Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

Technical Assistance for Health Systems Development: Benefits for HIV/AIDS Programs

Nicole Barcikowski, MAHealth Systems 20/20 Abt Associates Inc.

Global Health CouncilJune 17, 2011

Outline

National Policy Impacts Financial: Mali, Kenya, India Human Resources: Côte d’Ivoire

Organizational-level Impacts Financial: Mozambique, Liberia Information Systems: Kenya Human Resources: Côte d’Ivoire,

Guyana

National Policy Impacts: Mali CBHI

Strengthen community-based health insurance (CBHI) Develop policy, operational plan, budget for Mali’s first government-

subsidized CBHI policy Partners: MOH, World Bank, Ministerial Leadership Initiative

(Gates Foundation) Steering and technical committees met with MOH in Rwanda,

where 85% of population is covered by CBHI schemes Results

CBHI policy adopted by President and Board of Ministries in Feb 2011

Government will subsidize 50% of CBHI plan ($83 million over five years)

Complements 2009 law requiring formal sector employers to provide and subsidize health insurance for employees

National Policy Impacts: Kenya HAPSAT

HIV/AIDS Sustainability Analysis Tool (HAPSAT) assessment in 2010 found HIV/AIDS funding unstable, 75% from donors, and recommended: Use air traffic levy as short-term source of income for HIV/AIDS

programming Increase government contributions to health to 15% as per Abuja

Declaration Partners: MOH, National AIDS Control Council, National

AIDS and STI Control Programme Results

Cabinet memorandum to implement levy drafted in March 2011

National Policy Impacts: India PLWHA Insurance Coverage

Develop road map to cover people living with HIV/AIDS in broader risk pools and mainstream HIV/AIDS coverage in insurance packages

Partner: Indian government Result: Expect policy decision

on HIV/AIDS insurance coverage by fall 2011

National Policy Impacts: Côte d’Ivoire HRH

Assess human resources for health (HRH) to inform strategy Health Systems 20/20 (and PHRplus) assessments (public sector 2005,

private sector 2007) estimated HRH at 11,749 staff: nurses (58%), midwives (18%), doctors (14%)

Partners: MSHP, local stakeholders

Results Developed costed 5-year strategy

for HRH focused on both demand and supply Activity success attributable to consistent consultation with local

stakeholders and strong government leadership through MSHP

Organizational-level Impacts: Mozambique Global Fund Grants

Improve access to Global Fund grants MOH requests Health Systems 20/20 assistance to clear system

roadblocks to accessing Global Fund grants and create a more effective financial management system

Establish Global Fund unit within MOH Planning Department Work with the Department of Finance and Administration to customize financial

management system to receive, track, and report on various donor grants and activities

Results Clear backlog of Global Fund disbursements (Rounds 2, 6, 7) Use grant funding to serve 1.5 million living with HIV/AIDS and 110,000

with TB, and help prevent over 19,000 malaria deaths per year (WHO)

Organizational-level Impacts: Liberia NAC

Establish permanent National AIDS Council (NAC) Secretariat to provide coordination, strategy development, M&E, advocacy Define functions, develop staffing plan and position descriptions,

determine operating budget Clarify relationship of Secretariat to NAC Executive Committee Do team building, management capacity building, executive coaching

Results Legislation formally establishing NAC approved by Congress, awaits

president’s signature Revised National Strategic Framework for HIV/AIDS Fully staffed Secretariat with office space and operating funds Task forces being formed for M&E, partner coordination, etc.

Organizational-level Impacts: Kenya HIS

Strengthen HIV/AIDS data collection and reporting system to streamline service delivery and access Standardize national HIV/AIDS data collection and reporting

(number people screened, HIV positive, needing/receiving ART, etc.) Build capacity to collect higher-quality, standardized data Create HIV/AIDS framework within broader HIS, eliminating parallel

systems Results

Better M&E and data collection system at 6,000 facilities in 250 districts Improved information available for decision makers

Organizational-level Impacts: Côte d’Ivoire HRH (1)

Use performance-based incentives (PBI) to improve HRH capacity and HIV service delivery Health Systems 20/20 (and PHRplus) HRH assessments showed

severe maldistribution of HRH (60% in Southern region) and high worker turnover in hard-to-fill posts

Health Systems 20/20 support to: Pilot MSHP PBI scheme in Ferkessedougou district Build regional and district capacity in management and leadership in

decentralized health system

Organizational-level Impacts: Côte d’Ivoire HRH (2)

Results PBI

Return of HRH to areas affected by socio-political crisis (94% HRH presence) Increased funds for facility premises and equipment, higher-quality service delivery Improved availability and access to HIV and other priority services at peripheral level

Strengthened local capacity in management and leadership, including HIS management and reporting, planning

Organizational-level Impacts: Guyana HAPSAT

HIV/AIDS Sustainability Program Analysis (HAPSAT) of public sector HIV/AIDS services

Results Review distribution of HIV counselors Ensure clinics are open 8 hours to maximize limited HRH Rethink use of mass media for HIV awareness Establish electronic formats of paper data collection forms in

anticipation of construction of strategic information database Provide input into UNAIDS’ country ownership consultation and next

national HIV strategy, to help in better utilizing GF HIV/AIDS funding

Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

Thank you

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