This activity links with the Project Concern International (PCI) and JHPIEGO's assistance to the Zambia

Defense Force (ZDF) comprehensive HIV/AIDS care and treatment programs including PMTCT, Palliative

Care, TB/HIV and ART programs.

The program will contribute to improved service delivery in HIV care and treatment in the ZDF through

improvement, and expansion of infrastructure dealing in HIV/AIDS Counseling and Testing, PMTCT,

palliative care and ARV delivery, training institutions, and HIV/AIDS laboratories. Improvement of

infrastructure includes renovation of existing spaces which include, examination rooms, laboratory testing

facility and anti-retroviral (ARV) dispensaries so that they can be utilized more effectively for HIV/AIDS care

and treatment. Expansion includes new construction of anti-retroviral treatment (ART) clinics and

laboratories which will aid in scaling up the interventions to meet the health needs for the ZDF, their families

and vulnerable population living in these areas, which at many sites are predominantly civilians (non ZDF

dependents) who rely on access to Defense Force Medical Service (DFMS) clinical services for all routine

care. Years of under funding coupled with increasing population have left the DFMS with substantial

infrastructure deficits, which are compounded by the remote location of many of the 54 DFMS clinics, as

well as the lack of other donor support and the lack of Ministry of Health (MOH) support for DFMS

activities.

In FY 2005, the ZDF identified four regional model sites located in the following provinces: two in the

Copper belt (Tug Argan barracks and ZNS Kitwe), one in Southern (ZAF) and one in Lusaka (Maina Soko)

to focus on strengthening their HIV/AIDS treatment and care services. Those four sites received basic

laboratory equipment as well as training by the implementing partners.

In FY 2006, seven additional sites as follows: ZA Gonda, ZA Chindwin barracks, ZNS Chiwoko, Chishimba

and Kamitonte, ZAF Livingstone and Maina Soko will be provided with laboratory equipment and

comprehensive training as well as infrastructure support. Most of these sites are located in remote isolated

areas and their medical infrastructure is poor to deliver comprehensive services. Extensive renovation of

these facilities is needed to allow them qualify for the national HIV program where free test kits, ARV and

other HIV related drugs become available. These sites will serve as model sites for the ZDF medical staff in

the regions to rotate through for training in prevention for mother-to-child transmission (PMTCT), HIV/TB

care, ART and palliative care. These trainings for staffing ZDF medical facilities are conducted by PCI and

JHPIEGO.

In FY 2007, while continuously supporting sites provided support in FY 2005 and 2006 with laboratory

reagents and equipment support, in collaboration with CDC, DOD will expand infrastructure activities into

eight additional military medical sites as follows: ZAL85, Arakaan and Mikango Barracks, ZNS Mansa,

Chongwe and Nyimba , ZAF Lusaka and Mumbwa. Due to the remoteness and isolation of most of these

sites DFMS has been unable to provide adequate HIV care services. The principal constraint has been the

lack of adequate infrastructure to support HIV/AIDS care and treatment. Mansa Clinic will be supported

with major construction activity and when this site is equipped with adequate facility and equipment, the

ZDF will have one "model site" in each province to be able to coordinate all 54 military clinics in a network of

care and treatment.

Although Lusaka province already has one model site supported in FY05 in the district, the ZDF has

identified the need for an additional site since Lusaka district is a high density area with a large demand for

services and the Maina Soko hospital alone cannot accommodate the large patient burden. L85 unit

(Zambia Army) will receive major infrastructure support. In addition, some expansion and rehabilitation

services will be made available to Maina Soko Military hospital in order to support the development of the

Family Support Unit, as well as to the Defense School of Health Sciences to improve their ability to train

nurses.

HIV/AIDS unit coordinators as well as medical officers from the FY2007 sites have already been provided

adequate training for HIV/AIDS prevention, care and treatment and therefore support in equipment and

infrastructure improvement will immediately expand capacity to provide those services.

By working with the DFMS and in these facilities, DOD is able to establish a sustainable program through

strengthening of the physical and equipment infrastructures, implementation of a facility level quality

assurance/quality improvement program, improved laboratory equipment and systems. DOD's goal, over

the last two years, is to provide quality systems to ensure sustainable laboratory support after this aspect of

the program concludes.

FY08 activities focus on continuous strengthening of ZDF labs in the outlying areas and monitoring

performance of sites already improved. This activity will be linked to SCMS to ensure laboratories have

reagents and sustainable service.

The DoD will further support improvement of service delivery in HIV/AIDS care, treatment and testing

through infrastructure improvement and expansion on ten (10) ZDF sites and provision of equipment.

Improvement will include renovations to infrastructure while expansion will include new constructions.