Technical Assistance

Who we are

FPD’s Technical Assistance (TA) Cluster is the evolution of FPD’s Positive Life Project, a project initiated in 2005 in response to the urgent need to rapidly establish and scale up public sector antiretroviral Treatment (ART) clinics in South Africa. In response to the changing HIV service environment, following the decentralization of ART services to primary healthcare clinics under the supervision of NIMART (Nurse Initiated and Managed Antiretroviral Treatment) nurses and the new PEPFAR Partnership Implementing Framework negotiated between the South African Government and the US Government, FPD’s focus has shifted from supporting direct HIV service delivery to providing technical assistance (TA) in support of health systems strengthening.

Since October 2012, FPD has received funding from PEPFAR through USAID to work in partnership with nine district Departments of Health to provide technical assistance (TA) to strengthen the health system. The aim of FPD’s TA is to improve HIV and TB patient outcomes in these partnered districts. FPD defines Technical Assistance as “a dynamic, capacity-building process for designing or improving the quality, effectiveness and efficiency of specific programmes, research, services, products or systems.” As a guide for the FPD TA strategy, FPD adopted an approach based on the World Health Organization’s (WHO) Health Systems Framework and Systems Thinking for Health Systems Strengthening (WHO, 2010). This framework identifies six components of a healthcare delivery system known as the building blocks, namely: service delivery, health workforce, information, medical products vaccines and technology, financing and leadership and governance. Given the South African context, FPD has also adopted community as a seventh building block in our model of health systems strengthening (HSS). FPD uses this model to help frame its TA activities in order to strengthen the individual building blocks, as well as their interactions with an aim to improve access, coverage and quality of HIV and TB prevention, care and support services in public sector primary care clinics.

As a guide for the FPD TA strategy, FPD adopted an approach based on the World Health Organization’s (WHO) Health Systems Framework and systems thinking for health systems strengthening (WHO, 2010).

This framework identifies six components of a healthcare delivery system namely: Leadership, Human Resource, Information, Finance, Service Delivery, Products and Technology. In addition to the six building blocks, FPD has adopted Community as a seventh building block.

Figure 14: Health systems strengthening model

In line with the mandate from PEPFAR 3, the focus of FPD’s TA activities is rooted in district ownership, district management and strengthening the district health systems to accelerate PEPFAR core interventions for HIV epidemic control. Our end goal is to build district capacity and commitment to achieve the UNAIDS’s goal of 90-90-90 by 2020: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; 90% of all people receiving antiretroviral therapy will have viral suppression; for TB 90% of all high risk and vulnerable screened for TB, 90% of all prevalent TB diagnosed and on treatment and 90% of all on treatment successfully completing treatment.

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, the 90-90-90 District Implementation Plan (DIP) 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.

FPD provides TA through four complementary work streams that are needs-driven and contribute towards long-term sustainability:

  • Targeted Educational Programmes delivered through FPD’s Academic Cluster in partnership with Regional Training Centres and aligned to the District Health Plan, skills needs assessments and key priority areas.
  • Facility-Based Technical Assistance delivered through roving mentor teams and programme champions aligned to our PEPFAR mandate, NDOH policy, facility needs, the District Health Plan and priority programme areas and supported through Quality Improvement cycles using Ideal Clinic/Integrated Clinic Services Management.
  • District Management-Based Technical Assistance delivered through TA advisors and technical experts aligned to the WHO building blocks and implemented through District Health Management structures.
  • Sustainability and Resource Mobilisation delivered through the integrated TA cluster with the aim to secure future budgets and financing and/or leverage additional funding in support of the district health system and improved health outcomes.

The individual districts’ mixture of technical assistance services is determined by data, gap analysis and consensus regarding the priority needs expressed by the partnered districts and may involve a combination of training, mentoring, focussed direct services especially in support of the first 90 to identify the pool of undiagnosed and unknown HIV positives and provision of consultancy-like services to district health counterparts.

TA Cluster

Highlights of 2015

During 2015, FPD TA was awarded three new grants that contributed to improved health outcomes in South Africa:

  • USAID funding to implement Communities Forward (Sector Three): Comprehensive Community-Based HIV Prevention, Counselling and Testing Programme for Reduced HIV Incidence in fourteen districts in South Africa;
  • Global Fund funding to implement ART adherence clubs in six districts; and
  • Making All Voices Count (MAVC) funding to strengthen the engagement and feedback loop between survivors of sexual assault and service providers at Thuthuzela Care Centres.
  • In 2015 FPD sustained at least one more grant to provide technical assistance towards the elimination of mother to child transmission of HIV. UNICEF has commissioned FPD to assist with organising National and provincial level workshops, conducting facility visits, and supporting and monitoring data-related activities related to the Last Mile Reach for EMTCT.
  • In addition, FPD continued to implement its two existing PEPFAR grants through USAID to support comprehensive technical assistance in four districts (Tshwane GP, Vhembe LP, Capricorn LP and Nkangala MP) and district level technical assistance in five districts (Greater Sekhukhune LP, Amatole EC, Buffalo City EC, Nelson Mandela Bay Metro EC, and Cacadu - now Sarah Baartman District - EC).

For year three of these TA grants, FPD focussed on: implementing its district-level health systems strengthening strategies which were developed according to baselines and in consultation with district management teams in 2013; strengthening district health planning, budgeting and monitoring processes; prioritizing competency assessment and graduation of NIMARTtrained nurses; and transitioning FPD facility-level TA and NIMART mentorship to align with the Integrated Clinic Management Services (ICSM) and a commitment to facility graduation from NIMART mentorship. Cumulatively, FPD implemented donor funded activities in 22 health districts in 8 provinces under 6 grants.

Funding for FPD’s flagship TB project, the that’sit project, was discontinued and therefore all activities and support in Eden district in the Western Cape, Tlokwe sub-district in Dr Kenneth Kaunda and Molopo sub-district in Dr Ruth S Mompati in the North West province were discontinued at the end of March 2015.

Figure 15: Health district supported by FPD through TA activity

Health district supported by FPD through TA activities
In accordance with donor requirements, the Technical Assistance Cluster operates on the PEPFAR budgeting cycle that runs from October to September. All indicators reported below measure project output during the most recent PEPFAR year.

Performance against expanded (stretch) targets

FPD TA activities are implemented through four departments using a matrix management approach. The following sections give a brief overview of the TA Cluster’s four departments and their major achievements for 2015.