New GHFP-II Position Available: Advisor for Program Integration, Iringa Initiative and Evaluation

in Jobs, Practicums/Internships
May 10th, 2012

Global Health Fellows Program II

Technical Advisor II: Advisor for Program Integration, Iringa Initiative and Evaluation

USAID/Tanzania

Location: Iringa, Tanzania

Assignment: Two year fellowship

GHFP II-P1-034

The Global Health Fellows Program (GHFP-II) is a five year cooperative agreement implemented and managed by the Public Health Institute in partnership with CDC Development Solutions and Management Systems International. GHFP-II is supported by the US Agency for International Development (USAID).

GHFP-II’s goal is to improve the effectiveness of USAID health programs by developing and increasing the capacity of health professionals with tailored development opportunities. This is accomplished through the recruitment, placement and support of diverse health professionals at the junior, mid and senior levels, and professional development activities aimed at enhancing the technical and leadership skills of global health professionals.

BACKGROUND:

The United Republic of Tanzania is culturally diverse, with a population estimated at nearly 42 million persons, approximately 75% of whom live in rural areas. Tanzania is ruled by a united government, with many structures of government separate on the mainland and the archipelago of Zanzibar. Despite economic gains of approximately 7% over the last decade driven by tourism, mining, trade and communications, continued rapid population growth has increased the absolute number of Tanzanians living in poverty by over a million persons. The overwhelming demands from this growing population and poor health status put tremendous pressure on an already fragile social service system. Tanzania relies heavily on foreign aid, with roughly one-third of the national budget financed by direct budget support. Though over 40% of health financing comes from donors, per capita health spending in 2009/10 was only $14.70.

There are key systems challenges related to the growing financial demands for health services, particularly to address the Millennium Development Goals and the HIV/AIDS situation, with few immediate alternatives to increase funding levels for health. In addition, a crisis related to health worker shortages exacerbates an already weak system, with approximately two thirds of health worker positions vacant (primarily in remote, rural areas). Tanzania has decentralized services by devolution, where 131 districts are primarily responsible for the delivery of services through a network of district hospitals, health centers, and dispensaries, with referrals directed to regional hospitals (run by 23 regions) and then to 5 zonal hospitals operated by the Ministry of Health and Social Welfare (MOHSW). Sixty-four percent of health facilities are public, and 36% are private, including faith-based and for-profit providers. A dramatic expansion of health facilities is underway through a ten year primary health service expansion that will double the number of facilities – putting a health facility in every village and improving infrastructure at many higher level facilities that will exacerbate an already impossible manpower situation. Disparities in access to quality health services in rural vs. urban areas is a notable challenge.

Nonetheless, it is a time of significant opportunity in the health sector, with renewed attention to the human resources for health issues, pay policy reform and civil service expansion, local government reform, and the development of Tanzania’s first health financing strategy. These reforms are tied into the comprehensive Health Sector Strategic Plan III (HSSP III) 2009-2013 and Zanzibar’s Health Sector Reform Strategic Plan, presently being updated for the coming five years.

The US Agency for International Development (USAID) has been a strong development partner of Tanzania for over 30 years. USAID partners with the Government of Tanzania (GoT), other US Government (USG) agencies and implementing partners, as well as other donors, to address health challenges. USAID has made significant contributions in the areas of population/family planning; maternal and infant mortality reduction; child survival; malaria control; and HIV/AIDS prevention, care and treatment. In the last years, it has become very apparent that systems issues, if left unaddressed, stand to preclude sustainable progress in the health sector. Consequently, there has been heightened attention to critical systems challenges in Tanzania since 2008.

Tanzania has benefitted from the US President’s Malaria Initiative since 2005, with $46.9 million in funding for FY 2011. Family planning interventions include increased access to, use of, and demand for contraceptives, with FY 2011 funding of $22 million. The maternal/child health activities, with $8 million in funding in FY 2011, target major causes of maternal mortality, as well as reduction of under-five mortality through Integrated Management of Childhood Illness.

The budget for HIV/AIDS under the PEPFAR program was $357 million for FY 2011. Tanzania has been a focus country for the scale up of HIV/AIDS prevention, care, and treatment programs since 2004. PEPFAR/Tanzania, along with the Global Fund, is by far the largest donor for HIV/AIDs programs in the country. Presently, it has approximately 350,000 individuals under care and support, approximately 150,000 of whom are receiving antiretroviral treatment. In addition, approximately 300,000 orphans and vulnerable children (OVC) are served under the PEPFAR/Tanzania program. All of these programs are designed and implemented under the GoT’s HIV/AIDS National Care and Treatment Program or the National Plan of Action for Most Vulnerable Children. Approximately 40% of the PEPFAR resources are managed by USAID.  

PEPFAR programs are coordinated through an interagency management structure, which includes the US Centers for Disease Control and Prevention (CDC), the Department of Defense (DOD), the Department of State, Peace Corps, and USAID. Under the reauthorization of PEPFAR, entitled the Leadership Act, new targets include prevention of 12 million new HIV infections worldwide, provision of care to 12 million individuals infected with or affected by HIV/AIDS (including 5 million OVC) and providing antiretroviral treatment to 2.5 million individuals. In Tanzania, HIV/AIDS programs have been negotiated with the GoT through a five-year Partnership Framework.

All of these Health and HIV/AIDS programs will come together under the Global Health Initiative (GHI), which aims to take the many health accomplishments of the last decades to the next level by helping countries achieve long-term sustainability in their health services. Through the GHI, and under GoT guidance, partners will coordinate technical assistance across service delivery platforms and projects to strengthen health facilities’ capacity to provide a full range of services at multiple contact points with clients. These include HIV prevention, care, and treatment; maternal and child health clinics; and community-based services (such as gender-based violence, nutrition, programs for orphans and vulnerable children, HIV/AIDS prevention, etc.). In the Iringa region of Tanzania, in the name of the Iringa Initiative, efforts are already underway to start implementing USAID partner programs through a “HIV/AIDS combination prevention approach,” i.e., a combination of HIV/AIDS biomedical, behavioral and structural interventions. This also includes incorporation of family planning/reproductive health integration into existing HIV services. Gradually, maternal/ child health and OVC programs will also be closely linked with the combination prevention coordinated approach. A critical element of this coordinated and integrated model is to ensure the application of updated quality assurance and integrated program monitoring systems. In addition, a well-functioning environment of programmatic accountability will need to be in place whereby districts include the full array of essential health services in the district-level planning and budgeting systems.

The core principles of GHI include a women- and girl-centered approach; increased impact through strategic coordination and integration of services; leveraged donor and private sector engagement; country ownership; strengthened systems to build sustainability; improved metrics, monitoring, and evaluation, and increased research and innovation. The Iringa Initiative will be designed to achieve this vision building on the platform of health and HIV/AIDS programs that have been in place for several years. The Mission has prioritized the Iringa region because it has the highest prevalence of HIV/AIDS (15.7%) in the country, has high maternal and infant mortality, and a preponderance of orphans and vulnerable children. In addition, USAID has had a program underway in all districts in Iringa since 2010 to strengthen fiscal and programmatic accountability related to health programs, with a local “mentor” placed in each district to help with planning, budgeting, prioritization, and coordination.

At the same time, USAID has embarked on an ambitious reform effort, USAID FORWARD, to change the way the Agency does business, through expanded partnerships, an emphasis on innovation, and a relentless focus on results. It gives USAID the opportunity to transform the way it does business and unleash its full potential to achieve high-impact development. Critical elements of USAID FOWARD that will impact the Iringa Initiative are:  

• Procurement reform, where USAID will provide direct support to more and varied local partners as well as local government authorities, using host-country systems, while strengthening capacity.
• Application of cutting edge and evidence-based development policies, leveraging USAID’s relationships with other donors, using its strength in science and technology, and reintroducing a culture of research, knowledge-sharing and evaluation.
• Strengthened Monitoring and Evaluation, systematically monitoring performance and evaluating impact.
• Focus on innovation, searching for creative development solutions (e.g., through linkages with the private sector and academia) that can be piloted and brought to scale.

These developments coincide nicely with the selection of Tanzania to conduct a multimillion dollar, centrally funded (Office of Global Aids Coordinator, Washington) HIV/AIDS combination prevention evaluation study (Iringa Combination Prevention Evaluation). The focus on Iringa, as well as the fact that myriad partners have been working in that region for several years with USAID funding, provides a unique opportunity to create synergy through enhanced HIV prevention, care and support, and treatment services. To support this coordinated technical content are districts that have received technical assistance to strengthen leadership and management capacity for greater potential for sustainability. These systems strengthening interventions have been aimed at:

• addressing the shortfall of health workers through improved recruitment and retention of health workers and the potential for performance-based payments;
• improving the procurement and logistics systems for consistent and reliable supplies of health commodities;
• strengthened accountability for programs with local government authorities (LGAs), since they are the linchpin of successful USAID/Tanzania-supported health and community services;
• an enhanced policy environment to support the implementation of quality health and HIV/AIDS programming; and
• improved coordination of quality improvement efforts.

Given the potential for all these somehow unrelated pieces, there is great opportunity to see actual impact in terms of reduced morbidity and mortality through the aggregation of all these technical and systems strengthening efforts. At the same time, there will be significant need for coordination to pull these efforts together.

INTRODUCTION:

The Advisor for Program Integration, Iringa Initiative and Evaluation, will work with a multicultural, multi-specialty team bridging programs across development sectors – Health and Population (including HIV/AIDS), Education, Democracy and Governance, and Agriculture (Feed the Future). S/he will receive direction from the Iringa Initiative and Evaluation Team Lead. S/he will be expected to work independently yet very collaboratively with the team of professionals who are involved in managing activities included in the Iringa Initiative and Evaluation, make program recommendations, and take initiative. S/he will advise USAID/Tanzania on all aspects of the implementation of the Iringa Initiative and Evaluation, considering on-the-ground realities.

The Advisor for Program Integration, Iringa Initiative and Evaluation, under the guidance of the Iringa Initiative and Evaluation Team Lead, will coordinate field implementation of program activities across the HIV/AIDS and Health teams (including wraparound projects with the Education, Democracy and Governance and Feed the Future teams) to ensure a holistic approach and rational calibration of interventions to support an effective and well-functioning health system in Iringa. These activities range from facilitating effective communications, information sharing, and linkages across all USAID implementing partners in the region, to liaising with Regional and District Authorities, and USAID evaluation partners (Johns Hopkins University, Muhimbili University for Allied Sciences, and the Primary Health Care Institute), in monitoring programmatic inputs and results (in the form of meeting program implementation targets) with regards to the Iringa Combination Prevention Evaluation. S/he will work in consultation with technical staff for health and HIV/AIDS programs, to synchronize project work plans and analyze process bottlenecks and barriers to effective coordination and collaboration. With them, the Advisor for Program Integration and Evaluation will identify complementarities, as well as opportunities for greater synergy across programs. The Advisor will provide any recommendations for significant program corrective actions to both the Health and the HIV/AIDS Team Leaders in conjunction with the Iringa Initiative and Evaluation Team Lead.

Because of the interagency nature of the GHI programs, the Advisor will also support the Iringa Initiative and Evaluation Team Lead in working closely with technical staff from CDC, DOD, and the Peace Corps to coordinate and consolidate lessons learned across USG combination prevention efforts in country.

ROLES AND RESPONSIBILITIES:

The Advisor for Program Integration and Evaluation will:

I. Provide coordination and strategic oversight to the linkages between and among partner activities as well as local government in Iringa (50%)

 

(a) Serve as the primary point of contact for Iringa LGAs and Iringa Initiative Implementing Partners (IPs) in the field. S/he will facilitate and support programmatic planning, monitoring, information sharing and coordination in the field in Iringa region. S/he will maintain strong relationships with Iringa LGAs, encouraging their leadership and ownership of the Initiative as it evolves and facilitating their active engagement in programmatic and Iringa evaluation working sessions as appropriate. 

(b) Establish and maintain processes for coordination of activities in the field across USAID IPs to ensure collaboration, synergies and minimal duplication of efforts across programs. S/he will work with HIV/AIDS and health partners to ensure linkages are maintained across programs leading to minimal loss to follow up of people living with HIV/AIDS, but not eligible for ART, adherence to ART for people on treatment, and linking HIV negative and positive people with quality health care services.

(c) In consultation with technical staff from USAID, and under the guidance of the Iringa Initiative and Evaluation Team Lead, identify opportunities for integration of family planning, maternal/child health, malaria, and HIV/AIDS programs to achieve management and programmatic efficiencies that result in leveraged improvements in health and HIV/AIDS outcomes. In particular, along with existing USAID systems strengthening and capacity building partners in Iringa, the Advisor will identify ways to further accountability within LGA systems in Iringa. As systems begin to come together, the Advisor – in collaboration with the Iringa Team Lead – will leverage this activity as a safeguard to be certain that LGAs are engaged in achieving the desired results. S/he will also continually look for new opportunities for integration across development sectors – Education, Democracy and Governance, Feed the Future in addition to continually engaging already existing wraparound projects in the Iringa Initiative.

(d) Convene and facilitate quarterly Iringa Initiative IP meetings in the field as a forum to exchange ideas and showcase collaboration efforts and success stories. S/he will invite LGAs to actively participate and contribute to this process.

II. Monitor IP performance and target achievements to ensure quality and effectiveness of the program within the Iringa Combination Prevention Evaluation intervention areas, as well as facilitate the program evaluation feedback loop in the context of the evaluation (50%)

(a) Maintain close and continuous contact with the Iringa Combination Prevention Evaluation research team based in Iringa. This will include working closely with research staff from Johns Hopkins University, Muhimbili University, and the Primary Health Care Institute, to track the implementation of evaluation plans and report back to the Iringa Team Lead in Dar es Salaam, as well as USAID/Washington on a regular basis on progress made.

(b) Work closely with the Iringa Combination Prevention Evaluation Team to establish and implement a comprehensive monitoring system that tracks key indicators across a subset of USAID IPs. This subset of partners will include a mix of HIV/AIDS care, treatment and prevention partners identified as key service delivery partners within the evaluation intervention areas. The enhanced monitoring system will be designed to capture synergies as well as individual program contributions to the combination package. Once the system has been established and refined, s/he will work with the larger set of USAID IPs in Iringa to adapt it for implementation across the region as part of the larger Iringa Initiative outside of the Iringa evaluation areas.  

(c) S/he will have the overall responsibility of working with the respective program managers (Assistance Officer Representatives) in Dar es Salaam, for ensuring open and appropriate information sharing between USAID IP staff based in the field in Iringa and evaluation partners. S/he will serve as the link between USAID IP staff in the field and evaluation partners with regards to the day to day implementation of program and evaluation activities on the ground. The Advisor will also facilitate and ensure information from the field is fed up to IP headquarters through the respective program managers and the Iringa Evaluation Team in Dar es Salaam.

(d) Ensure that program monitoring data collected by the evaluation partners is shared across all IPs involved in the evaluation in a timely and meaningful manner. S/he will collaborate with the Iringa Evaluation Team in designing a feedback loop to efficiently and effectively facilitate program course corrections when necessary. Lastly, s/he will document operational and program management lessons learned to be shared across regions.

The Advisor will be based in Iringa Region and will travel to Dar es Salaam at least once every three months.  

 

REQUIRED SKILLS, KNOWLEDGE & EXPERIENCE:

• A minimum of a master’s degree in a relevant discipline such as health management, public health, the social sciences, reproductive health, MCH, or other field related to international development and/or public health.
• Minimum five years’ progressively responsible experience working with a donor agency and/or a development organization, with at least 2 years’ experience supporting development programs (Africa-specific preferred, but not required) in an international or resource challenged setting.
• Technical knowledge of HIV/AIDS care, treatment and prevention service delivery programs is required. Technical knowledge of family planning, maternal/child health, gender-based violence, malaria, tuberculosis, and public health service delivery programs and systems in developing countries is also desirable.
• Demonstrated experience working with developing country program managers, government authorities, and a broad array of local health service providers and community leaders highly desirable.
• Strong interpersonal skills and ability to work in a multicultural setting required. Able to motivate team members and work toward positive overall performance, work as a member of a technical or office management team, and to work independently required.
• Excellent collaboration skills; proven track record in building and maintaining relationships across multiple entities in a technical environment.
• Proven ability to communicate quickly, succinctly, and tactfully both verbally and in writing; ability to facilitate meetings and make oral presentations logically and persuasively to senior officials and partners in a multicultural context; ability to produce concise, clear reports, and use word processing, spreadsheet, and database programs required.
• Proficiency in Kiswahili highly desirable.
• US citizenship required.
• Ability to obtain and maintain medical clearance to live and work in Tanzania.  

SALARY AND BENEFITS:

Salary will be based on commensurate experience and earnings history.  The Public Health Institute offers a comprehensive benefits package including professional development programs http://www.ghfp.net/docs/2012_Benefits_Booklet_GHFP.pdf  

TO APPLY:

All applicants are required to apply for this position through GHFP’s online recruitment system at https://www.ghfp.net/recruitment/, which allows you to store your CV, profile and bio data form in our database. A separate cover letter describing your qualifications and experience, interest and familiarity with issues relating to this position, and how this position relates to your career goals is required for each application. All online applications must be submitted by 5:00 pm Eastern Time, June 6, 2012.