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: 2010 2011 2012 2013 2014
This TBD was awarded in August 09 reprogramming.
Context
Started in 2002, the Masa Program is currently supporting more than 108,288 (Aug 09) ART patients at 32 ART sites and their 109 satellite clinics (Aug 09). There are currently 138 satellite clinics countrywide. Constraints that will continue to impede the Botswana Government's plans to provide treatment and care to an estimated 125,000 patients in 600 ART treatment sites by 2013 are: shortage, turnover, and attrition of qualified health professionals; lack of coordination among HIV/AIDS-related programs, limited capacity to conduct timely CD4 and viral load testing; and an inadequate system of tracking and monitoring ART patients.
Goals and Objectives
The goal of the project is to support the Masa program and its current 32 sites and their 138 satellite clinics and future ART sites by: 1) developing a sustainable capacity in clinical care and treatment of HIV/AIDS patients through training, on-site support, and roll out of facilities; 2) developing a sustainable capacity in CD4, viral load, and other lab testing, and supporting countrywide decentralization of laboratories; 3) establishing a Monitoring and Evaluation (M&E)Unit to track ART patients and monitor the progress and effectiveness of the Masa program; and 4) implementing and operationalizing a fully functional Botswana-based NGO, Botswana Harvard Project (BHP), whose governance is shared between the Botswana Ministry of Health and Harvard to ensure PEPFAR sustainability.
Major Activities
Activities prior to FY10
In FY06, the Clinical Master Trainers' pharmacists, physicians and nurse/midwives conducted needs and pharmacy assessments, training in ART care and treatment, Nurse Dispensing and Prescribing, on-site and/or telephone support at 29 ART sites and 95(by Sept 09) satellite clinics.
BHP set up treatment failure management registries and pilot of Universal Highly Active Antiretroviral Treatment (HAART) in 4 sites (hospital, supporting clinics and feeder health posts).
Quality Assurance Initiative (QAI) activities continued to be integrated into site support.
The Laboratory Master Trainers collaborated on production of a laboratory training manual and provided training and follow-up support for 23 laboratories in CD4 and 10 laboratories in viral load testing. Decentralized labs performed 55% and 29% CD4 and viral load tests respectively countrywide this year.
The Monitoring and Evaluation Unit of Masa provided consolidated monthly reports, conducted data training and data audits, upgraded, piloted,, and rolled out a SQL-server-based electronic application (PIMS II), and provided a data set QOL.
BHP was operationalized as a Limited Liability Corporation (LLC) in Botswana on September 1. 2009. BHP applied for and was awarded two PEPFAR Cooperative Agreements as well as other USG and non-USG awards.
Activities in FY10
The Clinical Master Trainers will continue to provide training and support in HIV/AIDS treatment and care to all ART sites and their satellite clinics with specific training and support for nurse prescribing and dispensing, QAI, and pediatric scale-up.
BHP will continue to develop training materials; and collaborate to integrate Prevention of Mother to Child Transmission (PMTCT), TB and other HIV/AIDS-related activities.
The Laboratory Master Trainers will continue to provide training and support in, CD4 and viral load testing at the decentralized labs; provide new training in hematology, chemistry, microbiology, lab data management, reagent logistics, and QAI; and provide Rapid HIV and Dry Blood Spot testing training for lay counselors.
The M&E Unit will complete deployment and training on PIMS II, to ARV sites; refine and expand indicators and management tools, especially for PMTCT; integrate functions of the national system, and establish IT support to the department.
BHP as an LLC will be fully operationalized.
By the end of FY10, all established ART sites will have received training and support through the Clinical Master Trainer, Lab Master Trainer, and Monitoring and Evaluation Unit programs.
Enhancing Sustainability
All activities of the Harvard Botswana PEPFAR grant will be fully transitioned to the BHP LLC and will continue to apply for future funding
Monitoring and Evaluation
The M&E Unit will develop systems to monitor the national ART program and provided reports and analyses to inform the Government of Botswana in HIV/AIDS care and treatment policies.
10.C.AC06 BHP - Health care providers training - 100,000.00
In FY2008 and FY2009, the Clinical Master Trainer (CMT) program trained a total of 623 health personnel on ART and palliative care service delivery. These included ACCF (39), Introduction to AIDS Care (39), Pediatric and Neonatal care (52), ARV Nurse Prescribers (129), ARV Nurse Dispensers (299), and Universal HAART (65). It supported and mentored 32 Hospitals and 84 ARV Clinics Sites. The ARV Nurse Training curriculum completed and the Universal HAART Pilot at 10 facilities. The Laboratory Master Trainers (LMT) have decentralized to an additional 2 CD4 and 2 VL labs bringing CD4 labs to 21 and VL labs to 10. BHP trained 61 laboratory technicians on lab manuals, 56 nurses and 42 nurses on dried blood spot. An EQA program is running and the lab training manual completed. All 21 CD4 and 10VL labs are supported.
M&E reached all 32 sites. The M&E Unit has monitored the number of patients on HAART on a monthly basis. PIMS II application and associated SQL Server database has been finalized and was rolled out in August 2009. Data validation of Site Managers Reports has continued. Training on application systems has been conducted for 200 providers and the unit provided support for review of the tools and indicators for PMTCT, HIV Counseling and Testing, Safe Male Circumcision, and Community and Home Based Care. The KITSO Training Unit database was also evaluated.
BHP will have a three pronged approach to using the master trainer model, which will include Clinical Master Trainers, Laboratory Master Trainers and M&E Technical Advisors.
The Clinical Master Trainers will:
- train of nurse dispensers and nurse prescribers;
- train health care providers on QAI and implementation of QA activities at ART sites;
- provide continuing medical education at district level and telephone site support;
- develop training materials for the rollout of the universal HAART program and mentoring health facilities in implementing it; and
- integrate pediatric care in clinical care and site support.
The Laboratory Master Trainers will:
- support the established CD4, VL, hematology, chemistry, DBS and microbiology support;
- train on LIS issues on lab data management, reagent logistics and quality assurance;
- lead EQA activities;
- strengthen quality for hematology, TB and chemistry; and
- train on TB diagnostics.
C) The M&E Unit within Masa will:
- refine and expand indicators and management tools;
- roll out new PIMS II system to all PIMS locations;
- integrate functions with all other national systems;
- train end users on new systems;
- create a support desk and use DEC to perform vital roles; and
- conduct DEC trainings.
10.T.AT12: BHP - Health Care Provider Training - 413,038.00
BHP will develop a sustainable training capacity in clinical care and treatment of HIV/AIDS patients, expand CD4 and viral load laboratory testing to decentralized laboratories, and strengthen the Ministry of Health's (MOH) Monitoring and Evaluation (M&E) capacity to assess the effectiveness of the national anti-retroviral (ARV) program, Masa.
In FY07 and FY08, the Clinical Master Trainer (CMT) program trained a total of 492 health personnel on ART service delivery and 635 on palliative care service delivery. It also supported and mentored staff at 18 hospitals and 39 satellite clinics. The Laboratory Master Trainers have, so far, been able to train a total of 22 laboratory technicians and have supported and mentored staff at approximately 22 facilities, 15 of which were decentralized sites.
The M&E results indicated that there were 32 sites reached, 59 data entry clerks (DEC) trained, a data warehouse developed with the ongoing integration of Masa and DHIS, and a data security and confidentiality system with encrypt and decrypt completed.
BHP will have a three pronged approach to using the Master Trainer model, which will include Clinical Master Trainers, Laboratory Master Trainers, and M&E technical advisors.
- enhance task-shifting through training of nurse dispensers and nurse prescribers;
- train health care providers on QAI, implement QA activities at the ART site level, and provide QAI training for district/site leadership cadres;
- provide continuing medical education at district level and telephone site support; and
- develop training materials, SOPs, guidelines, memos, checklists, and other tools for care and treatment sites
- support the established CD4 and VL decentralized laboratories and expand training to include hematology, chemistry and microbiology support;
- formalize the training manuals on CD4, VL, hematology, chemistry and microbiology, including TB, in collaboration with the MOH and HHS/CDC/BOTUSA; and
- train staff on LIS issues, laboratory data management, reagent logistics and quality assurance at decentralized laboratories/sites.
The M&E Unit within Masa will continue to:
- replace PIMS (Masa) and roll out the new system to all PIMS locations;
- integrate functions of, for example, PMTCT, and integrate into all other national systems, for example, DHIS;
- train end users on the new systems;
- establish a support desk and use DEC to perform vital roles; and
- conduct a targeted patient evaluation study on medication adherence.
10.X.SI21: BHP - PIMS Support - 397,375.00
Goal 3 of the Partnership Framework is to strengthen the strategic information system of the national response. The following support to the national HIV patient information management system (PIMS II) project is required to achieve this goal.
Ongoing support for PIMS II
- Resources for staff and travel for an IT helpdesk to provide technical assistance to users of PIMS II and ensure its sustainability, optimization, and efficient use.
- Procurement support to maintain the effective use of the system during the initial phases of implementation. Central procurement of supplies, such as labels for the pharmacy label printers, will maximize the effectiveness of the system and minimize costs. Software required to establish and support the system may also be required, such as bug tracking software and/or the development of environment upgrades.
- Continued deployment (system installation and training) of PIMS II to newly operational and newly computerized ARV clinics.
System development
- Include PMTCT, HIV testing and counseling, and TB modules to PIMS II, which involves development of user requirements and actual programming. Pilot these modules in facilities piloting universal HAART and those at the forefront of TB/HIV integration before the national roll-out.
- Develop PIMS II as a distributed system, and pilot the transfer and record linkage of datasets between facilities to share and update patient records. This would allow clinicians to access historical information of patients who transfer between facilities and potentially improve the quality of patient care. At the local level, this would also make facility and site-level data available for routine analysis by site managers and district M&E Officers. At the national level, this would facilitate the routine collection of a truly national electronic dataset by collecting data from the districts/sites for all of their facilities and feeding back reports.
Strategy development
Post-deployment workshops are needed to gather feedback on future user requirements and areas for improvement of the current system.
