Lusaka Provincial Health Office (LPHO) is an auxiliary wing of Ministry of Health (MOH), Zambia whose unique mandate is to perform core public health activities. The office provides technical support to districts within the province namely Chongwe, Kafue, Luangwa and Lusaka in the delivery and management of health services which include: planning, priority-setting and optimal use of available resources. The mandate of Lusaka PHO includes data collection and its management, staff training, and policy advocacy. All non-governmental organizations (NGOs) and other agencies conducting health- related activities in the province work in collaboration with PHO. Lusaka Province has eighty (80) government health centers, three (3) district hospitals, and two (2) tertiary hospitals but has no general/secondary hospital(s). The province has two hundred and fifteen (215) private health facilities. All of these institutions offer either diagnostic services or both diagnostic and treatment services for Tuberculosis (TB) but anti-retroviral therapy (ART) services are not easily accessible outside Lusaka District. Lusaka Province has the highest HIV/AIDS prevalence rate in the country at 21% (Zambia Demographic Health Survey, 2007). The province notifies about one third of the total tuberculosis patients in the country (16,626 out of 47,000 in 2008). Seventy percent of these patients are HIV infected. PHO implements the STOP TB strategy for TB and TB/HIV control. Country estimates show that only about 10% of the population know their HIV status. The province is implementing different strategies to enhance counseling and testing, including community sensitization, provider initiated counseling and testing, and are moving towards strengthening couples counseling. The MOH has recognized male circumcision as one of the effective preventive strategies for HIV, so a policy direction has been issued to roll out this strategy to all districts in the country. Through capacity building workshops for staff, mentoring, and onsite supervision, PHO will address the limited capacity to diagnose and treat opportunistic infections in many facilities in the province. In order to strengthen the laboratory network and quality assurance program, we will support districts with infrastructure development, transport and logistics to facilitate on-site supervision, training and specimen collection to laboratories. Additionally, we will facilitate procurement of laboratory equipment, reagents and other supplies. In an effort to improve case detection by laboratory diagnosis, microscopists will be trained. Promoting effective and efficient use of resources, we will ensure integration of programs in the districts and coordinate partner programs in the province. Improvements in data and information management will be facilitated by LPHOs procurement of a broadband communication facility and employ of a data associate at PHO. LPHO will prepare and submit quarterly and annual reports to the MOH. LPHO will support districts to conduct monthly supportive supervisory visits to facilities. Districts will prepare and submit monthly and quarterly reports to the province. LPHO and the districts will hold quarterly program performance review meetings.

Lusaka Provincial Health Office (LPHO) will train health workers in psychosocial counseling, community volunteers in lay counseling and rapid HIV testing. Couples counseling will be strengthened in the districts through community sensitization and orientation to health workers on the need to provide counseling to couples. Sensitization messages will continue through various forms of media such as drama and information, education, and communication (IEC) materials to the target population. For continuous improvement of the counseling environment, LPHO will invest in minor infrastructure development in two sites in each of the three districts. We will provide technical supportive supervision on a quarterly basis with a view to mentoring district supervisors and building supervisory capacity to ensure quality of counseling and testing services. We will monitor district activities in couples counseling through monthly and quarterly reports and quarterly performance review meetings.

LPHO will also support the implementation of the SmartCare testing and counseling (TC) module. $75,000, of the $205,000 total amount, is provided to help assure training and oversight for the SmartCare TC module implementations, at all TC sites.

In order to improve data and information management, LPHO will facilitate procurement of a broadband communication facility - Very Small Aperture Terminal (VSAT) to provide linkages between the districts and the provincial health office. This is intended to enhance timely reporting and submission of data as well as general management of computer security in updating the antivirus software over the internet. LPHO will use this facility to disseminate updates and other communications for various programs. A data associate will be employed at LPHO whose responsibility will include collection and collation of TB, HIV/AIDS, ART, PMTCT, VCT and laboratory data and technical support to district staff. The data associate will also support the management of the SmartCare installations in Lusaka Province.

To provide enhanced PMTCT and ART services to positive mothers, SmartCare will be deployed in at least 80% of the sites offering PMTCT, which have sufficient electricity.

LPHO will improve the quality of SmartCare facility data through performance review meetings and supervisory activities. Likewise, LPHO will support DHIOs to collect, verify and timely report to the provincial health office and ensure that old and new health staff are competent to correctly and accurately record, analyze and report health data using SmartCare to support the HMIS system.

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LPHO will provide leadership in expanding male circumcision (MC) services to Kafue and Luangwa districts in addition to Chongwe. A rapid survey will be conducted in Kafue and Luangwa districts to assess attitudes, beliefs, practices and socio-cultural aspects of MC. LPHO will advocate for community involvement by engaging community leaders such as traditional rulers and other opinion leaders to mobilize communities for MC services. LPHO will facilitate human resource development through on-site and didactic training of staff and work with districts to develop district implementation plans for MC activities. Renovation of existing infrastructure in order to conform to national standards for MC services will also be facilitated by LPHO; further, we will support furnishing of buildings and procurement of equipment and supplies. We will link MC activities to HIV counseling and testing services in all facilities in order to contribute to risk reduction in contracting HIV infection. LPHO will provide supportive supervision in collaboration with the University of Zambia School of Medicine and engage other partners involved in MC activities such as Jhpiego and Society for Family Health. In order to ensure sustainability of the program MC services will be integrated within regular health services provided by the district health teams. LPHO will support districts in M&E and quality assurance through technical support visits, quarterly meetings, and reports.

Lusaka Provincial Health Office (LPHO) will support and build capacity in districts in order to collaborate with stakeholders in TB/HIV control to expand community education and awareness regarding STIs and the risk they pose for HIV infection. In order to promote sustainability and lasting behavior change, we will support STI services as part of regular health services provided by the district health teams. LPHO will build capacity in all four districts of Lusaka, Chongwe, Kafue and Luangwa. LPHO will support health education talks to include STI prevention and treatment seeking behavior. Activities that promote early treatment seeking behavior for STIs will target young people (males and females), adult men, and women in order to reduce the transmission of HIV. We will train Youth Peer Educators to deliver health talks in health facilities. This will revive Youth Friendly activities and services in health facilities. LPHO will continue to engage and educate community leaders such as traditional rulers and other opinion leaders to conduct community mobilization for the STI education. We will support districts to conduct HIV prevention activities through focus group discussions and drama performances. LPHO will support districts to produce IEC materials in local languages and promote accessibility to and availability of condoms. Through capacity building workshops, staff training and mentoring will take place and on-site supervision will be conducted regularly in order to ensure that appropriate preventive activities are implemented. In order to promote effective and efficient use of resources, LPHO will ensure integration of preventive programs in the districts and coordinate partner programs in the province. LPHO will prepare and submit quarterly and annual reports to the MOH.

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LPHO has a goal of improving the capacity of laboratories to provide effective and efficient quality laboratory services in order to enhance diagnosis and patient monitoring in HIV/AIDS/TB/STI related conditions. To meet the goal, LPHO will support selected laboratories to acquire laboratory accreditation. LPHO will initiate and conduct accreditation process(es) with MOH and CDC. We will support and ensure quality of all laboratories testing including HIV, build capacity of laboratory personnel through various trainings which will be undertaken in collaboration with MOH, CDC and other partners. In addition, We will support thirty laboratory staff to attend in-country training courses in lab accreditation, laboratory management, quality assurance (QA), basic computer skills, laboratory accreditation, phlebotomy, equipment maintenance, and lab information system.

LPHO will support TB QA activities in collaboration with the University Teaching Hospital TB reference laboratory. A QA system for laboratory related tests including but not limited to HIV rapid test, CD4, and TB smear microscopy will be established from province to district and district to health center. We will procure equipment maintenance services.

LPHO will create an operational logistic system to bring specimens from health centers to district and/or provincial laboratory where there is CD4 testing capacity and other clinical lab capacity. We will support specimen referral and transportation systems by procuring motor bikes for ART sites, procure fuel and cool boxes for transporting specimens.

We will monitor services through quarterly technical support, quarterly technical review meetings and progress reports.

LPHO trained 93 health workers in TB/HIV integration, 45 in provider-initiated testing and counseling and 100 treatment supporters in TB/HIV activities. Counseling and testing of TB patients for HIV increased from 54% in 2007 to 60% in FY 2008. In order to strengthen mechanisms for collaboration between TB and HIV programs, we will continue supporting provincial and district coordinating body activities and establish health center and community level bodies.

Training in intensified TB case finding in Anti-retroviral Therapy (ART), Voluntary Counseling and Testing (VCT), Sexually Transmitted Infections (STI) and antenatal clinics will be conducted, in order to reduce the burden of TB in HIV infected individuals. In addition, we will train microscopists and orient staff to improve case detection by laboratory diagnosis. Health workers will be trained in TB infection control and ensure TB infection control measures at facility levels. LPHO will continue supporting the employment of four clinicians and TB/HIV coordinator(s) to improve on the shortage of staff.

Coordination of partner activities and oversight of trained health workers as well as refresher trainings and/or technical updates for selected health workers in TB/HIV clinical management will continue. Provider initiated counseling in TB clinics and OPD for both suspects and confirmed TB patients will be maintained and support will be offered to districts in strengthening linkages and referral systems from TB to HIV services. TB/HIV co-infected patients will be encouraged to use condoms, notify partners and linked to support groups of people living with HIV/AIDS for continued care and support. We will strengthen Multi-Drug Resistant TB (MDR) surveillance in the districts by supporting specimen courier systems to laboratories. LPHO will continue to support income generating activities for community volunteers to motivate them, identify TB suspects, and care for patients on treatment. LPHO will continue to conduct technical support and quarterly TB/HIV data review meetings using MOH approved data collection and reporting tools.