Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013

Details for Mechanism ID: 11589
Country/Region: Botswana
Year: 2010
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: HHS/CDC
Total Funding: $450,000


URC works with the Ministry of Health (MOH) and the Ministry of Local Government (MOLG) to improve the quality of and increase access to HIV prevention and care services at facility levels.

Goals and Objectives

To strengthen HIV/AIDS prevention and care services in the Republic of Botswana.

Main Activities

- URC will expand its successful Routine HIV Testing (RHT) services strengthening program to new districts in the country.

- URC will employ up to six lecturers for the Serowe Institute of Health Sciences to expand the midwifery program.

- Other activities include supporting Multi-Drug Resistant Tuberculosis Program Evaluations (Health Training Institutes, National Association of State and Territorial AIDS Directors, and Makgabaneng), alcohol related harms reduction activities and four sub-awards (Nurses Association of Botswana, Futures Group, Catholic Relief Services and Francis Bagnound Xavier Center) will be implemented using carryover funds.

Target populations

The general population (adults and children) that visit health facilities and who will be tested for HIV, People Living with HIV/AIDS (PLWHA) who will be referred for care and treatment, and TB suspects who will be screened for MDR TB.

Emphasis will be placed on increasing recruitment of couples and families, including children and adolescents to Routine HIV Testing (RHT) services. URC supported program activities will reach a total population of about 700,000.

Approximately, 30,000 adults and children will receive RHT counseling and training.

6,000 PLWHA will be referred for onward care and treatment.

Geographic coverage

Healthcare facilities in up to six districts.

The project will cover 150 facilities providing RHT, MDR TB and counseling and training for children and adolescent and train 600 healthcare providers in RHT, alcohol prevention, behavior change communication, TB and counseling and training.

Leveraging HIV Resources

URC is leveraging government resources to improve and expand availability of high quality RHT and HIV prevention activities in the country. This helps us ensure that programmatic strategies are better integrated within the health system.

URC is leveraging WHO resources to develop and implement a national strategy for HIV testing among children and adolescents.

URC will support the MOH in Global Fund to Fight AIDS, Tuberculosis and Malaria supported areas to integrate provider-initiated testing and counseling and MDR TB interventions.

Cross-Cutting Areas

URC is working to advance the rights of marginalized communities that face stigma such as drug or alcohol users and people living with HIV. Plans to enhance support for RHT, TB and alcohol related harm prevention services will ensure equitable access to high-quality care for these marginalized populations.

URC will advocate for strategies to address male norms and behavior, specifically seeking male involvement in RHT and highlighting the importance of partner testing and partner support at all levels. The URC program includes sensitizing staff to the importance of male testing and participation in RHT programs. Male counselors will be trained at some facilities, to enhance the current system.

URC will assist participating facilities in building linkages with community-based groups to increase awareness about RHT as well as address issues of psychosocial support, stigma reduction and prevention of domestic violence for HIV-infected pregnant women. This will involve working with communities, community-based and home-based care organizations.

URC will host open days for clinic staff and community members to showcase improvement activities and encourage support for improvement initiatives.

Enhancing sustainability

URC has placed deliberate focus on the strategic strengthening of health systems in Botswana. The emphasis is on building a model of partnership with the MOH and Ministry of Local Government in order to enhance Botswana government's capacity to provide sustainable high-quality healthcare .

URC strategies for creating a sustainable program:

Working with Government of Botswana to identify, develop and implement harmonized health-system measurement tools

Strengthening patient records as well as recording and reporting systems

Integrating quality assurance/improvement at facility and district levels

Training and mentoring of healthcare workers and program managers

Working with sub-grantees to enhance their capability to find additional funding sources and properly monitor and manage existing resources.

Monitoring and Evaluation

URC will ensure proper monitoring and evaluation of PEPFAR old and next generation indicators for HTC.

URC routinely collects program data. It will use this information to inform and shape ongoing project design and implementation.

Funding for Testing: HIV Testing and Counseling (HVCT): $250,000

10.C.CT11: URC - Strengthening Routine HIV Testing - 250,000.00

Target population, coverage and promotional activities

Since FY08, URC has provided support to the Ministry of Health (MOH) and the Ministry of Local Government (MLG) in strengthening the quality and uptake of routine HIV testing (RHT) services in two pilot districts. In FY10, activities will be expanded to two additional districts for a total of 100 health facilities (HF) in the four districts, catering to 300,000 individuals. The participating facilities will integrate RHT services and will emphasis the recruitment of couples and families, including children and adolescents.

Facility-based RHT improvement teams, with support from URC and MOH/MLG staff, are responsible for improving RHT services through integration of services, referrals, improved case management and follow-up. Each facility team will be responsible for reviewing facility performance data and developing a plan for increasing RHT uptake. In FY09, RHT promotional materials were developed and volunteers were trained as RHT promoters. This activity will continue in FY10.

Supportive supervision, quality assurance and M & E

URC will conduct trainings for 600 health care providers (HCW) as well as train district- and facility-level supervisors in quality assurance (QA) methods and facilitative supervision techniques. Training will include ensuring service quality and compliance with national RHT guidelines. All HF will use a parallel, rapid HIV testing algorithm, with same-day results. URC will provide job-aids to support providers in service delivery and visit each facility at least twice a month to provide on-the-job support and mentoring to HCW in participating facilities. During these visits, URC will assist facility staff in carrying out regular review of program data to determine attainment of targets. URC will enhance internal/external quality assurance mechanisms as per national standards. Emphasis will be placed on indicators that monitor program performance, such as uptake of services by target population and quality.

Testing and counseling services provided

To ensure that RHT is widely available, innovative counseling and testing approaches, such as family-based, door-to-door, community-based, outreach services, youth-focused and home-based testing, will be incorporated into existing programs. URC will roll out couples HIV counseling and testing using the CDC curriculum that has been adapted by MOH for use in Botswana.

Referrals and linkages

URC promotes a continuum of care so that all clients or patients who test positive for HIV are referred for treatment, care and support.

Funding for Health Systems Strengthening (OHSS): $200,000

10.X.SS34: URC - Midwifery Tutors - 200,000.00

The Institutes of Health Sciences (IHS), public tertiary institutions for the training of health personnel, train the vast majority of nurses and other allied health workers for the country at basic and post-basic diplomas. There are eight health training institutes with a total of 1,500 students: three-hundred and twenty-five (325) general nurses, sixty-five allied health workers annually and one-hundred and seventy-five midwives (175) and 75 other post-basic nursing biannually Currently, there is a severe shortage of midwives in the country. In recent years, both midwives and midwifery lecturers have been leaving the system for other opportunities outside government because of poor conditions of service and pay. The midwifery course is 18 months.

This is a new activity to place 4 midwifery lecturers in the newly renovated Serowe Institute of Health Sciences. Currently the institute admits only 20 student midwives. Placing 4 additional lectures in the program for 18 months will allow a doubling of the output of midwives at the institution at the internationally accepted ratio of 1 lecturer to five students (1:5).

Human Resources for Health: The entire cost of this activity, minus management fees, is directly related to pre-service education of new Health care professionals. This activity will support salaries for additional faculty to enable the doubling of the current class size at the Serowe institution.

Cross Cutting Budget Categories and Known Amounts Total: $462,500
Gender: Gender Based Violence (GBV) $62,500
Human Resources for Health $400,000
Key Issues Identified in Mechanism
Addressing male norms and behaviors
End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services