Strengthening HIS, Capacity, and Infrastructure in the Republic of Mozambique under the President’s Emergency Plan for AIDS Relief (PEPFAR)
In 2017-18, the project aims to strengthen HMIS in Mozambique through direct support to PEPFAR/CDC and MOH at national, provincial, district and health facility levels, with significant focus on implementation of the individual-based Point of Care (POC) system for HIV, targeting 3,265 public health workers and 217,105 HIV affected people. The target is up to 52 PEPFAR Test & Start health facilities (initially this was 28 facilities). During the first month’s assessment phase, experiences will be used to refine this target in terms of the type, location and quantity of facilities that can realistically be included in the final rollout plan. The project will provide full technical and specialized support during all phases of the rollout process, including training, maintenance, post-implementation support and follow-up. Additionally, and to complement the main objective, significant effort will be put in strengthen and consolidate capacity building and local ownership of the new POC and support the existing HMIS system and field installations through dedicated provincial offices (Gaza, Sofala and Zambézia) and seconded staff in the 6 key MOH Provincial Directorates. Other project components include continuing Jembi’s support to the national HMIS: strengthening the complete MoH HMIS package, system interoperability, development of a national Master Facilities List and implementation of unique patient unique identification, targeting >54.000 public health workers and indirectly 16.000.000 people (60% of the population attending 1,778 public health facilities).
HIGH LEVEL ACTIVITIES FOR POC
The POC project will consist of three overall phases with the following set of activities some of them already ongoing:
- Project formalization and site selection: for year 1 of the implementation, the selection criteria is to consider the phase 1 PEPFAR test and start HF over all 11 Provinces (total of 160). From these Provinces 8 were chosen with the largest number of high volume HF to reach the target of 52, which include Maputo Cidade and Provincia (23 HF), Gaza and Inhambane (8 HF) Tete, Nampula and Zambezia (10 HF), Manica and Sofala (11 HF). The rationale behind the selection is the prioritization of provinces that are key to CDC, with the highest number of patients receiving HIV care as well as provinces with better geographical access were work can be organized in rational way reducing the logistic and the local offices to only 3.
- Define the architecture, hardware and infrastructure requirements: in the phase of planning a POC Hardware and Architecture Summary for Mozambique POC was developed based on the study of similar experiences and the field experience of Jembi and other implementing partners (annex document). According with the results a standard package for high and low volume HF was elaborated including cost and other key elements (spare parts, environment kit, optional elements definition and cost). The plan and budget was done considering different scenario and the result was used to define the actual plan and budget:
- HF with high volume of patients
- HF with low volume of patients
- HF with support of an implementing partner and favorable infrastructure and hardware situation
- HF without any infrastructure and hardware
Architecture Overview (MISAU/DTIC)
- Define all others needs and the human resources plan and workflow for implementation: a number of other planning elements was elaborated including: 1) Comprehensive Human Resource Plan for Point-of-Care System Implementation in Test & Start Health FacilitieS that describe in detail the rationale and the details of HR plan, distribution, workflow and task. The result was used to define the actual plan and budget. 2) Logistics plan that include the distribution of the HR, small support offices in 3 Provinces, travel plan and workflow.
- Standard toolkits and materials for the field team was defined including maintenance and spare parts KIT, communication, medical kits etc.
- Rapid distance assessment for site selection: develop and conduct form the desk a rapid assessment tool1 with the support of the implementing partners in the field on all 160 T&S HF to define the standard needs, guide in the final selection and elaborate the readiness assessment tool. The rapid assessment consists of elements such as: hardware and software, security, power supply, MOH approved EMR requirements and standards, patient workload, legacy patient data, server and technical infrastructure available, site personnel, managerial buy-in for new installation;
- Implementation planning, procurement, and system finalization based on identified gaps and assessment results.
2) Implementation (field team intervention per HF):
● Logistic preparation: recruitment, procurements of vehicles, of equipment, office setup, assembling of hardware, transportation of hardware, storage, team setup training of the trainers, logistics plans and protocols, M& instruments etc.
The following diagram shows the activities that occur during the roll-out phase in a sequential manner once the readiness assessment tools have been developed and approved, applicable standards identified,plans established and specific health facilities selected. All activities are explained throughout the implementation phase.
● Maintenance, support and emergency support: help desk, remote support and a defined number of field visits will be performed in addition to emergency support. Maintenance kits and spare parts will also be available.
● Data use and supervision: carry out supervision visits to ensure that that the system is being used, data is being entered appropriately and assess whether the system presents any technical errors;
● System upgrades where deemed necessary;
● Reporting, M&E system and feedback: collect all variables and draft periodic report and recommendations ;
BENEFICIARIES OF THE PROJECT
The project will contribute to the following beneficiary: