Implementing Mechanism Details
Mechanism ID: 17038
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Mechanism Name: Strengthening District Responses for Better HIV/TB Patient Outcomes in eThekwini & Umkhanyakude Districts in KwaZulu-Natal, South Africa
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Funding Agency: U.S. Agency for International Development
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Procurement Type: Cooperative Agreement
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Prime Partner Name: Maternal, Adolscent and Child Health (MatCH)
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Agreement Start Date: Redacted
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Agreement End Date: Redacted
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TBD: No
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New Mechanism: Yes
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Global Fund / Multilateral Engagement: No
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G2G: No
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Managing Agency:
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Total Funding: 10,289,365
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Funding Source
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Funding Amount
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GHP-State
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10,289,365
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Sub Partner Name(s)
(No data provided.)
Overview Narrative
MaTCH's goal is to build an effective and sustainable health system in SA by 2016 that is capable of responding to multiple disease burdens through coordinated use of resources and capacity building for successful implementation of national, provincial and district strategies, policies, standards, guidelines and implementation plans. MatCH staff work in ‘roving support teams’ providing intensive technical support, management training, on-site mentoring and coaching to QA and oversight to ensure that health systems are strengthened and sustained and to provide mentoring in comprehensive HIV-related clinical care, management, M&E and QA on a rotational basis with the objective of improving TB and HIV patient outcomes. MatCH provides capacity development and training, including on technical and managerial skills for provincial, district, sub-district and facility management teams to develop and implement costed workplans and to enhance facilities management, financial and HR planning, commodity and pharmaceutical supply, procurement, forecasting, and infrastructure. Rapid scale-up of successful practices and tools across all facilities will be facilitated through MatCH roving teams. Data flow from facility level to district will be improved to ensure that PHC clinic data is reported to hospitals and that all sites are reporting and to improve utilization of district level data. MatCH’s support through human resources, infrastructure and renovations, technical assistance, capacity building and health systems strengthening will allow more people to access care and improve health outcomes of patients through capacitating district and sub district management teams to sustain service delivery and quality of care.
Cross-Cutting Budget Attribution(s)
Food and Nutrition: Policy, Tools, and Service Delivery
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15,000
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Gender: GBV
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308,681
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Gender: Gender Equality
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514,468
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Human Resources for Health
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127,000
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Motor Vehicles: Purchased
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120,514
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TBD Details
(No data provided.)
Key Issues
Implement activities to change harmful gender norms & promote positive gender norms
Increase gender equity in HIV prevention, care, treatment and support
Child Survival Activities
Safe Motherhood
TB
End-of-Program Evaluation
Family Planning
Budget Code Information
Mechanism ID:
Mechanism Name:
Prime Partner Name:
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17038
Strengthening District Responses for Better HIV/TB Patient Outcomes in eThekwini & Umkhanyakude Districts in KwaZulu-Natal, South Africa
Maternal, Adolscent and Child Health (MatCH)
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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HBHC
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745,718
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0
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Narrative:
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MatCH provides support for adult care and support programs in eThekwini and Umkhanyakude districts in KwaZulu-Natal (KZN). KZN is the epicenter of the South African HIV epidemic with an antenatal (ANC) prevalence rate of 37. 4% in 2011. KZN has an estimated population of 10.5 million people, 42% of whom reside in eThekwini Metro district (urban) and uMkhanyakude district (rural). Potential beneficiaries of the proposed program of activities include approximately 4.1 million people (42% of KZN’s population) resident in eThekwini and uMkhanyakude who experience a disproportionately high incidence of HIV and TB, especially amongst young women of reproductive age (15-24 years).
MatCH will support the KZN DOH with technical skills development for adult care and support through in-service, on-site training and mentoring for health care workers including doctors, nurses, pharmacy assistants, counselors, data entry staff, managers, CCGs. Training programs will include PICT, HIV-related diseases, adolescent, nutrition, GBV, and HIV prevention topics. MatCH will also work with KZN DOH to pilot and roll out task shifting and task sharing interventions. MatCH mobile and on-site multidisciplinary roving teams will support program implementation and facilitate the transition from service delivery to technical support.
MatCH roving doctor advisors, pharmacy advisors and pharmacy assistants will mentor DOH staff in supply chain management for C&S services at PHC facilities in accordance with DOH rules and regulations. In addition, pre-and in-service training for pharmacist assistants will be conducted. HIV positive clients not eligible for ART will be referred into wellness services, and repeat CD4 testing will ensure clients are not lost from the system. Across all sites, prevention for positives will be emphasized with intensive counseling provided to discordant couples in conjunction with a strengthened condom distribution network. Male and female condoms will be provided at all sites and MatCH roving teams will provide training to DOH nurses and counselors around the demonstration and use of female condoms. In addition, referral for couple counseling, FP and secondary prevention will be strengthened.
MatCH will strengthen data collection on adult treatment and care at sites using standardized tools and reporting via the District Health Information System (DHIS). DOH Health care workers and data entry staff will be trained on M&E tools and indicators. Strengthening district capacity to conduct monitoring and capacity–building activities will be a key focus. Monthly and quarterly meetings of the DHMTs will be held to review DHIS data and monitor progress towards achievement of targets. In addition, an annual review of the KZN PSP 2012-2016 will be conducted.
MatCH will assist DHMTs with target setting and verifying data reported to the DHIS. MatCH will also support tracking of ‘Reach against Targets’, entry into care and retention in care and implement interventions to improve retention such as telephonic follow-up of clients, home visits, SMS reminders. Findings will be used to inform program improvement, and provide baseline information to initiate defaulter tracing programs; to improve data systems and quality of care at various sites; and to address loss to initiation and delays in accessing care.
Support for human resource development, financial management and governance will improve adult C&S service delivery and outcomes.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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HVTB
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1,193,148
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0
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Narrative:
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MatCH provides support for adult care and support programs in eThekwini and Umkhanyakude districts in KwaZulu-Natal (KZN),where the antenatal HIV prevalence rate was 37.4% in 2011.Potential beneficiaries of the proposed activities include approx. 4.1 million people resident in these districts who experience a disproportionately high incidence of HIV & TB, especially amongst young women of reproductive age (15-24 years). In FY12 MatCH provided > 26,000 TB patients with HIV screening and 29,000 HIV+ patients were screened for TB. Targets for FY13-14 are to screen 90% of HIV positive patients and to ensure 90% of TB patients are offered HIV screening.
MatCH will support KZN DOH with TB/HIV technical skills development through in-service, on-site training and mentoring for health providers (doctors, nurses, pharmacy assistants, counselors, data entry staff, managers, community care-givers (CCGs). Training will include ‘core’ topics such as PICT, HIV-related diseases, adolescent and pediatric care and counseling, sexual & reproductive health, nutrition, GBV, TB, and HIV prevention. MatCH will also work with KZN DOH to pilot and roll out task shifting and task sharing interventions focusing on TB/HIV. MatCH roving and on-site multidisciplinary teams will support program implementation. MatCH will work with DOH district, sub-district and facility teams to implement models for task-shifting including increasing skills and capacity of pharmacist assistants through pre-and in-service training, training of radiographers in TB diagnosis, and utilization of CCGs for HIV & TB defaulter tracing and case finding. The implementation of SOPs and guidelines for decentralizing and integrating HIV/TB care and related training of health providers and health management is key to successful, comprehensive task-shifting programs and MatCH will provide training and dissemination of good practice and lessons learned.
MatCH roving doctor advisors, pharmacy advisors and pharmacy assistants will mentor DOH staff in Supply Chain management for HIV/TB at PHC facilities in accordance with DOH regulations; In addition, pre-and in-service training for pharmacist assistants will be conducted.
MatCH will support TB monitoring via the ETR.net system. MatCH will also support the integration of adult and pediatric TB and HIV care, including TB screening at every visit, referral for services, fast tracking transition into care; and providing PHC clinics with mobile X-ray TB screening,’ including for screening of DOH staff. All TB positive patients will be offered PICT and all HIV positive patients will be screened for TB.
MatCH will support infection control at DOH sites including risk assessments and audits at 6 monthly intervals, provision of masks for patients and health workers. Training will be provided to health workers on adherence to infection control plans, triaging of patients, proper procedures for collection and handling of sputum samples and the importance of testing household contacts. MatCH will also assist KZN DOH to roll out IPT. Active TB case finding in children will be a focus area in FY13 through monitoring of growth faltering and screening of contacts of TB positive adults.
Support for human resource development, financial management and governance will improve TB/HIV service delivery and outcomes.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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PDCS
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298,287
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0
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Narrative:
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MatCH provides support for pediatric care and support programs in eThekwini and uMkhanyakude districts in KZN. KZN is the epicenter of the South African HIV epidemic with an antenatal (ANC) prevalence rate of 37.4% in 2011. KZN has an estimated population of 10.5 million people. Potential beneficiaries of the proposed program of activities include approximately 4.1 million people (42% of KZN’s population) resident in eThekwini and uMkhanyakude who experience a disproportionately high incidence of HIV and TB.
MatCH will support the KZN DOH with technical skills development for pediatric care and support through in-service, on-site training and mentoring for health care workers including doctors, nurses, pharmacy assistants, counselors, data entry staff, managers, CCGs. Training programs will include PICT, HIV-related diseases, adolescent, nutrition, GBV, and HIV prevention topics.
MatCH roving doctor advisors, pharmacy advisors and pharmacy assistants will mentor DOH staff in supply chain management for pediatric C&S services at PHC facilities in accordance with DOH rules and regulations. In addition, pre-and in-service training for pharmacist assistants will be conducted. HIV positive pediatric clients not eligible for ART will be referred into wellness services, and repeat CD4 testing will ensure clients are not lost from the system.
MatCH will support data collection on pediatric treatment and care at sites using standardized tools and reporting via the District Health Information System (DHIS). DOH Health care workers and data entry staff will be trained on M&E tools and indicators. Strengthening district capacity to conduct monitoring and capacity–building activities will be a key focus. Monthly and quarterly meetings of the DHMTs will be held to review DHIS data and monitor progress towards achievement of targets. In addition, an annual review of the KZN PSP 2012-2016 will be conducted.
MatCH will assist DHMTs with target setting and verifying data reported to the DHIS. MatCH will also support tracking of ‘Reach against Targets’, entry into care and retention in care and implement interventions to improve retention such as telephonic follow-up of clients, home visits, SMS reminders. Findings will be used to inform program improvement, and provide baseline information to initiate defaulter tracing programs; to improve data systems and quality of care at various sites; and to address loss to initiation and delays in accessing care.
Support for human resource development, financial management and governance will improve service delivery and outcomes for pediatric care & support.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Governance and Systems
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OHSS
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746,462
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0
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Narrative:
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MatCH provides support for health systems strengthening in eThekwini and Umkhanyakude districts in KwaZulu-Natal at district, sub-district and facility level to address key gaps and challenges identified. Support is provided in line with the annual district health planning cycle which includes planning, costing, implementation and regular reviews. Support is provided via training, followed up with workshops and mentoring and coaching with regular progress assessments to ensure implementation and progress towards targets. MatCH supports districts with technical assistance (TA) to strengthen leadership skills to coordinate, manage, implement, monitor, and scale-up HIV programs. MatCH also works with district management to strengthen their role in the multi-sectoral response focusing on developing the coordination, leadership, and management skills among role players. MatCH also supports evidence-based planning, identifying key populations and high-risk areas, and developing targeted programs to improve the response to HIV/TB. MatCH builds the capacity of district health management teams (DHMT) to coordinate with community structures and leadership and to link community-level services and support to DOH programs. This improves synergy between donors and partners and maximizes the use of government, private and public funds. MatCH provides TA for human resource management to support the scale up of HIV & TB prevention, treatment, care, and support services. TA is provided to strengthen health care worker’s capacity through mentorship and coaching, as well as didactic in-service and certified training programs. MatCH supports integration and strengthening of TB & HIV services to reduce morbidity and mortality as well as supporting the re-engineering of PHC services including the use of multi-disciplinary teams, community outreach teams, and moving to a chronic care model to maximize opportunities for intervention, improve early identification of disease and strengthen retention in care. All training and supervision is in line with SAG guidelines and policies, via accredited programs and uses standardized tools such as National Core Standards (NCS). MatCH supports strengthening financial management capacity at district level to increase efficiency and effectiveness of resources through targeted training of DHMT in financial management and mentoring managers, improving facility level financial management and supporting DHMT to conduct regular expenditure reviews. This is through a tailored program of trainings, workshops and ongoing mentoring and supervision, assessed periodically. HR strengthening activities include: Workforce Planning; Human Resource Information Systems (HRIS); In-Service Training; Task shifting; Performance Assessment/Quality Improvement; Retention Management and Leadership Development.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Prevention
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MTCT
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1,193,148
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0
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Narrative:
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MatCH provides support for scaling up PMTCT programs in eThekwini and Umkhanyakude districts in KZN province, the epicenter of the South African HIV epidemic with an antenatal (ANC) prevalence rate of 37% and 41% respectively in 2011. KZN has an estimated population of 10.5 million people, 42% of whom reside in eThekwini Metro district (urban) and uMkhanyakude district (rural). Potential beneficiaries of the proposed program of activities include approximately 4.1 million people (42% of KZN’s population) in eThekwini and uMkhanyakude who experience a disproportionately high incidence of HIV and TB, especially amongst young women of reproductive age (15-24 years). In FY12 MatCH reached over 25,000 women with counseling and testing and provided over 5,800 women with PMTCT services. Technical support will be provided to district level PMTCT services including training, coaching, quality assurance, assisting with complicated referrals and management of pregnant women, and post-delivery interventions to follow-up mother-infant pairs until 18 months to ensure early infant diagnosis and sustain feeding choices. Uptake of these specialized services will be monitored on a monthly basis.
MatCH will support the KZN DOH with technical skills development through in-service, on-site training and mentoring for health care workers including doctors, nurses, pharmacy assistants, counsellors, data entry staff, managers, community care givers (CCGs). Training programs will include PICT, PMTCT, adolescent care and counselling, SRH, nutrition, GBV, TB, and HIV prevention topics and will be based on nationally accredited curricula, national policies and guidelines, and standardized tools. MatCH will work with DOH district, sub-district and facility teams to implement models for task-shifting including NIMART for midwives at PHC sites and supporting PHC nurses to complete dispensing courses; increasing skills and capacity of pharmacist assistants through pre-and in-service training, and utilization of CCGs for increasing early access to ANC care. MatCH roving doctor advisors, pharmacy advisors and pharmacy assistants will mentor DOH staff in supply chain management for PMTCT at PHC facilities in accordance with DOH rules and regulations. Roving Teams will provide training around safe infant and young child feeding practices, including antenatal, peri- and post-partum counseling and support to HIV-infected mothers on infant feeding options and vertical transmission. Gender concerns will be addressed through training, provision of prevention, treatment and care that meets the needs of women and girls, such as linking HIV testing and treatment to antenatal care and building the capacity to implement national PMTCT and MNCWH programs at district and sub-district level. MatCH will support the District Health Management Teams (DHMT) to increase couple counselling, partner testing and male support to improve uptake of PMTCT interventions by women. MatCH will support PMTCT data collection at sites using standardized tools and reporting via the District Health Information System (DHIS). DOH Health care workers and data entry staff will be trained on M&E tools and indicators. Monthly and quarterly and annual meetings of the DHMTs will be held to review PMTCT DHIS data and monitor progress towards achievement of targets. Support for human resource development, financial management and governance will improve PMTCT service delivery and outcomes.
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