This mechanism supports the Cote dIvoire National HIV/AIDS Care and Treatment Program (PNPEC) and other Ministry of Health and AIDS (MSLS) ) structures to ensure coordination of HIV/AIDS interventions through integration and decentralization of HIV/AIDS and other health-care activities and implementation and enforcement of national policies, guidelines, and standards. Funding is requested in the OHSS, HVSI, HBHC, HTXS, HMIN, HLAB, and HVTB budget codes.

This overall result will be achieved by meeting three objectives:

1. Improve coordination of HIV control interventions at decentralized levels

2. Strengthen the regulatory framework and promote hospital hygiene

3. Strengthen management of strategic information for health .

The MSLS will implement activities through various technical divisions and foster stronger involvement of local government officials and other stakeholders to ensure efficiency and promote local ownership and sustainability. Activities will directly contribute to improving regional and district-level HIV planning, coordination, and implementation while strengthening human and institutional capacities for planning, strategic information, training, supervision, and resource mobilization.

Vehicles:

Through COP11: 12 plus 5 motorbikes

New requests in COP12: 1 pickup, 16 motorbikes

Total planned vehicles for life of mechanism: 13 vehicles, 21 motorbikes

New request justification:

1 pickup ($31,000) and 11 motorbikes ($22,000) will be used by the ministrys division of equipment and maintenance to monitor maintenance of lab equipment at PEPFAR-supported health facilities; 5 motorbikes ($10,000) will be used to collect routine prevention, care, and support data from far-flung villages to district-level data centers.

The Ministry of Health and AIDS (MSLS) Division of Equipment and Maintenance (DIEM) has decentralized services (CRIEM) in 6 of the 19 regions of Cote dIvoire and has the mandate to oversee all procurement, building, and renovation of health infrastructure and equipment.

Starting with COP 2011, the contracting and oversight for the maintenance of laboratory equipment used at PEPFAR-supported health facilities is being progressively transferred to the MSLS. This effort will continue in COP 2012, involving the contracting of maintenance services with local vendors, building the capacity of the DIEM at central and regional level for supervision and minor maintenance.

This is part of an overall effort to transition ownership of USG-funded activities to the host government and progressively contribute to better sustainability.

With USG funding, the National TB Control Program (PNLT) has taken the lead in the response to TB/HIV co-infection, along with the National HIV/AIDS Care and Treatment Program (PNPEC) and the Institut Pasteur of Côte dIvoire. The PNLTs response to the TB/HIV epidemic is focused on policies and guidelines promoting the development of a TB/HIV collaborative framework, improvement in diagnosis of TB among people living with HIV/AIDS (PLWHA), provision of routine HIV testing and counseling (TC) of TB patients, and integration of HIV care and support in all TB clinics.

With PEPFAR support, the TB program is implementing free routine provider-initiated opt-out TC at all 16 national TB specialist centers and 118 integrated TB diagnostic and treatment centers (20 other TB care and treatment sites still need to implement routine testing). PEPFAR-supported sites are on track to provide HIV tests and results to at least 21,651 TB patients in FY 2012.

The program is also training health care workers in monitoring and management of TB/HIV co-infection. In coordination with the PNPEC, PEPFAR-funded cotrimoxazole and ART are available in 110 TB diagnostic and treatment centers (December 2011), with links to HIV treatment sites following completion of TB treatment.

Through PEPFAR partners, the PNLT is also expanding TB screening at HIV care clinics and is working to make the referral system more efficient and the tracking of patients more accurate.

To improve TB infection control, the PNLT developed national guidelines and implemented infection control measures in 20 pilot sites in 2011.

To improve coordination of TB/HIV activities, the PNLT created a national TB/HIV joint committee with TB and HIV program partners, which conducts quarterly meetings to assess progress and improve implementation of TB/HIV activities.

Implementing partners are working with the PNLT and other programs to integrate HIV indicators within the national health system and at specialized TB centers and integrated peripheral sites, and job aids and training tools for counselors and other professionals are being adapted.

With FY 2012 funding, the PNLT will work to:

1. Organize 2 coordination meetings (1 per semester) on joint TB/HIV control activities, at the central level with the PNPEC and other donors and partners.

2. Support the organization of 1 annual coordination meeting at a TB center outside Abidjan.

3. Organize 2 update workshops and ensure the effective implementation of policies and guidelines for TB/HIV care and treatment

4. Coordinate the training of providers, in collaboration with the Ministry of Health Division of Training and Research (DFR), in care and treatment of co-infected patients.

5. Conduct 2 annual supervisions from the central to the regional level.

6. Support the Abidjan tuberculosis treatment center (CAT) in conducting 2 annual supervisions to the district tuberculosis treatment center (CDT)

7. Continue the deployment, maintenance, updating, and appropriate use of ETR software to improve data collection.

8.Organize a workshop for the validation of the PNLT National Strategic Plan 2012-2016.

In HLAB, FY 2012 funding will prioritize validation and implementation of the national laboratory strategic plan, human resource development, and accreditation plans and processes. Support for the Ministry of Health and AIDS (MSLS) will mainly focus on capacity building to strengthen the laboratory system throughout the country, with support for MSLS leadership and coordination through:

a. Support for the national public health laboratory (LNSP) to assume leadership as a true national reference laboratory by enhancing its infrastructure and human resource capacities, providing technical assistance to improve competencies for HIV diagnosis and expertise for the establishment and management of a national external quality assurance (EQA) program. LNSP will assume greater responsibility for reference HIV testing, ANC sero-surveillance, post-marketing surveillance of HIV rapid test kits, algorithms, and alternative blood collection methods.

b. Improved infrastructure at the national health worker training school (INFAS) to increase its educational capacities, including the procurement of lab equipment and renovation of lab classrooms at two regional schools.

c. Capacity building to help the MSLS division of equipment and maintenance (DIEM) to develop and implement a national program for the maintenance of lab equipment in public health facilities. DIEM will work with SCMS and the CDC/Retro-CI lab to develop policies, tools, and documentation for a global maintenance contract for biomedical equipment, including lab equipment procured by PEPFAR.

The Ministry of Health and AIDS (MSLS) decentralized M&E units aggregate health program data at regional level, analyze and transmit validated data to central level, and provide feedback to district health teams for decision making, under a strategic plan developed by the Division of Information and Monitoring Evaluation (DIPE). But the MSLS health information system, designed to support data collection from 23 MSLS programs, is hampered by a lack of qualified M&E staff, equipment, and standard procedures.

With USG support, notable progress has been made. The DIPE has conducted eight HIV sentinel sero-surveillance surveys among pregnant women since 1997. In 2011, MSLS/DIPE with the national HMIS TWG released version 1.5.5 of the national HIV/AIDS patient monitoring tool (SIGDEP, initially SIGVIH), which includes a functioning pharmacy module to address ART drug dispensation requirements. SIGDEP is currently used on 147 USG supported sites and aggregate data from 222 sites). On a regular basis, PNPEC and DIPE organize training sessions for 19,784 field-based healthcare providers. PNPEC organizes technical coordination and supervision on the central level (PNPECs supervision reports, 2009).

The goal of COP 2012 support is to continue building the capacities of the MSLS at the central and decentralized levels, with an emphasis on strengthening the management of strategic information for the health sector national response, to ensure that health districts and facilities dispose of reliable, accurate, and complete data to improve the quality of service delivery.

The MSLS will continue to focus on regional-level capacity to meet challenges and expectations for improved data management. This support will be provided through training, follow-up, and supervision, which will enable the identification of high-performing heath districts and facilities as well as difficulties in the availability of tools, data transmission completeness, analysis, and information use. These interventions will enable the regions to play their role in the data transmission channel and provide feedback information on a regular basis to districts for program performance improvement.

Interventions planned with COP 2012 funding will include:

1 Building operational capacities of five of 20 regional M&E units (in addition to 5 funded in COP 2010); this will involve M&E needs assessments and development of a capacity building plan for each region, office equipment, communications and IT support, development and implementation of M&E procedures at regional level, and supervision and/or data quality evaluation.

2 Organization of periodic forums for HIV data presentation and use for decision-making at central level

3 Implementation of community-level M&E activities planned in the national strategic information plan. These activities will be defined jointly by PEFAR and the MSLS.

4 Implementation of surveillance activities, including the development and approval of the third Warning Indicators Survey protocol and the validation of HIV and STI case reporting system protocol by local stakeholders

5 Evaluation of the utility of routine PMTCT program data for HIV surveillance

6 - Deployment of the electronic HIV data management tool SIGDEP in 80% of health facilities to better capture patient information

7 - Periodic data validation meetings at the regional level, which will help prepare national 2012 HIV/AIDS and health sector reports

Effective coordination, human resources, decentralization of services, and key supporting functions such as strategic information and resource mobilization remain key challenges of the national response to the HIV/AIDS epidemic in Cote dIvoire. The Ministry of Health and AIDS (MSLS), which leads the health-sector response (HIV testing, care, treatment, drugs), is working to improve its planning, coordination, and monitoring and evaluation capacities, as well as to strengthen the involvement of community-level actors whose contributions are critical for scaling up the national HIV/AIDS response.

With FY 2012 funds, PEPFAR will support the ministry and other partners to:

Strengthen coordination and monitoring capacities

The USG will help boost the MSLS planning, coordination, and policy-making capacities in support of the national HIV/AIDS response, mainly by providing direct funding to key ministry divisions, especially the Director General office (DGS/DGLS), to ensure routine supervision and specific interventions to meet overall coordination challenges both at the central and regional levels.

Funding will also be provided to the National HIV/AIDS Care and Treatment Program (PNPEC) and to the National Reproductive Health Program (PNSR to help improve the capacities of regional and district health management and technical teams to plan, coordinate, and improve the delivery of HIV/AIDS services, including integration of reproductive health and family planning and gender issues in HIV services.

The USG will support the department of finance and administration (DAF) in its plans to develop mechanisms that will help monitor the use of donor resources to ensure accountability. The DAF will also collaborate with other appropriate MSLS divisions to identify and share innovative ways to mobilize additional resources, including from the Cote dIvoire national budget.

Improve human resources for health (HRH)

To address the perpetual problem of inadequate health care personnel, which constitutes one of the major barriers to the expansion of HIV care services, PEPFAR funding will support the reinforcement of human and institutional capacity at the national health-care worker training institute (INFAS) by renovating classrooms and training 100 new laboratory technicians.

USG funding will also support the MSLS department of training and research (DFR) in improving the coordination of in-service training activities, especially by testing and rolling out the TrainSmart software to track all training in the sector, and by exploring other innovative ways to encourage and deliver continuing education using information technology, print materials, and other accessible media.

Improve coordination of STI/HIV/AIDS activities in the school health system

Based on a needs assessment, the national school and university health program (PNSSU) will develop and implement behavior change interventions, including dissemination of materials, and ensure quality data reporting on STI/HIV/AIDS care activities targeting in-school youth.

One of the key strategies of the National HIV/AIDS Strategic Plan is to strengthen the regulatory framework and promote good hygiene to prevent HIV and other diseases related to lack of hospital hygiene. This strategy calls for strong central level coordination and management of activities in health districts. From 2004 to 2009, PEPFAR supported the GoCI to implement safe injection and medical waste management (SIGDM) activities in 3 reference teaching hospitals (CHU) and 61 health districts (DS). Some other major achievements include the training of 9,508 healthcare staff, the introduction of 11,200,212 self-controlled and shrinkable syringes and 127,850 security boxes, the creation of the SIGDM National Coordination Committee, the provision of standards and guidelines and of SIGDM policy documents, and the introduction of a separate waste management system at the CHU in Yopougon and in 2 general hospitals. There has also been the dissemination of 11,362 media communications encouraging the integration of SIGDM concepts in training programs at the National Institute of Healthcare Training (INFAS).

Since 2010, PEPFAR is helping the GoCI roll out these successful interventions to other decentralized levels of the health system, based on a national SIDGM policy. To date, 63 health districts are involved in SIGDM activities, of which 60% are reference hospitals. Activities proposed in COP 2102 are part of Year 2 of this rollout process, which will target the health districts of Abobo Est, Abobo Ouest, Gagnoa, Agboville, Mankono, and San Pedro. Activities will include:

1. Integrate safe injection and biomedical waste management into the national supervision guide.

2. Organize 4 coordination meetings for SIGDM activities at central and regional levels.

3. Conduct a training needs assessment. Based on the results of this assessment, a training plan will be developed and implemented. All training will be coordinated with the division of training and research (DFR) and the division of human resources (DRH).

4. Update and produce a student guide and trainer manual for SIGDM, the national HHSIGDM 2013-2015 plan, and the national medical waste management plan, norms and guidelines.

5. Integrate HHSIGDM modules into the training curricula of the universities of Cocody, Abobo-Adjamé, Bouaké and INFAS. This process will involve a quick assessment of the ongoing integration at the INFAS and of resulting improvements in service provisions. Based on results obtained, the MSLS will develop a plan for integrating these modules at universities, to be funded under future COPs.

6. Conduct an assessment of health care-related accidental blood exposure prevalence. This assessment will allow the MSLS to have baseline data and organize activities base on the results.

7. Purchase and install 1 incinerator at Abobo General Hospital in Abidjan.

8. Conduct an assessment of the utilization of six existing incinerators.

9. Develop a protocol for piloting technologies other than incineration (autoclaves, grinding, etc.) for biomedical waste management.

10. Implement the new waste management technology selected.

11. Develop a strategy for integrating maintenance costs of the 7 incinerators in the MSLS budget, starting from COP 2014.

12. Develop a collaboration mechanism between the division of public hygiene and the division for infrastructure and maintenance for the maintenance of incincerators.

The Ministry of Health and AIDS (MSLS) Division of Equipment and Maintenance (DIEM) has decentralized services (CRIEM) in 6 of the 19 regions of Cote dIvoire and has the mandate to oversee all procurement, building, and renovation of health infrastructure and equipment.

Starting with COP 2011, the contracting and oversight for the maintenance of laboratory equipment used at PEPFAR-supported health facilities is being progressively transferred to the MSLS. This effort will continue in COP 2012, involving the contracting of maintenance services with local vendors, building the capacity of the DIEM at central and regional level for supervision and minor maintenance.

This is part of an overall effort to transition ownership of USG-funded activities to the host government and progressively contribute to better sustainability.