The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)

recognizes that elimination of pediatric HIV/AIDS cannot be

achieved and sustained without strong health systems. Effective

and locally owned leadership at the national, sub-national, and

community levels is critical to ensuring a viable and efficient

health system that delivers quality services and improves the

health of women, children, and their families.

The World Health Organization has defined six building blocks

of a strong health system: 1. Health service delivery; 2. Health

workforce; 3. Health information systems; 4. Access to essential

medicines; 5. Health system financing; and 6. Leadership and

governance. EGPAF programs support all six building blocks,

while also supporting local governments to increase coordination

amongst the six health system areas.

EGPAF is committed to working within the systems of

government programs, in close cooperation with ministries of

health (MOHs) and other local service providers. EGPAF works

to strengthen local health systems through in-country capacity

building which supports MOHs and other local organizations

to deliver services, fill short-term expertise gaps, manage

the sub-granting of donor funds, and help develop evidence-

based policy.

Health Systems Strengthening

Photo: James Pursey, 2012

Leadership and Governance

Building Capacity of Ministries of Health

To assist MOHs to meet their mandates, EGPAF provides

technical and operational assistance to ministries of health.

EGPAF also serves on national technical working groups that

provide technical guidance and policy recommendations, as

well as, national training curriculums for ministries. In Kenya,

EGPAF is building capacity of healthcare workers and district level

health management teams to support service delivery at more

than 130 HIV care and treatment sites, and approximately 700

PMTCT sites.

Strengthening Management Capacity of Goverment Staff

EGPAF programs work to increase the capacity of national

and decentralized health authorities to effectively plan and to

manage services, human resources, and funds while increasing

accountability and local ownership. In Lesotho and Swaziland,

EGPAF supports management, leadership, and planning of

training for public-sector health managers.

EGPAF is a leader in supporting implementation of the district

approach, a locally-owned and locally-driven method for

supporting the decentralized delivery of district-based health

services and capacity building, in serveral country programs.

Through this strategy, EGPAF provides technical, financial, and

operational assistance to help districts coordinate and manage

all partners and HIV services.

Building the Capacity of Local Organization

EGPAF has led the way in efforts to build local capacity for HIV

service delivery, with the ultimate goal of transition of program

implementation responsibility to national governments and local

organizations. EGPAF is committed to strengthening civil society

organizations (CSOs), and has contributed to building CSO

organizational capacity across a broad spectrum of organizations

from large, national nonprofits to very small, community-based

organizations. EGPAF utilizes a comprehensive organizational

development approach including baseline assessments,

management and leadership training, resource mobilization,

governance, coordination, and technical expertise.

In 2010, EGPAF supported the development of three independent,

local affiliates in Mozambique, Côte d’Ivoire, and Tanzania. EGPAF

provides on-going support to ensure that each organization has the

capacity to grow and lead efforts in the elimination of pediatric HIV.

Health Information Systems

Improving Collection, Analysis, and Use of Data

EGPAF supports health information systems at the national,

district, and site levels. EGPAF works to ensure that district- and

site-level reporting activities are robust, value-added, and locally

owned and that all data is of high quality. EGPAF provides TA

to improve clinical patient records, registers, and electronic

clinical information systems. EGPAF trains local and national

M&E staff, engages in supportive supervision, and supports local

stakeholders to use data for evidence-based decision-making

and care provision. In Zambia, EGPAF is working in partnership

with the MOH and CDC to roll-out the national electronic

patient records system, SmartCare, by providing strategic and

programmatic input, financial management, information

technology, staff, training, and procurement of computer

equipment and hardware.

Access to Essential Medicines

Strengthening the Supply Chain

To ensure a consistent supply of drugs and other commodities

to health facilities, EGPAF provides both national and local TA,

always ensuring that parallel supply chains either reinforce or are

integrated into national logistics systems. In Tanzania, EGPAF

developed a pharmacy mentorship program designed to improve

forecasting, quantification, and timely ordering of drugs and

other commodities, greatly reducing the number of stock outs

in country.

Health System Financing

Utilization of Grants to Strengthening Capacity of Regional and District Teams

EGPAF provides small sub-grants directly to regional and district

health authorities to finance HIV services and activities, which,

when coupled with EGPAF assistance, empowers local health

authorities to gain experience budgeting, managing, and

reporting on funds per international accounting standards, thus,

increasing accountability for services and results, and addressing

local health system priorities.

Improving Quality of Care Through Performance-based Financing (PBF)

EGPAF has been at the forefront in the use PBF of HIV funds

to improve the quantity and quality of HIV and other priority

services. EGPAF’s experience with PBF in Mozambique, Rwanda,

and Côte d’Ivoire has resulted in improved quality of care, and

reinforced district-level accountability and service management

capacity. With increased motivation, districts are more receptive

to capacity building for financial planning, management,

monitoring and evaluation, and strengthened HR systems

Improving the Efficiency of Health Care Services

EGPAF works directly with district and site level staff to

review practices related to the planning, management, and

implementation of health services. EGPAF works hand-in-hand

with local staff to identify bottlenecks and implement changes

with the goal of streamlining processes and increasing program

efficiencies.In Kenya, Lesotho, Malawi, Rwanda, Swaziland,

Zambia, and Zimbabwe, EGPAF has supported MOHs to establish

systems and services that immediately enroll HIV-positive clients

in care and treatment in MNCH, ANC, and TB services, thereby

reducing delay in referrals and the number of patients who are

lost-to-referral.

Health Workforce

Strengthening Human Resource Practices and Management

EGPAF works with MOHs and regional health authorities

to strengthen human resource processes by developing

management systems that allow MOHs to track staff trainings,

salaries, and retention. EGPAF supports pre-service and in-

service training and develops job aids to ensure all healthcare

providers have the most up-to-date technical knowledge and

skills for providing quality services to clients. EGPAF also engages

in innovative methods to support MOHs to attract and retain

health workers such as performance-based incentives and

ongoing supportive supervision, mentoring, and training. In

Mozambique, EGPAF is working with the MOH to develop and

roll-out its national human resources management manual and

accompanying standard operating procedures, has seconded

human resources for health (HRH) professionals to the MOH

and supported provincial and district health authorities with

performance management systems.

Health Service Delivery

Providing a Strong Foundation

EGPAF works through local government in cooperation with

ministries of health and other local service providers to strengthen

maternal, newborn, and child health (MNCH), antenatal care (ANC),

TB and primary care platforms, and to integrate HIV services into

these platforms to provide quality, cost-effective, comprehensive

services. In Lesotho, EGPAF supported the Ministry of Health

(MOH) through targeted technical and operational assistance to

successfully integrate HIV/AIDS services within broader MNCH

services at every health facility across the country.

Quality Improvement

EGPAF strives to improve clinical care by integrating quality

improvement (QI) processes into all facets of programming using

the Plan-Do-Study-Act model. QI efforts are facilitated through staff

supportive supervision and mentoring, frequent site visits to assess

performance, regularly scheduled meetings for staff to discuss

and share successful activities, and utilization of standardized

tools designed to improve performance. At the national- and

district-levels, EGPAF works with MOHs and local partners to

share experiences, identify best practices, and contribute to the

development of a well-coordinated approach to QI.

Improving Facilities

Adequate space and equipment is essential to improving the

quality of health services. EGPAF has supported the renovation

of many hospitals and clinics and provided crucial equipment

including CD4, biochemistry, and hematology machines, as

well as, delivery beds, blood pressure machines, weighing

scales, and other maternal and child health equipment. Where

possible, EGPAF assures strong local property management and

maintenance systems.

AREA OF EXPERTISE

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