EGPAF's Experience with Transitioning HIV Care and Treatment Programs to Local Partners, By Stephanie Cálves of EGPAF

For eight years, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has supported HIV prevention, care, and treatment services to women, children, and families through the Centers for Disease Control and Prevention (CDC)-funded initiative Project HEART in Côte d’Ivoire, Mozambique, South Africa, Tanzania, and Zambia. Through its groundbreaking, lifesaving work in these five countries, Project HEART has enabled 1 million people to lead healthier lives. In addition to scaling up access to care and treatment services, two additional focuses of Project HEART were strengthening government health systems and the empowerment of local partners to provide quality health services. As part of this effort, in 2008, EGPAF began a process to transition Project HEART’s programmatic work to local, independent partners, including local NGOs and host country government agencies.

Through Project HEART, EGPAF has helped launch and strengthen three new independent NGOs in Côte d’Ivoire, Mozambique, and Tanzania:

• Fondation Ariel Glaser pour la Lutte Contre le SIDA Pediatrique – Côte d’Ivoire
• Fundação Ariel Glaser contra o SIDA Pediátrico – Mozambique
• Ariel Glaser Pediatric AIDS Healthcare Initiative – Tanzania

In the organizational development process, local staff and stakeholders identified a need for a long-term partnership between EGPAF and the new NGOs in order to promote accountability to international standards; provide access to technical resources and shared management systems; facilitate capacity building; and provide brand credibility to enhance organizational viability. To address these challenges, EGPAF and the new NGOs have developed a model for long-term affiliation, which has resulted in the emergence of a network of organizations that has a shared investment in supporting HIV programming in each country.

Given the nature of the transition process, effective organizational change management was a key factor for success. The establishment of the new NGOs meant that new communication structures, coordination mechanisms, and supervisory roles for staff would be developed. Some of the staff responsible for implementing Project HEART for EGPAF would be starting to work for the new local organizations, thus requiring that human resources systems be harmonized and staff be capacitated to take on new levels of leadership within the new organizations. The transition also meant that new finance, administrative, human resources, and program management systems needed to be established. To ease the impact of these types of changes on staff, at both the global and country levels, EGPAF established working groups at both levels to lead the transition process and established regular forums for communication across the organization.

With the transition also came risks. These risks included the potential for interruption of the continuity of programs, mismanagement of funding, and reputational risks if the process did not proceed smoothly. To address these risks, the transition process included a strong monitoring component. An accreditation structure was established for the new organizations, which facilitates ongoing organizational strengthening, allows for early detection of problems, and facilitates capacity building to address weaknesses.

As the eight-year Project HEART initiative came to a close in February 2012, EGPAF is excited that these organizations are able to move forward independently through new projects funded by the U.S. Centers for Disease Control and Prevention (CDC). Through these projects, they will be able to continue to support HIV care and treatment programs, strengthen their organizational capacity, and expand their impact. In addition, EGPAF and these new local partners will continue to partner with host country governments to strengthen health systems at the national, provincial, and district levels to assume greater ownership, leadership, and management of HIV/AIDS programs. The success of these future efforts will require both EGPAF and its local partners to maintain strong partnerships with host country governments, innovative mechanisms for measuring capacity building activities, and a strong focus on strengthening operations, leadership, and management systems.

EGPAF has developed a number of important tools through the process of launching Affiliates and transitioning programs to these new organizations. We view these as important resources for other organizations also engaged in HIV/AIDS programming. EGPAF has brought these tools and resources together in the toolkit Sustainability Focused Organizational Development: Tools and Resources for Foundation Affiliates. This toolkit includes an overview of the EGPAF’s affiliation model and accreditation system, a checklist organizational start-up, and the EGPAF’s accreditation review tool. It also includes the Organizational Capacity and Viability Assessment Tool, which is a product of EGPAF’s collaboration with ICF International.

For more information on Project HEART or EGPAF, contact Stephanie Cálves at scalves@pedaids.org.

ICF/CEDARS completes work with EGPAF

Over the past three years, ICF/CEDARS has been supporting various different aspects of the Elizabeth Pediatric AIDS Foundation’s (EGPAF) transition monitoring efforts for their CDC-supported PEPFAR program, Project HEART (Help Expand Antiretroviral Therapy to children and families). This month marks the successful completion of both Project HEART and the technical support from CEDARS (the end-of-project report and more information on Project HEART can be found at: http://www.pedaids.org/ProjectHEART).

As part of the PEPFAR Track 1.0 treatment initiative, this eight-year project was launched in Côte d’Ivoire, South Africa, Tanzania, and Mozambique in an effort to scale up ART through existing organizations implementing PMTCT (prevention of mother-to-child transmission). A core goal of Project HEART was to transition care and treatment activities to local partners in a sustainable way.

EGPAF contracted ICF/CEDARS to provide technical assistance in 1) the development of a plan for this transition, 2) the design and development of tailor-made data collection tools to measure progress in this transition process: the Organizational Capacity and Viability Assessment Tool (OCVAT), the Site Capacity Profile (SCP) for facility level assessments, CBO Capacity Profile for local organizations providing ARV treatment support, and a service delivery site mapping inventory, 3) the design and development of a training curriculum for country programs on program design for sustainable health outcomes, based on the Taking the Longview Sustainability Planning Manual.

The fruits of this productive collaboration between EGPAF and ICF/CEDARS will be posted on the CEDARS website over the course of the next few weeks—keep any eye for them!

Watch this video about the impact of Project HEART:

Living Proof: A Father and Son Love Story from EGPAF on Vimeo.

Early Indicator of a Turning Tide?

The Center for Global Development shares a video of Liberia’s President Ellen Johnson Sirleaf. In her speech, President Sirleaf announces the intention to lead her country to be free of foreign assistance within a decade.

That may be a tall order, a long journey (pick your metaphor), fraught with challenges and unwanted effects. But I see this as a first furtive sign on the horizon that big changes are going to come. I remember the head of a bilateral agency in one of the poorest countries on us telling me: "we will align when they make us."

The transition to country ownership--whatever this means (hopefully not again government domination over civil society)-- is unlikely to be smooth and linear, when we have created self-replicating systems and institutions. There might be some turbulence before more functional inter-workings are found. But no matter what, it will start by countries and their governments raising a voice and taking charge.

Not sure it will always be pretty, but I think it's necessary.

Eric