The overall goal of this support will be to the MoH /GOU in meeting its mandate of providing adequate leadership for a well - coordinated national response to HIV/AIDS and related health conditions. In FY 2013 USG will continue to support MoH to implement the HIV/AIDS strategic Plan, Health Sector Strategic and Investment Plan 2010/11-2014/15 that aim to improve access to quality HIV prevention, care and treatment and social support / protection. In an integrated approach the MoH will apply this support to develop and update HIV program policies and technical guidelines, ensure availability of medicines, ARVs, health supplies and reduce on the frequency of stock out in health facilities, implement the national laboratory services strategic plan 2010-2015, the revised health management Information system, disease surveillance including HIV/TB, and conduct evaluation of program impact.

Specifically this support will strengthen the capacity of MoH, national health systems to deliver universal access to HIV prevention, care and treatment services, roll out PMTCT Option B+ for virtual elimination of MTCT, conduct and implement country ownership process that will lead to sustainable programming.

Specifically the following interventions will be supported under this mechanism:

1 Review , revise, and update national policies and technical guidelines relevant to all HIV scale up program

2 Strengthened MoH ownership and ACP management /programming,

3 Scale up of evidence based and comprehensive approach to HIV and AIDS

4 Strengthen the national laboratory infrastructure

5 Ensure technical support for strategic-information activities and improve human resources

6 Address Health System challenges

Ministry of Health (MoH) will be supported to scale up access to Combination Prevention Interventions: HIV prevention, care and treatment services, including virtual elimination of MTCT (eMTCT).

The specific areas of support are: 1. Develop and update national policies and guidelines for care; 2) Scale up comprehensive care services with integration of other priority health interventions; 3) Ensure technical support for strategic information activities related to care, including implementation of revised HMIS; and monitoring and evaluation of HIV programs; 4) Coordination of Global Fund activities;

5) Promote strategies to improve human resource for health; including recruitment of key health workers through district service commissions with PEPFAR support.

MOH will be supported to expand access to care to achieve universal access of 80% by 2015. In FY 2013, MOH will increase access to care to at least 812,989 clients (including HIV positive pregnant women); and improve the quality of care services. This target was derived using burden tables based on district HIV prevalence and need. The Continuum of Response model was also applied to ensure improved referrals and linkages. Specific attention will be given to key populations. Priority activities for MoH guidance include, but are not limited to: positive health dignity and prevention; linkages and referrals using linkage facilitators; quality improvement for adherence and retention; pain and symptom management; and support to targeted community outreaches in high prevalence, hard to reach and underserved areas. Other planned MoH activities include: support for comprehensive HIV training and mentoring; data quality assessments, and quarterly support supervision of care and treatment facilities will be conducted as part of quality improvement with the Quality Assurance Department. This program also aims at strengthening districts and regional health systems to increase coverage and quality of services.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MOH guidelines. This is a challenge to treatment scale up. Measures will be put in place to track any client waiting lists resulting from this. Working with the Central Public Health Laboratories and other stakeholders, CD4 coverage will be improved from 60% to 100% over 12 months through improved infrastructure and services.

In order to support supply chain management of HIV commodities for care, MoH will liaise with PACE and UHMG for provision and distribution of basic care kits. As well as coordinate with National Medical Stores, Joint Medical Stores, SCMS and MAUL for other HIV commodities. MOH will oversee implementing partner support to build the capacity of facility staff to accurately and timely report, quantify and order commodities.

MOH will develop and implement a comprehensive national M&E framework and update HIV care and support tools; data analysis and dissemination; and strengthen reporting through the HMIS. Support to strengthen coordination of all key stakeholders will be provided. MOH will coordinate USG partners providing technical support such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda for other health and nutritional services.

The relevant national technical working groups will be supported to provide overall guidance for the HIV care and support guidelines. Additionally, some MoH staff positions may be funded under the program.

Ministry of Health (MOH) aims to achieve universal access to treatment by 2015. In FY 2013, MOH will support enrollment of at least 73,169 children in care and support services. Targets were derived using burden tables based on district HIV prevalence and need; with application of Continuum of Response model for improved referrals and linkages.

Key areas for the program are to: 1) Develop and update national policies and technical guidelines for pediatric care and support; including guidance for a standard package of HIV services; 2) Treatment scale up with integration of other priority health interventions; 3) Ensure technical support for strategic information related to care and support, including the implementation of HMIS, monitoring and evaluation of HIV programs; 4) Support coordination of Global Fund activities; and 5) Promote strategies to improve human resource; including recruitment of key health workers through district service commissions with PEPFAR support.

MOH will support scale up of child friendly care and treatment services in line with national and PEPFAR guidance; strengthen linkages and referrals using linkage facilitators; implement quality improvement for adherence and retention; and support targeted community outreaches in high prevalence, underserved areas. Early Infant Diagnosis (EID) services at facilities will be scaled up to ensure follow up and active search of exposed children in facilities and communities. Focus will be on scaling up low cost approaches to support retention. The program will support community mobilization and targeted activities including Know Your Childs Status campaigns to identify children.

MoH will support improved adolescent care and support services, and retention using expert peers and support groups. Recommendations from the planned national adolescent service assessment will be implemented.

The program will work with Ministry of Gender, Labor and Social Development to strengthen referrals between OVC and HIV programs ensuring HIV positive children are linked to OVC services, and beneficiaries of OVC services are screened for HIV and appropriately linked to care and support. MoH will also support the integration of HIV services in routine pediatric health services, including national Child Health Days.

MoH will develop and implement a national M&E framework; update treatment tools; data analysis and dissemination; and strengthen HMIS reporting. Support to strengthen coordination of all key stakeholders will be provided, including USG partners providing technical support such as PIN, SPRING, HEALTHQual and Hospice Africa Uganda. To support supply chain management of HIV commodities for care and support, MoH will liaise with PACE and UHMG for provision of basic care kits; and coordinate with National Medical Stores, Joint Medical Stores, SCMS and MAUL for other HIV commodities. MoH will oversee implementing partner support to build the capacity of facility staff to accurately and timely report, quantify and order commodities.

Support for the relevant national technical working groups will be supported to provide overall guidance for care and support, as well as for the annual National Pediatric Conference. Additionally, some MOH staff positions may be funded under this program. Funding for activities under this program area is limited, and will leverage other program funds.

During FY2012, changes will be made in PEPFAR support for laboratory program in Uganda in line with the identified pivots. The pivots will focus on a change from facility based to lab network strengthening. Building on success of the Early Infant Diagnosis (EID) hubs there will be an increase in the number of hubs from 19 to 72 thus increasing the geographical coverage and access for specimen transportation, testing and result transmission. This is aimed at ART targeted population receiving CD4 tests from 60% to 100% improving the quality of laboratory services, reducing stock out of reagents ,laboratory supplies and commodities, reducing equipment downtime and improving data collection, transmission, analysis and utilization. To achieve this, technical staff will need to be hired and retained and where possible task shift non-technical activities to appropriately trained lay health workers. Implementation of the WHO Strengthening Laboratory Management Towards Accreditation (SLMTA) approach will be the mainstay for quality improvement in addition to other quality assurance activities.

The hubs are located health facilities identified by the MoH to serve as coordination centers for specimen referral, testing and result transmission for a catchment area of 30 to 40km radius serving 20 to 50 facilities. These centers will have CD4 testing capability, chemistry and haematology at the regional referral facilities while EID and Viral Load testing will be centralized at the Central Public Health Laboratory.

For FY 2013 MoH will provide leadership, coordination and technical assistance in assuring that this strategy leads to a highly functional and operational national health laboratory services for the support of the HIV/AIDS prevention, care and treatment programs. The MoH will work to coordinate these efforts to increase access to EID for HIV, CD4 and Viral Load testing; improved lab infrastructure; coordinate implementation of laboratory information management system, training of laboratory personnel in laboratory management, quality assurance, logistics management, biosafety and biosecurity and for the related diagnosis and management of HIV, TB and opportunistic infections at all levels. MoH will work with partners to roll out strengthening of lab management towards accreditation (SLMTA) in the hubs and achieve WHO three stars at all the hubs by the end of 2013.

MoH will recruit recruitment of 16 Laboratory personnel who will work to coordinate and monitor these activities which are embodied in the National Health Laboratory Policy and implemented through the National Health Laboratory Strategic Plan 2010-2015. As part of these activities MoH will develop and review national policies, guidelines, National Laboratory Standards, standard operating procedures and quality assurance and control systems and processes. MoH will strengthen management, coordination and provision of quality laboratory services through operationalizing the National Health Laboratory and work with other development partners such as the WHO, The World Bank, The Global Fund, the Japanese International Cooperation Agency (JICA), etc who assist the MOH in building technical, laboratory and financial capacity. Working with the health development partners and other indigenous organizations such as the Uganda Virus Research Institute, MoH will work to leverage financial and human resources dedicated to improve and sustain laboratory services in Uganda.

Under this support, MoH will focus on establishment of one M&E framework , develop national indicators that will improve on data capture, quality, analysis and use at all levels of health care in a more timely and complete form. In this way locally generated data will be part of the decision making process and improve programming particularly at the district level for target setting. MoH will work with UAC to operationalize regional support teams that will strengthen district-based activities.

Specifically the following activities will be accomplished in FY 2013.

1.

Review and update the existing SOPs, national standards, strategic framework, and policy guidelines for Health Information, web-based health facility reporting system (DHIS-2) and prepare for transitioning MEEPP into the MoH led system.

2.

Develop the Health Sector HIV/AIDS M&E Plan in line with the M&E Plan for the National HIV/AIDS Strategic Plan (NSP) 2011/12 to 2014/15.

3.

Lead secondary data analysis and conduct incidence estimation of the Uganda AIDS Indicator Survey (AIS) 2011.

4.

Support district-led evidence based consolidated planning using the burden tables and costing information.

5.

Implement electronic medical records to strengthen the WHO interlinked patient monitoring systems.

6.

Conduct annual Antenatal HIV Surveillance, annual modeling projections for HIV estimates that will inform programming and national planning processes.

7.

Implement integrated disease surveillance system, facility data capture and bring on board the community aspect of data capture and utilization.

8.

Support and lead the process of monitoring the eMTCT Option B+ roll-out, coordinate and harmonize eHealth activities country wide.

9.

Support the process for recruitment of key staff that will contribute to improved data management and build capacity for HIV/AIDS / TB surveillance.

During FY 2012 PEPFAR support for HSS focused on strengthening the capacity of the MOH to play its role of oversight , governance, leadership ,stewardship and provision of technical and advisory functions to all stakeholders supporting the national response to HIV/AIDS.

Under this support the MoH capacity to coordinate and provide Technical Assistance (TA) to the national response to the HIV epidemic will be consolidated and enhanced, support the scale up plan of interventions that have been proven to be effective in turning the tide of the current epidemic in light of the Uganda AIDS indicator Survey results (2011).

In addition to this mandate, the MoH will address in the short and medium/long term the Health System challenges to service delivery specifically limited health financing, governance and leadership, Human Resource for Health, infrastructure development and maintenance , supply Chain management and Health Information management at all levels of care and management.

In FY 2013, support will be provided to MOH to support HSS activities in line with the NSP and PEPFAR II principles while leveraging support for GOU and other development partners. Specifically this mechanism will enable MOH to address the following:

1

Review and update some of the relevant health and HIV related policies for scale up plan of combination prevention interventions, national coordination, support district led coordination of the decentralized response, district based data processes and use for planning, budgeting, performance monitoring and evaluation that will all lead to a country led and owned process.

2

Support and strengthen coordination of national efforts and stakeholders for the elimination of MTCT, ensure that 80% of women of the child bearing age who are infected with HIV do access highly efficacious ARVs.

3

Strengthen HRH/HRM (Planning and implementation) through strategic recruitment, deployment and retention of critical staff by district local governments to support scale up plan in the attainment of both World AIDS day and HIV free generation targets.

4

Support country led partnership Framework for harmonious implementation of PEPFAR and GFATM support to avoid duplication, improved information sharing, transparency and leverage other available resources in an integrated manner; improve health /HIV financing through partnership with other ministries and lobby the parliament and other government departments.

5

Build capacity for Commodity Logistics management to reduce stock out of medicines, ARVs and supplies by level in at least 80 % of health facilities; ensure that the Medicines TWG and commodity procurement and distribution committee meet regularly to harmonize and coordinate procurement.

6

Support implementation of the national health laboratory strategic plan especially in areas related to increasing staffing levels at the regional referral hospitals, district hospitals and Health Center IVs. In addition, technical and financial Support will be provided to the MoH and districts for investigation of disease outbreak and surveillance, establishment of 72 laboratory hubs, reduction of equipment downtime and implementation of SLMTA.

7

Improve on the strategic information system through the implementation of Health facility specific DHIS-2, open MRS and integrated disease surveillance.

In this new program period, the MoH will provide the guidance, leadership and national coordination to support the scale up of Voluntary Medical Male Circumcision (VMMC) as part of the comprehensive prevention package. Specifically this support will enable the MoH to support key personnel including SMC/VMMC National Coordinator that will oversee and coordinate the national efforts to scale up this prevention intervention according to the National VMMC Policy and National Prevention Strategy. The National Coordinator (Technical Officer) will monitor and coordinate activities related to VMMC implementation as prevention services. This support will provide facilitation for the National Coordinator to conduct supervision visits, Quality Assurance assessments, and strategic direction and guidance.

Support will be provided to transition the reporting system to MoH (daily reporting through the National Operational Center).

Infection prevention and control that promotes safety of medical procedures in health care setting and communities will be part of the broader prevention focus under this support to the MOH.

Specifically this will support mainstreaming of this intervention into comprehensive HIV prevention, care and treatment at all service points.

The following activities will be undertaken:

1

Re-orientation of national trainers, refresher courses for district based trainers that will cascade this training further down,

2

Scale up of the Post Exposure prophylaxis (PEP) services at all levels of care

In this planning period the MoH shall support innovative counseling approaches that include: Provider Initiated Testing and Counseling (PITC); index client and follow up for family access, special attention will be put to key populations like the fisher folks, sex workers and their partners, men who have sex with men, uniformed personnel and long distance truckers as defined by the National Prevention Strategy 2011-2015. MoH will support recruitment drive that will include key personnel that will improve linkage of clients through HIV Testing and Counseling (HTC), Pre-care, care and treatment service points for a continuum of response and reduce loss to follow up, counselors and HTC at community level.

The GoU will provide stewardship of the National HTC program through the National HTC Coordination office and the National HTC TWG. These structures formulate policies and implementation guidelines for HTC programs. The National HTC Coordination office will provide oversight and supervision to the program.

Under Other Prevention, MoH mandate is to focus on strengthening the pivot for condom distribution, and making policy decisions to reorganize the logistics, improve forecasting and distribution, and address the bottlenecks in condom distribution to increase accessibility and availability.

Through this support, MoH will strengthen the Condom Coordination Unit (within the AIDS Control Program) and address policy issues especially around the post shipment testing requirement.

In FY 2013 MOH will be supported to implement the new Health Sector Strategic and Investment Plan and the National HIV/AIDS Strategic Plan (NSP) for the implementation of PMTCT and specifically the adoption of option B+ that will ensure that 80% of HIV infected women access efficacious ARVS in the first one year and raise this in the subsequent years for virtual elimination of MTCT through a phased approach, assessment of sites, preparation and accelerated accreditation of all Health Center (HC) III, and holding four Training of Trainers .

Under the same support MoH will prepare guidelines, job aides, IEC materials and other tools for the implementation of eMTCT

The following interventions will be undertaken by MOH for the implementation of PMTCT option B+:

1

Hold National coordination meetings (joint quarterly /bi-annual stakeholders coordination meetings to share experience, best practices and find solutions to challenges.

2

Strengthen the district capacity to hold joint coordination meetings with district based implementing partners; support and hold RDQA to address performance gaps at the district level targeting those that are poorly performing.

3

Ensure uninterrupted supply of ARVs with no stock outs at national, district and Health facility levels.

4

Coordinate and Support integration of PMTCT services within the SRH set up and roll out the new eMTCT guidelines at both district and health facility levels for effective delivery of option B+ (at Hospitals, HC IVs and HC IIIs) in a phased approach.

5

Support supervision in an integrated approach to leverage other resources available by level of care and unlock the potential at the Regional Referral Hospital to oversee the implementation process (support National officers to Conduct Quarterly mentorships to the 13 Regional Referral Hospitals for the implementation of PMTCT Option B+).

6

Strengthen district based programming through generation of district based targets, provision of technical assistance and reduce loss to follow up through linkage facilitators both within the Health facility and the community. This will improve the overall coordination, monitoring and evaluation of the PMTCT program and track changes in the district specific profile / set targets.

7

The National PMTCT program will maintain five technical staff at national level to support coordination and management of PMTCT implementation country wide. These officers include 1 national PMTCT Coordinator, two M& E officers, one Logistics officer, one Community mobilization and education officer and two program assistants.

8

Develop a communication strategy for eMTCT, meaningfully engage all levels of governance and leadership (political, technical , civil, cultural , religious) for community mobilization and commitment for virtual MTCT elimination.

9

Under this support MOH will procure assorted office stationery, equipment, Double cabin 4 WD vehicle for field work, fuel for coordination and airtime for communication, motor vehicle maintenance and servicing.

Using a health systems strengthening approach, Ministry of Health (MoH) will be supported to implement the Health Sector Strategic and Investment Plan and the National Strategic Plan for HIV/AIDS (2011/12 -2014/15).

Key areas are to: 1) Develop and update national policies and technical guidelines for treatment, including guidance for a standard package of HIV services; 2 ) Scale up treatment services with integration of other priority health interventions; 3) Ensure technical support for strategic information activities related to treatment; 4) Coordination of Global Fund activities; 5) Promote strategies to improve human resource; including recruitment of key health workers with PEPFAR support; 6) lead and provide stewardship through national coordination of USG and other partners in this response. MoH aims to expand coverage from 57% to achieve universal access by 2015.

In FY 2013 enrollment of at least 190,804 new clients and maintenance of about 490,028 individuals on treatment is planned for. Priority will be given to enrolment of pregnant women, TB/HIV patients and key populations. This target was derived using burden tables based on district HIV prevalence and need.

In FY 2013, with PEPFAR support, MoH will roll out Option B+ through the following activities: Accreditation of at least 883 additional health facilities; pilot service delivery models integrating ART/PMTCT services; training, mentorship and joint PMTCT/ART support supervision.

Continuum of Response linkages and referrals will be strengthened using linkage facilitators and village health teams in facilities and communities to ensure early ART initiation. MOH will support integration of family planning and other health interventions in HIV services.

Other MOH activities include support for training and mentorship; data quality assessments and quarterly support supervision of treatment facilities will be conducted by the Quality Assurance Department. This program also aims at strengthening districts and regional health systems to implement quality improvement initiatives for the ART framework including: early initiation of ART eligible clients; improve adherence and retention; and monitor treatment outcomes. Use of innovative, low cost approaches for adherence, retention and follow up will be supported. Emphasis will be placed on adherence and retention of women on Option B+. Increasing access to CD4 for routine monitoring of ART clients in line with national guidelines is a priority. MoH will work with Central Public Health Laboratories and other stakeholders to expand the sample testing and referral network to improve CD4 coverage from 60% to 100%.MOH will develop and implement a national M&E framework; update treatment tools; data analysis and dissemination; and strengthen reporting through the HMIS. Support to strengthen coordination of all key stakeholders will be provided.

In order to support supply chain management of HIV commodities, MoH will liaise with PACE and UHMG for provision of basic care kits; and coordinate with National Medical Stores, Joint Medical Stores, SCMS and MAUL for ARVs and other HIV commodities. MoH will oversee implementing partner support to build the capacity of health facility staff to accurately and timely report, quantify and order for commodities. The national treatment working group will be supported to provide overall guidance for the treatment program. MoH staff positions may be funded under this program.

Ministry of Health (MoH) aims to achieve universal access to treatment by 2015. In FY2013, MOH will support enrollment of at least 38,161 new children and maintenance of about 63,704 on treatment. Targets were derived using burden tables based on district HIV prevalence and need; with application of Continuum of Response model for improved referrals and linkages.

Key areas for the program are to: 1) Develop and update national policies and technical guidelines for pediatric treatment 2) Treatment scale up with integration of other priority health interventions; 3) Ensure technical support for strategic information related to treatment, including the implementation of HMIS, monitoring & evaluation of HIV programs; 4) Support coordination of Global Fund activities; and 5) Promote strategies to improve human resource; including recruitment of about 1,300 district health workers with PEPFAR support.

MoH will support scale up of child friendly care and treatment services in line with national and PEPFAR guidance; strengthen linkages and referrals using linkage facilitators; implement quality improvement for adherence and retention; and support targeted community outreaches in high prevalence, underserved areas. Early Infant Diagnosis (EID) services at facilities will be scaled up to ensure follow up and active search of exposed children in facilities and communities. Focus will be on scaling up low cost approaches to support retention. The program will support community mobilization and targeted activities including Know yYour Childs Status campaigns to identify children. Treatment scale up through strengthening identification, follow up and treatment of infants through EID focal persons, peer mothers, and mobile phone technology is a priority. Facilities will be supported to strengthen test and treat for positive children under two years in line with treatment guidelines.

MOH will support improved adolescent care and treatment services and retention using expert peers and support groups. Recommendations from the planned national adolescent service assessment will be implemented.The program will work with Ministry of Gender, Labor and Social Development to strengthen referrals between OVC and HIV programs ensuring HIV positive children are linked to OVC services, and beneficiaries of OVC services are screened for HIV and appropriately linked to care and treatment. MoH will also support the integration of HIV services in routine pediatric health services, including National Child Health Days. MoH will develop and implement a national M&E framework; update treatment tools; data analysis and dissemination; and strengthen HMIS reporting. Support to strengthen coordination of all key stakeholders will be provided, including USG partners providing technical support such as PIN, SPRING, HEALTHQual and Hospice Africa Uganda. To support supply chain management of HIV commodities for care and treatment, MoH will liaise with PACE and UHMG for provision of basic care kits; and coordinate with National Medical Stores, Joint Medical Stores, SCMS and MAUL for ARVs and other HIV commodities. MoH will oversee implementing partner support to build the capacity of facility staff to accurately and timely report, quantify and order commodities.

The national ART technical working group will be supported to provide overall guidance for the pediatric treatment program. Additionally, some MOH staff positions may be funded under this program.