Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3580
Country/Region: Mozambique
Year: 2009
Main Partner: Columbia University
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $4,500,000

Funding for Treatment: Adult Treatment (HTXS): $4,500,000

This is a continuing activity from FY08 and the narrative replaces the FY08 narrative; it relates to Columbia

University's activities that are funded through country funds to supplement Track 1.0, as well as the system

strenghthing, PMTCT, pediatrics care and support, laboratory and infrastructure, and strategic information

activities funded in FY09.

Columbia University's (CU) scale-up of treatment services is supported by USG and guided by

Mozambique's national HIV strategic plan. In collaboration with the Ministry of Health (MOH), CU will

continue support to 41 HIV care and treatment facilities at various stages of development and expansion in

Maputo City, Gaza Province, Inhambane Province, Nampula Province, and Zambezia Province. SAPR data

reported from 13 sites for FY08 showed that 78% of patients were alive and on treatment at 12 months of

treatment initiation.

In FY09, CU plans to initiate support at 12 additional facilities to a total of 53 sites in 33 districts and 4 the

provinces reaching 60,000 adult patients on ART by the end of the fiscal year. Expansion plans are in

accordance with MoH policy and plans. Special emphasis will be maintained on the decentralization and

integration of services with a emphasis on urban settings. Major urban treatment facilities will be enabled to

down-refer stable patients on ARV treatment and similarly, urban Health Centers will be capacitated to

absorb these patients as well as to initiate new patients on antiretroviral therapy. Complicated cases and

treatment failures will be managed at bigger health facilities. This is a part of a national process of

decentralization and integration of HIV services that, according to the current MoH timeline should be

completed by December 2009.

The following activities will be implemented in FY09:

-Finance, train and mentor MOH staff per facility supported

-Provide equipment and supplies to maintain facility operations,

-Improve patient management, drug management and strategic information systems,

-Reinforce follow-up and referral systems,

-Strengthen linkages with organizations providing services for PLWHA, Voluntary Counseling and Testing

outlets, TB clinics and pMTCT centers

-Strengthen linkages with services to increase HIV case-finding (including TB, pMTCT, Youth Centers)

Human Resources: Continue financing the salaries of MOH health-care providers to supplement existing

staff at health facilities. These providers include, doctors, medical technicians (técnicos de medicina),

nurses, counselors, pharmacists, data technicians and administrative staff. This activity will be carried out

through sub agreements with Provincial Health Authorities (DPS) in provinces supported by CU. This is part

of a sustainability strategy with the final objective being of DPS to incorporate these staff in the MoH

system. Supported staff receives salaries in accordance with the national salary grids.

Training and Mentoring: CU will maintain clinical-support teams to work in the field and provide clinical

mentoring, technical assistance and logistical support to staff at the HIV care and treatment facilities and

districts supported by CU. Mentorship activities and formal training are carried out at site level (with

enhanced one on one skills-transfer for clinical, M&E, pharmacy and administration) as well as formal

training at site, district and provincial level. The clinical staff travels regularly to CU-supported facilities in

the province. Mentoring activities at facility level aim at building the local capacity in order help maintain the

activities and services currently offered once a phase out of support is implemented. CU will also work with

the USG Mozambique team to establish and standardize criteria and best strategies for site graduation.

Adherence and psychosocial support: Activities aimed at improving adherence to therapy will continue and

be reinforced during COP09. Activities will include provincial trainings on adherence and psychosocial

support, training of peer educators, initiatives with PLWHA including positive prevention using materials

already developed through CDC support, and support for "positive teas".

Sub-agreement will be established with organizations working in the community to strengthen defaulter

tracing, community linkages, and identification of new patients. The proposed sub agreements will work

through three complementary technical intervention areas: community mobilization for prevention and care

and treatment, improvement of quality of services through strengthening PLWHA support groups and

defaulter-tracing systems at HIV care and treatment and PMTCT services, and conducting Home Visits for

adherence support and defaulters tracking and return to care and treatment.

Linkages between services: CU will work on a "one partner per district approach" as per USG and MoH

guidance. This will include a process of transition of services between partners and will, once the transition

is completed, enable better integration between different services at the same site. The transition will result

in CU supporting all care and treatment, pMTCT and counseling and testing services within CU supported


CU will continue to provide technical support at the central level to the Department of Medical Assistance

(DNAM). This support is aimed to assist the Government of Mozambique in developing policies and

guidelines for managing the national ART expansion effort. Specifically, CU technical staff will provide the

following support: guidance to HIV Management and ARV Committees, development and revision of clinical

guidelines and HIV service decentralization plan, development and revision of training curricula and

materials, development of adherence and psychosocial support materials and guidance to the National

Adherence Support Work Group, and refinement and roll-out of the electronic patient-tracking system and

paper-based system.

Health System Strengthening:

In line with the USG partner rationalization, CU will be the lead partner in Maputo City, Inhambane Province

and Nampula Provinces. In these provinces CU will work particularly closely with the DPS to strengthen the

provincial system primarily by hiring three Clinical Advisors to provide technical support to the Provincial

Health Directorates in Nampula, Inhambane and Maputo City. The advisors will assist the DPS office in

planning, implementation, coordination and monitoring of clinical care and mentoring activities related to

HIV/AIDS and Tuberculosis within the province they are assigned to work. As lead partner, CU will also

support the DPS to coordinate HIV/AIDS activities at provincial level including organizing and convening

Activity Narrative: monthly/quarterly provincial partners' meetings, taking the lead in supporting expansion of treatment

services where there is no partner coverage provided resources permit such expansion.

In addition, CU will shift towards a district focus of support for ARV services and work more closely with the

District Health Management Teams for planning, budgeting, coordinating, supervising and monitoring HIV

programs within CU supported districts.

Sustainability plan:

CU has been working on a model to transfer knowledge and health management skills to the Mozambican

counterparts. In order to reach this objective, CU has been establishing sub agreements with Provincial

Health Directorates to create conditions for future absorption of these cadres into the national health

system. Beside this strategy, CU has been working and will increase efforts on development of

programmatic capacities of Mozambican staff across various intervention areas through participation in

quality of care initiatives, in implementation of larger and broader package of care, capacity building and

mentoring. Support to pre-service training will help creating additional local capacity. CU is supporting

infrastructure development through rehabilitation projects.

By 2012, ICAP will transition to indigenous organizations (governmental or non-governmental) key

functions in an organized, incremental and deliberate manner. In addition, ICAP will collaborate with USG

funding agencies to identify the domains in which technical support by international or local organizations

with expertise in these specific domains may be required to continue to support these indigenous

organizations after a successful transition.

Specific activities for this coming year include: 1- Conduct a mapping exercise with the goal of identification

of indigenous governmental and non-governmental organizations engaged in HIV-related programming in

Mozambique, with a focus on those with activities in the locations where ICAP works.

2- Define the domains of activities provided by ICAP with the goal of developing a listing of activities in

various domains that would be candidates for transitioning e.g. support activities, technical inputs.

3- Develop or adapt an assessment tool to identify an organization's capability to manage USG funds and to

implement the proposed activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13948

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13948 5181.08 HHS/Centers for Columbia 6665 3580.08 Track 1 ARV $4,125,000

Disease Control & University


8837 5181.07 HHS/Centers for Columbia 4765 3580.07 Track 1 ARV $4,500,000

Disease Control & University


5181 5181.06 HHS/Centers for Columbia 3580 3580.06 Track 1 ARV $4,500,000

Disease Control & University


Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $880,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.09:

Subpartners Total: $1,399,000
Ministry of National Defense: $190,000
Pathfinder International: $850,000
Zambezia Provincial Health Directorate: $99,000
Delgado Health Secretariat: $64,000
Delgado Health Secretariat: $196,000
Cross Cutting Budget Categories and Known Amounts Total: $880,000
Human Resources for Health $880,000