PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
09.P.PM06: Mullens - Impact of Infant Feeding Practices
ACTIVITY CONTINUING UNDER PERFORMANCE PASS
ACTIVITY UNCHANGED FROM FY2008
From COP08:
Title: Infant formula preparation and feeding practices among HIV-positive women in the Botswana PMTCT
program
Time and Money: 6 months protocol approval, 4 months study time; $100,000
Local Co-investigator: MOH Nutrition Unit; Botswana National PMTCT Program
Project Description:
A study was conducted in 2006 to assess infant formula preparation and feeding practices among HIV-
positive mothers. Numerous deviations from recommended practices were observed. In 2008, the
WHO/UNICEF IYCF training will retrain health workers in infant feeding counseling. The impact this training
will have on actual practices in the homes of HIV-positive women, however, is unknown. (Another intended
effect of the IYCF training, to decrease the automatic prescription of formula use and increase informed
choice of infant feeding method, will be measured in other ways.)
Evaluation Question: Has there been any improvement in recommended infant formula preparation
practices since the WHO Infant and Young Child Feeding (IYCF) course was used to retrain health workers
in infant feeding counseling?
Methods: Study participants will be identified after delivery and visited at their homes when their infants are
2-4 months old.
Population of Interest:
This is a repeat of a 2006 study and will use the same protocol. HIV-infected women (n=100) intending to
formula feed their infants will be recruited on the postnatal ward of delivery units in three districts in northern
Botswana. Study participants will be visited at their homes when their infants are 2-4 months old. Data from
questions about infant feeding and observations of actual feeding practices will be collected. Data will be
compared to 2006 data.
Technical support for training of study staff and analysis of data will be provided by CDC-Atlanta.
Information Dissemination Plan:
Data on infant formula preparation and feeding practices will be shared with sites, districts, and the national
PMTCT program in order to determine if the IYCF training has had the desired effect and assist in planning
for additional infant feeding quality improvement activities.
Budget justification for Year 1 Budget:
Salaries: $70,000
Supplies: $10,000,
Travel: $10,000
Equipment: $10,000
Total:$100,000
New/Continuing Activity: Continuing Activity
Continuing Activity: 17318
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17318 17318.08 HHS/Centers for Mullens & 8742 8742.08 CoAg (5444.08) $100,000
Disease Control & Associates
Prevention
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $150,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
09.C.AC14: Mullens - NGO Coordinator
The involvement of civil society organizations can be traced back to the first Short Term Plan of Action
(1987-1989) on HIV and AIDS, the Medium Term Plan I and II, respectively, and now the National Strategic
Framework for HIV/AIDS 2003-2009. The Government of Botswana (GOB), communities and other
development partners have acknowledged the strategic role played by civil society organizations in
responding to HIV and AIDS.
Civil society's role became evident in the early 1990s when the epidemic became more mature resulting in
many people suffering from chronic conditions related to HIV/AIDS, thus increasing the demand for
HIV/AIDS-related services. This increased need has overwhelmed the capacity of the public sector to
deliver services to all people in need, resulting in many of them, still needing care and support, being
discharged back to their families and communities who are not always capable of handling the varying
situations.
In 1995, the government adopted community home-based care (CHBC) as a strategy to ensure continuity
of care and to support people living with HIV and AIDS (PLWHA) and other chronically ill patients. The
government realized it had limited capacity to implement the program, hence family and community
mobilization was adapted as a major intervention. The community response has been very supportive, as
evidenced by the emergence of several civil society organizations working country-wide. In 1998, there
were 78 community groups and, currently, there are more than 300 local Civil Society Organizations (CSO)
involved in the response to HIV and AIDS, including Faith Based Organization (FBOs), NGOs such as
Botswana National AIDS Service Organization (BONASO), Botswana Network of People Living with
HIV/AIDS (BONEPWA), Botswana Network for Ethics, Law and HIV/AIDS (BONELA), Botswana Christian
AIDS Intervention Program (BOCAIP), and others. It is obvious that the public sector in Botswana
recognizes the importance of CSOs, so they have played an active role in establishing the CSO sector and
continue to nurture its growth.
CSOs, therefore, provide a strategic opportunity to increase geographical coverage of services and reach
marginalized, vulnerable and underserved communities with ease. They can provide a range of services,
both stand alone and integrated, depending on a given organization's capability and comparative
advantage. These services include traditional community mobilization, distribution of health resources such
as condoms, bed nets, and community TB Dots, dissemination, health information, psychosocial support,
voluntary counseling and testing, peer education on HIV, income generating activities, care for orphans and
vulnerable children (OVC), awareness campaigns, training on human rights, and advocacy to more
complex activities, such as anti-retroviral (ARV) treatment literacy and adherence counseling, palliative
care, home based care, hospices and day care centers, and youth and adolescent friendly reproductive
health services. They also play a role in the development of health sector HIV and AIDS related policies
and programs and in shaping the health systems. There is, however, significant variability in the scope and
quality of their services, as well as in their levels of accountability. The public sector, particularly the Ministry
of Health (MOH) still has the overall accountability to the public at large on the quality of services provided
by these CSOs in the health sector.
Needs assessments done in the country indicate that most of these organizations are faced with challenges
in terms of service delivery, adequate coverage, insufficient funding, and inadequate material and human
resources. Due to a lack of skilled personnel, most of them are operating with a minimal number of skilled
staff for both management and technical operations with most of staff being lay or unskilled volunteers.
Since the inception of the CHBC program, the government has been providing CSOs with financial, material
and technical support and most are still dependent on the government for these resources. It is important to
note, however, that as the numbers of CSOs increase and diversify their services, the provision and
coordination of both financial and technical support to all of them is becoming a challenge to the
government. The sharing of information on HIV and AIDS prevention and care and the support of
programmatic issues between CSOs and the public sector both at national and implementation levels of the
health sector response are weak. Additionally, public sector-CSOs collaboration linkages and patients
referral systems are inadequate. This has implications on both the CSOs' and the government/public
sector's accountability to the general public on quality of health services.
The above-mentioned capacity challenges experienced by the local organizations have attracted
international organizations through various donor agencies' bilateral twinning programs, such as PEPFAR,
United States Agency for International Development (USAID), Swedish International Development
Cooperation Agency (SIDA), and BMS among others, to assist and strengthen the capacity of CSOs in
Botswana. These international organizations come with both financial and technical expertise as well as
pre-packaged options and ideas. For the health sector, both government ministries and CSOs, to maximize
the benefits of these international NGOs' and donor agencies' support, there is a need to have formal
mechanisms for communication, for example, on the sharing of information about the support they are able
to give Botswana as well as what the public sector envisions, given the Botswana Health Sector HIV and
AIDS response's national priories, objectives, policies and guidelines and challenges. This will enable
NGOs and donor agencies to align their support with both local CSOs and the MOH to address the
country's needs within the policy and legal framework, further strengthen the public sector -CSOs
collaboration, and maximize the benefits of their financial and technical support to the country.
PEPFAR will support the position of a CSO Technical Advisor and Coordinator within the department of
HIV/ AIDS Prevention and Care (DHAPC) at a government scale of D2 to enable the MOH to coordinate
and strengthen links between CSOs and the public and private sectors.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.08:
09.T.AT01: Associated Fund Administrators
CONTINUING ACTIVITY UNDER PERFORMANCE PASS
From COP08
Associated Fund Administrators Botswana (Pty) Ltd (AFA) is an administrator of two medical aid
schemes/insurance organizations namely, Botswana Public Officers' Medical Aid Scheme (BPOMAS) and
Pula Medical Aid Fund (PULA). Through its managed care program, AFA facilitates; the provision of
antiretroviral therapy (ART) to insured patients and Government of Botswana funded patients, as well as
provision of continuous medical education and KITSO training to private practitioners (doctors, pharmacist
etc).
Subsequent to AFA being awarded a tender, in May 2005, to pilot the rolling out of ART services to private
sector through the GOB outsourcing program, to date AFA continues to manage and coordinate the
provision of ART services to GOB funded patients by the private sector (medical doctors, pharmacists and
laboratory services). This is a form of a Public-Private Partnership (PPP).
The AFA managed care program had, as at end of May 2007, about 12 600 patients (6, 800 insured
patients and 5, 800 GOB funded patients) on ART, therefore, it is the largest HIV/AIDS managed care
program in the private sector and nationally, it is the second largest after the GOB MASA program.
In view of the close association between AFA and the national ART program (MASA) and the former's
commitment to ensuring alignment between the public and the private sector with regard to HIV/AIDS
treatment, there is a need to ensure synergy in HIV/AIDS treatment and management training.
As a consequence, the proposed project activities necessarily relate to continually providing continuous
medical education (CME) and KITSO training to private practitioners, the printing and distribution of client
information leaflets for the promotion of information, education and communications (IEC) activities for
members and prospective members of administered schemes. In essence, the project aims to build on and
strengthen activities that would be completed for FY07.
The main objective of the project is to increase access to quality antiretroviral therapy and related services
in the private sector in Botswana, which is aligned to national and international clinical guidelines.
To date, and since we started this project with BOTUSA, we have facilitated the provision of KITSO Training
to 95 different private and public sector practitioners, done eight continuous medical education sessions (in
Francistown and Gaborone) which were attended by a total of 321 private and public sector practitioners. In
addition, more than 2,000 patients (excluding public-private partnership project patients) have been
indirectly reached and increased the number of medical practices providing ART services to 156.
The challenges, as previously reported, continue to be availability of funds, scarcity of IEC specialists to
assist in developing program specific IEC materials, limited capacity of the KITSO faculty to provide KITSO
Training as and when requested.
Going forward, we have decided to develop the IEC materials in-house with oversight from the a member of
the KITSO faculty, establish honorarium for private practitioners willing to accredit and provide KITSO
training to private sector practitioners, and continue to invite resource persons from abroad to provide
Continuous Medical Education, in collaboration with, amongst others, International Training & Education
Centre (I-TECH -University of Washington) and Aid for AIDS consultants from University of Cape Town..
In FY08 at least four continuous medical education sessions for private sector practitioners are planned for
the southern and northern parts of Botswana, two Government of Botswana (Ministry of Health) accredited
HIV/AIDS treatment training (KITSO) to ensure that treatment and/or antiretroviral services offered in the
private sector meet national and international standards. This activity will provide CME and KITSO Training
to about 210 private practitioners.
To strengthen and supplement Government information, education and communication activities (IEC), 15
000 program specific IEC materials / leaflets would be produced to provide knowledge and information to
insured and non-insured persons in order to increase the number of clients accessing the managed care
program and therefore accessing antiretroviral therapy. This would be done at the same time as promoting
HIV preventative strategies such as abstinence, be faithful and condoms (ABC). By distributing the IEC
materials, nationally, to the various employer groups, this activity is expected to increase current new
patients' enrollment rate.
In conclusion, the funding will also support the payment to the resource persons who will be providing the
continuous medical education and the KITSO Training, travel costs to the different training venues, venue
and other related session costs and production and distribution of IEC materials.
Continuing Activity: 17810
17810 4954.08 HHS/Centers for Mullens & 8742 8742.08 CoAg (5444.08) $32,000
10220 4954.07 HHS/Centers for Associated Funds 5422 1352.07 Contract $52,000
Disease Control & Administrators
4954 4954.06 HHS/Centers for Associated Funds 3563 1352.06 Contract $98,000
Table 3.3.09:
09.T.PT04: Mullens - Early Infant Diagnosis -Training
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAY:
The budget has been increased from US $100,000 to US $250,000. A recent assessment, undertaken by
the Prevention of Mother to Child Transmission (PMTCT) program and CDC, revealed that approximately
50% of staff who previously were trained in Early Infant Diagnosis had been transferred or had left their
jobs. They have been replaced by untrained staff who now need training.
2007 Accomplishments
A significant achievement was the national roll-out of EID using PCR testing on DBS. Over 800 government
health workers in all 27 districts were trained in EID and DBS collection between October 2006 and June
2007. All clinics with maternal-child health services can now offer routine early infant testing beginning as
early as six weeks. During the roll-out training more than 6,000 infants were tested for HIV using the new
system. Data such as PMTCT interventions received, feeding method, CTX use, HIV test results, etc. are
collected for each infant on the laboratory requisition form and data from 4,600 infants are now entered into
the national infant testing database.
2008 Plans
The successful new system of infant testing must be maintained and quality assurance needs to be
provided. The USG will provide funding for SCMS (see activity P0107) to procure the laboratory and clinical
supplies for the EID program. Training teams will revisit districts and provide feedback on issues such as
quality of data collection, quality of samples sent, prevalence of HIV by district from data collected during
the first months of the roll-out, and turn around time of sending back results from laboratories to clinics. The
training teams will provide on-site training as needed. The USG will provide support to maintain a database
of infant diagnosis data and to produce regular reports on infant HIV prevalence. The MOH will contract a
private data management firm for data entry, technical assistance and will upgrade skills needed to produce
regular reports on infant diagnosis by PMTCT managers.
Continuing Activity: 17303
17303 17303.08 HHS/Centers for To Be Determined 7726 5444.08 RFA-PS07-747-
Disease Control & Building Human-
Prevention Resource
Capacity to
Support
Prevention,
Care and
Treatment,
Strategic
Information and
Other HIV/AIDS
Programs
Estimated amount of funding that is planned for Human Capacity Development
Table 3.3.11:
09.C.OV12: Mullens - OVC Support
The Ministry of Local Government (MLG) through the Department of Social Services (DSS) with funding
from PEPFAR has developed a number of national guidelines and manuals that need to be disseminated
and implemented country-wide. Working in collaboration and in consultation with DSS and United States
Government (USG) OVC Section, Mullens will organize and support OVC stakeholder meetings and
workshop logistics. Their tasks will include identification of the venue, preparation of the workshop
materials, and meeting the costs of the workshops and other related costs.
In addition to disseminating and implementing the national guidelines and manuals, there is a need to
recruit an international consultant who will support the process of further development of OVC policy and a
technical advisor for the Nutrition Project at the Ministry of Health to provide leadership, guidance and
training.
Specifically, Mullens will be expected to perform the following tasks:
I. Organize and support DSS to conduct workshops to disseminate the following documents:
1. Situation Analysis Findings
2. National Guidelines on the Care of orphans and Vulnerable Children
3. OVC Monitoring and Evaluation Framework
II. Recruit an International OVC Policy Consultant to support the on-going process of the development of
the OVC policy. The international consultant will provide technical support and facilitate the completion of
the draft policy framework. Mullens will:
1. Participate in the recruitment process as requested by DSS and the USG OVC Section. This will be
limited to advertising for the consultant position on behalf of DSS.
2. In consultation with DSS and the USG OVC Section, make the necessary payments to the consultant.
III. Recruit a Technical Advisor for the Nutrition Project at the Ministry of Health who will provide technical
leadership, guidance and training to the Nutrition Rehabilitation program, which is implemented at two sites,
specifically, Gaborone and Francistown. The main duties and responsibilities of the technical advisor will be:
1.At the national level:
a. Serve as a liaison between the Ministry of Health and USG, working particularly with Coordinators of
OVC and HIV/AIDS Care and Treatment.
b. Serve as the contact point for OVC nutrition issues and interface with NGOs, community-based
organizations and other partners working with orphans and vulnerable children.
c. Recommend strategic directions for the program for effective and comprehensive management of
malnourished children infected and affected by HIV/AIDS and interface with other technical components, for
example, the Prevention of Mother to Child Transmission (PMTCT) and the Anti-retroviral Therapy (ARV)
teams.
2. General program implementation, management and leadership:
a. Provide technical assistance to the community-based nutrition rehabilitation program in the Ministry of
Health and coordinate its activities strengthening project design, implementation, and monitoring.
b. Facilitate the training of health workers and other service providers in the management of malnourished
children infected and affected by HIV/AIDS.
c. Facilitate training of community-based organizations serving OVC to ensure proper care of children.
d. Facilitate development of appropriate Information, Education and Communication (IEC) materials to
support the program.
e. Identify short and long term technical assistance required for successful implementation of activities to
support comprehensive management of malnutrition in children.
f. Facilitate procurement of equipment and other commodities necessary for the program in line with the
limits of the budget.
g. Establish and maintain strong linkages with other teams in the design and oversight of programs which
have synergistic elements, as well as strengthen synergies between the nutrition rehabilitation program and
other partners, such as community-based organizations, and the PMTCT ARV, TB, child survival, nutrition,
HIV counseling and testing, prevention, and child welfare programs.
h. Facilitate needs assessments for scale up of the program to other sites.
3. Monitoring, evaluation and reporting:
a. Prepare periodic planning and program implementation reports, including the annual Country Operational
Plan (COP), and submit to all relevant partners on time.
b. Undertake regular visits to program sites and projects and provide feedback to program coordinators at
USG and in hospital management.
c. Support and build capacity of program staff in data collection, analysis, and interpretation, management,
and advocacy, and ensure quality reporting and sharing of findings.
d. Exercise financial stewardship for the nutrition rehabilitation program and, on a quarterly basis, estimate
accruals to ensure that funds are obligated on time, programmed and spent in a timely fashion. Facilitate
audit evaluations.
e. In collaboration with USG OVC Section, document program findings to contribute to organizational
learning and identify any associated research opportunities.
Estimated amount of funding that is planned for Human Capacity Development $300,000
Table 3.3.13:
09.C.CT10: Mullens - National Counseling and Testing Workshops
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Funds from FY2009 will be used to engage short-term consultants, in consultation with the Ministry of
Health (MOH) and the in-country United States Government (USG) Counseling and Testing Core Team, for
the completion of specific identified needs, such as the development of an implementation manual for
counseling and testing, and the review the voluntary counseling and testing (VCT) training curriculum.
Additionally, a study tour to a country in the region for purposes of learning and benchmarking counseling
and testing (CT) activities with the best practices will be organized and implemented. Potential places with
related activities to understudy include the integration of male circumcision into CT in Zambia, the formation
of support groups for discordant couples in Uganda or Kenya, or the involvement of traditional healers in CT
in South Africa.
The purpose of the national counseling and testing workshop is to bring together implementers and
stakeholders on counseling and testing to:
1. Share information on national strategy, policy and technical issues and current coverage of counseling
and testing services
2. Share experiences on implementation, monitoring and evaluation of CT services
3. Identify strategies for future direction: overcoming challenges and filling gaps. Mullans and Associates will
provide faciltitation services for the workshop, in consultation with the counseling and testing technical
working group. An estimated 150 participants drawn from implementing partners, key stakeholders like the
UNAIDS, WHO, ACHAP and the networks of various HIV and AIDS organisations in Botswana will attend.
The counseling and testing technical working group will closely with the Communications working group to
ensure appropriate invlovement of the media. A deliverable from the workshop will be a report with
recommendations on how to efficiently and effectively strengthen and scale up counseling and testing
services in the country. This workshop is planned to preceed the COP planning exercise so as to draw from
the recommendations that will be made. Funding will cover conference venue, transportation and
accommodation, as well as general conference faciltitation like production of materials and the report.
Continuing Activity: 19648
19648 19648.08 HHS/Centers for Mullens & 8742 8742.08 CoAg (5444.08) $150,000
Table 3.3.14:
09.X.SS23: Mullens - GBDS & PWC Sub-contracts
This activity will support a prime partner, Mullens and Associates, to provide systematic pre-audit
assessments for partners preparing for statutory audits, as well as for partners preparing to become new
recipients. This activity will further support the prime partner to provide accounting, fiscal and financial
monitoring services to a number of cooperative agreements, including the Government of Botswana (GOB)
and other cooperative agreements outside the GOB, to ensure a systematic review of the recipients'
accounting and fiscal management practices, reporting structures and internal control systems, thereby
enhancing fiscal discipline and stewardship of (USG) resources among recipients. The sub partners under
this activity will also provide pre-audit assessments for new cooperative agreements scheduled for statutory
audits in FY2009. In addition, this activity will involve the provision of financial and accounting services
assistance to selected recipients who need to build their capacity on adequate accounting systems. As
such, through this activity, recipients would be assisted in preparing pre-audit schedules, pre-audit scopes
and assessments of compliance issues, and financial and expenditure schedules in line with approved
budget categories, as well as entire disbursements and reconciliations of draw downs. Each pre-audit
assessment will be based on the tenets of international accounting standards and generally accepted
accounting principles of the U.S. with the aim of providing project financial management services and
guidance to recipients and other stakeholders.
The objective of this activity is to ensure that recipients effectively carry out and execute project budgets in
compliance with laws, regulations, contracts and cooperative agreements' terms applicable to recipients. A
part of this activity is to establish a reasonable assurance regarding whether or not the basic financial
statements/project income and expenditure accounts are free of material misstatements, including those
caused by error or fraud, and to assess the recipients' compliance with certain provisions of the cooperative
agreements.
Further, this activity will contribute towards the objective of ensuring that there are adequate financial
reporting checks and balances for recipients conducting projects in multiple program areas to eliminate
possible double counting.
This activity will specifically contribute to the following results:
-Assisting cooperative agreement recipients to organize and prepare financial records in standardized
formats to minimize exposure to financial risks.
-Reporting on compliance with applicable laws, regulations and other cooperative agreement terms.
-Expressing opinions on recipients' payments and disbursements schedules and reconciliations of draw
downs to budget execution.
-Assessing and evaluating the strengths or weaknesses of financial systems of internal control.
-Providing feedback to prime partners and to the in-country CDC field office on recipients' improvements to
project management controls, changes to policies and procedures and implementation of loss control
measures to safeguard loss of information, money and other resources.
In FY2009, at least five cooperative agreements are planned to benefit from this activity. The five include
the mega Government of Botswana cooperative agreement which previously benefited from these services
for three years through a local purchase order mechanism.
The target group of recipients to benefit from this activity is drawn from both current recipients and planned
recipients in FY2009 with emphasis on the financial reporting capacity building for new recipients and those
recipients with project financial management constraints.
Estimated amount of funding that is planned for Economic Strengthening $180,000
Table 3.3.18:
09.X.SS24: Mullens - NACA ELHR Coordinator
This new activity provides Human Resource support to NACA to house the Ethics, Law and Human Rights
(ELHR) secretariat and is a continuation of previous work carried out by the Botswana Network of Ethics,
Law and HIV/AIDS (BONELA).
Since 2005, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported BONELA, as
secretariat of the National AIDS Council's Sector on Ethics, Law and Human Rights, to implement activities
in the sector plan. Many policy and legal gaps related to HIV/AIDS have been identified in Botswana as
documented by a legislative review conducted in 2005, particularly in the area of ethics and human rights,
gender and stigma. Among the most important of these are related to protection from discrimination in
employment, women's sexual and reproductive rights and the rights of marginalized groups, included
people with disabilities.
Activities in the sector plan focus on building consensus among policy makers on legislative and policy
reform; developing institutional capacity for compliance to ethics, law and human rights standards at sector
level; and raising public awareness of ethics, law and human rights related to HIV and AIDS. Training
workshops are held to address existing gaps in the knowledge and awareness of legislative and human
rights issues in Botswana by targeting policy makers, interest groups, the private sector, community
leaders, development organizations, people living with HIV/AIDS (PLWHA) support groups, District AIDS
Coordinators and the general public. Increased awareness of prevalent human rights and legislative issues
related to HIV/AIDS is expected to assist in legislative and policy reform and create a supportive
environment for the implementation of reformed laws.
In early FY2008, a decision was made by National AIDS Coordinating Agency (NACA) to move the sector's
secretariat to government and house it at the NACA. PEPFAR will continue to support the ELHR Sector by
employing a policy advisor for NACA. The advisor will be the secretariat for the sector and will lead
partners in the implementation of the sector plan.
Estimated amount of funding that is planned for Human Capacity Development $250,000
09.X.SS08: Mullens -- IDM - Sustainable Management Development Program
This is a continuous activity under which the President's Emergency Plan for AIDS Relief (PEPFAR) funds
the Institute of Development Management (IDM) to implement the Sustainable Management Development
Program (SMDP) program to strengthen HIV program and services management in the public and civil
society sectors. Funding has been reduced in FY2009 because FY2008 carryover will take the program
through early 2010. FY2009 funding will be used to strengthen the mentoring component of the program
and further develop it as a required follow on to the initial training. This will be done initially as a pilot
program focusing on SMDP graduates from the Botswana National TB Program. Graduates will be
mentored to sustain the continuous application of techniques and tools for the improvement of processes,
service delivery and quality. A monitoring and evaluation plan will be developed to assess short and
medium term outcomes of training.
The Sustainable Management Development Program (SMDP), established in 2003 at the Botswana
Institute of Development Management (IDM) with the assistance of CDC/BOTUSA, is based on the CDC
Management of International Public Health (MIPH) Course. The objective of this training is to build the
managerial and leadership capacity of public health program managers working in HIV/AIDS in the public,
non-governmental (NGO), community-based (CBO) and faith-based (FBOs) sectors.
The curriculum is in modular form allowing for shorter training in specific management areas. The major
component of the course is the Total Quality Management (TQM) module, designed to develop problem
solving and analytical skills for improving routine processes and service delivery in public health programs.
Other modules include leadership, communications, team building and strategic resource development.
The training is currently undergoing the accreditation process with the Botswana Training Authority (BOTA),
with two major components of the course, TQM and Effective Communications, in the final stages of
accreditation.
To date, the MIPH course has been adapted to Botswana and a local SMDP program established, ten
trainers have been trained in MIPH in Atlanta, 100 public health managers have been trained in SMDP in
Botswana, an external evaluation was conducted (2005) and the first SMDP Alumni Conference was held
(2007).
2007 achievements:
Trained 120 public health managers in the Botswana SMDP; held first annual Botswana SMDP Alumni
Conference (94 in attendance); two modules in the final stages of accreditation with the local training
authority; developing a mentor program which will train 20 SMDP graduates to be SMDP focal points in their
workplaces; update on the new TQM module scheduled for November
2008 plans:
Train 120 public health managers in SMDP (4 months); train 40 public health managers in TQM (1 week)
from MOH, Laboratory Services, Pharmacy Services and the TB program; train 40 managers from NGO,
CBO and FBO sectors in Leadership, Networking and Strategic Resource Development (1 week); hold
annual two-day conference for 150 Botswana SMDP alumni; train 40 mentors to support and supervise the
applied TQM projects; train one IDM staff member in MIPH course at CDC, Atlanta; train two IDM staff in
advanced public health management courses; course accreditation will continue.
Continuing Activity: 17916
17916 4543.08 HHS/Centers for Mullens & 8742 8742.08 CoAg (5444.08) $410,000
9837 4543.07 HHS/Centers for Institute of 5291 1370.07 Contract $200,000
Disease Control & Development
Prevention Management,
Botswana
4543 4543.06 HHS/Centers for Institute of 3373 1370.06 Contract $157,500
Estimated amount of funding that is planned for Human Capacity Development $195,000
09.X.SS15: Mullens - School of Public Health Curriculum Development
The President's Emergency Plan for AIDS Relief (PEPFAR) will continue to support the development of
public health education in the University of Botswana Faculty of Health Science by employing an expert
consultant to implement the strategic plan developed during FY2008. Activities in FY2009 will be a
continuation of those that will be built on the results of a needs assessment to be conducted in FY2008 and
will include:
- the review of existing curricula for public health content and the development of curricular proposals for
each undergraduate and post graduate program.
-the development of a strategy/plan for providing continuing education in public health for practicing health
professionals.
-assistance to the Faculty of Health Sciences to forge linkages, including the development of Memoranda of
Understanding (MOU) with Botswana Government Ministries, other relevant institutions within and outside
the country, and regional University partners
-assistance in faculty professional development and classroom teaching, as appropriate.
Botswana is currently in the process of establishing a medical school at the University of Botswana (UB),
with the first class able to do their entire medical education in country beginning this year. A local internship
program has just begun, residencies in pediatrics and internal medicine are being established and a new
teaching hospital is planned. Aside from the public health component, the curriculum has been developed.
The public health courses, when developed, will be integrated into the medical school curriculum, as well as
the larger Faculty of Health Sciences, with the longer-term vision of establishing a school of public health in
future.
The activity will support a partner, to provide technical assistance to UB and the new medical school to
develop its public health component. This assistance is likely to focus on faculty recruitment and growth,
curriculum development and the development of distance learning and telemedicine capacity.
Continuing Activity: 17923
17923 17923.08 HHS/Centers for Mullens & 8742 8742.08 CoAg (5444.08) $100,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
09.X.SS19: Mullens -- HIV/AIDS Policy Development (BONELA)
This is a continuing activity that will not need full funding in FY2009, because FY2008 funds will carry it
through to early 2010. The activities were modified in mid-2008, hence a description is provided below.
Since 2005, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported the Botswana
Network for Ethics, Law and HIV/AIDS (BONELA), as secretariat of the National AIDS Council's Sector on
Ethics, Law and Human Rights, to implement activities in the sector plan. In early FY2008, a decision was
made by the National AIDS Coordinating Committee (NACA) to move the sector's secretariat to
government. PEPFAR will continue to support the Ethics, Law and Human Rights (ELHR) Sector by
employing a policy advisor for NACA under another activity, while supporting BONELA to conduct policy
and advocacy work around the same issues. In FY2009, BONELA will continue to employ a Policy Advisor
to continue advocacy on policy issues from the review of laws, regulations and policies undertaken in 2005.
These issues include promoting sustainable HIV/AIDS medications and advocating for the right to health,
developing policies and programs targeted to address the sexual reproductive health needs of HIV positive
persons, particularly women, shadow reporting on CEDAW, and advocating for the ratification of the African
Charter on the Rights of Women in Africa and the formulation of the Botswana Charter on the Rights of
Women. Currently, Botswana's constitution does not expressly prohibit discrimination of persons on the
basis of gender. Advocacy will also include the need to harmonize the provisions of the constitution relating
to the protection of women. Other activities will include promoting the enactment of the Domestic Violence
Act and monitoring the implementation of national HIV testing guidelines relating to informed consent and
confidentiality. BONELA will report regularly to the NAC, develop a model policy on SRH services, hold
consultative meetings with ministries and parliamentarians, and conduct community education campaigns.
The outputs of this activity will include a model SRH policy, advocacy materials for community campaigns
on Domestic Violence Act, a shadow report to the UN Commission on Gender on CEDAW, and leaflets on
confidentiality and informed consent.
The Botswana Network on Ethics, Law and HIV/AIDS (BONELA), a non-governmental organization, is
secretariat to the Ethics, Law and Human Rights (ELRH) sub-committee of the National AIDS Council
(NAC) and is responsible for coordinating the implementation of the sector plan. Many policy and legal
gaps related to HIV/AIDS in Botswana were documented in a 2005 legislative review, particularly in the area
of ethics and human rights, gender and stigma. Among the most important of these are related to
protection from discrimination in employment, women's sexual and reproductive rights and the rights of
marginalized groups, included people with disabilities.Since 2005, BONELA has received USG funding to
employ a policy advisor to implement activities outlined in the ELHR strategic plan. These activities focus on
building consensus among policy makers on legislative and policy reform; developing institutional capacity
for compliance to ethics, law and human rights standards at sector level; and raising public awareness of
ethics, law and human rights issues related to HIV and AIDS. Training workshops address existing gaps in
the knowledge and awareness of human rights issues in Botswana by targeting policy makers, interest
groups, the private sector, community leaders, development organizations, PLWA support groups, District
AIDS Coordinators and the general public. Increasing awareness of prevalent human rights and legislative
issues related to HIV/AIDS is expected to assist in legislative and policy reform and create a supportive
environment for the implementation of reformed laws. 2007 Achievements:180 people (PLWAs,
government workers, policy makers, civil society, private sector) trained to strengthen political and popular
support for HIV/AIDS policies and legislative reform and build capacity to participate in policy development;
conducted national media campaign to create awareness on the need for an HIV employment law; project
to address HIV stigma in schools /is planned to start before the end of the year. 2008 Plans: Conduct
training workshops in 9 districts (100 participants) to address existing gaps in the knowledge and
awareness of legislative and human rights issues in Botswana by targeting policy makers, interest groups,
the private sector, community leaders, development organizations, PLWA support groups, District AIDS
Coordinators and the general public; conduct an awareness raising media campaign using leaflets,
advertorials, radio talk shows to disseminate the results of a situational analysis on vulnerable groups
(women, children, MSM) to be conducted with Global Funds (Round 7); hire a training officer to support the
above activities
Continuing Activity: 19622
19622 19622.08 HHS/Centers for Mullens & 8742 8742.08 CoAg (5444.08) $125,000
Gender
* Increasing women's legal rights
* Reducing violence and coercion
09.X.SS04: Mullens - MISA-Community Outreach
A partner will be selected to work with the local chapter of the Media Institute for Southern Africa (MISA) in
Botswana to conduct seminars on HIV AIDS and TB prevention in five underserved districts in: Selibe
Phikwe, Serowe, Ghanzi, Francistown and Kasane. MISA will help assure local media involvement and
support guest speakers who travel to the seminars to participate.
In 2008, at least 5 workshops are planned for up to 50 people each. MISA Botswana is part of a regional
organization for journalists and other media professionals throughout the SADC region. One of the
nongovernmental organization's objectives is to encourage social responsibility in the media to disseminate
accurate information on the pandemic. The Botswana chapter has 155 individuals and 20 organizations
affiliated with it and is well placed to expand coverage and information dissemination within Botswana and
beyond.
The target groups for the seminars are drawn from local media, community leaders, district administrators
and elected leaders, traditional chiefs, police. The dialogue will engage guest speakers and community
health workers the latest interventions, assessments and experience in Botswana in prevention, testing,
care, treatment and capacity building.
Continuing Activity: 17912
17912 17912.08 HHS/Centers for To Be Determined 7726 5444.08 RFA-PS07-747-
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $5,999,096
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In response to the challenges that HIV and AIDS present to Botswana, efforts continue to be made to diversify approaches, fine
tune technical support, and plan for future program sustainability with the support of the Presidents' Emergency Plan for AIDS
Relief (PEPFAR). The national HIV prevalence rate is 23.9% among adults ages 15 to 49, according to recent UNAIDS data, and
an estimated 300,000 are living with HIV/AIDS. About 53.2% of Batswana know their HIV status up from 25% in 2004, 95% of
pregnant mothers gaining that information through the Prevention of Mother to Child Transmission program. The Botswana 2007
Sentinel Survey indicated that HIV prevalence among pregnant women (15-49 years) is 33.7%, though the overall trend appears
to be decreasing from 37.4% in 2003. The Department of HIV/AIDS Prevention and Care reports that, as of the end of July 2008,
a total of 109,991 patients were receiving HAART, 97% of the 113,000 patients estimated to require treatment. Challenges
remain, however, with prevention, particularly the issue of multiple concurrent partnerships, alcohol abuse, nascent civil society,
and human capacity development.
The President's Emergency Plan for AIDS Relief (PEPFAR) in Botswana is implemented by six United States Government (USG)
agencies, of which five have resident staff in Botswana: Department of Defense (DOD); Department of Labor (DOL, non-
resident); Department of State; Department of Health and Human Services (HHS) both Centers for Disease Control and
Prevention (CDC) and Health Resources and Services Administration (HRSA); Peace Corps; and United States Agency for
International Development (USAID), through the Pretoria-based Regional HIV/AIDS Program (RHAP) at USAID/Southern Africa
and a Gaborone-based U.S. Personal Services Contractor (USPSC), the USAID Country Director. The overall PEPFAR
Coordinator will be hired as a USPSC by USAID and will report directly to the Deputy Chief of Mission. We are in the process of
recruiting for this position.
A key event in June 2008 that facilitated interagency teamwork was the co-location of PEPFAR CDC, DOD, USAID, State and
Coordinator's Office staff. The new facility is the former USAID/Botswana office complex owned by the Government of Botswana
(GOB)/Ministry of Health (MOH), which graciously offered its use to CDC. CDC occupies one building in the complex for its
administration and non-PEPFAR bilateral TB and HIV Prevention Research (HPR) programs. CDC manages a second building
for the interagency PEPFAR team and provides critical administrative and information technology support. Although the move
required significant staff time, the co-location of key PEPFAR staff in one building and the increased space available to staff have
been beneficial to teamwork and program management.
PEPFAR Botswana made significant progress during FY2008 in implementation of staffing for results (SFR). In February-March
2008, the interagency team undertook a management training and team building (MTTB) exercise that clarified interagency
management and Technical Working Group (TWG) structures and established a number of new structures and processes to
facilitate work. Most of these have yielded positive results and are summarized below.
Staffing Issues:
Botswana's SFR progress, however, must be considered in the context of severe and continuing staffing vacancies, particularly
affecting CDC and USAID programs. As of November 2008, at CDC (PEPFAR), all of the Locally Engaged Staff (LES) positions
remained vacant and only 3 of 6 United States (US) direct hire positions were filled. Most CDC technical program oversight is
carried out by COMFORCE contractors, who are committed and skilled, but lack the formal authority and training for key
management decisions and actions. At USAID, the PSC Country Director has been able to fill one of the four approved LES
positions (staffed through State Department). She has also received significant management support from the staff of RHAP and
the USAID Southern Africa Mission. Staff burn-out is becoming an increasing concern. Difficulties in computer assisted job
evaluation (CAJE) of highly technical positions, the tight Gaborone labor market, and relatively low USG salary levels do not bode
well for relief in the near future.
The GOB recently instituted a 40% salary increase for all "critical positions," including physicians and senior technical staff
working on the national AIDS response. This led to an almost immediate departure of two technicians from the CDC HPR
program, threatening pre-exposure prophylaxis Truvada trials. While this increase should foster sustainability of the GOB national
response, the HPR experience suggests that attracting qualified national staff for USG PEPFAR programs will be increasingly
difficult in FY2009 and beyond.
Functional Organizational Teams:
Botswana's Functional Organizational Chart and its April 2008 "SFR Roadmap" are included as an annex to this Country
Operational Plan (COP). The Botswana PEPFAR Interagency Team (IAT) was established in August 2004 during the
development of the PEPFAR Botswana Five-Year Strategy and has retained its critical leadership role since that time. The IAT
meets monthly under the leadership of the Deputy Chief of Mission, with the PEPFAR Coordinator serving as the Secretariat.
The MTTB process clarified the purpose of Botswana's "PEPFAR Info Group," which is to "share information relevant to the
PEPFAR Botswana program among professional personnel from all five agencies." The Info Group comprises a broad
representation of technical and management staff from all agencies and meets every other Tuesday for one hour. The
Information Group continues to serve as a useful forum to promote interagency coordination and collaboration.
The MTTB process reviewed PEPFAR Botswana's experience with TWGs and determined that formation of an explicit USG Core
TWG per key PEPFAR technical area was indicated. The USG Core TWGs are new (or more explicit) groups based on PEPFAR
program area budget codes that are intended to increase USG interagency collaboration and performance of some inherently
Governmental functions. The Core TWGs meet no less than quarterly, and more often for COP preparation.
Staff feedback indicates that Core TWGs are yielding positive results. The benefits are most notable for those program areas
previously managed by only one technical advisor: "Before I was so alone, now I can call on my colleagues at the Embassy and
DOD and get some help!" Several Core TWGs have undertaken joint field visits and, as noted below, undertook joint partner
performance reviews. The IAT recently decided to form a new USG Core TWG for male circumcision, which has taken the lead in
development of circumcision-related activities for this COP.
Peer Portfolio Review:
The USG PEPFAR team conducted interagency Peer Portfolio Reviews (PPRs) in June-July 2008. These were undertaken
through a two-tier process. First, using a standard template, all of the USG Core TWGs reviewed all activities funded under the
program area(s) for which they are responsible. In most cases, this involved presentations and consultation with each of the
implementing partners receiving funding in a given program area. In general, USG PEPFAR staff indicated a high degree of
satisfaction with the program area-level activity review process and outcomes. Feedback from partners, however, suggested that
they would prefer doing only one review covering several program areas, to avoid separate presentations with different TWGs on
different days. The USG team is taking this feedback and experience into account in planning for the next round of PPRs,
notionally in January-February 2009. The six-month portfolio review will be organized around the larger, more complex projects
being implemented by specific partner organizations.
In order to have an optimal number of professionals to assure the validity of conclusions and recommendations of the program
area-level reviews, PEPFAR Botswana also established USG Combined TWGs. The USG Combined TWGs comprise members
of selected Core TWGs for the purpose of the second-tier PPRs. The Combined TWG PPRs were less satisfactory. Concerns
are that too little time was given to consider the issues of the different program areas and/or issues were not resolved. Based on
this feedback, the USG team plans a two-to-three day all-team retreat for the next second-tier PPRs to assure adequate time for
discussion and resolution of issues.
Expanded TWGs:
The PEPFAR Botswana Five-Year Strategy (October 2004) established five TWGs that have served as a useful forum for
exchange by the USG, GOB, implementing partners and other stakeholders in Behavior Change Communications, Orphans &
Vulnerable Children, Counseling & Testing, Strategic Information and Capacity Building, and Care & Treatment. (For clarity,
PEPFAR Botswana will now call the existing joint GOB-USG TWGs "Extended TWGs" in USG documents.) They have been
maintained and/or reinvigorated to assure continued communication and collaboration with partners (funded and not-funded).
Several new "Extended TWGs" have been established during 2008 to provide for more focus on specific technical areas that have
not previously been covered in depth, notably for TB/HIV, PMTCT, and Laboratories. These - and the others - proved useful
during PPRs and provided important inputs into the COP2009 development process.
Instrument Management Teams:
Interagency program management is especially important in Botswana, given the high number of unfilled USG PEPFAR positions
and the fact that there is no USAID bilateral program. As mentioned above, this is progressing nicely on a technical basis, per
program area budget code. Following the MTTB exercise, the USG team began to establish cross-agency teams to manage
some of the larger and more complex instruments (contracts, cooperative agreements) that involve more than three program area
budget codes--a process that is progressing more slowly.
One of the outcomes of the MTTB was the realization that the different USG agencies do not share a common administrative
language, which has led to misunderstandings. For example, a USAID Cognizant Technical Officer and a CDC Project Officer
have different acquisition and assistance instrument management authorities, and CDC and USAID cooperative agreements are
often quite different in form and substance. Because of these administrative differences, and uneven understanding of different
authorities and responsibilities, cross-agency program management has had its ups and downs. The USG team is committed to
making it work, however, and will continue to pursue development of protocols and norms in the coming year.
Future Prospects and Issues:
While the SFR functional teams and processes are progressing well, the high number of unfilled positions continues to place
undue stress on existing staff. The highest priority in the HVMS program area is to find qualified staff to fill existing positions and
those that are turning over in late FY 2008-early 2009. Given the likelihood that Botswana's budget levels will level off for the FY
2009-2013 period, only one additional technical positions is sought at this time—a USAID Prevention Specialist who will manage
and provide technical support for the new, multi-year USAID prevention activities with local NGOs.
Table 3.3.19:
