Tulane University's goal is to provide technical and financial support to the Ethiopian Health Sector in order to achieve the objectives of the second phase of PEPFAR. Working from a national platform with the MOH, its objectives are to support: the National HMIS system and capacity; national surveys and surveillance; the health sectors strategic and annual planning process; the National Quality of Care Framework (HIV/QUAL-QualE); Integrated Supportive Supervision; national human resources for health strategy and implementation (2008-2020); the MOH to devise and implement various health worker retention mechanisms; pre-service training of health workers; the Jimma University and Mekele University Programs; the national scale up implementation of Electronic Medical Register and Data warehouse/GIS: and MOH Information Systems.

Tulane's close TA engagement with the MOH is a major component of the Partnership Framework's eventual contribution to health systems strengthening related to planning, leadership, human resources for health, and generation and use of strategic information. Since 2003, Tulane has been a UTAP awardee and its capacity statement outlines the long history of involvement in M&E through collaboration, capacity building, and participation with bi-lateral and multilateral partners in SI including World Bank and UNAIDS. It's Technical Assistance Project in Ethiopia since 2006 has worked closely with MOH and its Agencies at all levels of the health care system of Ethiopia. It brings leverage and experience as a lead partner for MOH in the development and expansion of the National HIV/AIDS monitoring system, implementation of the national HMIS, development of the National HRH Strategy and implementation plan and as a contributor to the ongoing MOH BPR reform process. Tulane has led efforts to scale-up HRH production, especially medical doctors and conversion to a new four-year problem-based learning curriculum.

Tulane's activities will have national coverage and a contribution to the overall strengthening of health systems in Ethiopia by workforce capacity building, improvement in health management, policy, HRH, e-health, M&E, surveillance, providing training and education on strategic information, planning and improved resource targeting in areas of greatest need. Tulane plays critical roles in capacity building of the National M&E system.

Tulane's collaborative work in Ethiopia, involves provision of technical and material support to the design and implementation of national planning and M&E at all levels; expansion of health information management and data use at service delivery level; national and regional surveys, surveillances and evaluations; development of a national health information structure and data warehouse that includes enhanced capacity to use GIS; development and scale up of a customized Electronic Health Record in collaboration with CDC/Ethiopia and CDC/Zambia; expansion of ICT within the health sector; develop and expand pre-service and in-service training including establishment of the Post-Graduate training in M&E at MSc level at Jimma University (JU), the first of its kind in Africa and only second after Brazil. In 2008, for the first time in its history, JU has begun enrolling international students, including students sponsored by CDC/Tanzania.

Tulane has established strong collaboration and partnership with both government and NGOs. At the MOH level, it works very closely with various departments and its Agencies including the Federal HIV/AIDS Prevention and Control Office, Ethiopian Health and Nutrition Research Institute and the Ethiopian Drug Administration and Control Authority. It also works with RHB's, Woreda Health Offices, hospitals, HCs and HPs. Its working relationship extends to MOE, EICTDA, CSA, NGO's and PLWHAA Associations (NEP+) and FBOs such as EIFDDA and CRDA.

Tulane and its partners have substantial domestic and international experience in HIV education, prevention, care and systems strengthening. These partners are Brazil's National School of Public Health, George Washington University Departments of Epidemiology and Biostatics, Global Health and Health Policy, Harvard University Department of International Health Systems, New York State DOH AIDS Institute, World Bank/GAMET, WHO, Abt Associates, Engender Health, Management Sciences for Health, Regis University and CDC/Zambia and South Africa. Each of these partners has access to extensive primary and secondary networks of collaborators and technical consultants.

In order to ensure continuation of the efforts initiated through this funding mechanism, Tulane will be working with in-country partners for each of the proposed activities, all of which have components of capacity building to ensure the sustainability of programs.

Tulane will be responsible for developing and executing an M&E plan, in consultation with in-country PEPFAR team. Tulane will develop a detailed plan of implementation for COP 2010 when awarded. Expected program results with indicators, mid-term milestones/benchmarks will be elaborated in line with PEPFAR II Indicators. The implementation plan will clearly outline the programmatic approach as described and provide a timeline for the completion of results and deliverables and developed in coordination with the USG PEPFAR teams. Tulane will comply with all country-specific PEPFAR reporting requirements, including but not limited to Annual and Semi-Annual Performance reports.

This activity comprises of two seperate entities: (1) The Tulane Technical Assistance Program Ethiopia (TUTAPE) continues to provide technical support for M&E systems and human capacity building for national, sub-national, and service-delivery levels. In FY09 TUTAPE provided TA to redesign the planning and M&E process for the health sector. This design includes annual and strategic planning, resource mobilization and financing, routine data aggregation and reporting, performance monitoring and quality improvement (through HIVQUAL), integrated supportive supervision, and evaluation and inspection.

In FY10, TUTAPE will support the Ministry of Health's Policy, Planning and Finance Directorate to implement all manuals and SOPs finalized to the Woreda level. This will include short-term in-service training for the scale up of the national HMIS, performance and quality improvement (HIVQUAL/QUAL-ET), M&E for program improvement, and use of data for decision-making to FMOH, its directorates and health institutions, NGOs, FBOs, PLHIV networks, and the Central Statistical Agency. In FY10, TA will be provided and staff seconded to support surveys, health sector strategic and annual Woreda planning, M&E and costing activities, and M&E updates and reports. TUTAPE will continue to conduct process and health-outcome evaluations to continually improve M&E systems and program implementation.

TUTAPE will continue its support to Jimma University and M&E graduate student cohorts to maintain a sustainable MSc program including joint appointments of academics, strengthening the summer institute for faculty training, hosting international short-courses in M&E, and providing international teachers. E-materials will continue to be produced and used for training. Support to the Ethiopian M&E network will continue to mentor RHBs, NGOs, FBOs, and other local stakeholders. In FY10, support will continue for two cohorts for the biostatistics/health informatics MSc program and RHSCs/TVETS's health information technicians (HITs) Level IV trainees to support the national M&E and health system. Institutional support will include provision of international faculty exchange, ICT support, education supplies, and renovation of learning centers to enhance the learning process. (2) In FY10, Tulane will implement and maintain the full scale Electronic Medical Records (EMR) system at 20 additional sites that have implemented the new HMIS. In FY10, Tulane will continue building technical capacity at the FMOH and Regional Health Bureaus (RHBs) to manage and lead the implementation and expansion of these systems to health facilities and institutions, seconding staff to MOH as well as capacity building for development and expansion of the full EMR in the country. Support will also extend to FY08/09 implemented sites. To implement the EMR, Tulane will purchase IT equipments, configure hardware, install LAN infrastructure installations, conduct ongoing trouble shooting , upgrade the software and EMR (SmartCare) installation at facilities, and conduct user training and mentorship.

Tulane University will provide guidelines and IT policies for USG partners for the implementation of the EMR (SmartCare) system HIV/AIDS module(s) for hospitals and health centers that have started the HMIS. Tulane University will provide training to USG partners, facility-level staff, RHBs, and other stakeholders on EMR (SmartCare) HIV/AIDS module software utilization. Tulane University will provide supportive supervision and oversee with CDC the implementation and use of the EMR (SmartCare) HIV/AIDS module at sites in close collaboration with RHBs and FMOH.

In FY10, support will continue to include human resource capacity building, hardware acquisition, software licensing, and application development to strengthen the data warehouse. Tulane will continue to support all information and communication technology activities at national, regional and facility level through continued trainings as well as seconding staffs as part of capacity building. Mapping and unique identification of all health institutions will continue as outlined in "The Signature Domain and Geographic Coordinates: A Standardized Approach for Uniquely Identifying a Health Facility" in collaboration with the MOH, the CSA, and the National Mapping Authority. In FY10, training will continue on all information and communication technologies as part of capacity building

This activity comprises of two seperate entities: (1) Tulane University Technical Assistant Program Ethiopia (TUTAPE) with PEPFAR support has provided technical assistance to the FMOH to draft HRH Strategy covering periods of 2009-2020.

TA will be provided to the FMOH, its federal agencies, regional health bureaus and health institutions to roll-out the implementation of the HRH strategy and implementation plan to improve the retention of key health professionals as well as enhancing the capacity of the HRH management focusing on the following key areas: Human Resource (HR) planning and TA to support the institutionalization of the estimation of detailed densities of health workforce to the Woreda level and as a result annually update the HRH data base; M&E and research; in-service training (CME/CPD); HRH development and career progression; HR management and administration including deploying HRIS to federal agencies, RHBs, Zonal Health Departments and Woreda Health Offices and health institutions; licensing and certification; health and HRH regulation including service and facility standardization and innovative ICT solutions to improve retention of critical health workers including the scaling up of telemedicine/tele-education for staff retention and improvement of quality of service including HIV/AIDS treatment. In addition, Tulane will assist FMOH and its agencies to assess the sequencing of investment in HRH Strategy and develop monitoring and evaluation activities needed to support the above areas and link it with other funded activities.

TUTAPE in FY10 will support FMOH in short term in-service HRH and Management training in collaboration with partners. In FY10, Tulane will continue to provide TA at the national level to the FMOH (the new Directorate for Human Resources Department, and the New Regulatory Licensing and Registration Division) and FMOE in the development of an implementation plan for the new HRH strategy and ICT to the RHB level, various aspects of human resources development including seconding and availing short term and long term technical experts in health policy, education, costing, workforce forecasting, management and retention and coordinate with other PEPFAR partners and other donors. (2) The FMOH has prioritized the scale up of pre-service training as part of its HRH Strategy. Tulane University has been a central partner with the FMOH on development of the HRH strategy, implementation plan and distance-learning methods. Tulane has also provided an experienced technical advisor to the FMOH to design and coordinate the implementation of the medical school curriculum and approach.

Tulane will strengthen the institutional capacity of public and private medical education institutions to deliver comprehensive pre-service medical education while integrating HIV, TB and Malaria modules originating from national and international guidelines. Tulane will analyze policy, legal and financial frameworks necessary to implement the scaling up of medical education.

In FY10, Tulane's support will include the development of a graduate course for faculty development; ICT infrastructure; procurement of educational materials and equipments; renovation of selected training space; exchange of faculty and medical education experts; and exposure of faculty to different delivery models for medical education. Tulane will develop M&E mechanisms to monitor the quality of the medical education in collaboration with the FMOH and FMOE.

Tulane will work to strengthen educational planning and the coordination and management roles of the FMOH, FMOE Higher Education Department, Higher Education Relevance and Quality Agency, Universities, and the National Medical Curriculum Review Panel. Tulane will engage these entities in curriculum development/review, benchmarks development, school management, student assessment, and licensure and accreditation activities.

Tulane will explore Public Private Partnership (PPP) involvement in strengthening the Ethiopian Medical Universities as a means of supporting Ethiopia's plans for rapidly expanding health professional training. Tulane will support and strengthen Campus Network Infrastructure; provide virtual classroom solutions (WebEx Conferencing and Collaboration, Tele presence, Digital Media Systems, Content Management platform); and establish Networking Academy Sites.