PEPFAR / MCC COLLABORATION YIELDS RESULTS IN LESOTHO

UNCLAS SECTION 01 OF 03 MASERU 000387

SIPDIS

STATE FOR O/GAC, AF/S
USAID FOR OHA, AFR/SA
STATE PASS TO MCC: JBLOOM AND ASHERINIAN
PRETORIA FOR USAID
CDC FOR OGHA

E.O. 12958: N/A
TAGS: EAID KMCA KHIV LT
SUBJECT: PEPFAR / MCC COLLABORATION YIELDS RESULTS IN LESOTHO

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Summary
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1. Excellent collaboration between Embassy Maseru's PEPFAR and
MCC teams is resulting in efficient linking of USG-funded
activities and leveraging resources for greater impact in
pursuit of common health goals. High level support for
interagency collaboration; common objectives; Lesotho
government-led development of the MCC Compact and PEPFAR
Partnership Framework; and on-the-ground coordination between
USG personnel have contributed to this success. Post values the
outstanding cooperation and strong interpersonal relationships
formed between the members of the PEPFAR and MCC teams in what
has became an outstanding example of effective interagency
collaboration.

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Background
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2. In 2003, the PEPFAR program began working in Lesotho from a
regional base in Pretoria. The focus of the program was to
assist the Government of Lesotho (GOL) in addressing the
HIV/AIDS crisis through supporting prevention of mother-to-child
transmission, counseling and testing, TB/HIV, and prevention
programs, while also strengthening the human resource and health
systems capacity of the Ministry of Health and Social Welfare
(MOHSW). Over the past three years, the PEPFAR program has
transitioned to management by a country-based team that includes
representatives from the Department of State, USAID, CDC, DOD,
and Peace Corps.


3. In 2005, the GOL started negotiations with MCC to develop a
Compact to reduce poverty through sustainable economic growth
targeting water and private sector reform. In 2006, GOL
requested assistance to broaden the proposed MCC Compact to
include a health component, recognizing the significant link
between poverty and HIV/AIDS. The proposal, developed by the
MOHSW, in consultation with other GOL bodies, NGOs, and
development partners, briefly analyzed gaps in the essential
health services program, including HIV/AIDS, and targeted health
infrastructure improvements for MCC funding. Priorities were for
enlarging and refurbishing health centers nation-wide, including
staff housing, strengthening up to 14 anti-retroviral treatment
(ART) centers at district and sub-district hospitals,
construction of a new National Reference Laboratory, a new
Blood Bank Center and a new dormitory facility at the National
Health Training Center. A significant health systems
strengthening component, addressing human resources, health
information and support for decentralization, was later added to
this proposal. The proposal included activities in infection
control, improving service quality, laboratory strengthening,
ART program strengthening, health information systems
development, support of de-centralization of health services,
medical waste management and human resources and capacity
building to maximize health service delivery.

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Early Collaboration and Support to the Lesotho Government
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4. Collaboration between MCC and PEPFAR was established early
during compact development in 2006 to facilitate development of
the health component of the compact. The PEPFAR Coordinator was
instrumental in providing information regarding USG and other
donor activities; frank assessment of the MCA request and
perceived strengths and weaknesses of the MOHSW; information
regarding the structure of the donor community; assistance in
identifying and accessing important informants; and identifying
important areas for MCC assessment. In addition, the PEPFAR
Coordinator hosted meetings with relevant NGOs and PEPFAR
contractors to facilitate discussion and fact-finding by the MCC
team. This collaboration between the PEPFAR and MCC teams was
fully supported and encouraged by Mission management.


5. During the ensuing 6 months - through December 2006 - the
PEPFAR Coordinator, her staff and PEPFAR contractors assisted
the MOHSW and the Millennium Challenge Account-Lesotho (MCA-L),
the national body responsible for proposal preparation, in
developing further information as needed for strengthening the
MCA-L health proposal. This included preparation of a human
resources/capacity building component to complement the original
infrastructure component, supported by a PEPFAR-funded

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IntraHealth consultant working in the MOHSW's Human Resources
Department, and assistance from the CDC in Pretoria to conduct
due diligence on the MOHSW's proposals for a new National
Reference Laboratory and a new Blood Collection and Processing
Center.

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Common Objectives/Comprehensive Health Response
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6. The goal of the MCC Compact was to reduce the excessive
mortality rates due to high prevalence of HIV/AIDS and
tuberculosis. Economic rate of return analyses undertaken by the
MCA-L and by MCC confirmed the importance of this goal not only
to improve lives and health, but also for economic growth. The
objectives for the MCA-L health proposal were to improve health
infrastructure needed to strengthen health services delivery and
to improve working conditions for health staff , thereby
improving job satisfaction and reducing the loss of qualified
health care workers to other countries. PEPFAR indicators were
reviewed, and those that focused on measuring reduction in
HIV/AIDS were included in the MCC Compact monitoring and
evaluation plan for the health project. These are now a main
element of the MCA-L evaluation framework.

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Compact Proposal Assessment
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7. Given the wide range of technical areas covered by the
proposal, and the extraordinary level of expertise represented
by PEPFAR implementing agencies CDC and USAID and their
respective contractors in the region, the MCC health team
requested support. CDC experts based in Pretoria provided
technical support for reviewing the proposed national laboratory
plans. PEPFAR-funded NGO Safe Blood for Africa, mobilized
consultants to review the proposal and plans for blood banking
facilities, and also provided consultant expertise on physical
means of infection control to the MCC infrastructure due
diligence team. In addition, the PEPFAR Coordinator continued to
play a role in donor and NGO coordination, calling meetings and
providing fora for consultation and discussion.

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Continued MCC PEPFAR Collaboration
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8. Since MCC Compact signing in 2007, the PEPFAR team in
Lesotho has grown to include resident staff from US Department
of State, USAID, CDC, DOD, and Peace Corps. PEPFAR support
through these agencies has also grown significantly, most
recently with the signing of PEPFAR's Partnership Framework
between Government of Lesotho and the USG. The Partnership
Framework (PF) includes significant investments in health
systems strengthening, which complement the MCC Compact health
infrastructure initiatives and health systems strengthening
activities. In developing the PF, PEPFAR set ambitious goals
and objectives, which took into account MCA-L's infrastructure
and other health plans. For example, PEPFAR intends to work
closely with the MOHSW and Ministry of Public Service to develop
a retention policy and strategy; MCA-L's support to develop a
education strategy, and its construction or refurbishment of
staff housing at health clinics, provide key pieces of that
strategy.


9. Collaboration continues to grow between PEPFAR and MCC in
both MCC Compact and PF implementation. PEPFAR and MCC hold
monthly strategic meetings to ensure collaboration and maximal
leverage of resources. PEPFAR has recently funded an additional
health infrastructure staff position within the MCA through a
PEPFAR partner. CDC has provided support to ensure infection
control training and consultation on MCC Compact infrastructure
activities. MCC and PEPFAR collaborate to support the MOHSW in
decentralization, human resources for health, and health
informatics initiatives. Likewise MCC and PEPFAR are
collaborating in assisting MOHSW to develop and operationalizing
a national infection control policy to prevent spread of TB,
including multi-drug resistant (MDR) and extreme drug resistant
(XDR) TB in health facilities.

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Lessons Learned
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10. Early collaboration between PEPFAR implementing agencies,
MCC, and the MOHSW led to fruitful and efficient design and
assessment of the MCC Compact's Health Project. US
Government-led donor coordination in the health sector provided
the background against which a gap analysis could be undertaken
and specific components targeted for MCC funding. It also
provided an effective framework for early agreement on project
goals and objectives, allowing MCC and MCA-L economic analysis
at an early stage to confirm the appropriateness of the proposed
activities in meeting the MCC economic growth mandate. Today,
ongoing work by MCA-L, and the newly signed Partnership
Framework, provide additional areas of collaboration to address
significant health challenges in Lesotho. The combined
coordination and expansion of USG efforts in health is providing
an opportunity to assist the Government of Lesotho in
overhauling the health system to meet the nation's needs.
NOLAN