Lusaka Provincial Health Office (LPMO) has the mandate to perform core public health activities within the Lusaka Province as part of the Ministry of Health with the key functions being supervision of services in the districts, interpretation of policy, data management technical support.Lusaka Province has 104 public health centers, four functional level-I hospitals. The MOH has constructed a one level-II hospital. There are three level-III hospitals UTH, CDH and CHH. In addition, there are 12 military facilities with more than 223 private health facilities which include twelve level-II hospitals.The funds received will avail LPMO with substantial financial ability to enable it supplement the implementation of the annual action plans. The Province notifies about one third of the total tuberculosis cases in the country which are over 18,000 cases. Seventy percent of these patients are HIV infected and PHO implements the STOP TB strategy for TB and TB/HIV control.Country estimates show that only about 15% of the population knows their HIV status. The province is implementing different strategies to enhance counseling and testing, including community sensitization, PICT strengthening couples counseling. The MOH has recognized male circumcision as one of the effective preventive strategies for HIV.

Through capacity building for staff, PHO will address the limited capacity to diagnose and treat opportunistic infections In order to strengthen the laboratory network and quality assurance programme, we will support districts with infrastructure development, transport and logistics to facilitate on-site supervision, training and specimen collection to laboratories and procuring of laboratory equipment, reagents and supplies.

Integration of TB and HIV services continues to be an important area of focus for LPMO. In order to achieve standardized treatment of patients refresher clinical trainings are ongoing in the province in collaboration with partners such as Center for Infectious Disease Research in Zambia (CIDRZ). Intensified TB case finding training was done for 45 Health workers from ART, VCT, PMTCT and STI clinics. LPMO trained 93 health workers in TB/HIV integration, 45 in provider-initiated testing and counseling and 100 treatment supporters in TB/HIV activities

LPMO had also embarked on ensuring that HIV positive individuals are screened for TB and all TB patients are tested for HIV. We continued to work on strengthening of referral systems between the 2 programs.

Program monitoring and evaluation will be carried out through quarterly supportive/supervisory visits to the districts by the province and monthly supervision by the district to health facilities. Counseling and testing of TB patients for HIV increased from 54% in 2007 to 60% in FY 2008. In 2010 the acceptance of TB patients who were counseled increased further to 83%In FY 2012, 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 bodies in facilities.

Fifty Health workers will be trained in TB infection control to ensure TB infection control measures are adhered to at facility levels.

LPMO will continue supporting the employment of four clinicians and three Laboratory technicians in order 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.

LPMO will wish to scale up and train health workers in Isoniazid Preventive Therapy (IPT) according to MOH guidelines once they are approved.

Adherence support volunteers will be trained in basic DOTs so as to on the number of defaulters and improve on treatment outcomes.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.LPMO will strengthen Multi-Drug Resistant TB (MDR) surveillance in the districts by supporting specimen courier systems to laboratories.

LPMO will continue to conduct technical support and quarterly TB/HIV data review meetings using MOH approved data collection and reporting tools.Health workers and community health workers will be trained in intensified case finding training and will be supported in implementation of this activity in all districts in 2012. Intensified TB case finding will be carried out at all clinical sites where HIV positive individuals are identified such as MCH, MC and STI sites. The PMO will procure sputum containers for distribution to all sites.

LPMO 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, LPMO will support selected laboratories to acquire laboratory accreditation. LPMO will initiate and conduct the accreditation process with MOH and CDC. Support will be given to ensure quality of all laboratory testing including HIV testing, build capacity of laboratory personnel through various trainings which will be undertaken in collaboration with MOH and CDC. In addition, 20 laboratory staff will be supported to attend in-country training courses in lab accreditation, laboratory management, quality assurance (QA), basic computer skills, phlebotomy, equipment maintenance, and lab information system.

LPMO 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. In order to ensure that equipment is always functional, maintenance services will be sourced.

LPMO 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. Specimen referral and transportation systems will be supported by procuring motor bikes for ART sites, procure motor bikes and cool boxes for transporting specimens.Services will be monitored through quarterly technical support, quarterly technical review meetings and progress reports.

The following are a summary of priority activities for 2012:

1. Quality Assurance both internal and external2. Train staff in lab information systems and basic computer skills3. Transportation of specimen through strengthening of the courier system.4. Basic equipment maintenance training5. Orientation of lab staff in phlebotomy due to poor quality of samples sent to the lab

In order to improve data and information management, LPMO will maintain communication between the provincial medical office and the districts using VSAT that should result in timely reporting and submission of data. Computer security will be maintained through regular updating of antivirus software. LPMO will use this facility to disseminate updates and other communications for various programs. In order to improve data management in the districts, we will employ a data associate at LPMO whose responsibility will include collection and collation of TB, HIV/AIDS, ART, PMTCT, VCT and laboratory data and technical support to district staff. This will promote effective collection, analysis, reporting and use of HIV and health information for program planning and improvement, monitoring and evaluation. LPMO will provide technical support supervision to districts in data management and use of Smart Care, support provincial and district data review meetings and provide training for staff in HMIS, Smart Care and the Hospital HMIS. Regular maintenance of equipment will be carried out.

The provincial office will support training of Provincial and District staff in data quality assessments, data analysis, M&E and report writing through advanced Epidemiology for Data User trainings each year. The Provincial staff would be trained as trainers who would then conduct two trainings for district staff. These trainings enable staff to create epidemiological profiles, conduct data quality assessments and conduct various analyses of HMIS, NACMIS and Smartcare systems to inform decision-making.

The main goal of MC services is to make high quality, safe male circumcision services accessible and available to all men and boys on a voluntary basis. In order to contribute to the MOH strategic goal of circumcising 2.5m males by 2020 LPMO will provide leadership in expanding male circumcision (MC) services in all the districts and provide 3,200 MCs to HIV negative males.

LPHO will strengthen the national MC program by recruiting an MC coordinator dedicated to overseeing MC program activities at provincial level and providing supportive supervision and coordination amongst partners; and focus on expansion of service delivery strategies with potential to significantly increase the MC program up-take volume and maximize efficiencies.Strategies will include prioritizing increased up-take of older men who are in the more sexually active age range and who are at immediate risk of HIV infection. LPMO will advocate for community involvement by engaging community leaders such as traditional rulers and other opinion leaders to mobilize communities for MC services.LPMO 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 LPMO; further, we will support furnishing of buildings and procurement of equipment and supplies.

Linkages of MC activities to HIV counseling and testing services in all facilities will be done in order to contribute to risk reduction in contracting HIV infection.

LPMO 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.

LPMO will support districts in M&E and quality assurance through technical support visits, quarterly meetings, and reports.

The following are the summary key activities that will be done in the year 2012:

1. Renovate 3 sites in district.2. Procure basic MC equipment.3. Orientation workshop of 15 health managers.4. Train 30 health workers in MC5. Accreditation of male circumcision sites.6. Conduct Technical support in M/C.

In order to increase the proportion of people in the Lusaka Province who know their HIV status, Lusaka Provincial Medical Office (LPMO) will increase the availability of counseling services through training of health workers in psychosocial counseling, Provider Initiated Counseling and Testing and advanced counseling and train community volunteers as lay counselors, including and rapid HIV testing.

Couple counseling will be strengthened in the districts through community sensitization and orientation to health workers on the need to provide counseling to couples in all settings. Sensitization messages will continue through various forms of media such as drama and information, education and communication (IEC) materials to the target population.

The PMO will provide technical support supervision on a quarterly basis with a view of mentoring district supervisors and build capacity to ensure quality of counseling and testing services. District activities in counseling, including couple counseling, will be monitored through monthly and quarterly reports and quarterly performance review meetings will be conducted.

The following are the summary key activities that will be done in the year 2012:1. Training of health workers and community volunteers.2. Community sensitization through drama on importance of couple counseling.3. Orient staff on importance of couple counseling4. Procurement and distribution of IEC materials.5. Technical support supervision.6. Holding quarterly meetings.

Lusaka Provincial Health Office (LPMO) will support and build capacity in districts in order to collaborate with stakeholders 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. LPMO will build capacity in all four districts of Lusaka, Chongwe, Kafue and Luangwa. LPMO 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.

LPMO 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.

LPMO 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, LPMO will ensure integration of preventive programs in the districts and coordinate partner programs in the province. LPMO will prepare and submit quarterly and annual reports to the MOH.