Supporting the Regional Health Bureaus in Ethiopia Zenebe Melaku, MD ICAP-Ethiopia

ICAP Guiding Principles Integration with national AIDS control plans Capacity building for health systems and broad infrastructure support Involvement of PLWHA - adherence, social support Integration of Prevention, Care & Treatment Family-centered care (adults and children) Multidisciplinary Team Approach High quality services with program evaluation, operations research, and program improvement

FMOH - National Road Map & ICAP Support ICAP- CU National Level - TA ICAP- CU Regional Road Map Implementation ICAP- CU Facility Level Implementation

Characteristics of ICAP-E Program National Pediatrics; EID; TB-HIV; PLWHA; MLDM Four RHBs Capacity Building/TA ICAP - Ethiopia Regional Univ. Comprehensive Site Level Support

Characteristics of ICAP-E Program Oromiya : 29,118,188 Somali : 4,325,446 Dire Dawa : 388,731 Harari : 194,745 Total Population : 34 million Characteristics of ICAP-E Program 5

Health Care System - Ethiopia Policy National Strategy Guideline and Training Curriculum FMOH RHB RHB RHB Oversee Program Implementation and Monitoring H H HC HC HC

Initial Step: Needs assessment with RHBs Critical Gaps Identified:- Identification of gaps Critical Gaps Identified:- Coordination and Strategic planning Human Resource Infrastructure Systems

Modalities of Support: Two mechanisms: Direct support: Short/Medium term Sub-agreement: Medium/Long term

Regional level Capacity Building – Coordination and Strategic Planning TA in the development of regional annual plan Regional Partners Forum Joint Regional Planning and Review Meetings

Building Regional Ownership through Participatory Planning A Key Strategy for Sustainability

Regional level Capacity Building – Human Resource Basic and ToT Local/International Training: Clinical Program Mx Financial Mx Multi-pronged Approach: Program staff Accountant Data clerks…. Secondment/ Additional staff Clinical, Program & Finance Mentoring Access to Internet Resource centers Office furnitures ….. Enabling Environment

Capacity Building: Human Resources (Training)

Regional Capacity Building – Resource Center

Regional level Capacity Building – Infrastructure – Training Centers Training Center with Video-conferencing Facility

Regional level Capacity Building – Systems Laboratory System: Development of SOPs: Sample referral Implementation of EQA systems Monitoring and Evaluation System: Data QA systems Data use for CQI Referral System: SOPs for decentralization Financial Management System: Development of SOPs

Key Achievements and the Way Forward Increased scope of activities with increased funding (5X) Responsibilities handed over to the RHBs : Annual review and planning meetings Quarterly Supportive Supervisions Hiring of supernumerary staff Sample transport system Management of minor renovations In the future: Phased and Incremental Manner

Challenges: Human Resource: At All Levels Financial management system Shortage Work overload Lack of staff motivation High Staff Turn-over Financial management system At All Levels

Conclusions-Lessons learned Regional level capacity building Key strategy for successful transition Requires commitment from government, availing HR and other required inputs It requires longer time-frame Phased and Incremental Manner Attention: Maintaining the ‘Desired Quality’

Thank You . Obrigado