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

1. Technical Assistance for Health Systems Development: Benefits for HIV/AIDS Programs Nicole Barcikowski, MA Health Systems 20/20 Abt Associates Inc. Global Health Council June 17, 2011

2. 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

3. National PolicyImpacts: 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

4. 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

5. 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

6. 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 costed5-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

7. Organizational-levelImpacts: 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)

8. 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.

9. 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

10. 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 maldistributionof 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 Ferkessedougoudistrict • Build regional and district capacity in management and leadership in decentralized health system

11. 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

12. 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

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