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Strategies for HIV/AIDS Prevention & CareModel Woreda Package

A Guide for the Intensified Woreda-Based Implementation of National Social Mobilization and Health System Strenghthening

December 2011

Strategies for HIV/AIDS Prevention and Care - NASTAD Ethiopia Model Woreda Package 2

Strategies for HIV/AIDS Prevention and Care - NASTAD Ethiopia Model Woreda Package Strategies for HIV/AIDS Prevention and Care - NASTAD Ethiopia Model Woreda Package

Table of Contents

Introduction 3

Rationale for Model Woredas 3

Definition of Model Woreda 2

Purpose of this Guide 4

Objectives of Having Model Woredas 4

Selection Criteria for Model Woredas 4

Selection Core Activities for Model Woreda 5

Estimated Budget Per Woreda for the First Year 7

Monitoring and Evaluation 8

Evaluation Plan 9

Appendix I. Model Woreda Package Monitoring 13

Appendix II. Baseline Data Collection Tools 39

Appendix III. Model Woreda Sample MOU 61

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Introduction

In 2005, Ethiopia launched national social mobilization (NSM) strategies for intensifying HIV prevention and care. The major strategies include community capacity enhancement through community conversation (CC), school based HIV interventions, HIV mainstreaming, voluntary anti-AIDS promoters (VCAP) and expansion of HIV/AIDS health services. In 2007, the government also endorsed implementation guidelines and manuals for most of these strategies.

Community Conversation (CC) is one of the key strategies of NSM. However, one of the major limiting factors of CC in most regions of the country (e.g., Oromia, SNNPR and Amhara) is maintaining a national quality standard for the strategy. Necessary quality standard indicators could include a target number of participants per CC group, a pre-determined schedule for implementation, specific requirements for group composition (for holistic CC), the skills of CC facilitators, and a methodological framework. Current gaps in quality can be attributed largely to limited budget and logistics support, limited follow up with facilitators by woreda Health Office - HIV/AIDS Prevention Control Office (HO/HAPCO) staff, and poor monitoring and evaluation systems.

Despite all these limitations, experience shows that social mobilization activities that include CC interventions have contributed to increased demand for HIV services, particularly in health care treatment (HCT), anti retroviral therapy (ART), and prevention-of-mother-to-child-transmission (PMTCT) services. The community has also started to provide care and support for people living with HIV (PLHIV) and Orphans and Vulnerable Children (OVCs), possibly the result of increased knowledge and decreased misconceptions and stigma. Yet despite the increased demand for HIV counseling and testing services, experience shows that the referral system for HIV positive individuals into chronic care services is very weak. This is due primarily to a lack of a standardized referral system/protocols and accountability at different levels. Similarly, follow up and tracking of HIV positive individuals in chronic care (both pre-ART and ART) are very weak, leading to a significant number of clients lost to follow up (LTFU) , amounting to as much as 25%.

Rationale for Model Woredas

Scale up and quality implementation of national social mobilization (NSM) strategies and standardized referral systems between the community and health facilities are keys to intensifying community-based HIV prevention and care. Social mobilization for HIV prevention and care leads to increased knowledge, decreased stigma, increased HIV service demand and increased care and support for PLHIVs and OVCs, while also mitigating the challenges of high numbers LTFU and problems related to adherence. Therefore, for Country Operational Plan (COP) 2010/11, NASTAD Ethiopia decided to have one model woreda in the regions of Oromia, SNNPR and Amhara support the zonal/woreda HO/HAPCO to implement:

• Standard community conversations.

• School-based HIV interventions (capacity building and school CC).

• HIV mainstreaming.

• Voluntary anti-AIDS promoters and use of traditional birth attendants (TBA’s) as referral agents for pregnant mothers.

• Strong referral systems and replication and scale it up in the other regional woredas.

• Comprehensive woreda-level planning for HIV prevention and care.

• Targeted HIV prevention interventions for vulnerable groups/most-at-risk-populations (MARPs).

• Community level information systems (for non-health HIV/AIDS prevention and care activities) and use of HNIS data for decision making and planning.

• Integrated refresher training (IRT) for health extension workers (a new initiative of MOH) to intensify community health activities.



Defintion of Model Woreda

A “model” woreda (according to this guide) is a woreda (i.e., local government district) with coordinated implementation of the national social mobilization (NSM) CC strategy, school-based HIV interventions (school CC), HIV mainstreaming, voluntary anti-AIDS promotion, a standardized referral system between the community and health facilities, an active and effective information system, and comprehensive woreda-level planning for HIV prevention and care. One woreda from the regions of Oromia, SNNPR and Amhara were selected jointly by R-HAPCO/HB, Zonal HAPCO/HD and NASTAD to receive technical and financial support for the implementation of the strategies mentioned above.

Purpose of this Guide

The general purpose of this guide is to have a uniform support package for model woredas in order to advocate with HAPCOs for budget allocation, possible replication, standardization and quality assurance of CC and other social mobilization (SM) interventions and referral systems.

The other basic purpose is to ensure common understanding among NASTAD staff to enable them to provide the necessary and realistic support for model woredas. This includes support for efforts that enhance sustainability and quality implementation of CC and other SM interventions and referral systems that result in a positive impact for HIV prevention and care.

Objectives of Model Woredas

The general objective of this activity for model woredas is to enhance the capacity of zonal/woreda health offices/HAPCOs to better coordinate and manage HIV prevention and care services.

The specific objectives are to support zonal/woreda HO/HAPCO to:

• Support implementation of a standard CC intervention.

• Support woreda coordination, follow up and support for school based HIV interventions particularly school CC.

• Support woreda coordination, follow up and support for HIV mainstreaming in all sector offices.

• Support implementation of voluntary anti-AIDS promoters (VCAP) program and promote use of TBAs as a referral agent for pregnant mothers.

• Initiate and strengthen a standardized referral system between the community and health facilities.

• Initiate and strengthen targeted HIV prevention interventions to reach vulnerable groups of most-at- risk-populations (MARPs).

• Support the woreda in developing planning, monitoring and evaluation systems for SM/CC to demonstrate results/outcomes.

• Learn and share experiences (management systems, resource allocation and logistics, etc.) and consider scale up in other regions and advocacy among NGOs interested in providing support.

• Support the woreda to implement integrated refresher training (IRT).

• Support the woreda to analyze, interpret and use HMIS data for the woreda level decision making and planning process.

Selection Criteria of Model Woredas

In consultation with the regional and zonal HB/HAPCO, a woreda from Oromia, SNNPR and Amhara regions will be selected based on the following selection criteria.

• Higher prevalence of HIV infection and risk factors – a ‘hot spot’.

• Lack of other NGO operating SM/CC.

• Presence of ART and PMTCT services in place (health center/or hospital).

• Presence of up to 20 kebeles (for easy management at the beginning).

• Geographic accessibility for easy follow up and support by NASTAD staff.

• Availability of current and updated data for the woreda district that can be used as a baseline OR one with a commitment to undertake baseline and year end assessment to demonstrate results/outcomes.

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• Willingness to commit resources and staff for the coordination, follow up and technical assistance to kebeles, schools and other sectors.

Selected Core Activities for Model Woredas

Standard kebele level CC interventions (holistic)

• In all kebeles (neighborhoods) of the selected woreda, two new CC groups per kebele will be formed for a holistic CC intervention. (The number of CC groups per kebele depends on the geographic size of kebeles.)

• Training of CC facilitators (CCFs) will consist of either basic initial training or refresher training based on the need. During this training, community ART adherence and basic HIV/STI prevention modules will be included. Two CCFs per CC group are to be considered for training.

• Without compromising the CC methodological framework, both community ART adherence and prevention issues will be included in the CC curriculum.

• Provision of regular supportive supervision and follow up visits to kebeles/CCFs by woreda staff (telephone follow up every week and on site SS every month).

• Regular review meetings of CCFs and kebele managers will be convened every 3 months. This review meeting will be integrated with VCAP review and can be taken as an opportunity to share experiences, provide refresher trainings, and reward and acknowledge participants as reinforcement mechanisms.

• Kebele level conferences in all kebeles of the woreda will be convened twice in a year. All CC participants in that kebele and other kebele residents will have a 2 - 3 hour discussion on the concerns identified and decisions made by the CC participants. This will enhance the resonance effect of CC and maximize the outcome. It is recommended that woreda HO/HAPCO staff attend the conferences.

School based HIV prevention interventions (school CC and support for mini media)

• Conduct a one day sensitization meeting for the school community and leadership.

• Conduct a training of school CCFs, including facilitators that are teachers and students. This will be either refresher training or basic initial training based on the need. Up to 10 CCFs per school will be trained in four sessions.

• Distribute school CC manuals to be distributed to all schools under consideration.

• Provide stationery materials (flip chart and markers, documentation and registration books, and reporting formats).

• Support school mini media (provide training of mini media club members and equipment support based on need).

HIV Mainstreaming

• Support a one-day sensitization meeting for woreda sector offices and other key organizations (NGOs, companies, CBOs and FBOs).

• Support the woreda to make sure that all government sector offices and other key organizations mentioned above have assigned HIV focal persons/HIV mainstreaming officers.

• Support two-day trainings for HIV mainstreaming officers/focal persons from sector offices and other key organizations mentioned above.

• Support the woreda to make sure that all government sector offices have allocated 2% of their recurrent budget for HIV prevention activities (for both internal and external mainstreaming).

• Support the woreda to make sure that all government sector offices have an annual HIV/AIDS mainstreaming plan and are implementing the plan.

• Support the woreda to make sure that sector offices, other key organizations and all kebeles have helped form an AIDS fund.

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• Make sure that HIV mainstreaming activities have been performed in all sector offices and other key organizations, including one-on-one follow up, supportive supervision and technical assistance by woreda health office/HAPCO staff.

Voluntary anti-AIDS promoters (VCAPs)

• Recruit and provide training for VCAPs. This can be refresher training if there are already trained VCAPs. The number of VCAPs to be trained depends on the geographic and population size of the kebele. Training five VCAPs from each kebele is recommended.

• Implement standard elements in national guidelines. • Have VCAPs closely work with and report to kebele health extension workers.

• Provide reference materials and guide documents, including reporting format to VCAPs.

Standardized referral system/protocol between the community and health facilities

• Prepare a list of services (service directory) of the woreda and the surrounding area that woreda residents may use.

• Develop/standardize the existing referral system/ protocol for the referral system between the community and health facilities with clear responsibilities and accountability including referral formats.

• Convene consultative meetings of all the stakeholders and service providers to discuss the protocol and reach consensus for the effective implementation of the protocol.

• Develop follow up mechanisms to ensure implementation of the protocol and document lessons learned for future improvements.

Targeted HIV/STI prevention interventions

TBA/VCAP

• Recruiting and training of TBAs as VCAP (5/kebele).• Logistics (supply reference guide and reporting format).• Follow up and incentives (2 review meetings in a year).• VCAPs report to Health Extension Workers (HEWs).• Follow up and technical assistance to be provided.

Targeted CC

• Recruiting and training of CCFs (CCFs per selected hot spot/urban kebeles).• Targeted CC participants can be grouped based on woreda prioritization of MARPS (commercial sex workers, PLHIVs, daily laborers, etc.).• Logistics (guidelines, reporting formats, registration and documentation materials, etc.).• Follow up and incentives (2 review/reflection meetings)• Refreshment for CC groups.• Incentives for CCFs.

Implement SISTA for commercial sex workers (CSWs) and other vulnerable women

• Training of facilitators (2 facilitators per urban/hot spot kebele).• Logistics (guideline, reporting formats, registration and documentation materials, M&E tools, etc.).• Follow up and incentives (3 review meetings).• Refreshment for SISTA groups.• Incentives for SISTA facilitators.

Conduct a Community Outreach Social Mobilization (COSM) event targeting the identified target population

• Target population and type of COSM based on woreda priority (pregnant women, panel discussion, etc.).

Purchase and distribute condoms using appropriate condom outlets

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Strong M&E system for SM/CC to demonstrate results/outcome

• Support woreda HO/HAPCO to conduct baseline assessment (rapid assessment to collect information) based on the developed tools by NASTAD Ethiopia.

• Support woreda HO/HAPCO to conduct a year-end assessment to measure results/outcome.

• Make use of the standardized reporting formats.

• Document issues discussed during review meetings and observations during field visits and supportive supervisions.

• Conduct data analysis to support decision making and future planning.

Support and TA for comprehensive woreda level planning process for HIV prevention and care

• NASTAD staff will provide TA and other necessary support for the comprehensive woreda level planning process for HIV prevention and care.

• Specific TA and support for the planning process will be determined as planning unfolds.



Activities Estimated Budget Needed in ETBDegem J. Tehnan H. Tulla Total

1. Standard kebele level CC interventions (holistic CC)Training of CCFs (either basic initial OR refresher training based on the need)

Training of CCFs (either basic initial OR refresher training based on the need) 77,900 39,000 33,033 149,933

Logistics for CC groups (Flip chart, markers, documentation book, registration and attendance form, and reporting formats

40,000 31,000 32,000 103,000

Refreshment budget for CC groups (optional) 1,000 * 20 = 20,000

1000 * 20 = 20,000

1000 * 12 = 12,000

52,000

Woreda level CC & VCAP review meetings (2 review & reflection sessions/meetings in one year)

(All CCFs and VCAPs, HEWs and kebele administration representatives are invited)Kebele level conferences. (Two conferences in a year- the first conference when concerns are identified and the second conference when decisions and action points are suggested by CC groups)

2 * 35,000 = 70,000

2 * 35,000 = 70,000

2 * 33,000= 66,000

206,000

Kebele level conferences. (Two conferences in a year- the first conference when concerns are identified and the second conference when decisions and action points are suggested by CC groups)

2 * 1,000 * 20 = 40,000

2 * 1,000 * 20 = 40,000

2 * 1,000 * 12= 24,000

104,000

Subtotal 247,900 200,000 167,033 614,933

2. School based HIV interventions (school CC)

A one day sensitization meeting for the school community and leadership 12,000 11,800 7,100 30,900

Training of school CCFs (both from teachers and students) – This will be either refresher training OR basic initial training based on the need

52,900 37,200 42,200 132,200

School CC manuals and stationary materials (flip chart and markers, documentation and registration books, and reporting formats)

12 schools * 400 = 4,800

25 schools * 560 = 14,000

12 schools * 400 = 4,800

23,600

Review and reflection session of school CC (2 meetings in a year) 2* 15,000 = 30,000

2 * 20,000 = 40,000

2 * 12,000 = 24,000

94,000

Provide schools with mini media materials 12 schools * 5,000 = 60,000

20 schools * 5,000 = 100,000

12 schools * 5,000 = 60,000

220,000

Train students on media and message production and dissemination related issues (3 from each school)

15,000 30,000 15,000 60,000

Subtotal 174,700 233,000 153,100 560,800

3. HIV Mainstreaming

Conduct two days training for HIV mainstreaming officers/focal persons from sector offices and other key organizations

21,200 22,000 10,100 53,300

Conduct sector offices and companies HIV mainstreaming review meeting ( 2 meetings)

(2 participants invited from sectors/companies)

2* 6,000 = 12,000

2* 9,000 = 18,000

2* 3,500 = 7,000

37,000

Subtotal 33,200 40,000 17,100 90,300

Estimated Budget Per Woreda for the First Year

Budget allocation is one of the critical elements for the realization of the stated objectives for model woredas. For the purpose of estimating a budget, the number of kebeles, the number of holistic CC groups, type and amount of targeted HIV prevention interventions, the number of schools and kind of support, the number of sector offices and the number of VCAPs/TBAs deployed are all considered. Based on this, the following table shows cost centers and estimated budget amount for one year for one model woreda.

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4. VCAP

Recruit and provide training for VCAPs. This can be refresher training if there are already trained VCAPs

78,000 54,000 51,600 183,600

Provide reference materials/guide including documentation/reporting formats for VCAP 2,000 2,000 2,000 6,000

Subtotal 80,000 56,000 53,600 189,600

5. Referral System

Consultative meetings for referral system (4 meetings) 4 meetings * 4,000 = 16,000

4 meetings * 4,000 = 16,000

4 meetings * 4,000 = 16,000

48,000

Printing of service directory and referral formats 1,000 1,000 1,000 3,000

Subtotal 17,000 17,000 17,000 51,000

6. Support for Comprehensive Woreda Level Planning

Support for comprehensive woreda level planning for HIV prevention and care (woreda level meetings & data collection related to planning)

4,000 4,000 4,000 12,000

Subtotal 4,000 4,000 4,000 12,000

7. Targeted HIV Prevention Interventions

Train TBA as VCAP to work as referral agent for pregnant mother (5 TBASs from each kebele)Training of TBAs as VCAP (5/kebele)Logistics (reference guide and reporting format)Follow up and incentives (2 review meetings)

32,0005,0002* 15,00 = 30,000Total = 67,000

32,0005,0002* 15,000 = 30,000Total = 67,000

20,0003,0002* 10,000 = 20,000Total = 43,000

177,000

Implement targeted CC for the identified vulnerable groups/MARPs. (2 CCFs/kebele)Training of CCFs for targeted CC Logistics (guideline, reporting formats, registration and documentation materials, etc.)Follow up and incentives (2 review/reflection meeting)Refreshment for CC groupsIncentives for CCFs

(20 CCFs)15,0001,0002 * 4,500 = 9,0001, 000 * 10 CCG = 10,00020* 12* 50 =12,000Total = 47,500

(40 CCFs)30,0002,0002* 9,000 = 18,0001,000 * 20 CCG = 20,00040 * 12 * 50 = 24,000Total = 94,000

(16 CCFs)12,0007502* 4,000 = 8,0001,000 * 8 CCG = 8,00016* 12* 50 = 9,600Total= 38,350

179,850

Implement SISTA for CSWs and other vulnerable women. (2 facilitators/kebele)Training of facilitatorsLogistics (guideline, reporting formats, registration and documentation materials, M&E tools, etc.)Follow up and incentives (3 review meetings)Refreshment for SISTA groupsIncentives for SISTA facilitators

(20 Facilitators)15,0002,0002*4,500 = 9,0001, 000 * 10 CCG = 10,00020* 12* 50 =12,000Total = 48,000

(40 Facilitators)38,0005,0002* 9,000 = 18,0001,000 * 20 CCG = 20,00040 * 12 * 50 = 24,000Total = 105,000

(16 Facilitators)12,0001,5002* 4,000 = 8,0001,000 * 8 CG = 8,00016* 12* 50 = 9,600Total= 39,100

192,100

Conduct COSM event targeting the identified target populationTarget population and type of COSM TBD

20,000 20,000 20,000 60,000

Purchase and distribute condoms using appropriate condom outlets 5,000 5,000 5,000 15,000

Subtotal 187,500 291,000 145,450 623,950

Estimated Budget Per Woreda for the First Year cont.




9. M&E and other crosscutting activities

A one day woreda level sensitization meeting chaired by woreda health office/HAPCO head and woreda administrator (participants invited are: 3/kebele, 2/sector offices, 2/school)

26,300 24,000 24,200 74,500

Woreda level review meetings - chaired by woreda health office/HAPCO head and woreda administrator (For review of all activities: CC, VCAP, school based CC and HIV mainstreaming) – 2 meetings in a year

(130 ppts)2 meetings * 15,000 = 30,000

(meetings 140 & 88 ppts)2 * 25,000 = 50,000

(100 ppts)2 meetings * 11,000 = 22,000

102,000

Support regular quarterly meeting of task force who oversee and support model woreda project (4 meetings)

1 meeting *1000 *4 = 4,000

1 meeting *1000 *4 = 4,000

1 meeting *1000 *4 = 4,000

12,000

Follow up and supervision visits to all kebeles, schools, and sector offices by woreda HO/HAPCO staff. (Budget here is for transportation, and other relevant logistics for program monitoring, one on one support and TA)

30,000 30,000 20,000 80,000

Assessment and data collection for baseline and year end evaluation 2 assessments * 4,000= 8,000

2 assessments * 4,000= 8,000

2 assessments * 3,000= 6,000

22,000

Subtotal 98,300 116,000 76,200 290,500

Grandtotal 940,988, 1,055,388 731,871 2,728,247

Estimated Budget Per Woreda for the First Year cont.

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Monitoring and Evaluation Framework(using logic model)

Activities Outputs Expected OutcomesI. Capacity Building and System Strengthening

Increased capacity of woreda health office/HAPCO

Increased number of individuals who receive HIV/AIDS services (HCT, ANC/PMTCT and ART)

Decreased harmful traditions

Increased capacity of sector offices to implement HIV mainstreaming

Woreda based health sector plan with comprehensive HIV/AIDS prevention and care interventions

Increased capacity of schools to implement HIV/AIDS interventions

Increased knowledge, attitudes and practices for HIV/AIDS prevention and care among target groups/ MARPs

Comprehensive functional referral system/protocol in place

Kebele level standard CC (holistic)

• Kebele CC (holistic)• TOF• Review meetings• Kebele level conference• One on one follow up and TA

• Number of kebeles supported and conducting CC• Number of CCFs trained• Number of meetings conducted and number of participants• Number of CC participants• Number of conferences

School based HIV intervention

• School CC• Support for mini media • Review meetings• One-on-one follow up and TA

• Number of schools supported and conducting CC• Number of CCFs trained• Number of meetings conducted and Number of participants• Number of CC participants

HIV Mainstreaming

• Trainings• Review meetings• One-on-one follow up and TA

• Number of sector offices supported and implementing mainstreaming plans• Number of focal persons trained• Number of meetings and number of participants

VCAP

• Trainings• Review meetings• One-on-one follow up and TA

• Number of kebeles supported and conducting VCAP• Number of VCAPs trained• Number of meetings conducted and number of participants• Number of households reached by VCAP participants

Strengthening referral system

• Meetings• Developing referral protocol/guideline/procedures

• Number of individuals participating in task force/forum for referral• Number of meetings

Support for woreda based planning process (including for HIV/AIDS prevention and care)

• Support for meetings and data collection related to planning• Provision of TA

• Support to be determined with woreda depending on the need

Woreda level general meetings

• Sensitization meeting• Review meetings

• Number of meetings and number of participants

Targeted HIV/STI prevention interventions

• VCAP (training of VCAP, review meetings and follow up)• Targeted CC (training of CCFs, review meetings, and follow up)• SISTA (TOF, review meetings, and follow up)• COSM (TBD)• Condom distribution

• Number trained (for VCAP, CCFs, SISTA)• Number of pregnant mothers referred to health facilities for ANC/PMTCT• Number of individuals/MARPS reached (by targeted CC, SISTA, etc.)• Number of COSM events and number of target groups reached• Number of condoms distributed



Evaluation Plan

Expected Outcomes Definition(Key defining Issues)

Source of data/Means of data collection

Frequency/ Timing of data collection

Increased capacity of woreda health office/HAPCO

Allocation of budget, dedicated staff for follow up, concrete annual plan for HIV/AIDS prevention and care activities

Discussion with woreda staff Year end


Health facility data Midyear and year end, Every year

Decreased harmful traditions Identified harmful traditions during CCs

Discussion with kebele administration staff, CCFs and HEW, review of CC documents

Year end

Increased capacity of sector offices to implement HIV mainstreaming

Allocation of budget, dedicated staff for follow up, concrete annual plan for HIV/AIDS prevention and care activities

Discussion with sector office staff, Review of reports, and review of sectors mainstreaming plan

Midyear and year end, Every year


review of annual woreda based health sector plan

Every year

Increased capacity of schools to implement HIV/AIDS interventions

Presence of ongoing school based HIV prevention interventions

Discussion with school directors, review of reports, and observations

Year end

Increased knowledge, attitude and practice for HIV/AIDS prevention and care among target groups/ MARPs

Pre and post test, and exit discussions/interviews

Ongoing

Comprehensive functional referral system/protocol in place

Observation and discussion with key stakeholders

Ongoing


Appendix I:Model Woreda Package Monitoring

A Guide for Monitoring of Model Woreda Package Activities (For Use by Woreda Project Officers)



One-on-one follow up visits and mentoring and technical assistance is very crucial for the successful implementation of model woreda package activities and to maximize outcomes. Therefore, project officers are expected to be aware of and make follow up on the following key technical areas during one on one follow up and visits to kebeles, schools and sec-tor offices in due course of implementation of the project. Kebeles

CC Activities

• Make sure that this activity fully involves health extension workers and health development army (awareness and appreciation about the program, supporting TBA/VCAPs, HEWs to report what has been done to woreda HO/HAPCO, etc.).• The number of CCFs trained (number active and number not active).• The number of kebeles conducting CC.• The number of CC groups formed/kebele and the total number of CC groups formed in all kebeles (the number that are active and number completing the cycle).• CC cycle reached (for active CC groups).• Average number of individuals participating on CC sessions by sex.• The number of kebeles conducting kebele level conferences (NB: Each kebele is expected to conduct kebele level conferences twice in a year).• Any documented/evidenced outcomes of CC intervention.• How is referral to different HIV services (ex: to HCT, and others)?• What gains are observed so far in concrete terms (as the result of CC)?• What are the key challenges? • What are the opportunities? • What actions are needed for improvement?

VCAPs (including TBA/VCAP)

• Make sure that this activity fully involves health extension workers and health development personnel (awareness and appreciation about the program, supporting TBA/VCAPs, HEWs to report what has been done to woreda HO/HAPCO, etc.).• The number of VCAPs trained (number active and number not active). Same for TBA/VCAP.• The number of kebeles where VCAPs are actively working. Same for TBA/VCAP.• The number of households reached. Same for TBA/VCAP.

• The number of individuals referred to health facilities for HIV/AIDS health services.• The number of pregnant mothers referred to health facilities for ANC (PMTCT) and institutional delivery.• What does ANC/PMTCT service uptake look like in health facilities? Is it increasing, same or decreasing after initiation of this activity?• What about the capacity of health facilities to provide ANC/PMTCT services? (in terms of trained staff, infrastructure, and supplies)?

Targeted prevention activities (targeted CCs, and others like SISTA)

• The number of groups formed (by target population).• The number of individuals that participated and completed the sessions (by target population and sex).• How is referral to different HIV services? (e.g., to HCT and others)?

AIDS fund establishment and management at community (kebele level)

• The number of kebeles that established AIDS fund.• Referral linkages established for HIV/AIDS services (clients from the community to health centers and vice versa).• How referral of individuals for HIV/AIDS services is being implemented. (Referral from the community to health facilities & vice versa and within health facilities.) Document successes, challenges and lessons learned.

Reporting

• Make sure that all kebeles are using Community Information System – CIS tool for documenting and reporting of HIV/AIDS activities.

Schools

School CC

• The number of CCFs trained (number active and number not active).• The number of schools conducting CC.• Average # of CC groups formed per each school.• The total number of school CC groups formed (in all schools) and number of groups that are active and the number that have completed the cycle.• CC cycle reached (for active CC groups).• Average number of individuals participating on CC sessions by sex.

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School mini media

• The number of schools with functional mini media.• What messages are regularly disseminated through mini media?• Referral linkages established for HIV/AIDS services (clients from the schools to health facilities and vice versa).

Any evidenced/documented outcomes of school interventions

• Document successes, challenges and lessons learned.

Reporting

• Make sure that all schools are using Community Information System – CIS tool for documenting and reporting of HIV/AIDS activities).• What gains are observed so far in concrete terms (as the result of CC and mini media supports)?• What are the key challenges? What are the opportunities? What actions are needed for improvement?

Sector Offices

Assignment of focal persons

The number of sector offices assigned a focal person.The number of focal persons (trained and not trained on HIV mainstreaming).

Allocation of budget for HIV mainstreaming

• The number of sector offices with an allocated budget for HIV/AIDS mainstreaming.• Amount of budget allocated in birr for one year/per sector offices (max, minimum and average).

HIV/AIDS plan and its implementation

• The number of sector offices having a work plan (for internal mainstreaming, for external mainstreaming, and for both).• What does their plan look like? Does it address both internal and external mainstreaming?• The number of sector offices implementing their work plan.• What are the challenges in implementing their plan? What are the opportunities? What needs to be done for improvement?

AIDS fund in sectors and its management

• The number of sector offices that have established an AIDS fund (number having clear guidance for managing this fund).

Referral linkage for HIV/AIDS services (clients from sec-tor offices to health centers and vice versa)

• Evidence that peoples are referred from sector offices to health facilities for HIV/ADS health services.

Reporting

• Make sure that sector offices are using Community Information System – CIS tool for documenting and reporting of HIV/AIDS activities).

Ownership, involvement and capacity building of woreda health office

• Involvement in planning, trainings, meetings, supportive supervisions, etc. of package activities. • Support for implementation of model woreda package activities (for example: assigning staff for specific HIV/ AIDS related duties, allocation of logistics/resources). • Availability of important logistics and capacity for HCT, PMTCT and ART services (health facilities).• Availability of condoms at all potential distribution (outlet) sites.• Woreda based planning process and follow up of implementation of the plan.• Meaningful inclusion of HIV/AIDS prevention and care activities in annual health sector woreda plan.• HIV/AIDS health services (HCT, PMTCT, ART, etc.) provision in health facilities (health posts, clinics, and health centers):

* The number tested for HIV by sex (with test result).* The number registered for HIV chronic care (ever, during quarter, annual; number put on ART (ever, during quarter, annual).* The number of mothers provided with ANC, number tested for HIV (for PMTCT), and number delivered in health facilities.

cont...



• Use of CIS tools for documenting and reporting of HIV/AIDS activities by NGOs and CBOs operating within model woreda.• Feedback and impressions of staff regarding implementation of model woreda activity package.• Make sure that woreda HO/HAPCO is reporting all activities in the package to the next higher (zonal/ regional) level, and also during woreda administrative/ political meetings.

Monitoring of M&E and Other Crosscutting Issues

• Establishment and activity of woreda level task force leading implementation of model woreda package activities.• Sensitization meetings at the beginning (woreda level general meeting, meetings specific for sector offices, school community, etc.).• Availability of logistics services.• Consultative meeting for improving referral system. • CC/VCAP review meetings. • Woreda level review/evaluation meeting.

17


Name of Model Woreda

Reporting Month and Year

Reported by

Guidance for Monthly Narration Summary Report (For Model Woreda Project Officers)

Trainings, Review Meetings and Other Meetings

Date(s) of the training or meeting

Location of the training/meeting

Title/purpose of the training or meeting

Number of participants attending the entire training or meeting by sex Males Females Total

For meetings: summary of the discussions (Points of discussions, successes, challenges/gaps and the agreed next steps).

Reports should include:

Date of field visit conducted

Name of kebeles/sector offices/school visited

Summary of the findings from field visit• Key findings• Successes and challenges• Recommendations for improvement

Technical Assistances and support through field visits (to kebeles, schools, and sector offices):



Guidance for Monthly Narration Summary Report cont. (For Model Woreda Project Officers)

Narrative update (please mention summary update here)

Number of kebeles conducting CC

Total number of CC groups active (within woreda)

Average CC groups currently active per kebele

Number of individuals participating in all CC groups (within woreda)

Males Females Total

Progress (update) of implementation of social mobilization activities:(INSTRUCTION: Please mention summary updates for each of the following activities by not more than one paragraph)

1. Model/Standard CCs


Number of sector offices assigned focal person for HIV mainstreaming

Number of sector offices assigned focal person for HIV mainstreaming

Number of sector offices with HIV/AIDS mainstreaming work plan

Number of sector offices established AIDS fund

Number of sector offices currently implementing their annual mainstreaming work plan

2. HIV Mainstreaming


Number of kebeles where VCAPs are actively working

Number of VCAPs actively working during the reporting month

Number of households reached by VCAPs

3. VCAP

19



Number of schools actively working on HIV/AIDS prevention interventions (School CC, mini media, others)

Number of individuals participating on school CC sessions Males Females Total

Progress (update) of implementation of social mobilization activities:(INSTRUCTION: Please mention summary updates for each of the following activities by not more than one paragraph)

4. School based CC and Support

TBA/VCAP


Number of kebeles where TBA/VCAPs are actively working

Number of TBA/VCAPs actively working during the reporting month

Number of households reached by TBA/VCAPs

Number of pregnant mothers referred to health facilities for ANC services

5. Targeted HIV Prevention Interventions

Targeted CC


Number of targeted CC groups established (disaggregated by target audience, example CSW and others)

Number of targeted CC groups completed (disaggregated by target audience, example CSW and others)

Number of individuals completed targeted CC groups (disaggregated by target audience and sex)



Guidance for Monthly Narration Summary Report cont. (For Model Woreda Project Officers)

SISTA

Number of SIASTA groups established for CSW and for Students

Number of SISTA groups completed for CSW and for Students

Number of individuals completed SISTA sessions for CSW and for Students

Any Narrative update (please mention summary update here)

Community Outreach and Social Mobilization (COSM) - (if any)

Date, place and purpose of the event

Estimated number of individuals attended the event

Number of primary target audience participated (from attendance sheet)


Condom Availability

Update on condom distribution outlets, and over all condition within woreda

Number of condom distributed during the month


21


Update of referral system (what the TWG/task force is doing and any outcome)

Any support and TA provided to woreda health office in reviewing implementation of woreda based plan

Update of any preparatory works for the next year woreda based plan

Update and status of CIS implementation in model woreda

Update of TA/support being provided to woreda health office/HAPCO

Any other issues (that is not included in I – III) Challenges, measures taken/solutions to overcome those challenges, and any lessons learned

Major activities planned for next month



Introduction

Comprehensive social mobilization, HIV prevention and Health System Strengthening activities being implemented are:

• Standard community conversations.• School based HIV interventions and support (school CC and mini media).• HIV mainstreaming.• Voluntary anti AIDS promoters.• Strengthening referral system between the community and health facilities.• Comprehensive woreda level planning for HIV prevention and care.• Standardized reporting for community level HIV/AIDS prevention and care activities (CIS). • Targeted HIV prevention interventions (use of TBAS as VCAP to promote ANC and referrals of pregnant mothers to health facilities, targeted CC and SISTA interventions for MARPs).

• TOR for Mid-Term Evaluation of Intensified Woreda Based Implementation of Social Mobilization (SM), HIV/STIs Prevention and Health System Strengthening Package

Objective

The specific objectives of this midterm evaluation are:

• To identify any evidence of concrete outputs/successes demonstrated so far (outcomes mentioned on the M&E framework as shown below).• To identify gaps and bottlenecks for smooth implementation of SM activities including any capacity building gaps for woreda health office/HAPCO.• To recommend possible actions and future next steps in order to improve and maximize the outcome of model woreda intervention package.

Methods

• Data will be collected from woreda health office, health facilities and kebele health posts (HEW) using interviews and document review.• Selected outcome variables for midterm evaluation and data collection method (source of data) are summarized by the following table.

23


Expected Outcomes Definition(key defining issues)

Source of Data/Means of Data Collection

Increased capacity of woreda health office/HAPCO Allocation of budget, dedicated staff for follow up, concrete annual plan for HIV/AIDS prevention and care activities

•Discussion with woreda staff


•Health facility data •Routine reports from HEWs and VCAPs

Decreased harmful traditions Identified harmful traditions during CCs

•Discussion with kebele administration staff, CCFs and HEW•Review of CC documents

Increased capacity of sector offices to implement HIV mainstreaming Allocation of budget, dedicated staff for follow up, concrete annual plan for HIV/AIDS prevention and care activities

•Discussion with sector office staff, review of reports, and review of sectors mainstreaming plan


•Review of annual woreda based health sector plan

Increased capacity of schools to implement HIV/AIDS interventions Presence of ongoing school based HIV prevention interventions

•Discussion with school directors, Review of reports, and observations

Comprehensive functional referral system/protocol in place •Observation and discussion with key stakeholders

Identified gaps/bottlenecks for smooth implementation of targeted CC •Discussion with woreda health office/ HAPCO staff, HEW, and sector office staff

Increased number of MARPs reached with targeted interventions Number and types of MARPs engaged on targeted intervention

•Routine report and discussion with woreda health office staffs

Sampling and Data Collection

Reports and secondary data will be reviewed from woreda, health office. Interview/discussion will be made with HEWs at selected five kebele, head of key sector offices (education, agriculture, finance, and woreda administration offices), selected schools, and head of woreda health office.

Data Management and Analysis

Quantitative data will be summarized using tables, propor-tions, and other means of summarization as appropriate. Qualitative data will be summarized using thematic analysis using the selected outcome indicators above.

Annex: Data Collection Tool

• Checklist for document review.• Interview/discussion guide for head of selected sector offices.• Interview/discussion guide for HEWs.• Interview/discussion guide for head of woreda health office.



Name of Woreda

Zone/CA

Form completed by

Date

1. HIV/AIDS services (HCT, PMTCT and ART) utilization during the Ethiopian fiscal year (EFY) 2002

Type of Facility HCT PMTCT ART

Hospital

Health Center

Health Post

Private Clinic

Type and number of health facilities proving HIV services:

Total Population of Woreda Males Females Total

Number of sectors eligible for HIV mainstreaming Public Private Total

Estimated number of pregnant women in woreda

Estimated HIV + pregnant women in woreda

Number of PLHIV associations in woreda

Estimated number of major condom outlets

Describe the outlets

What are the major sources for condom supply?

Number of condoms distributed during six months of the previous year (Hamle, 1 – Tahsas, 30, 2003 EFY)

Number of condoms distributed during six months of the previous year (Hamle, 1 – Tahsas, 30, 2003 EFY)

Data Collection Format and Checklist for Review of Documents

Condom Distribution and Utilization

25


PMTCT

Category During six months of the previous year (Hamle, 1 – Tahsas, 30, 2003 EFY)

During six months of this year(Hamle, 1 – Tahsas, 30, 2003 EFY)

ANC (at least first visit)

Number of pregnant mothers tested for HIV

Number of HIV+ pregnant mothers provided with ART prophylaxis

HCT

Number of individuals tested for HIV

During six months of the previous year (Hamle, 1 – Tahsas, 30, 2003 EFY)


Male

Female

Total

Chronic HIV Care

Number of HIV positive individuals put on chronic care and ART services

During six months of the previous year (Hamle, 1 – Tahsas, 30, 2003 EFY)


Males Females Total

Ever enrolled (pre ART + ART)

Existing & currently on care (pre ART)

Currently on ART

LTFU (pre ART) – this includes default and died

LTFU (ART) – this includes default and died



Number of schools conducting CC HighSchools

SecondCycle

Number of schools completed the cycle and devel-oped community plan of action

Number of schools interrupted the sessions (stopped)

Major reasons for interruption

Number of students participating on CC sessions Males Females Total

Number of CCFs trained (for school CC) Males Females Total

Number of CCFs currently active and facilitating sessions

Males Females Total

Documented major community concerns identified

Documented community actions taken for the iden-tified concerns (if possible kebele specific)

School-based CC and Supports

Number of CC groups actively running the sessions

Number of CC groups completed the cycle and developed community plan of action

Number of CC groups interrupted the sessions (stopped)

Major reasons for interruption

Number of individuals currently participating in the active CC groups by sex

Males Females Total

Number of CCFs trained (for kebele CC) Males Females Total

Number of CCFs currently active and facilitating sessions

Males Females Total

Documented major community concerns identified

Documented community actions taken for the iden-tified concerns (if possible kebele specific)

2. Status of the Current HIV/AIDS Social Mobilization InterventionsCommunity Conversation Kebele level community conversation (CC)

Data Collection Format and Checklist for Review of Documents cont.

27


Number of sector offices assigned focal person

Number of sector offices which have annual work plan of action for HIV prevention and care

•For internal mainstreaming only

•For external mainstreaming only

•For both internal and external mainstreaming

Number of sector offices allocated 2% of their annual recurrent budget for HIV mainstreaming


Number of sector offices conducted HIV/AIDS institutional impact assessment

Number of sector offices staff trained on HIV main-streaming by sex (woreda level summary)

Males Females Total

Number of sector offices began utilizing the allocated budget for intended activities

HIV Mainstreaming

Number of VCAP trained by sex (including TBAs) Males Females Total

Number of community leaders trained by sex Males Females Total

Number of households reached by VCAP during the last six months (Meskerem – Yekatit/2004 EFY)

Number of currently active VCAP by sex Males Females Total


Voluntary Community Anti-AIDS Promoters (VCAP)

Availability of referral guideline and procedure (for referral between the community and health facilities, intra facilities, and inter facilities and institutions)

Yes No

Availability of HIV/AIDS service directory Yes No

Availability of different formats for referral Yes No

Presence and documentation of referral feedback/track system

Yes No

Referral Network



Cross Cutting Issues

Assigned staff for full time coordination and managing of SM activities at woreda HO/HAPCO

Yes No

Allocated budget and logistics for SM activities (amount/type for EFY 2002 disaggregated by the type of SM activity)

Yes No

Sensitization meetings and trainings for the leadership to support SM activities

Yes No

Follow up and support by woreda staff (field visit to kebeles to support CCFs and VCAP, conduct review meetings)

Yes No

•Frequency of review meeting at woreda level

•Frequency of supportive supervision to kebeles

Data Collection Format and Checklist for Review of Documents cont.

29


For Woreda Education OfficeWhat measures have you taken to strengthen HIV mainstreaming in your organization?

Interview Guide for Key Sector Offices and Schools

Probe

Assigned focal person

Conducted HIV/AIDS risk assessment

Conducted impact assessment

Having (approved) HIV/AIDS work place policy

Allocated budget (2% of recurrent budget)

Work plan of HIV mainstreaming (Can you show me?)

Does this work plan include both internal and external mainstreaming?

Any others issue (specify):

How many schools are currently conducting CC?

What technical assistance and support your office provided to schools for HIV activities?

Probe: Training of CCFs, Provision of manuals and guidelines, Sensitization meetings for leadership, Supportive supervision.

Number of teachers and students trained as CCF

What achievements have been obtained in your wore-da as the result of school based HIV interventions?

What are the major challenges of CC implementation in schools?

What do you suggest to further strengthen HIV mainstreaming in your office and school based HIV activities?

Do you have any other comments or suggestions?



For Woreda Finance OfficeWhat measures have you taken to strengthen HIV mainstreaming in your organization?

Interview Guide for Key Sector Offices and Schools cont.

Probe









Does the government sector offices included budget for HIV mainstreaming in their annual budget plan? (please specify those sectors which have included and which have not included)

What achievements have been obtained in your office as the result of HIV mainstreaming?

What are the major challenges of implementation of HIV mainstreaming in your office?

What do you suggest to improve the current imple-mentation of HIV mainstreaming in your office?


31


For Woreda Agriculture OfficeWhat measures have you taken to strengthen HIV mainstreaming in your organization?

Probe















For Woreda Administration Social Affairs UnitHow do you support the Social Mobilization (SM) for HIV prevention and care intervention in your woreda?

Interview Guide for Key Sector Offices and Schools cont.

Probe

Provide directions and instructions for political leaders at all levels

Budget allocation

Supportive supervisions

Others (specify):

What measures have you taken to strengthen HIV mainstreaming in your organization













Probe

33


For School DirectorsWhat HIV prevention activities are being implemented in your school?

Probe

CC

Message dissemination through Mini media

Edutainment sessions

Others (specify):

Probe

Number of CCF

Number of CC Groups

Number of individuals participating in all CC groups Males Females Total

Time and place of meeting (for CC)

Any CC group completed all the sessions

Any CC groups interrupted (stopped) the sessions

Major reasons for irruption

Support from school administration

Perceived/documented outcomes from CC

Any referrals for HIV services (HCT, PMTCT, ART, ...)

What major student concerns were identified during CC in your school?

What measures (actions) was taken to address the identified concerns?

What are the major challenges of implementing HIV prevention interventions like CC in your school?

What do you suggest to improve the current imple-mentation of CC in schools?




Implementation of HIV/AIDS social mobilization interventions

Interview Guide for Head of Woreda Health Office

GeneralWhat are the different Social Mobilization (SM) strategies being implemented in your woreda?

Probe: Community Conversation (CC), HIV mainstreaming, VCAP.

Is there a staff that is assigned for full time coordination and managing of SM activities at woreda HO/HAPCO?

Number of staff assigned

Community Conversation (CC)What technical assistance and support your office provided for implementation of CC (both kebele and school CC) in your woreda?

Probe: Training of CCFs, Provision of manuals and guidelines, Sensitization meetings for leadership, Supportive supervision

What achievements have been obtained in your woreda as the result of Community Conversation (CC)?

What are the major challenges of CC implementation?

•Kebele CC

•School CC

What do you suggest to improve the current implementa-tion of CC?

What do you think is the work relation of HEWs with CCFs? How their work is integrated with HDA and health exten-sion program?

35


HIV MainstreamingWhat technical assistance and support your office provided for implementation of HIV mainstreaming in government sector offices, NGOs, CBOs, and community level in your woreda?

Probe: Training on HIV mainstreaming, Provision of manuals and guidelines, Sensitization meetings for leadership.

IWhat achievements have been obtained in your woreda as the result of HIV mainstreaming?

What are the major challenges of implementation of HIV mainstreaming?

What do you suggest to improve the current implementa-tion of HIV mainstreaming?

Voluntary Community Anti-AIDS Promoters (VCAP)What technical assistance and support your office provided for implementation of VCAP in your woreda?

Probe: Training of VCAP (basic and refresher training), Sensitization meeting for leadership, Supportive supervisions, Review meetings.

IWhat achievements have been obtained in your woreda as the result of implementation of VCAP?

What are the major challenges of VCAP implementation?

What do you suggest to improve the current implementa-tion of VCAP?

What do you think is the work relation of HEWs with VCAPs/TBAs? How their work is integrated with HDA and health extension program?



Interview Guide for Head of Woreda Health Office cont.

Referral NetworkWhat is your opinion and thoughts on the current referral network (for HIV services) in your woreda? (Referral between the community and health facilities)?

Probe: Strength, Weakness, Opportunities, and Threats

What do you suggest to improve the current referral network?

Woreda -Based Planning ProcessHow do you explain the technical and managerial capacity of your office for woreda based planning process?

Probe: Technical capacity (use of baseline data, resource mapping, evidence based planning tools, quality of trainings, target aggregation & reconciliation at all levels).

What do you suggest to improve woreda based planning process in your woreda?

What technical assistance do you need to improve the situation?

Probe: Managerial capacity (Logistics arrangement, Budget allocation for planning process).

Capacity building (for woredas health office/HAPCO)

1What is your impression about the support your office is getting from NASTAD?

What is your plan to sustain the SM activities being imple-mented with the support from NASTAD? Please would you explain the strategies for sustainability?

What specific capacity building need do you have for sustainability implementation of SM activities?


37


Data Collection Guide from Kebele (HEWs and/or Kebele Administration Staff)

Number of CCF

Number of CC Groups

Number of individuals participating in all CC groupsMales Females Total

Time and place of meeting (for CC)

Any CC group completed all the sessions

Any CC groups interrupted (stopped) the sessions

Major reasons for irruption

Work relations with HEWs

Support from kebele administration

Perceived/documented outcomes from CC

Any referrals for HIV services (HCT, PMTCT, ART, ..)

Challenges

Any other issues

Community ConversationDescribe how CC is being implemented.

Probe



Number of VCAPS (non TBA)

Number of TBA/VCAPs

Number of HHs in kebele

Number of HHs reached by all TBAs

How/When do VCAPs work?

Work relations with HEWs?

Support from kebele administration

Perceived/documented outcomes from VCAP

Any referrals for HIV services (HCT, PMTCT, ART, ..)

Challenges

Any other issues

Data Collection Guide from Kebele cont. (HEWs and/or Kebele Administration Staff)

VCAP and use of TBA as VCAPDescribe how VCAP is being implemented.

Probe


Appendix II:Model Woreda Package

Baseline Data Collection Tools



Introduction

In 2005, Ethiopia has launched social mobilization (SM) strategies for intensifying HIV prevention and care. Commu-nity capacity enhancement through community conversa-tion (CC), school-based HIV interventions, HIV mainstream-ing, voluntary anti-AIDS promoters (VCAP), and expansion of HIV/AIDS health services are among the major strategies. In 2007, the government has also endorsed implementation guidelines and manuals for most of the strategies including community conversation (CC).

Since the launching of the National Social Mobilization (NSM) strategy, experience in Ethiopia showed that social mobilization activities including CC interventions have contributed to increased HIV service demand, particularly in HCT, ART, and PMTCT services. The community has also started to provide care and support for PLHIVs and OVCs. These again might be as the result of increased knowledge, and decreased misconceptions and stigma. On the other hand, despite the increased demand for HIV counseling and testing services, experience showed that the referral system for HIV positive individuals to chronic care services is very weak due to various reasons. Lack of standardized referral system/protocol, and accountability at different levels are among the major reasons. Similarly, follow up and tracing mechanisms of HIV positive individuals on chronic care (both pre ART and ART) is very weak and as a result, the number lost to follow up (LTFU) from chronic care is high (as much as 25%).

Implementation of comprehensive social mobilization (SM) strategies in its full package and standardized referral system between the community and health facilities are believed to maximize the outcome of HIV prevention and care services in a certain community. Increased knowledge, decreased stigma, increased HIV service demand, increased care and support for PLHIVs and OVCs, and decreased lost to follow up and problems related to adherence are among the major benefits/outcomes of social mobilization for HIV prevention and care. In addition to this, the coordination and leadership capacity of woreda HAPCO/HO is expected o be built through the technical assistance that NASTAD is providing to their staff.

Therefore, in COP 2010, NASTAD Ethiopia planned to support (both financially and technically) one selected woreda HAPCO/HO in each of Oromiya, SNNPR and Amhara regions to implement the following social mobilization (SM) strategies:

• Standard community conversations. • School based HIV interventions (school CC).• HIV mainstreaming.• Voluntary anti AIDS promoters.• Strengthening referral systems between the community and health facilities.• Comprehensive woreda level planning for HIV prevention and care.

Baseline Assessment for Monitoring and Evaluation of Intensified Woreda-based Implementation of Social Mobilization (SM) Strategies for HIV/AIDS Prevention and Care

41


The following table shows the expected outputs and outcomes from woreda based implementation of intensified SM strategies (in one selected woreda):

SM Interventions Output Indicators Expected OutcomesKebele CC • All kebeles will be conducting CC

• 32 CC groups formed (30 holistic and 2 targeted CC groups)• 30 * 60 =1800 individuals participated (F=50%) who completed the CC cycle• 64 CCFs trained• 120 MARPS (SCW) reached with targeted CC intervention• Major issues/concerns identified, and decisions made will be documented

Increased capacity of zonal/woreda health office/HAPCO for better coordination and manage-ment of HIV prevention and care services

Increased sense of community owner ship

Increased HIV/AIDS knowledge of the general public

Decreased stigma and miscon-ceptions on HIV/AIDS

Increased demand for HIV services - (HCT, PMTCT, ART, and others)

Increased use of condom

Decreased lost to follow up and improved linkage of HIV positive clients to chronic care services

Eliminated/decrease harmful traditional practices (relevant for HIV transmission)

School CC • 200 school CCFs trained • All schools will be conducting CC• All students will participate on school based CC and completed the cycle according to the standard (F=50%)• Total # of CC groups formed• Major issues/concerns identified, and decisions made will be documented

HIV Mainstreaming • All sector offices and other key organizations:* Assigned HIV focal person/HIV mainstreaming officer* Allocated 2% of their recurrent budget for HIV mainstreaming (internal and external)* Formed AIDS fund

• 30 individuals trained on HIV mainstreaming • HIV prevention and care activities performed through HIV mainstreaming reported to WHO/HAPCO

VCAP • 90 VCAPs trained and actively working (those who submit regular report and have close communication with kebele HEWs) • At least 50% of the households in woreda visited by VCAPs (HHs visited 5 times and completed the package according to the guide attached) • 900 pregnant mothers referred by VCAPs to health facilities for ANC and PMTCT services

Referral System • Standardized referral protocol and system in place



Objective of the Assessment

General Objective

To collect data related to HIV social mobilizations that will enable us for detailed planning, monitoring and evaluation of the implementation of social mobilization (SM) activities in the selected woredas.

Specific Objectives

• To assess implementations of the current HIV social mobilization activities in the selected woredas.• To collect baseline and year end data that will enable us to measure the specific out comes as the result of implementation of social mobilization (SM) activities in the selected woredas.

Methodology

Assessment Design: This assessment is a descriptive cross sectional one that should be completed in two weeks period.

Data will be collected from the following organizations/institutions. These are woreda health office/HAPCO, and relevant woreda sector offices (social affairs unit of woreda administration, education, agriculture, and finance offices). Similarly, data will be collected from randomly selected 6 kebeles (one urban and 5 rural) and 2 schools with secondary cycle (one urban and one rural).

Measurement and Variables: The following are major variables of interest that will help us to know the current situation of social mobilization implementation and collect baseline data for comparison of changes over time (end evaluation). The following are selected variables.

• Demographics and health related variables.• HIV/AIDS services (HCT, PMTCT and ART) utilization during the Ethiopian fiscal year (EFY) 2002.• Condom use.• The presence of harmful traditional practices relevant for HIV transmission (as perceived by woreda health office staff, health extension workers (HEW), CCFs, and VCAPs).• Stigma and misconceptions (related to HIV) in the community (as perceived by woreda health office staff, health extension workers/CCFs, and VCAPs).

• Sense of community ownership (as witnessed by woredas health office staff, CCFs, HEWs, and VCAPs• Expected capacity building areas for woredas health office/HAPCO. • Status of the current HIV/AIDS social mobilization interventions (woreda level summary).

* Kebele level community conversation (CC)* School based CC* HIV mainstreaming* Voluntary Community Anti-AIDAS Promoters (VCAP)* Referral networks* Cross-cutting issues

Data Collection: Data will be collected by in-depth interview of relevant individuals, Focus Group Discussions (FGD) with relevant staff, and document review when necessary and appropriate. Therefore, in-depth interviews will be conducted with HIV/AIDS program facilitator of woreda health office /head of woreda HAPCO, head/or vice head of woreda health office, woreda education office, woreda finance office, woredas agriculture office, woreda administration social affairs unit, and school directors of the selected 2 schools (one urban and one rural). Similarly, two focus group discussion (FGD) will be conducted with the selected kebele health extension workers, CCFs, and VCAPs. Relevant documents from relevant offices (woredas HO/HAPCO, health facilities, education office, and finance office) will be reviewed in the due course of the assessment.

Data Management and Analysis: Quantitative data will be summarized using tables, proportions, and other means of summarization as appropriate. Qualitative data will be summarized using thematic analysis as shown on data collection tools.

Ethical Considerations: Letter of permission to be provided by the regional health bureau and respective zonal health departments? Verbal consent will be obtained from all individuals to be interviewed and FGD participants as well. FGD participants from kebeles will be provided with the appropriate per diem.

Baseline Assessment for Monitoring and Evaluation of Intensified Woreda-based Implementation of Social Mobilization (SM) Strategies for HIV/AIDS Prevention and Care cont.

43


Use of Data

The following are among the major uses of data (findings) from this assessment.

• Using the package for model woredas as a reference and framework, findings from this assessment can be used for micro planning of the SM activities based on the existing gaps and recommendations.• To see any changes overtime by conducting similar assessment (using same methodology and data collection tools) after the end of NASTAD project to support woreda based implementation of social mobilization strategies.

Roles and Responsibilities of NASTAD Regional and Woreda HO/HAPCO Staff

• NASTAD regional staff will provide training for woreda health office/HAPCO staff on data collection tools and procedures.• NASTAD regional staff will assist woreda health office/ HAPCO staff during data summarization/analysis and final report writing of the assessment.• Woreda health office/HAPCO is responsible for the overall implementation of the assessment. Therefore, the office will allocate logistics for data collection (stationeries, transportation, allowance/per diem both for data collectors and FGD participants), recruit and assign data collectors, data summarization/analysis and final report writing of the assessment.

AnnexData collection tools



Data Collection Format and Checklist for Review of DocumentsName of Woreda / SC

Zone/CA

Form completed by

Date

Demographics and Related Data

Ages Male Female Total

<10 Years

10-14 Years

15-24 Years

25-34 Years

>34 Years

Total

Total population disaggregated by sex and age.

Number of kebeles Urban Rural TotalKebeles

Number of schools with second cycle and above

•Number and name of schools with second cycle (not high school)

•Number and name of high schools

Type of School Male Female Total

Second Cycle

High School

Total

Number of students (M/F) in schools with second cycle and above.

45


Name of Member

Males Female

Number of PLHIV associations (with total number of member PLHIVs).

Name of Member

Males Female

Number of government sector offices (public).



Data Collection Format and Checklist for Review of Documents

Type of Facility Public Private Total

Hospital

Health Center

Health Post

Total

Number of health facilities (Health post, Health center, Hospital by ownership (public/private).


Hospital

Health Center

Health Post

Total

Number of HCT service providing centers (public/private).


Hospital

Health Center

Health Post

Total

Number of PMTCT service providing centers (public/private).

10 leading causes of morbidity with proportions (%)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Number of PLHIV associations (with total number of member PLHIVs).

47


Category Male Female Total

New

Existing/Current

Ever Enrolled

Defaulted

Died

Total

Number of HIV positive individuals registered in health facilities (both new and existing as of end of EFY 2002).

Number of TB cases registered in health facilities during EFY 2002

Male Female Total

TB case detection rate (%)

HIV/AIDS services (HCT, PMTCT and ART) utilization during the Ethiopian fiscal year (EFY) 2002Number of individuals tested for HIV in EFY 2002.


Hospital

Health Center

Health Post

Total

Category Male Female Total

New

Existing/Current

Ever Enrolled

Defaulted

Died

Total

Number of HIV positive individuals on ART and chronic care services in 2002 EFY. (fill in the table below)

Number of pregnant mothers attending health facilities for ANC in EFY 2002.

Number and % from eligible

Total

Number of pregnant mothers tested for HIV for PMTCT in EFY 2002.

Number and % from eligible Total

Number of HIV positive pregnant mothers provided with PMTCT services in EFY 2002.

Number and % from eligible Total

Number of total PLHIV’s enrolled to Care and sup-port (IGA program) in the woreda.

Male Female Total

TB case detection rate (%).

Number of OVC and number enrolled to Care and support (IGA program) in the woreda.

Male Female Total

TB case detection rate (%).

Number of documented condom outlets – if any (total in woreda)

Number of condoms distributed during EFY 2002

Condom Use



Data Collection Guide from Kebele (HEWs and/or Kebele Administration Staff)

Number of CC groups ever formed

Number of CC groups completed the cycle and devel-oped community plan of action

Number of CC groups *currently active*Currently active CC groups are those CC groups that conduct CC sessions according to the standard at least once during the last three months.

Number of individuals currently participating in the active CC groups by sex. Males Females Total

Number of CCFs ever trained (for kebele CC). Males Females Total

Number of trained CCFs currently active and facilitate those active CC groups. Males Females Total

Documented major community concerns identified:

Documented community actions taken for the identi-fied concerns (if possible kebele specific)

Kebele level community conversation (CC)

Status of the Current HIV/AIDS Social Mobilization InterventionsCommunity conversation (CC)

49


Number of second cycle schools conducting CC

Number of high schools conducting CC

School-based CC

Name of High School

Category SecondCycle

HighSchool

Number of currently active CC groups

Number of students participating on CC Males Females Total

Number trained CC facilitator

•Students Males Females Total

•Teachers Males Females Total

Number of active CC facilitators

•Students Males Females Total

•Teachers Males Females Total

Number of CC groups discontinued

Number of CC groups completed the cycle and devel-oped plan of action

Regular reporting of CC activities Yes No

(Please fill the following table for each of schools conducting CC)



Number of sector offices assigned focal person

Number of sector offices which have annual work plan of action for HIV prevention and care

•For internal mainstreaming only

•For external mainstreaming only

•For both internal and external mainstreaming

Number of sector offices allocated 2% of their annual recurrent budget for HIV mainstreaming


Number of sector offices conducted HIV/AIDS institutional impact assessment

Number of sector offices staff trained on HIV main-streaming by sex (woreda level summary)

Males Females Total


HIV Mainstreaming

Number of VCAP trained by sex (including TBAs) Males Females Total

Number of community leaders trained by sex Males Females Total

Number of households reached by VCAP during EFY 2002

Number of currently active VCAP by sex Males Females Total


Availability of referral guideline and procedure (for referral between the community and health facilities, intra facilities, and inter facilities and institutions)

Yes No

Availability of HIV/AIDS service directory Yes No

Availability of different formats for referral Yes No

Presence and documentation of referral feedback/track system

Yes No

Referral Network

Cross Cutting Issues

Assigned staff for full time coordination and manag-ing of SM activities at woreda HO/HAPCO

Yes No

Allocated budget and logistics for SM activities (amount/type for EFY 2002 disaggregated by the type of SM activity)

Yes No

Sensitization meetings and trainings for the leader-ship to support SM activities

Yes No

Refresher trainings provided (for CCFs, HIV main-streaming officers/focal persons, and VCAP)

Yes No

Follow up and support by woreda staff (field visit to kebeles to support CCFs and VCAP, conduct review meetings)

Yes No

•Frequency of review meeting at woreda level

•Frequency of supportive supervision to kebeles

51


Focus Group Discussion (FGD)(For CCFs, HEWs, and VCAPs)Introduction

Good day! My name is __________ and I am the facilitator for this focus group discussion. We will be talking with you today about HIV/AIDS prevention and care activities in your kebeles. Your experience, knowledge and what you have observed regarding HIV/AIDS prevention and care activities in is very important to understand the situation.

My colleague ____________ will be recording your responses. He/she will not be taking down anyone’s name, and when we use the results of this discussion, we will not share anyone’s name.

We have a few simple ground rules for this discussion. First, WE WANT YOU TO DO THE TALKING. We would like everyone to participate. I may call on you if I haven’t heard from you in a while. Second, THERE IS NO RIGHT OR WRONG ANSWERS. Every person’s experiences and opinions are important. Speak up whether you agree or disagree; we want to hear a wide range of opinions. Third, WHAT IS SAID IN THIS ROOM STAYS HERE. We want everyone to feel comfortable sharing when sensitive issues come up.

Questions

1. What harmful traditional practices fuelling HIV transmission exists in your woreda?

Probe: Ask about female circumcision, wife inheritance, abduction, uvula cutting, elimination of milk teeth, early marriage, Kimit (Warsa), and others if any. (list)

Probe: What about other emerging traditions (sugar-daddies, sugar-mammies)?

2. Stigma and misconceptions related to HIV/AIDS are common in our community. What are the features of stigma that you are observing in this woreda?

Probe: What about misconceptions related to HIV/AIDS?

3. Community ownership for HIV/AIDS prevention and care is one of the expected out-come of social mobilization (SM). What features of community owner ship are you observing in your woreda?

Probe: Establishment of AIDS fund by the community (at kebele level), Number of kebeles established AIDS fund.

Probe: Community actions to eliminate/reduce factors fueling for HIV transmission.

Probe: Provision of care and support for OVC and PLHIV.

Probe: Involvement of CBOs such as ‘iddirs’ and ‘Mahibers’ in HIV prevention, care and support program.

Probe: Others

4. What is your thought about the implementation of Community Conversation (CC) and VCAP activities in this woreda?

Probes: • Are CC and VCAP being implemented in this woreda? • How these activities are implemented? • How many CCF and VCAP trained per kebele? • Does CCF use manual and facilitate the discussion based on the manual? • What about documentation and reporting? Have you ever given refresher training? • What support are you getting from woreda health office/HAPCO? • What are the major community concerns identified through CC? • What about community actions taken for the identified concerns (kebele specific)?

Probes:What achievements have been obtained in your woreda as the result of Community Conversation (CC) and VCAP?

• What are the major challenges of CC and VCAP implementation? • What do you suggest to improve the current implementation of CC and VCAP? • Do you have any other comments or suggestions?

5. Referral Network for HIV/AIDS services is one of the very important social mobilization activities. People can be referred from the community to health facilities for HIV services like HCT, ART, PMTCT, and others. What do you say about referral network in your woreda?

Probes: • Availability of referral guideline and procedure (for referral between the community and health facilities, intra- facilities, and inter facilities and institutions). • Availability of HIV/AIDS service directory. • Availability of different formats for referral.• Presence and documentation of referral feedback/track system.

6. Do you have any other comments or suggestions

Thank you so much!



Informed Consent Form(For in-depth interview)Good morning/Good afternoon!

My name is _______________. I am selected as data collector by ___________ woreda health office/HAPCO. This woreda health office/HAPCO is coordinating HIV/AIDS prevention and care activities in this woreda through multi-sectoral approach. Currently, they are planning to scale up HIV prevention and care social mobilization activities to maximize the outcome. Therefore, this woreda health office/HAPCO would like to learn about the current situation with regard to HIV prevention and care social mobilization activities that will help for informed decision making, monitoring and evaluation purpose.

Therefore, I am going to ask you questions related to HIV prevention and care activities in our woreda. You are free not to answer for questions that you don’t know OR you don’t want to. This doesn’t affect your job or any of your benefits. Your name will not be mentioned on this report and any document related to this assessment. Your answers to these questions are very important to improve the HIV prevention and care social mobilization activities in this woreda. Do you have any questions? Do you agree to discuss about/or answer the following questions?

(If the answer is YES, continue the interview/discussion)

53


Informed Consent Form(For focus group discussion)Good morning/Good afternoon!

My name is _______________. I am selected as data collector by ___________ woreda health office/HAPCO. This woreda health office/HAPCO is coordinating HIV/AIDS prevention and care activities in this woreda through multi-sectoral approach. Currently, they are planning to scale up HIV prevention and care social mobilization activities to maximize the outcome. Therefore, this woreda health office/HAPCO would like to learn about the current situation with regard to HIV prevention and care social mobilization activities that will help for informed decision making, monitoring and evaluation purpose.

Therefore, I am going to ask you questions related to HIV prevention and care activities in our kebele. We want you to tell us what you know and what you see in the community regarding HIV prevention and care. You are free not to answer for questions that you don’t know OR you don’t want to. This doesn’t affect your job or any of your benefits. Your name will not be mentioned on this report and any document related to this assessment. I strongly remind you that, what we will discuss should remain here and not to be told to anyone else outside of this class. Your answers to these questions are very important to improve the HIV prevention and care social mobilization activities in this woreda. You will be provided with coffee/tea, and transportation allowance/per diem for your coming here and participating in this discussion. Do you have any questions? Do you agree to discuss about/or answer the following questions?

(If the answer is YES, continue the discussion)



IntroductionI will be talking with you today about HIV/AIDS prevention and care activities in your Woreda. Your experience, knowledge and what you have observed regarding HIV/AIDS prevention and care activities in this woreda is very important to understand the situation.

QuestionsImplementation of HIV/AIDS social mobilization interventions:

General

1. What are the different Social Mobilization (SM) strategies being implemented in your woreda?

Probe: Community Conversation (CC), HIV mainstreaming, VCAP.

2. What are the strength, weakness, opportunity, and threats (SWOT) of implementation of social mobilization (SM) in your woreda?

Interview Questions for HO/HAPCO Staff

Interviewer Details

3. Is there a staff that is assigned for full time coordination and managing of SM activities at woreda HO/HAPCO?

4. Have you allocated budget and logistics for SM activities in 2002 EFY? (amount (type of logistics) for EFY 2002 disaggregated by type of SM strategy)?

Community Conversation (CC)

5. How many kebeles and schools are currently conducting CC in your woreda?

6. What technical assistance and support your office provided for implementation of CC (both kebele and school CC) in your woreda?

Probe: Training of CCFs, Provision of manuals and guidelines, Sensitization meetings for leadership, Supportive supervision.

Interviewer

HAPCO/HB Staff

Date

Strengths

Weaknesses

Opportunities

Threats

Type of SM Strategy Allocated Amount / Type of Logistics

Number of kebeles

Number of schools

Number of staff assigned

55


7. What achievements have been obtained in your woreda as the result of Community Conversation (CC)?

8. What are the major challenges of CC implementation?

9. What do you suggest to improve the current implementation of CC?

HIV Mainstreaming

10. What technical assistance and support your office provided for implementation of HIV mainstreaming in government sector offices, NGOs, CBOs, and community level in your woreda?

Probe: Training on HIV mainstreaming, Provision of manuals and guidelines, Sensitization meetings for leadership.

11. What achievements have been obtained in your woreda as the result of HIV mainstreaming?

12. What are the major challenges of implementation of HIV mainstreaming?

13. What do you suggest to improve the current implementation of HIV mainstreaming?


14. What technical assistance and support your office provided for implementation of VCAP in your woreda?

Probe: Training of VCAP (basic and refresher training), Sensitization meeting for leadership, Supportive supervisions, Review meetings.

15. What achievements have been obtained in your woreda as the result of implementation of VCAP?

16. What are the major challenges of VCAP implementation?

17. What do you suggest to improve the current implementation of VCAP?

Kebele CC

School CC



Interview Questions for HO/HAPCO Staff cont.

Referral Network 18. What is your opinion and thoughts on the current referral network (for HIV services) in your woreda? (Referral between the community and health facilities)?

Probe: Strength, Weakness, Opportunities, and Threats

19. What do you suggest to improve the current referral network?

The presence of harmful traditional practices fuelling HIV transmission

1. What harmful traditional practices (that fuel HIV transmission) exist in your woreda?

Probe: (Female circumcision, Wife inheritance, Abduction, Uvula cutting, Elimination of milk teeth, Early marriage, Kimit (Warsa), and others if any) list.

Probe: Other emerging traditions (sugar-daddies, sugar-mammies).

Stigma and misconceptions (related to HIV) in the community

1. What are the common features of stigma due to HIV/AIDS among the community in your woreda?

2. What are the major misconceptions about HIV/AIDS observed in the community in your woreda?

Sense of community ownership

1. How many kebele and sector offices have established AIDS fund?

2. Does the community provide care and support for OVC and PLHIV?

3. What kind of care and support are commonly provided to OVC and PLHIV?

Probe: Economic support (example: food support, IGA, school support), psychological support, legal support.

4. Is there any community actions undertaken to eliminate/reduce factors fueling for HIV transmission? (Would you list those actions?)

5. Does CBOs such as ‘iddirs’ and ‘Mahibers’ involve in HIV prevention, care and support activities? (What are some of the examples of their involvements?)

Number of kebeles

Number of sector offices

Number of OVC supported

Number of PLHIV supported

57


6. What are other features/examples/ of sense of community owner ship for HIV prevention and care?

Condom use

1. What are the major sources of condom for your woreda?

2. What types of condom outlets (hotels, health facilities, FGAE, community workers, etc.) exists in your woreda?

Type and magnitude of most at risk population (MARPs) for HIV infection

1. Who are the most at risk populations (MARPs) for HIV infection in this woreda? (please describe the population groups, their estimated number and major risk behaviors).

Capacity building (for woredas health office/HAPCO):

1. What are the capacity building issues that your office wants

to see (or expect) at the end of this project?

Probe: Proper documentation and M&E system for SM activities.

Woreda based planning process:

1. How do you explain the technical and managerial capacity of your office for woreda based planning process?

Probe: Technical capacity (use of baseline data, resource mapping, evidence based planning tools, quality of trainings, target aggregation & reconciliation at all levels).

Probe: Managerial capacity (Logistics arrangement, Budget allocation for planning process).

2. What is the strength and weakness of woreda based planning process in your woreda?

3. What do suggest to improve woreda based planning process in your woreda? What technical assistance do you need to improve the situation?

Any other comments or suggestions?

Thank you so much!

MARPs Behaviors

EstimatedNumber

Major RiskStrengths

Weaknesses/Challenges



Interview Questions for OthersIntroductionI will be talking with you today about HIV/AIDS prevention and care activities in your Woreda. Your experience, knowledge and what you have observed regarding HIV/AIDS prevention and care activities in this woreda is very important to understand the situation.

QuestionsFor woreda education office

What measures have you taken to strengthen HIV mainstreaming in your organization?

Probe: Assigned focal person, Allocated budget (2% of recurrent budget), Conducted HIV/AIDS risk assessment, Conducted impact assessment, Having (approved) HIV/AIDS work place policy, others (specify).

1. How many schools are currently conducting CC?

2. What technical assistance and support your office provided to schools for implementation of CC?

Probe: Training of CCFs, Provision of manuals and guidelines, Sensitization meetings for leadership, Supportive supervision,

4. Number of teachers and students trained as CCF.

5. What achievements have been obtained in your woreda as the result of school Community Conversation (CC)?

6. What are the major challenges of CC implementation in schools?

7. What do you suggest to improve the current implementation of CC in schools?

8. Do you have any other comments or suggestions?

For woreda finance office

1. What measures have you taken to strengthen HIV mainstreaming in your organization?


2. Does the government sector offices included budget for HIV mainstreaming in their annual budget plan? (please specify those sectors which have included and which have not included).

3. What achievements have been obtained in your office as the result of HIV mainstreaming?

4. What are the major challenges of implementation of HIV mainstreaming in your office?

Interviewer

HAPCO/HB Staff

Date

Interviewer Details

Number of teachers

Number of students

59


5. What do you suggest to improve the current implementation of HIV mainstreaming in your office?


For woredas agriculture office







For woreda administration social affairs unit

1. How do you support the Social Mobilization (SM) for HIV prevention and care intervention in your woreda?

Probe: Provide directions and instructions for political leaders at all levels, Budget allocation, Supportive supervisions, others (specify).








Strategies for HIV/AIDS Prevention and Care - NASTAD Ethiopia Model Woreda Package

Interview Questions for OthersFor school directors

1. When did you start CC implementation in your school?

2. How many CCF trained from your school?

3. How many CC groups have ever established?

4. How many CC groups have ever completed the cycle and developed plan of action?

5. How many CC groups are currently under way?

6. How many students are currently participating on CC sessions?

7. What major student concerns were identified during CC in your school?

8. What measures (actions) were taken to address the identified concerns?

9. What achievements have been obtained in your school as the result of Community Conversation (CC)?

10. What are the major challenges of CC implementation in schools?

11. What do you suggest to improve the current implementation of CC in schools?


Thank you so much!

Number of males

Number of females

Strategies for HIV/AIDS Prevention and Care - NASTAD Ethiopia Model Woreda Package

Appendix III:Model Woreda Sample MOU



I. Introduction

NASTAD Ethiopia (National Alliance of State and Territorial AIDS Directors) and Degem woreda are hereafter referred to as the parties to this Memorandum of Understanding (MOU). This MOU reflects the parties’ intention to closely work together towards strengthening their partnership with the regions of Ethiopia in the fight against HIV/AIDS and through the provision and coordination of effective and efficient services. This MOU addresses the basic rela-tionship, roles and responsibilities of NASTAD Ethiopia and the identified woreda in supporting the implementation of the National Social Mobilization Strategy in a comprehen-sive manner according to the national guidelines and best practice experience.

II. Purpose

NASTAD Ethiopia and Oromia Regional HAPCO / Health Bureau have a successful history of collaboration and have an existing Memorandum of Understanding supporting all activities. The purpose of this additional MOU is to outline the specific terms and conditions under which NASTAD Ethiopia and Degem woreda will collaborate for the length of this project. The “Model Woreda Project” is being con-ducted with the full cooperation and oversight of the zonal and regional offices.

III. Roles and Responsibilities of the Parties

General

• The parties agree to work together to realize the goals of this project – best practice implementation of the National Social Mobilization strategy and coordination of HIV-related activities by the woreda HAPCO/health office.• The parties agree to share experiences and information that will help to facilitate the implementation of this MOU.• The parties understand that other stakeholders will be engaged so as to assure the successful implementation of this MOU.

Degem woreda shall:

• Demonstrate commitment of woreda, appropriate sector heads, and kebele administrations toward this project and the quality implementation of the National Social Mobilization Strategy with fidelity to the national and regional standards and guidelines and to make resources and staff available for leveraging a local match.• Assume the lead for this project to enhance and improve HIV social mobilization activities and HIV service coordination.• Form technical working group, with woreda health office chairing, to advise the planning, implementation, monitoring and evaluation, and documentation.• Conduct baseline assessment using provided templates and collaborate with NASTAD Ethiopia in conducting subsequent project evaluation.• Coordinate and facilitate the collaboration of health facilities to improve access to services (such as HCT, ANC/PMTCT, pre-ART and ART health care, STI tracking and treatment.• Provide office space and support for NASTAD Ethiopia staff person working with Social Mobilization lead person.• Insure that the equipment provided by NASTAD Ethiopia for this project will be maintained and used for the duration of this project strictly for the purpose specified, and will be prepared to show NASTAD Ethiopia the equipment upon request. This is necessary for NASTAD Ethiopia to remain in compliance with CDC Ethiopia/PEPFAR requirements.• Provide regular/monthly reports to NASTAD Ethiopia using the provided templates.• Demonstrate commitment to long-term sustainability and integration into woreda HAPCO/health office staffing and priorities as demonstrated by the development of a written transition plan.

NASTAD Ethiopia shall:

• Contract a qualified person as NASTAD Ethiopia Project Officer to work at the woreda HAPCO/health office level assisting the social mobilization lead, under the direction of the NASTAD Ethiopia Regional Coordinator of this region.• Provide the NASTAD Ethiopia Project Officer with a desk, chair, laptop computer, internet connection, printer, mobile phone/internet cards, and other necessary materials.

Memorandum of Understanding Between NASTAD Ethiopia and Degem Woreda, Oromia Region, Ethiopia

63


• Provide technical and financial assistance to woreda HAPCO/health office in coordinating this project and their social mobilization activities with quality and fidelity to the National Social Mobilization Strategy according to all of the relevant federal guidelines.• Support implementation of social mobilization activities including, but not limited to, holistic and targeted CC, woreda sensitization and review meetings, regular supportive supervision visits, and providing relevant NASTAD Ethiopia documents and applicable federal social mobilization manuals and guidelines to support quality implementation.• Communicate directly and regularly to the woreda HAPCO/health office head about the project activities through the Regional Coordinator and the assigned Project Officer.• Provide specific capacity support of the woreda HAPCO/health office:

* 3.6.1. one motorbike for supervisor of social mobilization activities for ongoing supportive supervision* 3.6.2. one desktop computer to best support data collection, planning, monitoring and evaluation related to social mobilization activities.* 3.6.3. some basic stationery materials for CC registration and documentation

IV. Duration of Agreement

This MOU shall be effective from May 31, 2011 through December 31, 2011. After this period this MOU will be reviewed and renewed as appropriate. Either party may ter-minate the MOU at any time by giving the other party thirty (30) days written notice.

V. Amendment of the Mou

This MOU may be amended or modified only via mutual agreement of the two parties.

VI. Settlement of Disagreement

Any disagreement arising from the interpretation or the execution of this memorandum of understanding will preferably be settled amicably by mutual agreement of both parties. The NASTAD Ethiopia Country Director and/or Country Deputy Director would be the persons to initi-ate resolution -- first with the program contact and then, if necessary, with the hospital administrator or health bureau director. If amicable settlement is impossible, the matter will be brought before NASTAD headquarters in Washing-ton D.C. and the designated regional party.

VII. Indemnification

Each party hereto agrees to be responsible and assume liability for its own wrongful or negligent acts of omission, and to those of its officers, agents or employees to the full extent required by law; and agrees to indemnify and hold the other party harmless from any such liability. Each party agrees to maintain reasonable coverage for such liabilities either through commercial insurance or a reasonable self-insurance mechanism, and the nature of such insurance coverage or self-insurance mechanism will be provided to the other party upon request.

VIII. Force Majeure

Any delays in or failure of performance of either party shall not constitute default or give rise to any claim for damages if and to the extent caused by or resulting from acts of God, earthquake, fire, explosion, flood, the elements, strikes, lockouts, boycotts, picketing, labor disturbances or differ-ences with workmen, acts of the public enemy, war, rebel-lion, riots, acts of any government or any cause whatsoever beyond the control of the party in default, but performance hereunder shall be resumed with all dispatch as soon as the cause preventing performance has been removed.

iX. Entirety of the Understanding

This MOU represents the full understanding of the par-ties and may not be amended in any manner except by an instrument in writing and signed by a duly authorized representative of each party.

In WITNESS WHEREOF, the duly authorized representatives of the parties have signed and delivered this Memorandum of Understanding effective as of February 1, 2011.

Signature

Date

Name

Position

Degem Woreda Representative

NASTAD Ethiopia Representative

Signature

Date

Name Tibebe Shenie

Position NASTAD Ethiopia Country Director

NASTAD Ethiopia | PO Box 1527 | 1110, Addis Ababa, Ethiopia PHONE +251 11 550 43 79 | FAX +251 11 550 94 11 | www.NASTAD.org