The National Department of Health (NDOH) is the implementing agency for health services within the public health sector. Its chief responsibility is to ensure the delivery of quality, affordable and accessible health services at primary, secondary and tertiary level in accordance with the national 10 point plan for health. Over the past year the NDOH through the Cooperative Agreement with US Center for Disease Control and Prevention has been able to expand and strengthen primary health care services to improve access to quality HIV and AIDS services in the public sector. Through this agreement employment of data capturers through recruitment and retention program to be placed at PHC facilities to improve the quality of data recording and reporting with priority given to HIV/AIDS and TB services; and funding of community based organizations (CBO) including faith based organizations (FBO) to provide HIV prevention services to the youth; health system strengthening, Pharmacovigilance; TB prevalence survey; TB/HIV; and Medical Male circumcision. No vehicles have been or will be purchased.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Principal Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHBHC Humana and TAC 1073316 Establish & support community structures with education, produce & distribute manuals. Undertaking outreach activities to promote utilization of HCTHLAB NHLS 14292832 Carry out TB testing using GenXpert technologyHTXD 48811300 Establish & support central procurement unit. Support all provinces with procurement forecasting & supply chain managementHVCT 153934 Distribute condoms in public & NGO sectorsHVTB 2006765 Strengthen HIV/TB monitoring & evaluation. Train & capacitate HIV TB staff to improve quality controlMTCT 9534400 Strengthen PMTCT services. Capacity building of community health care workers on integrated PMTCT

South Africa has one of the largest treatment programs in the world. There is however a need to increase access to ART. The government has adopted NIMART as a strategy to increase access to treatment. The NDOH is involved in strengthening Primary Health Care services and the development of a comprehensive care package for people living with HIV. The Increasing Access to Care and Treatment (I ACT) funding will support:NIMART training in all 9 provincesPrinting and distribution of revised guidelines for ARTSupport the national quarterly working group meetings on I ACTSupport re-engineering of PHC with a comprehensive care package for people living with HIVSupport provinces and grassroots for implementation of the I ACT and the comprehensive care package

South Africa has 70% TB prevalence amongst patience with infected with HIV. NDOH has recently introduced a program specifically focusing on TB and HIV co morbidity with the intention of ensuring that patients with both HIV and TB are prioritized and receive medical attention. South African President Jacob Zuma has announced during the World AIDS Day in 2009 that both pregnant women infected with HIV and patients infected with both HIV and TB should be fast tracked into the treatment. According to the NDOH data which is collected on routine basis very few people infected with TB and HIV and fast tracked into the treatment. NDOH and its partners i.e. PEPFAR, Global Fund, etc. are supporting and working on several strategies to minimize this challenge. Funds will be used to support strengthening of laboratory services that are needed to implement TB/HIV programs to ensure effective health systems response to appropriate and timely referral and counter referral. Activities will include:

Training and roll out of the new v2.0 ETR.Net and EDRweb to all 9 provinces, TB/HIV training (including PALSA+ training to four districts and IPT training), infection control/occupational health risk trainingPrinting of strategic materials to guide and advance the TB/HIV program nationally. Materials can include policies, guidelines, educational materials, reports, monitoring and evaluation tools/registers and other publications/postersSupport NDOH quarterly meetings with provinces to discuss TB/HIV related issuesInfection control activitiesTB/HIV assessmentsKick TB evaluationSupport for PALSA-plus activities

Laboratory services play a critical part in health care system of any country. Laboratory services comprises of three phases ie. the pre-analytical phase, the laboratory testing phase and the post-analytical phase. The pre- and post-analytical phases occur in a public health facility and the laboratory testing phase occurs inside a laboratory. In South Africa, the National Health Laboratory Services (NHLS) is responsible for all public health laboratory testing. While the NHLS is strengthening and improving their challenges that occur inside a laboratory setting, to observe an improvement in the entire laboratory cycle, it is critical that the pre- and post-analytical phases are also strengthened. The pre-analytical phase included evaluation on specimen collection, infection control, specimen cold-chain management, proper completion of requisition forms and the post-analytical phase included result management and record keeping. However, since HIV Rapid testing occurs inside a public health care setting, this process was also evaluated.

A non-governmental agency was tasked to do an evaluation of the gaps and challenges with the pre- and post-analytical phases in public health care services. Gaps and challenges were identified and recommendation where made by the respective NGO. CDC funds will assist NDOH to continue implementing recommendations made by the respective NGO. The implementation will include salary of the Laboratory Technical Assistant, training of POCT, External Quality Assurace (EQA) program and protocols, and other activities.

The NDOH is also in process of improving the diagnostics for TB through procurement of Gene Xpert machines. Current diagnostics for active TB are limited by cost, complexity, long diagnostic time, poor sensitivity or poor specificity. A point of care, affordable, easy-to-use, highly sensitive and specific test for active TB, analogous to HIV rapid tests, is urgently needed. NDOH has already started to procure these machines but will not be enough for all the facilities. Therefore some of this cooperative agreement funds under this program will be utilized in such procurement.

FY 2012 funds will be utilized to hold two national M&E workshops with all provinces and district represented discussing M&E implementation progress, challenges and strategies to overcome challenges.

South Africa has the largest ART programme globally with over 1.2 million people on ART. Until recently standardised tools have not been available to manage the facility level ART data. In December 2010 South Africas NDOH introduced the Tiered ART Monitoring Strategy comprising of a paper-based (Tier 1), non-networked (Tier 2) and networked system (Tier 3) for patient monitoring in line with the WHOs 3 Tiered ART M&E strategy.

The expansion of HIV/AIDS services to PHC level has put severe constraints on the national health budget. This is coupled with the global financial crisis. However, the NDOH embarked on a program to train data capturers to be placed at facilities within the PHC system to improve the recording, collation and reporting of health indicators with a special emphasis on HIV/AIDS and TB. Funds will be used to support the implementation of the tiered HMIS strategy.

Since the HIV was identified in South Africa, the NDOH has introduced a number of programs to provide prevention, treatment care and support services to patients infected and affected with HIV and AIDS. The NDOH under the leadership of the Minister of Health, Dr Aaron Motsoaledi, and together with provincial leaders is embarking on an urgent process PHC reengineering with the aim of effecting both short and long term sustainable improvements in the access to, and efficiency and quality of PHC services. CDC funds will continue to support this program by the payment of salaries of the PHC coordinators who will be placed at provincial level.Othe activities to support strengthening of the PHC re-engineering model will be implemented in collaboration with the SAG.The Clinical Associates program has been successfully launched at the University of Pretoria and Walter Sisulu University with PEPFAR funding. Some of these funds will be used to support UKZN to develop this program and graduate new Clinical Associates.

The NDOH has set aggressive goals for medical male circumcision and is employing a catch up strategy to ensure that 80% of HIV-negative South African men aged 15-49 (approximately 5-6 million) are circumcised as part of a package of HIV prevention and sexual/reproductive health services within the next five years. CDC is working closely with the NDOH on strategic planning and development of guidelines and is currently funding implementing partners to perform technical support services ranging from communications to training, as well as funding service delivery partners at public, private, fixed and mobile facilities. The NDOH is leading the national MMC program and responsible for significant coordination and information gathering and dissemination. Circumcision-related activities to be included in this award are:

Printing of strategic MMC program documentsPrinting of strategic materials to guide and advance the MMC program nationally. Materials can include policies, guidelines, standardized quality assurance (QA) tools, educational materials, reports and other publications.

Coordination of stakeholder meetingsIn its capacity as lead of the countrys MMC program, NDOH will organize periodic stakeholder consultations a) review MMC strategy, estimate MMC prevalence; identify gaps and synergies across SAG, donors, and implementing partners; b) plan, coordinate and implement the neonatal MMC and pMTCT integration; c) to finalize and validate MMC standardized quality assurance (QA) tools; and share lessons learned across all sites. Activities to include securing of venue, invitation of participants, development of relevant meeting materials, mechanisms for collecting and disseminating meeting minutes and reports.

Monitoring and evaluationDevelopment and execution of monitoring and evaluation (M&E) tools and processes to track and enhance the MMC program, to include (but not limited to) development and ongoing modification of the following:o monthly reporting forms and databases,o standard MMC register, and adverse event surveillance system.

In the last three years the Peer Education Program has been successfully implemented 3provinces (Mpumalanga, Limpopo and North West) Most provinces have indicated a need to have peer educators trained in their provinces. The NDOH is planning to roll out the program in all the nine provinces. The plan is to have 8 master trainers trained for each province. The NDOH would like to develop a standardized peer education curriculum and materials; that will be utilized by all. The NDOH will need to appoint a consultant to compile the curriculum and the materials for the implementation of the program. Technical advice and assistance will be required from CDC.

Integrated School Health ProgramThe NDOH will be assisting provinces to implement The Integrated School Health Program. The Department is planning to have 3 tri-provincial consultative meetings and one national meeting. The objective of these meetings is to assist and strengthen the Provincial, District and Local Task Teams on drafting their own implementation plans and finalize these plans at the National Consultative meeting for the Integrated School Health Program. Some of the activities to be done are mapping of resources, identify quintal 1 and 2; disadvantaged schools, development of the core packages and monitoring and evaluation.

Monitoring Quarterly Meeting Workshops:4 national monitoring meetings for the Integrated School Health Program will be conducted to monitor the progress on the implementation of the program, share lesson learned, identify gaps that province needs support from the National task team as well as challenges that provinces are experiencing in the implementation of the program and plan on how these can be addressed.

Capacity building of Integrated School HealthThe NDOH would like to appoint a provincial focal point person for youth services in all the 9 provinces. The role of this person will be to support the development and processes of the implementation of Integrated School Health Program, support the province to strengthen effective Provincial, District and local implementing structures of the program including monitoring.

In the effort to strengthen HCT services in health facilities, NDOH plans to provide PICT and CHCT Master and basic trainings to health care providers and SAG partners through the Regional Training Centers; provide basic HCT training to lay counselors through the Regional Training Centers; and printing of all training manuals. NDoH will also convene a National PPM Seminar that will bring together various USG agencies, PEPFAR supported implementing partners, National Department of Health and private health sector involved in the HIV programs, to enhance the role of the private sector in the delivery of provider Initiated HIV counseling and Testing. In addition, to ensure synergy of activities, NDoH will host lay counselor HCT and QA consultation meeting to improve the quality of counselling; systems and data .These efforts should see HIV testing increasing from 3% to 50% of patients being tested in health facilities as a standard of care.NDOH plans to strengthen the testing of children. Health care providers will be trained on how to appropriately counsel children and test them for HIV following the guidelines.Lastly, NDOH plans to strengthen the implementation of couple HCT and home-based HIV testing together with linkages to care, support and treatment so this funds will be used to execute these activities.

The NDOH has been involved in the Adaptation and pilot of the FMP by CDC through its partners by attending planning meetings and training workshops. The department have observed the impact of this program in areas where it is currently being implemented where it capacitate, teach and develop skills of parents and caregivers of the children between the age of 9 to 12 yrs old on how to communicate effectively with their children about sexuality and values. FY 2012 funds will be used capacitate NGOs to implement the FMP program.

Out of the 48 million people currently residing in South Africa (SA), over 5.7milllion are infected with HIV. Among those living with HIV it is also estimated that 240 000 are children under the age of 15. As of June 30th, 2008, approximately 500, 000 people were on ART in the public and private sector; approximately 9% of those on ART were children. South Africa is still one of the countries that are still experiencing very high infant mortality rates, which might be attributable to HIV exposure or infection in infants. Follow up of HIV exposed infants in South Africa is beyond 6 week is still a challenge, most of the infants do not access the final confirmatory test at 18 month after initially testing HIV negative at 6 weeks. Of the infants that test HIV positive, access to ARVs is often difficult due to few sites that initiate ARVs in children.Funds will support the implementation of the pediatric guidelines and strengthen PICT in children and improve access into care and treatment for children through IMCI training, task team meeting, providing support to the provinces and districts as well as building the capacity of managers at NDOH to support and monitor the program. Activities will include:

Printing of IMCI training manualsSupporting psychosocial support trainingPrinting of job aids and patients IEC material on psychosocial support for children infected by HIVSponsor two pediatric trainings for NDOH program managersSponsor two international pediatric conference for 2 program managers at NDOHFormation of the pediatric task team to review guidelinesNational Quarterly steering committee meetings for PaedsTOT for pediatric CCMT (IMCI) to all provincesPrinting of integrated postnatal care IEC materials (posters and baby registers)Support National Quarterly steering committee meetings for Paediatric HIV treatment and care

South Africa has one of the largest treatment programs in the world. There is however a need to increase access to ART. The government has adopted NIMART as a strategy to increase access to treatment. The NDOH is involved in strengthening Primary Health Care services and the development of a comprehensive care package for people living with HIV. The Increasing Access to Care and Treatment (I ACT) funding will support:NIMART training in all 9 provincesPrinting and distribution of revised guidelines for ARTSupport the national quarterly working group meetings on I ACTSupport re-engineering of PHC with a comprehensive care package for people living with HIVSupport provinces and grassroots for implementation of the I ACT and the comprehensive care package