Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7759
Country/Region: Botswana
Year: 2009
Main Partner: Project Concern International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $1,500,000

Funding for Care: Pediatric Care and Support (PDCS): $400,000

09.C.PC02: Project Concern International - Pediatric Palliative Care

ACTIVITY UNCHANGED FROM FY2008

From COP08:

The HIV/AIDS epidemic in Botswana is taking a toll on the capacity of the health and social welfare systems

to respond, and straining the capacity of extended families to care for infected/affected family members.

ART alone will not ensure the health and wellbeing of people living with HIV/AIDS (PLHA) and their families.

A comprehensive approach is needed emphasizing palliative care in the home and in the community,

including psychosocial support, treatment adherence support, positive living education and support, nutrition

support along with basic health care and referral. Coverage of comprehensive palliative care services is low

relative to the needs, tends to focus on adults rather than children, and tends to be geared towards end-of-

life care rather than promoting wellness.

Stronger linkages between CT, PMTCT, ART, and palliative care services that reach into the home are

needed, as are stronger partnerships between government health and social welfare services and CSOs.

CSOs are well placed to serve as a bridge between facility-based services and the communities and

households they serve. Yet the CSO sector in Botswana is young and needs significant capacity building to

play this role.

During the COP07 period (project year one), PCI expects to strengthen palliative care services through 8

CSOs in Francistown and Gaborone, and to train 40 individuals to provide palliative care, reaching 800

adults and/or children infected/affected by HIV.

Building upon the foundation established in 2007, PCI will continue and expand the provision of technical

and organizational capacity building services and sub grants to the initial 8 CSOs, and will extend palliative

care capacity building to an additional 11 organizations. PCI will also continue and expand its partnership

with BONASO, enabling BONASO to manage small grants and capacity building services for up to 4

partners. PCI in FY08 will support other local organizations that have previously been supported with USG

support.

Program objectives: 1) improved and expanded CSO delivery of palliative care services; 2) strengthened

capacity of local government agents (MOH, MLG) to deliver palliative care; 3) strengthened collaboration

and referral among government services and CSOs in the delivery of palliative care services; 4) improved

documentation and sharing of promising practices and lessons learned among CSOs and government

counterparts.

Partners: Through its work in OVC, Palliative Care, and ART Access & Adherence, PCI expects to begin

the COP08 period (project year two) with approximately 15-20 CSO partners. The ultimate aim is to

strengthen the capacity of all the partners to provide integrated services across all three areas. This will be

a phased process that will continue through the second year. Partners entering the program with palliative

care strengths will have been assisted in year one to strengthen the quality, range and reach of their

palliative care work, while beginning to incorporate ART access & adherence and OVC services.

Conversely, partners entering the program primarily with OVC strengths will be assisted to build those

strengths and incorporate palliative care and ART access & adherence services into their work.

PCI therefore does not expect to increase the absolute number of CSO partners in the second year, but

rather to extend palliative care capacity building and sub grants to an additional 5 CSOs within the 15-20

current partners. At the same time, PCI will assist CSO partners that received palliative care support in

year one to scale-up their activities in year two, through increased sub grants and technical assistance, and

to improve their service quality and linkages.

Capacity Building: During the first year, PCI will have identified specific technical and organizational

development (OD) needs among the CSO partners, as well as gaps in palliative care service delivery in the

project communities. This information will inform the design of specific technical and OD inputs to be

provided in year two. As in year one, capacity building is expected to balance technical and OD, and to

emphasize tailored, one-on-one mentoring and peer learning approaches, strategically combined with larger

group training activities.

Palliative care interventions to be strengthened include the full range of physical, psychological, social and

spiritual support activities needed by adults and children infected/affected by HIV/AIDS, guided by the

nationally-defined minimum essential package, and delivered collaboratively by government and CSO

agents from both health and social sectors. Palliative care service strengthening will emphasize tailored

approaches depending on the age, gender and life situation of clients.

The Family Care approach will continue to serve as the guiding framework for service delivery, focusing

interventions holistically on the family rather than singling out individual members based on which "target

group" they belong to. CSO partners will continue to be facilitated to develop project plans that emphasize

the family as the focal point for integrating palliative care, ART support, OVC, and other HIV/AIDS services.

PCI will continue to strengthen the capacity of CSO partners to utilize Participatory Learning for Action

(PLA) techniques, such as Journey of Life (REPSSI, 2006) or other context-appropriate methods identified

in year one, to change community attitudes, reduce stigma, and build community support and utilization of

HIV/AIDS services. Through PLA and other processes, PCI will continue to catalyze and strengthen

participation and resource mobilization from diverse public and private entities to strengthen palliative care

services, including commercial private sector.

Government partnership: Staff from district and community health centers, social workers, family welfare

educators, and government HBC volunteers, are considered key partners in this project. Support to

government may include inviting government personnel to attend CSO training activities; assistance with

rolling out new government-led training programs; assisting in the development/implementation of quality

standards for nationally-defined minimum packages of essential services; and other strategies to be

determined in consultation with government counterparts. Linkages between government and CSOs will

continue to focus on ensuring that all eligible families and children are registered and receiving all available

Activity Narrative: social welfare and health services, and that benefits such as food are being utilized appropriately

Documentation/Dissemination: In year one PCI expects to convene, with partner BONASO, a Learning

Forum to bring together CSOs, government and other key stakeholders to share promising practices in

delivering integrated palliative care, ART access & adherence, and OVC services. In year two PCI will

develop and disseminate case studies and other documentation of promising practices generated through

this event as well as through ongoing program M&E/documentation, and to find practical ways of sharing

such documentation locally as well as disseminating internationally.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17692

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17692 10298.08 U.S. Agency for Project Concern 7759 7759.08 New CoAg - PCI $1,300,000

International International

Development

10298 10298.07 HHS/Health University of 5285 1331.07 ITECH GHAI $700,000

Resources Washington

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $320,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $400,000

09.T.PT02: Project Concern International - Pediatric Uptake and Adherence

CONTINUING ACTIVITY UNDER PERFORMANCE PASS

From COP08:

The HIV/AIDS epidemic in Botswana is taking a toll on the capacity of the health and social welfare systems

to respond, and straining the capacity of extended families to care for infected/affected family members.

Botswana was the first country in Africa to roll out a national ART program, reaching 85% of those in need

through over 32 ART sites nationwide (WHO 2005). A relatively low treatment failure rate for adults,

approximately 4% (IRIN/AllAfrica.com, 6 June 2006), suggests that adherence has not been a major

problem for adults; however, among children treatment failure rates are estimated at 15% (verbal estimate,

ARV Program Coordinator, May 8, 2007), suggesting a need for adherence support closer to the home in

between scheduled hospital/clinic visits.

Adherence among children is complicated by their dependence on parents and guardians to bring them for

treatment and to care for them once on medications, parents who are themselves struggling with HIV

infection and its consequences. Palliative care programs are not equipped to focus on the distinct needs of

children on treatment, and there are no formal systems for follow up of children on treatment in the home

after they leave the hospital/clinic. Adherence among adolescents is also an emerging concern, as

teenagers tend to have compliance difficulties with medicines.

ART alone will not ensure the health and well-being of people living with HIV/AIDS (PLWHA) and their

families. A comprehensive approach is needed which integrates ART access & adherence support with

palliative care and OVC support services. CSOs are well placed to serve as a bridge between facility-based

services and the communities and households they serve. Yet the CSO sector in Botswana is young and

needs significant capacity building to play this role.

During the COP07 period (project year one), PCI expects to strengthen ART Access & Adherence services

through 8 CSOs in Francistown and Gaborone, and to directly train 80 individuals to provide ART access &

adherence services, reaching 300 adults and/or children infected/affected by HIV.

Proposed Activities

Building upon the foundation established in the COP07 period, PCI will continue and expand the provision

of technical and organizational capacity building services and sub grants to the initial 8 CSOs, and will

extend ART access & adherence capacity building to an additional 5 organizations.

Program objectives: 1) improved and expanded CSO delivery of ART access & adherence services; 2)

strengthened capacity of local government agents (MOH, MLG) to deliver ART access & adherence

services; 3) strengthened collaboration and referral among government services and CSOs in the delivery

of ART access & adherence services; 4) improved documentation and sharing of promising practices and

lessons learned among CSOs and government counterparts.

Partners: Through its work in OVC, Palliative Care, and ART Access & Adherence, PCI expects to begin

the COP08 period (project year two) with approximately 15-20 CSO partners. The ultimate aim is to

strengthen the capacity of all the partners to provide integrated services across all three areas. This will be

a phased process that will continue through year two. Partners entering the program with palliative care

strengths, for example, will have been assisted in year one to strengthen the quality, range and reach of

their work, while beginning to incorporate ART access & adherence and OVC services. Conversely,

partners entering the program with OVC strengths will be assisted to build those strengths and incorporate

palliative care and ART access & adherence services into their work.

PCI therefore does not expect to increase the absolute number of CSO partners in the second year, but

rather extend ART access & adherence capacity building and sub grants to an additional 5 CSOs within the

15-20 current partners. At the same time, PCI will assist CSO partners that received ART access &

adherence support in year one to scale-up their work in year two, through increased sub grants and

technical assistance, and to improve their service quality and linkages.

Capacity Building: During the first year PCI will have identified specific technical and organizational

development (OD) needs among the CSO partners, as well as gaps in ART access & adherence service

delivery in the project communities. This information will inform the design of specific technical and OD

inputs to be provided in year two. As in year one, capacity building is expected to balance technical and

OD, and to emphasize tailored, one-on-one mentoring and peer learning approaches strategically combined

with larger group training activities.

ART access & adherence capacity-building will include continuing to strengthen referral partnerships and

collaboration among a broad array of government and CSO agents at multiple levels, who are critical to

facilitating the identification of HIV-infected individuals, in particular infants and children, linking them to

treatment services, and for ensuring optimal care and treatment adherence after they leave a treatment

facility. HBC caregivers will continue to be equipped to act as the "eye of the ART center" in the

community, not only to provide ART adherence support, but also to refer patients who miss clinic

appointments and those with severe side effects to health centers. In year one PCI will have explored the

feasibility of placing "Community Liaison Officers" in ART sites to strengthen the linkage between the clinic,

the client, and community CSO support services; if this approach is successful it will be scaled up in year

two.

Families and communities will be sensitized about the importance of early intervention with adults and

children, educated about testing and treatment, and motivated to take advantage of CT, PMTCT, ART, and

other services. Linkages with PMTCT services will include follow-up with parents of children on treatment,

and building treatment literacy and adherence support skills using a family care approach that enlists all

family members in monitoring and supporting treatment adherence.

Activity Narrative: ART clients will continue to be assisted to form Self-Help Groups (SHG) as a platform for providing

treatment literacy education, counseling, and ongoing support for adherence. SHG members will be trained

as peer educators, who will work in coordination with existing CSO outreach workers, to reach out to and

support new ART clients as well as PLHA that are not yet on ART.

The Family Care approach will continue to serve as the guiding framework for service delivery, focusing

interventions holistically on the family rather than singling out individual members based on which "target

group" they belong to. PCI will continue to strengthen the capacity of CSO partners to utilize Participatory

Learning for Action (PLA) techniques, such as Journey of Life (REPSSI, 2006) or other context-appropriate

methods identified in year one, to change community attitudes, reduce stigma, and build community support

and utilization of HIV/AIDS services. Through PLA and other processes, PCI will continue to catalyze and

strengthen participation and resource mobilization from diverse public and private entities to strengthen

ART access & adherence services, including commercial private sector.

Government partnership: Staff from district and community health centers, social workers, family welfare

educators, and government HBC volunteers, are considered key partners in this project. Support to

government may include inviting government personnel to attend CSO training activities; assistance with

rolling out new government-led training programs; assisting in the development/implementation of quality

standards for nationally-defined minimum packages of essential services; and other strategies to be

determined in consultation with government counterparts. Linkages between government and CSOs will

continue to focus on ensuring that all eligible families and children are registered and receiving all available

social welfare and health services, and that benefits such as food are being utilized appropriately.

Documentation/Dissemination: In year one PCI expects to convene, with partner BONASO, a Learning

Forum to bring together CSOs, government and other key stakeholders to share promising practices in

delivering integrated palliative care, ART access & adherence, and OVC services. In year two PCI will

develop and disseminate case studies and other documentation of promising practices generated through

this event as well as through ongoing program M&E/documentation, and to find practical ways of sharing

such documentation locally as well as disseminating internationally.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17814

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17814 12304.08 U.S. Agency for Project Concern 7759 7759.08 New CoAg - PCI $600,000

International International

Development

12304 12304.07 HHS/Centers for Project Concern 6130 6130.07 PCI CoAg $600,000

Disease Control & International

Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $310,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: Orphans and Vulnerable Children (HKID): $700,000

09.C.OV11: PROJECT CONCERN INTERNATIONAL -OVC

ACTIVITY UNCHANGED FROM FY2008

From COP08:

The HIV/AIDS epidemic in Botswana is taking a toll on the capacity of the health and social welfare systems

to respond, and straining the capacity of extended families to care for infected/affected family members.

Children who are orphaned or otherwise made vulnerable by HIV/AIDS have benefited from government

services such as the food basket, support for school supplies, and free health care. However, needs such

as psychosocial support for children and succession planning are not being well met.

Barriers to children's access to education are also broader than school costs; a range of interventions are

needed with affected families to ensure that children stay in school over the long term. While the social

welfare system works to provide food support to the most needy children and adults, the number of children

in need in affected households is growing, stressing the capacity of this system.

ART coverage for adults is high (90%), with a relatively low treatment failure rate (4%, IRIN/AllAfrica.com, 6

June 2006); however treatment failure rates for children are significantly higher, estimated at 15% (verbal

estimate, ART Program Coordinator, May 8, 2007), suggesting a need for adherence support closer to the

home. There are no formal systems for follow up of children on treatment in the home after they leave the

hospital/clinic. Adherence among adolescents is also an emerging concern, as teenagers tend to have

compliance difficulties with medicines.

A comprehensive approach is needed which integrates ART access and adherence support with palliative

care and OVC support services. CSOs are well placed to serve as a bridge between facility-based services

and the communities and households they serve. The CSO sector in Botswana is young and needs

significant capacity building to play this role.

2008 Plans

Building upon the foundation established in the FY07 period, PCI will continue and expand the provision of

technical and organizational capacity building services and subgrants to the initial 10 CSOs, and will extend

OVC capacity building to an additional 5 organizations.

Program objectives: 1) improved and expanded CSO delivery of OVC services; 2) strengthened capacity of

local government agents (MOH, MLG) to deliver OVC services; 3) strengthened collaboration and referral

among government services and CSOs in the delivery of OVC services; 4) improved documentation and

sharing of promising practices and lessons learned among CSOs and government counterparts.

Partners: Through its work in OVC, Palliative Care, and ART, Access and Adherence, PCI expects to begin

the 2008 period (project year two) with approximately 15-20 CSO partners. The ultimate aim is to

strengthen the capacity of all the partners to provide integrated services across all three areas. This will be

a phased process that will continue through year two. Partners entering the program with palliative care

strengths, for example, will have been assisted in year one to strengthen the quality, range and reach of

their work, while beginning to incorporate OVC and ART access and adherence services. Conversely,

partners entering the program with OVC strengths will be assisted to build those strengths and incorporate

palliative care and ART access & adherence services.

PCI therefore does not expect to increase the absolute number of CSO partners in the second year, but

rather extend OVC capacity building and sub grants to an additional 5 CSOs within the 15-20 current

partners. At the same time, PCI will assist CSO partners that received OVC support in year one to scale-up

their work in year two, through increased subgrants and technical assistance, and to improve their service

quality and linkages.

Technical service strengthening will continue to focus on ensuring the health, development, education,

protection, socialization, and emotional well being of children infected/affected by HIV/AIDS. Services will

continue to be tailored to the age of the child, with specific interventions for under-fives, primary school age

and pre-teen children, and for adolescents.

Volunteers will be trained to provide PSS tailored to the needs of children. Sensitization and skills building

with parents will help them understand the psychosocial needs of infected/affected children and what

parents can do to support children's well-being, while also taking care of their own well-being. Parents will

be educated about succession planning and assisted to develop wills and take actions to protect children's

inheritance rights, and ensure that children participate in decisions about who will become their guardians

after parental death. Local traditional leaders and other influential members of society will be sensitized

about women's and children's property rights. Birth registration will be promoted through collaborative

activities among CSOs, government agents, and other relevant stakeholders

Linkages between government and CSOs will continue to focus on ensuring that all eligible families and

children are registered and receiving all available social welfare and health services, and that benefits such

as food are being utilized appropriately.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17727

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17727 10209.08 U.S. Agency for Project Concern 7759 7759.08 New CoAg - PCI $2,350,000

International International

Development

10209 10209.07 U.S. Agency for Project Concern 6131 6131.07 $1,211,000

International International

Development

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

Subpartners Total: $0
Bakgatla Bolokang Matshelo: NA
Botswana Christian AIDS Intervention Programme: NA
Botswana Association for Psychological Rehabilitation: NA
Botswana Retired Nurses Society: NA
Holy Cross Hospice: NA
House of Hope Trust: NA
Mothers' Union Orphan Care Centre: NA
To Be Determined: NA
Silence Kills Support Group: NA
Tsholofelo Trust: NA
Cross Cutting Budget Categories and Known Amounts Total: $630,000
Human Resources for Health $320,000
Human Resources for Health $310,000