title: Lessons Learned From Transitioning PEPFAR Track 1.0 Care and Treatment Programs: Case Studies in Financial Management Capacity Building in Zambia and Botswana.
abstract: In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions.
authors.affiliation: International Training & Education Center for Health, University of Washington, Seattle (Mr Kuehn); U.S. Department of Health & Human Services, Health Resources and Services Administration, Global HIV/AIDS Program, Washington, District of Columbia (Mr Tidwell); Independent Finance Consultant, Seattle, Washington (Ms Vhugen); and International Training and Education Center for Health, University of Washington, Seattle, and Liverpool Associates in Tropical Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Dr Sharma).
authors.forename: Chuck
authors.initials: C
authors.lastname: Kuehn
authors.forename: George
authors.initials: G
authors.lastname: Tidwell
authors.forename: Jann
authors.initials: J
authors.lastname: Vhugen
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
mesh_terms: D001902:Botswana; D057191:Capacity Building / Q000379:methods / Q000592:standards*; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D003906:Developing Countries / Q000191:economics; D005376:Financial Management / Q000379:methods* / Q000592:standards; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control; D006801:Humans; D009938:Organizations / Q000191:economics*; D015397:Program Evaluation / Q000379:methods*; D015024:Zambia