Creation of non-governmental organizations
The US Government is increasingly turning to host-country institutions to implement its programs. These new NGOs will initially work under US development institutions as sub-grantees or sub-contractors, with the goal of becoming self-sustaining NGOs that can take on a large part of the work currently performed by expatriate development institutions.
In accord with this policy, IDEAS has provided technical and planning assistance to create a non-profit, non-governmental organization for a USAID project in Afghanistan. The Afghan Social Marketing Organization (ASMO) – committed to building the demand for and supply of high-quality priority health and family planning products – is well under way, with strong support from IDEAS. IDEAS worked with ASMO to conduct its first Board of Directors meeting and drafted major portions of the organization’s business and transition plan. With IDEAS’ and others’ assistance, the organization completed several prerequisites and, in November 2010, became the largest sub-contractor on USAID’s social marketing project and the prime example of USAID’s “Afghanization” strategy.
InAfghanistan, IDEAS supported an assessment of the policy environment which encompassed the private sector’s provision of health services and products. Based on assessment findings, we assisted the Ministry of Public Health to draft the National Policy for the Private Health Sector. This groundbreaking policy fosters collaboration between the public and private sectors, with increased contribution by private health services to national public health goals. IDEAS then facilitated the development of a comprehensive strategic plan to implement the policy, as well as the strengthening of private-sector business associations to serve as intermediaries between the Government of Afghanistan and private-sector business entities.
Preparing for Global Fund Round 8 HIV/AIDS funding
With PEPFAR funding, IDEAS worked with the Country Coordinating Mechanism (CCM) to analyze gaps in HIV/AIDS programming in preparation for submission of the CCM’s proposal for Round 8 of the Global Fund. Collaborating with the public and commercial sectors and civil society groups, IDEAS facilitated the CCM’s efforts to prioritize interventions, create the framework for implementation, develop the workplan and establish the M&E plan.
Developing the Round 9 Global Fund proposal
With PEPFAR funding, IDEAS led a team of advisors to the CCM to develop a cross-cutting health systems strengthening strategy for HIV/AIDS, TB, and Malaria. The Team then worked with each disease-centered team to prepare a comprehensive implementation approach. Finally, IDEAS led the development of the final proposal submitted to the Global Fund, including translation from French into English.
Democratic Republic of the Congo
Improving quality of care in health zones
IDEAS worked with the Provincial Ministry of Health in both Kasai Occidental and Kasai Oriental to develop a quality improvement strategy at the health zone and health facility levels. The first steps were to adapt the Fully Functional Service Delivery Point model (used in several other country settings) to the specific DRC realities, and to build the capacity of local technical assistance teams to introduce the model. IDEAS then worked with district and zone leaders to field-test the model, conduct a baseline study, analyze preliminary results, modify the model, and then move to full implementation in 24 health zones.
Assessing monitoring and evaluation systems across multiple Global Fund Principal Recipients
The Republic of Ghana has received two large-scale HIV-AIDS grants from the Global Fund: one emphasizing care and treatment and the other focusing on prevention services. The prevention grant involves the coordinated efforts of four Principal Recipients (PRs), including the Ghana AIDS Commission, which is formally designated to lead the HIV-AIDS response in Ghana.
Once the prevention grant was approved, the Global Fund required each PR to conduct a formal assessment of its monitoring and evaluation (M&E) systems, and to use the results of that assessment in preparing an M&E systems strengthening plan. The Ghana AIDS Commission solicited proposals for assistance in this process and selected IDEAS because of its extensive Global Fund experience in assessing and strengthening the M&E systems of national disease programs.
IDEAS fielded two workshop facilitators who had significant experience with the Global Fund’s M&E Systems Strengthening Tool (MESST). This team worked with the Ghana AIDS Commission and two other PRs (Adventist Development and Relief Agency and Planned Parenthood of Ghana) to design and implement a two-day workshop for staff from more than 25 implementing organizations. The workshop was designed to foster dialogue and sharing of experiences as well as to contribute to stronger M&E systems.
In addition, the team worked with management and M&E staff from each of the PRs to develop and submit formal M&E system-strengthening plans. Senior managers from all the organizations expressed their satisfaction with the collaborative relationships created through this process, as well as with the quality of the final products..
Researching global health issues
IDEAS was engaged by an influential former Senior Vice Minister of Health of Japan to research global health issues for presentations at major international conferences and to promote Japanese government action on global health. This dignitary also used IDEAS’ services in his role as leader of a working group to prepare for the G8 Summit in Japan in 2008. This work made a substantive contribution to giving global health and health systems strengthening a high priority on the G8 Summit agenda.
Male circumcision to reduce the incidence of HIV/AIDS
Many research studies have shown that male circumcision can significantly reduce the risk of HIV acquisition by men. With funding from the US Centers for Disease Control and Prevention (CDC), IDEAS is working as a subcontractor to Westat to develop, validate, and apply tools by which to measure and monitor the quality of circumcision procedures conducted by local CDC grantees. Using these field-validated tools, IDEAS provides clinical expertise to the technical team assessing rapidly expanding male circumcision services in Kenya, Swaziland and other African countries. Working with colleagues on the external quality assurance team from CDC, USAID, National Institutes of Health, and ministries of health, IDEAS contributes to maintaining the quality of male circumcision services at public and private facilities.
Project assessment and health financing consulting
A two-person IDEAS team assisted the International Rescue Committee (IRC) PRIDE Project to assess its accomplishments after four years of work in two of the districts most affected by the devastating 2005 earthquake in northern Pakistan. The assessment showed that the PRIDE team achieved remarkable results which were featured in the local media. Important quality and service delivery indicators improved, some dramatically. Interviews with facility managers and committee chairmen indicated a strong belief that they could sustain many of the improvements after the end of PRIDE.
Earlier, through USAID funding, IDEAS provided PRIDE with health financing advice, in the same two earthquake-devastated health districts. With technical support from IDEAS, PRIDE completed an analysis of the increased recurrent costs of the expanded infrastructure being built to replace that which was destroyed in 2005.
Additional work with PRIDE staff provided support to develop district health plans, which increased prospects for the sustainability of the project’s interventions. We also worked with PRIDE staff to develop strategies to link financing to the achievement of service performance objectives in the two districts..
Improving quality management in health
IDEAS facilitated the Ministry of Health’s efforts to create a National Policy for Quality Management in Health, a five-year strategic plan, and associated implementation plans.
We created a set of common quality indicators for use throughout the health system; led the team which created the “Patient’s Charter of Rights and Responsibilities”; and proposed a new governance structure for government and civil society to monitor and assure quality services. IDEAS worked with USAID’s Performance-Based Financing Initiative, interviewing staff, clients, community members, and leaders of mutuelles to improve the quality measurement aspects of performance incentives. Based on the findings, we then worked with the Ministry of Health to begin a reform of district-level supervision, introducing a more formative and less punitive approach. This involved working with all donors and implementation partners in-country to achieve consensus around the need for change and the way forward.
IDEAS was called on to respond to the recommendation for a review of the financial situation at CAMERWA, the parastatal organization responsible for the purchase, storage, and distribution of medicines and other medical supplies. To strengthen overall performance, IDEAS assisted CAMERWA staff in installing and implementing the USAID-funded state-of-the-art financial management system. IDEAS also contributed to the assessment of options for active distribution by CAMERA, as opposed to the existing passive distribution system under which the staff of health facilitieshad to travel to CAMERWA’s warehouse to collect products.
Evaluating health care financing
Through a sub-contract to Development & Training Services, Inc. (dTS), IDEAS led an evaluation team in Senegal to evaluate USAID’s Health Care Financing and Systems Reform Program. This qualitative evaluation included document review, key informant interviews and focus group discussions. The team conducted multiple site visits to rural areas as well as consultations at varying levels of government. Data analysis was conducted in-country and the team made detailed recommendations to USAID and the MOH on next steps in health care finance reform.
The quality of male circumcision services
IDEAS is providing technical expertise for external quality assurance of new male circumcision services for HIV/AIDS prevention in Swaziland, which has one of the highest HIV/AIDS rates in the world. Quality assurance includes all aspects of male circumcision services, including counseling. It conveys two critical messages: that male circumcision reduces the risk of acquiring HIV/AIDS by about 60% and that other risk-reduction behaviors must also be used. IDEAS works in collaboration with the Swazi Ministry of Health, CDC, USAID, and Westat.