Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 10519
Country/Region: Ethiopia
Year: 2010
Main Partner: University of Washington
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/HRSA
Total Funding: $12,777,696

I-TECH's goal is to provide technical and financial assistance to the GOE to build human and organizational capacity and ensure sustainability in the scale up of effective HIV services that are integrated within the general health structure. I-TECH works with health bureaus, MOH, HAPCO, facilities, and NGOs to improve access to care/ART, monitor treatment standards and ensure quality services to decrease morbidity, mortality and ultimately improve quality of life of PLWHAA and curb the incidence of HIV infection. ITECH is part of a consortium of US-based universities funded through CDC that account for 69% of patients on ART in Ethiopia as of October 2009.

I-TECH provides TA that enhances effective prevention, care and ART service delivery through operational support and human resource development and quality improvement strategies to 42 facilities and is working in eight program areas. In COP 2010, it will add three new facilities and new programs (infection prevention, HIV pre-service and pre-service training for medical doctors) under flat funding. I-TECH operates in Afar, Amhara and Tigray regions, accounting for 40% of the HIV burden in Ethiopia. Target populations include PLWHAA, including children and pregnant women in all public hospitals in Tigray, Amhara & Afar and health centers in Afar. In COP 2010, I-TECH will target clients in selected private hospitals and health centers accredited by RHBs.

Eleven field based teams provide comprehensive onsite mentoring on prevention, and care/ART, including associated OIs, TB, STI, PMTCT, HCT, PWP and palliative care. Programs are evaluated and recommendations made for improving service delivery systems. Clinical mentors' pilot and implement draft tools, algorithms, and guidelines to help providers offer quality care. Quality improvement strategies such as CME, continuous quality improvement (CQI) & plan-do-studyact cycles are utilized. In-service trainings, consultation support and advanced training opportunities are availed to I-TECH mentors, university faculty, and facility level providers. Sustainability strategies include training, TOTs for national trainers, TA in developing policies and procedures and strengthening committees.

Task shifting is supported through training, curriculum development, and piloting as exemplified by case management and nurse prescriber initiatives. Facility-level performance reviews, quality improvement activities, and university staff retention by secondment of staff to Gondar & Mekele Universities will continue. Mentoring of Mentors insures that mentors are capable. Strengthening universities by supporting pre-service training and subcontracting in-service training to them will be implemented. I-TECH's clinical staff and mentors will be engaged in the pre-service effort as voluntary faculty. I-TECH, a joint program of the Universities of Washington and California San Francisco draws on deep clinical & pedagogical expertise to strengthen local educational institutions to design, deliver, monitor and evaluate educational programs and activities.

ITECH strengthens quality laboratory services following the health network model through which services are delivered. Quality laboratory services are as described by strategic objectives in the lab master plan and implementation strategies devised through joint planning with EHNRI and RHBs. Training and WHO accreditation of laboratories will constitute key strategies for health system strengthening and ensuring sustainability.

I-TECH will support implementation of the national HMIS at facilities including staff training, renovation of card rooms, and the purchase of furniture and equipment including support for installation of the electronic medical record. Renovation/construction efforts to improve quality of care will continue as needed, including support for the Center for Outpatient Care (COC) at GU. Renovations will incorporate sound infection prevention principles, including TB and hand washing. Procurement of equipments for medical, diagnostic and educational needs remain a priority.

I-TECH works closely with RHBs, HAPCOs and stakeholders to harmonize and coordinate service delivery and will continue supporting review meetings, participation in TWG and partner forums. It fosters public-private sector partnership led by regional health bureaus through sub-contracting and capacity building, I-TECH fosters meaningful involvement of PLWHAA associations, religious organizations and local NGOs by partnering with them and works towards sustainable, cost effective program implementation and improved services. Through patient support initiatives I-TECH will support patent education, safe water and healthy living initiatives, I-TECH supports decentralization strategies and strengthening support functions for efficient service delivery.

Programs will have in built CQI initiatives that contribute to meet service standards. Operational research that addresses key questions will be done. Mechanisms to monitor and evaluate programs will be incorporated that will be led by the M&E department according to national HMIS and revised PEPFAR indicators.

Funding for Care: Adult Care and Support (HBHC): $480,230


Funding for Treatment: Adult Treatment (HTXS): $6,827,073

This is a continuing activity. In COP09, I-TECH supported HIV treatment and care in 42 facilities in Afar, Amhara and Tigray Regions. Initiatives to improve standards and quality of care included standardizing and broadening on-site mentoring, mentoring of mentors, introducing quality improvement cycles (PDSA), case-based learning, expanded Case Management/Adherence Support (CM/AS) services, and greater involvement of PLHIV associations. In COP10, these initiatives will be strengthened with continued support of ART service to enroll new ART eligible clients through continued technical assistance (TA) to RHBs/HAPCOs. Other activities planned by I-TECH in COP10 include:

Expanding the multi-disciplinary mentoring program to 45 facilities.

Continuing to support two private hospitals and increase ART access to urban and pastoralist community in Afar with expansion of ART service to three new health centers.

Ensuring functional intra-facility linkage among services using CM service.

Collaborating with partners to have robust inter-facility referrals for transfers.

Retaining targeted adults with advance HIV infection receiving ART.

Building capacity of care providers on ART monitoring through in-service training, on-the-job mentoring, and case-based discussions.

Strengthening on-going CM/AS at facility and community levels to improve adherence and retention.

Expanding adherence support to in-patient wards.

Developing adherence education materials in appropriate languages.

Devising adherence sessions and teaching pill-counting to ART clients that are being transferred out.

Tracing lost to follow-up clients.

Building capacity of facility HIV committees and care providers on continuous quality assurance to monitor for desired ART outcome.

Providing service harmonization, equipment and commodity support to GU Center for Outpatient Care.

Under this activity in COP 2010, the partner is allocated additional funding to carry out basic function restoration (including ensuring consistent supplies of water and electricity) in selected care and treatment facilities in its operational zone. The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

Funding for Testing: HIV Testing and Counseling (HVCT): $469,017


Funding for Care: Pediatric Care and Support (PDCS): $136,800

The budget for this activity was increased by more than 20% because of the need to expand to new facilities and improve care and support (C&S) services. I-TECH is currently providing technical and material support to 42 sites on pediatric C&S. In COP 2010, I-TECH will continue to support implementation of appropriate C&S for HIV-exposed or infected infants, affected children and their families to improve their quality of life in 45 facilities. Onsite clinical mentorship, basic C&S provision, training, and supportive supervision will be conducted to improve the quality of care.

I-TECH will emphasize successful implementation and scale up of EID for early identification of HEIs; routine PITC for any infant or child with an indication for HIV infection and their parents; prevention and treatment of OIs and other HIV/AIDS-related complications including malaria and diarrhea; pain and symptom relief giving special attention to access to opioids for children; and nutritional interventions including integrating food provision with PMTCT and pediatric care programs. In addition, I-TECH will consolidate child survival interventions, including safe water and hygiene, micronutrient supplement, growth monitoring, improved infant and young child feeding, and treatment of life threatening childhood illnesses.

I-TECH will support counseling for disclosure and treatment and care adherence support group formation for children, adolescents, caregivers and families to enhance adherence to interventions. I-TECH will also support bereavement interventions and appropriate succession planning.

I-TECH will provide technical support for the provision of preventive services including infant feeding counseling; multi-micronutrient supplement; CPT, enhanced TB case-finding and provision of IPT; malaria screening and distribution of ITNs for HIV+ pregnant women and children <5 in endemic areas; and POU water sanitation, hand washing and personal and household hygiene. I-TECH will work with partners to conquer challenges for scaling up CPT for HEI and infected children. In addition, special emphasis will be given to enhance the documentation of all infants' HIV exposure status and follow-up. The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

Funding for Treatment: Pediatric Treatment (PDTX): $1,328,576


Funding for Strategic Information (HVSI): $200,000


Funding for Health Systems Strengthening (OHSS): $459,000


Funding for Biomedical Prevention: Injection Safety (HMIN): $100,000

In COP 2009, I-TECH received funding to improve infection prevention (IP) practices in health institutions in its operational regions. I-TECH will do replacement in-service onsite training for health care providers (HCP) to address staff turnover. I-TECH will supply IP and personal protective equipment (PPE) items as needed and support facilities through mentorship, TA and conduct baseline assessment and gap filling interventions. I-TECH will avail National IP Guidelines and IEC materials.

In COP 2010, I-TECH will provide replacement in-service trainings to HCP working in health institutions with high staff turnover. It will provide IP training to support non-clinical staff (housekeeping, laundry, kitchen, etc.) in both public and private hospitals in I-TECH's operational regions as well as selected NGOs and regional FGAE clinics. I-TECH will also provide clinical mentorship in IP in addition to the onsite and offsite trainings. It will supply critical IP items and PPEs to health institutions and support the establishment and strengthening of IP committees. The committees will follow and be responsible for the implementation of optimal IP practices in their respective hospitals. In addition, I-TECH will strengthen the existing HIV post exposure prophylaxis (PEP) practices by availing PEP protocols, PEP kits and assigning point persons. I-TECH will work with hospital management to avail the service at all times. It will also support health institutions in its regions in areas of health care waste management by renovating and constructing incinerators and placental pits and by availing sharps disposal containers. Moreover, it will renovate selected center of excellence facilities to assure functional hand-washing basins with water supply to promote hand washing, a core IP component.

I-TECH will provide support and TA to RHBs for the coordination of IP programs and support five medical universities in pre-service integration of IP trainings and provide TOT training to the university staff to enable them to do in-service training as a strategy for sustainability. M&E will target key areas such as hand washing and PEP.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $55,000


Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $220,000


Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,300,000


Funding for Laboratory Infrastructure (HLAB): $624,000

This is a continuing activity with a new goal emphasis and is part of the streamlined COP 2010 submission. In COP09, I-TECH is providing comprehensive technical assistance (TA) and implementation support to strengthen the laboratory system and improve service quality in 42 laboratories in its supported regions through on-site mentorship; strengthening QA programs; renovating and furnishing laboratories; and providing lab equipments and trainings on HIV, EID, TB and malaria laboratory diagnosis. I-TECH is also providing ART monitoring and supporting EID service expansion from 3 to 37 sites.

In FY10, I-TECH will continue to provide high quality HIV/AIDS services such as laboratory capacity building and system strengthening through on-site mentoring of lab technicians in 45 sites. I-TECH will provide inservice trainings using nationally-approved curricula and provision of TA to strengthen and standardize laboratory policies, protocols, guidelines and program evaluations. I-TECH supports the implementation of laboratory information systems in selected hospitals and continues to scale-up ART intakes through uninterrupted laboratory services at all sites.

Together with EHNRI, I-TECH will build regional capacity for laboratory equipment maintenance and will strengthen the laboratory quality systems. I-TECH will also:

Improve laboratory service quality through on-site mentorship on QC/QA and implementation of national and international EQA.

Renovate and furnish high patient-burden hospital laboratories in the three regions.

Support six laboratories for accreditation using the WHO-AFRO accreditation scheme.

Support the implementation of viral load testing and TB culture in selected university and hospital laboratories.

Introduce POC testing, along with PATH and the University of Washington.

Provide TA to EID program.

Provide TA to the national TB program through training on TB diagnosis and strengthening regional laboratories with TB culture implementation targeting >50% TB detection rate in the three regions.

Conduct M&E of programmatic successes and failures.

Strengthen partnership with major stakeholders like EHNRI, CDC and USG partners.

Support I-TECH laboratory staff skill development through south-to-south programs.

Funding for Care: TB/HIV (HVTB): $578,000


Subpartners Total: $0
Afar Regional Network of Persons Living with HIV Association: NA
Afar Regional Network of Persons Living with HIV Association: NA
African Services Committee: NA
Amhara Development Association: NA
Amhara Regional Health Bureau: NA
Ethiopian Nurses Association: NA
Ethiopian Orthodox Church Development and Inter-Church Aid Commission: NA
Family Guidance Association of Ethiopia: NA
Mekdim Ethiopia National Association: NA
Organization for Social Services for AIDS: NA
Save Generation Association of Tigray: NA
Tigray Regional Health Bureau - Ethiopia: NA
Tsadkane Mariam Mihrete Bizuhan Mahber: NA
Cross Cutting Budget Categories and Known Amounts Total: $4,162,500
Construction/Renovation $1,350,000
Food and Nutrition: Policy, Tools, and Service Delivery $630,000
Human Resources for Health $2,070,000
Water $112,500
Key Issues Identified in Mechanism