This activity links to CRS SUCCESS HBHC (#9180) and all other HBHC activities funded by USG Zambia.

USAID will continue to manage this twinning support for palliative care activity and channel funds for

American International Health Alliance (AIHA) Twinning Center through HHS/HRSA. AIHA will provide

south-south twinning support for Palliative Care in Zambia, in partnership with the African Palliative Care

Association (APCA) and its local affiliate/sub-partner, the Palliative Care Association of Zambia (PCAZ),

which will receive approximately 80% of these funds.

In FY 2005 and FY 2006, AIHA collaborated with APCA to provide technical assistance to the USG/Zambia

mission and PCAZ through a series of assessment and mentoring visits. To date, AIHA, APCA, and PCAZ

have reached a number of milestones. The PCAZ has a new, stronger management structure, led by a new

National Coordinator with strong management and business development skills as well as palliative care

experience. The PCAZ is now a larger, stronger membership organization. PCAZ helped develop a USG

Joint Palliative Care strategy in 2005, and participates in the USG Zambia Palliative Care Forum. PCAZ

has become a leader in taking palliative care for HIV/AIDS forward in the country. In late June 2006, APCA

organized a study tour to Uganda for Ministry of Health (MOH), PCAZ, pharmaceutical board, and drug

enforcement officials to learn about pain management and pain relief drugs (opiates). As a direct result,

upon their return, the Zambian participants formed a National Pain Management Advocacy Team. They are

now moving forward rapidly to advocate for new policy, guidelines, and regulatory change to permit the use

of opiates more widely for pain relief in HIV/AIDS care.

Starting in FY 2006, AIHA will have a regional Palliative Care technical advisor posted in South Africa to

support Zambia. AIHA and APCA staff will also make trips to Zambia as will AIHA twinning organizations to

provide technical assistance for the development/refinement of business plans for PCAZ and the GRZ, to

develop and conduct palliative training courses, and to assess progress in the area of palliative care in

Zambia.

In FY 2007, AIHA and APCA will continue to strengthen the PCAZ secretariat and executive functions,

making the PCAZ Board a more effective governing body. The partnership will also focus on strengthening

PCAZ's role as a voluntary coordinating body for Zambian palliative care institutions and care givers.

Particularly, the partnership will focus on the development of policy and advocacy skills within PCAZ, and

capacity to facilitate and manage palliative care trainings for all professional levels of HIV/AIDS palliative

care givers. Further, training will enable the PCAZ Secretariat to mobilize resources, including developing

grant proposals and seeking funding from other sources, such as the Global Fund for AIDS, TB, and

Malaria. Finally, PCAZ will implement the membership recruitment plan developed in FY 2006, and will also

advertise to increase membership and associated dues. This is a means to develop sustainable revenue

streams for the PCAZ, as part of its long-term business plan.

The APCA/AIHA partnership will continue to work together to strengthen PCAZ's ability to provide quality

services, thus attracting members. The activities will include: (1) A training of trainers program in palliative

care to scale-up and expand the program - eight participants out of all attendees will be trained further

through clinical placements to become master trainers-of-trainers within six months; (2) a country specific

advocacy workshop, focusing particularly on policies for pain medication procurement, prescription and

availability for PLWHAs in the advanced stages of AIDS and on easing prohibitive Zambian drug

enforcement practices that target pain medications; (3) adaptation and implementation of APCA standards

of palliative care and outcome scale, revision of national training manuals and material based on the revised

palliative care standards, and the development and implementation of M&E data collection tools to ensure

adequate quality and access to palliative care; and (4) publication of a quarterly palliative care newsletter to

keep members of medical and other caregiving communities informed of possible opportunities, new

developments, and evidenced-based best practices. PCAZ will train 150 palliative care medical

providers/caregivers in state-of-the-art palliative care for PLWHA.

To build sustainability, AIHA will continue to support twinning partnerships between US and regional

palliative care organizations and PCAZ to strengthen local human and organizational capacity in Palliative

Care. AIHA will support regional palliative care premier institutions such as APCA (which includes the

University of Cape Town, Sun Gardens Hospice in Pretoria, Hospice Uganda, and Zimbabwe Home-based

Care programs). AIHA will collaborate with USG partners working on palliative care in Zambia (including

SUCCESS, ZPCT, RAPIDS, PCI, JHPIEGO, and CDC partners) to provide mentoring, train palliative care

health care providers and managers, develop palliative care courses and training programs, and facilitate

technical information sharing.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity relates to UTH, SPHO, and Columbia University.

In cooperation with the Health Resources Services Administration, the Centers for Disease Control and

Prevention (CDC) will continue to manage this activity in Zambia. In 2006, American International Health

Association focused on the identification and establishment of a partnership with the two pediatric ART

centers of excellence. Efforts included communication with relevant stakeholders, including Columbia

University, University Teaching Hospital (UTH) in Lusaka, and CDC. Based on these discussions and fact

finding, AIHA posted an open solicitation to determine the best-suited partner. The solicitation closed on 31

August, and AIHA reviewed applications, selected a partner (the Center for International Health (CIH) in

Milwaukee, Wisconsin), and shared the selected partner with CDC-Zambia for concurrence. Once CDC

approved the partner selected, the initial exchange visit to introduce the partnerships was made in October

2006. During this visit, the partners discussed goals, objectives, and strategies of the partnership. The

Zambian partners from Lusaka and Livingstone then visited CIH in April 2007 to learn about CIH's

organization and resources and developed the partnership work plan. In keeping with Twinning Center

methodology, the partners worked together as equals to develop the partnership work plan, thereby

ensuring buy-in from the partners and increasing the likelihood of sustainability once funding ends.

In 2007, the partnership focused on achieving partnership goals and objectives by completing the year one

work plan and both partners conducted exchange trips. AIHA provided technical assistance, facilitation,

and management to the partnership to scale-up ART services in Zambia by increasing the pharmaceutical

service capacity at the two newly-established pediatric ART centers of excellence.

In FY 2008, AIHA will continue to assist this partnership through pharmacy trainings. Through this volunteer

-driven partnership, 25 pharmacists will receive direct on-site technical assistance in organizing and

managing a pharmacy in addition to acquiring necessary skills to address patient level management,

adherence, adverse affects, and medication management trainings. Upon successful training of these

pharmacists, AIHA anticipates an indirect beneficiary pool of an additional 100 pharmacists.

In FY 2008, the partnership will focus on UTH and Livingstone pharmacists training additional pharmacists

through the use of satellite services to replicate what has been implemented at UTH and Livingstone. The

cascade of trainings will integrate input to local organizations that already have successful pharmacy

systems in place to ensure trainings follow national guidelines. The activity will include a monitoring and

evaluation component to ensure the lessons learnt and the impact of trainings on pharmacy trainings is

documented. Trained pharmacists will train additional pharmacists at mission hospitals, and hospices

targeting primary healthcare with adult patients as well as children. Through this mechanism, 100 additional

pharmacists will be trained on service delivery.

AIHA and the partnership (which includes UTH) will continue to work closely with CDC, Columbia

University, and other relevant stakeholders to ensure that the activities are comprehensive and coordinated

in order to promote sustainability. AIHA has been instrumental in increasing and strengthening palliative

care in Zambia through its partnership with the Palliative Care Association of Zambia; this partner can be

brought in as a resource for the pediatric AIDS treatment centers partnership.

Targets set for this activity cover a period ending September 30, 2009.

All activities under this program are continuing and are linked to DOD, PCI and JHPIEGO's activities in

support of the Zambia Defence Force.

Activity One: Expand Learning Resource Centers to three additional sites in Zambia FY06 and FY07

Activities.

This activity is a continued activity from 2006 and 2007 when the AIHA Twinning Center established a

Learning Resource Center at Maina Soko Military Hospital. Initial and subsequent workshops were

conducted at Maina Soko to ensure staff were properly trained on evidence-based learning through the use

of the Internet and ongoing support was established through distance learning.

In 2008, AIHA Twinning Center proposes to expand the Learning Resource Center to three additional

military hospitals in Zambia. This activity has two components. One component is to roll out the learning

resource centre (LRC) established at the Maina Soko and the Nursing school to 3 additional camp hospitals

managed by the Zambian Defense Force. Funding will support the following activities in 3 camp hospitals

including the establishment of the resource centre, Internet, and resource materials. The staff will be trained

in evidence-based medicine to enable them to use current medical information to treat their clients. This

program will operate in TBD provinces in Zambia and will train 30 staff members in 3 hospitals and will

benefit the staff and patients accessing services in these camp hospitals. The Twinning Center will ensure

partnership activities are linked with other service providers on IT and data management, such as PCI for

counseling and testing and JHPIEGO for system strengthening and possibly have LRC coordinators

accompany these individuals on site assessments in order to maximize collaboration.

The second component of this activity is to support the establishment of the telephonic medical consultation

lines in the 3 Camp Hospitals to be connected to Maina Soko Hospital as a tertiary and teaching hospital for

the ZDF. The three Camp Hospitals, initially listed in three regions: Kitwe, Ndola, and Livingstone) that will

be involved in this pilot will go through a final selection process through consultation with ZDF and DoD This

consultation line is meant to support the junior medical staff during their patient consultations so that they

are able to identify and manage minor illnesses without referring patients to the Maina Soko. The medical

staff will be guided on both diagnosis and management of clients. The funds will support the establishment

of this line through a twinning partnership with a US-based institution. The US-based institution will be

identified through consultation with DoD and ZDF. The funds will support exchange visits between the

partners, appropriate equipment and setting up of the sites to initiate and respond to queries made by the

Camp Hospitals. The funds will also support training of the staff in initiating and responding to the queries.

In addition, funds will also be used to buy any additional equipment needed to ensure that the responses

are timely and the necessary documentation is of good quality and can be received on both ends. This

activity will reduce the number of HIV patients referred to Maina Soko and will increase the confidence,

knowledge and skills of medical staff at 3 Camp Hospitals in managing the needs of their clients. This

activity will train 30 staff in 3 Hospitals (Main Soko and 3 Camp Hospitals).

Activity Two: Providing Technical Assistance to DFMS (Defense Force Medical Services)

FY07 Program Activities

AIHA worked with the DFMS through PCI to provide technical assistance to the mobile VCT. AIHA Twinning

Center recruited the assistance of a consultant, Terry Cunningham, specializing in VCT who worked with

ZDF counselors to help organize the mobile unit staff and specifications, job descriptions, needs. The

consultant traveled with ZDF counselors during a routine visit to Northern provinces in Zambia and during

the course of seven days, over 1200 individuals were tested. When the counselors returned to Lusaka, Mr.

Cunningham conducted a follow-up training for 25 ZDF staff members.

In 2008, AIHA will continue Terry Cunningham's direct involvement with ZDF and the mobile VCT. AIHA

will logistically coordinate Mr. Cunningham's travel to Zambia to conduct refresher training with the mobile

unit core team including technical assistance for data collection and monitoring systems. Mr. Cunningham

will work with counselors to create referral systems and to strengthen the linkages between organizations

that have already-established case-management systems in place and that offer and integrated approach to

VCT. As well AIHA will facilitate, coordinate, and manage the south-to-south exchange program of 5 ZDF

VCT counselors to the South Africa where they will have the opportunity to visit mobile VCT sites.

Activity Three: Zambian Defense Force's Nursing School to partner with the University of San Diego

Nursing School

FY07 Program Activities

The program is directly linked to FY07 Twinning Center activities through the established Learning

Resource Center at the Zambia Defense Force's Nursing School.

In FY08, the Twinning Center will build the institutional capacity of the Zambian Defense Force's School of

Health Sciences through a twinning partnership with the University of San Diego Nursing School (or other

similar nursing school). This activity will have three components. One component is to build capacity of the

staff to plan, implement, and manage the academic programs offered by the school of nursing, through

twinning with the University of San Diego, Charlstate campus (or other similar nursing school). The school

is recommended because it is currently working with the ZDF Nursing School on HIV curriculum

implementation and palliative care. The funds will support the exchange visits of partners, planning, fund-

raising, training activities as well as recruitment of staff and procurement of equipment and materials to

support the operations at the school. The organizational development will include strategic and business

plans development, curriculum development for accreditation and setting up of different departments. This

activity will train five senior management staff and five academic staff.

The second component of this activity is to establish a care of the caregiver program to support the staff

and mitigate the impact of HIV/AIDS on the staff working in this school. The funds will be directed at

establishing a workplace program for both staff and students to access HIV/AIDS prevention, treatment and

care and support services. This activity will train 10 staff from the school as well as senior management

from Maina Soko and 3 Camp Hospitals (a total of 15 staff members) so that they can institute the program

in their hospitals. The module for caring of caregiver will also be developed and integrated into the current

curriculum and students at the school will receive this training. Approximately 30 students will be trained

(number depending on enrollment).

The third component of this activity is to integrate the case management approach to teaching HIV care and

Activity Narrative: HIV service provision in the school. This activity will include training of nurse educators and clinical

instructors in HIV nursing case management and will create organizational and management support for

nursing case management systems at the school. This activity will also require that a HIV Nursing Case

Management Module be developed for use in-service training of nurses already working in ZDF hospitals.

This activity will train 10 nurses who will become trainers. These trainers will be posted at Maina Soko and 3

Camp Hospitals and be responsible to train five additional nurse personnel in all ZDF managed hospitals.

Approximately 30 nurses will be trained in all hospitals. Through this training, case management will be

instituted in the 3 Camp Hospitals, including Maina Soko hospital in Zambia to improved quality of HIV care.

AIHA Twinning Center Methodology

AIHA will work closely with the sub-partners to ensure that the activities of the program objectives and

targets are met. AIHA will ensure partnership objectives are met and within the partnership budget and will

also provide management and technical assistance to the partners. AIHA will manage all funding and will

conduct on-site monitoring to provide technical assistance and ensure that the objectives are implemented.

AIHA's Twinning Center will also leverage private sector in kind contributions including books and other

materials needed to sustain the organizational development of the programs. To establish a sustainable

program, AIHA will work with a sub-partner to ensure that they provide ongoing support and mentoring and

will also identify local stakeholders that will provide ongoing technical assistance to partners. The

contributions of institutional twinning partnerships usually double the value of the initial funding contribution.