This document summarizes technical assistance projects that helped strengthen HIV/AIDS programs through improvements to health policies, financing, information systems, and human resources. Key impacts included: 1) Adoption of new community-based health insurance and HIV insurance policies in Mali and India. 2) Recommendations to increase government health funding in Kenya which led to drafting legislation for an air travel levy and Abuja Declaration targets. 3) Improved access to Global Fund grants in Mozambique which expanded treatment for over 1.5 million people. 4) Establishment of a permanent National AIDS Council in Liberia and strengthened HIV data systems in Kenya.

1. Technical Assistance for Health Systems Development: Benefits for HIV/AIDS Programs Nicole Barcikowski, MA Health Systems 20/20 Abt Associates Inc. Global Health Council June 17, 2011

2. Outline National Policy Impacts Financial: Mali, Kenya, India Human Resources: Côte d’Ivoire Organizational-level Impacts Financial: Mozambique, Liberia Information Systems: Kenya Human Resources: Côte d’Ivoire, Guyana

3. National PolicyImpacts: Mali CBHI Strengthen community-based health insurance (CBHI) Develop policy, operational plan, budget for Mali’s first government-subsidized CBHI policy Partners: MOH, World Bank, Ministerial Leadership Initiative (Gates Foundation) Steering and technical committees met with MOH in Rwanda, where 85% of population is covered by CBHI schemes Results CBHI policy adopted by President and Board of Ministries in Feb 2011 Government will subsidize 50% of CBHI plan ($83 million over five years) Complements 2009 law requiring formal sector employers to provide and subsidize health insurance for employees

4. National Policy Impacts: Kenya HAPSAT HIV/AIDS Sustainability Analysis Tool (HAPSAT) assessment in 2010 found HIV/AIDS funding unstable, 75% from donors, and recommended: Use air traffic levy as short-term source of income for HIV/AIDS programming Increase government contributions to health to 15% as per Abuja Declaration Partners: MOH, National AIDS Control Council, National AIDS and STI Control Programme Results Cabinet memorandum to implement levy drafted in March 2011

5. National Policy Impacts: India PLWHA Insurance Coverage Develop road map to cover people living with HIV/AIDS in broader risk pools and mainstream HIV/AIDS coverage in insurance packages Partner: Indian government Result: Expect policy decision on HIV/AIDS insurance coverage by fall 2011

6. National Policy Impacts: Côte d’Ivoire HRH Assess human resources for health (HRH) to inform strategy Health Systems 20/20 (and PHRplus) assessments (public sector 2005, private sector 2007) estimated HRH at 11,749 staff: nurses (58%), midwives (18%), doctors (14%) Partners: MSHP, local stakeholders Results Developed costed5-year strategy for HRH focused on both demand and supply Activity success attributable to consistent consultation with local stakeholders and strong government leadership through MSHP

7. Organizational-levelImpacts: Mozambique Global Fund Grants Improve access to Global Fund grants MOH requests Health Systems 20/20 assistance to clear system roadblocks to accessing Global Fund grants and create a more effective financial management system Establish Global Fund unit within MOH Planning Department Work with the Department of Finance and Administration to customize financial management system to receive, track, and report on various donor grants and activities Results Clear backlog of Global Fund disbursements (Rounds 2, 6, 7) Use grant funding to serve 1.5 million living with HIV/AIDS and 110,000 with TB, and help prevent over 19,000 malaria deaths per year (WHO)

8. Organizational-level Impacts: Liberia NAC Establish permanent National AIDS Council (NAC) Secretariat to provide coordination, strategy development, M&E, advocacy Define functions, develop staffing plan and position descriptions, determine operating budget Clarify relationship of Secretariat to NAC Executive Committee Do team building, management capacity building, executive coaching Results Legislation formally establishing NAC approved by Congress, awaits president’s signature Revised National Strategic Framework for HIV/AIDS Fully staffed Secretariat with office space and operating funds Task forces being formed for M&E, partner coordination, etc.

9. Organizational-level Impacts: Kenya HIS Strengthen HIV/AIDS data collection and reporting system to streamline service delivery and access Standardize national HIV/AIDS data collection and reporting (number people screened, HIV positive, needing/receiving ART, etc.) Build capacity to collect higher-quality, standardized data Create HIV/AIDS framework within broader HIS, eliminating parallel systems Results Better M&E and data collection system at 6,000 facilities in 250 districts Improved information available for decision makers

10. Organizational-level Impacts: Côte d’Ivoire HRH (1) Use performance-based incentives (PBI) to improve HRH capacity and HIV service delivery Health Systems 20/20 (and PHRplus) HRH assessments showed severe maldistributionof HRH (60% in Southern region) and high worker turnover in hard-to-fill posts Health Systems 20/20 support to: Pilot MSHP PBI scheme in Ferkessedougoudistrict Build regional and district capacity in management and leadership in decentralized health system

11. Organizational-level Impacts: Côte d’Ivoire HRH (2) Results PBI Return of HRH to areas affected by socio-political crisis (94% HRH presence) Increased funds for facility premises and equipment, higher-quality service delivery Improved availability and access to HIV and other priority services at peripheral level Strengthened local capacity in management and leadership, including HIS management and reporting, planning

12. Organizational-level Impacts: Guyana HAPSAT HIV/AIDS Sustainability Program Analysis (HAPSAT) of public sector HIV/AIDS services Results Review distribution of HIV counselors Ensure clinics are open 8 hours to maximize limited HRH Rethink use of mass media for HIV awareness Establish electronic formats of paper data collection forms in anticipation of construction of strategic information database Provide input into UNAIDS’ country ownership consultation and next national HIV strategy, to help in better utilizing GF HIV/AIDS funding

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