Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 11440
Country/Region: Rwanda
Year: 2010
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $834,334

These funds will be used to support technical area staff and TDY assistance. For all positions secunded

to GOR entities will be provided by the GOR entity with physical space. Additionally, these recruitements

will be done jointly with the appropriate GOR entity.

Funding for Health Systems Strengthening (OHSS): $834,334

The activities funded under this funding mechanism include: 1) HSS Adviser and support to the HSS activities 2) support to the PEPFAR gender initiative 3) FELTP 4) support to TRACK 1.0 transition

1) In FY 2007, the need for a Systems Strengthening Advisor was identified to facilitate and advocate policy changes needed to better implement PEPFAR. This position provides technical advice to the MOH and other GOR institutions on integrated and cost-effective health policies related to health finance, human capacity development and training, quality of care and infrastructure development; assists the GOR in coordinating/ consolidation of training activities, refresher courses and evaluation of training quality to support HIV and other health programs; serves as a liaison between (and technical expert to) the private sector and the donor community to ensure optimal use of resources and program activities/ strategies are complementary. The advisor works in close collaboration with various units of the MOH involved in the provision of services for HIV affected or infected adults and children to identify, develop, update, finalize and/or disseminate necessary HIV program policies and guidelines, training materials and job aids.

In FY 2009 the advisor provided support in the alignment of the Partnership Framework with the Health Sector Strategic and National HIV plans and the National strategies Application. This included support to the MOH in the finalization of the second HSSP, strengthening the Sector Wide Approach to promote closer coordination of USG activities with MOH and other donors.

In FY 2010 the advisor will support the donor coordination efforts of the health sector; provide advice on the transition of selected USG activities to the Ministry of Health; coordinate infrastructural development, including support in the development of a national health infrastructure plan, between MOH, Ministry of Infrastructure and USG clinical partners; support the Health Human Resources needs assessment and development of recommendations to inform future USG support to HRH in Rwanda moving towards incorporation of in service training into pre service training; provide advice to the MOH on harmonization

of the multitude of performance/quality management initiatives currently implemented; provide support to the PEPFAR gender focal person; support the ADS in efforts to ensure translation of PEPFAR supported evaluations/surveys/ research/assessments into policy and practice; assist USG PEPFAR to fulfill national reporting requirements and; assist in the monitoring and evaluation of USG PEPFAR supported activities.

Funds will allow the advisor to travel outside Rwanda be exposed to best practices and understand lessons learned in other developing country's health systems. Equally dissemination of best practices in Rwanda to countries in the region will be possible.

In FY 2010, short term TA will also be required to support the systems strengthening program.

2) A comprehensive review of gender mainstreaming in PEPFAR, World Bank and Global fund programs illustrated a deficit in systematic sensitization of the PEPFAR implementing partners in mainstreaming gender into routine activities. In the Rwandan PEPFAR program this deficit has been acknowledged. In FY 2010 technical assistance from the gender unit of CDC will solicited to assist the Rwanda USG PEPFAR team to address this deficiency. Specific activities for the Technical Assistance will be: to conduct a workshop for implementing partners to present effective gender mainstreaming strategies and techniques; to meet with individual partners to discuss current barriers faced regarding integration of gender-sensitive approaches and how to overcome such barriers; to brief PEPFAR Rwanda activity managers on USG gender-related policies and offer programmatic guidance; and to examine recent APR results to identify areas for improvement in increasing gender equity in access to HIV/AIDS services. The activities will be conducted in collaboration with the gender focal person and relevant activity managers.

3) HIV/AIDS, tuberculosis (TB), avian influenza, and malaria are diseases of concern in Rwanda. In large areas of the country, malaria is endemic predominantly due to P. falciparum, which exists throughout the entire country during the whole year. Rwanda has several other diseases of epidemic potential including H1N1, cholera, dysentery, and meningitis. Cholera is almost endemic in areas around Lake Kivu. There is an increasing threat of emerging infectious diseases due to Rwanda's proximity other countries where viral hemorrhagic fevers are common.

There is currently only one trained epidemiologist and no field epidemiologists in the Rwandan public health sector. The Rwanda FELTP will allow participants to serve the government at the national, provincial, district and local levels while undergoing training. In addition, there is no training plan for public health laboratory managers or veterinary field epidemiologists. This program will provide human capacity development within the public health workforce to strengthen the capacity of Rwanda in applied

epidemiology, laboratory, and management across public health institutions The absence of trained field epidemiologists has led to a weak surveillance system with delayed identification and understanding of outbreaks because it relies primarily on information from front line health providers (nurses and medical officers). This program will assist in strengthening the public health surveillance system, as well as laboratory-based surveillance for infectious diseases.

The RFELTP is based on the model developed by the US CDC's 50-year history with Epidemic Intelligence Service (EIS). This model was exported to other countries in the 1980's. There are currently several programs in Africa—Ghana, Uganda, Tanzania, Kenya, Southern Sudan, Zimbabwe, and South Africa. The South African and Tanzanian programs are supported by PEPFAR, as are the newly developing programs in Ethiopia and Nigeria. The FELTP is ideally suited for building human capacity in Rwanda. As FELTP trainees will remain in Rwanda during their training and afterwards they will continue to serve the Ministry of Health at the national, provincial, district and local levels during their participation in the program. On completion of training, the participants will function in positions that enable them to contribute to the public health system both as leaders and trainers, thereby sustaining health program infrastructure in Rwanda.

The FELTP will use a multi-phased approach to address these gaps by: 1) conducting situational analysis to identify management skills and performance gaps and to create an action plan for faculty and curriculum development and institution-building; 2) training of a large pool of nationals in epidemiology, laboratory and sound public health practice; 3) technical assistance by providing support to FELTP graduates in such areas as conducting needs assessments, conducting in-country investigations and supervising applied learning projects; and 4) ensuring sustainability by addressing such issues as local funding, and integrating FELTP with other programs and program evaluation.

The School of Public Health, along with the National Reference Laboratory (NRL) have been identified as "prime partners" for the implementation of the RFELTP. These institutions are moving towards developing a comprehensive national public health institution that is based upon the CDC model and consists of a national reference laboratory, and epidemiologic support services for provincial and district level health activities. In addition, the RFELTP will partner with the National University of Rwanda, School of Public Health (NUR/SPH) to offer a masters level degree, with specializations in applied epidemiology, public health laboratory management, or veterinary epidemiology to participants that successfully complete the requirements of the program.

The FELTP model is designed to provide funding and technical resources for the first 5-10 years of the project, while the program is being established. During this time, the program is becoming embedded within the Ministry of Health on the organization chart, budget, and career path for human resources in

the country.

More specifically the program will allow for: • Improved program monitoring and evaluation to achieve comprehensive evidence-based HIV disease management services; • Improved quality data and data analysis (specific to person, place and time); • Functional laboratory services and information systems; • Improved laboratory QA and QC and training in support of VCT and HIV rapid testing methodologies; and • Improved monitoring for HIV related opportunistic infections and ART drug resistance. • Improved ability to address opportunistic diseases among Rwandans living with HIV/AIDS • Improved ability to address strategic information needs for HIV/AIDS, tuberculosis and malaria programs. • Strengthening local or local partner organizations, particularly in management, leadership and policy development.