The document discusses the work of Health Alliance International (HAI) in strengthening Mozambique's health system and improving HIV care through its partnership with PEPFAR. It outlines how HAI worked within the public health system, expanding services like voluntary counseling and testing, PMTCT, HIV treatment and care, and home-based care. Through this integrated approach and decentralization of services, over 100,000 people have received HIV care and 25,000 have been placed on antiretroviral therapy. The document also discusses challenges and ways PEPFAR II can further improve support for treatment scale-up, integration, health systems strengthening, and addressing social determinants of health.

1. HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care Jennifer Kasper, MD, MPH Former Pediatric Technical Advisor and HIV Program Manager, Health Alliance International Board Member, Doctors for Global Health Physicians for Human Rights Student Conference January 31, 2009

4. Mozambique Civil War (1980-1992)

6. HIV Prevalence: Top 10 Countries Zimbabwe 25.84 Botswana 25.10 Namibia 19.94 Zambia 19.10 Swaziland 18.50 South Africa 16.70 Mozambique 16.00 Malawi 14.92 Tanzania 9.42 Lesotho 8.35

10. Foreign Policy May/June 2004 Additional management burden by donors & NGOs Tanzania 1,371 different projects to manage

15. HIV Treatment Expansion Plan 2003 HF Providing HAART 1 PLWHA Registered 2,000 Eligible in HAART 94 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava 2003

16. 2004 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 2 PLWHA Registered 7,300 Eligible in HAART 600 2003 2004 Free ART in Public Health Sector

17. 2005 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 7 PLWHA Registered 18,600 Eligible in HAART 2,520 CS HCB HR HPC HG HeathC CentH RurH ProvH GenH

18. 2006 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 17 PLWHA Registered 36,270 Eligible in HAART 5,250 2003 2004 2005 2006 Decentralization to Rural Sites

19. 2007 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 47 PLWHA Registered 63,390 Eligible in HAART 13,225 2003 2004 2005 2006 2007

20. HIV Treatment Plan 08-09 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART: 87 March 2008: 55 Registered: 180,000 March 2008: 92,600 HAART: 45,000 March 2008: 22,000 <15 y in HAART: 5,000 March 2008: 900 HeathC CentH RurH ProvH GenH Pending

27. Distribution of Disease vs Distribution of Funding

28. A Balanced Approach to Health Care Delivery: Vertical, Horizontal, Diagonal?

29. US FINANCIAL SUPPORT: GLOBAL HEALTH AND DEVELOPMENT