The funding level for this activity in FY 2009 will remain the same as in FY 2008. Narrative updates have

been made to highlight progress and achievement.

The goal of the Ministry of Health (MOH) is to extend PMTCT and Pediatric HIV prevention, care, support

and treatment services to 80% of the expectant mother population and to 80% of HIV exposed and infected

children by 2010. In order to achieve this, scale-up of services to 100% of MCH sites is required with

provision of quality ensured comprehensive PMTCT services which include: a) routine HIV testing of

pregnant women by "opt-out" approach; b) testing of their partners and other family members with an

emphasis on provision of "family-centered care"; c) screening for and management of other co-morbidities

and opportunistic infections such as Anemia, Malaria, Sexually transmitted infections and Tuberculosis; d)

counseling on infant feeding, safe sex practices and family planning; e) provision of family planning

methods with promotion of double protection; f) provision of antiretroviral drugs (ARVs) to the mother for

PMTCT prophylaxis as well as for her own health if in need; g) provision of ARVs to the baby for PMTCT

prophylaxis; h) early infant diagnosis through Polymerase Chain Reaction (PCR) at 6 weeks; i)

cotrimoxazole prophylaxis to all HIV exposed infants; and j) referral links to treatment, care, and support for

both mother and infant.

These efforts need to be supported and enhanced by full engagement of the community. Furthermore, by

ensuring that all PMTCT sites available at any one time have active provider-initiated counseling and testing

in place for children from all entry points, access to dried blood spots (DBS) testing services and an

effective referral system for referral of children to antiretroviral treatment (ART) services will ensure

achievement of 80% of HIV infected children in need being put on ART.

A fundamental component to achieving these goals and objectives is a robust Monitoring and Evaluation

(M&E) system. This provides the opportunity to track progress, identify and remedy bottlenecks.

Several milestones have been achieved in the M&E of PMTCT services with United States Government

(USG) support. In FY 2008, the Ministry of Health implemented the following:

1) Formation and functioning of an M&E subcommittee of the Technical Working group for PMTCT and

Pediatric HIV Prevention, Care, Support and Treatment; 2) integration of PMTCT and Pediatric HIV

indicators in the newly revised Health Management System (HMIS); 3) printing and distribution of new

registers in conformity with indicators included on the HMIS; 4) capacity built at provincial and district-level

for population based estimation, planning and tracking of progress; 5) establishment of quarterly data audit

and peer review meetings to review district performance in PMTCT and Pediatric HIV care; 6) strengthening

of feedback within M&E by initiating the holding of the first technical feedback meeting for provincial

technical staff; and 7) roll-out of the electronic tracking system, SmartCare.

These efforts have resulted in capacity being built at all levels to produce quality audited and validated

information that is peer reviewed. In addition, the entrenching of population based planning, implementation

and review is contributing to optimizing service delivery at district and facility-level, as program gaps are

more easily identified. In the past year we have held the first national technical consultation in PMTCT and

pediatric HIV, involving districts, provincial-level and national-level, which among other things made

recommendations and resolutions that have been outlined below, to enhance M&E, strengthen linkages,

and realize ownership at all levels.

The M&E of PMTCT and pediatric HIV care still requires several further actions towards its strengthening

and sustainability. In FY 2009, the MOH plans to implement the following:

Integrated PMTCT and Pediatric HIV Care on the health management information system (HMIS) and

revised and developed registers for primary data collection (cascade training is required from provincial to

district to facility-level). This will build capacity in use of these tools in recording, reporting as well as

analyzing the data to determine performance status and necessary action.

Mentorship to facilities for service delivery, recording, and reporting as a follow-up activity after PMTCT

services have been established. Training has been identified to only be effective in capacity building when

it is combined with mentorship. Mentorship provides an opportunity to give on-the-job guidance and support

towards quality and effective service delivery. Mentorship in the area of M&E will be introduced and

strengthened.

Building capacity at facility-level for population based estimation and progress tracking and sustaining this

capacity at provincial and district-level. Population based estimation of targets has been identified as a

critical component within the scale-up plan. This gives districts an appreciation of their burden and to what

extent their interventions are successful and helps with planning for resources to be able to effectively

achieve targets. Capacity has been built to this effect at provincial and district-level but still needs to be

strengthened and replicated at facility-level.

Inclusion and strengthening of quality improvement approaches as a deliverable of the Monitoring and

Evaluation subgroup of the Technical Working Group and Building capacity at provincial, district and facility-

level for use of Quality Improvement Approaches to intervene in areas of poor performance.

A large emphasis has been placed on scale-up or expansion of services in a drive towards universal

access. It is also important that these services are of quality to ensure that women and children receive

holistic care towards prevention, care, and treatment of HIV. This can be achieved through the adoption

and use of quality improvement approaches at all levels beginning at central level through the Monitoring

and Evaluation subgroup and building capacity in this area at provincial, district and facility-levels.

Developing strong feedback mechanisms and systems from one level to the next and interdepartmentally at

service implementation-level (facility) will ensure continuity to access of services and ease the health

workers in the follow-up of comprehensive ART services to HIV positive women. Communication of

Activity Narrative: performance findings is frequently a neglected area in the area of M&E and this inhibits the identification of

gaps and specific needs for technical support. Feedback will be enhanced through meetings and referral

slips at the different levels to provide a platform for analysis of performance and defining of required actions

within specific timelines.

The community is a key component of an effective PMTCT Pediatric HIV care program. Community

involvement spans from mobilization of its members, advocacy, communication, and taking up skills shifted

from health workers due to overwhelming workload. This immense involvement of the community entails

that information systems extend to tracking of activities at community-level. This can be done through the

development of simple data collecting and reporting tools that link service provision at facility-level with

community-level and skills building in their use.

Strengthening of the PMTCT logistic management system at facility-level and improving communication and

feedback within the PMTCT logistic management information system will ensure that there are no stock-

outs to avoid service disruption. The PMTCT logistics management system has been rolled out through

Partnership for Supply Chain Management Systems (SCMS); however its effectiveness has been

compromised due to poor reporting at facility-level with only about 25% of PMTCT sites reporting

consistently to MOH. This is likely to impact negatively on stocking levels at facility-level as well as

accurate projection of national consumption. Capacity building through mentorship is therefore required at

PMTCT sites and strengthening of communication and feedback of findings in the logistic management

information system for timely action.

Strengthening of the tracking of infant and young child feeding components of the PMTCT program through

policy updates to reflect new science in this field is needed. Nutrition is a key determinant of child survival

and has a strong influence on transmission of HIV from the mother to the child. Efforts towards uptake of

ARVs by mother and baby for PMTCT can be reversed if the infant and young child feeding component of

the program is weak. It will therefore be a priority to track infant and young child feeding practices so as to

facilitate timely intervention towards achieving prevention of mother-to-child transmission of HIV.

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

New/Continuing Activity: Continuing Activity

Continuing Activity: 15535

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15535 9737.08 HHS/Centers for Ministry of Health, 7175 3019.08 MOH - $225,000

Disease Control & Zambia U62/CCU02341

Prevention 2

9737 9737.07 HHS/Centers for Ministry of Health, 5009 3019.07 MOH - $325,000

Disease Control & Zambia U62/CCU02341

Prevention 2

Emphasis Areas

Health-related Wraparound Programs

* Family Planning

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

THIS IS A NEW ACTIVITY UNDER THE MINISTRY OF HEALTH (MOH) TO SUPPORT COORDINATION,

INTERVENTION, AND IMPROVED EDUCATION FOR SEXUALLY TRANSMITTED INFECTIONS (STIs) IN

ZAMBIA.

This activity also relates to activities in other prevention (Southern, Eastern and Western Provinces) and

Counseling and testing (HVCT # Clinic 3)

As in many other sub-Saharan African countries, curable STI's continue to represent a large burden of

disease in Zambia, accounting for about 10% of out-patient department attendances. The actual incidence

is much higher considering that many STI clients seek care with private clinics and traditional healers where

they feel more assured of privacy and confidentiality. In addition, asymptomatic infections remain high in the

general population especially in women.

The 2002 Zambia Demographic Health Survey (ZDHS) showed a Rapid Plasma Reagin (RPR) syphilis

positive rate in the 15-49 age-group of 7% for women and 8% for men and an HIV prevalence rate of

14.3%. In a report from the Corridors of Hope program in 2006, the prevalence rates of gonorrhoea,

chlamydia, trichomoniasis, and syphilis among female sex workers were 10.4%, 6.8%, 38.8% and 23.3%,

respectively.

The synergy between STIs and HIV is underscored by a significantly higher HIV prevalence among STI

clients, with reports of up to 40-50% in some settings, particularly those with ulcerative STI's. Controlling

STIs, through prevention as well as early and effective treatment is therefore a high priority for the country

and is one of the main strategies for HIV control advocated by the MOH.

The national response and intervention strategy includes the following emphasis areas: improved case

management; enhanced in-service and pre-service training in syndromic management of STI's with an

integrated approach; supervision and mentoring of primary health care workers; strengthening monitoring,

evaluation, STI surveillance, and reporting; strengthening STI supplies particularly drugs and condom

supplies; improved community participation in prevention, control and early treatment and broker synergistic

relationships and networks with private sector and stakeholders in STI prevention and control.

The main gaps identified in STI area can be summarized as follows:

At the community level, management of partners (notification and treatment) continues to be very poor

owing to various factors including gender and cultural issues which negatively affect communication

between partners.

At the clinic level, quality of STI services remains poor due to shortage of appropriately trained staff

(numbers and skills); poor clinic structures do not allow for patients being treated in privacy; irregular supply

of drugs for syndromic management; counseling is not done routinely by staff; and poor recording and

reporting of STIs hampers accurate estimate of incidence rates.

At district and provincial levels, there is inadequate support, supervision, and management as available

supervisors have several tasks in addition to supervision of clinics and or subordinates.

At national or program level, private clinics and other stakeholders (e.g. defense forces and non-

governmental organizations clinics) in STI management do not routinely report into the national Health

Management Information System (HMIS). Further, regular monitoring of interventions and operations

research are not carried out routinely or timely owing to difficulties to mobilize expertise and funds.

The STI program activities are budgeted for in the National Health Strategic Plan. The ministry has partners

such as the Global Fund who have been instrumental in capacity building front-line health workers in

syndromic management and providing equipment for use in STI clinics. Other partners such as CDC have

trained Training of Trainers, printed STI training manuals, and provided technical assistance (TA) during the

STI Syndromic Management Treatment guidelines adapted from WHO. World Bank has undertaken

refurbishment of national STI reference centre and number of clinics in the country specifically in youth

friendly corners.

FY 2009 funding is being requested to begin to fill some of the current gaps mentioned above. Particularly

it will be used to strengthen coordination of partners working in various parts of the country implementing

STI activities. It will also be used to strengthen the national efforts towards support supervision to improve

quality of routine data collected for HMIS, support routine provider initiated counseling and testing for STI

clients, regular updates on evidence based practice that feed into national guidelines and improve the

monitoring and evaluation of STI programs. Additionally these funds will be used to hold two meetings with

all stakeholders and key STI providers.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $10,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Activity Narrative:

ACTIVITY HAS BEEN REDUCED SINCE FISCAL YEAR (FY) 2008 BY $150,000. THESE FUNDS HAVE

BEEN ALLOCATED TOWARD MINISTRY OF HEALTH (MOH) PEDIATRIC ANTITRETTOVIRAL

THERAPY (ART). MINOR CHANGES AND UPDATES REFLECTED IN THE NARRATIVE

Activities related to this include monitoring visits, training, policy and guidelines dissemination, participation

national quality improvement efforts, and integration and scale-up of the national ART information system,

the SmartCare development which is also incorporating (the HIV resistance Early Warning System) and

implementation, MOH drug resistance Surveillance System . In FY 2006, the Zambian MOH started

implementing the policy of free ART and related services provision and in 2007 expanded provision of free

services to all eligible Zambians. To this array of free services the MOH endeavors to introduce viral load

and HIV resistance testing in a limited capacity using a stringent and highly selective test eligibility criteria to

be applied at tertiary level health facilities that handle complicated HIV patients.

In FY 2008, the MOH has strengthened supervision and coordination by national teams of ART service

delivery and has improved linkages with the provincial and district ART programs and intends to consolidate

this in FY 2009. Direct support to MOH in FY 2009 will enable key technical staff to plan and integrate

services with partners for the period 2009-2011. This will require updating the HIV/AIDS Treatment, Care,

and Support Plan. This plan will embrace the ideal of universal access and set targets for program

performance and ensures sustainability of the ART services. Direct funding for ART service delivery and

technical assistance will complement other support to MOH such as in tuberculosis (TB)/HIV, and strategic

information. In FY 2008, an HIV Drug Resistance (HIVDR) Surveillance System has been established and

the country working plan for HIVDR surveillance has been adopted with substantial resources from the

World Health Organization (WHO) having been secured for implementation during the FY 2009. FY 2008

funding will complement the WHO resources for expansion of these activities. With FY 2009 funding, the

activities of the working group and implementation of the work plan will be scaled-up. From the results and

experiences of the pilot HIV drug resistance program MOH intends with FY 2009 funding to establish four

additional monitoring sites across the country that will include a pediatric HIVDR monitoring site. Other

critical activities in FY 2009 are continued building laboratory capacity to perform genotypic HIV drug

resistance testing, support of management and analysis of data on the magnitude of HIVDR in the selected

study population, and coordination of report dissemination to the Government of the Republic of Zambia,

health professionals, the public, and the scientific literature.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15537

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15537 9754.08 HHS/Centers for Ministry of Health, 7175 3019.08 MOH - $300,000

Disease Control & Zambia U62/CCU02341

Prevention 2

9754 9754.07 HHS/Centers for Ministry of Health, 5009 3019.07 MOH - $300,000

Disease Control & Zambia U62/CCU02341

Prevention 2

Table 3.3.09:

THIS IS A CONTINUING ACTIVITY FUNDED FROM THE TREATMENT PROGRAM IN FY 2008, BUT IN

FY 2009 A NEW NARRATIVE SPECIFIC FOR PEDIATRICS HAS BEEN EXTRACTED.

Estimates for 2006 by UINCEF indicated that 130,000 children were HIV-infected in Zambia; of these,

40,000 were in immediate need of antiretroviral therapy (ART). However, from the onset of the scale-up of

ART services in Zambia, children have not been comprehensively addressed and this has resulted in few

children accessing the much needed HIV care, support and treatment services. The Ministry of Health

(MOH) in conjunction with its cooperating partners embarked on a scale-up of children accessing care,

support, and treatment services for Paediatric HIV. As a result of these concerted efforts, at the end of the

second quarter of 2008, over 15, 000 children were on record to be receiving ART.

Though the scale-up of pediatric HIV services has been progressing well, it is still recognizably in early

stages as only eight percent of the total number of people receiving ART are children. One of the

hindrances to achieving universal access to HIV care and treatment for children has been lack of knowledge

and skills on the part of the healthcare worker in managing children with HIV. Therefore building healthcare

worker capacity to provide Paediatric HIV services (through training and mentorship) involves a large part of

scaling-up HIV services for children. In FY 2007, the MOH embarked on the nation-wide training in

paediatric HIV management in order to equip health care workers with the knowledge, skills, and attitudes

essential to provide comprehensive HIV care services for all. More efforts are required to ensure that all

eligible health workers acquire these skills; in-service training of healthcare workers will therefore need to

continue until this is achieved.

Beyond training in management of HIV, healthcare workers require ongoing clinical mentorship; this

continues to build healthcare worker capacity at the point of care and ensures that good standards are

being maintained in paediatric ART service delivery. MOH in May 2008 developed guidelines on clinical

mentorship and began using these tools with central based mentors from the teaching hospital. In order to

make this mentorship program sustainable, it is vital that provincial and district driven mentorship is

established. Nationwide, sites differ in their capacity to develop Paediatric HIV clinical mentorship teams.

For sites that do not have much experience in handling children with HIV, teams will have to be trained in

provision of Paediatric HIV mentorship.

The MOH also recognized that in order to identify the children in need of ART there was need to expand

areas from which HIV-positive children could be captured. In this regard, in FY 2007, the ministry released a

memorandum recommending provider initiated testing and counseling to all children in contact with the

health system. This will need to go hand in hand with increasing the number of counselors equipped with

child-counseling skills to address the increasing demands of Paediatric focused counseling.

As part of the efforts to provide quality care and treatment service to HIV-positive children, the ministry has

also adopted the WHO recommendation to initiate all infants (12 months and below) on therapy, once

definitive diagnosis of HIV has been attained, regardless of CD4 counts. As the Paediatric HIV treatment

and care program expands, there will be need to evaluate the impact of the program by establishing areas

for operational research using various avenues including routinely collected data.

In FY 2009 funds for this activity will be used largely to carry out various training related to Pediatric

services, namely training of 50 health care workers in the delivery of paediatric ART services; training of 25

child counselors, who will serve to supervise child counseling activities and training of 20 selected providers

in clinical mentorship program. An additional activity will be monitoring and supervision of the trainings and

other Pediatric services within the provinces. This will leverage on technical support from various

cooperating partners currently working in the area of pediatric care and treatment.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $130,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

The funding level for this activity in FY 2009 will be the same as for FY 2008. Narrative updates have been

made to highlight progress and achievements.

Activity Narrative:

This activity relates to activities in counseling and testing (CT), laboratory infrastructure, palliative care, and

basic health support activities

This activity provides support for the national implementation of tuberculosis (TB) and HIV activities through

the following: 1.) TB/HIV collaborative meetings at National and Provincial levels; 2) provision of technical

support to the provinces and districts through supportive supervision; 3) National TB review meetings; 4)

and support for one full- time TB/HIV Officer to be based within the Ministry of Health (MOH).

In FY 2006 and 2007, the US Government (USG) provided direct support to the MOH through CDC

Technical Assistance (TA) in the following areas: integration of TB and HIV services at national and local

levels; support for the development of TB/HIV guidelines and materials; and preparation of TB clinical

decision support systems.

A national TB/HIV coordinating body within the MOH was convened with the following membership: staff

from TB, HIV, CT, and Prevention of Mother-To-Child Transmission (PMTCT) units in MOH; multilateral

organizations; research groups; faith based organizations; NGO; and representatives of the community .

This body was tasked with developing and implementing a single, coherent TB/HIV strategy and

communication message based on the most valid evidence. As a result, national guidelines for the

implementation of TB/HIV activities were developed based on the World Health Organization (WHO) Interim

Guidelines for TB/HIV collaboration. Additional support was provided for the revision of TB data collection

and reporting forms and registers based on WHO forms that incorporate the collection of HIV data. The

USG supported the MOH to print the revised patient treatment cards, identity cards and registers that were

distributed to all the provinces and districts. Technical support was also provided for the orientation of health

staff on the new forms. In addition, the USG co-funded with the MOH, WHO, and JHPIEGO, a training of

trainers course in Provider Initiated Counseling and Testing (PICT) using the national training of trainer's

module adapted by JHPIEGO for the initial group of 25 trainers in PICT

By the end of FY 2007, the USG provided support for regular meetings of the TB/HIV coordinating bodies at

the national and provincial levels. Other activities supported during 2007 included production and

dissemination of the TB/HIV guidelines to the provincial TB/HIV coordinating bodies and orientation of

health staff on provision of provider-initiated counseling and testing to TB patients. Technical assistance to

the districts for the implementation of these guidelines was provided in conjunction with other partners such

as USAID Child Survival Fund's for Tuberculosis Assistance Program (TBCAP) and WHO.

In FY 2008, the national TB/HIV coordinating body developed and disseminated terms of reference for the

provincial, district, health centre, and community, TB/HIV coordinating committees. The terms of reference

include building of capacity, coordination of the implementation, monitoring and evaluation of TB/HIV

activities, and the development and dissemination of information on TB/HIV. Guidance and technical

support is provided by the national body to ensure implementation in districts. Through this mechanism,

support was provided for quarterly meetings of the national and provincial TB/HIV coordinating bodies. By

the end of FY 2008, over 80% of the districts in Zambia would have formed the district TB/HIV coordinating

bodies.

In FY 2009, the National TB Program will continue to provide guidance and support to the provincial TB/HIV

coordinating committees with support from the USG and through these committees to the district and health

center bodies. It is expected that by the end of 2009 all districts in Zambia and at least 50% of health

centers would have formed the coordinating bodies and begun the process of forming the community

TB/HIV bodies.

The National TB Program holds national TB/HIV Review meetings on a biannual basis that includes

participants from the provincial health office (Provincial TB Focal person, Data Specialist), TB focal persons

from key hospitals and selected districts, and cooperating partners supporting the TB program. During this

meeting, data from all the provinces is compiled, analyzed, and used for planning. The USG has historically

provided direct support in FY 2007 and FY 2008 for the meeting as well as active facilitation services.

In FY 2009, the USG will continue to support the biannual National Review meetings through this

mechanism, whilst support for the review meeting in the provinces and districts will be provided either

directly to the Province through cooperative agreements or other available mechanisms. These meetings

provide a forum for information sharing, providing updates as well as validation of the national data as a

means of improving the quality of data.

The increased work load in the National TB Program coupled with shortage of human resource has

impacted negatively on the implementation of some TB/HIV collaborative activities. To strengthen the

human resource capacity in the national program, since FY 2007, the USG supported the MOH with the

placement of a full-time TB/HIV officer in the TB unit, thus increasing the number of staff in the unit to six,

including two officers (Data and Private Public partnership) supported through the Canadian International

Development Agency (CIDA)/ Netherlands Tuberculosis Foundation (KNCV) funds. The duties for this

officer are focused on the implementation of TB/HIV activities, working directly under the jurisdiction of the

National TB Program (NTP) Manager. This support will continue in FY 2009.

With the FY 2007 plus-up funds, technical supportive supervision was provided to all provincial health

offices and 35 districts. Through this supervision, the TB/HIV Program officers identified the strengths,

weaknesses, opportunities, and threats to the program and offered appropriate technical advice on

strategies to strengthen the program.

Activity Narrative: During FY 2007, a total of 800 health care providers received on the job training.

By the end of FY 2008 technical support and supervision would be provided by the national TB unit to

provincial health office, the provincial hospitals and a selection of districts twice a year. In order to enhance

the capacity for monitoring and evaluation of TB/HIV program, the supervisory visits included a component

of training in the use of information for management decisions at provincial, district, health center and

community levels including ensuring that health care providers are competent in the use of data collection

and reporting tools. It is expected that 850 health care providers will receive on the job training through this

supervision.

In FY 2009, the NTP, with support from the USG, will continue to provide technical supervision to the

provincial health office, which in turn will provide support to the districts and the districts will support and

supervise the health centers and this level will provide support to community health care providers. By the

end of FY 2009, it is expected that 900 health care providers will receive on the job training.

In FY 2007 and FY 2008 the National TB Program (NTP) began addressing the issue of Multi-Drug

Resistant (MDR) TB through the development of a notification system for MDR cases nationwide and the

appointment of an MDR working group as a sub-committee of the main TB/HIV committee. This committee

was tasked with developing the guidelines for the management of MDR TB and a training program for

clinicians and four members of this committee have participated in training of trainers in MDR by the World

Health Organization. One of the main concerns had been the development of a facility for the management

of MDR, and to this end the MOH began renovations of a building situated in the grounds of the main

referral hospital, the University Teaching Hospital in Lusaka with funds from Global Fund Round 1 phase 1

grant. However, these funds were not sufficient to complete the renovations and therefore funds available

from the USG would be used to complete the building that will serve as an isolation facility for all cases of

MDR TB. The support included training in the management of MDR TB for the clinicians and nursing staff

that would provide care in this facility and personal protective equipment would be procured based on the

national guidelines. Patients will be referred to Lusaka from the different health institutions in the country by

use of an ambulance service to be based in Lusaka and supported by the Ministry of Health National TB

program. Personal protective equipment will be purchased for use by the staff running this ambulance

system using funds from other sources. The MOH has plans to apply to the Green Light Committee (GLC)

for second line drugs and the development of a specific facility for the management of MDR TB is one of the

requisites to qualify for consideration by the GLC for second line drugs. In the interim the MOH will procure

the second line drugs needed for the management of the 50 MDR cases currently registered with the

national program. In FY 2008 the MOH began a national drug resistance survey in collaboration with the

Zambian AIDS Related TB Project (ZAMBART) with funds from the Global Fund Round 1 grant. This

survey will include testing all MDR specimens for extreme drug resistance. This support will continue in FY

2009. The TB/HIV subcommittee of the national TB/HIV Coordinating Body worked with JHPIEGO to

develop national guidelines for infection control in order to prevent the transmission of TB in health care

settings. These guidelines will be produced and training conducted at national and provincial level by

JHPIEGO with PEPFAR support (activity #). This support will continue in FY 2009 and include training of

20 health staff in the management of MDR cases.

There are no gender disparities in the provision and access to TB/HIV diagnosis and treatment in Zambia.

To ensure sustainability, the activities are enshrined in the Ministry of Health NTP strategic plan.

Targets set for this activity cover a period ending September 30, 2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15536

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15536 12445.08 HHS/Centers for Ministry of Health, 7175 3019.08 MOH - $500,000

Disease Control & Zambia U62/CCU02341

Prevention 2

12445 12445.07 HHS/Centers for Ministry of Health, 5009 3019.07 MOH - $365,000

Disease Control & Zambia U62/CCU02341

Prevention 2

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $300,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Training and implementation support will continue, but with a specific focus on data analysis. Assistance will

be provided for the hiring of a public health and research staff person to support surveillance and public

health activities.

This activity relates to Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Strategic Information (SI)

(#3709.08), JHPIEGO SI (#3710.08), AIDSRelief - Catholic Relief Services (CRS) (#3711.08), Eastern

Provincial Health Office (EPHO) (#9693.08), Western Provincial Health Office (WPHO) (#9696.08), Zambia

National Blood Transfusion Service (ZNBTS) (#9698.08), SmartCare COMFORCE (#9692.08), CHAZ

(#16972.08), and CHAZ (new OHSS).

The SmartCare related activities in fiscal year (FY) 2009 have components involving the continuation of

programs from 2008, including a continuation of the gradual shift in balance of responsibilities for

SmartCare as the requisite specialty skills and human capacity grow at the Ministry. As an instance,

procurement of Smart Card supplies (Care Cards) in the initial roll-out stages of SmartCare the care cards

have been bought first through CDC and then EGPAF with CDC technical support as this is quite technical,

the market is limited, and a small error results in substantial wastage; the Ministry of Health (MOH) would

like to move into this procurement responsibility in addition to the responsibilities of projecting needs

managing inventory, and distributing the Care Cards to the Provincial Health Offices and District Health

Offices which began in 2008.

The MOH central team will continue to conduct the majority the technical support site visits as Quality

Control and Quality Assurance checks in the places where SmartCare has been deployed, becomes better

institutionalized in 2009. The SmartCare application keeps on undergoing enhancements in order to make it

more user-friendly. Training in the new modules and the improved system will be ongoing in 2009, but most

trainers already are MOH staff.

The MOH will work with the General Nursing Council in the development of the SmartCare curriculum so

that it is incorporated into the nursing curricula, and the new systems strengthening activity though

Churches Health Association of Zambia working with the Nurse Training School (NTS) at Macha Mission

Hospital will be synergistic with this effort . The training of the examiners and tutors at the nursing colleges

will take place during the funding period.

The new MOH E-Learning Centre will continue holding training programs for different categories of staff

based on a Training Needs Assessment (TNA). The curriculum for this venue is being augmented by

volunteer Microsoft Certified Trainers, as well as MOH staff.

FY 2009 funding will also enable the Zambia MOH to support and expand surveillance of HIV/AIDS and HIV

-related morbidity and mortality through the following activities: 1) reporting and dissemination of results of

the 2008 Zambia Antenatal Clinic Sentinel Surveillance (ANC SS) and the Zambia Demographic and Health

Survey (ZDHS) on estimates of HIV and syphilis prevalence (and recent infections) in relation to important

socio-demographic factors and additional laboratory analyses; 2) strengthening the Zambia National Cancer

Registry and the Cancer Diseases Hospital in surveillance and reporting of AIDS-related malignancies to

enable the MOH to monitor the impact of PEPFAR antiretroviral therapy scale-up on the risk of important

AIDS-related complications; 3) supporting the MOH as it works with the Central Statistical Office to

implement death registration and to ascertain cause of death in health facilities to obtain mortality data; 4)

supporting MOH staff in training in analytic skills and to increase proficiency in data assessment issues that

are critical and fundamental to all HIV/AIDS SmartCare, M&E, and surveillance data collection and

reporting; 5) assisting the Ministry of Health to hire public health and research technical staff with

appropriate academic training and experience to support surveillance and public health activities. This

person will aid in health information analysis a) to inform planning, b) to evaluate the impact of health

programs, and c) to facilitate health research, evaluation, and communication of health information, to

health professionals, policy makers, and the general public.

These activities will increase the proficiency of MOH staff in the systematic collection, analysis, reporting,

and use of data, effective communication of results for MOH planning of HIV/AIDS services and program

evaluation, and capacity building within MOH so that these activities can be sustained by Zambian health

professionals beyond FY 2009/2010.

Targets set for this activity cover a period ending September 30, 2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15538

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15538 3713.08 HHS/Centers for Ministry of Health, 7175 3019.08 MOH - $920,000

Disease Control & Zambia U62/CCU02341

Prevention 2

9008 3713.07 HHS/Centers for Ministry of Health, 5009 3019.07 MOH - $750,000

Disease Control & Zambia U62/CCU02341

Prevention 2

3713 3713.06 HHS/Centers for Central Board of 3019 3019.06 MOH/CBoH- SI $200,000

Disease Control & Health

Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17: