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.PM02: URC - Health Care and Training
CONTINUING ACTIVITY UNDER A PERFORMANCE PASS:
ACTIVITY UNCHANGED FROM FY2008
From COP08:
Botswana's national PMTCT program has 100% geographic coverage, and midwives, nurses, and
counselors nationwide are trained in PMTCT. Training activities focus on new providers, evolution in
program guidelines, and solving of existing problems and weaknesses.
In 2008 the Francois Xavier Bayroud (FXB) Center from the University of Dentistry and medicine of New
Jersey (UMDNJ) will provide assistance to the PMTCT unit with curriculum development and maintenance
and training of staff. The FXB Center will evaluate the use and usefulness of existing training materials,
create new training materials and clinician support tools where needed, and revise generic international
training tools to meet local needs. In 2008, this may include adaptation of the new WHO infant and young
child feeding course, revision of existing PMTCT training manuals to incorporate new guidelines, and
increase emphasis on follow-up of mothers and infants.
The FXB center will also help maintain the currency of knowledge and skills among PMTCT staff by
conducting two trainings for national program staff on new developments in the field of PMTCT or areas in
which staff feel they had inadequate training. Three PMTCT training of trainers (TOT) sessions will also be
held on new PMTCT guidelines.
Finally, the FXB center will facilitate linkages between the PMTCT Unit and other relevant PMTCT
departments such as the Food and Nutrition Unit and the Sexual and Reproductive Health Unit on PMTCT-
related activities such as infant feeding and family planning for HIV-positive women. The FXB Center will
plan and implement two coordination workshops for MOH departments on PMTCT-related planning, training
and program management.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17290
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17290 4469.08 HHS/Centers for University of 8745 8745.08 UTAP $500,000
Disease Control & Medicine and
Prevention Dentistry, New
Jersey - Francois-
Xavier Bagnoud
Center
9819 4469.07 HHS/Centers for University of 5284 1047.07 UTAP $300,000
4469 4469.06 HHS/Centers for University of 3359 1047.06 UTAP $480,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $475,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
09.P.AB18: URC - Prevention Impact Assessment
The CDC/BOTUSA Prevention team has identified Makgabaneng (MKG), as a program which has been
running for five years and undertaking reinforcement activities, community-based activities that reinforce
messages from the radio drama. URC will work with MKG to conduct an outcome evaluation and followed
by an impact evaluation at a later stage. URC will review tools used to reinforce behave change messages
and develop a video that on Intergenerational sex, this video will be used in schools and during listening
and discussion groups. We see a need to continue the support for MKG with lessons learned as it is a mass
media program and has a component of community out reach. The other implementing partner, URC will
also work with Population Services International (PSI) whose interventions addresses Multiple Concurrent
Partnership, an impact evaluation will be done URC will work with PSI to conduct process evaluation as part
of the review.
We look to URC to develop a proposal for completing the following tasks, which themselves are open to
discussion at this point:
1. Contract local consultants or an agency with health research background to work alongside URC in
carrying out the reviews, including working with a technical advisory committee.
a. Identify through tendering advertisements and work with technical assistance (TA) for cross checking.
b. Mentor agency and individuals, as appropriate to skill and experience levels.
c. Craft a clear scope of work for the sharing of responsibilities.
2. Develop a general protocol for each partner review, including tools that will improve the program and the
reinforcement activities, such as a video addressing intergenerational sex or flip charts to help the Listening
and Discussions Groups, as tools to support the Reinforcement activities.
3. Document review, interviews with beneficiaries, including the Ministry of Health (MOH) stakeholders and
staff.
4. Tailor the general protocol to each organization in the review accordingly with input from the
organizations, namely MKG, PSI and CDC.
5. Carry out all the reviews over the six months, if possible. They can be done in a staggered manner,
depending on availability of staff to work simultaneously
6. Produce a readable, accessible final report for each partner organization, describing findings and specific
recommendations for future steps both short and long term.
7. Participate in meetings to disseminate the results to the organizations and to CDC.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
09.P.OP19: URC - Alcohol Activity
Alcohol is a mood altering drug and it can influence high-risk sexual behaviors, which can lead to HIV
infection. Alcohol substance abuse can impair a person‘s judgment and may lead to behavior that is often
contrary to socially learned behavior, for example, uninhibited high-risk activities, such as unsafe sexual
practices. It induces changes in thinking, judgment, and behavior. Alcohol abuse has caused many traffic
accidents, incidents of violent behavior, and rape. For HIV-infected persons, it is thought to depress the
CD4 count and facilitate HIV replication.
Surveys have been done in Botswana that describe the drinking patterns here and data from a 2006
population-based study show that 31% of men and 17% of women met criteria for heavy drinking behaviors.
Many other African studies have looked at the association between alcohol use and HIV and 20 of them,
including one study from Botswana, which concluded that alcohol use was associated with HIV infection in
Africa and alcohol-related interventions might help reduce further expansion of the epidemic.
Another study conducted in Botswana suggested that those patients who drank alcohol during treatment
were 3.8 times more likely to interrupt treatment than those who did not drink. All of these conclusions are
troubling and speak to the need for a comprehensive response to alcohol use and its risks.
Proposed Strategy:
1. Support structural interventions to reduce hazardous drinking.
a. Assist the Government of Botswana (GOB) to develop a draft National Alcohol Policy, which should be
based on the World Health Organization's (WHO) Best Evidence Policies. The process should be facilitated
by a reputable consultant who is conversant with alcohol and its implications for public health and
development.
b. Review current enforcement of Liquor Act (2004), identify gaps, and make recommendations to
strengthen those areas.
c. Conduct qualitative study to assist in developing behavior change interventions for the different age
groups.
d. Collect data from Botswana Epidemiology Network on Drug Use (BENDU) and SENDU on the
epidemiology of alcohol use.
2. Support networks of organizations working in alcohol risk reduction:
a. Expand and support existing interventions within the GOB and civil society, e.g., Botswana Network on
Ethics, Law, and HIV/AIDS (BONELA), Botswana Congress of Non-Governmental Organizations
(BOCONGO), faith- based organizations (FBO), and community coalitions and infuse messages of alcohol
risk reduction into existing programs.
b. Develop appropriate interventions that target the youth, aged 13-24 years, including vulnerable youths
and their guidance
3. Train Health Care Workers and all relevant professionals and organizations on issues alcohol as a drug,
alcohol as a risk factor for HIV transmission, and prevention and management of HIV in the context of
alcohol use and abuse:
a. Introduce Screening and Brief Interventions (SBI) or Brief Motivational Intervention (BMI) in primary
health care facilities, for example, Voluntary Counseling and Testing (VCT) centers, and Sexually
Transmitted Infections (STI), Anti-retroviral Therapy (ART, and Infectious Disease Care Clinic (IDCC)
clinics, and among support groups to identify high risk drinkers better. Train current counselors and peer
educators on links between alcohol abuse and HIV/AIDS.
b. Integrate alcohol screening at all points of entry to the health care system, e.g., clinical notes, emergency
visits, and antenatal care (
c. Look for incidence and prevalence of Fetal Alcohol Syndrome (FAS).
d. Document concomitant use of alcohol for all police cases and accidents/injuries in the workplace.
e. Create alcohol referrals and collaborate with all counseling facilities.
f. Support AA recovery programs which are free and have demonstrated success. Develop referrals, attend
their meetings to see how they work, and invite speakers.
g. Create, outside of AA, appropriate 12 Step Programs and train leaders. These groups can operate from
the clinical areas and local meeting places, for example.
h. Develop interventions for drinking venues, i.e., bars or shebeens, with the collaboration of the staff
servers, owners and the alcohol industry, including education and awareness programs, warning posters
and labels, condom negotiation, and other life skills.
i. Support and sponsor the SAHIV clinicians and the Botswana Medical Association to hold continuing
medical education (CME) courses to empower their members with the confidence and skills to consult on
alcohol.
4. Universal alcohol and HIV messages to raise awareness:
a. Develop interventions for drinking venues, i.e., bars or shebeens, with the collaboration of the staff
b. In primary schools, begin to educate and empower children in life skills and emotional intelligence, for
example, managing emotions, like anger, fear, and loss and taking responsibility for one's feelings and
consequent behavior). Teach about alcohol in drama and on the radio.
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $1,745,593
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.
Blood Safety
The National Blood Transfusion Services (NBTS) is responsible for the provision of a safe, adequate and accessible supply of
blood and blood products in Botswana. According to the World Health Organization (WHO) recommendations, a country such as
Botswana with a population of 1.7 million, requires a total 34,000 usable units of blood per year to be self-sufficient.
The President's Emergency Program for AIDS Relief (PEPFAR) Blood Safety project was implemented in September 2004,
covering seven key areas which ensure a safe and adequate blood supply and include infrastructure, blood collection, testing,
blood utilization, training, monitoring and evaluation, and sustainability. The Safe Blood for Africa Foundation (SBFA) provides
technical assistance to the NBTS of Botswana and the African Comprehensive HIV/AIDS Partnership (ACHAP) has contributed to
the Blood Safety Program by funding the Blood Safety and Youth HIV Prevention Project in 2003 and 2004, which it will continue
to support along with the additionally important Pledge 25 strategy. Supply Chain Management Systems (SCMS) procures test
kits, reagents and supplies for overall blood safety. SBFA, ACHAP and SCMS will continue to work with PEPFAR funding on
blood safety issues in FY2009.
Since the inception of the PEPFAR Blood safety project the NBTS has undergone significant transformation and implemented a
number of projects successfully, including:
- An increase in the annual blood collections from 13,210 units in 2004 to 22,230 units in 2007.
- A decrease in donations reactive for transfusion transmissible infections (TTIs) from 9.9% in 2004 to 4.4% in 2007.
- A decreasing in the HIV prevalence in donated blood from 5.7% in 2004 to 2.1% in 2007.
- The acquisition of equipment for all of the thirty (30) outlets which undertake blood transfusion activities.
- The revision of the draft of the Blood Policy.
- The training of 623 blood transfusion staff in different aspects of blood transfusion, specifically laboratory staff, nurses and
doctors, blood donor recruiters and other healthcare workers.
- The development of information, education and communication (IEC) materials on blood donation and related topics,
- The renovation of National Blood Transfusion center, which was completed in June 2008, and started operations in July, 2008.
The center houses both the blood collection center and the laboratories.
- The introduction of Hospital Transfusion Committees in 28 hospitals with 16 hospitals now having functional committees which
have formed the National Committee on Clinical Use of Blood and Blood Products.
In FY2009, PEPFAR will continue to support the seven focus areas with activities that include increasing the blood collection from
28,000 to 30,000, increasing the pool of regular blood donors and improving donor retention, reducing HIV prevalence in donated
blood from 1.6% to 1%, training 200 NBTS staff and other health providers, completing construction of the Regional Blood Center
in Francistown and a blood depot in Maun, continuing to pay salaries of 21 project staff, implementing the revised blood policy and
usage guidelines, improving quality management systems at NBTC and monitoring the implementation of the revised TTI testing
strategy. Monitoring and evaluation will continue to be an integral part of the blood safety project and the Botswana government
will implement a process that will allow sustainability.
Injection Safety
The exceedingly high prevalence of HIV in Botswana calls for a comprehensive prevention strategy that takes into account
medical transmission, despite the relatively small proportion of HIV infections resulting from this type of transmission.
Prior to the implementation of the injection safety project, there was no policy articulating clear safety procedures in the healthcare
settings. Rapid assessments conducted in 2004, found that none of healthcare workers had received any in-service training in
injection safety. The national annual prevalence of needle-stick injuries among healthcare workers was 26%, a potential risk for
occupational infections such as HIV, hepatitis B and C. A rapid assessment indicated that 23% of injections administered in the
facilities were unnecessary, used sharps were disposed of inappropriately in the majority of facilities and waste was poorly
segregated at the source. In most facilities, there were no logistic management information system tools to manage the injection
commodities or the drugs and no educational or behavior change messages communicating the importance of infection
prevention and injection safety.
With PEPFAR funding, Botswana started implementing injection safety interventions to promote the safety of healthcare workers,
patients, and the community in 2004. The project has been implemented through a collaborative approach with Ministry of Health
(MOH), implementing partners that include John Snow, Incorporated, and sub-contractors Academy for Educational Development
(AED) and Program for Appropriate Technology (PATH). The National Injection Safety Advisory Group (NISAG), a consortium of
medical, nursing and public health professionals that advise and guide the implementation of the project, has been actively
involved since its inception in November 2004. Currently, the injection safety is working in four health districts and with the
Botswana Defense Force Health Corps (BDF Health Corps). It is expected to scale up the interventions in ten additional districts
by September 2009.
To date, the Botswana Injection Safety Program has achieved the following:
- The development of a policy on injection safety with guidelines, service norms and standards that was submitted to Ministry of
Health for approval.
- Capacity building, training and support for infection prevention and injection safety, specifically, 4,723 healthcare workers
engaged in in-service and pre-service training in injection safety as of August 29, 2008 and 450 diabetic patients were trained to
manage used syringes and needles at home safely.
- Procurement, distribution and management of injection devices, including the successful completion of a study evaluating the
contribution of retractable syringes for reducing needle-stick injuries among healthcare workers. Botswana's primary task was to
ensure adequate and continuous availability of retractable syringes in the pilot districts. There will be adequate retractable
syringes in the pipeline for FY 2009, during which time the districts will have the commodities while MOH decides to scale-up its
use or terminate it.
- Implementation of sustained healthcare waste management, such that segregation of waste at the source has improved and
injuries sustained by waste handlers have been dramatically cut, according to the supervisory monitoring (February 2007).
Additionally, incinerator breakdowns have been minimized and protective clothing provided to workers in selected risk areas,
especially in hospitals.
- Development of an injection safety advocacy toolkit and behavior change messages, which have reached approximately
260,000 community members with injection safety messages through drama, brochures, posters and other media
communications, as of June 30, 2007. In preparation for scaling-up injection safety interventions, a multi-year advocacy and a
Behavior Change Communication (BCC) strategy has been developed.
- Promotion of healthcare worker safety through the national policy, guidelines and service norms and standards for injections
safety, which articulate measures that promote and advocate for institutional administrative procedures and improved healthcare
worker safety.
Linkages
The Injection Safety Program in Botswana works closely with Supply Chain Management Systems (SCMS), Safe Blood for Africa,
the National Blood Transfusion Services in the Ministry of Health, the Nurses Association of Botswana, several academic
institutions, notably the University of Botswana and the Institute of Health Sciences, other government ministries, including the
Ministry of Local Government (MLG) and the Ministry of Environment, Wildlife and Tourism (MEWT) and the World health
Organization (WHO).
Plans
In FY2009, the Government of Botswana (GOB) will scale-up the injection safety interventions to reach 54% national coverage by
September 2009. In the districts into which it expands, the project plans to train 1,070 healthcare workers, disseminate and
implement the national policy, guidelines and service norms and standards, replicate good practices for the sustained
management of healthcare waste, manage injection device supply, and produce behavior change communication messages.
Male Circumcision
Three recent rigorously conducted clinical studies done in South Africa, Kenya and Uganda suggest that male circumcision (MC)
can reduce HIV infection by up to 60%. These and other studies have led WHO, UNAIDS, PEPFAR and others to encourage
greater access to MC in countries of Africa where the current rates of MC are low and HIV infection rates high, Botswana being
one of these countries. Although traditionally MC was a part of some of the local cultural groups' practices, with the coming of the
missionaries and the British Protectorate in the 19th century, access to MC was greatly reduced. It is estimated that now less than
20% of males in Botswana are circumcised. A recent study by local and international researchers suggests, however, that the
potential to expand MC access rapidly would be favorably received by the population, if services were provided in a medical
setting.
In November 2007, then-President Mogae, in the face of increasing evidence of the potentially important role for MC in HIV
prevention, supported the idea that this intervention be part of Botswana's new Prevention strategy. The MOH, with the assistance
of WHO and UNAIDS, developed a Safe Male Circumcision Strategy which aims at reaching 80% of the male population in the
next five years at a cost of around US$25,000,000.
PEPFAR support for MC to date has included support for a MOH/JHPIEGO MC needs assessment in FY2006; support to the
Botswana Harvard Project for studying approaches to infant circumcision in FY2008; funding to the BDF for a conference on MC
and other prevention approaches for the militaries in all African PEPFAR countries to be held early in FY2009; funding to
Populations Service International (PSI) for an MC communications strategy and program; and funding to the MOH through the
CDC Cooperative Agreement for MC training and services. Also, a Public Health Evaluation (PHE) focused on adult MC has been
developed and approval is pending. Additionally, the Botswana PEPFAR program will be requesting US$ 2.6 million in FY2009 to
continue many of the above mentioned activities, including the recruitment of a staff member to manage the growing PEPFAR
Botswana MC portfolio.
Table 3.3.04:
09.C.AC12: URC - Nurses Association of Botswana, Caring for the Caregivers Program
The Nurses Association of Botswana (NAB) aims to continue to intensify its Caring for the Caregivers
activities through the employment of a dedicated project officer. The project officer will be responsible for
the following activities:
1. The continued roll out of the support groups' establishment and training to cover all health facilities in the
country in close cooperation with the relevant stakeholders in the Ministry of Health (MOH).
2. The monitoring and evaluation of the support groups' activities.
3. The determination the extent and impact of previous Nurses Association of Botswana (NAB) -Caring for
the Caregivers (CFC) activities, such as the publication of the various manuals and workshops.
4. The implementation of a research project on the impact of HIV/AIDS on the nursing profession.
5. The continuation of the current CFC projects, as well as the development and initiation of further CFC
activities, for example, the establishment of a pilot wellness center.
The purpose of the support groups for health workers is to provide and receive emotional, spiritual, social
and practical support from each other in health and professional related issues with emphasis on, though
not limited to, HIV/AIDS. Nurses and other health workers will be trained in how to organize and run support
groups, after which they will be assisted to establish support groups at their facilities and in their health
regions. The project will be implemented in close cooperation with the Wellness Program in the MOH. The
aim is for all health facilities to have sustainable support groups up and running, using guidelines and
training materials that have already been developed.
It is important to understand the extent and impact of previous CFC activities in terms of whether or not all
nurses have been reached, how nurses have directly benefited from these activities, and what other
activities nurses would like to see in place. This would go hand in hand with a research project, which aims
to determine the impact of the HIV/AIDS epidemic on the professional lives of nurses. An initial research
proposal has been drafted to this effect.
The Nurses Association of Botswana (NAB) aims to establish a Wellness Center of Excellence for Health
Workers. The purpose of such centers is to attend to the health and well being of health workers, to provide
professional development, and to establish a forum to address health issues and other concerns of the
health workers. It will deliver health and other professional services to all health workers and will serve as a
model of good practice. Through the provision of comprehensive, confidential health services to the health
workers outside of their workplace, the Nurses Association of Botswana (NAB) intends to sustain a healthy,
motivated and productive health work force. Services at the center would include testing, counseling and
treatment for HIV/AIDS and TB, antenatal services, PMTCT, stress management, Post-exposure
Prophylaxis (PEP), and screening, among other things. The center would also be a resource/ knowledge
center for continuous professional development. As has been suggested by research, nurses and other
health workers in Botswana are affected by HIV and AIDS at the same devastating rate as the general
population, but have the additional burden of care and treatment of the sick often in difficult working
conditions. The Wellness Center aims to address the issues of the health workers, who are increasingly
over-stressed, under-valued and often at risk for infection.
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $280,000
Table 3.3.08:
09.C.PC04: URC - Psychosocial & Home Visit Support to OVC
Catholic Relief Services (CRS) is implementing a multi-country PEPFAR Track 1 Orphan and Vulnerable
Children (OVC) program in Botswana in partnership with the Vicariate of Francistown (VoF).
The CRS-VoF project aims to provide as complete and holistic a package of OVC care and support services
as possible, by integrating activities and interventions across the PEPFAR domains of palliative care. This
project will directly provide Psychological Care in the form of psychosocial support (PSS) to OVCs and
guardians, Spiritual Care as part of home visits by trained community volunteers augmented by pastoral
visits, Social Care comprising several forms of prevention activities including OVC peer support groups
(PSGs) and broad based community sensitization, as well as assuring links to Government of Botswana
(GOB)-provided social services, food and education resources. Facilitating pre-school attendance is a
cornerstone of this project and will go a long way to reducing stigma against OVCs by integrating the
community's children in such a setting, while also serving as an entry point for PSS. The project will
indirectly provide Clinical Care by linking to the local health center in each project site for non-HIV health
care and its home based care (HBC) outreach service for HIV-related care and support.
Home visits lie at the heart of Palliative care programming. Regular home visits allow the project to provide
quality, holistic support to the OVC household and may include, for example, screening for health care
needs and appropriate clinical referrals, PSS, nutrition education or counseling. Depending on the
household situation, more extensive support may be needed for succession planning, will writing, and
understanding bereavement processes, which will augment guardian training. OVC home visits require the
identification and recruitment of respected, committed adult volunteers.
Given Botswana's extremely high HIV prevalence rate, and the GOB's commitment to provide anti-retroviral
therapy (ART) to its citizens, adherence to ART is an important issue, especially in the more distant areas.
Home visits are an ideal mechanism for identifying gaps in adherence support among people living with HIV
and AIDS (PLWHA). Especially where Home Based Care (HBC) for PLWHA is located in the same areas
with this OVC project, the OVC home visit volunteers can assure child and/or guardian referrals to HBC
providers and the clinics with which they are associated to assure adherence support.
Other emphasis areas will be HIV Prevention activities and nutrition education. The project will link to local
health centers and other reputable providers for voluntary counseling and testing (VCT) services, targeting
Tebelopele or local VCT providers. The project maintains monthly progress reports on all children attending
pre-school. This strategy provides an extra set of caring eyes for detecting any deterioration in nutritional
status. Since the Social and Community Development (S&CD) monthly food basket isn't available to all
OVC households who need it, its contents are not necessarily the highest nutritional quality, and rations are
pegged only to the registered OVC and not the entire household, the potential exists for poor nutritional
status among the three to seven year olds. The project will train the community volunteer caregivers to
provide nutrition education to the OVC households they visit, as well as to identify visually nutritional
problems present in the household. The project will utilize trainers from S&CD and district level nutritionists,
including the Nutrition Rehabilitation Project at Nyangabgwe Hospital in Francistown. The OVC project staff
will also facilitate referral links between communities, local hospitals and the Nutrition Rehabilitation facility
in Nyangabgwe Hospital.
The northern districts of Botswana vary as to risk levels for malaria. While the S&CD provides insecticide
treated bed nets (ITN) to registered OVC, a significant gap exists in terms of OVC registration. The project
will provide ITNs to its enrolled OVC households who cannot yet access them from S&CD.
The project will put great emphasis on setting up sustainable structures, such as Parish OVC Leadership
Committees and Community OVC Committees. Each parish in the project area will convene a committee
comprised of, for example, the parish priest, the local Chief, representatives from various churches, the
police, the Village Development Committee (VDC), the local clinic, Positive Living Groups, women's groups,
S&CD, and school headmasters. This Parish Committee might meet quarterly to determine its own
involvement in the oversight of the OVC project activities and outcomes. Such a committee will follow in the
project's founding principle of community participation, but would also build more structure into the OVC
project, which will assist in building sustainability. The Parish Committee will also serve as a model of
program integration, since it will comprise a cross-section of the community, including both civil society and
government representatives. Also, a Community OVC Committee will be formed in each ward in the project
area, which will serve as the unit of project intervention. This committee should include local leaders who
can be galvanizing forces in the support of OVC in their midst and assist with open and transparent
identification of those OVC most in need. Appropriate training will be provided, especially at the community
level, on group or organizational management to best insure low-stress committee participation and the
most effective building of community ownership of OVC care and support. The relationship between the
trained volunteer caregivers, the Community Committees, the Parish Committees and the project site staff
will need to be developed during FY2009. Ideally, the two levels of committees will determine their Terms
of Reference with project site staff.
While community awareness and sensitization efforts are well used strategies already in the project, there
will be a scaling up of such activities in FY2009, with a multi-sectoral emphasis.
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $100,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000
Estimated amount of funding that is planned for Education $30,000
Table 3.3.10:
09.C.TB17: URC - Strengthening Management of MDR TB and Cross Border Control
Supporting Multi-Drug Resistant (MDR)/Extensively Drug Resistant (XDR) and Infection Control at the
District and Facility Levels:
University Research Corporation, LLC (URC) is working with the Centers for Disease Control and
Prevention (CDC) to improve the quality of HIV/AIDS services in Botswana under a recently awarded grant.
URC has gained substantial expertise in the Southern African countries in strategies to improve TB,
including MDR/XDR prevention and control activities. Based on the lessons learned in the region, URC is
proposing to work closely with the Botswana National TB Program (BNTP) to strengthen MDR/XDR
prevention and control activities at the district and facility levels. URC proposes to cover three districts with
implementation of TB, TB/HIV and MDR/XDR initiatives. URC staff will help facilities identify programmatic
gaps for TB prevention and control and develop effective strategies for overcoming the same.
Strengthening national and district level response for preventing and controlling MDR/XDR TB:
URC will work with BNTP to strengthen the capacity at national and district levels to manage prevention and
control of MDR and XDR TB. Assistance will be provided to the BNTP to ensure proper training of staff to
diagnose and treat MDR TB appropriately, help the facilities to control primary transmission of MDR/XDR,
and implement initiatives to reduce development of resistance among TB patients treated with first and
second line drugs. Key activities will include the dissemination and implementation of MDR TB monitoring
tools by training healthcare workers and information officers on the use of the tools and by training medical
officers and nurses on clinical management of MDR TB.
Enhancing Implementation of Infection Control Policies and Guidelines:
Facilities will be assisted to conduct infection control risk assessments and to develop and implement
infection control plans. Technical assistance will be provided to districts and facilities in implementing TB
infection control strategies.
Strengthening Surveillance of MDR/XDR-TB:
URC will work with BNTP and local partners to improve and expand the surveillance of MDR/XDR-TB.
Assistance will be provided to design a simple framework to collect and analyze data on MDR/XDR patients
in each district. In addition, mechanisms will be developed and implemented for contact tracing of MDR
patients to minimize risk of nosocomial transmission.
Addressing cross-border issues related to the management of Drug Resistant TB:
URC will work with the BNTP and other PEPFAR funded partners to strengthen referral systems to
minimize spread of MDR TB to neighboring countries and to ensure continuous access to treatment and
laboratory services for migrant workers returning home after the diagnosis of MDR TB. Referral forms will
be developed.
Supporting Advocacy, Social Mobilization and Communication for MDR/XDR TB:
URC will help BNTP to increase awareness about MDR-TB through public education and social
mobilization.
* TB
Estimated amount of funding that is planned for Human Capacity Development $245,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $7,269,814
HIV/AIDS continues to debilitate many communities and families in Botswana. According to the Botswana National Situational
Analysis (NSA), the country is home to more than 130,000 orphans and vulnerable children (OVC). According to the UNAIDS, the
numbers of orphans will continue to rise even as rates of new infections level off and mortality rates will not plateau until 2020,
because of the unusually long incubation period of HIV, and as a result, the numbers of orphans will continue to increase for
several decades. UNICEF estimates that sub-Saharan Africa, especially Botswana, Malawi, Zambia and Zimbabwe will have the
highest proportions of orphans during this period. PEPFAR support serves this marginalized social group - children orphaned or
made vulnerable by HIV/AIDS - and bolsters their access to services, respect for their rights, identity and inheritance, tolerance
and inclusion, and education and health care.
The 2007 NSA, using the definition that an orphan is a child below 18 years who has lost one parent, when single, or both, if
married, either biological or adoptive, reported a prevalence rate of 6.5% or 51,806 children, and 3.1% of children had lost both
parents. The international definition, according to UNAIDS, states that an orphan is ‘a child below the age of 18 who has lost one
or both parents,' and using this, the prevalence of orphans is 17.2% (137,805. The 2001 Population and Housing Census Report
in Botswana indicated that there were 111, 828 orphans which included maternal, paternal and double orphans, similar to the
UNAIDS definition, out of a population of 737, 241 children or about 15%, which is slightly lower than the USAIDS rate, suggesting
that the number of OVC may be increasing. Children in Botswana are orphaned for the following reasons: 34% due to AIDS, 35%
due to chronic diseases, 25% due to accidents, and about 7% due to death of the mother during child birth.
The GOB provides care and support to orphans through the Short Term Plan of Action (STPA), launched in 1999 by the
Department of Social Services (DSS) under the Ministry of Local Government (MLG). The STPA serves as the normative
framework for responding to the immediate needs of orphans and has reached virtually all eligible registered orphans (50,000)
with key emergency services, a commendable accomplishment. It highlights the political will, leadership and management, and
financial commitment Botswana has made towards addressing the impact of HIV/AIDS on children.
Through the President's Emergency Program for AIDS Relief (PEPFAR) support both the GOB and the Civil Society
Organizations (CSO) have extended the scope of their combined efforts to address HIV and AIDS far beyond what either one
could have achieved individually. Collectively, they have leveraged their strengths to implement and deliver services more
effectively to OVC. Services that include: providing and ensuring OVC access to psychological and/or emotional care counseling,
education, including vocational skills training, nutritional support, succession planning; giving access to legal aid, including
protection from all forms of abuse including child labor and property grabbing; and assisting with access to health care, treatment
for HIV/AIDS-infected OVC, and shelter and related family care.
Major program accomplishments for FY2007 and FY2008 include the completion of the NSA, development of National OVC
Guidelines, Psycho-Social Support (PSS) National Training Manual, National Monitoring and Evaluation (M&E) Framework for
OVC, creation of linkages among OVC partners and government, and increasing the number of OVC benefiting from United
States Government (USG) support. In FY2009, it is expected that at least 30,000 OVC will be reached directly with services
through a mix of strategies, such as supporting activities within a geographic focus to attain higher coverage, investing in priority
sectors like social services, education and health, and making grants available to non-governmental organizations (NGO),
community-based organizations (CBO), and faith-based organizations (FBO).
The PEPFAR-supported partners and activities complement the GOB's efforts and strategies in implementing a truly
comprehensive national response to the HIV/AIDS epidemic by extending services to OVC who are almost always overlooked as
a result of programs attempting to cater for the more visible face of the disease - the adults living with HIV/AIDS. Additionally,
PEPFAR activities address gaps in OVC programming identified by the GOB and the 2007 NSA, which include PSS, improving
livelihoods, pre-school education, birth registration, and support and care in marginalized communities.
In FY2007 and FY2008, about 25,000 caregivers were trained to care for OVC on issues of PSS, child protection, and health care,
including anti-retroviral therapy (ART) adherence for infected OVC. In FY2009, 8,160 caregivers will be trained, a reduced
number due to the large pool of caregivers already trained. Follow-up activities will be initiated to assess the changes in OVC
services as a result of the trainings
Since 2005, the Marang Child Care Network has worked closely with DSS on policy issues as well as expanding its partner base
to 60 CBOs/NGOs/FBOs reaching over 10,000 OVC indirectly. Marang's work has gained recognition from the GOB such that
they have signed a Memorandum of Understanding with the network. One notable achievement is how Marang has managed
leverage PEPFAR resources to receive funds from the GOB. In a bid to expand the reach and strengthen the quality of service
provided by Marang, 24 member organizations will be assessed and given grants to provide comprehensive services to OVC at
the village level. The members will be selected on the basis of their geographical spread, program capacity and diversity to
include those working with OVC with special needs or disabilities
Despite the achievements made thus far, there still exists great potential capacity in communities to respond to the needs and
challenges of OVC. The major and most immediate challenge is scaling up successful community-based responses to match the
magnitude and extent of the HIV/AIDS epidemic. In that regard, capacity building efforts will be supported not as an end in
themselves, but as means to an end, the strategy being two-fold: capacity building on the one hand and service delivery on the
other
In FY2009, the USG support will continue to strengthen and scale-up the FY2007 and FY2008 activities by facilitating expansion
of OVC services and organizations working locally to address HIV/AIDS-related challenges, providing financial, material and
technical resources to organizations serving OVC, enabling them to better coordinate efforts and provide additional services, and
supporting the sharing of effective practices among stakeholders at all levels. They will build capacity, not as an end, but as a
means to improved service provision by investing in human resource development in technical and management support,
program design and implementation, mentoring and apprenticeships, logistical and equipment, and monitoring and evaluation.
Additionally, gender issues will be mainstreamed to ensure equal opportunities and access to basic services to reduce the
persistent and increasing burden of orphan hood and vulnerability in both boys and girls, and the discrimination against and
violation of the rights of the girl child.
Targeted interventions by the implementing partners resulting from the 2007 NSA, will increase access to birth registration,
education, adequate food, basic health services (including HIV services if appropriate), nutrition, PSS, succession planning, and
legal assistance. These interventions aim to improve income in affected households, build advocacy around inclusion and stigma
reduction, and catalyze public-private partnerships, which ultimately will be critical to expanding the resources available to
sustaining provision of the above services. Caregivers and guardians will benefit from training on the care of OVC. Parents and
Guardians, in particular those infected with HIV/AIDS, will be supported in writing wills and developing memory books.
In FY2009, the Ministry of Health (MOH) and the Ministry of Education (MOE) will each continue their particular roles in the
addressing OVC issues, including training caregivers and CSOs in the care of infected children, malnourished children, and other
childhood illnesses related to HIV/AIDS and ensuring access to education, specifically scaling up the Circles of Support program
to enroll and retain OVC in schools and train teachers in PSS.
In FY2009, DSS will implement the Community Carers Model (CCM) and Family Care Model (FCM) to assist families who have
little or no means of supporting the OVC and to ensure that all members of families with OVC are empowered and have their
needs addressed, respectively. Currently, the government provides basic needs to OVC; however, not all of the services reach
the intended children and families, especially the food basket support. In an effort to address this issue, the CCM, DSS and S&CD
at district level will identify community carers, through the existing community structures who will monitor the service delivery to
identified families to ensure that OVC receive quality care and support. The FCM will be used to ensure that the Marang Child
Care network, through its members, will assist DSS in monitoring the project and documenting the processes for continued project
improvement, so that the successes and lessons learned will be refined in preparation for replication and mainstreaming into
DSS's mandate.
The M&E Framework for OVC will be used to monitor and evaluate OVC programs and will include regular and systematic
assessments, structured quarterly meetings with partners, site monitoring, and semi-annual internal program reviews. The
Botswana ‘core indicators' on OVC have linkages with others being used by UNAIDS to assess global HIV/AIDS care and
prevention goals for 2005 and 2010. In FY2008, relevant stakeholders were trained on the M&E Framework and the application
indicators at different levels. DSS updated the OVC data base to capture the key national and program level indicators, including
the number of orphans, vulnerable children, children in need of care and support, and children registered and benefiting from
services. The update of the database has enabled DSS to capture, not only government data, but also data from the partners and
other stakeholders providing services to children. Facilitative supervision will continue to be provided in FY2009.
Efficient and timely transfer of lessons learned and best practices between programs will strengthen national strategies and
interventions in scaling-up of OVC programming by the GOB, CSOs, donors, and the private sector. To this end, an OVC National
Forum will be held with all relevant stakeholders in order to share best practices and lessons learned in OVC programming and
promote evidence-based programming.
Botswana has shown substantial commitment to the prevention of HIV infection and the mitigation of the impact of HIV/AIDS. DSS
collaborates with key stakeholders including the USG, Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), and
UNICEF. DSS with other local partners intends to ensure that policies and guidelines related to HIV/AIDS and OVC provide an
environment in which OVC needs are appropriately addressed. USG will support the strengthening of OVC coordination structures
both at the national, district and village level to ensure that OVC services are well organized and avoid duplication of efforts. In
addition to the coordination roles, these structures ensure that OVC continue to receive services in a timely manner and assist in
identifying OVC who require care and support. The activities supported by PEPFAR funds will continue to build capacities of
communities to maintain and sustain the interventions following the expiration of this grant
Referrals and Linkages were initiated in FY2007 and FY2008 with prevention, palliative care, treatment, and counseling and
testing and will be strengthened in FY2009. Some of the OVC activities have components of palliative child care, adherence to
treatment, counseling and testing and prevention for older OVC. Linkages with the PMTCT program will ensure that children
whose mothers are enrolled have access to basic essential services. NGOs/CBOs/FBOs will create linkages with local clinics to
ensure that families with infants who are diagnosed positive continue to access treatment.
Table 3.3.13:
09.C.CT05: URC - Child and Adolescent Counseling and Testing
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In four districts, there will be a roll out of training for providers of voluntary counseling and testing (VCT)
services in the use of protocols for child and adolescent counseling.
Additionally, the capacity of facility and district staff to collect, analyze and use VCT data to plan and
allocate resources for child and adolescent counseling and testing services, including linkages to care and
pediatric treatment, will be strengthened.
In Botswana, counseling and testing for children and adolescents remains an area of critical gaps in legal,
policy and program issues. The legal age of consent for testing in Botswana remains at 21, although major
efforts are underway to reduce the age to 16. Policy and guidelines for C&T of children are unclear, if not
unavailable. There are no C&T protocols to guide service delivery to children and adolescents. In addition,
counselors lack the skills and the confidence to provide services to this group. A number of children are
infected, but their status is not known, yet they would benefit from pediatric treatment and other services to
improve their quality of life. Some children are on HIV treatment, without knowing their HIV status. This has
posed challenges in relation to adherence.
In 2007, the MOH is working to develop policy and guidelines for counseling and testing of children and
adolescents, as part of the process to review and update C&T guidelines in general. A review workshop is
scheduled to take place in September 2007. Technical assistance from WHO/AFRO region has been
obtained for this activity.
2008 plans
Funds will support technical expertise for the MOH and key partners in developing an HIV/AIDS counseling
protocol for children and adolescents. The contractor will be required to form a working group comprising of
key stakeholders in the development of protocols. These stakeholders will include MLG - OVC program,
MOH, Botswana-Baylor Children's Clinical Center of Excellence, UNICEF, and representatives of civil
society organizations.
The process will include the review of current practices and relevant policy and guidelines in counseling and
testing of children and adolescents. The review will also include existing guidance and protocols from
UNICEF, WHO, UNAIDS, CDC and other international organizations, including resources from the region. A
consultative and participatory process will be engaged, to draw from all the stakeholders to develop draft
protocols for pre-testing in relevant settings. It is expected that the protocol will address the needs of health
care workers in providing C&T services for children and adolescents, on-going psychosocial and preventive
support, support for disclosure and referrals, among other areas. A curriculum will be developed for the
training of health workers on the use of the protocols. PEPFAR funds will also support training of 75 trainers
(TOT) of health workers/counselors on child/adolescent counseling.
Continuing Activity: 17744
17744 17744.08 HHS/Centers for University 8747 8747.08 $600,000
Disease Control & Research
Prevention Corporation, LLC
Table 3.3.14:
09.C.CT11: URC -Strengthening Routine HIV Testing
In FY2008, the Counseling and Testing Team successfully accomplished the following tasks:
-a coordinator for the Routine HIV Testing (RHT) position was recruited;
-the Ministry of Health (MOH) and the Ministry of Local Government (MLG) were supported in the
adaptation of the RHT training materials;
-the MOH identified two districts for the RHT baseline assessments;
-a Technical Working Group (TWG) was formed;
-partnerships were forged with the District Health Teams, the District Multi-Sectoral AIDS Committees, and
the MLG.
At the same time, the MOH and the MLG have been working with University Research Corporation (URC)
to pilot test a strategy to improve Routine HIV Testing (RHT) or Provider Initiated Testing and Counseling
(PITC) services in two districts. The RHT improvement strategy assists facilities to improve the quality of
testing, as well as post-test counseling, which is critical for promoting risk reduction behaviors among
clients. The improvement interventions put emphasis on enhancing referrals for further care and treatment.
All categories of staff who are involved in HIV testing and counseling are being trained in each facility. After
completing the provider training, URC staff along with MOH and MLG staff, will provide on-site mentoring
and coaching of RHT providers to ensure that implementation occurs and is aligned with the training
objectives, and the national guidelines for HIV Testing and Counseling (HTC). Mentoring will ensure that
data management concepts are clearly understood and implemented by the facility staff. The URC staff will
also observe and assess counseling and testing procedures periodically to determine levels of compliance
among providers with the RHT protocols.
The objectives for the program are:
-to increase the number of public and private healthcare facilities offering and performing high quality RHT
and post-test counseling;
-to improve the capability and skills of health workers in RHT and post-test counseling;
-to increase the number of health care clinic attendees who receive high quality RHT services;
-to improve the capacity of facility and district staff to collect, analyze and use RHT monitoring and
evaluation data, then plan and allocate resources for RHT and HIV care, treatment and support services
based on timely and accurate information;
-to improve the coordination and support supervision of RHT both at the facility and district levels.
Plans for 2009:
Activities and Expected Results:
Activity 1: Establishment of Quality Improvement Teams at the Facility Level
URC will work with facilities to identify a core team representing staff from the various clinical services. The
facility-based teams, with support from URC and MOH/MLG staff, will be responsible for improving uptake
and the quality of RHT services in the various clinical settings. Each facility team will conduct a rapid
baseline assessment to identify quality gaps in its current RHT services, if it has not already completed one.
These assessments and additional quality assessment (QA) tools will be used to develop and implement a
quality improvement plan. URC will assist facility teams in developing strategic plans for improving access
to and quality of RHT services.
URC will also integrate routine HIV testing services into this strategic plan, thereby increasing access to HIV
testing in all clinical settings. Emphasis will be placed on increasing recruitment of couples and families,
including children and adolescents, to RHT services. Facility staff will: (1) promote access to and availability
of confidential HIV testing; (2) ensure that HIV testing is informed and voluntary; (3) ensure effective and
prompt provision of test results for all clients who undergo HIV testing; (4) utilize a prevention counseling
approach aimed at personal risk reduction for HIV-infected persons and those at a high risk of HIV
exposure; and (5) link HIV-infected individuals to care and treatment. URC will ensure that all facility staff
are aware that HIV prevention counseling should focus on each client's unique personal circumstances and
risk and help each client set and reach an explicit behavior-change goal to reduce the chance of acquiring
or transmitting HIV.
The program will be rolled out to two additional districts in the FY2009.
Activity 2: Human Capacity Development
The MOH has requested URC to support the hiring of two counselor trainer positions to be based at the
ministry, but work in the districts to support training and implementation of the quality of RHT services. Staff
will receive training that includes specifics on RHT quality, the meaning of quality in services, and
compliance with national guidelines. Health care workers with basic RHT knowledge and skills will be the
target of capacity building activities. Emphasis will be placed on indicators used to monitor clinical
performance, such as the presence of guidelines at facility level or the knowledge and skills of counselors.
Specific case studies will be presented during the training and participants will work in groups to identify
quality gaps and suggest possible solutions. URC will provide job-aids, such as wall charts, to improve
compliance with clinical and RHT guidelines. URC will visit each facility at least twice a month to provide on-
the-job support and mentoring to healthcare workers in participating facilities. Mentoring will focus on
improving skills of RHT and other high-volume clinical service staff on HIV counseling and referring. During
these visits, URC will also review program performance data.
Activity 3: Referrals and Linkages
Activity Narrative: URC along with MOH/MLG will promote a ‘continuum of care' model for all HIV-infected persons. The model
emphasizes the identification and early referral of all people living with HIV/AIDS (PLWHA) to care,
treatment, and other support services. As part of this mandate, URC will work to link different levels of care,
including facility, community-based organizations (CBO), faith-based organizations (FBO), home-based
organizations, and other different services, to minimize missed opportunities. In order to ensure that RHT is
widely available, various innovative counseling and testing (CT) approaches, such as family-based, door-to-
door, community-based, outreach , youth focused and home-based care services, will be incorporated into
existing programs. They will continue to expand this focus and promote available methods for prevention to
all clients, with a specific focus on discordant couples. In addition, URC will continue to work with local
CBOs and FBOs to increase community outreach and support for knowing one's HIV status and will train
facility, CBO and FBO staff in analyzing their performance and quality, or in other words, outputs and
compliance, indicators. The staff will use site-specific data to monitor uptake of basic healthcare and
support services on a monthly basis. Additionally, URC will ensure that there will be linkages established
with facilities that provide male circumcision services and follow up risk reduction counseling.
Activity 4: Building Sustainability
In order to promote sustainability, URC will train district and facility-level supervisors in QA methods and
facilitative supervision techniques for improving the quality of RHT services. URC has begun the process of
reviewing national RHT guidelines and evaluating the quality of CT at the facility level, in partnership with
the district health department, which will be a key focus area in the next twelve months. To ensure the
quality and reliability of data obtained at all URC supported sites, it has been necessary to ensure uniform
reporting structures, including the introduction of HTC-specific data collection tools. URC will conduct
quarterly assessments in each facility/CBO/FBO to assess whether staff is in compliance with MOH HTC
guidelines. At least once a year, sample-based surveys will be undertaken in a small number of URC and
non-URC sites to assess the differences in compliance and other performance indicators.
ACTIVITY 5: Development and operationalization of RHT Training Manuals
URC will assist the MOH and MLG to finalize the development of RHT Trainer and Participants Manuals
and to develop job aids to support providers in service delivery. These will include cue cards and posttests
for group information and counseling sessions. URC will support training in approximately four districts
within one year and will evaluate training material adequacy and relevance among participants and trainers
through pre and post surveys.
* Increasing gender equity in HIV/AIDS programs
09.X.SS20: URC - Targeted Evaluation
ONGOING ACTIVITY WITH NO ADDITIONAL FY2009 FUNDS REQUESTED - DELAYED
IMPLEMENTATION
A number of PEPFAR-supported programs have been underway for several years now. Under this activity,
external process evaluations will be conducted on activities which have been supported for three or more
years and that are planned to continue in 2008. These activities include UMDNJ-FXBC Technical
Assistance to PMTCT, Pre-service Training and Health Worker Wellness, NASTAD Technical Assistance to
Community Planning and Community Capacity Enhancement Program (CCEP). Based on the scope of
work provided, URC will conduct site visits and interviews with key informants and beneficiaries of the
targeted partner activities in order to identify strengths and weaknesses of the program, and in turn, help
map the way forward. The focus of the evaluations will be on the technical content and management of the
activities, as well as the effectiveness of the interventions. Best practices and program challenges will be
documented and recommendations included.
Continuing Activity: 19647
19647 19647.08 HHS/Centers for University 8747 8747.08 $300,000
Table 3.3.18:
09.X.SS12: URC - Gender and HIV/AIDS
ONGOING ACTIVITY FOR WHICH NO FY2008 FUNDS ARE REQUESTED - DELAYED
In support of the Botswana National Strategic Framework on HIV/AIDS (2003-2009), the U.S.
Ambassador's HIV/AIDS Initiative has supported local partners to mitigate and reduce the stigma related to
HIV/AIDS. In order enhance the work already undertaken by this Initiative the US Embassy plans to
support a new activity that will address the gender emphasis area to increase women's access to income
and productive resources. This is in recognition that women and girls' lack of economic assets increases
their vulnerability to HIV/AIDS. Therefore providing women with economic opportunities empowers them to
avoid high risk behaviors, seek and receive health care services and better care for their families.
Botswana has prioritized poverty alleviation in its national development plan; however, women in Botswana
tend to suffer poverty and economic marginalization more acutely than men. A number of factors contribute
to the differences in the experience of poverty and economic disadvantage between the two groups. These
factors include legal and cultural norms that restrict women's access to, and control of, productive
resources.
Gender inequalities also exist in the education system and these impacts negatively on poverty alleviation
strategies. In the area of women and health, it is important to bear in mind the fact that people's health and
well being are outcomes of the economic, social, political and cultural context in which they lead their lives.
In the case of Botswana, women lack full and equal participation in the cited context, and therefore,
experience different and additional health barriers. Nevertheless, Botswana has made some strides in this
area of Women and Health. Since 1995, Botswana has revised the Family Planning guidelines with the aim
of removing barriers to accessing health services by women and girls. There is also an integration of STI
and HIV/AIDS prevention with family planning services and reduction of mother to child transmission of HIV.
However violence against women is one of the pervasive and escalating social problems in Botswana.
Despite the commendable work and initiative by GOB, many young women in poorer, outlying communities
remain highly vulnerable to HIV because they lack access to independent income generating activities, and
thus have the potential to be abused and exploited in their relationships with male partners. Since many
adult women and adolescent girls continue to lack direct access to cash income, their ability to successfully
resist sexual demands from male partners is greatly undermined. Over 50% of people in Botswana live in
rural areas and most of them are women. Studies also show that HIV/AIDS prevalence is also high in rural
areas. Botswana‘s rural areas are endowed with natural resources that if prudently utilized, can carry
Botswana sustainably into the future. Women residing in rural areas, as custodians of the natural
environment, need to be empowered economically and politically to improve their livelihood systems.
NGO's like Women Against Rape (WAR) have tried to break the dependency syndrome that results from
women not having their own income and their own resources through an Africa Development Foundation
(ADF) funded project that included conducting research on viable small businesses for women in Ngamiland
(from cooking, and sewing, to basketry and other activities). Somarelang Tikologo (Environment Watch
Botswana) also engaged in a project called Green Shop Project for Women's Economic Empowerment
funded by the Women's Affairs Department in which they educated and trained women, and developed
marketing centers. Other organizations such as Bomme Isago Association, are working with women to
empower HIV positive women on their reproductive health rights and available services.
This activity introduces a unique project approach that aims at economically empowering the rural woman,
using raw material from the natural resource base by giving them the resources needed to establish them
as enterprises. The uniqueness of this project lies in the emphasis to utilize the natural resource base,
which if prudently used, will bear sustainable outputs. The project also moves beyond training and
educating, and gives rural women the chance to utilize skills and indigenous knowledge to finally run output
-oriented enterprises.
Rural Women Economic Empowerment Project seeks to provide opportunity for rural and peri urban based
women aged 25 years and above to engage in business, sustainably utilizing their natural resources to
attain independence over livelihood choices, socio-cultural and political choices. Specific objectives are:
--To educate and empower women on HIV/AIDS issues.
--To reduce vulnerability to HIV/AIDS amongst women by avoiding dependence on men in relationships.
--To economically empower women to have independence in decision making at household level.
--To provide women with seed money to start businesses to improve their rural livelihood.
--To use the rural woman to conserve the environment while at the same time benefiting from it.
The activity will be implemented by an experienced Non -Governmental Organization, which has experience
in Gender issues and natural resource management, it will coordinate the program and work closely with 3
NGO's in 3 regions in Botswana. Women will be provided with funds to start up or improve on projects that
have natural resources as their raw material. They will also be sensitized on HIV/AIDS issues and their
reproductive health needs. Linkages with other PEPFAR supported partners such as BONASO, BONELA,
Hope World Wild, Catholic Relieve Services and BONEPWA will be formed to leverage support and
utilization of available technical assistance. Additionally support will be sort from Peace Corps volunteers
working in the NGO and PMTCT programs in order to foster collaboration and maximize available
The activity will assist Botswana in addressing a number of policy priority areas including economic
diversification, poverty alleviation, women empowerment, sustainable environmental management and rural
Continuing Activity: 17922
17922 17922.08 U.S. Agency for Constella Futures 7751 1339.08 GPO-I-00-05- $250,000
International Group 00040-00:
Development Health Policy
Project
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Economic Strengthening $350,000
