ACD’s office is based in Peshawar and is equipped with communication, data processing, audio-visual, laboratory and training equipment with a small library. A training unit and a reference laboratory for training, quality assurance and AFB culture and susceptibility testing support the projects.
Some field staff that includes social mobilizers and LLIN distributors are based in 3 FATA agencies and 10 districts of Khyber Pukhtoon khwa. By the end of April 2011, a regional office will be established in Quetta for implementation of GFR 6 activities in four districts of Baluchistan.

Staff Capability
The staff has extensive experience of project implementation, monitoring, supervision, needs assessments, establishing field TB and malaria microscopy centers, and implementing external quality assurance. The core technical team has worked with Italian Cooperation for Development and HealthNet International that supported TB and Malaria programmes in KPK from 1986 to 2000. The team comprises of public health specialists, general physician, laboratory technologist & technicians, entomologist, sociologist, social mobilizers and LLIN distributors supported by finance and administration personnel as well as other support staff.
The laboratory staff has almost twenty years of working experience in AFB microscopy, culture and susceptibility. All laboratory personnel are trained as master trainers.
The admin and finance section is staffed by postgraduates in finance, commerce, management and human resource development with working experience in the UN agencies and international organizations.
The staff has demonstrated ability to communicate in different local languages. Association has a part time panel of consultants comprising of an epidemiologist, sociologist, a social anthropologist and IT professional.

Policy and Procedures
ACD has functional policies and procedures for recruitment, procurement, logistics, transport, finance and administration. These policies are strictly followed for optimal utilization of resources and smooth running of the programme activities. Policy and procedures manual is revised annually to bring it in line with the organization and donors needs and acceptable standards.
Financial management capacity
The grants that ACD gets from its donors are for programmes for periods between one year and five years. The vast majority of the organisation’s expenditure is undertaken on the project activities and the unspent funds are returned to the donors.
ACD employs professional financial managers to ensure transparency and accurate record keeping and abides with the financial recording and reporting system and requirement of the donors. In general it follows the principles and standards of accounting and maintains the accounts on double entry system. The bankbooks, ledger, bank and cash reconciliation reports along with support documents are meticulously maintained. The financial reporting depend on the donors requirements. and are monthly or quarterly submitted to the donors.

Risk management and audits
ACD has an internal and external audit function in place. Internally accounts are monitored by the senior management. Monthly and quarterly reports are submitted to the donors. An annual independent audit of the accounts is carried out for independent projects according to the rules and regulations of Pakistan keeping the international recommended standards. The auditors firm selected for carrying out external audits is among the one’s on the Quality Control Rating (QCR) list of the Institute of Chartered accountants of Pakistan. The TORs for the external auditors is shared and approved by the donors.

Procurement and supply management
Logistics officer is responsible for ensuring the efficiency and transparency of supply chain and procurement management for both health and non-health products. His primary responsibility is to ensure donor regulations, procedures and that recommended technical standards are being adhered to. ACD has its procurement guideline defining capital assets, different modes of procurement, list of authorized person, authority matrix for procurement, procurement mechanisms, procurement controls, composition and responsibilities of the procurement committee. ACD has pre-qualified a group of reliable manufacturers and suppliers for different items needed for project implementation.

Monitoring and Evaluation Arrangements
On project level ACD currently uses project performance framework to ensure that the project’s process and outcome indicators are monitored. This is the responsibility of programme teams who analyses data for both project monitoring and implementation. This information, along with many other aspects of programming are reported to the donors on monthly and quarterly basis. Senior programme and finance management also conduct field monitoring and coordination visits in the target districts where appropriate. Regular monitoring visits of the project area are also performed by the donors and national programmes which are facilitated by ACD team. These monitoring visits are used for improving the performance of field teams. ACD’s monitoring and evaluation manual has incorporated donors requirement and tools for data verification and progress updates.

Partnerships/Technical support
ACD has been providing technical inputs to the National and Provincial TB control programme, WHO Pakistan, WHO, MOH and Global Fund office Afghanistan, UNHCR, GTZ and national and international NGOs. The technical assistance comprised of human resource development; material supply and management, monitoring and evaluation, developing network of peripheral microscopy centers and quality control mechanism in the province.
ACD has been closely working as a sister organisation with HealthNet International which has worldwide reputation for malaria control programme. HNI worked in Pakistan for the last 25 years for the local community and Afghan refugees. The organisations provide technical support to all implementing partners working for the control of malaria. ACD has the capacity to provide technical assistance regarding integrated vector control, case management, operational research, quality control and quality assurance, Laboratory strengthening and monitoring and evaluation of malaria programs.

Training Laboratory Assistants
Besides the national and provincial programmes ACD has established partnership with a number of national and international civil society organizations and has been providing technical support in the field of TB and Malaria control.

Human resource development
ACD has a comprehensive training programme targeting all levels of the health care system (ranging from, provincial and district levels to community health volunteers and school children at the grassroots level) to improve the capacity to respond to infectious diseases like TB and Malaria. Health awareness training and Community mobilization has improved community access to health services and encourages communities to take actions for the improvement of their health at local level.
Training all categories of health staff using national and international guidelines is one of the major activities that ACD carry out in its projects. ACD has been conducting training for program managers, doctors, paramedics and laboratory technicians, community health workers and community volunteers in TB- DOTS and Malaria control interventions.

Laboratory Strengthening
ACD has strengthened a network of field laboratories with technical and material support to diagnose sputum positive cases, monitor treatment progress and at the end of treatment document the outcome results by microscopic examination. Field laboratories are supported by the ACD central laboratory. The ACD central laboratory not only conducts training for different level of laboratory staff but also maintains quality control of the laboratories. It routinely performs culture and sensitivity testing for the primary and acquired drug resistance of mycobacterium TB for the TB patients referred by the public and private sector organizations.

Quality Assurance
Quality Assurance in Clinics
ACD gives significant importance to the quality assurance of the activities performed in the clinics to maintain the standard of services acceptable to donors, WHO and National programme. For this purpose ACD monitoring and evaluation teams that consists of clinicians, public health and laboratory personnel regularly supervise the clinics. These visits are also used for on the job training, supply of materials, data collection and feedback of field observations.

Research and development
The Association has been actively involved in developing TB training and health education materials in local language. This material has been used not only in Khyber Pukhtoonkhwa, but has also been used by the refugees programme in Baluchistan. The government of Afghanistan adopted ACD’s developed health education materials for its national program and has developed national postal stamps from it. The training material developed by ACD includes;
Manual for direct sputum smear microscopy and laboratory management.
Manual for sputum collection and smearing.
Manual for dispensers on TB management
Guideline for social welfare workers and volunteers
Health education material on DOTS implementation for community health workers
Charts on TB symptoms, transmission and prevention.
Poster on DOTS
Chart of standardized treatment categories.
Standardized TB suspects management chart.
Anti-TB drugs side effects management chart.
Flip charts for training community health workers and volunteers.
Booklets with important information about TB.
Handouts with frequently asked questions about TB and their answers.
Engagement of non MOH and non State sectors
With the support from International Union Against Tuberculosis and Lungs Diseases ACD implemented Strengthening of DOTS in 9 districts of NWFP, Pakistan through intersectoral collaboration under the Fidelis project. In this project ACD engaged para-statal and private sector health institutions for DOTS implementation. The institutions were supported for human resource development, laboratory strengthening, external quality assurance, material supply, introduction of NTP registration and reporting tools, public awareness, monitoring and evaluation

Health Information System
ACD introduced NTP health information system tools in the Afghan refugee TB programme and health institutions of the para-statal departments. It also trained health staff of public sector health facilities in the use of NTP-HIS. About 200 health facilities were supported for implementing the HIS.
Empowering people and communities through awareness
ACD has been involved in empowering the people and communities by increasing awareness and knowledge about communicable diseases and by improving health seeking behaviors of the communities. It has been focusing on building supportive environment for health through public and media advocacy and involvement. It has also worked on consensus building and commitment with the community based groups, organizations and the community through dialogue and social mobilization.

Coordination among the various partners involved in communicable disease control is very important to ensure the optimum utilization of the resources. ACD gives high priority to strengthening coordination activities with the donors and partners at the district, provincial and national levels and with the community. The coordination and functional relationship of the programme includes technical and management support in strategy and policy development, capacity building, human resource development, monitoring, quality control and supply of material required for project implementation.