The USG will provide the seed money to provide a Pre-Service Curriculum Development for the medical

technology program at the Technical School of Medical Care (TSMC). The TSMC medical technology

program is essential to the development and strengthening of diagnostic laboratory capabilities in

Cambodia. Of all the programs at the TSMC, the medical technology program has received the least

assistance. There is an urgent need to provide quality training in medical technology in Cambodia. Skilled

medical technologists were executed or died during the Pol Pot regime, so there has been no continuity in

the development of medical laboratory staff. Although many governmental and non-governmental

organizations are interested in improving the health infrastructure, there is serious shortage of qualified

laboratory personnel; in the country. The American Society for Clinical Pathology (ASCP) has created a

successful 24 month package for pre-service curriculum development which includes an in-depth curriculum

review, creation of lesson plans, curriculum finalization workshop and mentorship including seminars on

effective teaching, seminars for students on study skills and teaching in the classroom as required. The

USG will work with other partners to find additional funding to support this ASCP program in Cambodia.

New/Continuing Activity: New Activity

Continuing Activity:

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

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $1,473,100

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

USG plays a significant role in assisting the Royal Government of Cambodia (RGC) to strengthen national strategic information

(SI) activities by collaborating with the National AIDS Authority (NAA), the National Center for HIV/AIDS, Dermatology, and STDs

(NCHADS), other government organizations, civil society and major international donors and partners.

USG Cambodia HIV/AIDS program's close collaboration with RGC and major donors is imperative to ensure continued

advancement of various ongoing national Strategic Information /Monitoring & Evaluation (SI/M&E) activities and to identify vital

resources to cover future planned SI/M&E activities in support of the "Third One."

Surveillance

Cambodia has a well-developed surveillance system that provides essential information on the HIV epidemic in Cambodia,

particularly among several most-at-risk populations (MARPs). USG has provided significant financial and technical support to

establish the national surveillance program and to help build surveillance capacity. The national surveillance system, implemented

by NCHADS, is considered a model of second-generation surveillance, and one of the most advanced in SE Asia.

One of the USG's key activities is providing technical assistance (TA) to build capacity in the national HIV/AIDS program. USG

supports the National AIDS Authority, which is responsible for coordinating the national AIDS response, guided by the National

Strategic Plan for a Comprehensive and Multisectoral Response to HIV/AIDS, 2006-2010 (NSP-II). NAA coordinates M&E

activities through the National M&E Advisory Group, in which USG continues to play a lead role, which endeavors to harmonize

monitoring indicators and methods in line with the "Three Ones". In 2008, NAA issued the National HIV/AIDS Monitoring and

Evaluation Guidelines and coordinated a multi-ministry assessment based on the Global Fund M&E System Strengthening Tool,

providing a roadmap for needed improvements in the national M&E system. USG and UNAIDS provide substantial technical

support to NAA, and to the M&E functions of its member RGC ministries, including support for capacity building in data analysis,

interpretation, utilization, and reporting. NAA continues to be challenged by the lack of financial and political support, and is

unable to guide RGC member ministry M&E efforts due to a lack of experienced staff and the limited capacity of its M&E staff.

The overall USG SI Strategy focuses on providing SI/M&E TA and capacity building to RGC and all NGO partners. Sustainability

is a key component of the SI strategy, thus the USG will continue to focus on building local capacity for M&E with an emphasis on

data quality and use for program management and program improvement. USG will provide support to RGC in building a

sustainable and robust national surveillance and M&E system, with efforts to harmonize indicators and Health Management

Information Systems (HMIS), in line with the "Third One". USG supported development of the NCHADS indicators and guidelines,

and with WHO, UNAIDS, and others provided technical and materials support for training and placement of provincial data

management officers throughout the country. USG will assist RGC and NGO partners at both the national and provincial levels to:

1) strengthen national surveillance systems and surveys; 2) provide TA for conducting in-depth analyses of surveillance and

survey data; and 3) advocate for the use of data for evidence-based strategic program planning, program improvement, and

decision-making. As national HIV programs and their basic information systems become more established, the USG will need to

devote more attention to improving the use of data by government and NGO partners through Continuous Quality Improvement

(CQI) techniques and, occasionally, Operations Research. Finally, USG will support key program assessments as an integral part

of the USG program implementation focusing on MARPs.

With COP 09 funds, USG SI support will focus on four areas:

1. Strengthen national surveillance systems, surveys, and data use

Cambodia's surveillance system is relatively robust. Behavioral surveillance surveys (BSS) have been conducted regularly since

1997 (7 rounds). HIV sentinel surveillance (HSS) serosurveys have been conducted regularly since 1996 (8 rounds). DHS+ was

conducted in 2005 and two integrated behavioral and biological surveys (IBBS) have been conducted (2001 and 2005). IBBS

includes STI surveillance and will be repeated every three or four years. In 2007, RGC held an international consensus workshop

in which results of DHS+ HIV testing and HSS 2006 were analyzed to provide updated adjustment factors (male-to-female ratio of

people living with HIV/AIDS (PLHA), calibrator for estimating general population prevalence, and urban-rural population

distribution weights) needed for estimating national HIV prevalence. Workshop outcomes included revised national HIV

prevalence estimates and projections through 2012 of the number of PLHA (children and adults), AIDS-related deaths, new HIV

infections, and HIV-infected persons in need of ART. In 2008, the HSS 2006 specimens were tested with the BED-incidence

assay to directly measure the proportion of HIV infections that were recently acquired. USG also worked closely with partner

NGOs to design and conduct a project to improve previous estimates of men who have sex with men (MSM) population size.

Although financial support from USG was not provided, RGC also conducted a project with support from WHO to estimate the size

of the injection and non-injection drug using population and prevalence of HIV, hepatitis B, and hepatitis C among these two

groups. RCG is developing an antiretroviral (ARV) resistance surveillance system, with financial and technical support from WHO

and technical assistance from USG as needed. In 2008, NCHADS developed a protocol and tool for collection and analysis of

ARV resistance early warning indicators, and began data collection for an HIV drug resistance threshold survey.

Specific activities will include: (a) providing support to NCHADS to conduct an IBBS in five priority provinces among three target

groups -- female sex workers (FSWs), police (a proxy group for clients of FSWs), and MSM. USG will provide assistance with

protocol development; supply procurement; sampling; training at the national and provincial levels; laboratory quality assurance;

data analysis, interpretation, and reporting; and dissemination and publication of results; and (b) other behavioral surveys for

MARPs such as the Tracking Results Continuously (TRaC) surveys and other special assessments/formative research.

2. Building SI/M&E capacity in RGC (NCHADS, NIPH, NAA) and NGOs

Building M&E capacity within RGC (NCHADS, NAA, National Institute of Public Health [NIPH]) and especially local NGOs is an

essential component of the PEPFAR program for sustainability. Strengthening government partners ensures the leadership is in

place to lead national SI/M&E activity planning. Strengthening civil society's local M&E capacity ensures that various NGO

implementing partners collect high quality information for use in program planning and quality improvement.

Specific activities will include: (a) provide theoretical and practical SI/M&E training for NCHADS, NIPH, NAA and its member

ministries, and USG focus province staff to assure that skills development is in line with M&E system advancement. SI/M&E

training topics may include: M&E, HMIS, Geographic Information System mapping, surveillance, survey methodology, operational

research, data collection and management, data quality, using data for evidence-based decision making and program planning,

and indicator reporting; (b) promote analysis and use of data for evidence-based policy and program planning and design at the

national and provincial level. Support use of routine monitoring data by focus provincial AIDS program technical supervisors in

supervision visits to build service delivery staff capacity in analysis and use of data to improve service utilization; and (c) provide

support and TA to NGO partners and sub-partners to improve program monitoring systems for tracking individuals served and

monitoring intervention intensity, conduct new or refresher training on data quality, convene meetings to promote civil societies'

participation in successful implementation of district and provincial M&E systems, and build capacity of USG sub-partners to better

use data for performance management and program quality improvement, as well as to provide data needed for the revised

PEPFAR II project indicators.

3. Building and strengthening a sustainable national M&E system, with efforts to harmonize indicators and HMIS

USG will continue to provide technical support to NAA's M&E unit to build the national M&E framework and to improve data

analysis and use. Where possible, the USG will support national data systems compatible with national indicators needed for the

PEPFAR II program and other international standards. USG will also support expansion of the scale and scope of NCHADS' data

management system, including improved exchange of program monitoring data with relevant ministries and programs at district,

provincial, and national levels; and improved monitoring of data quality and increased analysis and use of data at the service

delivery level, including continuous quality improvement approaches. USG will continue to support the NCHADS Data

Management Unit to strengthen their data management and monitoring activities.

4. USG will support key assessments as an integral part of USG MARPs-focused program implementation.

In collaboration with NCHADS and NGO partners, USG will evaluate specific aspects of supported programs, including coverage

and quality of prevention services for MARPs; quality of life and risk behaviors of PLHA and OVC; and access to and participation

in PMTCT services, including a cost analysis of the PMTCT routine testing program and family-based care initiatives.

Table 3.3.17: