Investing in Different Models of Local Ownership to Ensure

Sustainable Patient CareTrack 1 Implementers Meeting

Maputo, MozambiqueAugust 2010

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Presentation Overview

Sustainability and building Local Ownership to support TransitionLessons Learned

GlobalKenyaZambiaSouth Africa

Questions2

Faith-Based Health Care in Africa

History of Faith-Based Health Care in AfricaCurrent Infrastructure – 30-70%Global Trends

PEPFAR provided opportunityLoss of resources

Seamless Relationship3

Sustainability: Sustained access to quality care with durable patient outcomesContinuing support to and scale-up of National programs Facilitating a seamless relationship between Faith-Based Health Networks and Government Health Systems

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Approach to Sustainability Fostering partnerships and developing sustainable capacities of Treatment Facilities and Local Partners

so that:

• Treatment facilities provide high quality treatment

• Local partners provide long-term support to sustain treatment facilities’ care delivery

• Local partners engage in productive dialogue with National Governments around the their role in provision of health services and Health Policy

Capacity Building Cycle

Support($, TA)

What is thisamount?

time

PartnerCapacity

Status of Partner Capacity

Plan Implement Scale Up Sustain

Vision for Transition

Faith Based Health Networks are an integral part of their countries Health Care Systems

Local Partners are leaders in the Anti-Retroviral Therapy programs with decreasing support from AIDSRelief across timeFaith Based Health Services are resourced adequately to serve the needs in the country and continue across time

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Local PartnersMeet PEPFAR Criteria:

Local organization or government entity

Have the capacity to: Be a competitive prime for USG fundingManage all functions of Track 1.0 projectReach a sustainable level of operations

Slide 8

Principal Approach to Technical TransitionBuilding capacity of MOH institutions at all levels to provide oversight for treatment programs and for outcomes evaluation

Building advanced clinical education capacity

Entering into partnership with medical institutions in host country through which TA to LPTFs will be sustained

Working with host MOH to develop evidence driven HIV policies

Strategic Approach to Technical Transition

Building partnerships with institutions that can take on different technical roles over the long term:Local Partners, Treatment Facilities:

For care and treatment delivery – site activation, evaluation/improvement, treatment planning

Ministries of Health:For technical oversight including continuous quality improvement and outcomes evaluation

Medical Education Institutions:For pre-service, in-service education and technical support to sites through on-going mentoring

National Labs Institutions:For laboratory systems strengthening

Where are we now: Year 7 Priorities for Transition

Transitioning – Not business as usualAligning – with Ministry of Health on Transition strategiesStrengthening – action plans rolled-out Transferring – site management to Local PartnersCompeting – preparing for FOAs

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Models for Local Partners Model 1: MOH or other government entity as local partner

Rwanda: Six Sites Transitioned as of March 2010

Model 2: Local partners (local umbrella org) in collaboration with national technical partner/s for clinical and SI (MOH/university/other)

Kenya: Faith Based Network MEDS with CHAK, KEC & University of NairobiHaiti: Faith Based Network St Boniface NGO with University of Notre Dame de Haiti

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Models for Local Partners Model 3: Local partners (local umbrella org) with sub-grantees providing technical assistance

Zambia: Faith Based Networks CHAZ & CHRESO South Africa: SACBC AIDS Commission & IYDSA NGO network

Model 4: Sites as direct primes to CDC South Africa: St. Mary’s Hospital in DurbanGuyana: St Joseph Mercy Hospital and Davis Memorial Hospital

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Lessons Learned for Transition

1. We are all learning as we go (AIDSRelief, Donors, Local Partners). In-country and global transition committees are critical to address practicalities of the process.

2. Communicate clearly and frequently on transition.

3. Strive for a shared long-term vision for the role of faith-based partners.

4. Technical transition requires a unique design per country, as there is not one model for medical or strategic information transition.

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Lessons Learned5. Flat-lined budgets mean reduced funding for transition

due to increasing numbers of patients on treatment.6. Switching treatment sites between different models is

difficult. Example: AIDSRelief to Global Fund7. The capacity strengthening of local health system for

long-term sustainability will take longer than 3-4 years. 8. Staff retention within Local Partners, Treatment

Facilities and with INGOs is essential for transition success.

9. Work to ensure future funding opportunities for local partners by Sept. 2011. Prepare to respond quickly.

Slide 15

Timeline for Transition (Expected)