How We Work
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is a proven leader in the global fight to prevent pediatric HIV infection, eliminate pediatric AIDS, and create a generation free of HIV. Since 2000, EGPAF, through support from the U.S. government, multilateral donors, and private donors, has played a key role in supporting local governments and partners in the scale-up of comprehensive HIV prevention, care and treatment services in the regions of the world most affected by HIV and AIDS.
EGPAF pursues its mission through a three-pronged approach focused on supporting program implementation, research, and advocacy. Program implementation is supported by providing comprehensive programmatic, technical, and operational assistance to local governments, ministries of health (MOHs), and local organizations to improve their capacity to deliver high-quality services and ensure program sustainability. EGPAF’s research efforts focus on operations research, clinical research, evaluations, and building the capacity of local government institutions and local organizations to conduct research and utilize the findings to improve program performance, efficiency, and outcomes. EGPAF engages in advocacy at the global, regional, and national levels.
EGPAF currently supports programs in 14 countries across sub-Saharan Africa and India and has country offices, staffed primarily by local nationals, in 12 high-burden countries. Its country programs are supported through a global network of technical, programmatic, and operational staff based in the United States, Switzerland, and regional posts across sub-Saharan Africa. EGPAF has developed implementation- and solution-oriented technical expertise that now supports 6,800 health care facilities and their surrounding communities worldwide in the following impact areas:
- Clinical services: prevention of mother-to-child transmission (PMTCT); adult and pediatric care and treatment; maternal, newborn, and child health (MNCH); TB/HIV; and HIV testing and counseling
- Health systems strengthening and capacity building
- Evidence-informed policy and advocacy
- Community engagement
- Strategic information and evaluation
- Research, innovation, and implementation science
Our Approach: Working in Partnership with Ministries of Health and Local Organizations
EGPAF supports HIV programs by working within government systems, in close cooperation with MOHs and other local service providers, rather than setting up parallel service delivery structures. Through its country offices, EGPAF plays a capacity building role, assisting MOHs and other local organizations to deliver services and manage public health programs, fill short-term expertise gaps, manage the subgranting of donor funds, strengthen MNCH and overall health systems, conduct research and evaluate programs, and help develop evidence-informed policy. Together, EGPAF, local governments, and nongovernment partners ensure that clients receive the full menu of quality services across a range of interventions for PMTCT, adult and pediatric HIV/AIDS care and treatment, TB/HIV, and MNCH, all while strengthening integration with other health services and supporting community engagement.
Specific approaches and activities for supporting MOHs and local governments within EGPAF’s impact areas include
Areas of Expertise
Plan, Building, and Support Effective Program Models
Program planning and implementation support:
EGPAF provides specialized technical assistance to facilitate evidence-informed planning processes to optimize the effectiveness and efficiency of services. EGPAF builds capacity in program management by providing grants to districts and non-governmental and community-based organizations for service delivery at the facility and community levels. In Côte d’Ivoire, Rwanda, and Mozambique, EGPAF implements performance-based financing subgrants to local health authorities. Through these grants, EGPAF has built the capacity of national, provincial, district, and facility staff in areas such as financial and program management.
In Côte d’Ivoire, EGPAF found that sites implementing performance-based financing had consistently higher levels of PMTCT uptake, including a 63% increase for infants on antiretrovirals (ARVs) and a 31% increase for women on ARVs across public sites.
Program assessment and evaluations:
EGPAF works with MOHs to conduct program assessments and evaluations to determine the effectiveness of innovative models of service delivery and identify strengths and weaknesses across the health system. For example, in 2012, EGPAF led an assessment of the national PMTCT program in Ukraine.
Documentation and dissemination of best practices:
EGPAF documents program models, successes and challenges in implementation, and results from program assessments and evaluations and disseminates them across all 14 country programs and beyond for global impact. For example, EGPAF produces a regular theme-based technical bulletin, Haba na Haba, to share program experiences.
Development, introduction, and evaluation of innovative program models:
EGPAF supports MOHs in rolling out and evaluating the effectiveness of new program models. In Côte d’Ivoire, EGPAF helped train health care providers in the provision of PMTCT services according to Option B. As a result, 75% of sites supported by EGPAF in Côte d’Ivoire are implementing Option B, with a plan to reach 100% of sites by the end of 2013.
Building Capacity for Governments and Other Local Organizations to Manage Programs
Capacity building of local organizations:
EGPAF supports the development of local organizations through organizational capacity assessments and development and implementation of capacity building plans. In Kenya, EGPAF has distributed 32 grants to build the capacity of civil society organizations to directly implement HIV services.
Training, mentorship, and supportive supervision:
EGPAF provides mentorship to frontline health workers such as nurses, doctors, and community health workers to improve practices and processes within clinics and in the community, and ultimately, to enhance the quality of care delivered to patients. In Uganda, EGPAF provides TB mentors at poorly performing sites, which has resulted in the identification of approximately 500 new TB cases per quarter, and to date more than 90% of those patients were tested for HIV.
EGPAF works to fill key gaps by procuring lab equipment and other essential supplies, printing data registers, and supporting critical renovations of government clinics. In Côte d’Ivoire, EGPAF improved patient access to CD4 testing by providing 13 sites with machines and training health care workers on the use of the machines.
Strengthening human resources:
EGPAF strengthens the human resources of local governments through specialized training, development of standard operating procedures and standard practices, and secondment of staff to MOHs to fill key human resource gaps. In Mozambique, EGPAF is working with the MOH to develop and roll out its national human resources management manual and accompanying standard operating procedures. Additionally, EGPAF has seconded human resources for health professionals to the MOH, and has supported provincial and district health authorities with performance management systems.
EGPAF led and participated in IATT national and subnational planning activities around eliminating mother-to-child transmission in Nigeria, Zimbabwe, and other countries.
In 2011, EGPAF supported the creation of three independent, voluntarily affiliated national non-governmental organizations that provide program implementation support in Côte d’Ivoire, Mozambique, and Tanzania. EGPAF continues to provide comprehensive capacity building support to these organizations.
Data management and analysis:
EGPAF supports MOHs and other local partners to improve processes for compiling, managing, analyzing, and using data for decision making. In Zambia, EGPAF has been instrumental in the development and roll-out of SmartCare, the national electronic health records system. EGPAF provides strategic and programmatic input, financial management and information technology support, and procurement of computer equipment, software, and hardware for SmartCare to set higher standards for the continuum of patient care, patient tracking,
and data collection.
Create a Favorable Environment for Effective Programs
Global and national advocacy:
EGPAF advocates for policy changes at the national and global levels to improve the quality of services and contribute to elimination efforts. In Côte d’Ivoire, EGPAF advocated to the Ivoirian MOH to include educational messages vis-à-vis HIV testing in outpatient waiting rooms throughout the country, and has now received a mandate to develop technical guides to promote and standardize this practice.
Participation in national technical working groups:
EGPAF plays a key role in national technical working groups across the countries it supports. Through these working groups, EGPAF supports MOHs to assess current program performance at all levels, roll out trainings, and adapt and disseminate national policies and guidelines.
Creation of evidence through research and evaluation:
EGPAF conducts implementation research to evaluate new and improved methods of service delivery so that successful PMTCT and treatment program models and innovations can be replicated to assist in HIV prevention and treatment efforts worldwide.
Maximize Impact Through Global Leadership, Sharing, and Coordination
Leadership and coordination of global partnerships and networks:
EGPAF works to manage global partnerships, and coordinate and provide leadership to global working groups. EGPAF plays a key role in working groups and organizations such as the Interagency Task Team on the prevention and treatment of HIV infection in pregnant women, mothers, and children (IATT) and the Global Steering Group (GSG) for implementation of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive.
EGPAF’s global team centralizes advocacy and policy efforts that are informed by its global programs and research to enhance strategies for eliminating HIV/AIDS in children.
Acceleration of learning and sharing of best practices across EGPAF-supported countries:
EGPAF works to accelerate learning, innovation, and dissemination of best practices to optimize programs and achieve elimination of pediatric HIV/AIDS. Through strong internal communications structures, EGPAF connects the experiences from over 6,800 service delivery sites in hundreds of districts in 14 countries to compare performance, address barriers, and promote sharing of innovations and best practices. EGPAF’s innovative Technical Directors Forum connects each country office’s Technical Directors to facilitate country-to-country communication and mutual assistance. EGPAF is also able to combine data from all countries to identify global trends and impact.
EGPAF is currently implementing a research study in Rwanda to evaluate 18-month HIV-free survival in a cohort of children who were born to HIV-positive women receiving universal lifelong antiretroviral therapy (prevention of mother-to-child transmission Option B+) and comprehensive infant feeding counseling and support.