1. Investing in Different Models of Local Ownership to Ensure Sustainable Patient Care Track 1 Implementers Meeting Maputo, Mozambique August 2010 1

2. Presentation Overview Sustainability and building Local Ownership to support Transition Lessons Learned Global Kenya Zambia South Africa Questions 2

3. Faith-Based Health Care in Africa History of Faith-Based Health Care in Africa Current Infrastructure – 30-70% Global Trends PEPFAR provided opportunity Loss of resources Seamless Relationship 3

4. Sustainability: Sustained access to quality care with durable patient outcomes Continuing support to and scale-up of National programs Facilitating a seamless relationship between Faith-Based Health Networks and Government Health Systems 4

5. Approach to Sustainability Fostering partnerships and developing sustainable capacities of Treatment Facilities and Local Partners so that: Treatment facilities provide high quality treatment Local partners provide long-term support to sustain treatment facilities’ care delivery Local partners engage in productive dialogue with National Governments around the their role in provision of health services and Health Policy

6. Capacity Building Cycle Support ($, TA) What is this amount? time Partner Capacity Status of Partner Capacity PlanImplementScale Up Sustain

7. Vision for Transition Faith Based Health Networks are an integral part of their countries Health Care Systems Local Partners are leaders in the Anti- Retroviral Therapy programs with decreasing support from AIDSRelief across time Faith Based Health Services are resourced adequately to serve the needs in the country and continue across time 7

8. Local Partners Meet PEPFAR Criteria: Local organization or government entity Have the capacity to: Be a competitive prime for USG funding Manage all functions of Track 1.0 project Reach a sustainable level of operations Slide 8

9. Principal Approach to Technical Transition Building capacity of MOH institutions at all levels to provide oversight for treatment programs and for outcomes evaluation Building advanced clinical education capacity Entering into partnership with medical institutions in host country through which TA to LPTFs will be sustained Working with host MOH to develop evidence driven HIV policies

10. Strategic Approach to Technical Transition Building partnerships with institutions that can take on different technical roles over the long term: Local Partners, Treatment Facilities: For care and treatment delivery – site activation, evaluation/improvement, treatment planning Ministries of Health: For technical oversight including continuous quality improvement and outcomes evaluation Medical Education Institutions: For pre-service, in-service education and technical support to sites through on-going mentoring National Labs Institutions: For laboratory systems strengthening

11. Where are we now: Year 7 Priorities for Transition Transitioning – Not business as usual Aligning – with Ministry of Health on Transition strategies Strengthening – action plans rolled-out Transferring – site management to Local Partners Competing – preparing for FOAs 11

12. Models for Local Partners Model 1: MOH or other government entity as local partner Rwanda : Six Sites Transitioned as of March 2010 Model 2: Local partners (local umbrella org) in collaboration with national technical partner/s for clinical and SI (MOH/university/other) Kenya : Faith Based Network MEDS with CHAK, KEC & University of Nairobi Haiti: Faith Based Network St Boniface NGO with University of Notre Dame de Haiti 12

13. Models for Local Partners Model 3: Local partners (local umbrella org) with sub-grantees providing technical assistance Zambia: Faith Based Networks CHAZ & CHRESO South Africa: SACBC AIDS Commission & IYDSA NGO network Model 4: Sites as direct primes to CDC South Africa: St. Mary’s Hospital in Durban Guyana: St Joseph Mercy Hospital and Davis Memorial Hospital 13

14. Lessons Learned for Transition 1.We are all learning as we go (AIDSRelief, Donors, Local Partners). In-country and global transition committees are critical to address practicalities of the process. 2.Communicate clearly and frequently on transition. 3.Strive for a shared long-term vision for the role of faith- based partners. 4.Technical transition requires a unique design per country, as there is not one model for medical or strategic information transition. 14

15. Lessons Learned 5.Flat-lined budgets mean reduced funding for transition due to increasing numbers of patients on treatment. 6.Switching treatment sites between different models is difficult. Example: AIDSRelief to Global Fund 7.The capacity strengthening of local health system for long-term sustainability will take longer than 3-4 years. 8.Staff retention within Local Partners, Treatment Facilities and with INGOs is essential for transition success. 9.Work to ensure future funding opportunities for local partners by Sept. 2011. Prepare to respond quickly. Slide 15

16. Timeline for Transition (Expected)