Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7804
Country/Region: Botswana
Year: 2009
Main Partner: To Be Determined
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $0

Funding for Care: Adult Care and Support (HBHC): $0

09.C.AC06: TBD - Health Care Provider Training

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The TBD organization is expected to develop a sustainable training capacity in clinical care and treatment of

HIV/AIDS patients, expand CD4 and Viral load laboratory testing to decentralized laboratories, and

strengthen the Ministry of Health's (MOH) Monitoring and Evaluation (M&E) capacity to monitor the

effectiveness of the national anti-retroviral (ART) program, MASA.

In FY2007 and FY2008, the Clinical Master Trainer (CMT) program trained a total of 492 health personnel

on ART service delivery and 635 on palliative care service delivery. It also supported and mentored 18

hospitals and 39 satellite clinics. The Laboratory Master Trainers have so far been able to train a total 22

laboratory technicians and have supported and mentored approximately 22 facilities, 15 of them

decentralized.

The M&E results indicated that there were 32 sites reached, 59 data entry clerks (DEC) trained, a data

warehouse developed with integration of MASA and DHIS ongoing, and a data security and confidentiality

system with encrypt and decrypt completed.

The TBD organization is expected to have a three pronged approach to using the master trainer model,

which will include Clinical master trainers, Laboratory master trainer and M&E technical advisor.

The Clinical Master Trainers will continue to do:

(1) task shifting: training of nurse dispensers and nurse pre scribers; (2) train Health Care Providers on QAI

and implementation of QA activities at ART site level and QAI training for district/site leadership cadres; (3)

provide CME at district level and telephone site support; 4) continue training material development, SOPs,

guidelines, memos, checklists and other tools for care and treatment sites.

B) The Laboratory Master Trainers will continue to:

(1) support the established CD4, VL decentralized and expand training to include hematology, chemistry

and microbiology support; (2) in collaboration with MOH and HHS/CDC/BOTUSA formalize the training

manuals on CD4, VL, hematology, chemistry and microbiology, including TB; (3) train on LIS issues at

decentralized labs/sites and on lab data management, reagent logistics and quality assurance.

C) The M&E Unit within MASA will continue to:

(1) refine and expand indicators and management tools; (2) replace PIMS (MASA) and roll out new system

to all PIMS locations; (3) integrate functions of (e.g. PMTCT) and integrate with all other national systems,

for example, DHIS;(4) train end users on the new systems; (5) establish a support desk and use DEC to

perform vital roles; and 6) conduct a targeted patient evaluation study on medication adherence.

From COP08:

With PEPFAR support, an organization (TBD) will assist GOB in strengthening the capacity of health care

providers in providing palliative care/ ART services. The organization TBD will put in place a training

program using the Trainer of Trainers Master trainer approach as described below. Three main activities will

be supported by the TBD organization: 1) support and strengthen a clinical master trainer (CMT) program;

2) support and strengthen a laboratory master trainer program; and 3) support and strengthen the M&E

component of the MASA program

A. The Clinical Master Trainer program consists of on-site specific training to bring MLG and MOH facilities

up to standard to prescription and dispensing level. Proper data recording and reporting is another area of

strengthening in the master trainers program. It consists of site assessments, on-site and centralized

training to support task shifting, support and follow up on clinical, laboratory, pharmacy and quality

assurance and improvement activities.

B. The CMT program should also involve a pharmacy training component. Activities should be scaled up to

include training on task shifting for nurse prescribers/ dispensers to support pharmaceutical officers and

prescribers for managing chronically stable patients. By the end of the program, all 32 sites and satellite

clinics should have received coverage. All roll out clinics should l have been supported and > 1,000 workers

trained in short term trainings including, Introduction to AIDS Clinical Care, Nurse Dispensing, Nurse

training for stable patients and facilitated other MoH training initiatives including palliative care.

C. Strengthening the capacity of laboratories through the laboratory master trainers (LMT) has been

instrumental in the decentralization of CD4 and VL testing (infrastructure funded by ACHAP and PEPFAR).

CD4 services were decentralized to 12 laboratories. The LMT program will continue to support the

established CD4, VL decentralized and expanded training to include hematology, chemistry and

microbiology support. All laboratory technicians from the 12 decentralized laboratories will be fully trained in

CD4 & VL, re-trained in hematology, chemistry, and micro and all 12 labs should be fully functional.

Attachment training at the Botswana-Harvard HIV Reference Lab, site support, telephone site support, and

capacity building through development of site-level LMT will continue. The LMT in collaboration with MOH

and HHS/CDC/ BOTUSA will formalize the training manuals on CD4, VL, hematology, chemistry and

microbiology (including TB) The activity will include training in quality issues at decentralized sites and LIS

at roll-out sites. Additionally they will provide training on lab data management, reagent logistics and quality

assurance in COP08.

D. Monitoring and Evaluation (M&E) Unit within the National ARV (Masa) Program will be assisted by the

TBD organization to develop standardized paper-based and electronic monitoring systems to track ARV

patients, specifically, clinical, laboratory and pharmaceutical monitoring systems. This will include

development of indicators and data capture instruments, harmonization of indicators, development of data

flow mechanisms including reporting guidelines and instruments, reporting schedules and routine feedback

documents to the sites. Staff at the ART sites will be trained on the new data capture instruments,

Activity Narrative: indicators, quality and flow. Activities for COP08 will continue in line with the MoH vision of developing a

viable and sustainable monitoring system for the ART program. Long term, the TBD organization will assist

the M&E Unit to do the following: 1) refine and expand indicators and management tools; 2) replace PIMS

(MASA) and roll out a new system to all PIMS locations; 3) Integrate functions of (e.g. PMTCT) and

integrate with all other national systems (e.g. DHIS); 4) Train end users on the new systems; 5) Establish

support desk and using DEC to perform vital role; 6) Unlock data warehouse; 7) Purchase and install

software to develop end user reporting tools for the data warehouse; 8) Establish end-user support (user

registration, user training).

New/Continuing Activity: Continuing Activity

Continuing Activity: 17675

Continued Associated Activity Information

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

System ID System ID

17675 17675.08 HHS/Centers for To Be Determined 7804 7804.08 New CoAg-

Disease Control & Health Care

Prevention Providers

Training

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $0

09.T.AT12: TBD - Health Care Provider Training

CONTINUING ACTIVITY UNDER PERFORMANCE PASS:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The TBD organization is expected to develop a sustainable training capacity in clinical care and treatment of

HIV/AIDS patients, expand CD4 and Viral load laboratory testing to decentralized laboratories, and

strengthen the Ministry of Health's (MOH) Monitoring and Evaluation (M&E) capacity to monitor the

effectiveness of the national anti-retroviral (ART) program, MASA.

In FY2007 and FY2008, the Clinical Master Trainer (CMT) program trained a total of 492 health personnel

on ART service delivery and 635 on palliative care service delivery. It also supported and mentored 18

hospitals and 39 satellite clinics. The Laboratory Master Trainers have so far been able to train a total 22

laboratory technicians and have supported and mentored approximately 22 facilities, 15 of them

decentralized.

The M&E results indicated that there were 32 sites reached, 59 data entry clerks (DEC) trained, a data

warehouse developed with integration of MASA and DHIS ongoing, and a data security and confidentiality

system with encrypt and decrypt completed.

The TBD organization is expected to have a three pronged approach to using the master trainer model,

which will include Clinical master trainers, Laboratory master trainer and M&E technical advisor.

The Clinical Master Trainers will continue to do:

(1) task shifting: training of nurse dispensers and nurse pre scribers; (2) train Health Care Providers on QAI

and implementation of QA activities at ART site level and QAI training for district/site leadership cadres; (3)

provide CME at district level and telephone site support; (4) continue training material development, SOPs,

guidelines, memos, checklists and other tools for care and treatment sites.

B) The Laboratory Master Trainers will continue to:

(1) support the established CD4, VL decentralized and expand training to include hematology, chemistry

and microbiology support; (2) in collaboration with MOH and HHS/CDC/BOTUSA formalize the training

manuals on CD4, VL, hematology, chemistry and microbiology, including TB; (3) train on LIS issues at

decentralized labs/sites and on lab data management, reagent logistics and quality assurance.

C) The M&E Unit within MASA will continue to:

(1) refine and expand indicators and management tools; (2) replace PIMS (MASA) and roll out new system

to all PIMS locations; (3) integrate functions of, for example, PMTCT, and integrate with all other national

systems, for example, DHIS; (4) train end users on the new systems; (5) establish a support desk and use

DEC to perform vital roles; and 6) conduct a targeted patient evaluation study on medication adherence.

From COP08:

With PEPFAR support, an organization (TBD) will assist GOB in strengthening the capacity of health care

providers in providing ART services. The organization TBD will put in place a training program using the

Trainer of Trainers Master trainer approach

as described below. Three main activities will be supported by the TBD organization: 1) support and

strengthen a clinical master trainer (CMT) program; 2) support and strengthen a laboratory master trainer

program; and 3) support and strengthen the M&E component of the MASA program

A. The Clinical Master Trainer program consists of on-site specific training to bring MLG and MOH facilities

up to standard to prescription and dispensing level. Proper data recording and reporting is another area of

strengthening in the master trainers program. ART site support is designed to provide a sustainable training

capacity for integrated, high quality HIV/AIDS treatment at public sector ART sites in Botswana. It consists

of site assessments, on-site and centralized training to support task shifting, support and follow up on

clinical, laboratory, pharmacy and quality assurance and improvement activities.

B. The CMT program should also involve a pharmacy training component. Activities should be scaled up to

include training on task shifting for nurse prescribers/ dispensers to support pharmaceutical officers and

prescribers for managing chronically stable patients. By the end of the program, all 32 sites and satellite

clinics should have received coverage. All roll out clinics should l have been supported and > 1000 workers

trained in short term trainings including, Introduction to AIDS Clinical Care, Nurse Dispensing, Nurse

training for stable patients and facilitated other MoH training initiatives including palliative care. The Master

Trainer Program will expand its clinical support to ARV sites in COP08 through these activities; 1) Training

of nurse dispensers and nurse prescribers for stable patients for ARV roll out; 2) strategies to improve,

integrate, monitor and evaluate services and programs at ARV sites and to increase capacity through

improved integration of programs. This includes training of the Health Care Providers on QAI and

implementation of QA activities at ARV site level and QAI training for district/site leadership cadres; 3)

provision of CME at district level, telephone site support for HIV/AIDS Management , the newly established

failure management phone support to enable clinical and pharmacy staff at all ART sites to obtain advice

on difficult cases, etc. from core Master Trainers and to ensure the best, quickest, and most efficient care &

treatment possible; 4) Development of training materials, SOP's, guidelines, memo's and checklists tools for

ARV sites; 5) seeking editorial and peer review services for developed material

C. Strengthening the capacity of laboratories through the laboratory master trainers (LMT) has been

instrumental in the decentralization of CD4 and VL testing (infrastructure funded by ACHAP and PEPFAR).

CD4 services were decentralized to 12 laboratories. The LMT program will continue to support the

established CD4, VL decentralized and expanded training to include hematology, chemistry and

Activity Narrative: microbiology support. All laboratory technicians from the 12 decentralized laboratories will be fully trained in

CD4 & VL, re-trained in hematology, chemistry, and micro and all 12 labs should be fully functional.

Attachment training at the Botswana-Harvard HIV Reference Lab, site support, telephone site support, and

capacity building through development of site-level LMT will continue. The LMT in collaboration with MOH

and HHS/CDC/ BOTUSA will formalize the training manuals on CD4, VL, hematology, chemistry and

microbiology (including TB) The activity will include training in quality issues at decentralized sites and LIS

at roll-out sites. Additionally they will provide training on lab data management, reagent logistics and quality

assurance in COP08.

D. Monitoring and Evaluation (M&E) Unit within the National ARV (Masa) Program will be assisted by the

TBD organization to develop standardized paper-based and electronic monitoring systems to track ARV

patients, specifically, clinical, laboratory and pharmaceutical monitoring systems. This will include

development of indicators and data capture instruments, harmonization of indicators, development of data

flow mechanisms including reporting guidelines and instruments, reporting schedules and routine feedback

documents to the sites. Staff at the ART sites will be trained on the new data capture instruments,

indicators, quality and flow. Activities for COP08 will continue in line with the MoH vision of developing a

viable and sustainable monitoring system for the ARV program. Long term, the TBD organization will assist

the M7e Unit to do the following: 1) refine and expand indicators and management tools; 2) replace PIMS

(MASA) and roll out a new system to all PIMS locations; 3) Integrate functions of (e.g. PMTCT) and

integrate with all other national systems (e.g. DHIS); 4) Train end users on the new systems; 5) Establish

support desk and using DEC to perform vital role; 6) Unlock data warehouse; 7) Purchase and install

software to develop end user reporting tools for the data warehouse; 8) Establish end-user support (user

registration, user training).

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $0

09.C.PC05: TBD - Masa Expert Patients Support

The Expert Patients Support program has been developed for the following reasons:

HIV-infected children are a vulnerable group with an extremely high morbidity and mortality, if they have not

been identified, tested and received care. It is estimated that about 25% of HIV-infected children would be

dead by the end of their first year of life and close to 50% would be dead at the end of second year. Even

infants who have received prophylactic antiretroviral drugs from the Prevention of Mother to Child

Transmission (PMTCT) program have slipped through the system without getting the full benefit of care.

The Expert Patients Support program will therefore:

-identify and refer children who need testing to health facilities.

-follow up on children from PMTCT and Under 5 clinics who need care and refer them to the point of service

sites for anti-retrovirals (ARV.)

-provide psychosocial support and appropriate referrals, as needed.

They shall be functioning from clinics where children are most often seen and also in the community. They

will link up with community based organizations (CBO) and NGOs in the respective communities to leverage

these resources in carrying out their duties, as there are other community resources that will add value to

child survival.

It is hoped that through this program care will be expanded care to many more children. Currently, less than

10% of the over 100,000 patients on ARVs in Botswana are children. Even though the exact number of

children in need of care in Botswana is not known, because of the high prevalence of HIV, it is expected

that more children will be identified and cared for.

The Clinton Foundation had supported a pilot project to see the feasibility of using Expert Patients for

identifying children in need of treatment. The project yielded promising results. With these results, Masa in

collaboration with the Botswana Harvard Master Trainer program will roll out the Expert Patients project

initially in three districts.

PEPFAR funds are requested for the purpose of training the Expert Patients in counseling, psychosocial

support and stigma reduction.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment

Total Planned Funding for Program Budget Code: $1,491,624

Total Planned Funding for Program Budget Code: $0

Table 3.3.11: