This program aims to identify need, recruit, hire and manage various levels of clinical, technical, and administrative health care staff to support the SAGs implementation of HIV and TB prevention, care and treatment services in South Africa. The following are NDOH and CDC agreed identified priority districts/areas for this project: Free-State: Xhariep, Motheo, Lejweleputsa, Fezile Dabe, Eastern Cape: Nelson Mandela Bay Metro, Buffalo City, OR Tambo, Northern Cape: Pixley ka Sema, Francis Baard, KwaZulu Natal: Zululand, Umzinthathi, Uthukela, Umgungundlovo, Limpopo: Waterberg, North West: Bojanala, Ngaka Modiri Moleme, R Moila, Tswaing. Measurable outcomes will be in alignment with: To rapidly assess and prioritise the human resource needs in the areas identified as well as conduct a baseline assessment of existing PEPFAR supported human resource provision to those areas, especially partners with current CDC funding which is about to expire, To conclude and implement memoranda of understanding with the relevant NDOH structures at the various levels to ensure the support for this project. To recruit, hire and place suitable staff to meet the identified needs in the areas based upon the priorities determined, To manage the consistent remuneration and administration of the placed staff based on equitable standards acceptable to the NDOH and in accordance with all relevant laws and regulations, To conduct adequate performance management of all staff throughout the grant period, To progressively and systematically arrange for the transfer to and absorption of staff into the NDOH by the end of the grant, according to agreed schedules, and To monitor and evaluate the performance of all role players in this project to ensure project performance.

This activity supports presently seconded human resources of present PEPFAR partners whose contracts are expiring in the priority districts listed in the Overview Narrative where HBHC activities are being undertaken. Furthermore, as additional Human Resource needs are identified in subsequent surveys of the target districts, we will negotiate with the DOH to place seconded employees into the target areas against an agreed absorption plan over an agreed time frame.

Aurum will cover the priority areas as well as a National DoH need with a human resources placement and absorption strategy. This will bolster the human resources capacity of the DOH as a key pillar of Health Systems Strengthening (HSS). HSS is a clearly identified component of the PEPFAR/SAG partnership framework agreement and thus this activity is aligned to bilateral strategic imperatives. At the community level, it is likely that the needs identification process will point to the strengthening of the community outreach team as defined in the Primary Healthcare (PHC) Reengineering strategy of the SAG. These outreach teams are likely to have a number of vacancies without initial mechanisms to fill them which is where this grant will be appropriate.The staffing to be provided will be targeted mainly at key district and community workers undertaking HBHC activities for HIV-infected adults and their families aimed at extending and optimizing the quality of life of such families. The PHC Reengineering strategy is one of outreach, so this work activity should build connection to the community and strengthen the linkages to care.The M&E approach is a fundamental component of the grant execution. For this budget code, the sub-partner (SEAD) executing a baseline HR survey of the target districts will include the HBHC needs analysis and the meeting of that need over the course of the grant. Annual re-surveys will inform HR planning for this category of health worker. The M&E plan also addresses internal performance of the consortium in meeting HBHC staffing targets.

Monitoring the quality of HBHC services will be executed through an individual performance management programme for seconded staff, assessed against DoH agreed job descriptions for HBHC roles.

This activity is aimed primarily at supporting new and presently seconded cross-cutting human resources of the CDC and present PEPFAR partners whose contracts are expiring, notably whose roles are HVTB activities.

The staffing to be provided will be targeted mainly at key national facilities including the National DOH offices (technical assistance in TB/HIV integration activity planning) and the National Health Laboratory Services (specialist data analyst reviewing trends in TB epidemiology and reporting). Specific district level integration technical assistance needs will also be identified and appointed where needed.

Whilst this budget code only provides direct human resources support for health, the work of the seconded staff will target health systems support work such as:

Alignment of annual planning activities to strategic level policies and plans for TB and HIV;Specialist data analysis to reviewing and report trends in TB epidemiology and diagnosis;Guide the NDOH on interpretation of reports on PEPFAR TB/HIV ;Researching innovative approaches to improved efficiencies in TB/HIV;Reviewing District level TB/HIV linkage issues with a view to finding efficiencies and more effective approaches.

A key activity of this code area is to transition staff to National and District DOH budgets over the course of the grant.

The monitoring the quality of care and support services in this category will be executed through an individual performance management programme for seconded staff..

This activity is aimed at supporting presently seconded human resources of present PEPFAR partners whose contracts are expiring in critical areas of the priority districts listed in the Overview Narrative where PDCS activities are being undertaken.The staffing to be provided will be targeted mainly at very high priority key facility and community workers undertaking PDCS activities for HIV-exposed children and their families aimed at extending and optimizing the quality of life of such children. Included in the activities undertaken are diagnosis, clinical, family and psychosocial support. The monitoring the quality of care and support services in this category will be executed through an individual performance management programme for seconded staff.

This activity is aimed primarily at supporting new and presently seconded human resources of the CDC and present PEPFAR partners whose contracts are expiring, notably whose roles are covering important health systems gaps at National and Provincial/central District level.

A) In the first instance (budget $600 000), a key activity area is to provide staffing that will be targeted mainly at roles which are cross-cutting the pillars of sound health systems, including human resource planning, financial planning, management and leadership, and interdisciplinary health professional capacity.

Whilst this budget code only provides direct human resources support for health, the work of the seconded staff will target health systems support work such as:

Identifying and developing proposed system solutions to district level systems barriers impeding overall programme efforts;Identifying and describing cross-cutting issues which could improve systems performance;Activities supporting the forward planning capacities of District Management Teams.Support for an NHLS project manager to coordinate a pilot project to evaluate cryptococcal antigen testing in NHLS facilities.

A key activity of this code area is to transition staff to National and District DOH budgets over the course of the grant.

B) In the second instance (budget $300 000), this budget code needs to support the development of a Human Resources Transition Plan together with the NDOH for all USG Care and Treatment personnel to the NDOH over an as yet to be defined transition period. This activity is likely to be a joint exercise between Aurum and sub-partner SEAD engaging with the NDOH and USG agencies.

The monitoring the quality of care and support services in this category will be executed through an individual performance management programme for seconded staff.

Aurum will maintain its established high volume MMC site in Ekurhuleni District, Gauteng, accomplishing 5,000 MMCs in 2012 and 5,000 MMCs in 2013 ($100/MMC). Unit costs per MMC reflect use of efficient staffing and site management and are the standard rate for MMC in South Africa. Aurum will operate against a sustainability plan to transfer their skill set to facility staff for impact past the completion of the project. Project will support SAG monitoring efforts by using reporting mechanisms that fold into district, provincial and national systems, avoiding creating parallel reporting structures. Their program will continue to build on best practices in MMC, including use of forceps-guided surgery, employing models to optimize volume and efficiencies (MOVE), incorporating gender messaging on male norms and proper treatment of females, and delivering these as part of a minimum package of HIV prevention services, including HCT, age-appropriate risk reduction counseling, condom demonstration, provision and promotion, and linkages to family planning, STI, HIV, TB, and other treatment services. Aurum will make efforts to retain patients in care through the duration of their healing to minimize complications and reinforce risk reduction messages. Demand creation will be essential and entail community dialogues, mass media, local media, engagement of female partners and caregivers, engagement of key influencers, employers, and community stakeholders, peer referral networks, word of mouth campaigns, and strong linkages from HCT, PMTCT and other touch points within the health system. The MMC activities are intended not only as a single biomedical intervention to reduce HIV acquisition risk, but also an opportunity to engage men in health services and maximize linkages to other key resources for males improved long-term engagement in the health sector, increasing their likelihood to seek support for sexual and reproductive health and chronic disease management.

This activity is aimed primarily at supporting presently seconded human resources of present PEPFAR partners whose contracts are expiring in the priority districts listed in the Overview Narrative where MTCT activities are being undertaken.

The staffing to be provided will be targeted mainly at key facility workers e.g. professional nurses, enrolled nurses, counsellors, administration staff, and data capturers specifically engaged in strengthening and expanding MTCT activities.

Whilst this budget code does not directly support anything other than human resources for health, the work of the seconded staff will target health systems support work such as:

Building the capacity of health care providers and facilities to provide PMTCT services at facility level in the priority sub-districts;Building capacity at national, provincial, district and clinical site level to oversee the program, routinely collect data and monitor the quality of services;Improving/coordinating practices that promote paired mother-infant care and linkage to other appropriate treatment, and care and support services;Supporting integration of PMTCT into routine maternal/child health services and other prevention programs.A key activity of this code area is to transition staff to Provincial and District DOH budgets over the course of the grant.

The monitoring the quality of care and support services in this category will be executed through an individual performance management programme for seconded staff.

This activity is aimed primarily at supporting presently seconded human resources of present PEPFAR partners whose contracts are expiring in the priority districts listed in the Overview Narrative where HTXS activities are being undertaken.

The staffing to be provided will be targeted mainly at key facility workers e.g. medical practitioners, professional nurses, enrolled nurses, counsellors, administration staff, and data capturers undertaking HTXS activities.

Whilst this budget code does not directly support anything other than human resources for health, the work of the seconded staff will target health systems support work such as:

Training activities, including pre- and in-service training and mentorship focusing on improved treatment quality and coverage;On-site HSS activities;Efforts to track and evaluate clinical outcomes and other performance data and current clinical outcomes to measure performance for quality improvement at the sub-district and site level;Efforts to improve retention of patients initiated on ART and outcomes of these activities;Adherence activities and outcomes of these adherence activities;Target population(s) and coverage with a comprehensive care and treatment package, including ART provision, cotrimoxazole prophylaxis, and TB screening;Efforts to improved efficiencies to allow for continued expansion of services; and

A key activity of this code area is to transition staff to National and District DOH budgets over the course of the grant.

The monitoring the quality of care and support services in this category will be executed through an individual performance management programme for seconded staff.

This activity is aimed primarily at supporting presently seconded human resources of present PEPFAR partners whose contracts are expiring in the priority districts listed in the Overview Narrative where PDTX activities are being undertaken.

The staffing to be provided will be targeted mainly at key primary facility workers e.g. medical practitioners, professional nurses, enrolled nurses, counsellors, administration staff, and data capturers undertaking PDTX activities.

Whilst this budget code does not directly support anything other than human resources for health, the work of the seconded staff will target health systems support work such as:

Training activities, including pre- and in-service training and mentorship focusing on improved treatment quality and coverage;On-site HSS activities with paediatric outcome objectives;Efforts to track and evaluate clinical outcomes and other performance data and current clinical outcomes to measure performance for quality improvement at the sub-district and site level;Efforts to improve retention of patients initiated on ART and outcomes of these activities;Adherence activities and outcomes of these adherence activities;Target population(s) and coverage with a comprehensive care and treatment package, including ART provision, cotrimoxazole prophylaxis, and TB screening;Efforts to improved efficiencies to allow for continued expansion of services; and

A key activity of this code area is to transition staff to National and District DOH budgets over the course of the grant.

The monitoring the quality of care and support services in this category will be executed through an individual performance management programme for seconded staff.