Quarterly Report. for the Global Fund Support in Lesotho. October-December Compiled By: Global Fund Coordinating Unit

Quarterly Report for the Global Fund Support in Lesotho October-December 2013 Compiled By: Global Fund Coordinating Unit 1

Acronyms AFB AHF AIDS ART ANC ARV BMI CCM CFCU CHAL CHWs CSS DNA PCR DST EGPAF GFATM (GF) GFCU GMS HCWs HBC HIV HSS HTC LCN LENEPWHA LENASO LFA MDR/TB M&E MNCH MOET MOF MOGYSR MOH MOSD MUAC NDSO OVC PLWAs PIH PMTCT PR RUTF SDA SOPs SRs SSF Acid-Fast Bacillus Aids Care Health Foundation Acquired Immune Deficiency Syndrome Antiretroviral Therapy Antenatal Clinic Antiretroviral Body Mass Index Country Coordinating Mechanism Global Fund Coordinating Unit Christian Health Association of Lesotho Community Health Worker Community System Strengthening Deoxyribo Nucleic Acid-Polymerase Chain Reaction Drug Sensitivity Testing Elizabeth Glaser Paediatric AIDS Foundation Global Fund To Fight AIDS, TB and Malaria Global Fund Coordinating Unit Grants Management Solutions Health Care Workers Home Base Care Human Immunodeficiency Virus Health Systems Strengthening HIV Testing and Counselling Lesotho Council of Non-governmental organisations Lesotho Network of People Living With HIV/AIDS Lesotho Network of AIDS Service Organisations Local Fund Agent Multi- Drug Resistance Tuberculosis Monitoring and Evaluation Maternal New Born & Child Health Ministry of Education and Training Ministry of Finance Ministry Of Gender, Youth and Sports Recreation Ministry of Health Ministry of Social Development Mid Upper Arm Circumference National Drug Service Organisation Orphan and Vulnerable Children People Living With HIV & AIDS Partners In Health Lesotho Prevention of Mother to Child Transmission Principal Recipient Ready to Use Therapeutic Food Service Delivery Area Standard Operational Procedures Sub Recipients Single Stream Funding 2

SSRs TA TB TRA VHW WHO WILSA Sub-Sub Recipients Technical Assistance Tuberculosis Touch Roots Africa Village Health Workers World Health Organization Women in Law Southern Africa 3

Table of Contents Chapter 1: Introduction and Background Information... 6 1.1 Introduction... 6 1.2Background Information... 6 Chapter 2: SSF-HIV Grant... 7 2.0 Service Delivery Areas (SDA)... 7 2.1 Prevention of Mother to Child Transmission - PMTCT... 7 2.2 CONDOMS... 9 2.3 BCC Community Outreach and Schools... 11 2.4 Support for orphans and vulnerable children... 12 2.5 Antiretroviral treatment (ARV) and monitoring... 13 2.6 Support for orphans and vulnerable children... 13 2.7 Strengthening of civil society and institutional capacity building... 16 2.8 Policy development including workplace policy... 17 2.9 Financial Performance... 17 2.10 Challenges... 18 Chapter 3 - Round 8 HIV/CSS... 19 3.1-BCC community outreach and schools... 20 3.2 Strengthening National Policy Frameworks... 21 3.3 Stigma reduction in all settings... 21 3.4 Community Systems Strengthening... 21 3.5 Financial Performance... 21 3.6 Challenges... 23 Chapter 4: Round 8 HIV/HSS... 24 4.1- BCC - Mass Media (Collaborative development of messages, materials and tools)... 24 4.2- BCC - Community Outreach & Schools... 24 4.3- Condom Programming... 25 4.4- Male Circumcision... 25 4.5- STI... 26 4.6- Testing & Counseling... 26 4.7- ART... 27 4.8- Prophylaxis... 28 4

4.9- Sexual Reproductive Health... 28 4.10 - Care & Support... 28 4.11- TB/HIV... 28 4.12 Strengthening National Policy Frameworks... 28 4.13 - Supportive Environment-Workplace Program: Public Sector... 29 4.14 - Service Delivery... 29 4.15 - Health Workforce... 30 4.16- Information system... 31 4.17 Financial Performance... 31 4.18 Challenges... 34 Chapter 5: Round 8 TB Grant... 35 5.1-Improving diagnosis... 35 5.2 -Patient support... 35 5.3 - Procurement and Supply Management... 36 5.4 - M&E... 36 5.5 - Management and Supervision... 37 5.6 - Human Resources Development... 38 5.7 -MDR-TB: Prevent, manage and control MDR/XDR-TB... 39 5.8 -Address High-risk groups and special populations... 39 5.9 Infection Control... 39 5.10 ACSM (Advocacy, communication and social mobilization)... 40 5.11 - Community TB care... 40 5.12 - Operational Research... 40 5.13 - Programme management and Administration cost... 41 5.14 Financial Performance... 41 5.15 Challenges... 43 Chapter 6: Conclusion... 44 Annex 1, Table16: Progress Update SSF grant... 45 Annex2, Table17: DISTRIBUTION REPORT FOR LAB ITEMS and STIs & OIs Drugs procured with the GF funds... 46 5

Chapter 1: Introduction and Background Information 1.1 Introduction This quarterly report illustrates progress made in the implementation of activities supported with the Global Fund Grants. The period covered by the report is October to December 2013. It is a consolidation by the PR, through the use of the reports from the different SR and SRRs covering the above mentioned period. The report is organized in six chapters, chapter one provides introduction and background information, SSF is discussed in Chapter two, Chapter three focuses on the R8 CSS grant, R8 HV/HSS is presented in chapter 4, R8TB grant is discussed in chapter 5, and finally conclusions is discussed in chapter 6. 1.2Background Information The Government of Lesotho has continued to benefit from financial resources provided by The Global Fund to fight HIV/AIDS and Tuberculosis. These Financial resources have enabled the country to accelerate efforts in prevention, impact mitigation, treatment, care in HIV/AIDS and Tuberculosis (TB). The support is in total of $90,316,328 USD with $80,645,110 USD being for HIV and $9,671,218 for TB between the periods November 2011 to September 2014. Currently the Ministry of Finance is the Principal Recipient of the Global Funds grant for both TB and HIV. The Ministry presently manages four grant portfolios namely three HIV/AIDS grants and one TB grant. These are Round 8 HIV/HSS, Round 8 HIV/CSS, SSF HIV and Round 8 TB for TB grant. Table 1 illustrates the GF support per grant, the disease supported, implementing period of the grant as well as the total budget per grant. Table1: Funding per disease component Grant No Disease Round Start Year End Year Current Phase Total Budget (Current Phase) LSO-809-G06-H HIV/HSS 8 Nov 11 Sept 14 Phase2 US$57.7 Million LSO-810-G09-T TB 8 Oct 12 Sept 15 Phase2 US$9.6 Million LSO-H-MOF HIV/AIDS SSF Apr 13 Mar 14 Extension US$22.9 Million LSO-813-G09-H HIV/AIDS 8CSS Apr 13 Feb15 Phase2 US$3.3 Million 6

Chapter 2: SSF-HIV Grant The grant implementation period ended March 2013, however, a no cost extension period for a year was granted to the country. The extension period covered April 2013 to March 2014. The main objective of the HIV/SSF grant is to prevent HIV infection among orphans and vulnerable children in Lesotho and Prevention of Mother to Child Transmission (PMTCT). Since the inception of the SSF from June 2012 and to cover the remaining period to March 2014, the GF has disbursed a total of USD 12, 864,853. Out of this and the cumulative expenditure thus far December 2013 is USD 8,860,539. The sections below will present performance and use of funds which covers period from October 2013 to December 2013 focusing on the Service Delivery Areas and Main Activities. 2.0 Service Delivery Areas (SDA) 2.1 Prevention of Mother to Child Transmission - PMTCT 2.1.1 Strengthening community level support for PMTCT services through training of 6,000 Community health workers (CHW) The activity is implemented by Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) the technical partner to the Ministry of Health. In this reporting period, 713 Village Health Workers (VHWs) were trained to promote PMTCT at community level. As of December 2013 a cumulative number of 2,515 VHWs were trained to promote PMTCT services. Village Health Workers are equipped with skills to enable them to promote good health practices as well as preventive and curative aspects of health care. They are trained to play a vital role in HIV education of the community and these include providing emotional support, promotion of early initiation of ANC for HIV positive pregnant women to benefit from early initiation of ARV prophylaxis; they also encourage and refer women for labor and delivery in health facilities. Furthermore, they track and bring mothers and children to health facilities if they fail to return for follow-up. 1700 VHW were to receive stipends during the reporting period however this was not achieved. The PR was engaged with the verification of the VHW lists submitted by the Ministry of Health. The verification entails establishing whether the VHW are still active and at work, confirming validity of their documents as well as their account numbers. The verification process is expected to be complete by the end of January 2014 and payments will be effected in February 2014. 7

Nurses from facilities trained Village Health Workers on PMTCT and SRH with the assistance of EGPAF. A total of 18 professional counselors are in place and providing the counseling services at the Maternal Child Health (MCH). The PMTCT Counselors are supported under this grant until March 2014. 2.1.2 Procure equipment and supplies to be used in health care Medical equipment and reagents were procured and distributed to health facilities during the period under review. These include 91 blood pressure machines 17, 090 under buttock bags for deliveries were procured and delivered in November 2013; 107 fetal heart monitor instruments were procured and delivered in October 2013. 285 Oxytocin Injections were procured instead of 385 planned, because of high tender prices than the original unit cost and 15,378 Hemocue Analyzers and reagents. 2.1.3 Mobilise communities to improve health seeking behaviour including male involvement A total of 55 people were to be trained so that they can be advocators for male involvement in the PMTCT, sexual reproductive health (SRH) and Maternal New Born and Child Health (MNCH) programme and in the promotion of health seeking behaviour, however only 53 people were trained to achieve the set objective. This intervention is aimed at promoting male health seeking behavior particularly on PMTCT, SRH and MNCH, and of partner testing. The 53 Man CBOs were trained to mobilize male involvement in PMTCT through the use of public gatherings and radio talk programmes. 2.1.4 Strengthen supervisory and monitoring capacity for PMTCT at central and district levels A total of 3,746 reporting tools and materials were printed and the table 2 illustrates the quantity and type of tool printed. Table 2: Patient monitoring tools printed Indicator Target Achievement Percentage Number of maternity registers printed Number of ANC registers printed 86 86 100% 330 330 100% 8

Number of ANC tally sheets printed Number of monthly summary forms printed 330 330 100% 3000 3000 100% 2.1.5. Supervise and mentor on MNCH/PMTCT data management and collection at the health facilities A total of 162 PMTCT supervision visits were conducted as scheduled by EGPAF, the technical partner to MOH. 1,450 PMTCT guidelines were printed to support and improve data collection and management at health facilities. 29 data verification visits were also conducted to verify data received from the district beforehand and to mentor and supervise the officers at district level. Sensitization meeting was conducted for 61 Health Care workers (HCWs) and Partners to discuss PMTCT guidelines and SOPs. EGPAF PMTCT Community Advisor Mrs. Agnes Lephoto conducts supervisory visits to the VHW trainings to promote PMTCT services. On the right GFCU DNC Mr. Mokhothu Makhalanyane conduct VHW incentives verification at St. Peters Clinic in Butha Buthe district. 2.16 Supplies for PMTCT related testing for laboratory and health centers A Stock Clerk, Data Clerk and Laboratory Technician were engaged for the Laboratory department to enhance and strengthen the capacities of the department. During this period under review, Laboratory technician resigned. 2.2 CONDOMS 2.2.1 Condom Procurement /Distribution 6,000,000 condoms were procured during the month of August 2013. During the period under review a total of 279,050 condoms were distributed by NDSO between October and December 2013, out of the total number of condoms distributed by NDSO, 22, 050 were male condoms and 257,000 were female condoms. Table 3 demonstrates condom distribution by type and place. Table3: Condom Distribution by place and gender 9

Male ( pack size 144 per box)condoms Place distributed to Female Condoms Place distributed to 250 TEBELLONG 2000 LPPA MASERU 220 MOKHOTLONG 1000 TEBELLONG 50 MPHAKI 1000 QUEEN II 150 QUEEN II 1000 M/HOEK DHMT 100 M/HOEK DHMT 1000 MALUTI 50 MALUTI 1000 MAFETENG 150 MAFETENG 2000 BEREA 250 BEREA 2000 MAPUTSOE SDA 200 BUTHA BUTHE DHMT 1000 MAPUTSOE F 150 BUTHA BUTHE 200000 PSI 150 MAPUTSOE SDA 5000 DISEASE CONTROL 50 SDA 10000 MAFETENG DHMT ATT NT TLELETLELE 200 MAPUTSOE F 1000 LERIBE DHMT 200 MOKHOTLONG DHMT 2000 MOKHOTLONG 250 DISEASE CONTROL 8000 FAMILY HEALTH ATT NTATE MOTHIBELI 3RD FLOOR 750 MAFETENG DHMT ATT NT TLELETLELE 2000 BUTHA BUTHE 600 NTSEKHE 2000 MAFETENG 50 MPHAKI 1000 MACHABENG 100 KHUBETSOANA 1000 BAYLOR LERIBE 11500 LENASO 5000 DISEASE CONTROL ATT; NTATE MOTHIBELI 2850 LENEPHWA 10000 MANTSOPA COMMUNICATIONS; MASERU CLUB 10

50 MALUTI 1450 TOUCH ROOTS AFRICA 150 MOTEBANG 50 MAFETENG 50 MORIJA PRINTING WORKS 50 LEJONE 50 MAHOBONG 300 MAPUTSOE SDA 500 AIDS PROGRAMME(MOH) 300 QOALING F 750 FAMILY HEALTH ATT NTATE MOTHIBELI 3RD FLOOR 50 MAPHOLANENG 2.3 BCC Community Outreach and Schools 2.3.1 Expansion of Life skills based Education (LSBE) in Primary and Secondary schools and out of school 10 road-shows and sports tournaments were conducted in all the ten districts. Overall, 260 out of School Youth were trained on string games from Youth Resource Centers, Kicck4Life and Sports associations. Furthermore, 619 young people were reached with life-skills education during HIV and AIDS campaigns. Youth sports conducted by Ministry of Gender during road show 11

Prices were awarded during sports tournaments in each district per sporting code; for soccer the first price was full set of soccer Jersey with printed messages of positive living, followed by a second price which included cones and a set of bibs. While the third price was one Soccer ball and a Score board, and the fourth price was one soccer ball. Netball prices were Netball for first price and a set of bibs for second price. Volleyball prices constituted volleyball as first price and set of bibs for second price. A total of 1293 young people were reached with life-skills education and HIV and AIDS through Sport during the reporting period. These youths were from Mafeteng, Botha-Bothe, Mohale'sHoek, Sekokong, Bana-Pele, Mokhotlong, Tsifa-li-Mali, Morija, Qacha's Nek and Hlotse Youth Resource Centers. 2.4 Support for orphans and vulnerable children 2.4.1 Implementation of OVC Exemption System for health and educational services During the reporting period, 3,750 Orphans and Vulnerable Children (OVC) were supposed to have received the local passports and 10 000 OVC were to receive birth death certificates. The Government of Lesotho has introduced a new system of Death and Birth Registration which entails obtaining new Birth certificates, Identification Documents (IDs) and passports. According to the new system people are required to have national IDs before they can apply for a passport. In order to obtain an ID one is expected to get a new birth certificate. Currently the Ministry of Home Affairs and the Ministry Of Social Development is in holding consultations with each other to agree on how best these essential documents process can be done for OVC. MOSD did not conduct supervisory visits this quarter because the districts were engaged in annual planning and budgeting, which required districts officers to be constantly in Maseru. The intention of this activity is to strengthen data collection and reporting of OVC activities by stakeholders at the district level. The problem of reporting by both partners and MOSD offices is still a concern. This is due to high turnover and inadequate trainings. MOSD did not conduct Quarterly meetings during this quarter at the district level for OVC interventions. 2.4.2 Develop Sustainable Food Security and Livelihood Interventions During the period under review, Caritas continued validating the list of beneficiaries from the three districts who are to be provided with the seeds and tools. The verification and validation of 10 000 OVCs took a longer time than anticipated, however was concluded in December 2013. Tendering processes for seeds and tools as well as toiletries were delayed pending the finalization of the lists of beneficiaries. The tender documents had to incorporate information on location of beneficiaries to factor in issues of transport costs during delivery. It is expected that identification of service providers for seeds and tools as well as the basic package will be concluded before the end of February 2014. Delivery of these items to the beneficiaries will then be concluded in March 2014. 12

Demonstrations on how to construct keyhole gardens and trench gardens were conducted for beneficiaries in two districts, Thaba-Tseka and Quthing. Approximately, 300 beneficiaries participated in the demonstrations. Table four shows the number of beneficiaries who participated per district. Table 4: Number of Beneficiaries participating in demonstrations per district District Council Villages Male Female Total Thaba- Tseka Linakeng Mashai 44 240 284 Sehonghong Sekhaupane Quthing Urban Sikara 4 12 16 Mpobolleng Lehlabela Total 48 252 300 No targets have been met or achieved by MOSD in support of the OVC since inception of this no cost extension. 2.5 Antiretroviral treatment (ARV) and monitoring 2.5.1 Increase access to pediatric HIV and AIDS care and treatment As part of increasing access to pediatric and HIV and AIDS care and treatment, seven (7) medical officers were engaged under the grant. These medical doctors have since been absorbed into Establishment List of the MOH. 2.6 Support for orphans and vulnerable children 2.6.1 Support for OVC at community level Upgrading of homes of OVCs, renovation and new construction have taken place in three districts Botha-Bothe, Quthing and Thaba-Tseka. In Botha-Bothe district, 5 houses were renovated and completed in during this quarter. With regard to new construction, hardware materials were delivered. In Quthing renovations of two houses were completed and hardware materials were delivered for five new houses. In Thaba-Tseka, procurement processes were completed and no objection approvals from MOH for Thaba-Tseka Hardware Suppliers and for engagement of builders were received. HFHL Staff has been working in Thaba-Tseka to sign contracts with Builders and to follow on submission of land documents. 2.6.2 Support the scale-up of Child Help line services During the reporting period Lesotho Save the Children held radio talks with four radio stations in the country; Radio Lesotho, People s Choice (PC), Moafrika and Harvest. These 13

radio talks focused on the child-helpline s operations, types of abuses that occur to children in Lesotho and the role of community in eradicating children s abuse. Outreach activities were undertaken to sensitise children and teachers about child abuse, children s rights and life skills in six districts namely, Leribe, Mohale shoek, Maseru (Semonkong), Thaba Tseka, Qacha s Nek and Quthing. Eighteen thousand, eight hundred and twenty seven (18, 827) children were reached at schools. Lesotho Save the Children mobilizes schools children and community on child helpline in the districts. 2.6.3 Expand basic literacy training for out-of-school OVC Interventions under this main activity are implemented by LANFE and LDTC. In this quarter new enrollments for out of school students were 438. 13 new Learning Centers were established in Mokhotlong as a replacement of the previously closed centers. These new establishments from Mokhotlong registered 427 learners and the other 11 enrollees were from the old (closed) learning centers from Mokhotlong. The learners include herdboys and domestic workers and they are reached with life skill education which incorporates HIV/AIDS education. Public gatherings were held for community members, parents, and employers, community leaders to create awareness of the importance of education. These public gatherings are intended to encourage girls and herd-boys to attend school. LANFE trained herdboys and domestic workers on HIV and AIDS. 14

2.6.4 Strengthen monitoring and evaluation systems for the OVC national response Distribution of M&E tools by Ministry of Social Development through its M&E unit is ongoing and new tools have been distributed in all districts. Reprinting for more tools has been planned for January-March 2014. 2.6.5 Develop and implement a pilot database to support SWRIS at national level Ministry of Social Development s contract with CBS came to an end during December 2013. The ministry is already using the database to support SWRIS at national. Data Clerks have been engaged temporarily to input data into the system. Terms of reference for the consultancy to conduct feasibility study for national rollout to all stakeholders were developed and they are awaiting approval by management. 2.6.6 Improve awareness and compliance with OVC bursary program During the reporting period the OVC bursary manual was printed. The manual will be distributed to all the ten (10) districts and it will be used by the bursary offices. District level training and orientation workshops on the manual were started in July 2013 and completed in October 2013. 2.6.7 Strengthen the human resource capacity of the Bursary Office at MOET The bursary program was strengthened with the recruitment of the one (1) data officer, ten (10) clerks and two drivers. The data Officer is based at the national level, the data clerks have been placed in all the districts while the two drivers are based at headquarters. Furthermore office equipment was procured for the program and these includes two (2) laptops,10 desktops and office furniture. The program has scheduled training of national & district Bursaries Unit staff on HIV and OVC, in the first quarter of 2014. The program will also participate in the regional and international conferences. 2.6.8 Provide fees and educational requisites for OVCs in schools 1234 OVC will receive the hygiene kits under the grant. Evaluation of the service providers for the procurement of the hygiene kits was completed and it is anticipated an appropriate service provide will be identified in the first quarter of 2014. With regard to procurement of school uniform, it was identified that to implement this activity a number of sub activities were required. These includes, information related to the size of school uniforms for every child as well as the size of shoes. Furthermore it was also identified that some items can only be supplied by the schools themselves. These items included jerseys, girl s dresses and blazers since they normally have a logo of the school. Other items such as shoes, socks, trousers and shirts are supplied by the service providers. Schools are therefore, expected to submit quotations for the supply of these items. The other items will be procured through the other service providers. This activity is planned to be completed by March 2014. 15

OVC are supported with bursaries education from form E and D. Sponsored children are also given uniforms and hygiene kits. 2.6.9 Strengthen M & E activities at district level During the reporting period, Bursary Unit did not conduct data verification as expected. However, the verification has been rescheduled for Jan- March 2014. 2.7 Strengthening of civil society and institutional capacity building 2.7.1 Assist in building capacity to monitor and evaluate HIV/AIDS interventions The Technical Assistance Plan for the PR has identified capacity gaps in four areas namely, governance and program management; monitoring and evaluation; financial management; and procurement supply management. As part of building M&E capacity at for all the SR, GFCU conducted a five days training on M&E and program management from the 9 th to 13 December 2013 at Mountain View Hotel in Leribe. 32 participants from all SRs and SSRs took part and completed the training. The training was facilitated by a consultant together with the assistance of GFCU M&E staff. The overall purpose of the training was to improve the monitoring and evaluation and program management capacities of implementers for effective implementation of Global Fund grants. The training capacitated SRs and SSRs M&E personnel and programs staff with necessary knowledge and skills to implement, monitor and report on Global Fund funded activities, ensure that all implementers are aware of the Global Fund program implementation and reporting requirements. Participants drawn from different Sub Recipients attended the M&E training convened by the PR. On the right is the training facilitator. 16

2.8 Policy development including workplace policy 2.8.1 Develop and implement public awareness program on the Child Protection and Welfare Act of 2010 The Simplification and Translation of Child Protection and Welfare ACT (CPWA) was done in collaboration with the Ministry of Social Development with the support of Management Sciences for Health. 10,000, Sesotho and English copies each were printed. Fifty (50) paralegals were selected and trained and 47 of these 50 were engaged. A total of 31,050 community members were sensitised on the CPWA. During the reporting period 20 monitoring visits were conducted and group discussions were held with chiefs and CBOs. As a result of this awareness eight hundred and ninety-two (892) mediations (Restorative Justice) by paralegals for community members were done.furthermore invitations to raise awareness on the CPWA were received e.g. Mohale s Hoek (Siloe). These activities are implemented by FIDA as one of the SR under the SSF grant. 2.8.2 Strengthen the policy and regulatory framework for the implementation of the Children s Protection and Welfare Act. Activities are implemented by the Ministry of Justice and the report has not been received. 2.9 Financial Performance This section provides analysis of financial performance for the period under review. The summary budget and expenditure for SSF is illustrated in table five. 50.6% of the budget for October to December 2013 was utilized during this quarter. Cumulatively, only 60.8% of funds were utilized as at December 2013. There is need for scaling up implementation so that funds are fully utilized. Table 5: Summary of Budget versus Expenditure for SSF Total Budget approved Funds disbursed as at December 2013 Cumulative expenditure Oct-Dec Budget Oct-Dec Expenditure 22,927,632 12,864,853 8,860,539 3, 101,697.27 1,569612 Table 6 indicates the budget allocation per service delivery area and the expenditure thereof. Most funds were utilized on Support for orphans and vulnerable children as well as Program management and administration. The least utilized budget was on Strengthening of civil society and institutional capacity building. While with Condom Programming no funds were utilized in this quarter. Table 6: Budget and Expenditure Report for SSF Grant for October-December, ` 2013 Service delivery Area Budget: Oct-Dec Expenditure: Oct- Dec % Budget Utilization PMTCT 1 481 331.70 777 909.15 53% Condom Programming 202 021.12 0% BCC - community outreach and schools - 3 910.63 17

Support for orphans and vulnerable 693 204.30 562 097.88 81% children Antiretroviral treatment (ARV) and 59 063.19 5 610.69 9% monitoring Strengthening of civil society and institutional capacity building 363 369.64 27 048.94 7% Policy development including 91 981.84 24 822.88 27% workplace policy Program management and 210 725.46 168 211.59 80% administration TOTAL 3,101 697.27 1 569 611.76 51% The table and chart below show expenditure by implementing agency for the quarter Table 7: Budget and Expenditure by SR IMPLEMENTING Budget Expenditure AGENCY PR 210 275 161 110 MOSD 462 105 457 681 MOH 2 116 698 857 750 MGYSR - 3 911 MOET 124 767 3 864 MOJ 66 982 - CARITAS 43 874 16 139 FIDA 25 000 24 823 LSC 23 473 17 015 LANFE 23 024 15 728 HFHL 5 499 11 591 TOTAL 3 101 697 1 569 612 18

Figure 1: Budget and Expenditure by SR: SSF 2.10 Challenges Conflicting priorities within MOH disabled some activities from being implemented for example trainings of VHWs were not conducted in October because of the National Immunization Days Venues for the VHW trainings remained a challenge, as some health facilities are still operating from borrowed space. Delays in agreeing with the MOH on the dates for the second round of data verification, as well as the data quality training. Budget restrictions inhibited implementation of some activities e.g. CBO members TV and radio talks were not done due to lack of transport support Unfavourable weather conditions hindered sports Payment of invoices outside of the quarter in which they were implemented Delayed implementation of activities especially trainings There are several vacant positions that were not replaced (only 78% of posts are filled). There is no condition precedent under SSF. There are misconceptions about the CPWA especially in the rural areas. e.g. culture/hard labor Chapter 3 - Round 8 HIV/CSS The main goal of the grant is to reduce HIV/AIDS morbidity and mortality in Lesotho. The CSS grant targets six sections of the population namely; youth out of school, herd-boys, couples, people living with HIV, women and girls. The Sub-Recipients are Touch Roots Africa (TRA) and is focusing to reach the Youth and Herd-boys; Lesotho Network of AIDS 19

Service Organizations (LENASO) to reach Couples; Lesotho Network of People Living with HIV and AIDS (LENEPWHA) to reach people living with HIV; and Women and Law in Southern Africa Research and Education Institute (WLSA) to reach women and girls. The sections below will present performance and use of funds which covers period from October 2013 to December 2013 focusing on the Service Delivery Areas and Main Activities. 3.1-BCC community outreach and schools 3.1.1 Identify peer educators to reach herd-boys through peer education on BCC Intervention using Media. Adverts for the recruitment of peer educators for youth were made in October 2013 by Touch Roots Africa (TRA) but there were no applications received by December 2013. They will be re-advertising in January 17th 27th 2014. Mobilization of Local Councils where implementation is going to take place has been scheduled to take place on 07th 08th January 2014, 09th 10th January, and 13th 15th January 2014 in Thaba-Tseka, Mokhotlong and Qacha snek respectively. The recruitment and training of Peer Educators is therefore planned for January March 2014. Training manuals were printed in December 2013 and are awaiting appointment of Peer Educators. 3.1.2 Identity focal group discussion facilitators to reach communities with prevention interventions through media Adverts were aired in three local radio stations for the identification of Focal person, Peer Educators as well as the Paralegals. LENASO was to engaged focal Persons, WILSA PARALEGALS while TRA Peer Educators to reach couples, Women and girls, and Youth and Herd-boys respectively with prevention interventions through focus group discussion. 20

Handing over of vehicles to LENASO, TRA, WLSA and LENEPHWA to enable monitoring of the projects in various districts. Two motor vehicles were procured and these were provided to TRA and WILSA, while LENASO and LENEPWA received used vehicles that were taken from the Previous Principal Recipient (LCN) and SR (Lesotho Business Labor Coalition- LBLC to enable implementation. 3.1.3 Supervise and Monitors districts where LENASO Facilitators from Support Groups at the Districts Maseru, Qacha's Nek and Mokhtlong LENASO managed to train the focal persons to enhance their skills so that they can reach couples with BCC interventions in the four districts of Berea, Maseru, Qacha s Nek and Mokhotlong. Trainings for Focal Persons in Berea and Maseru were done in December 2013. The other trainings for the remaining two districts are scheduled to be conducted early January 2014. Procurement processes for printing of M&E tools have already been initiated. 3.2 Strengthening National Policy Frameworks 3.2.1 Hire a project coordinator A Project Coordinator and Administrative Assistance were engaged in November 2013 to assist with implementation of activities for women and girls. 3.3 Stigma reduction in all settings 3.3.1 Strengthen monitoring and reporting systems Printing of M&E tools and laws for implementation have been initiated. Training for Paralegals is scheduled to take place in the first week of February 2014.WLSA focus is to reach Women and Girls with different Legal instruments that include Sexual Offences Act, Inheritance law and Capacity of Married Persons Bill. 3.4 Community Systems Strengthening 3.4.1 Support grants management units within SR through provision of Project Officer- for TRA, LENASO and LENEPWA All the positions for Finance Office, Grants Office and Monitoring and Evaluation Office for LENASO, TRA and LENEPWHA were filled and salaries for these officers are being paid on a monthly basis. 3.5 Financial Performance This section covers financial performance of the grant from October to December 213. Table 6 indicates the summary of funds disbursed and expenditure as at 31 st December 2013. Table 8: Summary of Budget versus Expenditure for CSS Total Budget approved Funds disbursed as at December 2013 Cumulative expenditure Oct-Dec Budget Oct-Dec Expenditure 21

3,316,275 846,632 162,540.41 343,359.46 135,591.49 Cumulative expenditure was 20% of the funds received. The expenditure incurred supported the advertisement for the staff from Central to district level, salaries of the SR staff, trainings that were conducted by LENASO, printing of manuals. The delayed disbursement for actual activities contributed to slow pace of activities such as trainings, and as a results very low absorptive capacity of funds. SRs will start the training in the next quarter as mostly were in the process of recruitment of personnel. Table 7 indicates the expenditure breakdown for this reporting period. Table 9: Budget and Expenditure Report for R8HIV CSS Grant for Oct-December, 2013 Service delivery Area Budget: Oct-Dec Expenditure: Oct-Dec % Budget Utilization BCC - Mass media - - BCC - community outreach and schools Strengthening National Policy Frameworks Stigma reduction in all settings Community Systems Strengthening Primary Recipient Operating Items 228 754.63 13 695.31 6% 9 011.94 2 355.04 26% 12 324.69 1 264.77 10% 65 913.33 95 136.45 144% 27 354.87 23 139.92 85% Total 343 359.46 135 591.49 39% The chart below shows expenditure by implementing agency for the quarter 22

Figure 2: Budget and Expenditure by SR: CSS The majority of spending constituted administrative costs for SRs, Salaries for SR Staff and three newly staff under PR coordinating this grant. 3.6 Challenges Transfer of vehicles from LCN took a long time thus impacting on implementation Recruitment of peer educators, paralegals, focal persons and facilitators was delayed hence training could not take place 23

Chapter 4: Round 8 HIV/HSS The goal of the grant is to reduce HIV and AIDS related morbidity and mortality in Lesotho. The grant has a component on Health Systems Strengthening aimed at making a viable environment for the Health sector to function. Strengthening of the health system entails focusing on factors that can improve the performance of the system like health sector infrastructure, human resource staffing, monitoring and evaluation, health commodities and procurement amongst others. These efforts are all made to contribute to the achievement of the three main objectives; i) of reducing the incidence of new infections in both the general and specific populations, ii) increasing universal access to HIV testing and counseling (HTC) services and iii) strengthening and scaling up comprehensive HIV chronic care services and ART for PLHIV. The sections below will present performance and use of funds which covers period from October 2013 to December 2013 focusing on the Service Delivery Areas and Main Activities. 4.1- BCC - Mass Media (Collaborative development of messages, materials and tools) 4.1.2 Production and dissemination of BCC materials Mantsopa communications is implementing this activity through the use of trained youth called Champions. The main objective of disseminating the BCC material is to promote behavior change among the vulnerable groups in the society. During the reporting period 750 training manuals were printed and will be used during the focus group discussions. 750 Champions were recruited from the 10 districts, and out of these, 168 (74 from Mohale shoek and 94 from Maseru) were trained. This was achieved with the help MOH s partners such as LANFE, World Vision and Lesotho Youth Forum. Training of the other champions is planned to take place in the first quarter of 2014. During the reporting period 27,925 booklets of khetho ea ka were printed and this was against the target of 28,200. These booklets are to be distributed to the audience during the focus group discussions. 4.2- BCC - Community Outreach & Schools 4.2.1Conduct peer education training for prisoners 30 inmates were reached with peer education during the reporting period. The training was aimed at increasing the inmates knowledge as a prevention strategy within the LCS institutions; outlining the benefits of routine HIV testing and counseling to vulnerable groups such as prisoners; creating awareness about the available HIV and AIDS services within the LCS institutions and reduction of stigma and discrimination surrounding HIV and AIDS. The ultimate goal of the training was for the inmates to go out and reach their peer with knowledge gained. During the reporting period, 471 inmates were reached with 24

prevent interventions in Quthing, Qacha snek and Mohale s Hoek. Furthermore, 301 inmates received HTC within the LCS institutions and 29 of them tested HIV positive. LCS trains inmates with HIV and TB. On the right the correctional staff commemorate AIDS day. 4.2.2 Continue training support for youth to manage the centres During the reporting period 300 youth were trained on Life-skills education, HIV and AIDS, including entrepreneurship and educational promotion. In addition 100 youth volunteers managing the centers were provided with incentives. The youth volunteers are providing peer education on Life-skills education, HIV and AIDS, including entrepreneurship and educational promotion within the centres. 4.3- Condom Programming 4.3.1 Print and disseminate the condom policy, condom distribution strategy The Ministry has finalized the condom policy and printing of 200 copies was initiated. Delivery of the printed document is expected by February 2014Thereafter the document will be circulated to all the stakeholders. 4.3.2 Procure and distribute male and female condoms 6 million male condoms were procured and delivered in August 2013. Currently, these condoms are being distributed to various institutions such as the health facilities, DHMTs, and MOH partners. The condoms were procured under the R8 HIV/HSS and SSF grants. During the period under review a total of 279,050 condoms were distributed by NDSO between October and December 2013, out of the total number of condoms distributed by NDSO, 22, 050 were male condoms and 257,000 were female condoms. 4.4- Male Circumcision 4.4.1 Sensitize all sectors' health care workers and community leaders on male circumcision Sensitization of health care workers and community leaders on male circumcision was carried out in December 2013 in Mafeteng and Mohale s Hoek districts and 2 sessions were held for each group. One was held for HCWs and the other for community leaders. As part of ensuring that MC services are strengthened, procurement of male circumcision kits has been initiated through NDSO. 25

Furthermore the Ministry of Health will be undertaking the mid-term of the VMMC scale up plan 2012-2017. The TOR for the assessment were finalized and approved by the VMMC technical working group. The Ministry has requested Technical Assistance for The World Health Organization (WHO). The assessment is scheduled to commence in March and to be concluded by June 2014. 4.5- STI 4.5.1 Procure and distribute STI drugs and commodities within the public and private sector. Procurement of the Sexually Transmitted Infection (STI) drugs and commodities has been completed and delivery occurred between august and October 2013. These commodities are already been distributed to health facilities. 4.6- Testing & Counselling 4.6.1 Establish new HTC access points of underserved and rural areas using public, private and non-governmental partners ALAFA is implementing some of the activities under this SDA. During this reporting period, the HTC team was able to conduct only 5 mobilizations in Maseru and Maputsoe and 2400 workers were reached with HTC messages. One mobilization was cancelled with advice from the factory management due to death occurring in that factory. 3037 workers were tested for HIV in this period and this was attributed to the mobilizations and drives conducted in previous quarters. Counseling sessions tallying to 1664 were held for the factory workers. Moreover, data verification exercise was conducted in all factories except one in Mafeteng as the factory could not accommodate the ALAFA team on the set date. 28 spot checks were conducted and this was 97% of the quarterly target. ALAFA provide HIV testing and TB screening in the textile factories in Maseru and Maputsoe 4.6.2 Convene monthly meetings at the district level Monthly meetings at the district level by the central team from MOH were not conducted in this period. These meetings are important in discussing all the HTC activities carried at the district and facility level. It is envisaged that the meetings will resume in the first quarter of 2014. 26

The MOH was able to procure 1315 rapid HIV tests and consumables. These health products are already been distributed to the health facilities. The total items procured are 1512 and the balance of 120 which is still to be delivered. 4.7- ART 4.7.1 Procure ARVs for adults and children at all levels ARVs for adults and children at all levels were procured and delivered between August and October 2013. These health products are already been distributed to the health facilities. Table 9 indicates adult and paediatric ARVs procured. Table 10: Health Products 10a: Adult ARVS Description of goods Pack size Quantity procured Tenofovir/Lamivudine/Efavirenze 300/300mg/600mg tablets 30 Zidovudine/Lamivud:300/150mg tabs 60 Tenofovir/Lamivudine + NVP 300/300+200mg tablets 30 Tenofovir/Lamivudine 300/300 tablets 30 Lopinavir/Ritonavir 200/50mg Tablet 120 30 345974 60 36922 90 69409 120 29747 30 6293 Efavirenze 600mg tabs 30 30 106 626 Abacavir/3TC tabs 300/300mg 60 60 46 629 Lamiv/Zid/Nev 150/300/200mg Tablet 60 60 117 878 Tenofovir 300mg tabs 30 30 250 10b: Paediatric ARVs Description of goods Pack size Quantity procured Tenofovir 300mg tabs 30 30 6000 Abacavir/Lamivudine 60/30mg Lopin/Reto. 100/25mg Tabs 60 30 7480 60 2186 27

Lamiv/Zid/Nev 30/60/50mg Tablet 60 60 36260 4.8- Prophylaxis 4.8.1 Procure drugs for management of opportunistic infections Drugs for management of opportunistic infections were procured and delivered between august and October 2013. These include cotrimoxazole and INH. These products are already been distributed to the health facilities. 4.9- Sexual Reproductive Health 4.9.1 Train HCWs on integrated management of sexual reproductive health and HIV Two trainings for the health care workers were conducted in Berea district on the 10-12 December 2013, and 17-19 December 2013. AIDS Care Health Foundation (AHF) provided technical support during these trainings. A training of VWH workers for the Berea District was postponed to February 2014. The training focuses on capacitating the health care workers on the integrated management of sexual reproductive health and HIV. 4.10 - Care & Support 4.10.1 Procurement of HBC kits for community health workers Processes of procuring Health Based Care (HBC) kits were initiated in this period. 1341 HBC kits are going to be procured using the year five (5) budget. These kits will be utilized by the Village Health Care Workers in the provision of the HBC services at the community. 4.11- TB/HIV 4.11.1Conduct joint TB/HIV joint supervisory and quarterly visits Two main activities were planned in this period and these included joint TB/HIV supervision visits and TB/HIV quarterly district meetings. These activities were not implemented and they have been rescheduled for January and February 2014. 4.12 Strengthening National Policy Frameworks 4.12.1Conduct HIV sentinel surveillance, Data collection has been completed. The MOH is in the process of recruiting the consultant who will train Data Capturers and write the report. The budget in the grant provides for only two data clerks; these have been deemed insufficient. The UNAIDS has committed to providing support for extra data clerks. UNAIDS has also committed to providing TA for report writing. Data entry is expected to start in April, data analysis expected in May and first draft of the report is expected by June 2014. 4.12.2 Conduct situation analysis on the status of the epidemic in prisons Lesotho Correctional Services has submitted a proposal to the Global Fund to conduct a survey which will look at strengthening provision of HIV and TB services at its institutions. 28

The TOR, justification and budget for the new study have been submitted to Global Fund for approval. 4.12.3 Conduct BSS The study has successfully taken off in Maseru; to date 50 Female Sex Workers (FSW) has been recruited out of which 19 have already completed the questionnaires and done biological tests. On the hand, 61 Men having Sex with other Men (MSM) have been recruited and 35 of them have completed the questionnaires and done the biological tests. The expectation is to complete the study in Maseru by end of May; the study team will then relocate to Maputsoe immediately. The study is still on track in terms of time and also in terms of targets. The Global Fund money is supporting HR under the survey. 4.13 - Supportive Environment-Workplace Program: Public Sector 4.12.1Train LMPS officers in HIV/AIDS and TB competency 45 police were trained on TB and HIV competency. These police officers are trained as peer educators for HIV/AIDs and TB activities within their respective working stations. Furthermore, during the reporting period 210 000 male condoms were distributed to LMPS institutions and 14 Home base kits were distributed to police units to support HBC activities. LMPS Commissioner officially opens the HIV and TB workshop. On the right are the participants. 4.14 - Service Delivery 4.14.1 Refurbish hospital radiological suites: Reinforce walls, install lead paneled doors, install leaded control panel glass Procurement is at the advanced stage for the refurbishment of upgrading hospitals radiology facilities in 6 hospitals namely Mokhotlong, Mafeteng, Maluti, Tebellong, St. Joseph s and Leribe. 29

4.15 - Health Workforce 4.15.1Recruit additional health workers in PHC facilities according to MOHSW HR Development and Strategic Plan (2005-2025) and subsequent Emergency HR Plan. Various positions continued to be supported with remunerations. Table 10 depicts these positions and how many people are still in place currently. Despite these positive improvements, resignations are no longer filled because of the CP. Table11: Number of Human Resources supported by GF Position Target Achievement Reasons for variance Safety, Training & Quality Officer 3 0 Vacant since July 2012. Not filled due to HR condition precedent Drivers 15 15 0 Counselors 285 240 Late processing of 37 lay counselor contracts. 8 resignations Clinical Officer 1 1 0 Senior Tutors 21 16 Due to 2 resignations and 1 death Human Resource Officers 10 8 Due to 2 resignations Prevention Manager 1 1 0 Programme Officer 1 1 0 Pharmacists 18 6 12 absorbed into government Accountants 2 2 None Compensation & Benefits Manager 1 1 None Data Clerks 85 55 Vacant posts not filled NDSO Support 5 2 Positions absorbed 30

Officers into NDSO Procurement Officer 1 1 None 4.16- Information system 4.16.1Conduct data verification visits During this reporting period data verification was not conducted and is planned for the first quarter of 2014. On previous quarters the data verification was conducted using WHO funds. 4.16.2Conduct health facility accreditation surveys Implementation of the accreditation survey is under underway. The Quality assurance unit from the Ministry started to disseminate the findings of the baseline assessment report from December 2013. The assessment was funded by WHO while the grant will continue to support the dissemination, and the survey. The dissemination is expected to be completed by early February 2014. This activity is important as it shows the identified gaps and deficiencies from a sample of facilities so that corrective measures can be undertaken during dissemination and sensitization period. The main National Accreditation Survey is scheduled to take in April 2014. 4.17 Financial Performance Implementation of this grant was affected by the delays in the disbursement of funds from GF due to Conditions Precedent. Funds were received during the 2 nd year of the grant. As a result little expenditure was incurred prior to December 2012. Consequently, some of the 1st year activities were combined with 2 nd and 3 rd year activities. Table12: Summary of Budget versus Expenditure for HSS Total Budget approved Funds disbursed as at December 2013 Cumulative expenditure Oct-Dec Budget Oct-Dec Expenditure $57,717,479 $29,112,431 $20,957,867.81 $11,016,398 $5,208,143.26 Cumulative disbursement received from the GF stand at $29,112,431 and out of the funds received the cumulative expenditure is $ 20,957,867.81 as at December 2013. The budget for the reporting period from October to December 2013 is USD 11,016,398 and the corresponding expenditure is USD 5,208,143.26. Table 12 demonstrates the analysis of the budget and expenditure breakdown for the period under review is illustrated through the Service Delivery Area in a table 12. Table13: Budget and Expenditure Report for R8HIV/HSS Grant for October-December, 2013 31

Service Delivery Area Budget (USD): Oct-Dec Antiretroviral treatment (ARV) and monitoring BCC - community outreach and schools Expenditure (USD): Oct-Dec % Budget Utilization 7 928 528.00 3 964 189.45 50% 49 548.00 24 273.99 49% BCC - Mass media 95 851.00 17 512.19 18% Care and support for the chronically ill Community Systems Strengthening 183 529.00-0% - 10 327.52 Condom - 18 402.52 Male Circumcision 191 477.00 10 673.62 6% Prevention: Testing & Counseling 366 671.00 60 836.37 17% Prophylaxis and treatment for opportunistic infections 646 139.00 321 308.82 50% Sexual and Reproductive Health 45 603.00 3 929.32 9% STI diagnosis and treatment 205 629.00 66 030.84 32% Strengthening National Policy Frameworks Supportive Environment- Workplace Program: Public Sector - 1 446.00 51 319.88 3549% TB/HIV 14 662.00 30 462.27 208% Primary Recipient Operating Items 39 814.00 48 443.38 122% HSS: Health Workforce 868 149.02 412 357.58 47% HSS: Procurement and Logistics 123 533.00 59 216.64 48% HSS: Information system 136 069.81 54 433.40 40% HSS: Service Delivery 119 748.70 54 425.48 45% TOTAL HIV/HSS Y5 Q1 11 016 397.53 5 208 143.27 47% Budget and expenditure analysis: The bulk of the expenditure incurred this quarter is on Medicines, Health Products, Prophylaxis and treatment Opportunist Infections, with products that include ARV drugs, laboratory reagents and consumables, STI drugs, Cotrimox, INH and OIs drugs to the tune of o USD 4,369,931.63. This has been followed by expenditure incurred on support for Health Workforce with emphasis to remuneration of professional counselors, Data Clerks, Lay Counselors, Pharmacists, Human Resource Officers, Senior Tutors, and Village Health Workers, administration staff like Accountants, Program Officers and drivers. Significant expenditure was also realized under HIV Testing Counseling; the main cost driver being HTC services for factory workers as well as installation of EMR software; 32

conducting series of trainings for MOH health care workers; provision of champions incentives for conducting focus group discussions on prevention and behavior change; provision of allowances to Youth leaders in support for their contribution towards the running of the Youth Resource centers. The chart below shows expenditure by implementing agency for the quarter Figure 3: Budget and expenditure by SR: R8HIV/HSS As depicted in table 12, absorptive capacity of the budget is below optimal level at 47%. This was as a result of various reasons including but not limited to the following reasons: There are several vacancies within Ministry of health which could not be filled due to condition precedent related to retention of health workforce. Currently, only 78% of the posts are filled. Payments for activities that were implemented this quarter were effected outside the reporting period 33

Payment of CHW incentives has not yet been effected pending completion of the verification of the CHW lists. Currently GFCU is verifying CHW lists submitted by MOH as well as those provided by the Health center nurses with the Database for CHW supported under the R8 HIV grant before any payment can be issued. 4.18 Challenges HTC mobilisation was low because factories were busy in this quarter. Payment of invoices outside of the quarter in which they were implemented Delayed implementation of activities especially trainings There are several vacant positions which have not been filled due to the condition on Human Resources (only 78% of posts are filled) Collection of beneficiary lists for CHW payment and verification process A quarterly report from the Ministry of Health was not received for this period hence the report has gaps due to incomplete reporting. It was reported that non-submission of the quarterly report is related to incompleteness of HTC and ART data. Data capturing was scheduled to be completed by last week of February. Most trainings were not implemented as planned Monthly and quarterly review visits at the districts were also not implemented according to plan thus affecting the budget negatively. 34

Chapter 5: Round 8 TB Grant The goal of Round 8 TB Grant is to reduce the burden of MDR/XDR-TB by providing universal access to high quality diagnosis and patient-centered services in line with Global Plan to Stop TB targets. The R8 TB grant is in phase 2 of the implementation since October 2012. The total budget of USD 9,671,218 was approved for the grant implementation in phase 2 and the grant was signed in May 2013. A total of USD $ 1,883,415 was disbursed in June 17, 2013 covering the period April to December 2013. The sections below will present performance and use of funds which covers period from October 2013 to December 2013 focusing on the Service Delivery Areas and Main Activities. 5.1-Improving diagnosis 5.1.1Conduct QA supervisory visits to peripheral labs External Quality Assurance(EQA) was conducted for 17 hospital laboratories, by the Central Laboratory team. The EQA report showed that 13 Laboratories showed adequate performance among those that received EQA for smear microscopy. The recommendations made to Laboratories which demonstrated inadequate performance were the following; 35 Microscopists have to improve on smear preparation and staining Microscopists have to improve on managing AFB statistsics Laboratory staff,tb Coordinators and Officers have to expedite ways to acertain that patients produce quality specimen. 5.1.2Refresher training for Microscopists to perform smear Microscopy The National TB Reference Laboratory and National TB Programme conducted refresher training on sputum smear microscopy for microscopists and laboratory technicians. The training was carried out on the 21 st October 01 st November 2013 and 30 participants attended the training. As part of strengthening laboratory services 30 microscopists are still supported under the grant. 5.1.3 Procure GeneXpert machines Cartridge The Ministry is awaiting the delivery of consumables and reagents and health equipment from NSDO. These include five Genexpert machines, respiratory marks and consumables and reagents for the 2 nd line DST. 5.2 -Patient support 5.2.1Procurement of food packages A total of 206 patients were provided with food package during the reporting period. Food packages are given to every patient who is enrolled on treatment to improve adherence and to ensure that one of the MDR-TB drugs is taken with a meal every day. The package

consists of, sorghum 10 kg, beans 500 g(4 packets), peas 500(4 packets), sugar 2kg (2), mealie-meal 25kg(1), cooking oil 2(1), salt 500g(1) and Nespray milk Food is provided monthly to MDR patients when comes for doctor s check-ups and drugs refill 5.2.2 Procurement of food packages for severely malnourished patients Severely malnourished patients among the MDR-TB patients are provided with Ready to Use Therapeutic Food (RUTF), for example, plump nut. 15 patients were given ready to Use Therapeutic Food. Patients weights, MUAC and BMI are monitored every time they come for their scheduled visits and when their status improves provision of the food is stopped. 5.2.3 Transport assistance to patients 224 patients were provided with transport assistance. The assistance is vital in ensuring that patients are able to attend follow up visits on schedule.the transport fees paid are based on the Department of Traffic, transport fares. 5.2.4 Provide temporary accommodation In October and November nine (9) and six (6) patients were provided with temporary accommodation respectively. Patients are provided with accommodation after being released from hospital. Houses within Maseru district are rented for patients until their Treatment Supporters are trained and competent to support and monitor MDR patients to ensure that they take their medicines as prescribed. 5.3 - Procurement and Supply Management 5.3.1Conduct quality control testing for 2nd line anti-tb drugs During the reporting period there was adequate supply of the second line drugs for MDR- Drugs. There was un-interrupted supply of quality assured second line anti-tb drugs and supplies for effective Drug Resistant TB management. A request has been made to NDSO to conduct quality control testing for 2nd line anti-tb drugs. It is envisaged the activity will be implemented in the next quarter. 5.4 - M&E 5.4.1 Conduct Drug Resistance Survey (DRS): Training of staff on DRS protocol The overall objectives of a TB DRS are; i)to understand resistance patterns in Lesotho in order to plan for future treatment regimens, ii) to make necessary adjustments to guidelines 36

and iii) to improve the implementation of DOTS. Stationery was purchased to facilitate during the three regional refresher trainings on the protocol and these training were held in December 2013, for Laboratory personnel, TB Coordinators, TB Officers and Health Center nurses. A computer was bought to enable implementation of the study. Data collection and is ongoing and it is envisaged to be completed by March 2014. 5.5 - Management and Supervision 5.5.1 Enhance NTP staff with 1TB Advisor and 2 Program Officers Funds has also been earmarked for the support of NTP programme Staff for the following positions; TB advisor, Programme Officer, ten (10) Adherence Psychosocial Officers and four (4) Drivers. All these critical personnel are in place. 5.5.2 Hold Quarterly Programme meetings with technical partners and Districts NTP conducted a Bi-annual TB Review programme meeting from the 29 th October to 01 st November 2013. The objective of the meeting was to: Share updates and progress on implementation of Global Fund R8 TB activities Share interventions to improve performance of TB Control indicators Discuss findings of the 3 rd quarter 2013 support supervision and also discuss 3 rd quarter 2013 aggregated data. Share best practices in implementation of the 3Is and scale-up of collaborative TB/HIV activities. Share updates on new technologies in diagnosis of TB - roll out plan of Genexpert Introduce the revised TB and TB/HIV reporting and recording tools 5.5.3 Participate in Cross-border collaborative meetings with NTP South Africa. Cross border meetings with NTP and South African counterparts were held in Kokstad from 18 th to 22 nd November 2013 and the NTP Manager and TB Coordinator from Qacha s Nek participated. The other meeting was held on 12-14 th December 2013 in Johannesburg. These meetings are intended to indentify collaborative TB/HIV activities for the migrant workers in the two countries. 5.5.4 Conduct quarterly review meetings with Health centres to discuss implementation progress Quarterly review meetings with Health Centers did not take place as planned. In addition transport support to 1,800 CHW is yet to be implemented. The delays were due to many factors that include modalities of disbursement of these funds to the beneficiaries. The NTP is still exploring ways to accelerate implementation of the activities. 5.5.5 Conduct twice weekly Supervisory visits to Districts by Central team During the reporting period 19 visits were conducted to see patients on treatment. The team that undertakes the supervisory visits consists of three nurses and one doctor from Partners in Health (PIH). Moreover Community Nurses conducted 47 supervisory visits to the community treatment supporters. 37

Training of treatment supporters for the MDR patients. 5.6 - Human Resources Development 5.6.1 Training of National TB Reference Laboratory scientists on Second line DST. Two TB Coordinators from Mafeteng and Berea attended short course training on programmatic management of TB, TB/HIV and MDR-TB from 25th November to 13 th December 2013 in Arusha Tanzania. Pharmacy and Laboratory Technicians will be trained on the 21 st February 2014. The National TB Programme jointly with Family Health Division trained nine (9) in-house Pediatricians. The training was funded by World Health Organization (WHO) and its focused was on introduction to the stop TB strategy, International Standards of TB Care (ISTC), MDR-TB and TB/HIV collaborative exercised as well Programmatic Management of Drug Resistant TB (PMDT). 5.6.2 Training of 31 Medical Officers in two groups, on MDR/XDR AND TB/HIV management. Private, CHAL and public facilities doctors will be mixed for cross fertilization 30 Medical Officers from Government, CHAL hospitals and the Private Practitioners were trained on MDR/XDR and TB/HIV management. The objective of the trainings was to: Provide knowledge and skills to the Medical Officers on how to diagnose, treat and support TB, MDR/XDR-TB patients, both adults and children Improve knowledge on programme management of TB including the stop TB strategy Share the latest updates guidelines and new case definitions 5.6.3 Community Health workers trained on TB/HIV collaboration and integration for referral models By end of December 2013, 2139 Community health workers were trained. The aim of the trainings was to capacitate CHW in TB case finding, patient support and education on TB/HIV. 38