Early lessons learned and promising practices: Supporting Provincial Health Departments and Districts in Mozambique Dr. Antonio Mussa 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

O VERVIEW T RANSITION A PPROACHES IN M OZAMBIQUE A CTIVITY UP - DATE L ESSONS LEARNED NEXT STEPS 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

T RANSITION A PPROACHES IN M OZAMBIQUE To augment sub agreements with the Government of Mozambique (GOM) at provincial & district level to include some of the activities previously directly supported by ICAP To ensure sustainability and to directly strengthen health system capacity To strengthen role of civil society by facilitating transfer of key activities to existing or new local NGOs 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

H ISTORY OF SUB AGREEMENTS ICAP - GOM H UMAN R ESOURCES FOR H EALTH (HRH) / S TAFFING WITH 5 P ROVINCIAL H EALTH D EPARTMENTS (DPS), 1 C ENTRAL H OSPITAL, M INISTRY OF I NTERIOR & M INISTRY OF D EFENSE SINCE 10/2008 P ROVINCIAL H EALTH S CIENCES I NSTITUTE (N AMPULA ): 3 PRE - SERVICE T RAINING COURSES S INCE 9/2008 N EW PRE - SERVICE T RAINING SUB AGREEMENTS WITH I NHAMBANE P ROVINCE & M INISTRY OF D EFENSE FOR 5 COURSES IN th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

HRH/STAFFING 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

E XPENSES ON HRH S TAFFING 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

S UB AGREEMENTS 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

Step I Expand SOW of Provincial and District subcontracts to further transition responsibilities for greater sustainability and strengthening of health systems C ONSENSUS B UILDING MEETINGS WITH EACH DPS D ISTRICT P LANNING S ESSIONS : ICAP provincial teams discussed facility reports (checklists and programmatic data), Standards of Care (SOC) Continuous Quality Improvement (CQI) instruments with the Districts as a basis for District planning: Indicators with low performance were prioritized & analyzed Solutions identified have been transformed into activities for the District plans 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

Step II Transition responsibility to Provincial & District level to ensure sustainability and strengthening of health systems P ROVINCIAL P LANNING MEETINGS Participants: District Director, Chief Medical Officer & admin/finance staff from each District where ICAP is operating, representatives from DPS & ICAP team Presentation of transition objectives, planning process and tools to be used Districts & DPS present their plans which include activities, time line and the resources needed Compilation and final revision of an overall plan by Districts & DPS 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

L ESSONS LEARNED - I Transition is a new approach for all stakeholders (CDC, ICAP, MOH) “learning by doing” Time constrains of DPS that impede participation in scheduled meetings & review and release of documents lead to slowing of process; a focal point person could facilitate progress Limited planning and administrative/finance management capacity at DPS level indicates need for increased capacity building activities 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

L ESSONS LEARNED II More guidance from central level MOH to DPS would facilitate planning and implementation process More consensus building needed among central level MOH & CDC to better define indicators and targets; strengthen M&E system to monitor transition Need for better harmonization of tools used by Track 1.0 transition implementers (planning, finance training, funding proposal writing) to standardize the USG approach for DPS support 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

N EXT S TEPS - I Finalize and obtain CDC approval for DPS subcontracts Build operational capacity of the DPS through: additional staffing & program management training of existing staff building financial management capacity 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

N EXT S TEPS - II Build programmatic capacity of DPS in: data collection and reporting supportive supervision partner coordination activities program management in technical areas adherence support & patient empowerment Monitoring & Evaluation of the successful implementation of sub agreements and plans 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

CONCLUSION Plan to support and monitor the process from the administrative/financial perspective as well as from its potential impact on achievement of targets and on quality of care 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010

T HANK Y OU ! 8th Annual Track 1.0 ART Program Meeting Maputo - ICAP Mozambique August 11th, 2010