Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7301
Country/Region: South Africa
Year: 2009
Main Partner: Right to Care
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $485,450

Funding for Care: Adult Care and Support (HBHC): $97,090

SUMMARY:

Right to Care (RTC)'s Umbrella Grants Management (UGM) project will support several sub-partner

organizations through financial oversight, project management, human capacity development, training,

mentorship programs, program development, treatment expertise, and strategic planning in providing Adult

HIV Care and Support (ACS) services. With the variety of program activities that RTC currently implements

or oversees, they have developed a wide base of skills and capacity to manage a range of organization

activities, including organizations that provide prevention, training, HIV treatment care and support, pediatric

care and treatment, cervical cancer screening, care for orphans and vulnerable children (OVC), home-

based care and TB care and treatment.

BACKGROUND:

The following proposed activities are designed to support sub-partner initiatives to implement the goals of

PEPFAR and the South African Government (SAG)'s Comprehensive Plan. Over the last two years, RTC

has developed a UGM capacity while developing specific skill sets, competencies and capacity to support

many sub-grantee organizations. RTC has developed in-house capacity in financial management, pre-

award assessments, training functions in financial management and USAID regulatory compliance. In

addition, the technical expertise in medical aspects will be supported by internal RTC capacity and through

the Clinical HIV Research Unit, an extension of the ongoing activities of the current RTC grant.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: UGM Technical Assistance and Quality Assurance

Needs assessment and program planning will be done on a regular basis with sub-partners. Site visits will

be conducted alongside sub-partner staff to systematically evaluate needs of capacity, human resources,

facility planning, approaches to programmatic areas such as treatment and care, in order to effectively

reach determined targets and quality of care. The needs assessments will use the experience of RTC

clinicians and program staff to develop proper planning and forecasting to facilitate patient growth.

Programmatic technical assistance will be provided on an ongoing basis, with clinical mentors responding to

requests and providing treatment updates, ongoing training, updated guidelines, and case-specific support.

ACTIVITY 2: UGM Financial Management

The finance department at RTC has developed systems to support sub-partners that enable compliance

and capacity to manage PEPFAR funds effectively. Support includes a complete range of necessary

financial management. RTC will meet with sub-partners annually to align financial and programmatic

planning.

Regular oversight and support will be given with monthly financial reports required for all sub-partners.

Periodic internal audits will also be conducted at the sites of all sub-partners to establish the quality of

financial management and human resources (HR) management, review of asset control and alignment with

USAID financial management policies.

The finance department at RTC has developed a state-of-the-art financial software tool, which uses

Business Intelligent Tools, to monitor and track all sub-partner transactions against budget projections for

modeling and cash flow. This integrated program will allow proper management of budget at all sites.

Combined with the monthly financial reports, RTC will be able to use this system to produce up-to-date fund

accountability statements and fund balances for its sub-partners.

ACTIVITY 3: UGM Monitoring and Evaluation

RTC's monitoring, evaluation and reporting (MER) system (standards, systems, procedures and tools) is

established, documented and continuously improved, based on best practices and quality criteria, in the

programmatic areas of Adult Treatment, Adult Care and Support, Pediatric Treatment, Pediatric Care and

Support, TB/HIV, voluntary counseling and testing (VCT), Outreach and Training.

All implementation sub-grantees/programs will be provided with support, training and technical assistance to

necessary for sub-partners to effectively meet USAID reporting requirements. In addition, RTC

programmatic experts will monitor the reports for quality assurance.

ACTIVITY 4: UGM NGO Management and Sustainability

RTC supports NGOs with established policy guidance and procedures that meet the requirements of both

the South African labor law as well as the USAID regulations. All sub-partners will have access to the RTC

human resources capacity.

Support of infrastructure will be given through expertise within RTC for advice and consultation. Through

various infrastructure projects, RTC has developed expertise in proper clinic flow, effective interior space

design in both CCMT sites as well as TB clinics. Other sub-partners facing infrastructure challenges will be

able to make best use of limited resources which are necessary in increasing clinic capacity.

Sustainability of sub-grantees will be supported through RTC's continued relationship with the Department

of Health to ensure that continued HIV and AIDS response is in line with the strategic plan for South Africa,

ensuring that once the PEPFAR program is complete, that the activities of the NGO can be taken over by

the South African Government.

Where systems are identified to be inadequate, RTC aims to capacitate NGO organizations to manage their

programs independent of RTC. Within the implementation plan and budget, RTC has planned to provide

financial reporting systems, management SOPs, human resources policies and procedures, clinical

guidelines, and monitoring evaluation systems that will ensure sustainability beyond RTC support.

ACTIVITY 5: Technical Assistance (TA) for Adult Care and Support (ACS)

RTC will support its UGM sub-partners by disseminating policies and guidelines and providing quality

assurance through sharing best practices and monitoring. With FY 2009 funding, RTC will provide ongoing

Activity Narrative: training, staff counseling and supervision of counselors, and continued medical education to assure that

staff is aware of the latest guidelines. Non-governmental organization (NGO) clinicians will also be able to

participate in the mentorship program with doctor training and regular rounds at identified sub-partner sites

(according to province).

RTC will give TA to sub-partners to ensure that each HIV patient at RTC-supported facilities receives a

comprehensive basic package of ACS services and preventive care, including clinic, community and home-

based services. This minimum package includes clinical and pathology monitoring, management,

prevention and treatment of opportunistic infections, psychosocial counseling, healthy living education,

prevention with positives services, nutritional counseling, assessment, monitoring and referral, home-based

care, advice and assistance on welfare issues and applications for welfare grants, end-of-life care for

terminally-ill patients, and bereavement support for the family.

Emphasis will be placed on increasing the number of HIV-infected children and pregnant women in care.

Home-based care programs will be oriented around a family-approach, identifying family members who

have not yet tested for HIV or TB or who are positive but have not yet enrolled in HIV care; expanding

services to these other family members. Sub-partners will be encouraged to do nutritional counseling at

community level and refer for nutritional assessment and monitoring. Examples of non USG-funded

community activities include food gardens and income generating programs in order to support patients that

are on ART.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $95,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $97,090

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

UGM non-governmental organization (NGO) Management and Sustainability:

Right to Care (RTC) will support sub-partners with established policy guidance and procedures that meet

the requirements of both the South African labor law as well as the USAID regulations. All sub-partners will

have access to the RTC human resources capacity.

Support of infrastructure is given through expertise within RTC for advice and consultation. Through

various infrastructure projects, RTC has developed expertise in proper clinic flow, effective interior space

design in both CCMT sites as well as TB clinics. Other sub-partners facing infrastructure challenges will be

able to make best use of limited resources which are necessary in increasing clinic capacity.

Sustainability of sub-grantees will be supported through RTC's continued relationship with the Department

of Health to ensure that continued HIV and AIDS response is in line with the strategic plan for South Africa,

ensuring that once the PEPFAR program is complete, that the activities of the NGO can be taken over by

the South African Government.

Where systems are identified to be inadequate, RTC aims to capacitate sub-partner organizations to

manage their programs independent of RTC. Within the implementation plan and budget, RTC has planned

to provide financial reporting systems, management standard operating procedures, human resources

policies and procedures, clinical guidelines, and monitoring evaluation systems that will ensure

sustainability beyond RTC support.

Adult Antiretroviral Therapy (AART):

RTC will help sub-partners to accelerate the implementation of AART and to support non-governmental

organization (NGO) treatment sites in districts where government provision has not yet been rolled out.

RTC, with its extensive treatment expertise, will give TA to sub-partners to ensure that each ART patient at

sub-partner-supported facilities receives a minimum package of ART services, including clinical and

pathology monitoring, adherence counseling and support, and follow-up of defaulting ART patients.

Adherence activities focus on reducing stigma and encouraging disclosure in order to enhance drug

compliance and to improve patient retention. Emphasis will be placed on an integrated, family approach,

increasing the number of HIV-infected children and pregnant women on ARVs, couple counseling,

prevention and disclosure, linkages and referrals to care for sexually transmitted infections (STIs), family

planning, and TB, and enrollment and retention in care.

Sub-partner pediatric treatment funding will be used for: (1) human capacity development and salaries --

NGO and faith-based organization (FBO) clinics receive sub-awards for doctors, nurses, pharmacists and

counselors (2) developing a training program for pharmacy assistants as human capacity development for

the distribution of ARVs and HIV services; (3) addressing minor infrastructure needs where necessary at

NGO, FBO sites, (4) procurement of health commodities; (5) procurement of laboratory services for

pathology monitoring; (5) provision of ARVs and related medications (i.e. cotrimoxazole prophylaxis)

RTC supports its AART providers by disseminating policies and guidelines and sharing best practices.

Ongoing quality assurance and supportive supervision is undertaken by centralized treatment experts.

Clinical mentorship is provided in various forms. Doctors and nurses at sub-partner organization's sites can

spend time working at Themba Lethu clinic or other RTC-supported government sites, call hotline numbers

for urgent assistance, receive case-specific advise on patient management, and request mentors to see

difficult cases alongside as part of the learning process.

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

This is a new activity in FY 2008.

SUMMARY:

Currently, the USG PEPFAR Task Force supports institutional capacity building of indigenous organizations

that implement PEPFAR programs through four competitively selected Umbrella Grants Mechanisms: Pact,

the Academy for Educational Development (AED), Family Health International (FHI) and Right to Care

(RTC). The main purposes of these new umbrella organizations are to (1) facilitate further scale up of HIV

treatment services; and (2) to develop indigenous capability, thus creating a more sustainable program. The

major emphasis area is local organizational capacity development. Primary target populations are

indigenous organizations, including non-governmental organizations (NGOs), faith-based organizations

(FBOs), and community-based organizations (CBOs).

RTC will use PEPFAR funds to support one or more NGO treatment organizations through financial

oversight, project management, human capacity development, training, mentorship programs, program

development, strategic planning, and audit readiness. PEPFAR funds will support components of UGM

within RTC, but the predominant focus will be on the pass through of funds to sub-grantee implementation.

BACKGROUND:

RTC currently supports 12 NGOs, and under the new UGM, additional organizations will be supported with

FY 2008 funds. The following proposed activities are designed to support sub-grantee initiatives to

implement the goals of PEPFAR and the South African Government's Comprehensive Plan. Over the last

two years, RTC has developed an Umbrella Grants Management capacity while developing specific skill

sets, competencies and capacity to support additional PEPFAR-funded organizations that will provide ARV

services.

RTC will work with Sustainability Solutions Africa, a financial management company, to conduct pre-award

assessments, and training in financial management and USAID regulatory compliance. RTC and the

Activity Narrative: Clinical HIV Research Unit, an extension of the current RTC PEPFAR-funded program, will provide

technical assistance in medical issues.

There are four main areas of activity:

ACTIVITY 1: Program Planning

Needs assessment, and program and budget planning are conducted regularly with new partners. Site visits

take place alongside sub-grantee staff to evaluate capacity, human resources, facility planning, and

approaches to treatment and care systematically. This evaluation helps sub-grantees meet determined

targets and ensure quality of care. The experience of RTC clinicians and program staff is extended to sub-

grantees to help develop proper planning and forecasting, and to facilitate organizational and program

growth.

ACTIVITY 2: Finance

The RTC finance department has developed systems to assist with sub-grantees' compliance and capacity

development to manage PEPFAR funds effectively. Support given to sub-grantees will include a complete

range of financial management tools, such as pre-award audits, regular budget reviews, and close-out

procedures. RTC currently meets with sub-grantees annually to align financial planning with programmatic

planning.

Regular oversight and support is extended to all sub-grantees, and monthly financial reports are required

from sub-grantees. Periodic internal audits are conducted at the sites of all sub-grantees to establish the

quality of financial management and asset control, and alignment with USAID financial management

policies.

The RTC finance department has developed a state of the art financial software tool, which uses Business

Intelligent Tools, to monitor and track all sub-grantee transactions against budget projections for modeling

and cash flow. This integrated program will allow for responsible management of budgets at all sites.

ACTIVITY 3: Monitoring, Evaluation and Reporting

RTC's monitoring, evaluation & reporting (MER) system (standards, systems, procedures and tools) is

established, documented and regularly updated. The system is based on best practices and quality criteria

in the programmatic areas of ARV treatment, HIV care and support, HIV/TB, counseling and testing,

outreach and training.

All sub-grantees will be provided with the support, training and technical assistance necessary to meet

USAID reporting requirements effectively. This includes data quality assessments (DQAs).

ACTIVITY 4: Technical Support

The Clinical HIV Research Unit will provide additional technical assistance on treatment issues to new sub-

grantees. Clinicians employed by NGOs will also be able to participate in the mentorship program that will

include doctor training and regular rounds at the Helen Joseph Hospital.

RTC will train NGOs on established policies and procedures that meet the requirements of the South

African labor laws as well as the USAID regulations.

RCT has had extensive experience in working on a variety of infrastructure projects, and the organization

has developed collective expertise in proper clinic flow and effective interior space design in care and

treatment sites, as well as in TB clinics. RCT staff will be able to advise sub-grantees on any infrastructure

developments.

The training department within RTC has trained healthcare professionals at all levels within the various

clinics and care organizations. Training will continue with doctors, nurses, social workers and counselors, as

well as with traditional healers, community members, and non-health staff members. This training will

continue to support new sub-grantees in increasing their expertise and capacity.

RTC's relationship with the Department of Health will continue to grow, to ensure that the response is in line

with the strategic priorities for South Africa will ensure sustainability, and hopefully the program will be

transferred to the South African government on completion of PEPFAR.

RTC aims to capacitate organizations who currently have inadequate programs and management systems.

Training and support will be provided to all sub-grantees so that they will be able to manage their programs

independently by the end of the training period. RTC plans to provide financial reporting systems,

management standard operating procedures, human resources policies and procedures, clinical guidelines,

and monitoring evaluation systems that will ensure sustainability beyond RTC support.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15944

Continued Associated Activity Information

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

System ID System ID

15944 15944.08 U.S. Agency for Right To Care, 7301 7301.08 UGM $500,000

International South Africa

Development

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $95,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Treatment: Pediatric Treatment (PDTX): $97,090

SUMMARY:

Right to Care (RTC)'s Umbrella Grants Management (UGM) project will support several sub-partner

organizations through financial oversight, project management, human capacity development, training,

mentorship programs, program development, treatment expertise, and strategic planning in providing

Pediatric HIV Care and Support (PCS) services. With the variety of program activities that RTC currently

implements or oversees, they have developed a wide base of skills and capacity to manage a range of

organization activities, including organizations that provide prevention, training, HIV treatment care and

support, pediatric care and treatment, cervical cancer screening, care for orphans and vulnerable children

(OVC), home-based care and TB care and treatment.

BACKGROUND:

The following proposed activities are designed to support sub-partner initiatives to implement the goals of

PEPFAR and the South African government's (SAG) Comprehensive Plan. Over the last two years, RTC

has developed a UGM capacity while developing specific skill sets, competencies and capacity to support

many PEPFAR sub-grantee organizations. RTC has developed in-house capacity in financial management,

pre-award assessments, training functions in financial management and USAID regulatory compliance. In

addition, the technical expertise in medical aspects will be supported by internal RTC capacity and through

the Clinical HIV Research Unit, an extension of the ongoing activities of the current RTC grant.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: UGM Technical Assistance and Quality Assurance

Needs assessment and program planning will be done on a regular basis with sub-partners. Site visits will

be conducted alongside sub-partner staff to systematically evaluate needs of capacity, human resources,

facility planning, approaches to programmatic areas such as treatment and care, in order to effectively

reach determined targets and quality of care. The needs assessments will use the experience of RTC

clinicians and program staff to develop proper planning and forecasting to facilitate patient growth.

Programmatic technical assistance will be provided on an ongoing basis, with clinical mentors responding to

requests and providing treatment updates, ongoing training, updated guidelines, and case-specific support.

ACTIVITY 2: UGM Financial Management

The finance department at RTC has developed systems to support sub-partners that enable compliance

and capacity to manage PEPFAR funds effectively. Support includes a complete range of necessary

financial management. RTC will meet with sub-partners annually to align financial and programmatic

planning.

Regular oversight and support will be given with monthly financial reports required for all sub-partners.

Periodic internal audits will also be conducted at the sites of all sub-partners to establish the quality of

financial management and human resources (HR) management, review of asset control and alignment with

USAID financial management policies.

The finance department at RTC has developed a state-of-the-art financial software tool, which uses

Business Intelligent Tools, to monitor and track all sub-partner transactions against budget projections for

modeling and cash flow. This integrated program will allow proper management of budget at all sites.

Combined with the monthly financial reports, RTC will be able to use this system to produce up-to-date fund

accountability statements and fund balances for its sub-partners.

ACTIVITY 3: UGM Monitoring and Evaluation

RTC's monitoring, evaluation and reporting (MER) system (standards, systems, procedures and tools) is

established, documented and continuously improved, based on best practices and quality criteria, in the

programmatic areas of Adult Treatment, Adult Care and Support, Pediatric Treatment, Pediatric Care and

Support, TB/HIV, Voluntary Counseling and Testing (VCT), Outreach and Training.

All implementation sub-grantees/programs will be provided with support, training and technical assistance to

necessary for sub-partners to effectively meet USAID reporting requirements. In addition, RTC

programmatic experts will monitor the reports for quality assurance.

ACTIVITY 4: UGM NGO Management and Sustainability

RTC supports NGOs with established policy guidance and procedures that meet the requirements of both

the South African labor law as well as the USAID regulations. All sub-partners will have access to the RTC

human resources capacity.

Support of infrastructure will be given through expertise within RTC for advice and consultation. Through

various infrastructure projects, RTC has developed expertise in proper clinic flow, effective interior space

design in both CCMT sites as well as TB clinics. Other sub-partners facing infrastructure challenges will be

able to make best use of limited resources which are necessary in increasing clinic capacity. Sustainability

of sub-grantees will be supported through RTC's continued relationship with the Department of Health to

ensure that continued HIV and AIDS response is in line with the strategic plan for South Africa, ensuring

that once the PEPFAR program is complete, that the activities of the NGO can be taken over by the South

African government.

Where systems are identified to be inadequate, RTC aims to capacitate NGO organizations to manage their

programs independent of RTC. Within the implementation plan and budget, RTC has planned to provide

financial reporting systems, management SOPs, human resources policies and procedures, clinical

Activity Narrative: guidelines, and monitoring evaluation systems that will ensure sustainability beyond RTC support.

ACTIVITY 5: Technical Assistance (TA) for Pediatric Antiretroviral Therapy (PART):

RTC will help sub-partners to accelerate the implementation of PART at NGO treatment sites in districts

where government provision has not yet been rolled out.

RTC, with its extensive treatment expertise, will give TA to sub-partners to ensure that each pediatric ART

patient at sub-partner-supported facilities receives a minimum package of ART services, including clinical

and pathology monitoring, adherence counseling and support, and follow-up of defaulting ART patients.

Adherence activities will include a focus on reducing stigma and encouraging disclosure in order to enhance

drug compliance and to improve patient retention. At many RTC supported NGO sites, support groups are

helping families to deal with the issue of disclosure to older children. Emphasis will be placed on an

integrated, family approach, increasing the number of HIV-infected children and pregnant women on ARVs,

couple counseling, prevention and disclosure, linkages and referrals to care for STIs, family planning, and

TB, and enrollment and retention in care.

Sub-partner pediatric treatment funds will be used for: (1) human capacity development and salaries -- NGO

and FBO clinics receive sub-awards for doctors, nurses, pharmacists and counselors (2) developing a

training program for pharmacy assistants as human capacity development for the distribution of ARVs and

HIV services; (3) addressing minor infrastructure needs where necessary at NGO, FBO sites; (4)

procurement of health commodities; (5) procurement of laboratory services for pathology monitoring; and

(6) provision of ARVs and related medications (i.e. cotrimoxazole prophylaxis).

RTC will support its PART providers by disseminating policies and guidelines and sharing best practices.

Ongoing quality assurance, clinical mentorship, and supportive supervision will be undertaken by

centralized treatment experts. Doctors and nurses at sub-partner organizations' sites can spend time

working at Themba Lethu clinic or other RTC-supported government sites, call hotline numbers for urgent

assistance, receive case-specific advise on patient management, and request mentors to see difficult cases

alongside as part of the learning process.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $95,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $97,090

SUMMARY:

Right to Care (RTC)'s Umbrella Grants Management (UGM) project will support several sub-partner

organizations through financial oversight, project management, human capacity development, training,

mentorship programs, program development, treatment expertise, and strategic planning in providing Adult

HIV Care and Support (ACS) services. RTC currently implements or oversees a wide variety of program

areas, and in response, has developed a wide base of skills and capacity to manage a range of

organization activities, including organizations that provide prevention, training, HIV treatment care and

support, pediatric care and treatment, cervical cancer screening, care for orphans and vulnerable children

(OVC), home-based care and TB care and treatment.

BACKGROUND:

The following proposed activities are designed to support sub-partner initiatives to implement the goals of

PEPFAR and the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP). During the past

two years, RTC has developed a UGM capacity while developing specific skill sets, competencies and

capacity to support many sub-grantee organizations. RTC has developed in-house capacity in financial

management, pre-award assessments, training functions in financial management and USAID regulatory

compliance. In addition, the technical expertise in medical aspects will be supported by internal RTC

capacity and through the Clinical HIV Research Unit, an extension of the ongoing activities of the current

RTC grant.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: UGM Technical Assistance and Quality Assurance

Needs assessment and program planning will be done on a regular basis with sub-partners. Site visits will

be conducted alongside sub-partner staff to evaluate needs of capacity, human resources, facility planning,

approaches to programmatic areas such as treatment and care, in order to reach determined targets and

quality of care. The needs assessments will use the experience of RTC clinicians and program staff to

develop proper planning and forecasting to facilitate patient growth. Programmatic technical assistance will

be provided on an on-going basis, with clinical mentors responding to requests and providing treatment

updates, on-going training, updated guidelines, and case-specific support.

ACTIVITY 2: UGM Financial Management

The finance department at RTC has developed systems to support sub-partners that enable compliance

and capacity to manage PEPFAR funds effectively. Support includes a complete range of necessary

financial management. RTC will meet with sub-partners annually to align financial and programmatic

planning.

Regular oversight and support will be given with monthly financial reports required for all sub-partners.

Periodic internal audits will also be conducted at the sites of all sub-partners to establish the quality of

financial management and human resources (HR) management, review of asset control and alignment with

USAID financial management policies.

The finance department at RTC has developed a state-of-the-art financial software tool, which uses

Business Intelligent Tools, to monitor and track all sub-partner transactions against budget projections for

modeling and cash flow. This integrated program will allow proper management of budget at all sites.

Combined with the monthly financial reports, RTC will be able to use this system to produce up-to-date fund

accountability statements and fund balances for its sub-partners.

ACTIVITY 3: UGM Monitoring and Evaluation

RTC's monitoring, evaluation and reporting (MER) system (standards, systems, procedures and tools) is

established, documented and continuously improved, based on best practices and quality criteria, in the

programmatic areas of Adult Treatment, Adult Care and Support, Pediatric Treatment, Pediatric Care and

Support, TB/HIV, VCT, Outreach and Training.

All implementation sub-grantees/programs will be provided with the support, training, and technical

assistance necessary for sub-partners to meet USAID reporting requirements effectively. In addition, RTC

programmatic experts will monitor the reports for quality assurance.

ACTIVITY 4: UGM NGO Management and Sustainability

RTC supports non-governmental organizations (NGOs) with established policy guidance and procedures

that meet the requirements of the South African labor law as well as the USAID regulations. All sub-partners

will have access to the RTC human resources capacity.

Support of infrastructure will be given through expertise within RTC for advice and consultation. Through

various infrastructure projects, RTC has developed expertise in proper clinic flow, effective interior space

design in both Comprehensive Care Management and Treatment sites as well as TB clinics. Other sub-

partners facing infrastructure challenges will be able to make best use of limited resources which are

necessary in increasing clinic capacity. Sustainability of sub-grantees will be supported through RTC's

continued relationship with the Department of Health to ensure that continued HIV and AIDS response is in

line with the strategic plan for South Africa, ensuring that once the PEPFAR program is complete, that the

activities of the NGO can be taken over by the South African government.

Where systems are identified as inadequate, RTC aims to capacitate NGOs to manage their programs

independently of RTC. Within the implementation plan and budget, RTC has planned to provide financial

Activity Narrative: reporting systems, management standard operating procedures, human resources policies and procedures,

clinical guidelines, and M&E and evaluation systems that will ensure sustainability beyond RTC support.

ACTIVITY 5: Technical Assistance for TB/HIV

RTC supports the South African government's TB program and the World Health Organization's policy on

collaborative TB/HIV activities. RTC will provide technical assistance (TA) to sub-partners on integration of

the services aimed at TB/HIV co-infected patients at sub-partner NGO or faith-based organization (FBO)

sites. Sub-partner PEPFAR-funded TB/HIV activities at the sites will include (1) access to HIV counseling

and testing for patients with TB, (2) improved linkages between the HIV and TB programs at each of the

sites through referral, notification, and follow-up; and (3) appropriate infection control procedures to prevent

the transmission of TB. FBO/NGO clinics focusing on underserved populations in rural areas, industrial

areas and informal housing sectors as well as targeted gender specific support groups and family-centered

approaches will be targeted. The programs will promote sustainability through training health-care workers

and partnerships with the National Department of Health (NDOH) to provide partial funding for the ongoing

running costs and staff components over time.

Sub-partner TB/HIV treatment activities will emphasize identification of co-infected individuals, through

promoting routine HIV counseling and testing for TB patients and TB screening of HIV patients who present

with risk factors. Co-infected patients will be evaluated for correct application of ARVs and TB medications.

Those on combined ARV and TB treatment will be monitored for the development of Immune Reconstitution

Inflammatory Syndrome. Emphasis is placed on adherence support to address the increased risk of non-

compliance due to high pill burden, and overlapping toxicities, particularly hepatotoxicity. Human capacity

development in the management of anticipated drug interactions and shared adverse effects is an additional

expected result.

At sub-partner TB/HIV treatment sites, the family and community support network will be educated and

trained in basic TB knowledge to help screen clients and family members of clients for TB and to refer for

testing and treatment, to trace family members of patients with TB, and to support the client with his/her

treatment to improve compliance. NGO clinics that have not been accredited to provide TB services will

strengthen referral links to government clinics that provide TB services so that co-infection can be

managed.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $95,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $97,090

SUMMARY:

Right to Care (RTC)'s Umbrella Grants Management (UGM) project will support several sub-partner

organizations through financial oversight, project management, human capacity development, training,

mentorship programs, program development, treatment expertise, and strategic planning in providing adult

HIV care and support (ACS) services. With the variety of program activities that RTC currently implements

or oversees, they have developed a wide base of skills and capacity to manage a range of organization

activities, including organizations that provide prevention, training, HIV treatment, care and support

services, as well as pediatric care and treatment, cervical cancer screening, care for orphans and

vulnerable children (OVC), home-based care and tuberculosis (TB) care and treatment.

BACKGROUND:

The following proposed activities are designed to support sub-partner initiatives to implement the goals of

PEPFAR and the South African Government (SAG)'s comprehensive plan. Over the last two years, RTC

has developed a UGM capacity while developing specific skill sets, competencies and capacity to support

many sub-grantee organizations. RTC has developed in-house capacity in financial management, pre-

award assessments, training functions in financial management and USAID regulatory compliance. In

addition, the technical expertise in medical aspects will be supported by internal RTC capacity and through

the Clinical HIV Research Unit, an extension of the ongoing activities of the current RTC grant.

ACTIVITIES AND EXPECTED RESULTS:

RTC will carry out five separate activities in this program area.

ACTIVITY 1: UGM Technical Assistance and Quality Assurance

Needs assessment and program planning will be done on a regular basis with sub-partners. Site visits will

be conducted alongside sub-partner staff to systematically evaluate needs of capacity, human resources,

facility planning, approaches to programmatic areas such as treatment and care, in order to effectively

reach determined targets and quality of care. The needs assessments will use the experience of RTC

clinicians and program staff to develop proper planning and forecasting to facilitate patient growth.

Programmatic technical assistance will be provided on an on-going basis, with clinical mentors responding

to requests and providing treatment updates, on-going training, updated guidelines, and case-specific

support.

ACTIVITY 2: UGM Financial Management

The finance department at RTC has developed systems to support sub-partners that enable compliance

and capacity to manage PEPFAR funds effectively. Support includes a complete range of necessary

financial management. RTC will meet with sub-partners annually to align financial and programmatic

planning.

Regular oversight and support will be given with monthly financial reports required for all sub-partners.

Periodic internal audits will also be conducted at the sites of all sub-partners to establish the quality of

financial management and human resources (HR) management, review of asset control and alignment with

USAID financial management policies.

The finance department at RTC has developed a state-of-the-art financial software tool, which uses

business intelligent tools to monitor and track all sub-partner transactions against budget projections for

modeling and cash flow. This integrated program will allow proper management of budget at all sites.

Combined with the monthly financial reports, RTC will be able to use this system to produce up-to-date fund

accountability statements and fund balances for its sub-partners.

ACTIVITY 3: UGM Monitoring and Evaluation

RTC's monitoring, evaluation and reporting (MER) system (standards, systems, procedures and tools) is

established, documented and continuously improved, based on best practices and quality criteria, in the

programmatic areas of adult treatment, adult care and support, pediatric treatment, pediatric care and

support, TB/HIV, VCT, outreach and training.

All implementation sub-grantees/programs will be provided with support, training and technical assistance to

necessary for sub-partners to effectively meet USAID reporting requirements. In addition, RTC

programmatic experts will monitor the reports for quality assurance.

ACTIVITY 4: UGM Non-Governmental Organization (NGO) Management and Sustainability

RTC supports NGOs with established policy guidance and procedures that meet the requirements of both

the South African labor law as well as the USAID regulations. All sub-partners will have access to the RTC

human resources capacity.

Infrastructure support will be given through expertise within RTC for advice and consultation. Through

various infrastructure projects, RTC has developed expertise in proper clinic flow, effective interior space

design in both comprehensive care, management and treatment (CCMT) sites, as well as TB clinics. Other

sub-partners facing infrastructure challenges will be able to make the best use of limited resources which is

necessary for increasing clinic capacity.

Sustainability of sub-grantees will be supported through RTC's continued relationship with the Department

of Health to ensure that the continued HIV/AIDS response is in line with the strategic plan for South Africa,

ensuring that once the PEPFAR program is complete, that the activities of the NGO can be taken over by

Activity Narrative: the South African Government.

Where systems are identified to be inadequate, RTC aims to capacitate NGO organizations to manage their

programs independent of RTC. Within the implementation plan and budget, RTC has planned to provide

financial reporting systems, management standard operating procedures (SOPs), human resources policies

and procedures, clinical guidelines, and monitoring and evaluation systems that will ensure sustainability

beyond RTC support.

ACTIVITY 5: Technical Assistance (TA) for HIV Counseling and Testing (CT):

RTC will help sub-partners to support the implementation of CT services through supporting selected

antiretroviral treatment (ART) sites and through direct, community-based CT access. CT is used as a

prevention mechanism to promote abstinence, being faithful and condom use, as well as an entry point into

care, support and ART. It is also an essential tool for fighting stigma and discrimination. Specific sub-partner

target populations include adults, pregnant women, HIV-infected infants, couples (including discordant

couples), youth, and public and private sector healthcare providers.

FY 2009 sub-partner CT funds will largely be used for human capacity development and for the

procurement and distribution of HIV test kits for NGOs and faith-based organizations (FBOs). RTC will also

encourage and support sub-partners in obtaining SAG accreditation as CT sites, which would increase

sustainability through the SAG's provision of stipends and test kits.

Sub-partners will support healthcare providers in an NGO treatment site to implement provider-initiated

testing and counseling (PITC) as recommended in the HIV & AIDS and STI Strategic Plan for South Africa,

2007-2011.

The strengthening and expansion of referral networks and linkages with care and treatment services for

clients identified as HIV-infected remains one of the central focus areas of RTCs CT TA activities. Sub-

partner NGOs will be linked with community mobilization and outreach activities and will continue to

promote the uptake of CT services and to normalize CT-seeking behavior using community lay counselors

and educators. These linkages and capacity building with indigenous organizations will affect long-term

sustainability. Prior to all CT activities, referral linkages will be established for direct referral at the time of

CT with the network of other RTC-supported NGO, FBO and government clinics.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $95,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Subpartners Total: $459,684
South African Institute of Health Care Managers: NA
AgriAIDS: $459,684
Cross Cutting Budget Categories and Known Amounts Total: $475,000
Human Resources for Health $95,000
Human Resources for Health $95,000
Human Resources for Health $95,000
Human Resources for Health $95,000
Human Resources for Health $95,000