The Samarth project is implemented by Family Health international (FHI) and contributes to implementation of quality HIV/AIDS prevention, care, and treatment through technical assistance (TA), capacity-building and institutional strengthening of government and civil society. The overall goal of Samarth is to improve the effectiveness of the response of government and civil society for evidence-based HIV policy and programs in India.

The project provides TA to the National AIDS Control Organization (NACO), the Global Fund, key government ministries, State AIDS Control Societies (SACS) in the USG priority states, USG partners and civil society organizations under the framework of the National AIDS Control Program III (NACP III). Samarth uses a variety of approaches for providing technical support including mentoring and training, influencing policy through collaborations and partnerships, sharing knowledge and good practices and strengthening data quality systems and placement of program and technical experts.

With the roll-out of NACP-III and increasing demand for TA, the project refocused its strategies to prioritize TA in areas of health system strengthening (HSS) including Human Resources for Health (HRH), orphans and vulnerable children (OVC) and strategic information (SI) to the national and state governments and other stakeholders. Samarth identifies program gaps and provides support in areas like development of the national operational guidelines for implementing OVC programs and national Greater Involvement of People Living with HIV/AIDS (GIPA) strategy, mentoring of technical staff at NACO and SACS; and mainstreaming HIV/AIDS into the Ministry of Women and Child Development (MWCD).

Samarth supports key personnel in NACO to provide national leadership and support to SACS and Distract AIDS Prevention Coordinating Units (DAPCUs) in responding to technical and programmatic needs related to implementation of NACP-III. At the government's request, Samarth supports the National Technical Support Unit (NTSU) at NACO to provide TA in key technical areas. This includes support for key positions -Team Leader, National Epidemiologist and Monitoring and Evaluation (M&E) Specialist. The mentoring plan for NACO and SACS developed by Samarth has leveraged resources from various donors and built strategic partnerships for in-service training of technical and senior management officials in the key areas of program management, M&E and institutional strengthening.

NACP III does not have budgetary allocations for OVC, which have been included under the Round 6 of the Global Fund Project covering four high prevalence states. Samarth has been successful in advocating for a focus on OVC under NACP-III. This has resulted in development of the National Operational Guidelines for OVC in collaboration with the National OVC Task Force (TF) consisting of NACO, MWCD, USAID, UNICEF, International HIV/AIDS Alliance and Clinton Foundation.

Samarth's strategic guidance and support to the TSU to India's largest state of Uttar Pradesh (UPTSU), has facilitated the substantial scale up of prevention programs for most at risk populations (MARPs) and migrants in the state from 20 interventions to over 100 interventions. The project also provided support to UPSACS to streamline SI systems. Samarth is part of the national Technical Working group (TWG) on BSS and Sentinel Surveillance and provides regular guidance to the Strategic Information Management Unit (SIMU) in NACO.

Samarth works in close collaboration with the India Country Coordination Mechanism (CCM) Secretariat of the Global Fund and provided TA for development of the national proposal on HIV. It also supports regional and national consultations for greater engagement of the civil society and the private sector in the Global Fund projects. Following an interim arrangement of support for the India CCM, the Samarth Project has successfully submitted a proposal for mobilizing resources for the India CCM Secretariat from the Global Fund. Samarth has been a key player in mainstreaming HIV/AIDS in various government departments. In collaboration with UNICEF and UNIFEM, HIV/AIDS cell has been established to integrate HIV/AIDS activities into existing and future schemes of MWCD. Samarth was able to leverage resources for mainstreaming of HIV/AIDS into MWCD.

Samarth in partnership with the Indian Network for People Living with HIV/AIDS (INP+) provides guidance and leadership to People living with HIV/AIDS (PLHIV) at the national and state levels, influences national greater involvement of people living with HIV/AIDS (GIPA) policy, and strengthens the capacities of networks of PLHIV. Samarth also has two demonstration projects in Delhi which focus on community and home-based care (CHBC) for OVC and their families; and prevention of HIV among street and vulnerable youth and children. Samarth demonstration partners continue to leverage services such as nutrition, medicines, investigations, transportation for antiretroviral therapy (ART), hospital services, education, vocational training and household economic strengthening for OVC.

Samarth will establish mechanisms for sustainability of existing support to its stake-holders beyond the life of the project. An HSS assessment in early March of the various technical positions at NACO revealed a significant number of vacancies and duplication of federal-state human resources. Based on this feedback, the project facilitated a restructuring of various TA mechanisms at NACO, including that of the TSUs to optimize efficiency and scale up of programs. This includes decentralized mentoring assistance at the district level to provide hands-on TA and capacity building to local implementing partners. The project also advocated with NACO to revise the technical support assistance from various donors and led a consortium of donor partners to develop a common mentoring plan that will leverage donor-supported resources for optimal human resource utilization.

Samarth has mechanisms to address gender equity in its program. INP+ will ensure increased participation of women living with HIV (WLHA) into the network and in GIPA implementation. Samarth during implementation of the OVC program will emphasize access for young girls to HIV/AIDS care and treatment services, school education, linkages for income generation and vocational training activities. Samarth, through the gender consultant placed at the MWCD will advocate for improving WLHIV's access to various services through program and budget provisions in ministry work plans.

SUMMARY

With USAID support (1999-2006), Family Health International (FHI) piloted child-focused demonstration models with 50,000 infected, affected, and vulnerable children in situations of low/high HIV prevalence, including children with/without parents, sex workers' children, children living on the street, children using substances, and children in rural, urban, and slum communities. With partners, FHI devised innovative strategies and tools: Life Skills Education (LSE) toolkit, protocol for child counseling on HIV, protocol for child detoxification and rehabilitation, and other communication materials. These initiatives informed national policy and programming: setting up of a national OVC Task Force (TF) with other stakeholders to bring issues to the forefront; developing National Operational Guidelines for orphans and vulnerable children (OVC) and prioritizing children and AIDS issues in the third phase of the $2.5 billion National AIDS Control Program (NACP-III).

Under the NACP-III, the long term goal is to achieve the highest quality of life for OVC which includes HIV-infected children and their families through delivery of a comprehensive package of care and support services.

Samarth with its mandate to provide technical assistance (TA) to the National AIDS Control Organization (NACO) program has identified the following strategic priorities in the area of OVC programming: contribute to USG strategic vision on OVC programming; develop the National Operational Guidelines for OVC in collaboration with the National OVC Task Force (TF) consisting of NACO, Ministry of Women and Child Development (MWCD), USAID, UNICEF, International HIV/AIDS Alliance, Clinton Foundation and FHI; Provide TA to NACO, SACS and USG partners to implement the National Operational Guidelines for OVC in collaboration with the National OVC TF; develop a resource base for tools for OVC programming; estimate HIV/AIDS orphans in India in collaboration with the National OVC TF; review the national OVC program in 2010 and influence NACO, allied ministries and the OVC task force members in future planning. These strategic priorities of Samarth cover all the top five PEPFAR priority actions on OVC.

Samarth addresses these areas through a two-pronged strategic approach: coordinated national action through the National OVC TF; and community-based demonstration project Chelsea in Delhi. The demonstration project also acts as community-based laboratory for Samarth to pilot innovative activities like LSE, Child Counseling on HIV/AIDS, Data Quality Assurance (DQA), Quality Assurance/Quality Improvement (QA/QI) and the Child Status Index. The learning from the pilots is used to influence the National Program and Policy for OVC. Samarth addresses the needs of children 0-17 years old, both male and female with increased focus on girls as traditionally girls have been neglected in terms of access to services, and are more prone to exploitation. The national activities of the project are for the entire country with a focus on high prevalence states and districts; the demonstration projects are in the slums of east Delhi and vulnerable neighborhoods of central and south Delhi. Samarth covers all the seven PEPFAR OVC services and the National Operational Guidelines on OVC also provide a framework for implementing all the seven services. The demonstration projects provide all services either directly or through referral and leveraging.

The Samarth project will continue to play a leadership role in the national TF and advocate for implementation of quality OVC programs. The Samarth project led the development of the first national operational guidelines for OVC programming and will provide TA to implement the national guidelines in select districts of the country. An OVC Trust was set up in select districts to provide financial support for health and educational needs of children. To support evidence-based programming for OVC in the absence of national data on OVC, the project facilitated a nation-wide exercise to estimate the numbers of OVC in the country using appropriate size estimation methods.

As a first step towards building health systems for convergence between NACP-III and other health systems involved in maternal-child health programs, the project facilitated the development of the HIV/AIDS cell in the MWCD and developed an annual work plan to mainstream HIV/AIDS activities. Similarly, as part of integration of child survival programs with HIV/AIDS, the project collaborated with the National Institute of Public Cooperation and Child Development (NIPCCD),the nodal training institute for staff implementing the government Integrated Child Development Services (ICDS) for revising their training curriculum to include HIV/AIDS prevention and care services.

The demonstration projects Chelsea implemented services for OVC and provided TA to other NGOs and government to design, implement and monitor OVC projects. Chelsea developed a training module on home-based care for OVC. The project influenced review and development of government policies and guidelines on child services. Samarth provided leadership to the national program on LSE and Child Counseling. A resource base was developed for tools for OVC programming. Samarth provided TA for leveraging services such as nutrition, education and household economic strengthening for children infected and affected by HIV/AIDS. The development of the guidelines required coordination with a number of Government departments particularly NACO and MWCD.

In FY10, the following activities will be carried out:

ACTIVITY 1: TA to implement the national OVC program as per the Operational Guidelines

The National Operational Guidelines for OVC will be finalized based on the learning from the first phase implementation in the highest HIV prevalence districts. Samarth will provide technical support to NACO, SACS, and USG partners in scaling-up implementation of OVC programs in India. The MWCD will be supported in strengthening functioning of the HIV/AIDS cell, and mainstreaming the OVC services. Samarth will review the functioning of OVC Trusts set up in FY09; the findings will contribute to strengthening of the Trusts and setting up trusts in more districts. The resource base for OVC tools established in FY09 will be updated every six months. The good practices will be documented and disseminated nationally and in select states through workshops and other means. The geographical focus of the activity will be national and select states and districts. This activity will contribute to PEPFAR OVC strategic priorities "Strengthen systems/government/policy" and "Improving quality service delivery".

ACTIVITY 2: OVC Demonstration Program

Chelsea will implement services for OVC and provide TA to other NGOs and government to design, implement and monitor OVC projects. The geographical focus for delivery of OVC services will be Delhi and for TA it will be both Delhi and outside. Samarth will continue to provide mentoring and supportive supervision to build capacity of the partners in implementing high quality services to OVC and provide TA to different government and non-government agencies. Samarth will conduct three monthly program data audits and six monthly Quality Assurance/Quality Improvement audits. Samarth will also provide support for documentation and dissemination of good practices. Being the last year of Samarth, the support will be phased out in June 2011.

ACTIVITY 3: Wrap-around Support for OVC Programs

In FY10, Samarth will continue providing TA for leveraging services such as nutrition, medicines, investigations, travel to clinic/hospital, tuition fee, vocational training and household economic strengthening for children infected and affected by HIV/AIDS. The good practices will be documented and disseminated. The geographical focus of the activity will be national and select states and districts. Samarth will document the progress on leveraging on a quarterly basis. This activity will contribute to PEPFAR OVC strategic priorities "Community support and coordination" and "Family/household strengthening".

Indicator targets: The activities under this budget code will be monitored by the following output level indicators.

o Number of eligible adults and children provided with a minimum of one care services;

o Number of HIV-positive adults and children receiving a minimum of one clinical service; and

o Number of eligible children who received food and/or other nutrition services.

In FY10, a total of 800 adult and 300 children will be reached through care services, 250 HIV infected adults and 150 children will be reached through clinical services and 150 infected children will be reached though food and nutrition services.

SUMMARY

With USAID support (1999-2006), Family Health International (FHI) piloted child-focused demonstration models with 50,000 infected, affected, and vulnerable children in situations of low/high HIV prevalence, including children with/without parents, sex workers' children, children living on street, children using substances, and children in rural, urban, and slum communities. Realizing the need for strengthening the quality of child counseling and testing (CT) services, FHI along with the experience of its partners and in consultation with experts from different agencies including National AIDS Control Organization (NACO) and Ministry of Women and Child Development (MWCD) developed "Protocol for child counseling on HIV testing, disclosure and support". The document was published after review by the National OVC Task Force (TF) comprising the MWCD, UNICEF, USAID, International HIV/AIDS Alliance and Clinton Foundation.

Samarth with its mandate to provide technical assistance to NACO program has identified the following strategic priorities in the area of CT: influence the strengthening of the National CT Protocol, particularly for children; provide technical assistance (TA) in roll-out of training for counselors in the National Program; develop quality standards for CT; enhance capacity of Samarth Demonstration Projects in Child counseling; provide on-site child counseling training to counselors from government and non-government agencies. Samarth addresses these areas through a two pronged strategic approach: coordinated national action through the TF and community-based demonstration projects in Delhi (Chelsea, Salaam Baalak Trust (SBT). The demonstration projects also act as community-based laboratories for Samarth to pilot innovative activities like Child Counseling on HIV/AIDS and Quality Assurance. The learning from the pilots is used to influence the National Protocol and Program on CT. Samarth addresses the needs of children 0-17 years old, both male and female with increased focus on girls who have traditionally been neglected in terms of access to services; they are also more prone to exploitation). The national activities of the project are for the entire country with focus on high prevalence states and districts; the demonstration projects are in slums of east Delhi and vulnerable areas of central and south Delhi.

Samarth invests modestly in CT only as part of demonstration models to government and nongovernmental organization (NGO) stakeholders to showcase quality CT delivery of services including a focus on data quality and on the full spectrum of CT services. Since FY10 will be the last year of the Project, the major activity will be to transition out and ensure Delhi State AIDS Control Society (SACS) is equipped to take over the community-based child counseling and testing service for OVC. The demonstration projects have implemented child counseling in line with the FHI protocol and have developed strong referral linkages with the government integrated counseling and testing centers (ICTCs). They have developed and practiced the quality assurance system for community-based CT. The pioneering work has drawn a number of visitors to the projects and interns have been placed by the National Institute of Public Cooperation and Child Development (NIPCCD) to develop skills on child counseling. Staff from the demonstration projects has been invited as trainers by different agencies.

In FY09, FHI provided TA to NACO in adaptation of the Regional Training Module on Counseling (developed by FHI Headquarters, UNICEF and WHO). FHI in collaboration with the National Task Force on Children Affected by HIV/AIDS (CABA) identified and trained master trainers on Child Counseling in the country. Chelsea and SBT projects provided hands-on skill building training to counselors. The most important challenge Samarth has experienced is influencing a revision of the national CT protocol to provide a comprehensive framework for dealing with different issues related to child counseling for testing, disclosure and support.

In FY10, the following activities will be carried out:

ACTIVITY 1: Transition of model sites that showcase delivery of high quality CT services

As part of the transition, Samarth will make adequate arrangements to phase-out Chelsea and Salaam Baalak Trust (SBT) projects. The local state government has evinced an interest in continuing with the community-based child counseling and testing service initiated by the demonstration projects. Chelsea and Salaam Baalak Trust (SBT) will provide TA to Delhi State AIDS Control Society (DSACS), local government health facilities and other NGOs to implement and monitor child counseling. The projects will conduct child counseling trainings and provide hands-on skill building training to counselors. The geographical focus of the activity will be Delhi. FHI will continue to provide mentoring and supportive supervision to build capacity of the partners in implementing high quality CT services to OVC and provide TA to different Government and non-government agencies. FHI will conduct three-monthly program data audits and six-monthly Quality Assurance/Quality Improvement audits. FHI will also provide support in documentation and dissemination of good practices.

ACTIVITY 2: Institutional capacity building at national and state level to improve depth and scale of CT services

Samarth supports staff for oversight of the 4,000 plus CT centers scaled-up under the NACP-III. The project will work closely to ensure the quality delivery of CT services and operational guidelines to expand CT services to the round-the-clock primary health care centers currently operational under the National Rural Health Mission (NRHM). TA will also be provided to NACO and SACS in development and/or adaptation of technical standard operating procedures (SOPs) and development of a quality assurance (QA)/quality improvement (QI) framework. Good practices in counseling will be documented and disseminated.

ACTIVITY 3: Wrap-around Support for CT Programs

Samarth will continue to support Chelsea to implement CT activities for the most-at-risk children, youth and most at risk populations (MARPs) in the local communities. The demonstration project will leverage HIV test kits and human resources from the DSACS for organizing the community "Know your Status" camps.

SUMMARY

Under the National AIDS Control Program III (NACP-III), the long term goal is to achieve the highest quality of life for HIV infected children and their families through delivery of a comprehensive package of care and support services.

Samarth with its mandate to provide technical assistance (TA) to the National AIDS Control Organization (NACO) has identified the following priorities for pediatric care and support: contribute to USAID strategic vision on programming for HIV infected children; develop the National Operational Guidelines for care and support of HIV infected children in collaboration with the National OVC Task Force (TF) consisting of NACO, Ministry of Women and Child Development (MWCD), USAID, UNICEF, International HIV/AIDS Alliance, Clinton Foundation and FHI; provide TA to NACO, State AIDS Control Society (SACS) and USG partners to implement the National Operational Guidelines; develop a resource base for tools for pediatric care and support programming; and estimate HIV-infected children in India in collaboration with the National OVC TF. Samarth addresses these areas through a two-pronged strategic approach: coordinated national action through the National OVC TF and Family Health International (FHI) sub-partner Christian Medical Association of India (CMAI); and support for a community-based demonstration project, Chelsea in Delhi.

CMAI has conducted training programs for various stakeholders, including health care providers in the private medical sector (missionary hospital settings). CMAI supported development of strong HIV care and support services for HIV-infected children within their member hospitals, with special focus on four hospitals, one in each of the USG priority states of Maharashtra, Karnataka, Tamil Nadu and Andhra Pradesh. CMAI also previously provided support to scale-up quality care for HIV-infected children through facility- and home-based care. However, the project was phased out in FY09 due to changes in the strategic priorities of Samarth.

The demonstration project Chelsea operates four clinics including three community clinics in the slums and one at a drop-in-center. The Medical Officer visits the clinics once a week to provide consultation on general health ailments and management of opportunistic infections (OI) to HIV infected children. Referrals are made to government hospitals for specialized consultation and hospitalization. The project also acts as a community-based laboratory for Samarth to pilot innovative activities such as Life Skills Education (LSE), Child Counseling on HIV/AIDS, Data Quality Assurance (DQA), Quality Assurance/Quality Improvement (QA/QI) and the Child Status Index. The learning from the pilots is used influence the National Program and Policy for HIV-infected children. Samarth addresses the needs of children 0-17 years old, both male and female with increased focus on girls traditionally have been neglected in terms of access to services. The national activities of the project focus on high prevalence states and districts; the demonstration project is in the slums of East Delhi. The demonstration project provides services to HIV-infected children either directly or through referral and leveraging

The demonstration project Chelsea implemented care and support services for HIV-infected children and provided TA to other nongovernmental organizations (NGOs) and the Government of India to design, implement and monitor projects on HIV infected children. Chelsea developed a training module on home-based care for HIV infected children. Samarth provided leadership to the national program on LSE and child counseling for HIV-infected children.

In FY10, the following activities will be carried out:

ACTIVITY 1: Support to Demonstration Program on HIV-infected Children

Chelsea will implement services for HIV-infected children and provide TA to other NGOs and government to design, implement and monitor projects for HIV-infected children. Chelsea will continue to monitor the progress of quality of life of HIV-infected children through Child Status Index. The geographical focus for delivery of the services will be Delhi and for TA it will be both Delhi and outside. FHI will continue to provide mentoring and supportive supervision to build capacity of the partners in implementing high quality services to HIV-infected children and provide TA to different government and nongovernment agencies. FHI will conduct three monthly program data audits and six monthly Quality Assurance/Quality Improvement audits. The Quality Improvement initiative on improvement of nutritional status of children on antiretroviral therapy (ART) in Chelsea will be completed and the learning disseminated. FHI will also provide need-based support in documentation and dissemination of good practices. Being the last year of Samarth, the support will be phased out in June 2011.

ACTIVITY 2: TA to NACO, SACS and USG Partners for program with HIV- infected children

Samarth will provide technical support to NACO, SACS, and USG partners to scale-up implementation of care and support programs for HIV-infected children in India. The MWCD will be supported in strengthening functioning of the HIV/AIDS cell, and mainstreaming the services for HIV-infected children. Samarth will continue to provide TA to government and nongovernment organizations in implementing LSE and child counseling on HIV/AIDS. The good practices will be documented and disseminated nationally and in select states through workshops and other means. The geographical focus of the activity will be national and select states and districts.

ACTIVITY 3: Wrap-around support for HIV-infected children programs

In FY10, Samarth will continue providing TA for leveraging services such as nutrition, medicines, investigations, and travel to clinic/hospital, tuition fee, vocational training and household economic strengthening for HIV infected children. The good practices will be documented and disseminated. The geographical focus of the activity will be national and select states and districts. FHI will document the progress on leveraging on a quarterly basis.

SUMMARY

Strategic Information (SI) is considered a priority under the National HIV/AIDS Control Program III(NACP-III). In order to have a robust strategic information and management system, Strategic Information Management Units (SIMUs) were established at both at national and state levels to monitor strategic planning, monitoring and evaluation, surveillance and research activities. Samarth's SI program area will focus on providing technical assistance (TA) at national, state, and district levels to strengthen data collection, analysis and its use for program planning.

Samarth as part of the national technical working group on estimation contributed to strengthening systems for national HIV surveillance and national estimates in close collaboration with the National AIDS Control Organization (NACO), National Institute of Medical Statistics, National Institute of Health and Family Welfare, Center for Disease Control (CDC), UNAIDS and World Health Organization (WHO). Samarth provided training and ongoing mentoring support to state level epidemiologists to strengthen state HIV surveillance systems, program data collection and analysis and monitoring and supervision of data quality. Samarth also developed and implemented a monitoring and evaluation (M&E) mentoring plan in coordination with other development partners to improve data management system, quality of the monitoring data and data usage.

In line with NACP-III goal to saturate coverage of targeted intervention programs, Samarth supported mapping of most at risk populations (MARPs) in all 71 districts of Uttar Pradesh. Samarth provided technical support to NACO and Uttar Pradesh State AIDS Control Society (UPSACS) to conduct a mid-term review of the national program and conducted behavioral surveillance survey (BSS) in the state of UP. As a part of strategic support to UPSACS, the project also coordinated data triangulation exercise to understand the HIV epidemic profile and developed district-level action plans to feed into the overall strategic action plan for the state.

Samarth conducted workshops for the USG partners on abstract writing and monitoring and implementation of quality interventions for orphans and vulnerable children (OVC) based on the needs expressed through a technical need assessment workshop. The project also contributed to integrating PEPFAR indicators into the existing reporting systems and collecting and reporting gender-disaggregated information on key indicators. Technical support was provided to USG partners for ensuring data quality and data accuracy through sharing best practices in data collection and management developed under Samarth.

In FY10, following activities will be conducted under the Strategic Information program area. ACTIVITY 1: TA to NACO and State AIDS Control Societies (SACS) on improving M&E and the National HIV Surveillance System

Samarth will continue to provide mentoring support to the epidemiologists at the national and state level in strengthening state HIV surveillance systems, monitoring and supervision of data quality, analyzing data from computerized management information system (CMIS) and conducting focused operation research and targeted evaluations. These epidemiologists will also contribute to analysis of epidemiological scenarios at the state and district level, identifying gaps in the existing intervention strategies and helping SACS to prepare strategic plans to address those issues. In addition, Samarth will share tools for assessing data management system including data quality and service quality standards and build the capacities of the M&E officers at the state level to implement those tools for monitoring data quality at collection, collation and reporting level and in the use of data for programming. Samarth will conduct trainings at the national and state level on the use of various models of data triangulation to track the epidemiological trends and using the findings to develop implementation strategies and designing new intervention programs.

ACTIVITY 2: TA to NACO to improve functioning of Strategic Information and Management Unit (SIMU)

Samarth will continue supporting the position of National Strategic Information Management Systems Specialist at the National Technical Support Unit (NTSU). Through this position Samarth will facilitate and coordinate with the national level M&E group and other development partners to establish an M&E framework in the spirit of the "Three ones"; review and modify indicators in line with national needs and standardized for global comparison; supervise and monitor the functions of state-level SIMUs; and provide technical inputs to the Evaluation and Operation Research Unit by analyzing programmatic data. In addition, Samarth will assess the needs of the state level SIMUs and will develop training modules in consultation with NACO and provide trainings to build the capacities of the SIMU team members for effective functioning of the unit. In addition, Samarth will provide support to documentation of best practices of the SIMU and will share with other SIMUs.

ACTIVITY 3: TA to NACO on improving the Computerized Management and Information System (CMIS)

Samarth will continue supporting the M&E Specialist at national level and provide trainings at the national and state level. The specific activities envisaged in FY10 includes upgrading existing CMIS to accommodate process-level indicators based on the national priorities; incorporate the provision of technical, logistics, and financial program monitoring; standardize existing reporting formats for each program area; facilitate implementation of SMART cards for ART patients; facilitate the process of digitizing HIV service centers across the country by type up to sub-district level; and facilitate GIS mapping of hotspots for MARPs. Through this position, Samarth will facilitate training of the state and district level data entry operators to increase reporting rates. In addition Samarth will review the existing system of data validation and consistency checks and will incorporate provisions for generating reports to ensure quality of the reporting data and taking corrective measures

ACTIVITY 4: TA to UPSACS on improving quality of prevention programs for MARPs Samarth will continue support to UPSACS and provide TA through the UP Technical Support Unit (UPTSU). Samarth will share service quality assessment tools and train identified staff members form UPSACS and TSU to implement those tools for assessing quality of the prevention programs for MARPs and migrants in the state. Samarth will also contribute to developing action plans based on the quality assessment findings. Samarth will provide technical inputs to UPTSU to monitor the quality of the reporting data submitted by targeted interventions (TI) and support for preparation of a plan to improve the data management and usage of monitoring data for evidence based planning. In FY10 the project will also provide specific support to UPSACS for designing and implementing an evaluation plan for TI program and triangulate evaluation findings with other data sources to measure the effectiveness of these interventions at the state.

ACTIVITY 5: Mentoring support to NACO for M&E

Samarth has been providing mentoring support for M&E to NACO in collaboration with other development partners. In FY10, the Samarth project will coordinate with the identified state-level mentors and regional research institutes to identify further capacity building needs at the state and district level. Based on the needs assessment, Samarth will facilitate development of training curricula, prepare plan and execute mentoring support. In addition Samarth will also facilitate different trainings in collaboration with other development partners and will assess the effectiveness of the mentoring support.

ACTIVITY 6: Knowledge sharing with stakeholders

Samarth will document the unique experiences as a TA provider in strengthening the health systems at the national, state and district levels through adoption of different approaches, strategic collaborations and leveraging with other donors and partners. These lessons learned will be widely disseminated through a national level workshop.

In FY10, a total of 10 organizations and 90 individuals will be reached under this budget code area.

SUMMARY

Samarth has been supporting the National AIDS Control Organization (NACO) since 2006 in implementing the National AIDS Control Program Phase III (NACP III). It has succeeded in establishing its place as a technical assistance (TA) and capacity building (CB) support project at the national, state and district levels. Health systems strengthening (HSS) is a major focus area for NACP III and is also a major priority area for Samarth.

Samarth has been able to provide valuable contributions towards strengthening health systems. Samarth provided support to NACO, State AIDS Control Societies (SACS), USG partners and civil society in building capacities of government and civil society for effective management of HIV/AIDS programs and its quality, improved strategic information and built bold leadership and visibility of the USG-supported program. During the past three years, Samarth adopted different approaches in providing TA for HSS at the national, state, and district levels to improve the effectiveness of the response of government and civil society for evidence-based HIV policy and programs in India.

Under leadership and governance, TA provided includes; development of national operational guidelines for OVC; trainings and mentoring support to key staff of NACO and SACS including technical and program officers, M&E and F&A staff and SACS project directors as part of the approved national mentoring plan as a long-term strategy to build human resources for health at NACO and SACS; support to Uttar Pradesh Technical Support Unit (UPTSU) for providing technical support to Uttar Pradesh State AIDS Control Society (UPSACS) for strengthening the State-level Targeted Intervention Program; support to national and state HIV program for implementation of Greater Involvement of People Living with HIV/AIDS (GIPA) policy and building capacities of state-level positive people networks for supporting GIPA in their respective states in collaboration with UNIFEM and UNICEF to establish an HIV/AIDS cell at the Ministry of Women and Child Development (MWCD) for enhancing support for women and children affected by HIV/AIDS in policy and program areas, with special focus on gender issues and child nutrition; building capacity of UPSACS and TSU on project management and TIs and support for selection of new State Technical Resource Center for trainings of TI staff; continuing support to Global Fund Country Coordinating Mechanism (CCM) to strengthen the Secretariat in India by facilitating the enhanced role of private sector and wider civil society participation and support for proposal development.

As part of HSS the Samarth project has placed technical advisors and consultants at NACO in key technical areas of counseling and testing (CT), PMTCT, ART, Surveillance and monitoring and evaluation (M&E) including at the NTSU; as well as capacity building of health care providers across all 71 districts of UP on stigma and discrimination and of civil society and NGO partners in PEPFAR priority areas.

The Samarth project invests substantially in building state and national level information systems through its membership at the national TWG on behavioral surveillance survey (BSS) and Sentinel Surveillance and also provides regular guidance to the SIMU at NACO. Samarth contributed to the mid-term review (MTR) of NACP-III through mapping, behavioral surveillance surveys and data triangulation in Uttar Pradesh. The project provided support to UPSACS to streamline the strategic information systems and the evidence generated strengthened the strategic planning process and the Annual Action Plans. As Samarth enters its last year, it will focus HSS investments on documentation of good practices in provision of TA at the national and state level.

ACTIVITY 1: Institutional capacity building at national level

Samarth will continue with support for institutional strengthening of NACO and ensure its sustainability by supporting the national technical support unit (NTSU) and key technical positions. In the first six months of FY10, Samarth will facilitate an in-depth assessment of human resources requirement at NACO in terms of revision of job descriptions, revision of the organogram and analysis of work-load of technical officers.

In continuation to the mentoring support provided in past years, Samarth along with the other development organizations will facilitate the design of long-term sustainable capacity building system for NACO staff to continue providing cutting edge leadership to the National Program beyond the Samarth project period. The facilitation will also explore possibilities for consolidation of donor support for training and mentoring including involvement of external experts and institutions as mentors.

Based on the revised national operational guidelines on orphans and vulnerable children (OVC) for the nationwide pilot, Samarth will provide technical support to NACO, SACS, and USG partners in scale-up implementation of OVC programs in India.

Samarth will continue to be part of the technical working groups for BSS, M&E and Sentinel Surveillance System. The Project will provide support to NACO for the strengthening of the strategic information management unit (SIMU); facilitate and coordinate with national level M&E group and other development partners to establish M&E framework in the spirit of "Three ones"; review and modify indicators in line with national needs and standardized for global comparison.

ACTIVITY 2: TA to build capacity at state and district level

The project supports the TSU in UP and will work on developing milestones to highlight transition of skills of TSU to the local SACS. The skills include project management, financial management, HRH and evidence based planning. During the three years of support to TSU, Samarth has been able to streamline management, quality, strategic information generation, supportive monitoring and evaluation and documentation which will be handed over to SACS during the transition phase. The strategies for smooth transition and take-over by SACS will include hands-on TA support, consultant support for short term if necessary, trouble-shooting, developing guidelines and facilitating effective linkages with the State Training Resource Center.

Samarth will continue to provide cross learning between USG Supported SACS by engaging experts from other states for trainings and learning visits.

ACTIVITY 3: TA for mainstreaming HIV/AIDS into other Government of India ministries

This is an intentional spillover activity which leverages the work done by other national health programs that address maternal and child health and reproductive health. Hence, Samarth will continue to collaborate with MWCD in addressing gender issues particularly women living with HIV and OVC.

Samarth, jointly with UNIFEM and UNICEF, has led the mainstreaming of HIV/AIDS into the MWCD and has facilitated the establishment of the HIV/AIDS cell. Samarth will continue the support of the HIV/AIDS cell and mainstreaming services for women and OVC and the implementation of the operational plans. Samarth along with the partners will transition on ensuring enhanced collaboration between MWCD and NACO and establishing mechanisms for addressing HIV/AIDS issues into their regular programming. The efforts will be documented and shared with other ministries and NACO as models of replication and establishing linkages between them.

ACTIVITY 4: Strengthening the Secretariat of the India CCM of the Global Fund

As part of its transition, Samarth has successfully mobilized Global Fund support to the local Secretariat including support to fulltime staff. In FY10, Samarth's support to the CCM will focus on TA to develop the Global Fund national strategic application and also support the various regional consultations for proposal development. The project will work in close collaboration with NACO and the various principal recipients to strengthening monitoring and evaluation of the various Global Fund supported programs under Rounds 2,4,6 and 7 Samarth will also work with Global Fund to enhance civil society participation in the program, including orientation of new members of the CCM. Samarth along with other donors will support CCM towards greater participation of the private sector in submission of joint proposals with government and civil society to Global Fund.

ACTIVITY 5: Institutional capacity building of civil society

The two demonstration projects, Chelsea and Salaam Baalak Trust will continue to provide on-site training and mentoring to local nongovernmental organizations (NGOs) and community-based organizations (CBOs) on OVC program and working with street children. Samarth will share with NACO and SACS the achievements from the two demonstration projects on: the community-based approach to providing services to HIV/AIDS infected and affected children and prevention of HIV among street children; the Life Skills Education (LSE); Child counseling; Quality Assurance and Quality Improvement Systems including the Standard Operating Procedures (SOPs) and Checklists; child status index for assessing quality of life of children; the Quality Improvement initiative for improving nutritional status of HIV infected children; data quality assurance (DQA) system; the training modules on OVC and HIV prevention and other implementation tools. Samarth will further strengthen the capacity of the demonstration projects in providing TA to Delhi SACS and NGOs. This will enable them to access increased resources from government and other sources and continue to serve as learning sites.

The institutional review of Indian Association of People Living with HIV/AIDS (INP+) conducted in FY09 to identify gaps in their institutional systems and assess their performance has highlighted the positive impact of building positive networks at district and sub-district level and enhanced linkages with prevention programs. INP+ will provide guidance at national and state level for implementation of GIPA policy and support State networks for providing support to SACS. INP+'s national and state level women's forums will be leveraged to ensure gender equity. This will include strategies and activities towards implementation of GIPA with enhanced participation of women living with HIV/AIDS, ensuring women's issues are addressed in policies and providing support for increased access to services. As GIPA policy would have been finalized by NACO and implemented by SACS during FY09, INP+ would provide supportive monitoring to SACS and NACO for comprehensive coverage. INP+ with its state level networks will continue to provide support on GIPA and positive prevention as required beyond Samarth.

In FY10, a total of 120 organizations and 500 individuals will be provided training under this budget code area.

SUMMARY

Samarth, with its mandate to provide technical assistance (TA) to the national HIV/AIDS program is working on a model for HIV prevention among street children through promotion of risk avoidance behaviors: practice of abstinence; and promotion of secondary abstinence for sexually active children, mutual faithfulness and partner reduction among sexually active children. Samarth demonstration project Salaam Baalak Trust (SBT) acts as community-based laboratory to pilot innovative activities, and serves as a site for training other non-government and government personnel. SBT addresses the needs of children 0-17 years old, both male and female with increased focus on coverage of girls who are more prone to sexual abuse and have less access to supportive services. The project takes special care to prevent sexual abuse of children below 10 years; risk avoidance is promoted among 10-17 years old children. The national activities of the project are for the entire country with focus on high prevalence states and districts; the demonstration project has an outreach on railway platforms and vulnerable streets of central and south Delhi.

The focus in the last year of Samarth will be to transition out of the intervention and provide TA to government and nongovernmental organizations (NGOs) in promoting HIV risk avoidance behavior among vulnerable children. SBT has developed a training module on "HIV related institutional capacity building, stigma and discrimination and community mobilization on HIV prevention services to street children". The work has drawn a number of visitors to the projects and interns have been placed by National Institute of Public Cooperation and Child Development (NIPCCD) to develop skills on promoting HIV risk avoidance behavior. Staff from the demonstration project has been invited as trainers by different agencies. SBT has a number of case studies to demonstrate the successful maintenance of HIV risk avoidance behavior; however, bringing street children back to abstinence (secondary abstinence) has been quite challenging. SBT will further strengthen its peer education, counseling and communication package to promote secondary abstinence.

In FY10, the following activities will be carried out:

ACTIVITY 1: Develop model of quality delivery of services for addressing vulnerable populations

Samarth will continue supporting SBT to develop best practices in HIV risk avoidance behaviors among street children in Delhi. The street children are mostly without their parents/guardians, runaway from their homes. On the street they are exposed to substance use and sexual abuse; the older children often abuse the younger ones. The outreach activities include mobilizing the children to attend non-formal education, life skills education and skills development to promote livelihood security. The activities prevent children from engaging in high-risk behaviors. FHI will conduct three monthly program data audit and six monthly Quality Assurance/Quality Improvement audits. FHI will also provide support in documentation and dissemination of the good practices. Being the last year of Samarth, the support will be phased out in June 2011.

ACTIVITY 2: Advocacy with government to include quality prevention programming in interventions mainstreamed for vulnerable populations

As part of the HIV/AIDS cell at the Ministry of Women and Child Development (MWCD) and National AIDS Control Organization (NACO), the project will continue to advocate for the life skills education (LSE) program promoting HIV risk avoidance behavior among children. Samarth will provide technical assistance (TA) in implementing LSE activities through the MWCD and NACO. SBT will provide hands-on skill building training on AB prevention through LSE and other activities to different government and non-government agencies. The geographical focus for delivery of the TA will be both Delhi and outside. FHI will continue to provide mentoring and supportive supervision to build capacity of the partner to provide TA.

Indicator targets: The activities under this budget code area will be monitored by the following output level indicators.

o Number of the targeted population reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required;

o Number of community health volunteers who successfully completed in-service training program.

In FY10, a total of 850 adult and children above 10 years will be reached through A and/or B prevention messages and 45 outreach workers will be trained on providing prevention messages through community outreach services.