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Planning for Sustainability of MMC Programs Panel discussion Dr. Alex Opio Arusha, Tanzania (June Planning for Sustainability of MMC Programs Panel discussion Dr. Alex Opio Arusha, Tanzania (June 2010) 1

Background • MMC will only have long-term impact on HIV prevention if the services Background • MMC will only have long-term impact on HIV prevention if the services are developed in a sustainable manner • Thus, the planning process for MMC programs should take into consideration the factors that facilitate sustainability • Some thoughts on the above 2

Key Facilitating Factors for Sustainability of MMC Programs • • • Advocacy Appropriate leadership Key Facilitating Factors for Sustainability of MMC Programs • • • Advocacy Appropriate leadership Strategic planning based on evidence of needs Integrated implementation approach Working in partnership Innovative implementing approaches 3

Advocacy • Advocacy needed at international, national and community levels to build consensus on Advocacy • Advocacy needed at international, national and community levels to build consensus on developing sustainable MC programs • Advocacy for MC services is vital right from the beginning of establishment of MC programs and during the implementation – Builds support for key decisions on policies – Encourages involvement of high level leadership 4

Appropriate Leadership • Leadership can champion development and implementation of sustainable MMC programs • Appropriate Leadership • Leadership can champion development and implementation of sustainable MMC programs • High political support is conducive for sustainability of MC interest and keep MC high on the national health agenda • Leaders who are on board of MMC programs will advocate for support and provide or mobilization resources • Supportive leaders can set enabling policy and regulatory environment. Leadership is expected to provide the required direction and guiding principles and set national goals 5

Strategic Planning Based on Evidence of Needs • Clear MC strategies facilitate advocacy and Strategic Planning Based on Evidence of Needs • Clear MC strategies facilitate advocacy and resource mobilization; hence sustainability • Ensuring that national MC strategies complement or are part of the existing HIV prevention strategy can promote sustainability • Implementing situational analysis is an important method for creating stakeholder support, engaging leaders and ensuring informed policies and programs 6

Integrated Implementation Approach • Leveraging all MC service delivery sectors (public and private) is Integrated Implementation Approach • Leveraging all MC service delivery sectors (public and private) is vital for the sustainability of MC programs – Integration across sectors • Many levels of the existing health systems may be able to provide MC services with little additional investment 7

Working in Partnership • The scale-up of MC services requires actions at many levels Working in Partnership • The scale-up of MC services requires actions at many levels and across different sector • Partnership facilitates advocacy, resource mobilization and bringing knowledge and experiences from different program areas • Partners can contribute to MC services based on their comparative advances 8

PEPAR budget allocation IP Agency Geog coverage No. sites Activities Targets Model of service PEPAR budget allocation IP Agency Geog coverage No. sites Activities Targets Model of service delivery Budget Walter Reed DOD Kayunga & Mukono districts 2 sites -Establish training satellite -provide MMC 10, 000 Static, outreach $1, 150, 000 UPDF DOD Countrywide 6 sites -Site preparation -provide MMC 6, 000 Static $372, 000 HIPS USAID Country wide 10 sites Site preparation -provide MMC 4, 000 Static $354, 580 HCP USAID National level Policy, Communication strategy, job aides, IEC 516, 587 MOH CDC National level Policy development $100, 000

PEPAR budget (1) IP Agency Geog coverage STAR E USAID STAR SW STAR EC PEPAR budget (1) IP Agency Geog coverage STAR E USAID STAR SW STAR EC No. sites Activities Targets Model of service delivery Budget Kapchorwa, TBD Sironko, Bududa, Pallisa, Busia, Bukwo, Budaka, Butaleja, Mbale Site preparation Provide MMC TBD Static $50, 000 USAID Kisoro, Kabale, Ibanda, Isingiro, Rukungiri, Ntungamo, Kiruhura, Kanungu TBD Site preparation Provide MMC TBD Static $50000 USAID Iganga, Bugiri, Mayuge, Kaliro, Kamuli, Jinja 8 sites Site preparation Provide MMC 16, 000 Static, outreach $850, 000

PEPAR budget (2) IP Agency Geog coverage No. sites Activities Targets Model of service PEPAR budget (2) IP Agency Geog coverage No. sites Activities Targets Model of service delivery Budget MUSPH CDC Rakai, Lyantonde, Masaka 14 sites -TOT -training service providers -MMC 8, 000 Static, outreach 1, 900, 000 TBD Comprehensive prevention CDC 8 districts 40 sites -Site preparation Provide MMC 10, 000 Static, Outreach $500, 000 TBD Prevention USAI D TBD -Site preparation -Surgery TBD Static, Outreach $500, 00 TBD-KCC CDC Kampala district 7 sites -Site preparation -Surgery 6, 000 Static, Outreach $300, 000 TBD-Mbarara CDC Mbarara Reg hosp, 8 sites -Training Satellite -provide MMC 8, 000 Static, Outreach $423, 420

Innovative Implementing Approaches • Implementing a mix of both vertical and integrated approaches ü Innovative Implementing Approaches • Implementing a mix of both vertical and integrated approaches ü • • Vertical approach at the beginning to attain high MC volumes Task-shifting approach to sort out human resource problems; especially at peripheral health facilities Ensuring the incorporation of the MMC commodities into lists of national essential medicines and equipment and in the procurement and distribution systems used by service delivery sites 12

I thank you 13 I thank you 13