NO FY 2009 FUNDING IS REQUESTED FOR THIS ACTIVITY:

This activity was approved in the FY 2008 COP, is funded with FY 2008 PEPFAR funds, and is included

here to provide complete information for reviewers. No FY 2009 funding is requested for this activity.

PEPFAR funds were allocated to SI for this activity in FY 2009. Scientific Medical Research (SMR) is a sub-

grantee under the Care International umbrella but stands on its own. The activity involves quality monitoring

and evaluation of existing partners including but not limited to counseling and testing partners. The partner

evaluation suggested they receive a 15% decrease in funding for FY 2009, so this will be reprogrammed to

SI in January 2009. Therefore there is no need to continue funding this activity with FY 2009 COP funds.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16022

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16022 16022.08 HHS/Centers for Scientific Medical 7315 7315.08 Care UGM $1,000,000

Disease Control & Research

Prevention

Table 3.3.14:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Scientific Medical Research (SMR) activity area for FY 2009 COP within the Center for Disease Control and

Prevention (CDC) was changed from "Counseling and Testing (CT)" to "Laboratory, Infrastructure, Strategic

Information and Policy" because SMR's activities are broader than one activity area.

To further the activities described in FY 2008, SMR implemented the high-level evaluations of partner

organizations which are linked to strategy development.

ACTIVITIES AND EXPECTED RESULTS:

A) Development of pilot tools for CT:

In FY 2008, SMR developed the CT evaluation tool, and held a workshop with CDC on the draft tool. The

tool evaluates fourteen thematic areas: Management/Staffing; Infrastructure; Policies, Process/Systems;

Rapid HIV Test QA; Training; Integration; Consultation; Marketing; Sustainability; Data/QA Plan; M&E;

Project-Specific Objectives; VCT Client Profile; and Budget. Input and comments from CDC were taken into

consideration in finalizing the tool which was then approved by CDC for pilot testing. In parallel to this

process, an evaluation Standard Operating Procedure (SOP) was also developed by SMR, and following

CDC's input and comments, a final SOP was approved by CDC.

B) Pilot testing of the tool in the field with partner organizations:

The CDC approved the evaluation tool and SOP which were piloted initially with two partners, one offering a

client-initiated CT, while the second partner operated in a provider-initiated CT environment. Following the

pilot, a report back meeting was held with both the evaluated partner and the CDC. Both the tool and the

SOP, together with the strategic recommendations were made to improve partner's efficiency and alignment

with PEPFAR were well received by the evaluated partners. Feedback on issues raised from both the

partners and the CDC was used to further improve and refine both the tool and the SOP. Additionally, two

partners were evaluated after March 2008 and provided with feedback and strategic advice on how to

improve their program's efficiency at a combined partner/CDC report back meeting, and the

recommendations were again well received. Of importance, is the fact that one of the evaluated partner

operates in a private sector setting, while the other partner is in a provider-initiated CT environment. Thus, a

total of four partners to date have been evaluated and provided with strategic advice on program

improvement and alignment with PEPFAR.

For FY 2009:

C) Development of additional tools for further partner program areas:

Draft tools for two additional program areas have been developed, i.e., Care and Treatment, and PMTCT. A

workshop for the draft Care and Treatment tool has been held with CDC, and the tool is currently being

finalized and will be presented to CDC in September 2008 for final review and possible approval, and once

approved, it will be pilot tested at selected partners before rolled out to a larger number of partners. A

workshop will also be held with CDC to discuss the draft PMTCT tool.

The CT evaluations that have been done to date have been very well received by both CDC and the partner

organizations. The challenge is now to scale up these activities to new levels, so as to impart as much

strategic wisdom as possible to the partner organizations, so that they may operate as optimally as possible

and be well-aligned with the national program. The tools have also been streamlined by sub-dividing them

into Part A which evaluates common business, administrative and logistic thematic areas; followed by Part

B which addresses the HIV program-specific thematic areas.

FY 2009 COP activities will be expanded to include: (1) expanding program monitoring and evaluation at

additional CT, Care and Treatment, and PMTCT sites as identified by CDC, Pretoria; (2) developing

additional monitoring modules for the following program areas: TB-HIV Services, and Laboratory Services;

(3) monitoring and evaluation at additional sites for care and treatment program area, PMTCT, and with

additional partners for: TB-HIV, and Laboratory program areas, as identified by CDC, Pretoria; and (4)

assessing feasibility of (in consultation with CDC Pretoria) expanding the CHAQA monitoring and evaluation

model. SMR activities are also aimed at Health Systems Strengthening for sustainability of HIV/AIDS

services in multiple program areas.

SMR's FY 2009 COP activities are synergistic/additive to activities contemplated in the upcoming South

Africa PEPFAR Partner Performance Assessment (SAPPPA) contract, and SMR would be willing to work in

conjunction with (and mentor) the organization selected for contract implementation.

-------------------------

SUMMARY:

Scientific Medical Research is developing an innovative monitoring and evaluation program that (a)

assesses the quality and impact of HIV programs in the public sector; (b) generates regular feedback to the

programs and donors; and (c) aims to improve the quality of service to the communities and program

implementing institutions through appropriate feedback mechanisms.

BACKGROUND:

This program is a continuation of a Tucker Strategy supplementary PEPFAR funding proposal which

commenced on 1 December 2006 for the initiation of this novel comprehensive assessment mechanism.

Funds used for the initial set-up phase are allocated to the employment of a small core of appropriately

qualified persons to drive the establishment of this process, and to a relatively small consumables budget.

The response to the HIV epidemic in South Africa is expanding, as public and private institutions scale up

Activity Narrative: their efforts to prevent new infections, as well as care for and treat those who are already HIV-infected.

These programs are either self-funded or funded by external agencies such as PEPFAR. The quality of HIV

services, however, varies dramatically in both public and private sectors. Many people only have access to

a limited package of prevention measures and/or counseling and testing (CT), while others have access to

a comprehensive package of education, prevention and care including antiretroviral treatment. Even where

CT (and other) services exist, the impact and quality of services varies substantially.

There is currently no agency that assists both public sector funding agencies and implementing institutions

to make objective, external evaluations of the quality of workplace-based HIV programs, and use that

information in a positive way to improve the quality of care offered. A gold standard by which they can

assess the HIV-related activities will tend motivate towards more and better corporate interventions. In the

absence of adequate external review and quality assessment of HIV programs, both donors' and

implementing institutions' management are unable to monitor the successes and failures of the programs,

and where required, institute appropriate changes to improve the quality of the programs.

Scientific Medical Research is an independent organization that has no ties any HIV services providers. Its

staff will comprise a mixture of skilled staff able to develop the systems for this organization as well as staff

with the ability to assess/audit medical programs. The company is "black empowered," in keeping with the

aims of the South African Healthcare Charter.

ACTIVITIES AND EXPECTED RESULTS:

In the initial 12 months of this project, Scientific Medical Research will carry out three activities.

ACTIVITY 1:

A small core of appropriately qualified persons will be employed and trained to drive this process. Staff will

attend relevant monitoring and evaluation courses and conferences.

ACTIVITY 2:

In consultation with CDC Pretoria staff, program assessment methodology will be piloted, initially at two

sites. The pilot will be followed by review and where necessary, modification of the assessment

methodology. Additional sites will be assessed as advised by CDC.

ACTIVITY 3:

Scientific Medical Research will establish appropriately designed databases to manage the program

assessment activities. FY 2008 COP activities will be expanded to include: (1) expanding monitoring at

additional CT sites as identified by CDC, Pretoria; (2) developing monitoring modules for care and

treatment; (3) monitoring at care an treatment sites, as identified by CDC, Pretoria; and (4) assessing

feasibility of (in consultation with CDC Pretoria) expanding the CHAQA monitoring model to other program

areas and sharing with other countries.

These results contribute to the PEPFAR 2-7-10 goals by strengthening the ability of local institutions to

implement programs efficiently, especially improved quality assurance and leadership through evaluation of

national prevention, care and treatment efforts.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.17: