Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 5371
Country/Region: Cambodia
Year: 2012
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $700,000

Goal and objectives:University Research Corporation (URC) works with the Ministry of Health to strengthen Cambodias public health system. Specific objectives include: 1) lowering the cost of prevention of mother-to-child transmission of HIV services; 2) increasing access to family planning for HIV-infected women; 3) increasing the use of health data in planning processes; and 4) increasing the number of HIV-infected patients with health equity fund eligibility. In FY 2012, URC will support: 1) integration of prevention of mother-to-child transmission of HIV activities into routine antenatal care; 2) delivery of family planning services to HIV-infected women in HIV care and treatment sites; 3) integration of HIV information in the broader health management information system; and, 4) identification of poor HIV-infected patients eligible for free health care through health equity funds.

Geographic coverage and target populations:Target populations include pregnant women in Pursat, Battambang, and Siem Reap provinces, and women in the HIV care and treatment groups of the Battambang, Sampov Meas, and Maung Russei Referral Hospitals. URC will also provide technical support to help public health facilities in Phnom Penh and Banteay Meanchey provinces extend services to urban HIV-infected poor citizens.

Cost-efficiency:URC will develop and pilot models and approaches designed to increase cost efficiency. URC will advocate for the incorporation of successful approaches by the Ministry of Health as part of national standard operating procedures.

Monitoring and evaluation:URC supported the design of the Ministry of Healths routine health information system, and the monitoring of specific URC activities is managed through a linked database.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Neither3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesMTCT Royal Government of Cambodia Ministry of Health, National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Infections. 200000 Integration of prevention of mother-to-child transmission of HIV services into routine antenatal care in support of the Global Fund Round 9 grant.

Funding for Health Systems Strengthening (OHSS): $500,000

Vertical programs (which work with a single issue from start to finish within the health system) supported by PEPFAR have proven to be very good at delivering targeted services but sometimes do so at the cost of creating inefficiencies by duplicating existing Ministry of Health functions. This service duplication is particularly true of health management information systems, where parallel systems cost more money and constrain opportunities for more holistic data analyses.

URC, in partnership with InSTEDD (Innovative Support to Emergencies Diseases and Disasters), will work with the national HIV program to integrate its data into the broader health information system in a two-step process: first establishing a conduit so that aggregate HIV/AIDS service delivery data is transferred to the health information system, and then developing a patient level data system that is shared between the overall Ministry of Health and the national program. The results will be measurable using the health information system dashboard that URC previously developed with the Ministry. The health information system soon will include private and NGO provider health data, which also will improve the quality of HIV/AIDS data in Cambodia.

Cambodia has one of the developing worlds largest social health protection mechanisms, Health Equity Funds, which provides free medical care to people identified as poor. URC has been integral to this systems development, which now covers 60 percent of Cambodia and is expected to expand nationwide in 2012 and 2013. The system, designed to identify the rural poor, is having a difficult time identifying the poor in urban, mobile or other non-traditional populations, so the expansion is moving slowly.

Most-at-risk populations are frequently in these latter categories. URC will work with local non-government organizations to develop new mechanisms to identify both HIV-infected people and members of at-risk populations who are economically eligible for health equity funds. In collaboration with the Ministry of Planning, the responsible entity for the identification process, URC will enroll eligible participants in the equity fund program.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $200,000

Target populations:Target populations include pregnant women and HIV-exposed infants.

Interventions:HIV prevalence among pregnant women in Cambodia is less than 0.4 percent, meaning that more than 250 pregnant women need to be screened for every one identified as HIV-infected. The Ministry of Health has been working to increase the use of antenatal care in health centers as a tool to lower maternal mortality rates. A health center will see on average about 350 pregnant women a year, and antenatal care programming now covers 89 percent of pregnant women, making it more cost-efficient to integrate HIV screening services into health centers than to run a separate, freestanding prevention of mother-to-child transmission of HIV program.

URC supports a service integration approach that involves the screening of every pregnant woman for HIV, anemia, eclampsia, and syphilis using point-of-contact diagnostic tools in health centers. URC works with the national program to implement this model in areas of the country not supported by Global Fund grants. All relevant antenatal care data are collected monthly through the health centers.

Reaching HIV-infected women with family-planning counseling and services has been difficult due to Ministry of Health regulations limiting access to hormonal contraceptive methods to health centers only, while the antiretroviral therapy patients were in hospitals. URC has worked to overturn this regulation and ensure that hormonal contraceptive methods are included on the Cambodian governments essential drug list. This change helped URCs work with the national program in developing approaches and training materials to deliver family planning to HIV-infected women in HIV care and treatment sites. The model, which requires HIV/AIDS providers to work hand-in-hand with maternal and child health providers, will be disseminated with URC support in FY 2012. The number of HIV-infected patients accepting family planning methods will be reported monthly in the national health information system.

Subpartners Total: $0
To Be Determined: NA
Cross Cutting Budget Categories and Known Amounts Total: $350,000
enumerations.Construction/Renovation $50,000
Human Resources for Health $300,000
Key Issues Identified in Mechanism
Child Survival Activities
Safe Motherhood
Family Planning