- Epidemiology, Statistics and Computing
- Research methods in Health services
- Qualitative Research Methods
- Health and Governance
- Marginal Budgeting for Bottlenecks
- Performance Based Financing (Impact Evaluation)
Several partners support the School of Public Health in this; they include: Tulane University, The World Bank, FHI, University of Berkeley, CDC, WHO among others.
THE RHPIF PROGRAM DOCUMENT 2006
RWANDA HIV-AIDS PUBLIC INTEREST FELLOWSHIP PROGRAM(Reinforcing the not-for-profit response to HIV-AIDS)PROGRAM DOCUMENT
Rwanda has a population of 8.129 million (National Census Service, MINECOFIN Final Results, November 2003) and an HIV/AIDS prevalence rate of 13% in urban populations, according to the Government of Rwanda (GOR). UNAIDS estimates an 8.9 % prevalence rate, which confirms the gravity of the epidemic. More than 370,000 Rwandans are living with HIV and about 180,000 of them have developed AIDS. AIDS is one of the three leading causes of death in Rwanda. By 2005, the crude death rate will be 40 percent higher than it was in 1990, primarily due to AIDS.1 Rwanda faces many obstacles toward overcoming the HIV/AIDS epidemic. They include the continuing impact of the 1994 genocide on social stability, the country’s severe poverty, and a high fertility rate that increases pressure on land in Africa’s most densely populated country. Rwanda has a per capita Gross National Income of $230, is ranked 154 out of 174 countries on the United Nations Human Development Index (UNHDI Report, 2001), and has a fertility rate of 5.8 suggesting that the population could total 11.7 million by 2025. The 1994 genocide has had a major impact on HIV/AIDS programming choices in Rwanda. Four years of civil war beginning in 1990 reversed the country’s progress in improving access to essential health services. In 1990, HIV prevalence was very high in Kigali but very low in the rest of the country, which was then 95% rural. During the three months of killing in 1994, mass rape, sexual torture, and psychological trauma were common. Although the exact number of survivors of sexual and gender violence (SGV) committed between 1990 and 1994 is not known, it is thought that 250,000 women were raped and 30,000 pregnancies occurred from rape. A 1999 study focusing on physical and psychological torture and sexual violence committed during the genocide indicated that 80.9% of survivors had symptoms of trauma and 67% were considered HIV positive. The massive population flows that accompanied and followed the genocide resulted in new urban and rural settlement patterns and dramatic fluctuations in HIV prevalence rates. The number of orphans and vulnerable children (OVC) jumped. Children and adolescents constitute 45.3% of Rwanda’s current population, many of whom are considered at risk of contracting HIV. Among this population, an estimated 300,000 children live in 80,000 child or youth-headed households. The nearly 3,000 minors interned at centers face the prospect of growing up in institutions, while an additional 9,000 adolescents and children live on the streets. Children have limited access to education. Adolescents and youth face limited to no opportunities for their economic growth and development and consequently often engage in classic risk behaviors. The collapse of traditional community and family support networks combined with ongoing regional instability in DRC and Burundi causing population movements, the continued active deployment of the military and the increasing presence of commercial sex workers add to the challenge of solving the HIV/AIDS crisis.
PROGRAM JUSTIFICATION AND STRATEGY
In Rwanda, the problem of trained human resources is more complex than in any other African country, due to the lingering demographic impact of the genocide, combined with the devastating human toll HIV-AIDS taking on from its population. A whole generation of trained human resources was lost during the genocide. Of the Rwandans who perished or were displaced, a disproportionate number were highly skilled and educated members of society, including doctors, medical students, nurses and health workers, lawmakers, engineers, etc. This loss, combined with the destruction of physical infrastructure, greatly debilitated the GOR’s efforts to recover from the genocide and, now, its efforts to respond effectively to HIV/AIDS. Today, sickness and death due to AIDS is exacerbating the trained labor shortage, and particularly that of trained managers so that Rwanda suffers from an inadequate critical mass of trained people in many areas, including in the public health, education, justice and social sectors. Although the exact number of professionals suffering from the infection is unknown, the number of educated individuals living with the disease is certainly significant. Confronted with these hurdles, the GOR continues to demonstrate enormous commitment, determination and leadership in the fight against HIV/AIDS; however it is still in urgent need of support to train skilled professional HIV-AIDS managers.
Though traditionally restricted to the health sector, HIV-AIDS needs to be addressed as a societal issue in a comprehensive sense. HIV/AIDS curricula and training programs have traditionally been designed around disciplines, not problems. The disease has been regarded as a primarily medical and epidemiological topic and has been widely ignored by other disciplines and sectors. As a result, its symptoms have received attention most often, while the underlying socio-economic dynamics and socio-cultural problems have been neglected. However, since there is no vaccine or treatment to cure HIV/AIDS and because the existing medication is expensive and inaccessible to the majority of people living with HIV/AIDS (PLWHA) in the developing world, treating HIV/AIDS as an infectious disease in a traditional sense—as a primarily medical problem—no longer seems to be justified. HIV/AIDS is first of all a development problem. When behavior change and other social changes are needed, the “de-medicalization” of HIV/AIDS becomes an important approach. Uganda and Thailand, which have had success in combating AIDS not through the medical sector, but rather by using a society-wide approach, provide powerful examples.
Guided by the above-mentioned vision and motivated by the urgent need to help the GOR fill the gap in trained human resources in Rwanda, the Fellowship program proposes the following strategy.
Based on lessons learned in other countries and drawn from years of addressing HIV-AIDS as a strictly medical issue, the Rwanda HIV-AIDS public interest Fellowship program (herein referred to as “the Fellowship”) proposes to help fill the gap in skilled human resources in the field of HIV-AIDS in Rwanda through a multi-sector approach. The success of Uganda’s initiative not only revealed the necessity of such a multi-sector strategy, but also highlighted the importance of Government commitment and involvement at all levels in the fight against HIV-AIDS. The Fellowship therefore proposes to focus on training young professionals to work as knowledgeable program managers capable of making evidence-based decisions supporting HIV-AIDS prevention, care and treatment programs in a variety of sectors. The goal of the program is to place the fellows in leadership positions in the not-for-profit sector,1 in order to reinforce the Government’s capacity to fight against HIV-AIDS.
The Fellowship program takes into consideration the complex nature of the Rwandan problem, and is based upon evidence from two major currents that have been the hallmarks of HIV/AIDS successes in other countries, notably Thailand and, more appropriate as a model, nearby Uganda.
The program’s challenge is to develop large numbers of middle and senior level managers who will be able to provide support at both central and local levels for the development of integrated approaches to HIV/AIDS prevention and treatment. The need for these middle level managers is particularly acute in Rwanda where, as noted, a generation of trained middle and senior level leaders was lost to the genocide. Combined with an increase in qualified professionals, the program works toward mainstreaming HIV/AIDS into all aspects of society, in order to expand multi-sector responses to HIV/AIDS. Resulting strategies will, consequently, scale up responses and address the developmental impacts of HIV/AIDS within Rwanda.
Lessons learned from Thailand and Uganda indicate that until primarily medical solutions such as vaccines become realities, it is imperative for all levels of society to internalize those mainly behavioral, change-oriented approaches that have proven successful.
While much work still needs to be done in systematically evaluating the many contexts and interventions that have been part of the worldwide war on HIV/AIDS, there are some key issues that have emerged from the literature which can provide us with guidance. Several basic principles guide the focus of the program. These principles, based on evidence from successful projects in Uganda and Thailand, will enable those working at different levels and on different aspects of HIV/AIDS policy to make an impact at the country level. They include advocacy and capacity building, which allow for the provision of better organizational platforms to those people managing the crisis.
Within the idea of mainstreaming are at least two domains worthy of focus: the internal domain or workplace, where staff risks and vulnerabilities are addressed; and the external domain, where the institution undertakes HIV/AIDS interventions based on its mandate and capacities, in support of local or national strategic efforts. Managers need to be trained to understand and implement interventions in both domains and across all levels of society.
A training model and a comprehensive list of skills, knowledge and competencies have emerged from the review of several hundred articles and professional training curricula from the fields of public health, public administration, and management.
The Fellowship provides training and skills appropriate for rapid integration of research from the worldwide biomedical, social science, and operational research community, with an increased emphasis on scaling-up proven high positive impact interventions. Emphasis is put on a field-driven and field-centered approach, including monitoring and evaluation of results.
The Fellowship lasts two years, during which the Program tries to reach a balance between theoretical background and hands-on work experience. The chosen methodology is built on two major components:
- Formal classroom type of training spread as follows in several sessions throughout the two-year fellowship. Training is provided by faculty from the National University of Rwanda School of Public Health (SPH) health professionals, economists and development specialists.
- A one-week introductory course covering the basics in epidemiology, cross-culture and cross-gender handling of HIV/AIDS, program management ethics, delivery of HIV/AIDS services in Rwanda, behavior change communications, best practices and multi-sector participation. This training is aimed at giving fellows some basic knowledge before they are placed in internships. SPH acts as the implementing agency and is working with Tulane’s technical assistance to develop a complete fellowship curriculum. This one-week training is supplemented by two weeks of computer training before the beginning of the internship.
- A two-day training at the six-month mark of the program (see annex for modules originally planned to be covered). The program is currently developing curricula for the topics to be taught.
- A training module at the one-year mark must still be further developed. The length of this module will depend on the new curriculum. SPH will use external technical assistance to make necessary changes while developing the curriculum for this training.
- A two-month certificate course at the 18-month mark (October) of the program which focuses on HIV/AIDS, program management, research methods and field work. Since the inclusion of this course in the Fellowship program in March 2006, the university has recognized the Fellowship. The course is equivalent to 9 credits that can be used toward an MPH or other masters-level programs. This certificate course is valuable to the fellows for three reasons:
- It validates the classroom training component of the Fellowship
- Its status as a “certificate” course can be used for career enhancement
- It will most likely offer a better opportunity for fellows to be accepted into masters programs, regardless of their field of study (i.e. upon application to a masters program, this Fellowship will be a “plus”)
- A computer-training course every six months. With the elimination of the two-week startup course a new schedule was developed for teaching fellows how to use computer programs.
Proposed curricula for above training sessions as they were originally configured are attached in Annex 1, because we are still in the process of reviewing and modifying it. The curriculum is being transformed in such a way in order to legitimize the Fellowship within Rwanda.
The training calendar is attached in Annex 2.
- A major on-the-job training component comprised of:
- An internship at a local host agency to be identified by the program where fellows are placed for two years.2 Supervisors are identified within each host agency and are responsible for the on-the-job training component. Because fellows spend most of their time working with the host agency, selection of the agency and supervisor is key to the program’s success. Be referred to paragraphs 7.1 & 7.2 outlining the selection procedure of host agencies and supervisors;
- Ongoing monitoring of the fellows’ work through regular facilitation visits in their place of work should have a strong formative character. In the first six months, these visits occur once every month. After this period, the visits are quarterly. Be referred to the facilitation visits calendar in Annex 3.
- Practical experience is evaluated through progress reports and final performance evaluations.
PROGRAM OBJECTIVES AND RELATED ACTIVITIES
Goal: To build the professional capacity of young graduates in order to prepare them for dynamic roles in ethics-driven leadership and management of HIV-AIDS programs in Rwanda’s not-for-profit sector organizations and institutions.
Activities table for specific objective 1
|Specific Objective 1: Train 70 young graduates as knowledgeable HIV-AIDS program managers and place at least 28 in leadership positions in the not-for-profit sector supporting HIV-AIDS prevention, care and treatment programs or in advanced study in Rwanda following completion of the two-year Fellowship.|
|Activities for specific objective 1||Calendar 3|
|Selection and recruitment of fellows||Yearly, December-February|
|Information meeting for finalists (where necessary)||Once in 1st year, February 2004|
|Identification and enrollment of host agencies and supervisors||Yearly, January-March|
|Matching of fellows and host agencies||Yearly, April|
|Curriculum development and refinement||Ongoing|
|One-week start-up training||Yearly, March|
|Placement of fellows (fellows might stay two-years with the same host agency or change after one year; to be decided on a case by case basis following mid-term evaluation)||Yearly, May|
|Two-day training sessions at six month mark||Yearly, October-November|
|One-week or two-day training after one year||Yearly, April-May|
|Facilitation visits to fellows||Monthly in first six months, and then yearly.|
|Review of quarterly progress reports of fellows||Quarterly|
|Review and approval of quarterly work plans||Quarterly|
|Oversee process of fellows’ performance evaluations||Yearly, April|
|Two-month certificate course at 18 month mark||Yearly, October|
|Award-giving ceremony to successful fellows||Every time a cohort finishes, April/May|
|Advisory Board Meetings||Yearly, October|
|Executive Committee Meetings||Yearly, February/March|
Activities table for specific objective 2
|Specific Objective 2: Build the capacity of local coordinating and implementing partners in running the program independently without external technical support and ensure program continuity after this 5-year plan.|
|Activities for specific objective 2||Calendar 4|
|Equip coordinating and implementing body with adequate basic modern office equipment||Once, January 2005|
|Support coordinating and implementing body with running costs (communication) and office supplies||Monthly|
|Recruit program coordinator and driver for coordinating and implementing body and support their salaries||January 2006 for recruitment – Monthly for salary support|
|Technical assistance to SPH through on-the-job training (executed by Tulane staff members based in Rwanda) in setting-up an adequate administrative system to implement the program: |
1. For transparent and fair recruitment and selection of fellows, host agencies and supervisors;
|Full time during first year of program, 50% during second year. No more support starting from year 4. SPH has hired someone to execute recruitment and management skills are being transferred to SPH.|
|Technical support from Tulane staff based in the US along with local partners and local trainers (see next activity) for increased efficiency on the part of SPH in executing trainings in curriculum development and refinement.||Yearly in years 1, 2 & 3. No more in years 4 & 5. December 2004.|
|Identification and selection of local trainers/resource persons to execute training||Now the responsibility of SPH which can use its faculty or contact other local or international resource persons to provide trainings.|
|Resource mobilization activities: identification of and liaison with potential donors in order to secure funding after 5-year program (concept of “adopt a fellow”)||Ongoing starting in year 4|
|Participatory mid-term follow-up evaluation||Once, August-September 2008|
|Participatory mid-term external evaluation||Once, December 2006|
Rwanda’s National HIV/AIDS Control Commission (CNLS) requires that every organization in every sector have an HIV/AIDS focal point in charge of issues relating to HIV/AIDS. In addition to their jobs’ normal responsibilities, focal points act as contacts for any HIV/AIDS- related issue within the organization and must start and then continue programs which promote awareness and eliminate discrimination against employees with HIV or AIDS. In order to increase focal points’ technical and theoretical knowledge, CNLS has asked the Fellowship to include them in its training courses.
|Specific objective 3: Enhance the competence of 297 already existing focal points in the public, private and community sectors by making those specific focal points recommended by CNLS beneficiaries of the formal classroom-type of training in HIV/AIDS and program management.|
|Activity for specific objective 3||Calendar|
|Establishment by CNLS of selection criteria for focal points who will benefit from the fellowship program.||January 05,06,07,08,09|
|Identification of 17 focal points to be trained in the classroom-type training along with fellows. These focal points work in the public sector—they represent each of the government’s ministries.||February 13th through 27th, 2005 year 1|
|First training course||Beginning March 2005|
|Follow up of focal points on their progress in drawing work plans executed by the CNLS focal point coordinator|
Has not yet been done
|Identification and training of 40 additional focal points from local organizations||Training scheduled for one week exclusively for focal points is currently being planned.|
|Identification and training of 60 focal points per year||Yearly; starting in 2006, an additional 60 focal points will be trained per year for four consecutive years. (60X4)|
|Evaluation of the knowledge and skills acquired by the focal points through training||Ongoing starting with year 1|
EXPECTED GAINED SKILLS AND COMPETENCIES
Consistent with its objective to train fellows and focal points to become knowledgeable HIV-AIDS program managers in the not-for-profit sector, the curriculum focuses on the five following main competencies/skills:
- Knowledge and understanding of HIV-AIDS as a societal and developmental issue;
- Basic health;
- Program management: financial management (including budget planning and monitoring), planning, monitoring and evaluation, etc.;
- Analytical and research skills;
- Leadership skills: human resource management (including coaching), communication skills, language and writing skills.
More specifically, at the end of the two-year Fellowship for fellows, and the designated period of training for focal points, the fellows and focal points should be able to:
- Conduct and document a full needs assessment (identify, organize, appraise and summarize background information on HIV-AIDS in their given academic field);
- Integrate/mainstream HIV-AIDS as a cross-cutting issue in other sectors’ action plans, policy papers and budgets;
- Analyze public health problems and make realistic proposals to address the issue, including drafting resource mobilization proposals for HIV-AIDS programs and initiatives;
- Prepare a program plan for HIV-AIDS intervention, including defining measurable goals and objectives and designing implementation and evaluation tools (action plans, logical frameworks, M&E plans, etc.);
- Participate in research projects related to HIV-AIDS;
- Communicate complex information to a variety of audiences by means of formal and informal presentations, using a variety of appropriate media support;
- Be a “people’s manager”: be able to provide day-to-day leadership to a team of people based on the recognition of individual strengths;
- Introduce concepts of the private sector culture (e.g. efficacy, efficiency, customer-oriented professionalism, transparency, accountability, quality, etc.) into the management and delivery of public interest services.
PROGRAM BENEFICIARIES: ELIGIBILITY AND SELECTION
The Fellowship draws students from many different backgrounds, consistent with the documented need to confront HIV/AIDS as a societal issue and the reality that the majority of students (71.7%) from the National University of Rwanda (NUR)—the country’s largest university5—graduate with an undergraduate degree in humanities and social sciences. Consequently, a curriculum will be developed that ensures that all students have a common knowledge base.
A yearly selection and recruitment process takes place in order to enroll a new cohort. Ten fellows were selected in the first year to be placed with district health teams. Subsequent cohorts are composed of 15 fellows.
Fellow Selection Criteria
- Be of Rwandan nationality;
- Hold a Bachelor’s degree or A0 diploma in social sciences, management, political science, health, law, public administration and/or any other relevant academic field;
- Have graduated in the last three academic years;
- Not be older than 30 years of age;6
- Speak and write Kinyarwanda and French or English (be fluent in French or English and have at least technical knowledge of other language);
- Do not currently work in the non-profit sector.
Further criteria such as general point average might be applied in case of many applications. The rest of the selection shall be done based on:
- Grade point average
- Review of application papers which candidates are requested to submit along with their application files;
- Individual interviews;
- Final language and computer skills test.
A group of already existing focal points have been identified and recommended by CNLS to benefit from classroom-type trainings intended for the fellows as well as courses exclusively designed for focal points. Forty focal points were trained in the first year. Subsequently, 60 focal points per year will be identified and trained for a period of four years. Focal points are chosen from a variety of sectors including the public, private and community sectors. The criteria of selection of focal points to be trained by the Fellowship program shall be established by CNLS based on general training needs.
The program’s institutional framework is represented by the organizational chart below. The mandate, roles and responsibilities of each major actor and/or body are outlined below.
MINISTRY OF EDUCATION (MINEDUC)
As the Ministry in charge of education in Rwanda, MINEDUC is the program’s line Ministry and is mandated by the Government to ensure that implementation of all training and education programs is in line with national training and education standards and policies. One of the Fellowship’s objectives from the very beginning was to become accredited by various Rwandan Universities and Institutes of Higher Learning. The Fellowship is therefore under the umbrella of MINEDUC, the signatory of the grant agreement with Tulane University through which CDC funds are transferred to MINEDUC and the Fellowship program.7 MINEDUC has extensive experience in working with donors. It has fiduciary responsibility for ensuring smooth, timely and quality program implementation so that Fellowship objectives can be met. As such, MINEDUC is free to implement the program on its own or to delegate all or part of its coordination and implementation to a third party, pending approval by the donor. And in effect, it has officially appointed SPH to run the program, so that all the responsibilities officially delegated to MINEDUC are carried out by SPH. MINEDUC and CDC, the primary donor, jointly select the organization providing technical assistance, which has been Tulane for the first two years.
FELLOWSHIP ADVISORY BOARD
Because the fellowship is multi-sectoral and because of its objective to address HIV-AIDS not only from a public health perspective but also as a societal issue, the primary objective of the Fellowship Advisory Board (herein referred to as the “Board”) is to ensure that the program has enough political and multi-sector support at the highest possible levels and among a variety of key partners, both in Government and in Civil Society. The Board is therefore composed of senior officials invited by MINEDUC, whose designated representative is also the chair of the Board (see organizational chart above for list of members). The Board met only once, at the inception of the program.
The Advisory Board’s mandate is as follows:
- To approve the program’s institutional framework;
- To appoint and dismiss members of the Executive Committee (see below);
- To validate the progress of the Fellowship and fellows by reviewing documents, annual reports and annual action plans;
- To evaluate the implementation of the program by the Executive Committee and the other implementing members (the coordinating and implementing body, CDC/Tulane, NUR/SPH and perhaps more in the future);
- To provide advice and guidance to the program and make recommendations for quality implementation and further program development;
- To advocate and mobilize resources – public and private – to support the Fellowship;
- To create and approve fellow selection criteria as well as broad matching criteria (between fellows and host agency).
FELLOWSHIP EXECUTIVE COMMITTEE
The Fellowship Executive Committee (herein referred to as the “Committee”) is composed of senior executives (rather than top officials) emanating from some of the institutions represented on the Advisory Board (see organizational chart above for a list of members). These senior executives are appointed by the Board for a period of two years, renewable, and have been mandated by their respective organizations/institutions to make the necessary decisions during the Committee meetings so as not to delay program implementation. The Committee meets yearly to supervise the final interviews in the selection process. In order to avoid conflicts of interest, the Committee members involved with day-to-day implementation of the program (the NUR/SPH representative, Tulane representatives and perhaps others in the future) do not have a voting right.
The Committee’s mandate is:
- Final approval of fellows’ selection;
- Approval of fellows’ placements in host agencies and in not-for-profit sector institutions at the end of the two-year internship period, as proposed by the coordinating and implementing body;
- Approval of program curriculum and training contents;
- Mediation in case of conflict:
- Between fellows and the coordinating and implementing body (this is why a representative from the fellows elected by his peers is to be a member of the Executive Committee);
- Whenever a conflict arises with a host agency;
- In case of any other problem arising during the program implementation.
NATIONAL UNIVERSITY OF RWANDA/SCHOOL OF PUBLIC HEALTH (NUR/SPH)
Because of a pre-existing partnership between CDC/Tulane and NUR SPH, and because of the latter’s ability to train professionals to fight against HIV-AIDS, most of the training components have been delegated by MINEDUC to NUR/SPH, with technical support from CDC/Tulane. Its responsibilities include curriculum development and refinement and active participation in the execution of all trainings. Technical assistance is subject to changes pending evaluation of its quality and as more universities and partners get interested in the program. SPH also acts as a subcontractor of MINEDUC by running the coordinating and implementing body (see next paragraph). The duration of this role is indefinite.
COORDINATING AND IMPLEMENTING BODY
As mentioned earlier, MINEDUC was free to implement the program on its own or to delegate all or part of its coordination and implementation to a third party,8 pending approval by the donor. In case MINEDUC opts for sub-contracting implementation and coordination, a sub-grant agreement between MINEDUC, the designated organization and the donor would be signed. MINEDUC has appointed SPH to act as coordinating and implementing body through a sub-grant agreement between the two parties. The coordinating and implementing body’s terms of reference are as follows:
- Propose criteria for selection of candidates and assist MINEDUC Selection Commission with selection of candidates; ensure selection procedures are conducted in total transparency and well documented; submit selection report to Executive Committee for final approval of selected candidates; all with technical assistance from CDC Tulane;
- Propose criteria for selection of host agencies and supervisors; active ongoing identification of host-agencies; select host-agencies and supervisors to be submitted to Executive Committee for approval and establish a pool of host-agencies;
- Prepare a placement proposal to be submitted for approval based on the best match between fellows’ academic backgrounds and host agencies’ scope of work;
- Establish a pool of candidates by working with Universities and Institutions of Higher Learning in Rwanda and by advertising the Fellowship;
- Promote the Fellowship to all Universities and Institutions of Higher Learning in Rwanda and work towards accreditation of the Fellowship curriculum by Rwanda’s major Universities and Institutes of Higher Learning, a goal which has been successfully accomplished;
- Ensure responsibility for curriculum development with technical support from NUR/SPH, Tulane and CDC;
- Take responsibility for planning, organizing and executing all trainings with technical support from NUR/SPH, Tulane and CDC;
- Oversee implementation of fellows’ job descriptions in conjunction with supervisors through:
- Review and approval of the fellows’ quarterly work plans and quarterly progress reports; ensure quarterly progress reports are evaluated;
- Ongoing support to the fellows through regular field visits (ensure facilitation visits to fellows and supervisors for the on-the-job training component of the fellowship are conducted according to the agreed calendar: prepare calendar, checklist for visits, write visit reports);
- Regular contact with fellows, supervisors and mentors.
- Report problems on time to the Executive Committee;
- Ensure the calendar and procedures for the fellows’ performance evaluations are respected by all parties; review evaluation reports and submit them to the Executive Committee for approval;
- Act as a liaison with the Ministry of Education, Ministry of Health, Ministry of Labor and other partners in order to mobilize host agencies and to find jobs for fellows at the end of the two-year fellowship; identify job opportunities in the not-for-profit sector and try to facilitate employment of the fellows after successful completion of the training by making contacts and writing recommendations;
- Develop measurable indicators to evaluate the program’s success and implement the M&E plan as an integral part of the program activities;
- Call for quarterly (or as often as necessary) meetings of the Executive Committee and prepare and document these meetings;
- Oversee the implementation of MOU’s, contracts and/or agreements signed by MINEDUC to ensure the program’s success (e.g. in order to retain fellows, host agencies, etc.) and report any breach to the Executive Committee;
- Pay fellows their stipends and assure all applicable laws of employment are respected;
- Ensure fellows are enrolled in a health insurance scheme;
- Submit progress reports to the Executive Committee twice a year;
- Manage grant according to the terms of the sub-contract with the donor, including reporting requirements to the donor through MINEDUC.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)/RWANDA
CDC/Rwanda is the Fellowship’s funding agency, through a cooperative agreement with Tulane University and with money from President Bush’s Emergency Plan for AIDS Relief (PEPFAR). CDC/Rwanda has a representative on both the Executive Committee and the Advisory Board and has substantial involvement in the design of the Fellowship. CDC is also willing and ready to provide technical assistance in the design and execution of trainings, though SPH has taken over this responsibility. As more donors are identified, they shall also be represented on the Advisory Board and the Executive Committee.
In addition to being the agency from which NUR/SPH receives financial resources via sub-contract9—and in that capacity having to approve financial reports and budgets and conduct the necessary audits—Tulane University is also providing substantial technical support to the Fellowship through:
- Technical assistance in development of selection criteria, recruitment of fellows and selection of host agencies and supervisors;
- Overall conception and design of the Fellowship;
- Ongoing capacity-building of various partners in program management;
- Active participation in both the Executive Committee and the Advisory Board;
- Assistance in developing and executing the curriculum that will ensure that fellows have a common conceptual framework despite their various academic backgrounds;
- Assistance in designing and implementing various training sessions taught by an interdisciplinary group of faculty from NUR/SPH (at least for the first year), including health professionals, economists and development specialists;
- Regular field visits to fellows and support visits to program staff;
- Review of quarterly progress reports and grades;
- Approval of mid-term and final evaluations reports of fellows; approval of bi-annual narrative progress reports presented by the coordinating and implementing body.
OTHER KEY STAKEHOLDERS
Responsibility and selection:
The host-agency is responsible for the on-the-job training component of the fellowship program and therefore bears a high responsibility for the program’s success. As a consequence, interested agencies undergo a selection procedure. Potential agencies are contacted by the program and invited to make their interest in hosting a fellow known through the submission of a file containing the following information.
The agency’s file should demonstrate that the agency:
- Is legally registered according to Rwandan laws and has existed for at least 3 years by producing a copy of a valid registration certificate;
- Is directly or indirectly active/involved in the fight against HIV-AIDS and/or planning to do so in the immediate future (e.g. a local NGO planning to launch a new HIV-AIDS program, a private sector organization planning to develop and implement an internal HIV-AIDS policy for its staff, a Ministry planning to put in place HIV-AIDS focal points at a decentralized level, etc.) by submitting:
- A copy of the agency’s statutes;
- A one page summary of activities implemented during the previous and actual year;
- A one page summary of planned activities to be implemented during the period of placement of the fellow;
- The projected activities of the fellow
- Has at least 3 staff members, by attaching a staffing list (staff names are not necessary, only names of positions and dates of hire should be listed);
- Has identified one, and if possible two, employees matching the terms of reference and profile below within the existing staff; one to be appointed as actual supervisor of the fellow and another to be designated as back-up supervisor in case the first one falls sick and/or leaves the host agency over the course of the internship; the supervisors’ current job descriptions and updated CV’s should be attached.
- Has a staffing need of at least 12 months for a junior graduate in HIV-AIDS direct or indirect intervention (see above), as demonstrated in the job description (see attached format in Annex 5).
It has been observed that potential host agencies often do not fully understand the objectives and structure of the Fellowship program. In the first year, for instance, many organizations demanded additional benefits once they realized that the program was funded by CDC and PEPFAR and that the interns’ labor would be free. In addition, once the host agencies and fellows were matched, it was reported that many supervisors believed their fellows would be experts in the field. In fact, these fellows have very little practical experience. In August 2005, six months after the first cohort began their internships, a meeting was convened in which Tulane clarified the goals and requirements of the fellowship and the training needed for fellows.
A marketing strategy whereby host agencies will gain a clearer understanding of the Fellowship program is being pursued. The marketing company hired will clarify the Fellowship’s goals and structure and promote it to host agencies by highlighting the advantages of accepting an unpaid intern for two years. It will also improve the program’s image in Rwanda by emphasizing its benefit to the nation’s non-profit sector.
Matching host agencies and fellows
Host agencies are first selected based on the above information. Then, matching of selected fellows and host-agencies takes place. Matching mostly consists in comparing the host agency’s scope of work and the job description it has submitted for a fellow, together with the fellow’s profile and academic background. It is therefore possible, despite the fact that a host agency has been selected, that it shall not receive a fellow immediately if matching fails. Priority is given to host agencies having completely filled out the application. If an organization already has a fellow from a previous cohort it is put on the waiting list, since one goal of the program is to diversify the workforce it produces. Efforts to identify a suitable fellow during the recruitment of a next cohort shall however be deployed.
Memorandum Of Understanding
Since host agencies are so crucial to the program’s success, they are requested to officially commit by signing one Memorandum of Understanding with the program, represented by MINEDUC, and another with the fellow. Be referred to Annex 6 for a copy of the Memoranda Of Understanding.
Host agencies meetings
No meetings have yet been organized. The program’s goal is to organize an annual mixer in which old and new host agencies can meet. This meeting will be an opportunity for host agencies to exchange experiences, give feedback and contribute to the development and refinement of the on-the-job training component of the program.
ROLE AND PROFILE OF SUPERVISORS
The fellow’s supervisor at the hosting agency is tasked with the day-to-day coaching and monitoring of the fellow. He or she therefore plays a crucial role in the internship’s success and must be ready and willing to dedicate time and effort to the fellow.
The supervisor’s terms of reference are defined as follows:
- Introduce the fellow to the host-agency staff and partners and ensure he/she is fully integrated in the team;
- Ensure the fellow is fully briefed on the agency’s scope of work and has had exposure to all aspects of the agency’s activities within the first month, allowing him/her to start fulfilling the job description in the second month of the internship;
- Facilitate the fellow’s access to all individuals, documents and equipment relevant to his/her position and the success of the internship;
- Actively participate in training sessions organized by the program and help the fellow put into practice the knowledge gained from these training sessions;
- Develop quarterly work plans based on the fellow’s job description jointly with the fellow, to be submitted to the coordinating and implementing body for approval; monitor work plan implementation on a day-to-day basis;
- Ensure that skills and knowledge relevant to the fellow’s job description are transferred from the host agency staff to the fellow;
- Provide ongoing feedback and technical and moral support to the fellow throughout the duration of the internship;
- Conduct performance evaluations every six months (a standard evaluation form has been designed for that purpose);
- Report major problems jeopardizing the success of the internship immediately to the program coordinator, including the supervisor’s own capacity to play his role as a supervisor.
Supervisors should match the following profile:
- At least be holders of a university degree (minimum “license”) or A0 diploma from an institution of higher learning in social sciences, management, political science, health, law, public administration and/or any other relevant academic field;
- Have at least 5 years of experience working in a leadership position, of which at least three years were spent on program management, including monitoring and evaluation, financial management and human resource management;
- Have good interpersonal and communication skills;
- Have good coaching and training skills;
- Have a strong interest in HIV-AIDS; direct experience in HIV-AIDS programming is an added advantage;
- Be interested in developing Rwanda’s human resource capacities in the field of HIV-AIDS and willing to commit time and effort to the program by supporting the fellow on a daily basis;
- Be fluent in Kinyarwanda and French or English.
The directors of host agencies often act as supervisors, because they are often the only employee of their organization with the necessary qualifications. Though many do not have time for meetings and training sessions, most have effectively supervised the progress of fellows.
ROLE AND PROFILE OF FELLOWS
Be referred to chapter 5 “Program beneficiaries: Eligibility and selection” for the profile of fellows. As for their roles, it is very important to stress that the fellows are enrolled in the program with the primary objective of learning, but that they will do so mostly through on-the-job experience, which means that the fellows will actually be working. If matching is successful, fellows will represent a free motivated workforce for the host agency. They will have a full time position with a detailed job description. Their productivity and output will be an important element by which to measure the fellows’ success.
MONITORING AND EVALUATION PLAN
PERFORMANCE AND SUSTAINABILITY INDICATORS
The immediate success of the program will be measured by the number of fellows who successfully complete the two-year Fellowship. Progress is determined through the following tests and reviews:
- A post-test associated with each formal classroom type of training;
- A performance evaluation carried out by the CNLS focal point coordinator to ascertain the progress and knowledge acquired by focal points following the training; this test is planned but has not yet taken effect;
- A participatory mid-term evaluation carried out by the fellow’s supervisor in the host agency after 6, 12 and 18 months;
- A final participatory performance evaluation carried out by the fellow’s supervisor in the host agency in the last month of the Fellowship;
- Evaluation of field work carried out in the last two months of the fellowship;
- A score obtained based on the quality of content and timeliness of submission of quarterly progress reports (for fellows).
In order to be admitted in the second year, fellows must obtain a general point average of at least 10 out of 20 at the end of the first year. And to successfully complete the Fellowship, fellows must obtain a grade point average of at least 12 out of 20 for all of the above at the end of the second year. Scoring techniques have not yet been developed, because the first cohort has not finished its fellowship. A questionnaire has recently been formulated which resembles an employee appraisal form. It was completed by fellows and supervisors and results were sent to SPH and Tulane for review. The coordinating and implementing body is still in the process of developing this system and deciding whether an interview is necessary as well.
The real success of the program will be measured by the number of fellows that the program is able to place and retain in leadership positions with HIV-AIDS components in not-for-profit sectors including the public sector and other local civil society organizations. The table below summarizes the target indicators for both the immediate and the long-term success of the Fellowship.
Table: Fellowship performance and sustainability target indicators
|YEAR 1||YEAR 2||YEAR 3||YEAR 4||YEAR 5||YEAR 6||YEAR 7||TOTAL|
|Nr of fellows enrolled each year||10||15||15||15||15||1510||15||90/40|
|Nr of fellows who successfully complete 1st year||9||14||14||14||14||14||79/19|
|Nr of fellows who successfully complete 2nd year||8||13||13||13||13||73/18|
|Nr of fellows who find a leadership position in HIV-AIDS in: |
within three months following completion of the Fellowship
|Nr of fellows who find a leadership position in HIV-AIDS in: |
between four and twelve months following completion of the Fellowship
|Nr of fellows who have successfully completed the Fellowship and who enrolled in advanced study in Rwanda following program accreditation by Rwandan Universities.||1||1||2 (1+ 1)||2 (1+ 1)||2 (1+ 1)||8|
|Nr of focal points to enrolled each year||17||20||20||20||20||280|
1st cohort, 2nd cohort, 3rd cohort, 4th cohort, 5th cohort.
FELLOWSHIP TRAINING QUALITY INDICATORS
The program’s success shall very much depend on the quality of the different forms of training. Each training component (on-the-job training, formal classroom type of training and mentoring) shall therefore be subject to an ongoing evaluation. The following mechanisms and indicators have been designed for that purpose:
- On-the-job training: the success of the hands-on work experience part of the Fellowship lies mostly in the choice of the right host agency and supervisor. Besides a strict selection process of the host agencies and supervisors (see paragraphs 7.1 & 7.2), fellows are requested to give feedback on a quarterly basis (as part of their quarterly progress report) about their supervisors’ availability and training skills. If problems are reported, the program staff shall investigate the issue (through a meeting with representatives of the host agency and the supervisor) and will try to mediate in order to find a solution. As a last resort, the Executive Committee may decide to appoint a new supervisor or to change the host agency. Therefore, the number of fellows whose supervisors change during the Fellowship and/or who change host agencies before the end of the agreed period acts as an indicator of on-the-job training quality;
- Formal class-room type of training: the quality of this component shall be measured in two major ways:
- First, all fellows and focal points undergoing the classroom-type of training are required to take a post-test at the end of each module. The fellows’ understanding of a specific topic at the end of the training as demonstrated by the results of the post-test is an indicator of the training quality;
- Second, at the end of each training session, trainees are requested to fill out an individual evaluation form on the training. They indicate their level of satisfaction on both training content and methodology and are given the opportunity to formulate recommendations for improving training quality.
Table: Training quality indicators
|YEAR 1||YEAR 2||YEAR 3||YEAR 4||YEAR 5||YEAR 612||YEAR 7|
|% of fellows for whom the relationship with the supervisor is found to be: |
|% of fellows whose supervisors were changed during the Fellowship and/or who changed host agency|
|% of fellows and focal points whose knowledge on the covered topics increased at the end of the formal class-room type of training as demonstrated by the results of the post-test|
|% of fellows who give a mark in the following range : |
to formal classroom type of training
|% of fellows and focal points who report being: |
in evaluation at the end of formal classroom type of training
% of focal points who found the training method and modules satisfying and useful in their day to day work
In addition to the ongoing collection and analysis of above-listed indicators, two external evaluations are planned at mid-term, in the third year, and at the beginning of the fifth year of the Fellowship. Terms of reference include a review of achievements based on the above-listed target indicators as well as a review of the training contents, methodology and overall quality.
Program sustainability lies at two different levels. First, the program will try to retain recruited fellows in Rwanda’s not-for-profit sector in the field of HIV-AIDS at the end of their Fellowship. Second, the program needs to ensure that enough local capacity is built during these five years and that funding is secured for MINEDUC to continue implementing the program in the future without external technical support.
HOW TO RETAIN FELLOWS:
The first challenge lies in ensuring that fellows complete the two-year Fellowship. In order to succeed, it is important to ensure that selected fellows fully understand the objectives and approach of the program. The program therefore dedicates a lot of attention to information dissemination, so that candidates who apply are very well informed about the ultimate purpose of the program and the fact that it aims at training young professionals to become HIV-AIDS program managers in the not-for-profit sector. A new marketing strategy will further clarify the program’s methods and objectives. The candidates’ motivation to pursue a career in the local not-for-profit sector will be scrutinized during the selection process. In addition, once enrolled in the program, it is extremely important that the fellows’ motivation is maintained. In order to do so, emphasis should be put on the learning experience and personal value gained through the Fellowship. Fellows should learn at the theoretical, professional and personal levels. They should feel satisfied with their work environments, valued for the work they do and they should recognize their personal and career growth. Similar programs around the world (e.g. Peace Corps) built their success on these two pillars: a professional and personal learning experience, combined with increased self-esteem based on personal satisfaction out of their work and how it is valued. Supervisors at the host agencies are key actors in achieving this. Their selection should therefore be handled with utmost care and the fellow-supervisor relationship monitored very closely.
The Fellowship has also worked towards official recognition of the curriculum by Rwandan Universities and Institutes of Higher Learning so that fellows who are interested in continuing their studies can consider enrolling into advanced study following the granting of credit hours based on accreditation of the Fellowship curriculum.
Retaining fellows in the local not-for-profit sector is another challenging aspect of the program in terms of sustainability, especially if one takes into consideration the low salaries and working conditions in most local organizations, as compared to other more attractive potential employers active in the field of HIV-AIDS, such as International Organizations (NGOs, UN organizations, Bilateral organizations, etc.). Taking into account the overall employment market of Rwanda and the ongoing civil service reform, the Fellowship cannot guarantee that all successful fellows will find a job as soon as they finish the two-year fellowship. However, the program shall to try to facilitate employment as much as possible.
In order to maximize chances of retaining fellows to work in Rwanda’s not-for-profit sector, the Fellowship proposes the following:
- Selected fellows will have to sign a Memorandum of Understanding with SPH (see Annex 8) in which they commit to at least two years of work in the not-for-profit sector. Fellows do drop out, however, especially when they are offered jobs with better pay. In these cases, they must refund the program and return their computer. It is often the case that the fellow taking his or her place at the host agency will not have taken the one-week training course. We must develop a system whereby we reduce the number of dropouts while also training those people who have not been selected but do have the possibility of joining on after a few weeks;
- The stipend paid to fellows by the program during the two-year Fellowship is equal to the salary of an entry-level civil servant in a leadership position with a first degree, as per the Ministry of Labor’s salary scale. In other words, the stipend is equal to what the fellow would get if he were to be immediately employed in the public sector. This strategy prevents the fellows from getting accustomed to standards of living that they shall not be able to sustain once they are actually employed in the not-for-profit sector. The Fellowship also requests that once fellows are actually employed in the public sector, and after successful completion of the Fellowship, the salaries they are given by the Ministry of Labor reflect the two years experience gained through the Fellowship. Fellows shall not therefore start working in the public sector as entry-level civil servants.13 This scheme shall also be negotiated with potential employers outside the public sector.
- Limiting the period of unemployment at the end of the Fellowship will be key to retaining fellows. The program will try to facilitate employment by actively looking for job opportunities in the public sector and local organizations. Most agencies hosting the first cohort of fellows have said that they would willingly hire their interns as full-time employees at the end of the fellowship. By only accepting host organizations with staffing needs, the program anticipated this result. We believe that once fellows have a job, even if it is on a civil servant salary, they will prefer to keep it rather than shift to a job with a more attractive package but little long-term security;
- Official recognition/accreditation of the Fellowship by Rwandan Universities has increased its attractiveness and legitimacy;
- The program is currently researching methods by which to develop an alumni network which would not only enable SPH to keep track of fellows’ careers, but also create a system of professionals willing to advise or mentor current fellows.
HOW TO ENSURE PROGRAM CONTINUITY
Considering the devastating effects of HIV-AIDS on Rwanda and the fact that the epidemic’s biggest effects on human capital are expected to be felt in the coming 10 years, it is important that more professionals continue to be trained to work in the field of HIV-AIDS after this five-year program ends. The Fellowship has therefore been institutionalized from its inception at MINEDUC, in order to promote program ownership by the Ministry. Though MINEDUC has chosen to have the program day-to-day coordination and implementation subcontracted to SPH as a third party, technical support to both MINEDUC and the coordinating and implementing body is still provided (currently by Tulane and CDC). This technical assistance takes the form of on-the-job training, as most activities are jointly designed and implemented. It will gradually be reduced over the period of five years.
Without funding, the Fellowship shall not be able to continue after this five-year budget. The mobilization of resources is therefore an important strategy to achieving program sustainability and a budget has been reserved for that purpose in years four and five. The Advisory Board shall also play a very important role in advocating for the program and helping to mobilize resources. Innovative strategies should be developed to market the program to potential donors, including the private sector. For example, the concept of having a fellow “adopted” (in the sense of “sponsored”) by an organization should be developed. Fellows should also be involved in resource mobilization.
Rwanda is one of the fourteen focus countries identified to participate in President Bush’s Emergency Plan for AIDS Relief (PEPFAR) that will assist “host countries in the development of sustainable prevention, care and treatment programs for HIV/AIDS.” The CDC is financing the Fellowship through PEPFAR funds. Therefore, particular care has been taken to ensure that the Fellowship embodies the major focus of the PEPFAR initiative implemented in Rwanda by CDC, USAID and DOD (Department of Defense) under the leadership of the US Embassy. Priorities include those overall objectives established under the leadership of the Global AIDS Coordinator and the PEPFAR initiative and scaling-up Rwanda’s human resource capacity to address HIV-AIDS as a societal issue is one of them.
The total budget for a period of five years, from August 1st 2004 until July 31st 2009 amounts to $ 1,344,329.22. Half of the responsibility for spending has been transferred from Tulane to SPH. Be referred to Annex 9 for the detailed budget and the corresponding explanation.
As the program prepares to initiate the third cohort of fellows in their internships, certain areas of the Fellowship have yet to be developed. In the following months, we plan on pursuing these matters:
- A new two-year curriculum taking into account changes in training modules;
- Performance evaluations for focal points following the training modules;
- A marketing strategy for recruiting host agencies;
- Mixers involving present and past host agencies must be organized regularly;
- A methodology for scoring and evaluating the work of fellows over the course of their internship must be further developed, especially as the first cohort prepares for graduation in December 2006;
- A method for creating an alumni network should be established by December 2006.