1 Janna Brooks HIV Care and Treatment Branch Global AIDS Program U.S. Centers for Disease Control and Prevention

Project started as result of findings from Track 1.0 M&E meeting in November 2009 Many existing tools and frameworks for assessing capacity of ART sites and local partners organizational capacity Lack of existing analytical approaches for provincial and district health systems capacity to sustainably plan, organize and support delivery of HIV services 2

Strategic Planning for Integrated HIV Services Stakeholder Management and Coordination Human Resource Management for Clinical Services Financial Management of Funding for HIV Services Supervision of Clinical Services HMIS, M&E Systems Pharmacy Supply/Logistics Renovation/Maintenance/Equipment Laboratory Services Support Quality Management/Improvement Systems Community Linkages 3

Predominant conceptual framework is WHO Health System Building Blocks Existing approaches focus on health facility or national health system performance Lack of operationalization of WHO concepts at provincial and district capacity levels Validation of core domains, identification of gaps Review of assessment methodologies Annotated bibliography of sources reviewed 4

5 Strategic Planning for Integrated HIV Services Stakeholder Management and Coordination Human Resource Management for Clinical Services Supervision of Clinical Services HMIS, M&E Systems Pharmacy Supply/Logistics Financial Management of Funding for HIV services HF Renovation/Maintenance/Equipment Laboratory Services Support Quality Management/Improvement Systems Integration of Service delivery Community Linkages

Identify strengths and weaknesses in organizational structures, managerial processes, and provision of support for HIV services Provide evidence for better planning and implementation of health systems capacity-building support to provincial/district health teams Measure baseline assessment of capacity & performance, and to measure improvements as a result of support Can be used flexiblyfrom structured discussions to formal capacity assessments 6

Capacity = ability of an organization to implement its mandated activities Performance = how effectively the organization actually implements its activities and achieves it objectives Relationship of capacity to performance is not simple Interdependent, but multidimensional and non- linear relationship 7

Capacity rating for the province or district for each of the capacity domains through checklists for compliance interviews with the DHO, verified by supporting documentation; the scoring is determined according to decision rules for each capacity area (i.e. whether a minimum threshold level is reached) Performance rating based on key performance indicators for each of the capacity areas quantifiable data from district health management information system records performance scores = good (>80%), fair (50% -80 %), poor (< 50%) Validation of ratings – random sample of facility level 8

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10 Low Capacity High Performance Why? High Capacity High Performance Low Capacity Low Performance High Capacity Low Performance Why? Capacity Performance

11 Governance / Leadership Health Workforce HMISPharmacyFinanceService Delivery Community CapacityPerformCapacityPerformCapacityPerformCapacityPerformCapacityPerformCapacityPerformCapacityPerform District 1 GoodFairPoor District 2 District 3 District 4 District 5 District 6 District 7

Limitations Offers only a rapid check on a limited number of capacity and performance areas Does not provide a comprehensive assessment of capacity or performance Not yet validated in field implementation Benefits Ease of implementation; consistent systemic approach Lean methodology quickly focus effort on areas that need in-depth analysis and support Comparable assessment approach across domains and/or health system units 12

Feedback process of first draft Field test/validation Development of User Manual Development of In-depth discussion guide in each technical area for follow-up actions 13

14 Contact: Janna Brooks Josef Amann Acknowledgments …Jennifer Yourkavitch Eric Sarriot, Leo Ryan, Lela Baughman, Rozalin Wise, Joe Barker, Laura Porter, Nancy Fitch, Tshiwela Neluheni, Pat Bass, John Donahue, Kristen Stafford, Charity Alfredo, Jackie Sallot, Philippe Chiliade, Kjersti Schmitz, Angeli Achrekar, Jaime Butler-Dawson, Lanette Burrows, Ilona Varallyay