The BroadReach Healthcare (BRHC) program supports the following objectives in support of SAG: 1) improve HIV-related population outcomes by strengthening health and patient management systems at district level; 2) build capacity of District Health Management Teams (DHMT)in coordination with provinces to support HIV/TB services and HSS; 3) support development and implementation of SAG policies for HIV-related interventions; and 4) support transition to a sustainable national comprehensive HIV/TB program. The objectives and TA delivered will be aligned to the USG-SAG PFIP, NSP, NSDA, PHC Reengineering program, NCS and NHI objectives. The BRHC Team supports the following districts: Ekurhuleni (GP), Sisonke (KZN), West Coast (WC), Bojanala (NW), and Ngaka Modiri Molema (NW) covering a total population of over 6,000,000. BRHC support will focus on the DHMT, while a CDC partner will focus on HSS at sub-district and facility levels.

BRHCs capacity building and TA approach empowers SAG to assume leadership in the delivery of HIV/TB services, thus reducing costs over the life of the project. The mentorship and supervision provided by the BRHC Team will transition to SAG staff, and be monitored through the use of implementation and M&E plans. The approach leverages the BRHC Teams technical expertise to deliver scalable and sustainable solutions while ensuring cost efficiencies.

BRHCs M&E strategy will track results achieved, providing the basis for monitoring patient and client outcomes; monitoring performance and program quality; data quality management, reporting, dissemination and use; strengthening M&E capacity; and measuring program effects in the achievement of program, USAID and SAG objectives. Project outcomes will be monitored through mid-term and final evaluations

BroadReach Healthcare (BRHC) will deliver TA to SAG in 5 designated districts in Adult Care and Support (AC&S) using an approach that supports foundational principles of scalability, sustainability and comprehensive, integrated solutions to ensure a strengthened health system and improved patient outcomes. BRHC will support districts with TA and skills to operationalize policies and guidelines aimed at improving AC&S services. By strengthening of DHMT management and leadership skills through problem solving, consulting services and workshopping solutions, BRHC will support districts in improving program planning and target setting, the formation and coordination of key multisectoral partnerships, and performance monitoring to achieve measureable AC&S results. BRHC will work in each district with a designated CDC facility-based support partner. Interventions to strengthen the HR information system, address issues of recruitment/retention and equitable distribution of staff, performance management, and alignment to national staffing norms will result in appropriate staffing for the effective delivery of AC&S Services. Similarly, health financing TA and supportive supervision at district level to increase capacity in financial management and budgeting will benefit AC&S services as a component of overall health services.

The BRHC team will support districts in the identification, development, implementation and measurement of health service delivery innovations to address challenges in AC&S service delivery such as lack of referral networks, tracking systems to address LTFs and loss to initiation, TB and cervical cancer screening, treatment of OIs and other HIV/AIDS-related complications like diarrhea and cryptococcal diseases, STI diagnosis and treatment as well as condom provision. Clinical quality of AC&S services will be addressed by equipping districts to improve the reach and sustainability of clinical mentorship programs. Through TA, mentorship and advisory support to district managers key national initiatives to improve service quality, such as PHC reengineering and (NCS) will be strengthened. TA for supply chain management will address issues around quantification and forecasting, stock inventory and management, and procurement systems for drugs and commodities. Lab strengthening of AC&S will be addressed by supporting the operationalization of policies and guidelines aimed at minimizing the delays in receiving/actioning patient results which lead to missed opportunities for ensuring the continuum of patient care and providing early access to services.

TA for CSS will focus on supporting DoH develop a curriculum and a formal qualification for CHWs, promotion of partnerships with traditional healers to enable effective referral and tracking of clients between traditional and allopathic sector and support for referral/tracking systems between clinical and community-based social services. Underlying all TA in AC&S will be a focus on improving availability and use of SI at all levels. BRHC will support activities aimed at improving the quality of HIV/TB data and reporting as part of the overall DHIS. TA will be provided on capturing, reporting and analyzing data for decision making. BRHC will further capacitate DHMTs to improve use of data for program strengthening by supporting them generate timely and accurate reports, use these in making decisions; and also report results to various stakeholders.

BroadReach Healthcare (BRHC) will deliver TA to SAG in their 5 designated districts to support TB/HIV services using an evidence-based sustainable approach to HIV/TB prevention, care & impact mitigation. Comprehensive integrated solutions will be employed to support SAG in addressing challenges of the current structural separation of TB & HIV programs. TA will focus on strengthening the DHMTs management & leadership (ML) capacity to successfully implement national HIV/TB programs aligned to budget & national targets through problem solving, consulting services and workshopping solutions. BRHC will work in coordination with a designated CDC facility-support partner to achieve overall district goals and targets. Activities will include delivery of ML training coupled with mentorship to address key HIV/TB service delivery challenges & to lay the groundwork for HIV/TB programs in the context of the imminent implementation of NHI. HR development will be achieved through district-wide interventions to strengthen task shifting & build capacity of health workers through pre-service & in-service clinical training, with mentoring & provision of supportive supervision (SS) to ensure delivery of quality HIV/TB clinical care. Similarly, health financing TA & SS at all levels will increase capacity in planning, budgeting & financing ensuring better integration of TB/HIV programs as a component of overall health services.

BRHC will support districts in identification, development, implementation & measurement of health service delivery innovations to improve HIV/TB service delivery such as: integration of PICT within other services; early initiation of care interventions for TB; new diagnostic technologies like GeneXpert; and management of MDR/XDR TB. Clinical quality of TB services will be addressed by equipping districts to improve the reach & sustainability of clinical mentorship programs. Training & mentorship will strengthen PICT skills & competencies and management of HIV/TB care & treatment. TA to help strengthen referral, tracking & tracing systems and intensified TB case finding will improve TB cure rates and defaulter rates.

TA for supply chain management & mentorship to pharmacy staff will address issues around quantification, forecasting, stock inventory & management, & procurement of PICT essential commodities & drugs including ARVs & TB drugs. Similarly, district-wide lab strengthening TA will include mentorship in QA/QI & logistics, which will benefit all HIV/TB services in terms of improved linkage of lab results to patients & efficiency solutions to address key bottlenecks. TA for community systems strengthening will focus on improved TB screening and referral, including development & implementation of task-shifting models to health extender cadres; supporting implementation of effective & efficient referral systems; & comprehensive HIV/TB care training.

TA for HIV/TB will focus on improving availability & use of SI at district, subdistrict, facility & patient levels to improve HIV/TB related pro-active disease management. The BRHC team will support SAG in the measurement of key patient outcomes & in driving demand for improved data quality through increased data use for performance management & planning. This will include improved collection, analysis, distribution & use of TB data, support for ETR.net, patient tracking, & recording of all TB patient results in the TB register.

BroadReach Healthcare (BRHC) will deliver TA to SAG in 5 designated districts in Pediatric Care and Support (PC&S) using an approach that supports foundational principles of scalability, sustainability and comprehensive, integrated solutions to ensure a strengthened health system and improved pediatric outcomes. BRHC support will be aimed at extending and optimizing the quality of life for HIV+ children. BRHC will provide TA to SAG in delivering services along the continuum of care, including: early infant diagnosis, prevention and treatment of OIs and other HIV/AIDS related complications in children, addressing the needs of adolescents with HIV, nutritional evaluation, and appropriate use of CTX and INH prophylaxis. By strengthening management and leadership skills for DHMTs through problem solving, consulting services, and workshopping solutions, BRHC will support districts in improving program planning and target setting, the formation and coordination of key multisectoral partnerships, and performance monitoring to achieve measureable PC&S results. BRHC will work with a designated CDC facility-based support partner in each district. Interventions to strengthen the HRIS, address issues of recruitment/retention and equitable distribution of staff, performance management, and alignment to national staffing norms will result in appropriate staffing for the effective delivery of PC&S Services. Similarly, health financing TA and supportive supervision at district level to increase capacity in financial management and budgeting will benefit PC&S as a component of overall health services.

BRHC will support districts in the identification, development, implementation and measurement of health service delivery innovations to address challenges in PC&S service delivery such as early infant diagnosis, early initiation for ART and TB treatment, effective mechanisms to track children and monitor adherence, as well as integration of PC&S services with other routine pediatric care services and maternal health. Clinical quality of PC&S services will be addressed by equipping districts to improve the reach and sustainability of clinical mentorship programs. Through mentorship and advisory support to DHMTs key national initiatives to improve service quality, such as PHC reengineering and NCS, will be strengthened. TA for supply chain management will address issues around quantification and forecasting, stock inventory and management, and procurement systems for drugs, food and other commodities for pediatrics. Lab strengthening of PC&S will include mentorship in quality management and improved logistics which will benefit paeds in terms of improved TATs and efficiency solutions to address key bottlenecks.

TA for community systems strengthening will focus on addressing psychosocial support of children as well as services that will increase direct linkages to the community to improve communication between facilities and community services for HIV+ children. Underlying all TA in PC&S will be a focus on improving availability and use of SI. BRHC will support activities aimed at improving the quality of HIV/TB data and reporting as part of the overall DHIS. BRHC will further capacitate DHMTs to improve use of data for program strengthening by supporting them generate timely and accurate reports, use these in making decisions; and also report results to various stakeholders.

BroadReach Healthcare and its sub-partners (The BRHC Team) will deliver TA to SAG in 5 districts to improve HIV-related population outcomes by 1) strengthening health and patient management systems at district level, 2) building capacity of district management teams and district management systems in coordination with provinces to support HIV/TB related services and overall HSS, 3) supporting development and implementation of SAG policies for HIV-related interventions, and 4) supporting transition to a sustainable national comprehensive HIV/TB care and treatment program.

BRHCs technical assistance will focus on strengthening DHMTs management and leadership capacity through problem solving, consulting services and workshopping solutions. We will work in coordination in each district with a CDC facility-based partner to achieve overall district goals and targets. While strengthening leadership and governance, BRHC will provide TA in planning processes, target setting, supporting formation of relationships/coordination, and supporting and building capacity around performance monitoring. The aim over the life of the project is to transition responsibility for delivery of TA and supportive supervision in management, leadership and governance to DHMTs and other district managers. District-wide interventions to improve the availability and use of strategic information by rolling out Tier.Net and strengthening data quality. This will be achieved through the provision of strategic information and program evaluation capacity building support, provision of data quality improvement training and mentoring, and support in the roll out of Tier.Net. BRHC will develop, conduct and institutionalize research and assessments to identify best practices and improve systems and interventions to promote health service delivery innovations. BRHC will provide TA in supply chain management by capacitating provincial, district and facility staff to address challenges around quantification and forecasting, stock inventory and management, and procurement systems to support the improved efficiency of national, provincial, district and facility procurement systems. Likewise, health financing TA and supportive supervision at provincial, district and facility level for financial management supports improved efficiency and efficacy of national, provincial, district and facility health system budgeting and financial monitoring. Further, BRHC will undertake district-wide activities to provide staff retention, performance management and HRH planning TA to establish efficient and effective HR development. BRHC supports the development and implementation of SAG policies through collaboration with SAG ministries, donors and technical groups. Activities will include identifying implementation gaps, modifying training modules on areas such as gender mainstreaming, policy, planning, and financial analysis, training SAG officials to improve engagement with policy progress, and participating in technical working groups at all DOH levels. Similarly, BRHC will support HIV&TB policy development based on new evidence-based research.

BRHCs HSS approach is also described under several other technical areas, including Care and Support, Treatment, TB/HIV and PMTCT. The activities will contribute to the strengthening of health districts by supporting finance, leadership and governance, institutional capacity building, and supply chain systems.

BroadReach Healthcare (BRHC) will deliver TA to SAG in 5 designated districts in MTCT using an approach that supports foundational principles of scalability, sustainability and comprehensive, integrated solutions to ensure a strengthened health system and improved patient outcomes. TA will focus on strengthening the DHMTs management and leadership capacity to successfully implement the national MTCT program aligned to budget and national targets. BRHC will work in coordination with a designated CDC facility-based partner to support districts in achieving their targets and strengthening the overall health system. Activities will include delivery of management and leadership training coupled with continued mentorship to address key MTCT service delivery challenges. By strengthening management and leadership skills, BRHC will provide support to districts in improving program planning and target setting, formation and coordination of key multisectoral partnerships, and performance monitoring to achieve measureable results. District-level interventions to strengthen the HR information system, address issues of recruitment/retention and performance management, and alignment to national staffing norms will result in appropriate staffing for effective delivery of MTCT services. Similarly, health financing TA and supportive supervision (SS) for the DHMT and key financial staff will increase capacity in financial management and budgeting benefitting MTCT services as a component of overall health services.

BRHC will support districts in identification, development, implementation and measurement of health service delivery innovations to address challenges in PMTCT service delivery such as rapid ART initiation for pregnant women, integration of MTCT services with SRH/FP and IMCI services, early booking, and increasing infant testing at 18 mos. Clinical quality of MTCT services will be addressed by equipping districts to improve the reach and sustainability of clinical mentorship programs. Through mentorship and SS to DHMT, key national initiatives to improve service quality, such as PHC reengineering and NCS, and implementation of national MTCT guidelines and protocols, will be strengthened. TA for supply chain management will address issues around quantification and forecasting, stock inventory and management, and procurement systems for key MTCT supplies, drugs and commodities. Similarly, lab strengthening TA will include mentorship in quality management and improved logistics for the DHMT which will benefit MTCT services in terms of improved TATs, linkage of lab results to patients, and efficiency solutions to address key bottlenecks.

TA for community systems strengthening will focus on demand creation for MTCT services, strengthening referral mechanisms for mother-infant pairs between community- and facility-based services, and improved tracking of mother-infant pairs to ensure continuity of service and better health outcomes for families. Underlying all TA in MTCT will be a focus on improving availability and use of SI BRHC will support SAG in the measurement of key patient outcomes, and in driving demand for improved data quality through increased data use for performance management. In addition to intensive support for operationalization of Tier.net and overall strengthening of DHIS at the district level, TA will be provided in development of M&E plans, research & evaluation design, surveillance, and application of research findings.

BRHCs past and future work in adult treatment is driven by evidence, experience and a deep understanding of the SA health system. TA in Adult Treatment will focus on strengthening DHMTs management and leadership capacity to successfully implement the national treatment program aligned to budget and national targets through problem solving, consulting services, and workshopping solutions. BRHC will work in coordination with a CDC partner focused on facility and sub-district level support. Activities will include delivery of management and leadership training coupled with continued mentorship to address key treatment service delivery challenges. We will support districts to ensure that health workers effectively test and then refer all persons testing HIV positive for related HIV and TB treatment services, including IPT, CTX and PMTCT, without losing individuals along the health service chain.

BRHC will also deliver district-level TA improve the availability and use of strategic information, ensuring collection, analysis and distribution of treatment data in a timely manner to inform the precision and efficiency of treatment interventions. We will facilitate the development of functional linkages between the community and health services for early identification and treatment initiation through community systems strengthening, including adherence support and tracking of defaulters, as well as facilitate the development of integrated patient management systems and referral networks for holistic treatment. BRHC will support existing health service delivery innovations such as NIMART and PHC reengineering, as well as support districts in identification, development, implementation and measurement of new innovations to address challenges in HIV treatment service delivery such as early diagnosis and rapid referral to treatment and care. For optimum treatment outcomes BRHC will support identification and introduction of new diagnostic technologies to facilitate faster, simpler and more accurate screening and diagnosis.

District-level TA to strengthen the HR information system, address issues of recruitment/retention and performance management, and alignment to national staffing norms will result in appropriate staffing for the effective delivery of treatment services. BRHC will provide TA to districts to facilitate better integration of HIV & TB programmes at structural, organisational and management levels (including the promotion of joint planning, budgeting and financing). BRHC will facilitate the availability treatment by providing TA to pharmacy staff in forecasting, quantifying, ordering and procuring drugs, and the introduction/installation of DoH mandated automated pharmacy systems. Health financing TA and supportive supervision at the district level to increase capacity in financial management and budgeting will benefit treatment services as a component of overall health services in the district. Clinical quality of treatment services will be maintained through expansion of effective mentorship programs, use of replicable quality improvement models, and support for implementation of the National Core Standards district-wide. In addition to intensive support for operationalization of Tier.net and overall strengthening of DHIS, TA will be provided in development of M&E plans, research & evaluation design, surveillance, and application of research findings.

TA in Pediatric Treatment will focus on strengthening DHMTs management and leadership capacity to successfully implement the national treatment program aligned to budget and national targets through problem solving, consulting services, and workshopping solutions. BRHC will work in coordination with a CDC partner focused on facility and sub-district level support. Activities will include delivery of management and leadership training coupled with continued mentorship to address key treatment service delivery challenges. We will support DHMTs to ensure that health workers effectively test and refer all persons testing HIV+ for related HIV and TB treatment services, including IPT, CTX and PMTCT, without losing individuals along the health service chain.

BRHC will also deliver district-level TA improve the availability and use of strategic information, ensuring collection, analysis and distribution of treatment data in a timely manner to inform the precision and efficiency of treatment interventions. We will facilitate the development of functional linkages between the community and health services for early identification and treatment initiation through community systems strengthening, including adherence support and tracking of defaulters, as well as facilitate the development of integrated patient management systems and referral networks. BRHC will support existing health service delivery innovations such as NIMART and PHC reengineering, as well as support districts in identification, development, implementation and measurement of new innovations. BRHC will support DHMTs to develop district capacity to provide training and mentorship to clinicians to gain skill & confidence in pediatric HIV treatment. Pediatric treatment is anchored on prevention and will track/improve PCR rates of exposed infants at 6 weeks, HIV rapid testing at 18 months and early testing in all children with signs and symptoms suggestive of HIV infection. This will involve support for onsite mentorship in diagnosis and management of pediatric HIV care and treatment including how to identify and deal with treatment failure.

District-level TA to strengthen the HR information system, address issues of recruitment/retention and performance management, and alignment to national staffing norms will result in appropriate staffing for the effective delivery of treatment services. BRHC will provide TA to districts to facilitate better integration of HIV & TB programmes at structural, organisational and management levels (including the promotion of joint planning, budgeting and financing). BRHC will facilitate the availability treatment by providing TA to pharmacy staff in forecasting, quantifying, ordering and procuring drugs, and the introduction of DoH mandated automated pharmacy systems. Health financing TA and supportive supervision at the district level to increase capacity in financial management and budgeting will benefit treatment services as a component of overall health services in the district. Clinical quality of treatment services will be maintained through expansion of effective mentorship programs, use of replicable quality improvement models, and support for implementation of the National Core Standards district-wide. In addition to intensive support for operationalization of Tier.net and overall strengthening of DHIS, TA will be provided in development of M&E plans, research & evaluation design, surveillance, and application of research findings.