Models of Support to FBO providers to scale up HIV services

Members• Martin Sirengo-Kenya• Bruno Miteyo-DRC• Samuel Mwenda-Kenya• Jean Claude Kazadi-USA• Robert J. Vitillo –Caritas Int• Carla Smith-USA• Abubakar Sebwela-RSA• Lebo Mothae-Lesotho

• Gift Werekhwe-Malawi• Mona Bormet-USA• Nyambura Njoroge-

Switzerland• Mafase Sesani-Malawi• Bzorg Sandkjaer-Norway• Sue Parry-Zimbabwe• Theresa Maseka-Zambia

Introduction

• Arrangements date back to colonial period• Many countries have national secretariats

coordinating discussions and service delivery• Some have one umbrella secretariat like

Malawi (CHAM) and Zambia (CHAZ) whereas others are separate like Uganda and Kenya

• Gentleman's agreement used initially until no funding was forthcoming. This has led to govts entering into MOUs with FBOs

Current models (MOUs)

General1. MOUs-general2. PPP agreements

Specific• Financial support agreements

– Between Govt-FBO secretariatMOH-FBOsMOF-FBOs

• Service agreements -for compensation for certain services provided– May differ from one area to another

Areas of collaboration

• Human resource support– Hire/secondment of HCWs– Training of HCWs

• Payment of utility bills e.g. Electricity and water• Supply of commodities and essential drugs• Policy formulation and IEC role• M&E: Reporting and accountability• Service delivery

Challenges• Respect and operationalization of MOUs?-Sometimes

Misinterpretation of MOUs• Changes in the Political landscape affects existing MOUs• Govts may have reservations about capacity of FBOs to

provide services. NB: FBOs services are complementary• Government support not matching the workload of FBOs• Staff turn-over (back and forth movement depending on

funding esp among seconded HCWs)• Nationalization of church services by governments causing

suspicion and mistrust• Compensation may not be commensurate to the workload,

cost of services and may not be timely

Recommendations

1. Have and operationalize MOUs and its specifics i.e Funding HR support Supply chain support Service delivery M&E

Additionally: Monitoring and accountability mechanism for the MOU

implementation Harmonization of terms of service, salaries and benefits for

HCWs