Group 5 Strengthening health services at District level (Referral pathways, capacity building, training & support, Coordination of stakeholders) Members; Dr. Mpundu Makasa – Chair. Dr. F. Adatu-Engwau –Rap. Dr. Amy Bloom Dr. Charlotte Colvin Dr. Olusegun Obasanya Dr.Anna Vassal Dr. Paul Pronyk Dr. Lindiwe Mvusi Dr. Paul Nunn

Communication and collaboration with stakeholders (E). Group 5.1: Essential components proTest sites supported services at district level. Communication and collaboration with stakeholders (E). Management systems –Technical training, on the Job training, Project management/Budgeting and organograms (E). Elaborated the linkages between services –OPD, ANC, Lab , Community, Outreaches. (Catalyst / Mobilize for testing) (E). New services (F-gaps). Supplies – Quantification, Procurement procedures and distribution (F.gaps). Monitoring and evaluation system (E).

How did the sites do the referral? How was this monitored? Group 5.2: What general recommendations can be made about establishment and maintenance of referral mechanisms between stakeholders? How did the sites do the referral? How was this monitored?

- Establishment of a forum for coordination of all DHS. Group 5.3: What area the ways of measuring the impact of this support to DHS? - Establishment of a forum for coordination of all DHS. - Integrated Training plan developed. - Monitoring system jointly agreed on. - No. of staff trained on TB/HIV care. - No. of TB Cases detected cf Baseline. - VCT uptake

Situation analysis and networking of all stakeholders (Partnership). Group 5.4: What are the most effective ways of developing health service capacity? Situation analysis and networking of all stakeholders (Partnership). Coordinated joint planning, training, monitoring and reporting. Clearly define management responsibilities. Sharing of roles between public and NGO sectors.

Group 5.5: When should volunteers be made employees/professionals? Depending on the Cultures, Resources, Responsibilities envisaged, Management systems in place, there is a role for volunteers BUT in the context of expanded services – VCT will need full time employees.

Group 5.6: Should we have dedicated health care staff for TB/HIV or multi-skilled workers? Depends on the demand for the services; it is recommended that at lower level units adopt multi-skilled workers while at secondary & tertiary level we have dedicated TB/HIV services.

Quality Support Supervision. Group 5.7: How can we engender a culture of performance management and accountability into district health services? Adoption of Continued Quality Improvement (CQI) approach in management of district health systems. Quality Support Supervision. Clear definition of roles and responsibilities. Strengthening of Data management, use and feedback.

Group 5.8: Does TB/HIV collaboration improve staff morale? Yes. - Empowers staff with knowledge. - Equips them with new skills. - Fosters confidence. - Broadens health workers scope through collaboration with other stake holders.

Proper drug management skills to facilitate; -Quantification (data) Group 5.9: What is needed to ensure a consistent and uninterrupted supplies, drugs, test kits etc.? Proper drug management skills to facilitate; -Quantification (data) - Procurement (Policies & Systems) - Storage and (Infrastructure) - Distribution (system).

Group 5.10: Should we recommend the Malawi or Zambia approach? Approaches adopted should suit different situations as found necessary. (Results of situation analysis) Set a priori clear objectives and targets to ensure that you achieve what you set out to do.