Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 10814
Country/Region: Mozambique
Year: 2009
Main Partner: To Be Determined
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: USAID
Total Funding: $0

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $0

THIS IS A NEW ACTIVITY

Recently, the Government of Mozambique (GOM) made a declaration which detailed its commitment to the

strengthening of primary health care through community health workers and enlisting the involvement of the

community to address their most critical health needs. The GOM's commitment to the Agente Polivalente

Elementar (APE) or Community Health Worker (CHW) program is reflected in the MOH's five year health

workforce plan (August 2008) which includes an annex projecting the APE staffing levels, description and

requests to donors. The GOM has made it clear that revitalization of the APE program, which is an

integrated approach to health, is imminent and urgent. The MOH is therefore seeking USG support and

technical assistance to roll out the program on a national basis which current donor and public sector

financing precludes. Mozambique is considered by health experts to have one of the worst human capacity

problems in the world. This activity provides a framework for a set of USAID-financed human capacity

development interventions over a five-year period, in close coordination with other USG agencies, the

Government of Mozambique, othre donors and implementing partners. These interventions will lead to a

rapid scale-up of a revitalized national Mozambican model for community prevention and care.

This integrated health project will support a balanced mix of maternal and child health, reproductive health,

HIV/AIDS and other infectious diseases applying both prevention and curative care measures that directly

respond to the MOH request to reestablish a nationwide community based cadre of community health

workers. The MOH reinvigorated APE plan was outlined in a September 2008 17-point, inter-ministerial

action plan that describes the broad framework for a nationwide community based health system. This

action-plan builds on a September 2007 MOH meeting which articulated the MOH intentions to launch a

nationwide primary health care program which would be anchored at the community level by the APEs.

The 2008 MOH plan calls for four training centers to be set up, master trainers and provincial trainers to be

trained and in place, the issuance of clear MOH guidance to health districts on how to select and recruit

APEs, guidance on the supervisory system and most importantly, establishment of a line item in the Ministry

of Planning and Finance Plan's budget to subsidize the APEs. The APEs as outlined by the MOH will

deliver a defined package of quality preventive and basic health services which matches Mozambique's

health profile, is evidence based and sustainable. The APEs will also supervise and coordinate the

activities of all other community health volunteers (ACSs), mothers' groups, on-site TB volunteers and other

community-based health workers who are currently carrying out a broad range of disease specific

interventions, including distribution of insecticide impregnated bed nets, contraceptives and condoms.

These interventions include family planning, follow-up with tuberculosis and HIV patients on treatment,

organization of vaccination campaigns, growth monitoring and treatment of acute malnutrition and diarrhea.

The APEs will also provide a vital official link between the community-based health information system and

health centers.

This activity is the next logical programmatic step for the USG, following earlier investments and an

upcoming short- term, FY08 PEPFAR-financed, community based human resource and training team

consultancy. This expert planning team is scheduled to complete its work by February 2009. The products

from this consultancy will advise the MOH on the content, length, and scope of the APE curriculum (there

are at least three or four different curricula for training APEs currently in use) and on the development of an

operational plan to launch, train, deploy, and supervise a national APE system. This assessment will also

inform any future procurement.

The MOH APE program is expected to roll out this fiscal year with World Bank funding in a pilot region of

Northern Mozambique. Approved in 2007, this World Bank loan for $46.8 million is designed to strengthen

primary health care systems and build human capacity. The loan includes a pledge of $6.8 million by the

Russian Government for malaria prevention, $17.5 million by CIDA, and $17.5 million from the Swiss

Development Agency. Approximately $8 million were approved in Global Fund (GFTAM) rounds 6 and 8 for

support to APEs, including funds for developing trainers, conducting training, APE salary support for up to

4.5 years and expansion of 3 existing training centers. The U.K. also pledged assistance to the health

sector as part of an international bilateral agreement on joint work in Africa between Prime Minister Gordon

Brown and President George W. Bush in 2007.

The USAID financing of the GOM's APE program will consist of five components which are central to

building a national program over a five-year period, FY 2009 being the first year of this financing. They

include both training, institution strengthening interventions and direct financing support for APE salaries in

the initial two years of the program, procurement of essential medical supplies and equipment, and an

appropriate and sustainable means of transportation and communication between districts and communities

to support a system for supervision which is currently on paper but in practice does not exist outside of large

cities. A community "bright ideas" matching grants fund would also be made available for the best APEs.

1. Operationalize New Training Facilities: Finance and support with expert technical assistance launch of

two of the MOH's four planned community health training centers in two Southern provinces which coincide

with other USG health investments. Train and equip up to 10 master trainers from the designated provinces

in community-based preventive and curative care, supervision, refresher training programs, and support to

the communities who accept the APE program.

2. Finance the First Cadre of APEs: USG provided salary support will be conditioned on the gradual uptake

by the MOH of these community workers onto the MOH or district level payrolls and the assignment of

permanent district level supervisors so that USAID would not be expected to absorb this full five year cost.

3. Train and Equip 400 community and APE supervisors and Provincial Mobile Teams. Furnish motorcycles

and a virtual communication system to launch supportive supervision programs in USG financed provinces.

The existing mobile teams consist of three MOH staff and include a community health supervisor, a

reproductive health specialist and a logistics specialist which is often the driver. Computers, cell phones,

and radios will be purchased for this element of the program.

Activity Narrative: 4. Support the development/revision of APE reporting, refresher training, other APE materials including

audiovisuals for prevention and counseling, community assessment and epidemic control: Based on best

practices from various regions and existing materials, support the MOH health resources and

communications department to assemble an APE prevention/communication education kit. A four year full-

time advisor and short-term advisors across a range of specialty will be assigned to the MOH for this

purpose. The training/materials package must be a product the MOH intends to support in the future.

5. Support local public/private partnerships which strengthen the public health system: Each year, the

APEs that demonstrate exemplary performance in improving public health conditions, will be granted a

small project fund. This could be the Peace Corps seed funds, or an entirely new fund. Funds would be

used for community water and sanitation measures, a famine early warning system, better radio

communication with the provinces or other ideas. These grants would be overseen by a community

leadership council which already exists in many regions. These seed funds would require a 50% match by

the private sector or community.

With FY 09 HVAB funds USAID will support the first year of revitalization of the APE program aimed at

strengthening delivery of community-based prevention. Funds will support the development of APE

materials including audiovisuals for prevention and provide support the MOH health resources and

communications department to assemble an APE prevention/communication education kits for the 7,000

APEs.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $0

NEW ACTIVITY

Recently, the Government of Mozambique (GOM) made a declaration which detailed its commitment to the

strengthening of primary health care through community health workers and enlisting the involvement of the

community to address their most critical health needs. The GOM's commitment to the Agente Polivalente

Elementar (APE) or Community Health Worker (CHW) program is reflected in the MOH's five year health

workforce plan (August 2008) which includes an annex projecting the APE staffing levels, description and

requests to donors. The GOM has made it clear that revitalization of the APE program, which is an

integrated approach to health, is imminent and urgent. The MOH is therefore seeking USG support and

technical assistance to roll out the program on a national basis which current donor and public sector

financing precludes. Mozambique is considered by health experts to have one of the worst human capacity

problems in the world. This activity provides a framework for a set of USAID-financed human capacity

development interventions over a five-year period, in close coordination with other USG agencies, the

Government of Mozambique, othre donors and implementing partners. These interventions will lead to a

rapid scale-up of a revitalized national Mozambican model for community prevention and care.

This integrated health project will support a balanced mix of maternal and child health, reproductive health,

HIV/AIDS and other infectious diseases applying both prevention and curative care measures that directly

respond to the MOH request to reestablish a nationwide community based cadre of community health

workers. The MOH reinvigorated APE plan was outlined in a September 2008 17-point, inter-ministerial

action plan that describes the broad framework for a nationwide community based health system. This

action-plan builds on a September 2007 MOH meeting which articulated the MOH intentions to launch a

nationwide primary health care program which would be anchored at the community level by the APEs.

The 2008 MOH plan calls for four training centers to be set up, master trainers and provincial trainers to be

trained and in place, the issuance of clear MOH guidance to health districts on how to select and recruit

APEs, guidance on the supervisory system and most importantly, establishment of a line item in the Ministry

of Planning and Finance Plan's budget to subsidize the APEs. The APEs as outlined by the MOH will

deliver a defined package of quality preventive and basic health services which matches Mozambique's

health profile, is evidence based and sustainable. The APEs will also supervise and coordinate the

activities of all other community health volunteers (ACSs), mothers' groups, on-site TB volunteers and other

community-based health workers who are currently carrying out a broad range of disease specific

interventions, including distribution of insecticide impregnated bed nets, contraceptives and condoms.

These interventions include family planning, follow-up with tuberculosis and HIV patients on treatment,

organization of vaccination campaigns, growth monitoring and treatment of acute malnutrition and diarrhea.

The APEs will also provide a vital official link between the community-based health information system and

health centers.

This activity is the next logical programmatic step for the USG, following earlier investments and an

upcoming short- term, FY08 PEPFAR-financed, community based human resource and training team

consultancy. This expert planning team is scheduled to complete its work by February 2009. The products

from this consultancy will advise the MOH on the content, length, and scope of the APE curriculum (there

are at least three or four different curricula for training APEs currently in use) and on the development of an

operational plan to launch, train, deploy, and supervise a national APE system. This assessment will also

inform any future procurement.

The MOH APE program is expected to roll out this fiscal year with World Bank funding in a pilot region of

Northern Mozambique. Approved in 2007, this World Bank loan for $46.8 million is designed to strengthen

primary health care systems and build human capacity. The loan includes a pledge of $6.8 million by the

Russian Government for malaria prevention, $17.5 million by CIDA, and $17.5 million from the Swiss

Development Agency. Approximately $8 million were approved in Global Fund (GFTAM) rounds 6 and 8 for

support to APEs, including funds for developing trainers, conducting training, APE salary support for up to

4.5 years and expansion of 3 existing training centers. The U.K. also pledged assistance to the health

sector as part of an international bilateral agreement on joint work in Africa between Prime Minister Gordon

Brown and President George W. Bush in 2007.

The USAID financing of the GOM's APE program will consist of five components which are central to

building a national program over a five-year period, FY 2009 being the first year of this financing. They

include both training, institution strengthening interventions and direct financing support for APE salaries in

the initial two years of the program, procurement of essential medical supplies and equipment, and an

appropriate and sustainable means of transportation and communication between districts and communities

to support a system for supervision which is currently on paper but in practice does not exist outside of large

cities. A community "bright ideas" matching grants fund would also be made available for the best APEs.

1. Operationalize New Training Facilities: Finance and support with expert technical assistance launch of

two of the MOH's four planned community health training centers in two Southern provinces which coincide

with other USG health investments. Train and equip up to 10 master trainers from the designated provinces

in community-based preventive and curative care, supervision, refresher training programs, and support to

the communities who accept the APE program.

2. Finance the First Cadre of APEs: USG provided salary support will be conditioned on the gradual uptake

by the MOH of these community workers onto the MOH or district level payrolls and the assignment of

permanent district level supervisors so that USAID would not be expected to absorb this full five year cost.

3. Train and Equip 400 community and APE supervisors and Provincial Mobile Teams. Furnish motorcycles

and a virtual communication system to launch supportive supervision programs in USG financed provinces.

The existing mobile teams consist of three MOH staff and include a community health supervisor, a

reproductive health specialist and a logistics specialist which is often the driver. Computers, cell phones,

and radios will be purchased for this element of the program.

Activity Narrative: 4. Support the development/revision of APE reporting, refresher training, other APE materials including

audiovisuals for prevention and counseling, community assessment and epidemic control: Based on best

practices from various regions and existing materials, support the MOH health resources and

communications department to assemble an APE prevention/communication education kit. A four year full-

time advisor and short-term advisors across a range of specialty will be assigned to the MOH for this

purpose. The training/materials package must be a product the MOH intends to support in the future.

5. Support local public/private partnerships which strengthen the public health system: Each year, the

APEs that demonstrate exemplary performance in improving public health conditions, will be granted a

small project fund. This could be the Peace Corps seed funds, or an entirely new fund. Funds would be

used for community water and sanitation measures, a famine early warning system, better radio

communication with the provinces or other ideas. These grants would be overseen by a community

leadership council which already exists in many regions. These seed funds would require a 50% match by

the private sector or community.

With FY 09 HVOP funds USAID will support the first year of revitalization of the APE program aimed at

strengthening delivery of community-based prevention. Funds will support the development of APE

materials including audiovisuals for prevention and provide support the MOH health resources and

communications department to assemble an APE prevention/communication education kits including

condoms for the 7,000 APEs.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Orphans and Vulnerable Children (HKID): $0

THIS IS A NEW ACTIVITY IN COP 09.

This activity is being funded across several program areas. OVC funding has been allocated to contribute

to a process that will provide greater access to basic health care services for OVC.

According to a 2006 UNICEF report on Childhood Poverty in Mozambique, 17% of children under five years

experience severe health deprivation. These are children who have never been immunized against any

diseases or young children who have had a recent severe episode of acute respiratory infection and did not

receive any medical advice or treatment. The report also cites that poor physical accessibility (one hour

distance to health facility on foot) to health facilities and long waiting times, are barriers to health care which

contribute to high mortality rates and poor health status among Mozambican children. Supporting the

revitalization of the community health worker program is an important component in improving the overall

health status of OVC, as CHW bring the services closer to the children and their mothers, in a more user

friendly environment - the beneficiaries own community.

Recently, the Government of Mozambique (GRM) made a declaration which detailed its commitment to the

strengthening of primary health care through community health workers and enlisting the involvement of the

community to address their most critical health needs. The GOM's commitment to the Agente Polivalente

Estratégico (APE) or Community Health Worker (CHW) program is reflected in the MOH's five year health

workforce plan (August 2008) which includes an annex projecting the APE staffing levels, description and

requests to donors. The GOM has made it clear that revitalization of the APE program, which is an

integrated approach to health, is imminent and urgent. The MOH is therefore seeking USAID support and

technical assistance to roll-out the program on a national basis which current donor and public sector

financing precludes. Mozambique is considered by health experts to have one of the worst human capacity

problems in the world. Focused on strengthening community based prevention programs and basic health

care. This activity provides a framework for a set of USAID-financed human capacity development

interventions over a five-year period. These interventions will lead to a rapid scale-up of a revitalized

national Mozambican model for community prevention and care.

This integrated health project will support a balanced mix of maternal and child health, reproductive health,

HIV/AIDS and infectious diseases applying both prevention and curative care measures to directly respond

to the MOH request to reestablish a nationwide community based cadre of community health workers. The

MOH reinvigorated APE plan was outlined in a September 2008 17 point, inter-ministerial action plan that

describes the broad framework for a nationwide community based health system. This action-plan builds

on a September 2007 MOH meeting which articulated the MOH intentions to launch a nationwide primary

health care program which would be anchored at the community level by the APEs.

The 2008 MOH plan calls for four training centers to be set up, master trainers and provincial trainers to be

trained and in place, the issuance of clear MOH guidance to health districts on how to select and recruit

APEs, guidance on the supervisory system and most importantly, establishing a line item in the Ministry of

Plan's budget to subsidize the APEs. The APEs as outlined by the MOH, will deliver a defined package of

quality preventive and basic health services which matches Mozambique's health profile, is evidence based

and sustainable. The APEs will also supervise and coordinate the actions of all other community health

volunteers (ASCs), mothers' groups, on-site TB volunteers and community based distributors of insecticide

impregnated bed nets, contraceptives and condoms who are currently carrying out a broad range of disease

specific interventions. These interventions include family planning, follow-up with tuberculosis and HIV

patients on treatment, organization of vaccination campaigns, growth monitoring and treatment of acute

malnutrition and diarrhea. These APEs will also provide a vital official link between the community-based

health information system, health posts and health centers.

This activity is the next logical programmatic step for the USG, following earlier investments and an

upcoming short- term, FY08 PEPFAR-financed, community based human resource and training team. This

expert USAID health training and human resource planning team is scheduled to complete its work by

February 2009. The products from this consultancy will advise the MOH on the content, length, and scope

of the APE curriculum (there are at least three or four different curricula for training APEs currently in use

and an operational plan to launch, train, deploy, and supervise a national APE system. This assessment

will also inform any future procurement.

The MOH APE program is expected to roll out this fiscal year with World Bank funding in a pilot region of

Northern Mozambique. This World Bank loan for $46.8 million is designed to strengthen primary health care

systems and building human capacity and was approved in 2007. The loan includes a pledge of $6.8

million by the Russian Government for malaria prevention, 17.5 million by CIDA, and $17.5 million from the

Swedish Development Corporation. An October 2008 Global Fund (GFATM) grant, approved by the USG to

strengthen health systems, includes funds for APE salary support and for setting up several training

centers. The U.K. also pledged assistance to the health sector as part of an international bilateral

agreement on joint work in Africa between Prime Minister Gordon Brown and U.S. President George W.

Bush in 2007. Other donor related grants include a broader application of a CIDA financed APE curriculum

that is also currently under review for future financing.

The USAID financing of the GOM's APE program will consist of five components which are central to

building a national program over a five-year period, FY 2009 being the first year of this financing. They

include both training, institution strengthening interventions and direct financing support for APE salaries in

the initial two years of the program, procurement of essential medical supplies and equipment, and an

appropriate and sustainable means of transportation and communication between districts and communities

to support a system for supervision which is currently on paper but in practice does not exist outside of large

cities. A community "bright ideas" matching grants fund would also be made available for the best APEs.

1. Operationalize New Training Facilities: Finance and support with expert technical assistance launch of

two of the MOH's four planned community health training centers in two Southern regions which coincide

with other USG health investments. Train and equip up to 10 master trainers from the designated provinces

Activity Narrative: in Community based preventive and curative care, supervision, refresher training programs, and support to

the communities who accept the APE program.

2. Finance the First Cadre of APEs: USAID will determine the best mechanism for financing the first groups

of APEs. Options include contributing the Common Fund which many of the European donors utilize to

channel grant and loan funds to the MOH; capitalize on an internal MOH mechanism run by the World Bank

or another UN Agency; contribute to the same mechanism the Global Fund intends to develop and staff

within the MOH; or put the financing into a technical assistance contract and have the contractor pay the

APEs for a limited period of time. Salary support will be conditioned on the gradual uptake by the MOH of

these community workers onto the MOH or district level payrolls and the assignment of permanent district

level supervisors so that USAID would not be expected to absorb this full five year cost.

3. Train and Equip 400 community and APE supervisors and Provincial Mobile Teams. Furnish motorcycles

and a virtual communication system to launch supportive supervision programs in USG financed provinces.

The existing mobile teams consist of three MOH staff and include a community health supervisor, a

reproductive health specialist and a logistics specialist which is often the driver. Computers, cell-phones,

and radios will be purchased for this element of the program.

4. Support the development/revision of APE reporting, refresher training, other APE materials including

audiovisuals for Prevention and Counseling, community assessment and epidemic control: Based on best

practices from various regions and existing materials, support the MOH health resources and

communications department to assemble an APE prevention/communication education kit. A four year full-

time advisor and short-term advisors across a range of specialty will be assigned to the MOH for this

purpose. The package must be a product the MOH intends to support in the future.

5. Support local public/private partnerships which strengthen the public health system: Each year, the

APEs that demonstrate exemplary performance on improving public health conditions, will be granted a

small project fund. This could be the Peace Corps seed funds, or an entirely new fund. Funds would be

used for community water and sanitation measures, a famine early warning system, better radio

communication with the provinces or other ideas. These grants would be overseen by a community

leadership council which already exists in many regions. These seed funds would require a 50% match by

the private sector or community.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

Funding for Health Systems Strengthening (OHSS): $0

This is a new activity under COP09.

Recently, the Government of Mozambique (GOM) made a declaration which detailed its commitment to the

strengthening of primary health care through community health workers and enlisting the involvement of the

community to address their most critical health needs. The GOM's commitment to the Agente Polivalente

Elementar (APE) or Community Health Worker (CHW) program is reflected in the MOH's five year health

workforce plan (August 2008) which includes an annex projecting the APE staffing levels, description and

requests to donors. The GOM has made it clear that revitalization of the APE program, which is an

integrated approach to health, is imminent and urgent. The MOH is therefore seeking USG support and

technical assistance to roll out the program on a national basis which current donor and public sector

financing precludes. Mozambique is considered by health experts to have one of the worst human capacity

problems in the world. This activity provides a framework for a set of USAID-financed human capacity

development interventions over a five-year period, in close coordination with other USG agencies, the

Government of Mozambique, othre donors and implementing partners. These interventions will lead to a

rapid scale-up of a revitalized national Mozambican model for community prevention and care.

This integrated health project will support a balanced mix of maternal and child health, reproductive health,

HIV/AIDS and other infectious diseases applying both prevention and curative care measures that directly

respond to the MOH request to reestablish a nationwide community based cadre of community health

workers. The MOH reinvigorated APE plan was outlined in a September 2008 17-point, inter-ministerial

action plan that describes the broad framework for a nationwide community based health system. This

action-plan builds on a September 2007 MOH meeting which articulated the MOH intentions to launch a

nationwide primary health care program which would be anchored at the community level by the APEs.

The 2008 MOH plan calls for four training centers to be set up, master trainers and provincial trainers to be

trained and in place, the issuance of clear MOH guidance to health districts on how to select and recruit

APEs, guidance on the supervisory system and most importantly, establishment of a line item in the Ministry

of Planning and Finance Plan's budget to subsidize the APEs. The APEs as outlined by the MOH will

deliver a defined package of quality preventive and basic health services which matches Mozambique's

health profile, is evidence based and sustainable. The APEs will also supervise and coordinate the

activities of all other community health volunteers (ACSs), mothers' groups, on-site TB volunteers and other

community-based health workers who are currently carrying out a broad range of disease specific

interventions, including distribution of insecticide impregnated bed nets, contraceptives and condoms.

These interventions include family planning, follow-up with tuberculosis and HIV patients on treatment,

organization of vaccination campaigns, growth monitoring and treatment of acute malnutrition and diarrhea.

The APEs will also provide a vital official link between the community-based health information system and

health centers.

This activity is the next logical programmatic step for the USG, following earlier investments and an

upcoming short- term, FY08 PEPFAR-financed, community based human resource and training team

consultancy. This expert planning team is scheduled to complete its work by February 2009. The products

from this consultancy will advise the MOH on the content, length, and scope of the APE curriculum (there

are at least three or four different curricula for training APEs currently in use) and on the development of an

operational plan to launch, train, deploy, and supervise a national APE system. This assessment will also

inform any future procurement.

The MOH APE program is expected to roll out this fiscal year with World Bank funding in a pilot region of

Northern Mozambique. Approved in 2007, this World Bank loan for $46.8 million is designed to strengthen

primary health care systems and build human capacity. The loan includes a pledge of $6.8 million by the

Russian Government for malaria prevention, $17.5 million by CIDA, and $17.5 million from the Swiss

Development Agency. Approximately $8 million were approved in Global Fund (GFTAM) rounds 6 and 8 for

support to APEs, including funds for developing trainers, conducting training, APE salary support for up to

4.5 years and expansion of 3 existing training centers. The U.K. also pledged assistance to the health

sector as part of an internationa l bilateral agreement on joint work in Africa between Prime Minister Gordon

Brown and President George W. Bush in 2007.

The USAID financing of the GOM's APE program will consist of five components which are central to

building a national program over a five-year period, FY 2009 being the first year of this financing. They

include both training, institution strengthening interventions and direct financing support for APE salaries in

the initial two years of the program, procurement of essential medical supplies and equipment, and an

appropriate and sustainable means of transportation and communication between districts and communities

to support a system for supervision which is currently on paper but in practice does not exist outside of large

cities. A community "bright ideas" matching grants fund would also be made available for the best APEs.

1. Operationalize New Training Facilities: Finance and support with expert technical assistance launch of

two of the MOH's four planned community health training centers in two Southern provinces which coincide

with other USG health investments. Train and equip up to 10 master trainers from the designated provinces

in community-based preventive and curative care, supervision, refresher training programs, and support to

the communities who accept the APE program.

2. Finance the First Cadre of APEs: USG provided salary support will be conditioned on the gradual uptake

by the MOH of these community workers onto the MOH or district level payrolls and the assignment of

permanent district level supervisors so that USAID would not be expected to absorb this full five year cost.

3. Train and Equip 400 community and APE supervisors and Provincial Mobile Teams. Furnish motorcycles

and a virtual communication system to launch supportive supervision programs in USG financed provinces.

The existing mobile teams consist of three MOH staff and include a community health supervisor, a

reproductive health specialist and a logistics specialist which is often the driver. Computers, cell phones,

and radios will be purchased for this element of the program.

Activity Narrative: 4. Support the development/revision of APE reporting, refresher training, other APE materials including

audiovisuals for prevention and counseling, community assessment and epidemic control: Based on best

practices from various regions and existing materials, support the MOH health resources and

communications department to assemble an APE prevention/communication education kit. A four year full-

time advisor and short-term advisors across a range of specialty will be assigned to the MOH for this

purpose. The training/materials package must be a product the MOH intends to support in the future.

5. Support local public/private partnerships which strengthen the public health system: Each year, the

APEs that demonstrate exemplary performance in improving public health conditions, will be granted a

small project fund. This could be the Peace Corps seed funds, or an entirely new fund. Funds would be

used for community water and sanitation measures, a famine early warning system, better radio

communication with the provinces or other ideas. These grants would be overseen by a community

leadership council which already exists in many regions. These seed funds would require a 50% match by

the private sector or community.

With FY 09 OHSS funds USAID will support the first year of revitalization of the APE program aimed at

strengthening a community health system capable of strengthening the local primary care referral system

and to make an essential link at the community level to provide basic primary services to the vulnerable

members of society who live out of range of fixed health facilities.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: