Jhpiego will build on past experience working with CDC/Zambia and the Ministry of Health (MOH) to achieve the goal of supporting Zambias response to the HIV/AIDS epidemic by expanding quality interventions in HIV/AIDS prevention, care and treatment and building the capacity of MOH, National HIV/AIDS/STI/TB Council (NAC) and other Zambian organizations to deliver quality service in a sustained manner.

Jhpiegos objectives support the Government of the Republic of Zambias (GRZ) National AIDS Strategic Framework (NASF) goal and the joint GRZ and USG Partnership Framework goal to reduce new HIV infections while scaling up treatment, care and support. Our capacity building of healthcare providers is in line with the National Health Strategic Plan (NHSP) objective to improve the availability of and distribution of health workers in the country.

The target geographical areas are mainly the Southern, Western and Eastern Provinces of Zambia which were chosen to continue building capacity and to strengthen the integration of results obtained in the past. Jhpiego works at the national level by supporting the MOH in their ongoing activities such as the Epidemiology for Data Use Package work group, MC roll-out in all nine provinces, and implementation of the ART Continuing Medical Education.

To ensure collection of necessary PEPFAR program-level indicators and other output data for project monitoring, Jhpiego will work through the MOH district, provincial and central level information systems, when feasible, and directly with health facilities when proper information systems are not in place, especially for newer areas such as MC. Jhpiego will use the training information monitoring system (TIMS), to track persons trained in order to facilitate follow-up and record keeping.

Jhpiego will continue to strengthen and expand the capacity at provincial and district level in training skills, supervision and monitoring.

Jhpiego will support the following trainings:HIV/TB training skills by training 20 new trainers at district level60 health care providers in TB management training80 health care providers in TB infection control80 health care providers in OJT management of TB and other common Opportunistic Infections (OIs)15 health care workers in MDR-TB20 health care providers in ICF20 Pre service nurse tutors/lectures trained in TB/HIV

In all the above areas, Jhpiego will provide supportive supervision and mentorship in order to increase the transfer of knowledge and skills and to support the local PMO/DMO teams in order to provide post training follow-up, supportive supervision and OJT to ensure the implementation services.

Jhpiego will also:support the MOH to develop MDR TB training materialssupport the development of TBICF training materialsparticipate in joint technical supportive supervision with the National TB Program (NTP) and the Provincial Medical Office on the TB/HIV program.support the TB/HIV coordinating bodies at national, provincial and district level and work to strengthen and ensure that they are functional and active.continue supporting the national TB Data review meetings and the provincial TB review meetings.

Jhpiego will continue working with CBTO and PMO/DHO to support the training of 120 Community Care and Treatment Supporters (CCTS). The focus will be on strengthening supportive supervision and exploring an integrated system that includes HIV/TB/PMTCT/Malaria. To enhance good record keeping, 3000 home visit diaries will be provided to the CCTS.

Jhpiego will support the pre-service education institutions in strengthening their TB/HIV curricula component through continuing education programs. The initial educational modules will be provided to 38 pre-service education institutions nationwide, reaching 700 final year students to support the educational process of medical and nursing students. Jhpiego will train 20 lecturers and tutors so they can then train their students on TB/HIV services.

To support the Ministry of Health strengthen the care and support for an HIV positive child through the development and implementation of a nutrition assessment tool.

Jhpiego will provide technical assistance to the Ministry of Health in order to review and adapt pediatric nutritional assessment tool and strengthen linkages to nutritional support services in the community. After the tool has been finalized, orientation meetings will be held to orient both trainers and nutritionists to the use of this tool.

Jhpiego will continue to support Ministry of Health and Ministry of Defense in the scale-up and deployment of electronic patient monitoring and data management tools to enhance continuity of care.To support the scale up of SmartCare in Zambia, Jhpiego will train MoH and Independent facility Support personnel as well as Provincial and District Nursing/MCH Officers/Coordinators in Smart Care Essentials, ToT and OJT. In order to ensure ownership and sustainability, Jhpiego will also orient Managers and Supervisors in SmartCare. In addition, Jhpiego will continue supporting the deployment of SmartCare to new MoH and independent health facilities. In line with the above, 40 support personnel will be trained in SmartCare Essentials. An additional 80 support personnel will be trained in SmartCare Technical Support and TOT.In addition to the above, 80 MoH Managers and Supervisors and 40 ZDF managers will be oriented in SmartCare.To facilitate integrated health services reporting, Jhpiego will support the networking of SmartCare systems at sites where 2 or more SmartCare stations exist in stand alone mode by procurement and provision of networking equipment. Jhpiego will also support the procurement and provision of Smart Cards (Care Cards) in order to enhance continuity of care as well as to support service integration within and across health facilities.In order to provide technical support to the MoH provinces and the Ministry of Defense Medical Services in the implementation of activities, Jhpiego will conduct Technical Supportive Supervisory visits to MoH and Independent health sites. Jhpiego will also support the MoH Provincial Health Offices (PHOs), District Health Offices (DHOs) and Ministry of Defense Medical Services to carryout routine follow ups and On-the-Job training to facility staff. These visits will be to assure quality and sustainability.Jhpiego will also support and provide TA to MoH in the area of data migration and backlog entry. Jhpiego will support the Institutionalization of Feedback mechanisms through deployment of SmartMonitor.To mitigate the effect of high staff attrition within the MoH and Independent health facilities, Jhpiego will continue supporting Pre-service training institutions to strengthen systems for rolling out SmartCare to Pre-Service training Institutions and support Pre-Service Smart Care training. In addition, Jhpiego will provide IT support as well as support supervision to training institutions. Therefore, Jhpiego will train 50 Pre-service Educators in SmartCare TOT.Jhpiego will also conduct three activities to support the development of post-deployment supervision methodologies and tools. Consequently, two activities to facilitate the implementation of post-deployment supervision methodologies and tools to 10 Pre-service institutions will be conducted. Four activities for the deployment of SmartCare Computers to 10 Pre-service institutions will be carried out. In addition, three activities will be carried out for the development of a SmartCare Learning Management System. Jhpiego will also help develop medical the licentiate curriculum at Chainama College of Health Sciences to include SmartCare and priority health services. Jhpiego will increase awareness of SmartCare through production and dissemination of IEC materials in addition to production of Training Materials.

Jhpiego is committed to supporting the GRZ in providing quality health care services to all people living with HIV/AIDS and accessing these services. Health care services planning and patient care can be improved through the utilization of high quality data. Through the systems strengthening program, Jhpiego will continue to support the MOHs National Epidemiology for Data Use (EDU) program. Jhpiego has been involved in the development, piloting, and implementation of EDU from its inception, and will continue providing technical assistance in the areas of training and supervision and through participation in the monthly coordination and technical meetings. To strengthen and improve the quality of data and its use at facility level, Jhpiego will continue to support building capacity of those involved in data collection, analysis, reporting and utilization. This will be achieved through the training of 75 providers, information officers and program managers from a number of selected districts and hospitals in EDU. Jhpiego will also work closely with MOH, NAC, CSO and other partners to provide supportive supervision to at least 50 EDU trainers as they conduct their district level trainings. This is in line with the Jhpiego trainer pathway, where supportive supervision and mentoring is provided to the new trainers as they conduct their first training to ensure quality of training and appropriate transfer of knowledge. Various technical supportive supervision tools, quality assurance tools, and mentoring tools are being used by different implementing partners. Jhpiego will provide technical and logistical support to the Ministry of Health in order to revise the existing quality improvement and quality assurance tools in order to contribute towards enhanced systems for organizational support to health facilities, for continuous performance improvement and thus quality of PMTCT services.Nationally standardized tools will be produced and a two day meeting at national level will be held to disseminate the revised. Jhpiego will support the Ministry of health in under-taking these activities and will further provide support in the dissemination of the tools to at least two people per province. The resulting tools will complement existing Ministry of Health systems and guidelines in order to strengthen quality improvement and quality of clinical services provided to pregnant women for PMTCT of HIV and syphilis.Jhpiego has over the years supported the MOH with the in-service training of several hundreds of health care providers in various program areas. The information and details of all these health care providers is managed through the Training Information Monitoring System (TIMS) developed and used by Jhpiego. In FY 2012 Jhpiego will conduct a TIMS study to follow up on all providers who have been trained by Jhpiego in all programs and to investigate whether or not they are still providing the services for which they were trained and whether or not they are still at the institutions from which they were trained.

Using base funds, Jhpiego will continue to support 22 MC sites and will expand support to eight new sites. All sites will be supported with surgical instruments and supplies. Jhpiego will work with the MOH and Provincial Medical Offices to ensure coordination of all processes. For the new sites, Jhpiego will hold two-day orientation workshops to provide an overview of MC. In addition, Jhpiego will conduct three MC skills courses using the UNAIDS/WHO/Jhpiego training package to equip providers with the necessary knowledge, skills to provide comprehensive safe MC services. Two MC Counseling courses will also be conducted. Further, Jhpiego will promote couple counseling and facilitate referrals between services such as family planning, STIs, HIV care and PWP programs. Jhpiego will also conduct three diathermy trainings and procure diathermy machines for 15 high volume sites. Jhpiego will support integration of MC into the training curriculum of Medical Licentiate at Chainama College of Health Sciences. Jhpiego will support community mobilization and MC campaigns in April, August and December; and support local demand generation in neighborhoods surrounding the sites through radio announcements and support through sub-agreements with either local or international NGOs and CBOs. Jhpiego will support high quality data collection, reporting, and use through support to part time data clerks or allowances to existing data clerks. Building on the systems strengthening foundational work that Jhpiego has supported in 22 facilities in the past three years, Jhpiego will utilize an additional $582,595 of PFIP funds to implement innovative approaches that improve MC program efficiencies and volumes; as such an additional 5,000 men MC, over and above the targeted 42,000 men that will be circumcised using the base COP12 funds. Jhpiego will pilot a center of excellence model site with full time dedicated staff; to demonstrate improved efficiencies with the use of diathermy, task shifting. At this site all departmental heads will be oriented and engaged to participate in MC demand creation; and an incentive program to honor departments sending most referrals will be piloted. Further, Jhpiego will support 2 MC part time providers at other sites to provide routine mobile outreach services and MC over weekends; this will be enabled by leveraging resources from the base COP12 funds. Jhpiego will expand its work on demand creation by working with the local DHMTs, community radio stations, Zambia Information services, traditional leadership and engaging community mobilizers to intensify interpersonal communication approaches. Jhpiego will support distribution of IEC materials.

Jhpiego will continue to work with Ministry of Health (MOH), the PHOs for Southern, Western and Eastern Provinces and other partners to:1) train lay workers in HIV counseling and testing (HCT)2) ensure that lay workers provide quality services and meet the demand for HCT, both in service delivery sites and in the surrounding community

Jhpiego will continue training new lay counselors in counseling and testing using finger prick. Jhpiego will seek technical assistance from CDC and the University Teaching Hospital (UTH) virology laboratory in the training of 15 trainers in the CDC/MOH standardized 3 days HIV testing course. The trained trainers will comprise of laboratory personnel and qualified health care workers.

In order to increase the availability of the counseling and testing service in the community as well as at health facilities, more lay counselors will be needed. Jhpiego will support the training of 120 new lay counselors in HCT using finger prick. Jhpiego will also promote couple counseling and prevention counseling for both HIV-positive and negative individuals. Six trainings of 20 participants each will be conducted in Eastern, Southern and Western. A sub-grantee, CommunityBased TB HIV Organization (CBTO) will conduct the training.

Jhpiego shall provide ongoing follow-up support supervision to the 120 previously trained lay counselors at their clinic sites. CBTO and CDC/MOH will conduct the support supervision.

Some clients who require counseling and testing are identified and referred to the health facility, and the same clients are referred back into the community for continued support and care. Therefore, a reliable referral system must always be in place so that clients are not lost on the way. Referral meetings will be conducted by PMO/DMO teams, CBTO and Jhpiego. These referral meetings will take 3 days including 2 travel days, and 120 people are expected to be reached with this exercise.

Jhpiego Zambia will continue to contribute towards the acceleration of the Ministry of Health (MOH) plan for prevention of mother-to-child transmission (PMTCT) program at country level through guideline/protocol development support to the Ministry of Health. Using COP12 PMTCT ACCELERATION funds ($500,000 total across 3 seperate budget codes) Jhpiego will implement one-off activities intended to strengthen the base of the national PMTCT program.

Jhpiego will identify existing materials on gender based violence and guidance from traditional leaders and local community systems and use these to develop standardized protocols for the identification and referral of victims of gender based violence (GBV) to appropriate services in the community. These protocols will provide for enhanced identification of women in need of economic empowerment and link them to appropriate life skills education programs; and develop a male involvement program in two districts.

To ensure institutionalization of strategies, Jhpiego will work towards facilitating local ownership and leadership in implementing a comprehensive PMTCT package by developing an orientation package and conducting managers orientations.

Jhpiego will work with the MoH and partners to identify family planning needs for HIV positive women and victims of GBV; this will facilitate the revision of family planning and prevention with positives guidance to be used for re-training of providers.Jhpiego will support revision of the community health worker training package to incorporate the family planning, GBV components, and knowledge and skills for community based distribution of contraceptive methods. Jhpiego support revision and standardization of an M&E framework and data tools for the community level PMTCT activities; this will be designed to inter-digitate with facility level PMTCT M&E systems to allow effective continuity of care from facility to the community. Further, Jhpiego will support standardization of PMTCT technical support supervision and mentoring tools. Jphiego will also support MOH in revision of performance assessment guidelines and tools and standaize and disseminate PMTCT Quality Assurance/ Quality Improvement tools.

Jhpiego will continue to support building the capacity of the MOH, NAC and Health Professions Council of Zambia (HPCZ) in order to ensure the provision of high quality ART services in the country.

Jhpiego will build the capacity of health workers in providing high quality ART services by implementing Continuing Medical Education (CME) programs for HIV clinical staff in both public and private health institutions. This will include the DVD-based distance learning platform, online courses, and ART training simulation. The Adult ART CME modules revised in FY 2011 will be disseminated to 450 health care providers, and the Pediatric ART CME modules will be developed and disseminated to an additional 450 health workers through DVD-ROM based distance learning CME modules.

Jhpiego will work with the NAC and the Care and Treatment working group to revise and to distribute the national guidelines on management and care for people living with HIV and AIDS. These guidelines were last revised in 2009. Jhpiego will support the printing of 5000 paper based copies of the guidelines and will also produce 5000 copies on DVD. In addition Jhpiego will support the hosting of these guidelines on the NAC website.

Jhpiego will support the NAC in running the website so that these guidelines are regularly updated and will provide for a mechanism where visitors to the website can post questions on issues in the guidelines and Jhpiego will be able to offer Technical assistance in providing feedback to the questions.

Jhpiego will support the HPCZ to strengthen the ART accreditation systems. Jhpiego will support the HPCZ in the retraining of 100 ART accreditation assessors nationwide.