USAID ASSIST Project Lesotho Country Report FY16 Cooperative Agreement Number: AID-OAA-A-12-00101 Performance Period: October 1, 2015 – September 30, 2016 DECEMBER 2016 This annual country report was prepared by University Research Co., LLC for review by the United States Agency for International Development (USAID). The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is made possible by the generous support of the American people through USAID. USAID ASSIST Project Applying Science to Strengthen and Improve Systems Lesotho Country Report FY16 Cooperative Agreement Number AID-OAA-A-12-00101 Performance Period: October 1, 2015 - September 30, 2016 DECEMBER 2016 DISCLAIMER This country report was authored by University Research Co., LLC (URC). The views expressed do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Acknowledgements This country report was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, which is funded by the American people through USAID’s Bureau for Global Health, Office of Health Systems. The project is managed by URC under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC's global partners for USAID ASSIST include: EnCompass LLC; FHI 360; Harvard T.H. Chan School of Public Health; HEALTHQUAL International; Initiatives Inc.; Institute for Healthcare Improvement; Johns Hopkins Center for Communication Programs; and WI-HER, LLC. For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or write [email protected]. Recommended citation USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. 2016. Lesotho Country Report FY16. Published by the USAID ASSIST Project. Bethesda, MD: University Research Co., LLC (URC). Table of Contents List of Figures ............................................................................................................................................. i Abbreviations .............................................................................................................................................. i 1 INTRODUCTION ....................................................................................................................................... 1 2 PROGRAM OVERVIEW ............................................................................................................................ 2 3 KEY ACTIVITIES, ACCOMPLISHMENTS, AND RESULTS .................................................................... 4 Activity 1. Strengthen linkages and retention to improve clinical services ................................................ 4 Activity 2. Strengthen the capacity of DHMTs in five “sustained response districts” to oversee and monitor the quality of services for PLHIV currently enrolled in PMTCT and care and treatment ...... 9 Activity 3. Build capacity for national level QI program coordination and management ......................... 12 Activity 4. Quality improvement in OVC programming ............................................................................ 12 4 IMPROVEMENT IN KEY INDICATORS .................................................................................................. 15 5 SUSTAINABILITY AND INSTITUTIONALIZATION ............................................................................... 17 6 KNOWLEDGE MANAGEMENT PRODUCTS AND ACTIVITIES ........................................................... 17 7 GENDER INTEGRATION ........................................................................................................................ 19 8 DIRECTIONS FOR FY17 ........................................................................................................................ 19 List of Figures Figure 1. Improving retention, quality of care and data quality, Lithipeng Health Center, Mohale’s Hoek (April 2014-Sept 2016) .................................................................................................................................. 6 Figure 2. Improving retention, quality of care and data quality, Morifi Health Center, Mohale’s Hoek (April 2014-Sept 2016) ........................................................................................................................................... 7 Figure 3. Improving retention, quality of care and data quality, Mofumahali-Oa-Rosari Health Center, Mohale’s Hoek (April 2014-Sept 2016) ......................................................................................................... 8 Figure 4: Slice of the health system .............................................................................................................. 8 Figure 5: Slice of the health system in multiple districts ............................................................................... 9 Figure 6. Percentage of mother-baby pairs retained, 12 PHFS sites (Nov 2013-Sept 2016) .................... 11 Figure 7. Percentage of mother-baby pairs receiving standard package of care, 4 faith-based facilities, 2 government hospital, and 6 other government facilities (Nov 2013 – Sept 2016) ...................................... 11 Figure 8. Progress among sub-grantees in registering and developing care plans for vulnerable families, 8 sub-grantees (Sept 2016) ........................................................................................................................... 14 Abbreviations AIDS Acquired immunodeficiency syndrome ANC Antenatal care ART Antiretroviral therapy ASSIST USAID Applying Science to Strengthen and Improve Systems Project CBO Community-based organization CC Community Council CDC U.S. Centers for Disease Control and Prevention CHAL Christian Health Association of Lesotho COP Country Operation Plan USAID ASSIST Lesotho Country Report FY16 i DCPT District Child Protection Teams DHMT District Health Management Teams FY Fiscal year GOL Government of Lesotho HBC Home-based care HIV Human immunodeficiency virus HTC HIV testing and counselling IP Implementing partner LENASO Lesotho Network of AIDS Services Organisations LVHIT Lesotho Vulnerable Household Identification Tool M&E Monitoring and evaluation M2M Mothers 2 Mothers MNCH Maternal, newborn, and child health MOH Ministry of Health MOSD Ministry of Social Development MSH Management Sciences for Health NGO Non-governmental organization OVC Orphans and vulnerable children PEPFAR U.S. President’s Emergency Plan for AIDS Relief PHFS Partnership for HIV-Free Survival PLHIV People living with HIV PMTCT Prevention of mother-to-child transmission QA Quality assurance QI Quality improvement REPSSI Regional Psychosocial Support Initiative RFA Request for Applications SIMS Site Improvement through Monitoring System SRD Sustained response district SUD Scale-up district TA Technical assistance TWG Technical working group USAID United States Agency for International Development WHO World Health Organization ii USAID ASSIST Lesotho Country Report FY16 1 Introduction The Government of Lesotho (GOL) launched its National Antiretroviral Therapy (ART) Program in November 2004. Since the national program was launched, the GOL’s efforts to provide ART have been hampered by chronic shortages of staff due to high staff attrition rates and historically high costs of drugs. In recent years, the country has made significant progress in scaling up treatment for HIV and AIDS. The number of people on treatment has risen steadily since the onset of the national program, in spite of service delivery gaps. A key problem still being encountered is that only a few of the children requiring therapy receive it. Since November 2013, the GOL has worked with the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project on the following areas: Development of a national strategy for improving the quality of clinical services. This strategy is to be consistent with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Quality Framework; Strengthening linkages between HIV testing and counselling (HTC), antenatal care (ANC), maternal, newborn, and child health (MNCH), HIV care and treatment, prevention of mother-to-child transmission of HIV (PMTCT), and home-based care (HBC) services; Improving the quality, uptake, and retention of services along the continuum of PMTCT care; and Scaling up of quality improvement (QI) within integrated clinical services. In fiscal year 2016 (FY16), ASSIST’s work in Lesotho was revised to align it to the PEPFAR Country Operational Plan (COP 15). COP 15 defines the intention of USAID to increase the number of eligible people receiving ART with the key aim of achieving 80% coverage in five priority scale-up districts (SUDs) defined as being most burdened by HIV: Berea, Leribe, Mafeteng, Maseru, and Mohale’s Hoek. The other five districts have been designated as sustained response districts (SRDs). In the SRDs, ASSIST has been asked to direct support to the District Health Management Teams (DHMTs) and health unit in- charges. In June 2016, Lesotho became the first country in the world to launch the new World Health Organization (WHO)-recommended “Test and Treat Initiative” for managing the HIV pandemic. This initiative is expected to exponentially increase the number of patients of all ages on ART in Lesotho. ASSIST has been requested by USAID to support an enhanced