Overview of the ClASS Framework
The Health Resources and Services Administration (HRSA), with support from the International Training and Education Center for Health (I-TECH), developed the ClASS framework to promote long-term sustainability and country ownership of high quality HIV/AIDS programming. ClASS brings the advantage of experience gained in building the capacity of 99 organizations, including governmental and civil society organizations, to manage programs in 17 PEPFAR countries in sub-Saharan Africa, the Caribbean and eastern Europe. From its initial development, the ClASS model involved input from a variety of global health partners including the Health Resources and Services Administration (HRSA), Centers for Disease Prevention (CDC), Ministries of Health, and civil society organizations. Since its inception, the ClASS framework has been adapted and revised for use in a variety of countries and contexts. The ClASS framework is a comprehensive objective assessment process used in support of transition of programs to indigenous organizations.
The ClASS framework is based on the recognition that the quality of any health care system is a result of access to good technical, administrative and financial management capacity. The framework identifies opportunities for strengthening the health delivery system through a comprehensive approach that aims to:
- Maximize resources and avoid duplication
- Promote good governance and leadership
- Promote efficiency, effectiveness and sustainable outcomes
- Ensure financial stability
- Ensure programmatic compliance
Consistent with these goals, the ClASS framework involves a participatory, multi-disciplinary review of specific capacity-building needs with the provision of technical assistance based on review findings.
The ClASS framework is not meant to supersede country-led planning, routine assessments or the provision of technical assistance. The framework is best used when an external approach is needed and is not otherwise available. The ClASS approach is expert-based and comprehensive in scope; it incorporates administrative, financial, leadership and management, counseling & testing and clinical/technical areas at the local partner level and service delivery sites.
The ClASS Toolkit
The ClASS tools follow a modular format and can be used to assess administrative, financial, leadership and management, counseling & testing and clinical/technical capacity at all levels. Each module is divided into 3 sections: Core Competencies, Open-ended Questions and Performance Criteria/Verification Information. The modules serve as a guide for each technical subcomponent, and also serve as a gauge for assessing grantee or partner technical assistance needs.
Key Principles of the ClASS Framework
The ClASS Framework is based upon the following key principles:
Successful Transition: HRSA has successfully used the ClASS framework to support the transition of 13 HRSA/PEPFAR programs to local partners in 9 countries, including Harvard’s Nigeria program, which was the largest of all at approximately $40 million at its peak.
Strategic Coordination: ClASS is an expert-based assessment that is complementary to other monitoring assessments used at the country-level. It is not intended to substitute or duplicate the first line of assessment used by ministries of health, United States Government, or implementing partners.
Adapted for Relevance: The ClASS methodology is designed to provide requisite, culturally sensitive, and non-punitive monitoring and support. In recognition of the uniqueness of every setting, ClASS provides a comprehensive framework that can be adapted by using consultative and qualitative methods to assess and strengthen local capacity, ownership, and leadership at all levels of health care.
Technical Assistance (TA) and Activity Planning: TA provided through the ClASS process is driven by assessment findings and evidence-based practices. The TA process begins in conjunction with the on-site assessment phase and all TA recommendations are informed by financial, administrative and technical considerations for effective implementation. Improvements are prioritized based on USG and country requirements and the realities on the ground.
Strong Foundations: The ClASS framework draws on 20 years of experience from HRSA’s domestic HIV/AIDS program. The Primary Care Assessment Tool (PCAT), which has been used to monitor domestic HIV/AIDS programs funded by HRSA under the Ryan White CARE Act, was adapted and further enhanced through an extensive review of over 30 tools used by PEPFAR implementing partners. Domestically, HRSA has been integrating TA into HIV planning to ensure effective use of resources since 1998.
Adapting the ClASS Framework for a Variety of Needs:
The ClASS methodology allows for focused in-depth analysis and assistance. ClASS provides local partners with the capacity and support that they need to develop responses appropriate for their communities with the goal of more sustainable national health services. Since 2009, the ClASS module has been used in:
- Assessing organizational capacity to provide and maintain quality service delivery
- Assessing potential grantee capacity in program management, financial management, clinical program management, counseling & testing and leadership and management
- Baseline assessments of grantee/sub-grantee grants management capacity
- Identifying capacity building needs
- Transition readiness technical assistance
- Support assurance of quality of care
- Administrative and fiscal systems capacity
- Leadership and management capacity
- Clinical service delivery, in-service training, teaching facility identification
Subcontractor and Partner Selection:
- Organizational capacity assessment
- TA for capacity enhancement/systems strengthening
- Preparation for transition to local ownership