From Vision to Action:
Empowering Local Partners to
Deliver Sustainable Care
Michele Broemmelsiek and Ruth Stark
Track 1.0 Implementers Meeting
Dar Es Salaam, Tanzania August 4th – 6th 2009
Key Messages
Faith-Based Health Care is critical to Africa.
There is significant value added in including FBO
health networks in national health planning.
Successful transition must consider at least the
site management and technical aspects.
South Africa transitioned successfully because
the program was built on strong relationships
and planned to transition from Day 1.
FBOs and Health Services in Africa
30-70% of health infrastructure in Africa
is owned by FBOs (WHO, 2006).
Lesotho: 40% of health services
Zambia: 30% of health services
Kenya: 40% of health services
Uganda: 43% of health services
Where Do We Work?
34
6
19
3
242
Local
Partner
Treatment
Facilities
(Clinic)+ >151
satellite sites
28
16
95
19
22
Slide 4
FBO Role in Transition
Overall, 242 sites, 27% public and 73% nonpublic (FBO and Private).
The proportion between public and non-public sites
differs by country from 100% FBO to 50% FBO.
Consultative process to identify the local
partners who can support sites
Recognize treatment site ownership and
ensure that transition strengthens their
management and stewardship
Vision for Transition
Strengthen the capacity in treatment sites for a
high quality care delivery system
Promote local ownership and good stewardship
of program for sustainability
Leverage existing structures and develop
referrals for effective program integration
Ensure long term access to services for patients
Ensure long term viral suppression for patients
Guiding Principles to Transitioning
Retain local human resource capacity
(clinical, technical and managerial)
Strengthen health systems
Focus on best practices
Link to existing national institutions and
government structures
Align transition process to timeline and
specific benchmarks
Expected Outcomes from Transition
Sustained access to quality care with durable
patient outcomes
Continued support to and scale-up of local
organization’s ART programs
Local partners have the capacity to:
Become a competitive prime for USG funding
Manage all functions of Track 1.0 project
Reach a sustainable level of operations
COMPREHENSIVE HIV CARE
Critical Capacities for Sustainable Transition
Technical Capacities
–Ambulatory HIV Care, Nursing
Quality Improvement, Lab, MCH
-M&E and coordination of SI, HMIS
and DDIU TA
Organizational Capacities
–Grant Management
-Community Linkages
-Supply Chain and Pharmacy
-Finance and Compliance (USG)
Partners:
National
District
Treatment Site
Funding Capacities
-Cost Management
-Resource Mobilization
-Communications
Policy Capacities
-Program Evaluation and
Organizational Learning
-Networking and Policy Input
Key Program Components for Transition
Program Management
Finance and compliance
Human Resources
Site and community management
Technical Assistance Support
Strategic information
Clinical mentoring and quality assurance
Laboratory services strengthening
Supply chain management
Identification of Local Partners
Identification of local partners that are part
of the faith based health network:
Sustainable institutions
Stewards of quality health care
Potential for sustainable level of operations
Current or potential Prime USG partner
National umbrella and/or a few sites
Identification of local partners for local
government sites
Determined with MOH for specific sites
Identification of Local Technical Orgs
Sustainable institutions
Potential for sustainable level of operations
Sub grantees to, or MOU with, local partner for
medical/technical assistance to sites
Current or potential USG partner
Proven technical expertise
MOH, university medical schools, specialized
technical institutes and other local technical
organizations
Models for Site Management Transition
Model 1: Local partners (local umbrella org.)
with sub-grantees providing TA
Model 2: Local partners (local umbrella org.)
in collaboration with national technical partner/s
for clinical and SI (MOH/university/other)
Model 3: Sites as direct primes to CDC
A combination of these models
Models for Transitioning SI
 Model 1: Local Partner Manages all Strategic
Information responsibilities.
 Model 2: Local Partner manages monitoring and
reporting (TA & training) to sites and subcontracts
Futures Group for more rigorous data analysis, data
demand and information use TA and feedback.
 Model 3: Local Partner subcontracts all monitoring and
evaluation activities to Futures Group..
 With all models, Futures Group will continue
collaborations with national M&E and HMIS partners.
Model for Technical Transition
Specific to each country, but based on building
partnerships with institutions that can take on
different technical roles over the long term with
or without long term support:
Medical education institutions
Ministries of Health
National Labs Institutions
Network of Sites/LPTFs
Successful Transition Example
Transition to Local Partners
South Africa
Transition in South Africa
In South Africa, CRS worked through two
Indigenous Umbrella Partners:
Institute for Youth Development SA (IYDSA)
with 5 ART sites in the Eastern Cape Province
Southern African Catholic Bishops Conference
(SACBC) AIDS Office with 20 ART sites in 7 of
the 9 provinces
The Transition
In June 2009, 2009 IYDSA and SACBC transitioned to local
leadership and now receive funds directly from CDC.
St. Mary’s Hospital (previously working under the SACBC),
now functions independently and receives funds directly
from CDC.
SACBC has a service agreement with CRS to support M&E,
training, clinical coordination, and some aspects of
financial management.
Funding flow Pre-Transition
HRSA/CDC
CRS/HQ
CMMB
IHV
CAF
IMA
CF
CDC/SA
CRS/SA
IYD-SA
SACBC
ART site
ART site
St. Mary’s
ART site
ART site
Post-Transition
HRSA/CDC
CRS/HQ
CMMB
IHV
CAF
IMA
CF
CDC/SA
SACBC
CRS/SA
ART site
IYD-SA
ART site
St. Mary’s
ART site
ART site
Preparation for Transition
Began preparation for transition on Day 1.
Established relationships with local government.
Identified local vendors for outsourcing pharmacy and
laboratory services.
Utilized local clinical experts for training, mentoring and
evaluation.
Facilitated direct relationships between local partners and
donors.
The Process of Transition
Working as a Team
Built on long established partnership relationship.
Learned together and jointly planned and implemented the
program.
Assigned roles and responsibilities on basis of skills, NOT
organizational identity.
Local partners gained experience in managing USG-funded
projects and applied directly for support
Today local partners lead the team as the prime, with a service
agreement with CRS for continued technical support.
Transition Lessons Learned
Respect local capacity
Begin early
Learn together
Approach donors jointly
Utilize local resources
Work with the host government
Build an effective team
Work side by side
Disengage gradually
Challenges for Transition
Flat-lined budget which means in fact reduced
funding for transition, due to increasing
numbers of patients on treatment.
Technical transition requires a unique design
per country, as there is not one model for
medical or strategic information transition.
Effective Health Systems Strengthening for
sustainable transition will extend far beyond the
transition period.
Opportunities through Transition
Strengthen local organizations to lead health
advocacy at a national level and to access
resources from multiple donors
Improve health status in Africa by
strengthening health systems to provide
quality services (MDGs)
Improve the linkages between the
Government and Non-Governmental
structures providing health services
Slide 26
Thank You