Cross-cutting Capacity Building Needs of Proposed Local Partners

1. Cross-cutting Capacity Building Needs of Proposed Local Partners Philippe Chiliade, MD,MHA HHS / HRSA Maputo, Mozambique August 12, 2010

2. Overview • HRSA’s transition approach and the ClASS process • Basis for the analysis • Administrative systems findings • Financial systems findings • Clinical systems findings • What are the next steps?

3. HRSA’s Transition Approach: Programmatic Process

4. ClASS Process

5. ClASS Modules • Review by technical areas • Administrative systems • Financial systems • Clinical systems

6. Administrative Module • Facility • Organizational Structure and Governance • Risk Management and Legal • HIV Program/Clinic Organization and Management • Staffing • Personnel Policies, Procedures and Files • Collaborations (MOH, donors, other providers) • Community Linkages • MIS Functions, Maintenance and Security • Data Management

7. Finance Module • Financial Management and Oversight • Budget Management • Financial Policies and Procedures • Accounting Systems • Chart of Accounts and Data Security • Accounts Payable, Receivable and Cash Flow • Payroll • Internal Controls • Purchasing, Inventory, and Travel • Charges/Fees and Billing/Collections

8. Clinical Module • Facility • Clinical Operations and Management • HIV Care & Treatment, PMTCT, Pediatrics,… • Medical Records and Information Systems • Infection Control and Post Exposure Prophylaxis • Quality Improvement Processes • Referrals • Pharmacy and Dispensing • Laboratory and other Diagnostic Services • Patient Health Literacy Support

9. Basis for the Analysis • HRSA experience assessing LP between March 2009 and June 2010 • ClASS at 12 “proposed” local partners • 6 countries (Uganda, Nigeria (2), Botswana, Kenya, Rwanda, Zambia)

10. ClASS Assessment Administrative Review Findings

11. Administrative Systems Issues • Governance • Conflict of interest • Organization Management • Problem solving / Quality improvement • Human Resources • Salary and allowance schedules • Job descriptions • Performance evaluations • Employee health screening

12. ClASS AssessmentFinancial Review Findings

13. Financial Systems Issues Financial Management Oversight Grant Management Financial Policies & Procedures Internal Control Accounting System (Payroll) Accounting System (Charts of Accounts)

14. ClASS AssessmentClinical Review Findings

15. Clinical Systems Issues Quality Improvement Medical Records and Information Systems Staff Turnover Infection Control Retention Issues (pre-ART > ART) Enrolment of pediatric pts and male pts Integration of Services Access (user fees, transportation costs)

16. Clinical Systems Issues Referral network Capacity of existing sites Decentralization Identification, Documentation, and Spread of promising practices Task shifting/sharing Limited access to Primary Care Access to 2sd line ART

17. What are the Next Steps? • Detailed debrief at the end of the visit • To CDC in-country • To the grantee • To the local partner(s) • ClASS Report Developed with feedback of the stakeholders • Grantee to develop a capacity building plan of the local partners