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ICAP LesothoTransition Strategy for Sustainability
M&E Technical Meeting
Introduction• ICAP’s supports the Lesotho MOHSW to
reduce the impact of TB/HIV• Provide technical assistance within the
framework of Lesotho TB/HIV Strategic Plan• Provide nationwide support– all 10 districts – all health facilities(21 hospitals + 184 HCs & FCs)
• All facilities are owned by the MOHSW, CHAL or are Private– no ICAP facilities
LS TB and HIV/AIDS landscape
• STI, HIV and AIDS Directorate (SHAD)– HIV/AIDS programs
(HTC, PMTCT, Care, Treatment, BCC, etc)
– Nascent M&E system– EGPAF main partner
• Department of PHC – Dept. of Disease Control• National TB Program (NTP)• Strictly TB activities only• Fairly well developed TB
surveillance system
– ICAP main partner
HIV/AIDS patient TB/HIV patient TB patient
Current (inherited) TB/HIV Surveillance System
Partner support
Partner support
HC1
Hospital B
HC2 HC3 HC4 HC5
DHMT/District hospital(maintenance of district TB Rx reg, ETR, dispatches, reports, backups)
National TB Program (data cleaning, analysis,
dissemination)
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Why the parallel M&E system?
• No data collection tools at the beginning of support
• No dedicated MOHSW data personnel• Meet reporting requirements
• internal ICAP, URS, PEPFAR• Tight deadlines
• Indicators not harmonized• ‘Pre-transition era’
Effects of the parallel M&E system
• Undermined the national M&E system• Threatened relationships with MOHSW• Not sustainable
• One positive - Lesotho has embraced data personnel– Plan to have at least 1 data clerk in each health
center– 65 recruited for the northern districts to date
Major shift in new program
• MOHSW is (rightly!) insisting on ownership: – partners must support the ONE M&E system– no ICAP sites, so no parallel systems
• PEPFAR/CDC promoting transition– “If not a local indigenous organization, the
applicant must articulate a clear exit strategy which will maximize the legacy and sustainability of this project…..”
Strategy for sustainability
Remove the parallel M&E system and support the NTP’s TB/HIV surveillance system
What comes out of the NTP goes to partners and funders
• Surveillance System Strengthening• Data Quality• Data feedback• Data appreciation and use• Monitoring of community activities
Strengthening the TB/HIV Surveillance System
Maintenance of site tools (TB cards, suspects, Rx)
ICAP support
ICAP support
ICAP support HC1
Hospital B
HC2 HC3 HC4 HC5
DHMT/District hospital(maintenance of district TB Rx reg, ETR, dispatches, reports, backups)
National TB Program (data cleaning, analysis,
dissemination)
ICAP LS
WHO
URSCDC
GFCU
Surveillance System Strengthening
• Human resources (2 SO)• Regular supervision & follow-up• Data collection & reporting tools– Advocate for incorporation of TB variables in HIV
tools• Enhance Electronic TB Register– Eradicate errors, improve report generation– Train HCW– Ensure regular updating– Ensure regular data dispatches to NTP
Data Quality
• Routine supervision of paper tools at sites and ETR at district level
• Improved validation criteria in the ETR• Quarterly data verification exercises– NTP, DHMT, partners
• Annual structured QDA• NTP, DHMT, partners
Data Appreciation and Use• PERFORMANCE
FEEDBACK• Quarterly district
progress review meetings
• Annual Joint Review (national)
• Identify “star” HCW or sites and use them as “peer-educators”
Rea Leboha (Thank You)