This activity was approved in the FY 2006 COP, is funded with FY 2006 PEPFAR funds, and is included here to provide complete information for reviewers. No FY 2007 funding is requested for American International Health Alliance (AIHA) in the area of F. Care: Basic Health Care & Support (HBHC)

For this twinning activity in FY 2006, the AIHA worked closely with the Foundation for Professional Development (FPD) to strengthen the ability of two district hospitals in rural North West province to provide high quality integrated HIV, TB and palliative care services to patients seeking treatment at hospitals/clinics in the Brits District Hospital network. Activities included strengthening operational/management systems; assisting in the development of an integrated HIV/TB/Palliative care model; and strengthening the down-referral system.

This project is being revised in FY 2007 to more accurately reflect the best utilization of the AIHA twinning concept and the relevant strengths of the two organizations. FPD will continue to provide the Basic Health Care & Support services described above. A fuller description of FPD activities is provided in the HBHC section of this COP. AIHA activities are now reflected in the Policy and Systems Strengthening section of this COP. Please view the AIHA activities listed there.

This activity was approved in the FY 2006 COP, is funded with FY 2006 PEPFAR funds, and is included here to provide complete information for reviewers. No FY07 funding is requested for American International Health Alliance (AIHA) in the area of K. Treatment: ARV services.

For this twinning activity in FY 2006, the AIHA worked closely with the Foundation for Professional Development (FPD) to strengthen the ability of two district hospitals in rural North West province to provide high quality integrated HIV, TB, and Palliative care services to patients seeking treatment at hospitals/clinics in the Brits District Hospital network. Activities included strengthening operational/management systems; assisting in the development of an integrated HIV/TB/Palliative care model; and strengthening the down-referral system.

This project is being revised in FY 2007 to more accurately reflect the best utilization of the AIHA twinning concept and the relevant strengths of the two organizations. FPD will continue to provide the services delivery described above. A fuller description of FPD activities is provided in the Treatment Services section of this COP. AIHA activities are now reflected in the Policy and Systems Strengthening section of this COP. Please view the AIHA activities listed there.

SUMMARY:

The American International Health Alliance (AIHA) will conduct activities to support strengthening national and organizational policies and systems to address human resource capacity development through two components: twinning and volunteers (both are issues of legislative interest). Twinning between the Foundation for Professional Development (FPD) and Yale University in the U.S. will focus on strengthening FPD's capacity to provide HIV and AIDS in-service training for healthcare providers; a twinning partnership between FPD and a U.S. nursing program will develop nurse case manager systems in selected ARV sites. The volunteer activity will result in placing infectious diseases (ID) specialists in primary healthcare clinics in four provinces to help develop those clinics' capacities to deliver high-quality HIV care. The primary emphasis areas for the twinning and volunteer activities is local organization capacity development and the minor emphasis areas are training, human resources, and quality assurance, quality improvement and supportive supervision. The specific target populations for these activities are public and private healthcare providers and host country government policy makers.

BACKGROUND:

These are new twinning and volunteer activities. The twinning activities build on an existing collaborative relationship between FPD and AIHA which was developed during a twinning partnership that the Twinning Center facilitated between FPD and Brits District Hospital. That partnership was jointly funded by PEPFAR through the South African Country Operational Plan (COP) and Twinning Center core funding.

The new twinning activities are implemented through a sub-grant to either one or both partners, with partnership development, management and evaluation provided by the Twinning Center. The Twinning Center South Africa Regional Office will manage, monitor and evaluate the volunteer activities.

ACTIVITIES AND EXPECTED RESULTS:

Two activities will take place as a result of this partnership:

ACTIVITY 1: Twinning

Two twinning partnerships, each with a different emphasis, will be developed with FPD. The first twinning partnership is between FPD and the Department of Epidemiology and Public Health's Health Management Program (HMP) at Yale University. The focus of this partnership is threefold: (1) to strengthen FPD's faculty in policy research and analysis; (2) to redesign the current management development program and to expand it by introducing new short courses targeted at program managers working in the health sector; and (3) to expand FPD's current management alumni program to be a fully fledged mentorship program. This program will be informed by the Master's degree program initiated by HMP in Ethiopia. The partners will design training materials that address HIV and AIDS in the workplace. An initial assessment is underway to determine the skills and competencies required to inform the curriculum development of these courses. The anticipated results of this partnership include improved knowledge and skills of human resources and integration and use of tools to better manage health programs including ARV clinical care services in South Africa.

The second twinning partnership with FPD will develop nursing case management systems in four selected clinics, and this will garner support for this approach within the nursing profession. A U.S. nursing program with a strong case management component will be selected as the twinning partner. The key objectives of this partnership are to:

- Train a cadre of nurses, nurse leaders, nurse educators and key clinic management personnel from selected clinics, associations, and schools in HIV nursing case management; - Implement HIV nursing case management in selected ARV clinics identified by the National Department of Health (NDOH) and USG; - Create organizational and management support for nursing case management systems; - Implement a training/mentoring model of "nurses supporting nurses" to institute and

support HIV nursing case management and to expand the model to additional clinics/down referral sites; and - Develop an HIV Nursing Case Management Module to use for in-service training of nurses and hospital and clinic management personnel.

These twinning activities will strengthen effective and efficient case management in selected clinics, and training on nursing case management will be incorporated into in-service/continuing education course offerings. Both of these outputs will result in improved quality of HIV care by South African nurses.

ACTIVITY 2: Volunteers

The Twinning Center will place up to 16 ID specialists (physicians and nurses) for up to three months in selected primary care clinics in four provinces: KwaZulu-Natal, North West, Northern Cape and Mpumalanga. Depending on the capacity and needs at the identified sites, volunteers will be assigned to work in just one clinic for the entire time, or to rotate between clinics in a designated area. The volunteers are expected to support at least five health professionals per site. The volunteers will quickly determine the training and systems management gaps at the clinics and help find solutions to fill the gaps, provide training and ongoing mentoring to staff, help to cement relationships between the hospitals and the down-referral sites, ensure that supplies and systems are in place to handle an increased patient load, and provide encouragement and support to clinic staff. Twinning Center core funds will support the costs of recruitment, pre-travel logistics (i.e. vaccination, medical screening, passports, etc.) and pre-assignment orientation. South African COP funds will cover transportation and in-country costs, including orientation, housing, living allowance and program monitoring.

The volunteer activities are expected to increase the knowledge and expand the skills of healthcare professionals in primary care clinics that deliver HIV services. The volunteer activities will result in the implementation of functional down referral systems. It is also expected that the volunteers will continue to provide technical assistance to their host clinics after their return to the U.S.

All of the Twinning Center activities support PEPFAR 2-7-10 goals by strengthening HIV care in primary care clinics, by enhancing HIV care training for health care providers, by creating innovative models of service delivery, and by expanding the role of primary care nurses in HIV care. Moreover, these activities address four South African strategic priorities for National Health System (NHS) 2004-2009 namely:

- Human resource planning, development and management; - Improving governance and managements of NHS; - Contributing towards human dignity by improving quality of care; and - Strengthening primary health care and hospital delivery systems.