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Comprehensive Health Systems Strengthening

FPD’s HSS programs were implemented under two USAID/PEPFAR agreements: Comprehensive and Hybrid. FPD’s HSS programmes are implemented by means of a TA package comprising of training, mentoring and quality assurance (QA), targeted HSS interventions and expert technical advice, and HIV program-focused, time-limited direct service delivery (DSD) at high volume/high yield sites. Both programmes continued to invest heavily in strengthening District Health Management Team (DHMT) capacity and District Health System (DHS) management systems to plan, finance, manage, implement and M&E an integrated and evidence-based HIV and TB prevention, care and treatment response that is based on population needs, national policy and best practice. The Comprehensive HSS programme works in partnership with three health districts in Tshwane (Gauteng), Nkangala (Mpumalanga) and Capricorn (Limpopo), South Africa, and supports activities at community, health facility, hospital and district health management team level. The Hybrid pro- 44 FOUNDATION FOR PROFESSIONAL DEVELOPMENT Annual Report 2016/2017 Overview Developing People Strengthening Systems About FPD Innovation grammes works in partnership with two health districts in Amatole and Buffalo City Metro (Eastern Cape), South Africa, and supports activities at hospital, sub-district and district health management team level. During 2016, FPD successfully handed over activities and transitioned out of two health districts Nelson Mandela Bay Health Metro (Eastern Cape) and Greater Sekhukune (Limpopo) after four years of Hybrid HSS funding. In complement to the USAID/PEFPAR-funded HSS programmes, FPD also received funding from Global Fund to implement ART adherence clubs in five districts across three provinces. The ART adherence clubs assisted to decongest crowded facilities, streamline ART patients’ access to treatment and screening services and maintain overall high adherence and retention rates.

Through our partnership with the South African government, FPD works to: develop and inform strategies to strengthen capacity of Health Districts, to realize the National Strategic Plan on HIV/AIDS and PHC Re-Engineering Strategy; to draft, implement and monitor progress against District Health Plans (DHP), District Implementation Plans (DIP) and related work plans; and build capacity of staff to achieve and maintain good health outcomes aligned to PEPFAR’s priority HIV and TB programmes. Although FPD’s focus area remains strengthening HIV/ TB related prevention, care and treatment services, our approach is rooted in a comprehensive health systems strengthening to ensure long term sustainability and optimal integration of HIV and TB in the primary package of primary healthcare in South Africa. During the latter half of the year FPD re-focused its TA work to focus on scaling up direct service delivery in support of HIV Testing Services, ART initiation in line with the new mandate for Universal Test and Treat and improved data availability and data quality.

Key statistics from FPD’s HSS programmes in 2016 include:

  • Supported 227 facilities (comprehensive) and 15 hospitals (hybrid) with facility based TA and mentorship
  • Trained 220 Basic and Post Basic Pharmacist’s Assistant Learners (comprehensive and hybrid)
  • Trained and mentored 1,417 NIMART nurses (average of 8.6 trained nurses per facility)
  • Supported 738 nurses to achieve NIMART competence (comprehensive)
  • Retained 24,590 ART patients in Adherence Clubs(Global Fund)
  • Enrolled and completed 6,962 newly diagnosed HIV positive clients in IACT support groups (comprehen sive)
  • Supported 595 to achieve and maintain Phase 6 tier. net status) 257 comprehensive + 338 hybrid)

Supported the Department of Health in FPD’s three Comprehensive districts (July-June 2016) to:

  • Test 809,146 clients for HIV and diagnose 78,787 as HIV positive
  • Initiate 54,970 new on ART
  • Support a total ART patient load of 276,185
  • Maintained Viral Load Suppression at roughly 90%
  • Initiate more than 96% of HIV positive pregnant women on ART
  • Maintain a mother to child transmission rate of less than 1.9%
  • Enroll 134,676 clients in CCMDD, of which 66% were accessing treatment at external pick up points


The United Nations Development Programme on behalf of UNODC engaged the Trimbos Instituut, a Netherlands based organization of Mental Health and Addiction, a non-profit research and knowledge centre, to develop regional guidelines and training for provision of HIV Prevention, Treatment, Care and Support Services in Prison Settings in eleven countries in Sub-Saharan Africa. FPD has been the collaborative partner responsible for the writing of the Standard Operating Procedures in the seven areas covered by the contract, i.e. Voluntary Counselling and Testing (VCT) for HIV and AIDS in Prison Settings; Condom Programming in Prison Settings; Prevention of Mother-to-Child Transmission (PMTCT) in Prison settings; Collaborative HIV-TB activities; basic model of care and treatment in prisons aiming at psycho-social support for people living with HIV and AIDS while incarcerated and after release; general counselling for MARPs and Anti-Retroviral Treatment (ART) Service Provision. FPD, through Dr Margot Uys and Mrs Louise Badenhorst, was responsible for the deliverables (SOPs) and quality control as well as the facilitation of the workshops with assistance of the Trimbos Instituut experts. The contract started in June 2014 and ended with the final workshop on the training of the SOPS, and Guidelines in March 2016 with delegates from the eleven countries participating. The final product was delivered to UNODC (SA) at the end of April 2016 for further printing and distribution.


During 2016, FPD continued to work on a tender to assist UNICEF with providing support to provinces, districts, and facilities to close gaps in the Prevention of Mother to Child Transmission of HIV (PMTCT) continuum of care to contribute to the Last Mile Reach for Elimination of Mother to Child Transmission of HIV (EMTCT). The tender, allocated in April 2015, ended in March 2016 but was extended until December 2016. Through this work, FPD supported the Technical Working Group (TWG) meeting, supported the PMTCT symposium at the IAS conference in Durban in July, submitted monthly data for action reports, provided monitoring and evaluation support, and facilitated yearly stock-take workshops in each of the provinces, with a focus on those with the highest PMTCT rate. The 2016 National stock-take workshops kicked off in November with workshops in KZN and Limpopo and is projected to continue on into 2017.