Program Transition to Locally Controlled Entities August 4, 2009 Track 1.0 Meeting Dar es Salaam.

Program Transition to Locally Controlled Entities

August 4, 2009Track 1.0 Meeting

Dar es Salaam

Three Countries – Three Models Nigeria – Creation of APIN with no Harvard

governance representation and independent of Harvard from outset

Tanzania – Creation of MDH with Harvard majority governance, switching to complete local governance after sufficient capacity-building period

Botswana – Creation of BHP, as joint Harvard-MOH initiative, with Harvard majority governance; PEPFAR governed by board committee with local governance majority

Harvard-MDH Transition Plan

for Tanzania

Dr. Guerino Chalamilla, Deputy Country Director - Tanzania(future CEO of MDH)

Harvard- PEPFAR Program in Tanzania

Track 1 participant funded through HRSA (Tanzania, Nigeria, Botswana)

As of 2004, collaborating institutions included: Muhimbili University College of Health and Allied

Sciences (MUHAS) Dar es Salaam City Council Harvard School of Public HealthKnown as - “MDH”

Cumulative Ever EnrolledInto HIV care

71,925

Active on ARVs28,843 (65%)

Cumulative Ever Initiated on ARVs44,404 (61.7%)

Summary of Patient Enrollment(as of June 2009)

Sites 27 Public 14 Private 1 Faith-based

Locations of MDH supported sites in Dar es Salaam

Mwananyamala Municipal Hospital TMJ HospitalSinza Health Center Oysterbay HospitalTandale Health Center Kinondoni HospitalUDSM Health Center Mikocheni Mission HospitalKimara Dispensary Massana HospitalMikocheni Babra Dispensary THI HospitalBunju DispensaryMbezi DispensaryMwenge DispensaryMburahati Dispensary

Amana Municipal Hospital Aga Khan HospitalMNH Referral Hospital TMS HospitalBuguruni Health Center Hindu Mandal HospitalMnazi Mmoja Health Center Regent HospitalIDC Specialized Clinic Khan HospitalTabata Dispensary Tumaini HospitalVingunguti Dispensary St. Bernard HospitalBuguruni Anglican Dispensary Jaha DispensaryChanika Dispensary Sykes DispensaryKitunda Dispensary Apollo DispensaryPugu Dispensary

Temeke Hospital TOHS HospitalVijibweni Hospital Arafa DispensaryKigamboni Health CenterMbagala Rtatu DispensaryMbande DispensaryYombo Vituka DispensaryTambuka Reli Dispensary

PUBLIC PRIVATE

TemekePUBLIC PRIVATE

PUBLIC PRIVATEKinondoni

Transitioning

Important for sustainability Establishment of local ‘Not-for-Profit’

organization – with governance by local/national public health leaders and Harvard faculty and administration

Retain the name ‘MDH’ – Management & Development for Health Ltd Transition will be gradual and smooth In transitioning, Harvard to partner (MDH Ltd.)

to ensure admin, financial and programmatic infrastructure is strong

Governance Transition At inception, 7 directors: 4 Harvard-appointed, 3

Tanzanian public health leaders When MDH has reached capacity for full self-

governance, Harvard will relinquish all director positions it holds with non-Tanzanian directors, and those directors will resign

Remaining Tanzanian directors will then appoint all vacant director positions, and local self-governance will be complete

We expect this “switch” to occur roughly at same time that MDH is ready to assume direct funding responsibilities, as prime grantee – likely at outset of Y8

Expectations For Y6 onward funding will remain the same

Y6-Y9 MDH Ltd will ensure maintenance of current activities and, if possible, add more sites depending on availability of funds

At Y8 Harvard will have transitioned all clinical program activities to MDH Ltd, as well as relinquished role as appointee of directors

Work Plan - Year 6 The formation of MDH, Ltd. Governance through the establishment of

Board of Directors Develop and establish administrative staff

levels, policies and procedures Prepare for transfer of technical and

programmatic units in Year 7 Harvard will continue providing technical and

administrative/financial support

Year 7: Administrative Transition

At the onset of Year 7, Harvard will remain as the prime grantee, with three subcontracts in place – MUHAS, Dar City and MDH, Ltd.

The budgets for each subcontract will be revised as functions are re-arranged from one partner (MUHAS or Dar City) to MDH, Ltd.

Programmatic activities will continue

Year 7: Program Activities Harvard technical assistance will consist of:

direct technical assistance mentorship of local MDH, Ltd. staff by Harvard staff

for program activities and quality assurance, with support for devising and

implementing corrective action plans, as needed Harvard will review regular performance reports and

conduct spot assessments

Harvard will continue providing oversight, provide assistance as areas for improvement are identified and quality assurance of services

Year 8: Program Activities MDH, Ltd. will have assumed all the tasks of the prime

partner and prime grantee MDH, Ltd. will receive PEPFAR COP funds directly from

USG-Tanzania MDH, Ltd. will subcontract Dar City and MUHAS for

execution of various site level patient care activities If requested, Harvard School of Public Health may

choose to be a subcontractor to MDH, Ltd., or may continue to receive some limited funds directly from HRSA and/or CDC to provide technical support and quality assurance functions to MDH Ltd., MUHAS, and Dar City Council

Year 9: Program Activities Harvard may continue to serve as a source

for technical assistance for the PEPFAR program through MDH, Ltd.

Collaboration will continue on the implementation of research, training and education and capacity building activities (for continuous quality improvement and expansion of established programs and services)

Botswana Harvard AIDS Institute/”BHP”

Transition Plan

Ria Madison, BHP Chief Operating Officer

HSPH and BHP in Botswana Harvard activities – primarily research

projects – far pre-date PEPFAR involvement Harvard’s continued pre-PEPFAR

collaborative effort at Princess Marina Hospital to operate national HIV laboratory

PEPFAR represents only about 20% of HSPH activities in Botswana

BHP chartered in 2007 as new legal entity, in cooperation with MOH

Master MOU between Harvard and Government of Botswana/MOH, grandfathers in BHP

Organizational Structure

Board of Directors

Julio Frenk, Dean of Faculty of Public Health (HSPH) John Lichten, Senior Advisor to the Provost Myron Essex, Professor (HSPH) Richard Marlink, Professor (HSPH) Modisa Motswaledi, Botswana Ministry of Health Joe Makhema, BHP Chief Executive Officer Ria Madison, BHP Chief Operating Officer

BHP Transition

Planning Timeline Developed, operational September 1, 2009

ActivityResponsible Person(s)Status/NotesMonthly Planned ActivityProjected Deadline for Completion

BHP Transition

Administration and Finance

GovernancePersonnelAdministrative IssuesFinancial/Budgeting IssuesPEPFAR Funding

BHP Transition

Cut-Off periods to Establish Specific Tasks

Review of QuickBooks – BHP & PEPFAR

Review of Lab & General InventoryReview of VIP Payroll SystemReview of Internal Controls

BHP Transition

Review of Workflows & Reporting Structures

LLC Annual BudgetTax Registration for LLCGrant ManagementAllocation/Apportionment of Expenses

to GrantsTimelines for LLC Preparation

Nigeria Transition:AIDS Prevention Initiative

Nigeria (APIN Ltd/Gte)

Ernest Ekong, M.D., M.P.H., Harvard Country Director for Nigeria, APIN Clinical Director

Introduction

AIDS Prevention Initiative in Nigeria (APIN) was established as a program of HSPH in 2000 with a grant from the Bill & Melinda Gates Foundation

The Harvard PEPFAR(APIN Plus) Program commenced in 2004 building on the gains of the

Gate’s funded APIN program

APIN Ltd. was incorporated in October 2007 as a local NGO to gradually take over the functions of HSPH PEPFAR in Nigeria.

Outcomes of APIN Project

Capacity Development Human Infrastructural

Established Collaborations Government local institutions

Evidence in support of interventions

Strong Administrative Presence

Triggers to NGO Formation

Human Resource Management challenges Need to diversify funding base (sustainability

plan) Visionary leadership by project staff, including PI Support from the Government of Nigeria Growing complexity of the program outside of

Harvard traditional mandates Track 1.0 deviation waiver and its requirement

for transition to local entities

Organizational Governance

MEMBERS

Professor Adetukunbo Lucas

Professor Ibironke Akinsete

Professor Souleymane Mboup

Professor Michael Reich

Professor Richard Marlink

Members (5)

Directors (10)

Officers (3)

Organizational Governance

DIRECTORS

Prof. Oladapo Ladipo

Prof. John Idoko

Prof. Saidi Kapiga

Dr. Emmanuel Idigbe

Dr. Jean-louis Sankalé

Prof. Rob Murphy

Prof. Wafaie Fawzie

Dr. Wole Odutolu*

Mr. Farouk Mohammed

Prof. Phyllis Kanki

Chief Clinical Director

Program Director

Satellite Coordinators

(North&South)

PMTCT Coordinator

TB/ Palliative

Care Coordinator

Program Associate

Quality Assurance

Coordinator

I .T. Specialist

Prev. & Lab.Coordinator

Database Specialists

North&South)

Chief Financial Officer

Resource & Benefits Manager

Program Associate

Chief Pharmacist

Snr. Finance Officer (Lagos Office)

Senior Admin Officer

Logistics Officer

Pharmacist

Admin Assistant

Finance Officer

Admin Associate

Front Desk Officer

Finance Officer

Office Assistant

Office Assistants (Lagos)

Drivers (Abuja)

Drivers (Lagos)

Office Assistant (Abuja)

Cleaners (Lagos)

Cleaners (Abuja)

AIDS Prevention Initiative In Nigeria Organization Chart

Procurement Specialist

I nternal Auditor

Cashier

Country Director/ Chief Executive Officer

APIN Board

Store Assistants

Snr. Finance Officer (Abuja Office)

Snr. Finance Officers (North &

South Sites)

HR Specialist

Laboratory Officer

Prevention Officer

Snr. Admin Associate

M & E Officers (North & South)

Care & Support Officer

Program Associate

I .T.Associate

Systems Development

Strategic InformationHuman ResourcesFinance and AdministrationPharmacy/LogisticsQI/QAProcurementAudits

APIN Ltd and Harvard PEPFAR Sites

Nigerian states that currently include sites under

APIN Ltd & Harvard PEPFAR

APIN/Harvard PEPFAR Sites: as of 2007

APIN Program Offices

Sites Under Harvard PEPFAR

Sites Under APIN LtdSites Under APIN Ltd

68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research

National Military Hospital, ‘Creek’ Lagos University Teaching Hospital

University of Lagos, College of Medicine Mushin General Hospital

PHC-Iru Victoria Island Onikan Women’s Hospital

Sacred Heart Catholic Hospital Lantoro

Federal Medical Centre Makurdi

Jos University Teaching Hospital

Our Lady of Apostles Hospital Jos

8 Satellite Hospitals, 44 PHCs

University of Maiduguri Teaching Hospital

State Specialist Hospital MaiduguriNursing Home Maiduguri

University of Nigeria Teaching Hospital

Ahmadu Bello University Teaching Hospital

Widowcare Abakiliki Ebonyi

Federal Medical Centre Nguru

University of Ibadan College of Medicine

3 Satellites under UCHAdeoyo Maternity Hospital

Site Allocation: 2007-2008Harvard PEPFAR APIN Ltd

Oyo State 43 Oyo State DOTS

Centres

Lagos State PHC Iru Victoria Island

Ogun State Sacred Heart Catholic

Hospital

Benue: Federal Medical Centre Makurdi Borno

University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri

Ebonyi: Widowcare Abakiliki Enugu: University of Nigeria Teaching Hospital Ituku-

Ozalla Kaduna: Ahmadu Bello University Teaching Hospital Lagos

68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research National Military Hospital, ‘Creek’ Lagos University Teaching Hospital University of Lagos, College of Medicine

Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital

Ogun: Sacred Heart Catholic Hospital Lantoro Oyo

University of Ibadan College of Medicine 3 Satellites under UCH

Adeoyo Maternity Hospital Plateau

Jos University Teaching Hospital 8 Satellite Hospitals, 44 PHCs

Our Lady of Apostles Hospital Jos Yobe: Federal Medical Centre Nguru

APIN/PEPFAR Sites: 2008

APIN Program Office

Onikan Women’s Hospital

Onikan Women’s HospitalPHC-Iru Victoria IslandPHC-Iru Victoria Island

43 Oyo DOTS Centres43 Oyo DOTS Centres

Site Transitions: 2008-2009Harvard PEPFAR APIN Ltd

Lagos PHC-Iru Victoria Island

Ogun: Sacred Heart Catholic Hospital Lantoro

Oyo 43 Oyo State DOTS

Centres

Ebonyi: Widowcare Abakiliki Enugu: University of Nigeria Teaching Hospital Ituku-Ozalla Kaduna: Ahmadu Bello University Teaching Hospital Lagos

68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research National Military Hospital, ‘Creek’ Lagos University Teaching Hospital University of Lagos, College of Medicine

Mushin Gen. Hosp.,Onikan Women’s Hosp.

Oyo University of Ibadan College of Medicine

3 Satellites under UCH Adeoyo Maternity Hospital

Plateau Jos University Teaching Hospital

APIN Program Office

43 Oyo DOTS Centres43 Oyo DOTS Centres

Nigerian Institute for Medical Research Lagos University Teaching Hospital

Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s

Hospital

Nigerian Institute for Medical Research Lagos University Teaching Hospital

Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s

Hospital

68 Nigerian Army Reference HospitalNational Military Hospital, ‘Creek’University of Lagos Coll. of Medicine

Site Transitions: 2009-2010

Harvard PEPFAR APIN Ltd

Lagos Nigerian Institute for

Medical Research Lagos University

Teaching Hospital Mushin General Hospital Onikan Women’s Hospital PHC-Iru Victoria Island

Ogun: Sacred Heart Catholic Hospital Lantoro

Oyo 43 Oyo State DOTS

Centres

Ebonyi: Widowcare Abakiliki Enugu: University of Nigeria Teaching Hospital

Ituku-Ozalla Kaduna: Ahmadu Bello University Teaching

Hospital Lagos

68 Nigerian Army Reference Hospital National Military Hospital, ‘Creek’

Oyo University of Ibadan College of Medicine

3 Satellites under UCH Adeoyo Maternity Hospital

Plateau Jos University Teaching Hospital

8 Satellite Hospitals, 44 PHCs Our Lady of Apostles Hospital Jos

Yobe: Federal Medical Centre Nguru

43 Oyo DOTS Centres

APIN Program Office

Site Allocation: 2010 proposedHarvard PEPFAR APIN Ltd

Lagos 68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research National Military Hospital, ‘Creek’

Lagos University Teaching Hospital University of Lagos, College of

Medicine Mushin Gen. Hosp, Onikan Women’s PHC-Iru Victoria Island

Onikan Women’s Hospital

Ogun: Sacred Heart Catholic Hosp. Lantoro Oyo

General Hospital Ijebu-Ode General Hospital Ogbomosho St. Mary’s Catholic Hospital Eleta

Adeoyo Maternity Hospital 43 Oyo DOTS Centres

Ebonyi: Widowcare Abakiliki Enugu: University of Nigeria Teaching Hospital

Ituku-Ozalla Kaduna: Ahmadu Bello University Teaching

Hospital Plateau

Jos University Teaching Hospital 8 Satellite Hospitals, 44 PHCs

APIN/PEPFAR Sites: 2010 proposed

43 Oyo DOTS Centres

APIN Program Office

Sites Under Harvard PEPFAR

Sites Under APIN LtdSites Under APIN Ltd

Indicator Year 1 – COP08

Year 2 – COP 09

Cumulative On Care

Adult 1500 21,350

Pediatric 200 1,050

Cumulative On ART

Adult 550 13100

Pediatrics 200 1050

No of Sites 1 5

Cumulative on PMTCT

Women accessing PMTCT 5,000 14,200

Women receiving Prophylaxis 852

No of Sites 2 6

Annual Budget $1.705m $12.325m

APIN, Ltd

Challenges

Stakeholders’ skepticismOverlapping Harvard/APIN

responsibilitiesDifferent funding Cycles – anticipated

gap for each year of transitionAPIN’s lack of working capital Implementation of transition Timeline

The Future Continue to maintain and improve management

systems Improving access to services at the lower levels Diversify funding base as a plan to sustainability Continue to receive technical assistance from non-

local partners Ensure the highest level of good business practice

and high quality care and treatment for our patients

Thank You

AIDS Prevention Initiative Nigeria

Program Transition to Locally Controlled Entities August 4, 2009 Track 1.0 Meeting Dar es Salaam.

harvardmdh transition

y8 harvard

harvard faculty

independent of harvard

locations of mdh

formation of mdh

governance transition

harvard pepfar program

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