1. ICAP Lesotho Transition Strategy for Sustainability M&E Technical Meeting

2. Introduction ICAP’s supports the Lesotho MOHSW to reduce the impact of TB/HIV Provide technical assistance within the framework of Lesotho TB/HIV Strategic Plan Provide nationwide support – all 10 districts – all health facilities(21 hospitals + 184 HCs & FCs) All facilities are owned by the MOHSW, CHAL or are Private – no ICAP facilities

3. LS TB and HIV/AIDS landscape STI, HIV and AIDS Directorate (SHAD) – HIV/AIDS programs (HTC, PMTCT, Care, Treatment, BCC, etc) – Nascent M&E system – EGPAF main partner Department of PHC – Dept. of Disease Control National TB Program (NTP) Strictly TB activities only Fairly well developed TB surveillance system – ICAP main partner HIV/AIDS patientTB/HIV patientTB patient

4. PMTCT, Care & Treatment Program M&E System Maintenance of site tools (pt cards, registers) ICAP support HC4 Hospital HC5 HC1HC2HC3 District Health Management Team (data capturing, cleaning, verification, analysis) STI, HIV/AIDS Department (data cleaning, verification, analysis, dissemination) PEPFAR URS ICAP LS M&E System (maintaining tools, data capture, cleaning, verification, reporting) GFCU, CHAI

5. Current (inherited) TB/HIV Surveillance System Partner support HC1 Hospital B HC2 HC3HC4HC5 DHMT/District hospital (maintenance of district TB Rx reg, ETR, dispatches, reports, backups) National TB Program (data cleaning, analysis, dissemination) WHO GF Funder Partner parallel System (electronic patient level db)

6. Why the parallel M&E system? No data collection tools at the beginning of support No dedicated MOHSW data personnel Meet reporting requirements internal ICAP, URS, PEPFAR Tight deadlines Indicators not harmonized ‘ Pre-transition era’

7. Effects of the parallel M&E system Undermined the national M&E system Threatened relationships with MOHSW Not sustainable One positive - Lesotho has embraced data personnel – Plan to have at least 1 data clerk in each health center – 65 recruited for the northern districts to date

8. Major shift in new program MOHSW is (rightly!) insisting on ownership: – partners must support the ONE M&E system – no ICAP sites, so no parallel systems PEPFAR/CDC promoting transition – “If not a local indigenous organization, the applicant must articulate a clear exit strategy which will maximize the legacy and sustainability of this project…..”

9. Strategy for sustainability Remove the parallel M&E system and support the NTP’s TB/HIV surveillance system What comes out of the NTP goes to partners and funders Surveillance System Strengthening Data Quality Data feedback Data appreciation and use Monitoring of community activities

10. Strengthening the TB/HIV Surveillance System Maintenance of site tools (TB cards, suspects, Rx) ICAP support HC1 Hospital B HC2 HC3HC4HC5 DHMT/District hospital (maintenance of district TB Rx reg, ETR, dispatches, reports, backups) National TB Program (data cleaning, analysis, dissemination) ICAP LS WHO URS CDC GFCU

11. Surveillance System Strengthening Human resources (2 SO) Regular supervision & follow-up Data collection & reporting tools – Advocate for incorporation of TB variables in HIV tools Enhance Electronic TB Register – Eradicate errors, improve report generation – Train HCW – Ensure regular updating – Ensure regular data dispatches to NTP

12. Data Quality Routine supervision of paper tools at sites and ETR at district level Improved validation criteria in the ETR Quarterly data verification exercises – NTP, DHMT, partners Annual structured QDA NTP, DHMT, partners

13. Data Appreciation and Use PERFORMANCE FEEDBACK Quarterly district progress review meetings Annual Joint Review (national) Identify “star” HCW or sites and use them as “peer-educators”

14. Rea Leboha (Thank You)