The SAG, PEPFAR, GHI & I-TECH recognize the importance of strong systems for integrated health programs. COP12 activities will be expanded to include TA to the NDoH & PDOH to meet the goals and objectives of the partnership framework and the National Strategic Plan in support of the national HIV/AIDS, and TB response (2012 2016). Priority will be given to developing sustainable programs that will be transitioned to country-owned and country-driven. I-TECH SA Goal: To improve the effectiveness, efficiency and sustainability of the SA national HIV, STI and TB Response. I-TECH Objectives: Reduce HIV and TB incidence; Strengthen community systems to prevent HIV/TB transmission; strengthen managerial capacity across the public sector particularly in M&E, information systems, implementation and HIV mainstreaming; Increase institutional capacity to deliver health system functions; and Invest in OR & new innovative methods to evaluate the true impact of programs. I-TECH SA will strengthen the National Health System with emphasis on 4 of the 6 building block of the WHO HSS framework, which include human resources for health, information, service delivery, and governance. Specifically, I-TECHs TA to the NDOH, PDOH & RTCs will included strengthening the 9 RTCs capacities based on the US AETC model with primary emphasis on: 1. Human capacity development (leadership & governance capacity building, human resource development/ management, financial management); 2. Strategic information (strategic planning, data management and reporting systems, monitoring and evaluation, target indicator development, disseminating best practices to improve program efficiency/ effectiveness).

I-TECH aims to reduce HIV and TB incidence. I-TECH SA will support the scale-up of a national advanced HIV, AIDS and TB training program in collaboration with the National and Provincial Departments of Health as well as District Management Teams in three priority districts with possible expansion to other areas, targeting worst performing districts at primary health centres to improve specific TB and HIV quality of prevention, care and treatment indicators. As part of this effort, I-TECH will strengthen programs against TB, MDR-TB and XDR-TB aligned to the decentralized TB prevention, care and treatment guidelines. I-TECH will conduct a baseline assessment, collaborating with the University of Free State to standardize the approach that has already been used in Northern Cape and Eastern Cape, develop a training plan and then scale-up the training program. One of the focus areas of the baseline assessment would be the data quality and reporting tools used at the facility. I-TECH will ensure that national tools are used and that TB indicators are reported correctly so that high-quality data is available for progress monitoring and outcome evaluation. I-TECH maximizes its impact through a training of trainers and mentors strategy. This leverages large numbers of new HCW trained and assures that departments of health have internal master trainers/mentors available who allow them to rely less and less on external technical assistance (TA). Using this model, I-TECH will work closely with the RTCs to develop a network of district trainers to implement the national training program at the sub-district level. I-TECH will train nurse mentors to support knowledge into practice at the district level. Additionally, I-TECH will work with the Department of Correction Services to develop and implement an HIV and TB training program. The goal of the program is to support health care workers working in the prison system to provide essential HIV and TB prevention care and treatment for inmates. As with the facilities, I-TECH will assist in improving the quality of the treatment data and evaluate the flow of data to ensure that Correction Services TB data is included in national reporting. I-TECH will conduct on-going monitoring and an outcome evaluation to ensure that the TB and HIV quality of prevention, care and treatment indicators improve as a result of the interventions.

During FY 2012, I-TECHs OHSS-funded activities will assist the strengthening of the South African Health System mainly as follows:1. Regional Training Center (RTC) Capacity Building: Using the International AIDS Education and Training Center (IAETC) model, I-TECH SA will capacitate the Provincial Regional Training Centers (RTCs) to ensure a sustainable, high-quality and standardized training program in the management of HIV, AIDS, TB, STIs, chronic diseases and mental health. I-TECH will:(i) Conduct a situational analysis of the RTC models identifying best practices and lessons learned, the envisaged role of RTCs in the PHC re-engineering process in collaboration with the HRD at NDOH.(ii) Analyse potential models for a decentralized RTC structure that includes recommendations for leadership and managerial capacity, human resources needed to support RTC functions, a standardized training program (including distance learning options), infrastructure, data management, and trainer competencies required to implement continuing education for health care workers using the IAETC model.(iii) Develop a standardized training program working with the NDOH and key partners.(iv) Develop six provincial plans for RTC strengthening. Implementation will begin in 3 priority RTCs in COP12 with scale-up in COP13 to remaining RTCs.2. District Leadership and Management Development. I-TECH SA will strengthen district, sub-district and facility-level health systems through the development of practical management skills of key managers through implementation of a leadership and management initiative (LMI). I-TECH will train officials from districts through provincial trainings, with focus on the 10 pilot districts for National Health Insurance and other priority districts identified by the NDOH.3. Human Resources Information System (HRIS): I-TECH will strengthen the national HRIS through:(i) Expanding the implementation of the Training System Monitoring and Reporting Tool (TrainSMART) from 3 to 6 provinces and Department of Correctional Services providing a national platform for training data collection and reporting. TrainSMART is an open-source, web-based training data collection system developed by I-TECH aligned to the reporting requirements of PEPFAR.(ii) Providing TA to DOH at all levels with the development and national roll out of the Skills System Monitoring and Reporting Tool (SkillSMART) to become the national HRIS tool. The system will be used to capture data from health care workers (HCW) on qualifications, skills, past trainings, and levels of confidence and competence at an individual level.(iii)Expanding the electronic library nationally with NDOH.I-TECH will lead the process of assessing current similar resources to propose a standard or linked national resource.4. Department of Correctional Services: I-TECH will strengthen the HIV, AIDS, STI and TB prevention, care and treatment of inmates through targeted training and systems strengthening activities.

I-TECH SA COP 12-13 will focus on TA to strengthen the SA NDoH, PDoH, District Management Teams, RTCs and HCWs/CHWs in the implementation of prevention of STI, TB and HIV with HIV positive people (PwP) as a key building block for HSS. I-TECHs TA will support prevention activities in the Free State (FS), KwaZuluNatal(KZN), Mpumalanga(MP) and Gauteng(GP) provinces. I-TECH will build capacity and provide on-the-job training for HCWs and CHWs on Prevention with Positives (PwP), and Post Test Clubs (PTCs), enhancing knowledge, skills and practices in service delivery to ultimately improve patient outcomes. The goal of the PwP program is to reduce transmission of HIV to uninfected persons (partners and children) and promote prevention and healthy living in communities and clinical settings.Objective 1: To integrate PwP activities into clinical care settings. I-TECH conducted a formative assessment in FS to evaluate the HIV prevention information conveyed by HCWs & information received by patients in selected health care settings. I-TECH COP 12 activities will implement the same evaluation in GP, MP and KZN provinces and will implement a 4 hour onsite PwP training course for HCWs & CHWs. Content is adapted from the CDC PwP training course and piloted in GP. Additionally, I-TECH will standardize PwP approaches and materials; conduct 4 TOTs on PwP trainings for RTCs & PEPFAR partners to rapidly scale up PwP activities in districts, sub district & community level. I-TECH will work with NDOH/PDOH to scale-up a nationalized STI training program to RTCs and priority districts and leverage support of NDoH/PDOH to integrate PwP training into the NIMART training & PHC re-engineering process. Objective 2: Strengthen community systems to prevent HIV and TB transmission. I-TECH will expand the Post Test Clubs (PTCs) to interface with the Integrated Access to Care and Treatment (I-ACT) initiative and the HIV testing process to empower communities to provide support for persons living with HIV. I-TECH will provide TA to roll out PTCs in GP, MP & KZN in COP 12. PTCs empower newly diagnosed HIV persons with PwP messages, positive living, teach life skills & nutrition. Clinics & community linkages will be strengthened. Program evaluation will assess the impact on key PwP indicators for adherence, disclosure of status, partners testing, loss to follow-up, risk reduction behaviours& improved quality of life. Five training of trainers will be conducted for RTCs, partners and Community Based organizations (CBOs) for scale-up of PTCs to rapidly scale-up and deliver the training across the country.