With the Ministry of Health, CDC, and other partners, EGPAF helps manage the Zambian national electronic health records (EHR) system, SmartCare, providing strategic input, finance management, seconding information technology (IT) staff and procuring computer equipment. SmartCare, adopted by the MOH in 2006 operates in over 570 health facilities as the national patient record system.

Health workers capture patient data in SmartCares robust database. Data is kept in an EHR affording clinicians the ability to run data queries, check patient progress, identify missed visits, and track clinic performance. It allows patients to travel with their complete medical history through use of SmartCards which increase patient ownership of their health record and enhance continuity of care. EGPAF will support training, deployment and maintenance in all nine provinces and will lead national data use for continuous quality improvement (CQI).

Under the Reducing Maternal Mortality project, EGPAF will support data collection and monitoring and data use activities in partnership with the MOH and select districts for CQI. Lessons learned and promising practices in SmartCare data use and CQI will be shared. The use of data and geographic information systems (GIS) mapping to identify resources and gaps will inform strategies to provide quality, cost-effective, and equitable maternal health services.

EGPAF will support pediatric care and treatment services; including mentorship and training of counselors, sub-grants for CBOs providing palliative care and psychosocial support (PSS), support for Child Health Weeks and the nations only dedicated pediatric hospice, and support for Zambias Pediatric Clinicians Society to share promising practices in pediatric HIV services.

EGPAF supports critical pediatric care and support services which fill gaps in pediatric HIV services in Lusaka District. The targets for the PDCS category are included in the narrative and detailed in the indicator/target section.

Pediatric counseling mentorship increasing pediatric enrollment and retention, and promoting innovative approaches for pediatric PSS: EGPAF has trained more than 100 pediatric HIV/AIDS counselors using the MOH-endorsed course for counseling HIV-infected children and adolescents. EGPAF provides mentorship of HIV counselors, who primarily operate out of clinical sites. Routine program data show that sites with trained pediatric counselors have higher pediatric enrollment and retention than those without. EGPAF will continue to provide mentorship for counselors to improve quality of care and strengthen health services. EGPAF will also share innovative tools with counselors, and will continue to assess the effects of counselors on pediatric enrollment and retention. EGPAF, through its Pediatric Counseling and Support technical advisor will work with the MOH and other key stakeholders including implementing partners to improve the quality of pediatric care and support programs. EGPAF will convene quarterly workshops for implementing partners to share experiences and lessons learned in clinic based counseling of HIV positive children, disclosure methods, adherence counseling and support group formation and development.

Tiny Tim and Friends (TTF) providing pediatric palliative care: Although clinic-based efforts have increased the number of children enrolled in HIV programs, CBOs are integral to the provision of PSS. EGPAF will continue to support TTF, a Zambian CBO, for PSS and pediatric palliative care programming. EGPAF will also continue to build the capacity and sustainability of TTF in programs, monitoring and evaluation (M&E), and operations. EGPAF will continue to support the TTF program which mentors Our Ladys Hospice pediatric palliative care unit with technical assistance and secondment of a nurse practitioner as well as leading its own child support program.

Our Ladys Hospice (OLH) providing pediatric hospice services: EGPAF will continue to support the pediatric in-patient palliative care program at OLH. EGPAF, OLH, and TTF will continue to work collaboratively on this project, which is the countrys only dedicated pediatric hospice unit. EGPAF will continue to provide financial support to OLH to employ one full time pediatric palliative care nurse. In addition, EGPAFs technical director and nurse trainer (trained in pediatric palliative care) will provide quarterly supportive supervision to OLH.

Africa Directions (AD) pediatric psychosocial support: EGPAF will continue to support AD, a Zambian CBO, through a sub-grant to support pediatric support group programming for approximately 60 children infected and affected by HIV. EGPAF will also continue to build the capacity and sustainability of AD for programs, M&E, and operations.

EGPAF will continue to implement and manage the national EHR system; SmartCare, by providing strategic input and financial management and supporting IT staff and the procurement of computer supplies. EGPAF will continue to support SmartCares training, deployment and maintenance needs across all nine provinces. In addition, EGPAF will continue to lead national data use and optimization efforts for program improvement. Specific activities include:

Support completion of SmartCare PMTCT module roll-out and related training

Procure, deploy, and maintain SmartCare equipment and supplies

Strengthen local area networks and electricity access

Disseminate SmartCare guidelines and policies

Support health care worker trainings, provide feedback on training curricula, and develop and roll out reusable training materials

Ensure adherence to data flow procedures

Leverage SmartCare data for program improvements

Hold data reviews to identify and fill program gaps

Use data to advocate for policy changes to reduce barriers and missed opportunities

Support quarterly SmartCare user forums

Support data use training-of-trainer classes for SmartCare staff

Explore how SmartCare can be used for program surveillance

Explore additional SmartCare enhancements and innovations

Build MOH capacity to lead and manage comprehensive, quality HIV/AIDS services, with a focus on data use

Under the integrated Reducing Maternal Mortality project, EGPAF will continue to support the data collection and monitoring process through a strategic use of the SmartCare system and through leading data use activities in partnership with the MOH and selected districts. EGPAF will coordinate data collection efforts with other partners for optimal M&E. Lessons learned and promising practices in SmartCare, data use, and QI will continue to be shared between the two integrated projects. To ensure the provision of comprehensive, integrated, and quality maternal c services, EGPAF will continue to use SmartCare data to create standard reports of site-level service quality. Using GIS software, EGPAF will continue to map out key resources such as Safe Motherhood Action Groups and emergency transport services.

EGPAF will continue to support Provincial Health Offices (PHOs) in Lusaka, Western, Eastern, and Southern Provinces in capacity building in financial and program management following needs identified but not yet addressed in PY1 (October 2011-September 2012). EGPAF will work with the four provinces, training PHOs (HR, Finance, and Provincial Medical Officer) in USG fund management, accountability and governance, and report requirements.

[Human Resources for Health] The MOH, EGPAF, and CDC have implemented the SmartCare Essentials Certification program and have trained and certified more than 300 SmartCare users. Project funds will be used for SmartCare trainings for healthcare workers such as data entry clerks, senior District Nursing Officers, Nursing tutors, Clinical Officers, and program managers. EGPAF will continue to support the dissemination of and training on SmartCare guidelines and policies at each level of the health system to ensure SmartCare functionality and ensure data use for QI.

As part of the capacity building and sustainability effort, trainings will continue to be led jointly by EGPAF and the MOH. Finally, EGPAF will continue to support SmartCare Training Labs in each province, where trainings for SmartCare will be held using multiple workstations networked together. These trainings will include pre-service practical sessions for healthcare workers in each province. EGPAFs QA/QI staff seconded to the MOH will continue to review SmartCare training curriculum to ensure harmonization with the national QA/QI system.

EGPAF will support the training of at least 70 personnel in use of SmartCare to the level of SmartCare Essentials Certification training. At the same time, EGPAF will support SmartCares goals of using trained trainers at the district level to provide follow on training in clinics and nursing schools through in-service and pre-service training to support widespread awareness for and use of SmartCare.

EGPAF is committed to supporting the MOHs goal of providing affordable quality health care as close to the family as possible.

Africa Directions (AD) - EGPAF will support Africa Directions (AD) through a sub-grant, to continue providing voluntary HIV counseling and testing (VCT) for the people of Mtendere area of Lusaka. The goal for FY 2012 is for AD to reach and provide VCT to a total of 2,000 men, women and children in Mtendere. EGPAF will continue to work with AD to improve the use of a data through development of program management database. This work has begun but is not yet completed. The EGPAF technical team will oversee the use of this database and track testing by sex and age and linkage to care and treatment. EGPAF will also provide AD VCT program with health education materials specifically on child counseling and testing.

EGPAF supports activities that promote integration of PMTCT with routine MCH services including access to syphilis testing.

EGPAF will continue to support the MOH to roll out RST in ANC where RPR testing is not available: EGPAF investigators co-led an implementation research study on the acceptability, feasibility, and cost-effectiveness of introducing RST along with HIV testing in ANC facilities and within PMTCT. Analysis has shown that RST is acceptable, feasible, and cost-effective in urban and rural settings and does not negatively affect HIV services. As a result, national policy was changed in 2011 to adopt RST in sites without access to RPR. EGPAF will continue to work closely with the MOH and CDC to support the roll-out and sustained use of RST where RPR is unavailable. EGPAF will meet regularly with relevant MOH staff and the STI TWG at least biannually. The LiveFree Project will support one national ToT training for all nine provinces, including one lab specialist, one clinical specialist and one MCH coordinator to strengthen roll out and use of RST as well as laboratory quality assurance.

HTXS Budget Code: EGPAF will support the Ministry of Health to carry out a national Antiretroviral (ART) outcomes and impact evaluation; this will inform the Government of the Republic of Zambia and PEPFAR on priority areas for continued support and expansion of ART services. This will be the first nationally representative evaluation with the proposal to collect outcome data and subsequently use these to model impact indicators.

EGPAF supports critical pediatric treatment services which fill gaps in pediatric HIV services in Lusaka District. The targets for the PDTX category are included in the narrative and detailed in the indicator/target section.

Tiny Tim and Friends (TTF) intensive pediatric HIV case management: EGPAF will continue to support TTF, a Zambian CBO, through a subgrant to support care and treatment needs for 300 children, including those with treatment failure. EGPAF will also continue to build the capacity and sustainability of TTF for programs, M&E, and operations.

Zambia Pediatric Association (ZPA) promoting promising practices: EGPAF will continue to support biannual meetings of the Zambia Pediatric Clinicians Society as a forum for sharing best practices on pediatric PSS, pediatric counseling,, pediatric palliative care, and intensive pediatric HIV case management. To promote partnerships and sharing of lessons learned, EPGAF will work with TTF to present their work using an intensive case management model at the biannual ZPA meetings.

Child Health Week - supporting HIV testing of children to increase pediatric enrollment on ART: EGPAF/Zambia targets support for innovative initiatives which increase rates of pediatric enrollment in care and treatment services, including HIV testing during Child Health Week (a biannual national immunization campaign for children under five). EGPAF has seen increases in the number of children enrolled into care during the quarters in which Child Health Weeks are implemented with integrated HIV counseling, testing, and linkages to care. Given the positive results, EGPAF will continue to support the MOH to effectively manage Child Health Weeks with a focus on HIV testing and linkage to care and treatment services. In this year, EGPAF will support 2 districts to conduct HIV testing during child health week.