, but will not be limited to a file

review; on-site interview of leadership and staff; on site review of administrative, financial, clinical and

support services (in a clinical setting); review of curricula, plans and observation of activities (in a

community setting); focus group interviews with clients who are receiving services; and each partner will

conduct a follow-up consultation to provide appropriate technical assistance or modify program activity as

needed. SAG involvement will ensure buy-in and strengthen a sustainable health care system for persons

affected with HIV and AIDS. This activity is in support of and provides strengthening for all aspects of

PEFPAR and plays a meaningful role in assisting partners to achieve the 2-7-10 goals.