1. Historical perspective
The evolution of the management arrangements in NCHADS has fallen into several identifiable phases.
1.1 The initial phase: 1998-2001
The National Centre for HIV/AIDS Dermatology and STD (NCHADS) was established in 1998 following the amalgamation of the National AIDS Programme (NAP) and the National STD and Dermatology Clinic. Since then, its primary purpose is to respond to the HIV/AIDS epidemic through the implementation of HIV/AIDS Strategic Plan within the health sector responses.
From its inception, the Centre has worked consistently to develop its internal management arrangements to improve performance. At the start in 1998, a formal structure with detailed unit Terms of reference and individual job description for each staff member were developed. Subsequently, in 2000 a functional analysis of the roles and responsibilities of staff in NCHADS was carried out to enable it to better respond to the development of the Centre’s roles and to its work programme. This also addressed the organisational development needs resulting from the Strategic Plan for HIV/AIDS and STD Prevention and Care 2001-2005.
1.2 The second phase: 2001-2003
During this period there were further developments within the Centre, such as the addition of a clinical research component, a major strengthening of the Finance Unit, and significant changes in funding sources and patterns, with substantial grant fund from ADB, CDC-GAP, DFID, EU, World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNSW being managed by NCHADS, and disbursed to provinces for program implementation. In addition, NCHADS works in partnership with a number of institutions and organizations, such as CHAI, ITM, and over eighty international and local NGOs.
It was during this period that the concept of stimulating performance of NCHADS staff and health care workers at sub-national levels that were actively participated in HIV and STI responses within the health sector, by the use of incentive payments first emerged and which was subsequently developed into the Performance Based Incentive Scheme (PBIS). Currently, it has changed to the Priority Operating Costs’ Schemes (POC).
1.3 The third phase: 2004-2007
A Mid Terms Assessment of the NCHADS Strategic Plan in 2004 led to a review and up-dating of NCHADS’ functions, structure and programme and to a revision and re-alignment of the NCHADS Strategic Plan 2003-2007 with the Ministry of Health’s Health Sector Strategic Plan 2003-2007. Following this, NCHADS has concentrated on strengthening decentralization of the programme to Provincial and OD levels, with increased emphasis on expanded access to treatment and care for PLHIV through the introduction of the responses to the need for OI and ART services, plus closer collaboration to develop comprehensive work plan with partners. As a result, the NCHADS Annual Comprehensive Work Plan (AOCP), now includes the work plans from most partners, and is integrated at both central and provincial levels into the Ministry of Health Annual Operational Plan (AOP) process and outcome. All this has required a continual re-structuring of NCHADS’ Technical Units to respond to the demands of the expanded treatment and care programme and changes in the delivery of the NCHADS’ programme, plus increased requirements for improved data management, logistics and supply management.
1.4 The latest phase: 2011-2015
At the time of this functional review, NCHADS looks forward to further changes and developments as it pursues improved referral and follow-up linkages with other health institutions, and improved the quality of care and treatment services, through the implementation of the Continuum of Prevention to Care and Treatment (CoPTCT) for MARPs, Continue of Quality Improvement (CQI), and Quality Insurance (QI), strengthening linkages of HIV, STI, Sexual and Reproductive health matters that was approved by the Ministry of Health on 19th December 2007. The update of FTA was also to assist the implementation of NCHADS Strategic Plan for HIV/AIDS and STI Prevention and Care in the Health Sector Responses 2011-2015 as well as to improve the quality of care and treatment services by upgrading the laboratory services at national, provincial and referral hospital levels. NCHADS therefore needs to establish a Laboratory Management Unit that plays a vital role in building up the capacity of the laboratory staff of the integrated laboratory facilities at health facilities through trainings, and regular technical supports. The unit’s staff also manages and performs the quality of the new established national laboratory services at NCHADS.
Over the past few years, NCHADS has implemented many initiatives and developments in HIV and STI control programmes: The Continuum of Prevention to Care and Treatment, Three I’s Strategy, Positive Prevention, and Linked Response Approach, increasing HIV testing coverage among MARPs through the introduction of C/PITC, updated National Treatment Guidelines for Adults and Children, and update NCHADS strategic plan for HIV/AIDS and STI Prevention and Care in the health sector (2011-2015). The Nation-wide implementation of a more comprehensive and improved quality packages of HIV and STI Control activities will be reflected in an updated health sector HIV and STI strategic plan 2011-2015. Roles and responsibilities of the structural responses at national, provincial and operational district levels need to be revised to be able to fulfill the mission and targets set in the updated Strategic Plan.
2. NCHADS Mission and Role
2.1 Mission statement
The National Centre for HIV/AIDS, Dermatology and STD (NCHADS) is one of the national programmes of the Ministry of Health with lead responsibility for recommending and implementing policies, strategies and standard operating procedures for the health sector response to HIV/AIDS and STI in Cambodia. Through the programme management of effective health services, it works to:
- to reduce the HIV prevalence rate from 0.9% to 0.6% by 2015;
- to maintain and sustain the universal access to care and treatment of PLHIV;
- to increase survival of PLHIV on ART after 12 months initiation to more than 85%;
- to move towards to reach three Zero goals (Zero new HIV infection, Zero Death related to HIV, and Zero Discrimination);
- To ensure that NCHADS, provincial and OD programmes, including activities are cost-effectively managed.
2.2 Roles of NCHADS
The National Centre for HIV/AIDS, Dermatology and STD is a National Programme of the Ministry of Health functioning as a programme management unit enabling the
delivery of HIV/AIDS and STI related services within the health sector. The NCHADS strategy for HIV/AIDS and STI Prevention, and Care in the health sector (2011-2015) provides the framework for this conform to the National Strategic Plan III for a Comprehensive and Multi-sectoral Response to HIV/AIDS 2011-2015, (NSPIII) which is coordinated by the National AIDS Authority (NAA), and to ensure full support the MoH Health Strategic Plan II (2008-2015).
As programme coordination and management at national level, NCHADS does not deliver direct prevention, care, and treatment services by itself, except the National Dermatology and STD Clinic that provides STI and skin disease clinical services, NCHADS’ Social Clinic that provides care and treatment services for PLHIV, and NCHADS’ laboratory services provide HIV, Viral Load, and CD4 testing services, and other related HIV testing associated for HIV research purposes. Instead, NCHADS oversees the HIV/AIDS and STI programme activities at provincial and operational districts, providing technical skills and capacity to develop an annual operational comprehensive plan (AOCP), setting annual target, monitoring and evaluation, reporting, programmatic management, financial management, resource mobilization, build capacity, and administrative support as well as the provision of logistic supports for VCCT/CD4/Viral Load reagents, ARV/OIs drugs and supplies in close coordination with CMS. Additionally, NCHADS undertakes development relevant health sector policy/strategic/guidelines/SOPs and research activities and disseminates updated information on epidemiology, behavior change and effective prevention and care or other matters relating to the response to HIV/AIDS or STIs. The Centre manages the disbursement of programme and government fund according to the approved annual work plan, and its own Strategic Plan. Subsequently, it monitors and reviews progress against those annual plans and targets, taking action to achieve conformance where necessary. Looking to the future, the response to HIV/AIDS and STI is likely to be further integrated into the MoH Comprehensive Package of Activities which is delivered by public health systems at provincial, operational district and health center levels. NCHADS needs to strengthen for fully integrate of HIV/AIDS, and STIs prevention, care and treatment services into the public health care system, and further linkage with other health components including reproductive health, sexual health, safe abortion, safe delivery, and TB.