1. Project HEART Transition Monitoring Challenges and Successes of Monitoring Health System Capacity August 12, 2010 Rozalin Wise

2. Transition Monitoring System: Goals Document capacity of health system to meet HIV/AIDS Prevention, Care and Treatment needs pre, during and post transition Increase monitoring of systems and processes to guide program interventions focused on health systems strengthening beyond site level More uniform monitoring system across countries

3. Transition Monitoring System: Design Overview Capacity assessment of each Result area proposed in Transition Plan Assessment scores transformed to same scale allowing plotting on spider diagram Capacity assessments repeated annually at minimum

4. The Transition Vision: A strong house! Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Operational Capacity of Government or Local Organizations managing health system RESULT 3 Health Outcomes (“the roof”) Client and Community Engagement RESULT 2 Health Outcomes (“the roof”) Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Operational Capacity of Government or Local Organizations managing health system RESULT 3 Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Operational Capacity of Government or Local Organizations managing health system RESULT 3 Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Client and Community Engagement RESULT 2 Operational Capacity of Government or Local Organizations managing health system RESULT 3 Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Client and Community Engagement RESULT 2 Operational Capacity of Government or Local Organizations managing health system RESULT 3 Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (“the foundation”) Policies, political stability, human rights, gender equality, etc. Health Outcomes (“the roof”) Client and Community Engagement RESULT 2 Operational Capacity of Government or Local Organizations managing health system RESULT 3 Health Service Provision (Quality & Access) RESULT 1 Enabling Environment (the “foundation”) Policies, political stability, human rights, gender equality, etc. Health Outcomes: Clients have continuous high quality HIV care and treatment delivered by local partners (the “roof”) Client and Community Engagement (active civil society, high demand) RESULT 2 Management Capacity of Government, NGOs & Private Sector managing health system RESULT 3 Health Service Provision (Quality & Access) RESULT 1

5. Transition Monitoring System: Design Overview Result AreaUnit of Measure Assessment Tool/Process RESULT 1: Services Provision Health FacilitiesSite Capacity Profile (SCP) RESULT 2: Health System Management - District Health Authorities - Primary local NGO (transition partner) supporting systems strengthening - SCP/MoH Capacity Assessment - Organizational Capacity Assessment (OCVAT tool) RESULT 3: Community Linkage Key informants in health facility catchments areas SCP/Structured Interviews with CBOs and Support Groups Enabling Environment (policy, political stability, corruption, etc.) NationalExisting development/ policy indexes

6. Transition Monitoring Timeline AssessmentFirst Implementation OCVATJune - Sep 2010 Site Capacity Assessment Sep - Oct 2010 pilot Nov 2010 – Feb 2011 First Implementation Community Capacity Assessment Same as Site Capacity MOH Capacity Assessment Pending finalization of CDC H-CAT 2

7. Organizational Capacity: The OCVAT (Organizational Capacity and Viability Assessment Tool) Semi-quantitative: Each indicator scored on 1-5 scale, representing stages of capacity Implementation: Two phases – External Assessment – conducted by EGPAF Global – Self-Assessment – facilitated workshop w/ staff representing all departments/functions External evaluators give scores Participating staff give scores, median = official score Results presentation: Compare scores, highlight strengths, weaknesses, discussion External facilitator decides final scores if no consensus

8. Service Provision: Site Capacity Profile (SCP) Capacity Areas: ART, PMTCT, Peds, Treatment Support, Pharmacy, Laboratory Services, M&E/Reporting, Quality Improvement Program, Finance Measures infrastructure, staffing and management/provision of services for each capacity area Coupled with existing Quality of Care measures Score generated per capacity area Implementation: Program Officers complete using existing routine data, visit site to collect the rest OR use as QI activity with site QI Committee

9. MOH Capacity Assessment Will be based on CDC MOH Capacity Assessment tool Working Group with representation from all EGPAF Project HEART countries will adapt ensuring necessary country context specification and comparability to extent possible

10. Community Capacity Assessment Focused on provision of support services For key support services, measures core competencies: – Availability, Quality, Linkage (referral process), Utilization Barriers – Rapid – each competency, a few key questions Informants: Site Staff, CBO Leaders, Support Groups Countries decide which support services to focus on (modules developed for all)

11. Conclusion Series of capacity assessments capture health system’s capacity to provide continuous quality HIV/AIDS care and treatment Demonstrates relationship of key components and their contribution to the whole

12. Thank you!