Country Programs

Worldwide

Expanding PMTCT programs in Emergency Plan Countries
To address logistics challenges in expanding programs for prevention of mother-to-child transmission (PMTCT), MSH has worked with decision-makers around the world to evaluate health facilities' capacity and drug management procedures through an assessment methodology that has made our organization a world leader in pharmaceutical management. With careful planning, coordination, and collaboration with local partners, MSH’s RPM Plus program has provided information that has accelerated PMTCT program expansion in 10 of the 15 countries named in the Emergency Plan for AIDS Relief: Côte d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Namibia, Rwanda, South Africa, Vietnam, and Zambia.

» Story: Antiretroviral Treatment in Africa

AFRICA

Improving drug and commodities procurement
To make quality HIV/AIDS pharmaceuticals available to clients in east, central, and southern Africa (ECSA), MSH’s RPM Plus program helped to establish a Regional Pharmaceutical Forum that provides technical leadership to ECSA member states. The Forum has developed a model strategy for pooled procurement of HIV/AIDS-related products, a regional formulary for treatment of priority diseases and treatment guidelines for HIV/AIDS, TB, and malaria. The Forum links policymakers and technical decision-makers among the ECSA countries to enhance pharmaceutical policy dialogue. MSH is committed to supporting such national leadership efforts to make the best use of scarce resources.

Kenya

Addressing staff shortages
To support the expansion of critical AIDS treatment services and to reverse staffing shortages in Kenya, MSH and partners established an emergency hiring mechanism, enabling 800 more nurses to be deployed to antiretroviral (ART) treatment sites around the country. MSH focuses on building leaders at all levels to improve HIV/AIDS services, using innovative team approaches to identify challenges, develop solutions, and monitor results. Through the Virtual Leadership Development Program—a blended learning approach that combines internet-based individual learning with face-to-face sessions—MSH has worked with numerous HIV/AIDS organizations. A Virtual Leadership Development Program with Kenerala, a network of religious leaders and teachers in Kenya, increased the impact of this grassroots organization, which mobilized communities and increased knowledge and awareness of HIV/AIDS.

Introducing ART
Through the Rational Pharmaceutical Management Plus (RPM Plus) program, MSH works with health organizations in developing countries to assess the strengths and weaknesses that affect the success of ART and to develop appropriate interventions to meet patients’ needs and bolster the capabilities of health facilities. In partnership with USAID, Family Health International’s IMPACT Project, and Population Council’s Horizons Project, MSH has helped the Government of Kenya and local stakeholders to introduce ART in four Mombasa facilities. MSH worked with health providers and laboratory technicians to establish drug inventory and laboratory procedures. This assistance has helped the facilities set standards reflecting the most current guidelines. MSH is now introducing tools and methodologies to help scale up ART in other provinces.

» MORE about MSH’s work in Kenya

» Story: Virtual Pathways Leading Africa's Fight Against HIV/AIDS

» Story: Managing People: Kenya Addresses Staff Shortages in Health Facilities

Malawi

Scaling up counseling and testing
MSH worked with District Health Management Teams in eight districts in Malawi to scale up counseling and testing services in fixed-site VCT centers, and clinics for antenatal care, tuberculosis, and sexually transmitted disease. MSH provided the basics: we helped hire and train two full-time VCT counselors per district, upgraded testing sites at district hospitals, strengthened the management of the sites by counselors, and established community outreach. Working closely with the National Tuberculosis program, MSH introduced routine diagnostic testing and counseling and cotrimaxazole prophylaxis for HIV-positive patients.

MSH went further to strengthen management practices that support scale-up and longer-term sustainability of services. MSH put systems in place to help counselors manage their sites well and to guarantee the availability of test kits and a reliable supply of essential commodities. Rosters were used to ensure the continuous availability of counselors, referral forms were developed and put into use, and clinicians were coached on how to communicate with clients. From the start, MSH implemented a simple 12-indicator data collection system that enabled staff at all levels to identify problems and focus on improvements.

This package of technical expertise, paired with sound management practices, produced results in newly introduced services: in just 12 months, a total of 53,634 persons received counseling and testing services.

» MORE about MSH’s work in Malawi

» Story: Building Integrated HIV/AIDS Services into Malawi's Health Sector

South Africa

Building multisectoral partnerships
Even where human resources are scarce, it is possible to expand health services by establishing partnerships that span different sectors and geographic regions, encompassing nongovernmental, community-based, and faith-based organizations. In South Africa, MSH helped to bring together staff from a provincial health department, a pharmaceutical company, three mining companies, a mining recruitment organization, and a hospice to establish the Bambisanani Project. Since 2002, Bambisanani workers have cared for terminally ill patients, referred vulnerable children and orphans to support services, and helped families that have lost primary wage-earners to generate income. Bambisanani is now established as an independent NGO and its model is being emulated in other areas.

Integrating HIV/AIDS programs with STI and TB services
MSH is assisting health facilities in five provinces in South Africa to integrate HIV/AIDS services into routine primary health care services. Facilities with integrated services now offer HIV counseling and testing services to clients presenting with symptoms of STI and TB, as well as those who seek prenatal care and family planning services. This effort has increased the uptake of counseling and testing services in the health facilities. MSH has trained 409 health care providers in VCT, followed by on-site supervision and mentoring, and helped expand VCT services to 125 sites in the Eastern Cape. MSH and partners also trained 432 nurses in basic care and support of HIV clients, focused on testing for ARV therapy, on-going counseling, and screening of clients for opportunistic infections, and syndromic management of STIs.

A manual for site-based clinic monitoring and supervision
MSH and partners worked with the Eastern Cape Department of Health to develop an on-site clinic supervision manual focused on priority health problems, including HIV/AIDS. With an emphasis on monitoring quality of care, the manual includes checklists to guide supervision, clinical updates to support in-service training, and background information on specific areas such as health management information systems. Site-based supervision and a continuous performance improvement approach foster good team work and collaborative problem solving, and build good interpersonal relationships between supervisors and their staff. The manual has now been adopted for nationwide use by the National Department of Health, and a web-based version has been adapted by provinces to fit their local contexts.

» MORE about MSH’s work in South Africa

» Story: Traditional Leaders Encourage Healthy Behavior in Youth: An HIV/AIDS Prevention Campaign

Tanzania

Improving financial management
In 2004, MSH led a multisectoral planning process for a Global Fund proposal that resulted in a $480 million grant for HIV/AIDS programs in Tanzania. MSH worked with the Commission and eight international donors to create the Rapid Funding Envelope (RFE), a governing body that expedites the release of these funds through grants to HIV/AIDS programs. The RFE has distributed over $3.4 million to 23 recipients through its electronic grants management system, which often helps NGOs receive funding within one day of an award decision.

» MORE about MSH’s work in Tanzania

» Story: Managing Money: Tanzania Rapidly Funds Innovative HIV/AIDS Projects

» Story: Increasing Access to Quality Essential Medicines in Tanzania

» Story: Tanzania: Building on Successes to Expand HIV/AIDS Programs

Uganda

Improving human resource management
MSH and partners worked with managers at 49 clinics in rural Uganda to address poor service delivery largely caused by rapid staff turnover. MSH worked with clinic managers to adjust staff salaries, improve supervision, reward exceptional staff, and strengthen communication among geographically dispersed health facilities. These improvements have made the clinics’ employment structure more equitable, supportive, and transparent. Employees report increased job satisfaction, while managers report decreased absenteeism and reduced staff turnover. As human resource management has improved, health services have increased: the clinics experienced a 64% increase in family planning visits, a 55% increase in well-child health visits, and a 41% increase in prenatal and postnatal visits.

Expediting the transfer of funds for HIV/AIDS services
MSH works with donors and national coordinating bodies to streamline grant funding and reporting to support HIV/AIDS services. In Uganda, MSH assisted the Inter-Religious Council of Uganda (IRCU) to develop an efficient grant-making process and improved reporting structure for Ugandan NGOs receiving HIV/AIDS grants. The IRCU has distributed $2.1 million from the Emergency Plan for AIDS Relief to 70 faith-based organizations in Uganda, which have provided care and support to approximately 7,900 orphans and vulnerable children and 33,500 people living with HIV/AIDS, and have trained 32,700 providers and community members in HIV/AIDS-related services.

Strengthening laboratory management and leadership
In Uganda, MSH is working with partners and the Ministry of Health to strengthen the management of laboratory systems by building strong interdisciplinary teams, composed of medical directors, hospital administrators, laboratory managers, doctors, and technicians, whose members share responsibility for improving their facilities. MSH and partners facilitated a process by which staff and managers together now identify challenges, clarify roles and responsibilities, develop plans to initiate changes that are within their reach, and use a monitoring and evaluation tool to measure their progress. Among the notable improvements are creation of hospital budget line items for laboratory supplies, staff who hold regular team meetings to address problems, and additional space allocated to key laboratory functions.

» MORE about MSH’s work in Uganda

» Story: Strengthening Laboratories in Uganda

» Story: Managing Systems: Improving Use of Resources to Effectively Fight AIDS in Uganda

Zambia

Improved commodities information for VCT
An RPM Plus program assessment of commodities management at Zambian voluntary counseling and testing (VCT) facilities revealed ineffective monitoring and inadequate information sharing. In response, MSH helped health personnel standardize the data collected at VCT sites, and, with Zambian partners, trained health providers from all provinces in a new VCT information and commodity management system. Prenatal VCT is now offered as part of PMTCT services in Zambia, providing clients with access to information on infant feeding, family planning, seropositivity, and involvement of men.

» MORE about MSH’s work in Zambia

LATIN AMERICA & THE CARIBBEAN

Haiti

Implementing performance-based contracting for HIV/AIDS programs
MSH developed a “payment-for-performance” system in collaboration with USAID and a network of NGOs that provide health care to one-third of Haiti’s population. Management and leadership skills among health staff improved as they developed organizational plans and reported their activities to funders. Integrated services, including VCT, are now provided by 31 sites in the network; a total of 33,040 pregnant women were tested for HIV between October 2003 and February 2005, and HIV-positive women were enrolled in PMTCT programs.

Coordinating implementation of US Government-supported HIV/AIDS services
MSH was named as the coordinating agency for the US government in Haiti for operational implementation of the Emergency Plan country operational plan for 2004 and 2005, working with the government of Haiti and over 30 cooperating agencies to carry out a comprehensive HIV/AIDS treatment, care, and prevention program. MSH provided technical consultation for development of the country's national treatment guidelines for HIV/AIDS and for scaling up service capacity. Working with Haitian and international partners to create a broad base of support, MSH managed the development of the process, certified by the Haitian Ministry of Health, for governance and coordination of services to advance the national program to combat HIV/AIDS.

» MORE about MSH’s work in Haiti

» Story: Managing Medicines: Haitians Receive Urgently Needed HIV/AIDS Medicines

Guyana

Strengthening human and institutional capacity
As a subcontractor to Family Health International, MSH is working with the Guyana HIV/AIDS Reduction and Prevention (GHARP) Project to help the group meet its service delivery goals.

MSH is conducting management and leadership training courses with several of Guyana’s HIV/AIDS nongovernmental organizations to remove operational roadblocks to service delivery. Bringing together ministry officials and NGO managers, these courses focus on project management, workplanning & budgeting, and governance for NGOs. MSH is also assisting in the development of a local NGO that will address capacity building issues for Guyana's HIV/AIDS programs in the future. In addition to these activities, MSH’s Paul Alexander Fellow is working with two small NGOs to enhance their eligibility for HIV/AIDS program funding.

Managing commodities
MSH is also training pharmacists in effective management of pharmacy stocks, with an emphasis on ARVs. In partnership with GHARP, we are in the process of establishing a satellite warehouse for HIV/AIDS drugs and commodities that will be used as a pilot site for integrating best practices into the national commodities system.

» MORE about MSH’s work in Guyana