Nathan Tumwesigye Chief of Party – SUSTAIN Project.

Nathan TumwesigyeChief of Party – SUSTAIN Project

Introduction

• 5 year cooperative agreement awarded to URC beginning June 11, 2010

• Follow on to the former TREAT program implemented by JCRC (2004-2010)

• Supports delivery of HIV services at 34 health care facilities

• The facilities are:

RRHs Other Hospitals Other facilities Mbale Gulu Kabale F/Portal Mubende Lira Hoima Jinja Soroti (Mbarara)

Lab support only: Arua Masaka

Nsambya hospital Masindi hospital Moyo hospital Kawolo hospital Nebbi hospital Ngora hospital Kiboga hospital Kagando hospital Gombe hospital Kaabong hospital (Kakira JCRC CE)

Kalangala HC IV Kawempe Home Care

Initiative MUJHU Hope Clinic - Makindye Mukuju HC IV (Tororo) MRC-Entebbe Namugongo Children’s

Clinic St Paul HC IV Kasese Katakwi HC IV Luwero HC IV Mpigi HC IV

Goal

• Support quality HIV/AIDS, prevention, care and treatment and lab services at RR and other health care facilities, and support strengthening of capacity for the facilities to continue providing these services:

– Build on coverage levels achieved during the USAID-supported TREAT program (2004 – 2010)

– Strengthen capacity of respective public health care facilities to build sustainable systems for achieving and maintaining success

Objectives:

1. Support continued delivery of HIV care and treatment, laboratory, PMTCT, and TB/HIV services within 34 public RR and other health care facilities

2. Enhance quality of HIV services within the 34 public RR and other health care facilities

3. Support increased stewardship by the Uganda MoH and individual facility leadership to provide sustainable, quality HIV services within the public health system

Objective 1:

Ensure the provision of HIV care and treatment, laboratory, PMTCT, and TB/HIV services within public RR and other health care facilities

Objective 1 ………

Key activities:• Maintain coverage of clinical services at

facilities: Seamless transition of service delivery from TREAT Support to SUSTAIN-support:

- Care, treatment & support; HCT; PMTCT&EID; TB/HIV

• Strengthen laboratory services:- HR; space; equipment; specimen/results referral systems

• Ensure a reliable, cost-effective supply chain:- ARVs and other HIV commodities- Storage and inventory management- HR

Objective 2

Enhance quality of HIV care and treatment, laboratory, PMTCT, and TB/HIV services within public RR and other health care facilities

Objective 2 …….

Key Activities:

• Improve quality of clinical services- Appropriate training, coaching/mentoring

• Improve quality of lab. services- Appropriate training, coaching/mentoring- QA strategy/plan & activities

• Improve models of care for HIV patients- Chronic Care Model, appropriate for local settings- Linkages with networks of PHAs, CBOs and VHTs (CHWs) - Patient and program monitoring systems

Objective 3

Support increased GoU MoH stewardship to provide sustainable, quality HIV within the public health system

Objective 3 ……….

Key Activities:

• Joint planning & implementation with MOH and other govt structures- Central MOH (ACP, QoC Initiative, Dept Clinical Services, QAD,

CPHL, VHTCCU); DHTs, facility teams

• HR strengthening approaches – agreed with and managed by facility management and MOH• Job task analysis and rationalization of personnel needs • Support “employee engagement” innovations – to facilitate

motivation and productivity.

Key Activities – 2

• Building technical and leadership capacity at all levels of health care system:• HIV clinical care service delivery (technical & QI skills) - training,

coaching and mentoring • Leadership and management: Facility & service delivery team

managers; DHOs; Central MOH (ACP, CSD, CPHL, etc) staff

• Technical functionality level of RRHs to backstop lower level facilities (as regional training/knowledge hubs):

- Capacity as regional training centres- Respond to district and private sector driven technical support needs

Objective 3 ……..

Key Elements of the Approach

• Building strong & functional partnerships– Individual facility management and service delivery teams– MOH structures, including GFTAM support structures– District Health system structures– JCRC/TREAT/THALAS– Other USAID and CDC, including URC-Ug projects– Between provider service facilities and communities

• Integrating into MOH activities and structures:– GoU/MOH/individual facility stewardship – Jointly identify, implement and support institutionalization of

long-term sustainability approaches

• Focus on improving quality of services and measuring results at all levels

Grants Management

Orientation

Objectives of this orientation

• To understand the overall background & requirements of SUSTAIN grants to facilities

• To enable planning for and utilization of the grants in line with the SOW budget and all other relevant guidelines inherent in the grant

• To provide and understand guidelines & tools that will facilitate timely financial accountability and ensure that funds are available to facilities, and accounted for, in time

• To share useful experience and challenges in utilizing the grants so far

• Build consensus on cross-cutting issues and provide guidance on way forward

• To agree on the responsibilities for SUSTAIN and facilities in managing the grants

Areas of support and budgeting

• Support to facility sites through several mechanisms:– On-going technical assistance– Training, mentoring & support supervision– Seconding critically needed clinical services

personnel, – Operational grants to facilities:• Administrative/coordination and • Actual HIV clinical service delivery

Administrative /Coordination (~30% of Total Budget)

• Utilities: – Water, Electricity, Back-up Power Supply (part contribution to generator

fuel)

• Stationary/Filing: – Routine Stationary Requirements (paper, pens, etc.), – Filing cabinets and filing folders for patient data management

• Internet Communication: – Monthly subscription fee for modems/wireless hardware provided by

SUSTAIN

• Telephone/Airtime Communication: – Patient follow-up and – communication with SUSTAIN office team

• Maintenance and Cleaning: – Allowances for cleaners, consumables

• Vehicle Maintenance: Routine maintenance for one vehicle (servicing once per quarter)

HIV Service Activity Costs (~70% of Total Budget)

• Mentorship/support supervision: Support to lower level health facilities to improve their skills in HIV/AIDS clinical service delivery. – Per diem/safari day allowances– Facilitation Allowance– Transport – Refreshments for mentees/supervisees.

• Community Outreaches: Outreaches for HIV/AIDS activities, community mobilization, patient follow-up, and meetings with Village Health Teams (VHT) and other community stakeholders.– Per diem/safari day allowances– Transport – Refreshments for VHTs and community meetings

HIV Service Activity Costs (~70% of Total Budget) - 2

• Clinical Outreaches: – Provision of clinical services at selected sites

lacking capacity for comprehensive HIV/AIDS Care. – Aimed at building local capacity toward site

accreditation; once sites are accredited outreaches can be stopped.

– Costs include: • Per diem/safari day allowances• Transport • Refreshments for mentees/supervisees

HIV Service Activity Costs (~70% of Total Budget) - 2

• Facility-Based Volunteer Allowances: Data entry/filing, other volunteers, People Living with HIV (expert clients/peer educators). – Facilitation for these volunteers includes:– Lunch & tea– transport allowances.

• Transportation of Laboratory Samples: – Fuel and allowance for transporting lab samples to JCRC

lab where it is far from facility• Staff Welfare: – Tea/coffee and snacks

• Patient Welfare: – Porridge/snacks for children

Responsibilities of SUSTAIN project

• Utilization of grants:– With facility clinical teams, develop SOW– Assist with budgeting as per guidelines– Assist with management of the grant given: grant

agreement signed by both parties– Support accountability and financial reporting –

grants officers, technical officers– Provide tools for disbursing funds to users at facility,

documentation and reporting– Train facility staff in grant management and reporting– Reporting grant utilization to H/Q and USAID– Ensure grant supports intended activities as per SOW

Responsibilities of facilities– Work with SUSTAIN to develop SOW– Lead budgeting process as per guidelines provided– Open bank account for the project funds

• Signatories: Director/MS, Accounts, Head of HIV service (non-JCRC)

• All requisitions generated/endorsed by HIV clinic head: ensure within grant SOW

– Management of the grant given, on day-to-day basis– Ensure correct procedures for requisitioning, paying out

and retiring advances by staff– Accountability and financial reporting as per guidelines

provided (grants officers, technical officers available to assist)

– Ensure grant supports intended activities as per SOW

Key updates

• Ushs 291m out of 388m obligated to 27 facilities

• To-date we should have liquidated the first (Sep’10-Dec’10) advances to zero– Only 8 out of the 27 facility accountabilities have

been approved for December’10 disbursements: check sent to bank on 02.02.11

– The remaining 19 facilities accountabilities still have some queries

Updates cont.

• Review of accountabilities indicate that there is insufficient documentation for most payments made by facilities

• Most sites visited intimated that they lacked guidance on how to administer the grant

Key Challenges

• Delayed submission of accountabilities and supporting documents

• Differing facility accounting and financial mx systems

• Non-compliance with reporting guidelines & guidelines for supporting documentation under the grant by most facilities

• Delayed budget submission and subsequently signing final agreement