The purpose of this new mechanism is to support a local, sustainable, cost-efficient response to the HIV epidemic through ongoing strengthening of the capacity and systems of the Ministry of Health and Social Welfare (MOHSW), building upon previous CDC-MOHSW collaborations. This strengthened capacity lays the foundation upon which all other HIV and AIDS interventions are built. Integrating this strengthening within the public health system will ultimately ensure the achievement of GHI goals, especially to promote improved quality of integrated services. The MOHSW now requires targeted support in order to further strengthen their capacity. Key challenges facing the MoHSW include inadequate HRH in epidemiology and laboratory management; a lack of coordinated, timely and accurate monitoring and evaluation (M&E) systems; inadequate services for key populations (KP); and poor quality of infection prevention and control (IPC). This mechanism includes a focus on 1) enhanced field epidemiology and laboratory training of MOHSW staff and others; 2) enhanced evidence-based decision-making through the coordination of resources and the implementation of the M&E Strengthening Initiative Combined Plan; 3) active engagement in integration and regulation of services for HIV prevention, care and treatment for KP; and 4) support of the IPC program. Future strengthening of other partnerships are anticipated, including increased contributions from other funding sources, and greater government buy-in and support of transition plans consistent with the Partnership Framework, resulting in URT ownership of these programs. These programs have nationwide coverage and target HCWs, MOHSW staff, KPs and clinic providers and patients. All programs include process indicators for ongoing M&E.

With FY2013 COP funds, PEPFAR/T will continue to provide financial and technical support to the Ministry of Health and Social Welfare (MOHSW) to strengthen national M&E, HMIS and ICT systems, and enhance coordination of Strategic Information inputs across multiple donors and implementers. Through a co-operative agreement with the MOHSW, CDC will provide direct government-to-government funding to the central MOHSW M&E section, including Surveys and Surveillance and HMIS units and the Central MOHSW ICT section.

PEPFAR will build individual, institutional, and organizational capacity in country monitoring and reporting results, support health information systems, strengthen national systems, and conduct related analyses and data dissemination activities.

The MOHSW established the M&E Strengthening Initiative (MESI) to bring together the Global Fund, the Netherlands, PEPFAR and other partner resources, and to coordinate the efforts of multiple implementing partners into one coordinated strengthening initiative. The initiative uses a comprehensive approach to build capacity for evidence-based decision-making, which includes the roll out of new harmonized M&E tools, deployment of DHIS software for enhanced data management, strengthening of data analysis and dissemination capabilities, and longer term support for Strategic Information capacity through the development of In-service and Pre-Service M&E training programs.

The PEPFAR inputs to the MOHSW specifically support coordination of investments through the MESI and help ensure that the MOHSW is able to provide leadership to all health programs to realize efficiencies and ensure national systems evolve to meet the HIV and other vertical program requirements. HIV/AIDS M&E will be integrated into central MOHSW systems and support analysis and dissemination of evidence to all stakeholders for evidence based decision making. The MOHSW is planning on completing a roll-out of updated and harmonized HMIS tools to all 160 districts by September 2014.

HVSI funding will also support the ICT section to strengthen its capacity to coordinate multiple system investments so that they are architected to enable data-sharing and integration across different business functions. The initiative is targeting 2014 for approved e-health infrastructure and enterprise architecture plans for the health sector.

The MOHSW direct cooperative agreement funding complements technical assistance from RTI and the m-health PPP. In addition, the NACP, UCC and the new FY2013 COP TBD, New HIS-UCC Follow On, are all strengthening HIV/AIDS-specific M&E systems, and the MESI will incorporate these into a broader national vision over time. NIMR is also supporting GIS and Master Facility List activities that are also included in the MESI.

In support of both PEPFAR/T and URT priorities that are aligned with the GHI strategy to improve the quantity and quality of the health workforce, the goal of this program is to assist the Ministry of Health and Social Welfare (MoHSW) to ensure that the country has a health workforce qualified to use data for decision-making. This includes the collection and analysis of surveillance data from clinical and laboratory sources. District health staff forms the front line health workforce. They experience the greatest turnover but also the greatest need to understand the collection and appropriate use of health data for decision making. The MOHSW will be supported to design and develop a formal certificate-based in-service training program intended to equip existing health workers with key competencies in epidemiology, surveillance, and lab management. This builds on previous short course training experiences and emphasizes field projects and formal recognition of this training by the MOHSW to ensure that participants utilize new knowledge and skills and are recognized for this capacity. In the FY2013 COP, 80 health personnel from district, regional, and national levels will receive training in these key competencies, and all of participants will be encouraged to conduct field-based projects relevant to key public health issue in their geographic area. Additionally, the program aims to work with the Ministry and its technical support partners to gradually transition full management and coordination of the FELTP program to the URT, with development of a transition plan as a key outcome of this process.

Infection Prevention and Control (IPC) is an integral component of quality health care service provision, but there are gaps in the national program, including inadequate health care worker capacity in IPC & quality improvement (QI); inadequate implementation/operationalization of existing post exposure prophylaxis (PEP) guidelines; lack of supportive supervision for IPC; and inadequate infrastructure for safe and appropriate management of medical waste in health facilities. As a result of FY2013 COP funding, the MoHSW will be expected to have systems and capacity in place to prevent transmission of infections through exposure to blood and other body fluids as well as other communicable infections in healthcare settings.

This program will also:

1) Strengthen the capacity of Regional Health Management Teams (RHMTs), Council Health Management Teams (CHMTs) and Health Management Teams (HMTs) to implement policy guidelines and standards for IPC;

2) Build capacity of the health training institutions to incorporate IPC in their curriculum;

3) Promote universal precautions to reduce risk of medical transmission of HIV by supporting needlestick surveillance, advocating for PEP and hepatitis B vaccination for health care workers, and improving the safety of phlebotomy practices; and

4) Ensure safe and appropriate health care waste and sharps management in high output health care facilities.

PEPFAR/T plans to transition these programs by 2015, which will reinforce country ownership, strengthen the capacity of URT to manage IPC programs, and facilitate transition of project activities to local partners, ensuring the sustainability of IPC interventions without ongoing USG financial support. Finally, PEPFAR/T and the MOHSW will jointly develop a performance evaluation tool to enable national, district and health facility authorities to master IPC indicators.

Key populations (KP) are a driver of the HIV and AIDS epidemic, yet they are not receiving adequate preventive and care services due to stigma and lack of targeted interventions. Although health and non-health personnel are delivering some services through outreach, there is a need for improved MoHSW coordination outside of formal facilities. Through this mechanism, the MoHSW will deliver comprehensive targeted HIV prevention, care, and treatment services to KP, including people who inject drugs, men who have sex with men, and sex workers. Goals include :

1) Ensure an adequate supply of medical commodities unique to KP (e.g. methadone) and those used at a higher rate when serving KP in facilities and programs that provide services to KP;

2) Institute quality assurance mechanisms in services for KP, including accreditation of training curricula and facilities, and supportive supervision of personnel; and

3) Recruit and train health care workers and deploy them to districts to provide specialized prevention and treatment services to KP targeted areas based on epidemiology, and track provision of prevention and treatment services to key populations through the HMIS.

The MOHSW will integrate appropriate monitoring and evaluation to reflect KP accessing health services (ART, HTC, TB, among others) for appropriate tracking. This will support country ownership and efforts to achieve PEPFAR's goals.