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Mozambique

Improving management systems for improved HIV/AIDS service delivery

The US government is contributing funds from the President's Emergency Plan For Aids Relief (PEPFAR) to a coordinated, multi-donor-supported effort to build the capacity of Mozambique’s National AIDS Council (CNCS) through technical support from Health Systems 20/20.

As increased aid flows to Mozambique to battle the onslaught of the HIV/AIDS epidemic, the CNCS must concurrently strengthen its capacity to financially, administratively, and programmatically manage the HIV/AIDS resources provided by the World Bank, numerous bilateral donors, the Global Fund, and the budget of the Government of Mozambique in support of the multisectoral National AIDS Strategy II–2005-2009. Improved management systems and procedures at CNCS's central and provincial offices are essential for this key partner to effectively lead, coordinate, and report on the results of the national response. Read the Health Systems 20/20 Mozambique Country Brief for more information on the HIV/AIDS epidemic and the suggested response for health systems strengthening.

PHRplus, the predecessor project to Health Systems 20/20, commenced technical support for HIV/AIDS activities in Mozambique in 2004 by providing technical assistance to the CNCS to improve its operational and human resources systems.

Health Systems 20/20 continues to work with the National AIDS Council (CNCS) to identify areas for strengthening financial management and minimizing operational bottlenecks. Critical needs identified include streamlining and decentralizing the financial and grant management process and revising key policy and procedure manuals related to financial management and monitoring and evaluation of operations. Another critical intervention area entails improving the financial management capacity of implementing agencies in order to meet basic CNCS financial reporting requirements.

Project interventions have focused on the following areas:

• Initiate and facilitate dialog between senior-level CNCS management and funding partners to design uniform requirements for financial management that meet the needs of all parties and follow the guidelines set forth by the Paris Declarations
• Update the financial and grant management policies and procedures manuals and train central and provincial CNCS staff and implementing partners on said procedures
• Decentralize the financial management operations – including dissemination of state-mandated accounting software – to the provincial level offices
• Assure adoption of standard procedures and decentralization of financial systems by providing in-service training in provincial offices

Health Systems 20/20 also began to address high staff turnover, which impeded the organization’s ability to manage and deliver services. Yet it quickly became apparent that turnover was a touchstone for more fundamental issues. Turnover – up to 40% per year among CNCS staff in the eleven provinces – is a serious issue in Mozambique, as in many developing countries, where the supply of qualified personnel is limited and the labor demand for personnel in the HIV/AIDS sector is high. Moreover, recruitment and hiring of personnel in Mozambique is a laborious and costly process. Labor laws dictate a long set of procedures, and in the government’s case, all new contracts must be reviewed and approved against arcane standards set by the judicial system. To make a lasting difference, Health Systems 20/20 is addressing these issues with the following integrated approach:

1. Conducted a function review of ‘who does what’ in the organization to determine whether current staffing and job assignments are aligned with CNCS objectives.

2. In coordination with the Ministry of Public Service, carried out a classification of position grade ‘step’ so as to provide an opportunity to raise salary and status within a given grade without having to promote or pay a position above grade. By instituting step-level pay raise, CNCS is now working to create a platform for more meaningful annual performance reviews.

3. Launched a collaborative effort with the Ministry of Public Service to constitute CNCS as a full governmental agency, not with just an emergency type status. This effort has a number of important implications for the organization and will allow CNCS employees to benefit from the range of in-service health benefits and eventual retirement benefits.

4. Implement organizational redefinition and consequent restructuring along more functional lines of CNCS’ mandate: “coordination of the response to the challenge of HIV/AIDS, communication of behavior change messages and campaigns, and monitoring/evaluation of results.” The critical role of the CNCS provincial entities has been redefined, reinforced, and given recognition and support by the central structure. At the national level, CNCS has become an operational secretariat for decision-makers in the health and HIV/AIDS sectors, and assists in determination of allocation of donor resources, along with much scarcer Mozambican human and material resources.