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Supporting the Regional Health Bureaus in Ethiopia
Zenebe Melaku, MDICAP-Ethiopia
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ICAP Guiding Principles• Integration with national AIDS control plans
• Capacity building for health systems and broad infrastructure support
• Involvement of PLWHA - adherence, social support
• Integration of Prevention, Care & Treatment
• Family-centered care (adults and children)
• Multidisciplinary Team Approach
• High quality services with program evaluation, operations research, and program improvement
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FMOH - National Road Map& ICAP Support
Regional Road MapImplementation
Facility Level Implementation
ICAP- CU
ICAP- CU
National Level - TAICAP- CU
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ICAP - Ethiopia
National• Pediatrics; EID; TB-HIV; •PLWHA; MLDM
National• Pediatrics; EID; TB-HIV; •PLWHA; MLDM
Four RHBs • Capacity Building/TAFour RHBs • Capacity Building/TA
Comprehensive Site Level SupportComprehensive Site Level Support
Regional Univ.Regional Univ.
Characteristics of ICAP-E Program
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Oromiya : 29,118,188Somali : 4,325,446Dire Dawa : 388,731Harari : 194,745Total Population : 34 million
Characteristics of ICAP-E Program
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Health Care System - Ethiopia
FMOHFMOH
RHBRHB RHBRHBRHBRHB
• Policy•National Strategy •Guideline and •Training Curriculum
• Policy•National Strategy •Guideline and •Training Curriculum
• Oversee Program Implementation and Monitoring
• Oversee Program Implementation and Monitoring
HH HH
HCHCHCHCHCHC
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Initial Step:
• Needs assessment with RHBs– Identification of gaps
• Critical Gaps Identified:- – Coordination and Strategic planning
– Human Resource
– Infrastructure
– Systems
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Modalities of Support:
• Two mechanisms:
– Direct support: • Short/Medium term
– Sub-agreement:• Medium/Long term
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Regional level Capacity Building – Coordination and Strategic Planning
• TA in the development of regional annual plan
• Regional Partners Forum
• Joint Regional Planning and Review Meetings
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Building Regional Ownership through Participatory Planning
A Key Strategy for Sustainability
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Regional level Capacity Building –
Training:Training:
Multi-pronged Approach:
Multi-pronged Approach:
• Basic and ToT
• Local/International
• Basic and ToT
• Local/International
• Clinical • Program Mx• Financial Mx
• Clinical • Program Mx• Financial Mx
Secondment/Additional staff
Secondment/Additional staff
MentoringMentoring
Enabling EnvironmentEnabling Environment
•Program staff•Accountant•Data clerks….
•Program staff•Accountant•Data clerks….
•Clinical, Program & Finance•Clinical, Program & Finance
•Access to Internet•Resource centers•Office furnitures …..
•Access to Internet•Resource centers•Office furnitures …..
Human ResourceHuman Resource
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Capacity Building: Human Resources (Training)
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Regional Capacity Building – Resource Center
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Regional level Capacity Building –
Infrastructure – Training Centers
Training Center with Video-conferencing Facility
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Regional level Capacity Building –
• Laboratory System:– Development of SOPs: Sample referral– Implementation of EQA systems
• Monitoring and Evaluation System:– Data QA systems– Data use for CQI
• Referral System:– SOPs for decentralization
• Financial Management System:– Development of SOPs
SystemsSystems
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Key Achievements and the Way Forward
• Increased scope of activities with increased funding (5X)
Responsibilities handed over to the RHBs :– Annual review and planning meetings– Quarterly Supportive Supervisions– Hiring of supernumerary staff – Sample transport system– Management of minor renovations
In the future:– Phased and Incremental Manner
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Challenges:
• Human Resource:– Shortage– Work overload– Lack of staff motivation– High Staff Turn-over
• Financial management system
At All Levels
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Conclusions-Lessons learned
• Regional level capacity building– Key strategy for successful transition
• Requires commitment from government, availing HR and other required inputs
• It requires longer time-frame
• Phased and Incremental Manner• Attention: Maintaining the ‘Desired Quality’
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Thank YouObrigad
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