Transcript Slide 1

President’s Emergency Plan
for AIDS Relief (PEPFAR)
Lisa J. Nelson, MD MPH MSc
UEM/UCSD MEPI External Advisory Board
Meeting
Maputo
March 14, 2011
Outline
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President’s Emergency Plan for HIV/AIDS
(PEPFAR) Overview and Coordination
Mozambique USG-GRM Partnership
Framework Goals
PEPFAR Support to Health System
Strengthening
Synergies between PEPFAR and MEPI Initiative
PEPFAR: the US Response to the Global
AIDS Crisis
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2003: PEPFAR was launched
2008: PEPFAR reauthorized through 2013
Committed $32 billion through FY2010
Interagency coordination model
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PEPFAR Mozambique Organization and
Coordination
Interagency initiative lead by U.S.
Ambassador
– HHS (CDC, HRSA, NIH)
– Department of Defense
– Peace Corps
– Department of State
– USAID
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Chief of
Mission
Deputy Chief
of Mission
Interagency management
structures
– Coordination Office
– Senior Leadership
– Technical Working Groups
Agency
Heads Team
Interagency
Technical
Forum
PEPFAR
Steering
Committee
TWG
TWG
TWG
TWG
USG-Government of Mozambique
HIV/AIDS Partnership Framework Goals
2009-2014
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Reduce new HIV infections in Mozambique
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Strengthen the multi-sectoral HIV response in Mozambique
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Strengthen the Mozambican health system, including human
resources for health and social welfare in key areas to support
HIV prevention, care, and treatment goals
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Improve access to quality HIV treatment services for adults and
children
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Ensure care and support for pregnant women, adults and
children infected or affected by HIV in communities and health
and social welfare systems
Sustainability and Country Led Response
Governments and Civil Society empowered to lead, prioritize,
implement, and be accountable for a country’s response to HIV/AIDS
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Align with GRM priorities
Increase joint planning
Build capacity of national/ provincial systems
– Provision of technical assistance, organizational
capacity building
– Use of government systems
– Direct funding to regional governments and local
partners
Support quality, sustainable services
Developing Efficiencies in Programs
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Expanding use of costing studies
and modeling
Coordinating our response with
the Global Fund and other
donors
Identifying, quantifying and
disseminating potential
structural and program
efficiencies
Key Partners in Mozambique
• Clinical Partners in 11
provinces
– Columbia University/ICAP
– Family Health International
(FHI)/Abt Associates
– Elizabeth Glaser Pediatric
AIDS Foundation (EGPAF)
– Vanderbilt
University/Friends in
Global Health
– CARE
• Funding directly to
Mozambican institutions
– MISAU (2), INS + CMAM
– UEM (MPH)
– Provincial Health
Directorates (2)
– M-OASIS
– Ministry of Women and
Social Action (MMAS)
Key Partners in Mozambique
• American International Health
Alliance (UCLA, ANEMO)
• American Society for Microbiology
• Universidade Federal do Rio De
Janeiro
• Food and Nutrition Technical
Assistance (FANTA)
• Health Systems 20/20
• IntraHealth International
• ITECH
• JHPIEGO
• New York AIDS Institute (HIVQUAL)
• Pathfinder
• Partners for Appropriate Technologies
• SCMS
• Strengthening Pharmaceutical Systems
(SPS)
• Association of Public Health
Laboratories (APHL)
• American Society for Clinical Pathology
• Clinical Laboratory Standards Training
Institute
PEPFAR Support
2010 Annual Progress Report
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Supported HIV prevention, care and treatment services in all 11
provinces in Mozambique
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Provided direct support to >138,000 persons on ART
(70% of national total on ART)
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Counseled and tested >600,000 persons for HIV in facility-based
and community counseling settings
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Support prevention of mother-to-child transmission (PMTCT)
services at 338 clinical sites (>30% of all PMTCT sites nationally)
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Provided HIV counseling, testing and results to >500,000 pregnant
women
HIV Prevalence by
Province
Percentagem de mulheres e
homens de 15-49 anos com
infecção por HIV
Niassa
3.7%
Nampula
4.6%
Tete
7.0%
Zambézia
12.6%
Sofala
15.5%
Moçambique
11.5%
Manica
15.3%
Gaza Inhambane
8.6%
25.1%
Source: INSIDA
Cabo
Delgado
9.4%
Maputo
Província
19.8%
Maputo Cidade
16.8%
Health Systems Strengthening
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Goal: Strengthen the Mozambican health system,
including HR for health and social welfare in key areas to
support HIV prevention, care and treatment goals
1. Increase # of health care and social workers and
improve the capacity and quality of pre-service, inservice training, faculty development and postgraduate training
2. Improve management capacity, motivation and
retention of health and social workers
3. Improve supply chain system at all levels
4. Health Information System (HIS)
5. Improve and expand the public health infrastructure
USG Systems Strengthening
Support
HSS budget in million $
PEPFAR Funding
U.S. Fiscal Year
(USD)
2006
2.0
2007
2.8
2008
6.8
2009
8.7
2010
41.4
2011
39.4
• PEPFAR II: focus on HSS
• Strong HR component:
140.000 HCW target
• Huge infra-structure
investments (training
facilities, rural health
centers, warehouses, lab,
etc)
• GHI: improve and sustain
health outcomes through
strengthened HS (beyond
HIV)
Existing Conditions
Recent Improvements in Lab
Infrastructure
Current HIV-Related Lab Capacity in
Mozambique
• 41 CD4 instruments
• PIMA point of care CD4
instrument currently in pilot
sites in Maputo city (2) Maputo
province (2) Sofala (2) and Niassa
(2).
– Plans underway to expand to 9 sites
in Gaza
• 4 labs performing DNA PCR for
early infant diagnosis (EID)
• 1 labs with viral load capacity
Male Circumcision (MC)
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3 clinical trials demonstrated >60% effect in
preventing HIV transmission
Completed surgical capacity assessment in 2008
Pilot project in 6 sites approved by MOH6000
procedures to date
Expanding to 24+ sites in 2011
Systems Strengthening – Human
Resources
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Support the MOH Dept of Human Resources’ (DRH) National
Strategic Plan for HR development (PDRH 2008-2015)
1. Support to MoH in-service training institutions: faculty
development and scholarships
2. Strengthen the Community Health Worker (CHW) program
3. Support MPH degree in epidemiology and lab (FELTP) at
UEM
4. Support in-service training activities
5. Strengthen the HR Information System (HRIS)
Mechanisms of Support
1. Cooperative Agreement with Implementing partners
2. Direct Technical Assistance (Technical Advisor) to CHW
program
3. Cooperative Agreement and Technical Support to UEM
(FELTP)
USG Strategic Information - HIS
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Support the MOH Dept of Health Information’s (DIS) National
Strategic Plan for Health Information Systems (HIS) (20102014)
1. Securing sufficient qualified human resources for the HIS
activities at all levels
2. Improving management of the HIS
3. Securing appropriate infrastructure & information and
communication technology at all levels
Mechanisms of Support
1. Cooperative Agreement with MOH DIS
2. Direct Technical Assistance (Technical Advisor) to DIS
3. Cooperative Agreement and Technical Support to MOASIS (Mozambique node of Open Architecture and
Standards in Information Systems, based at UEM)
Areas for Potential
Coordination/Synergy with MEPI (1)
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Maputo Central Hospital (MCH)
– MOH DIS is developing a patient-level medical
record system at MCH
– CDC support for lab information system (NetAquire)
at MCH
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Health training institutions
– Support faculty development in surgery technicians
courses
Areas for Potential Coordination/Synergy
with MEPI (2)
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Strengthening Human Resources in HIS
– Coordination of HR development with M-OASIS
– Financing courses for Health Statistics Technicians (Técnicos
Médios de Estatística Sanitária) at Maputo’s Institute for
Health Sciences (ICS)
– Responding to for identified HIS needs (e.g. at Provincial
level)
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Enterprise Architecture
– MOH DIS (with M-OASIS support) is in the early stages of
developing an enterprise architecture for HIS in Mozambique
– Importance of inclusion of various HIS initiatives to ensure
overall coordination and ultimately interoperability
Key USG PEPFAR Contacts for MEPI
Collaboration
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Overall Contact: PEPFAR Country Coordinator,
April Kelley, [email protected]
Human Resources Contact: Shirley Eng-Breard,
[email protected]
HMIS Contact: Strategic Information Branch
Chief, Amy Dubois [email protected]
USAID IHO Lead: Polly Dunford,
[email protected]
CDC Mozambique Director: Lisa Nelson,
[email protected]
Thank You
For further information, please visit:
www.PEPFAR.gov