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: 2007 2008 2009
Using FY09 PEPFAR funding, the Ministry of Health (MOH) of Côte d'Ivoire, through the Public Hygiene
Regulation Department (DRHP) of the General Direction of Public Hygiene, will take the initiative in
spearheading the national injection safety program to prevent the transmission of HIV and other blood
borne diseases by improving medical injection safety. With the John Snow Inc. (JSI) CDC cooperative
agreement ending in September 2009, the transfer of capacity to the MOH will serve to strengthen national
commitment, reinforce local capacity, and encourage program sustainability in the area of injection safety.
An injection safety team under the MOH will oversee national injection safety activities in the following
domains: capacity building, logistics management, behavior change communication (BCC), advocacy,
waste management, and monitoring and evaluation (M&E).
1-Capacity building: MOH will engage in both pre-service and in-service injection safety training for 800
health care workers to encourage safe injection practices, and decrease occupational exposures to HIV and
other blood borne diseases. MOH will work in close collaboration with the National Institute of Training for
Health Care Workers (INFAS) to develop in-service training modules for health care workers through a pool
of regional and district-level trainers. The MOH will work to ensure the integration of injection safety into the
national medical, nursing, and midwifery curricula for pre-service training.
2-Logistics management: At present, 34 districts are being provided with safe-injection materials, which
include auto-disable syringes, retractable syringes, and safety boxes for syringe disposal. Because the PSP
has a 1.5-year supply of syringes in stock from JSI, the Partnership for Supply Chain Management Systems
(SCMS) will procure only safety boxes in FY09. Although funds for commodities procurement will be
provided directly to SCMS, the MOH will be heavily involved in determining supply volume and needs in the
field. Collaboration with the PSP will ensure district-level procurements, help in tracking stocks and
responding to demands from local hospitals and health centers for safe-injection supplies, and help manage
the large stock of syringes. FY09 funding will also be used to equip the 34 intervention districts with
adequate waste management equipment such as waste bins, waste bin liners, and disposal carts.
3-Behavior change communication: The MOH will develop strategies to address BCC both in health centers
and among the community. Information sessions for prescribers will encourage a decrease in non-
necessary injections. Strategies for community outreach and sensitization will be developed to educate the
public about injection safety and waste management, particularly concerning ways to reduce non-necessary
injections, through BCC materials and multimedia campaigns in collaboration with other PEPFAR partners.
4-Waste management: The MOH will lead the collaboration of partners involved in national medical waste
management including the Ministry of Environment, WHO, World Bank, and GAVI. The MOH will work with
partners to map the placement of district incinerators and identify locations where there is a need for
incinerator construction or repair. The MOH will fund the strategic construction (and repair) of incinerators
where needed and in collaboration with other partners. This construction and repair will accompany training
of incinerator operators and the provision of their protective equipment.
In line with the JSI injection safety project's displaying the feasibility and advantages of waste segregation
through its pilot study, the MOH will develop a strategy to enforce the Tri-system of waste segregation on a
national level. Hospitals and health centers will be provided with necessary waste management training and
protective equipment for waste handlers. The MOH will put in place a system of district-level medical waste
collection, storage, and transport.
5-Advocacy: The MOH will conduct advocacy activities promoting hepatitis B vaccination for health care
workers as a means of prevention against contamination during accidental needle sticks. In addition, the
MOH will advocate for the availability of and training for post-exposure prophylaxis (PEP) in health centers
and hospitals. The MOH will also conduct advocacy activities for increased involvement of local authorities
(municipal centers, local councils, etc.) in the construction and repair of incinerators.
6-Monitoring and evaluation: In collaboration with JSI, the MOH will conduct a nationwide baseline analysis
to evaluate work that has already been conducted in the areas of capacity building, logistics management,
and BCC for injection safety and waste management activities. This analysis will serve to better guide
annual work plan development and strategy elaboration for next steps.
The MOH will designate and train an M&E focal point for each district to ensure effective monitoring and
tracking of project activities. These individuals will be responsible for the regular monitoring of injection
safety and waste management indicators in their district. As a part of ongoing M&E activities, the MOH will
conduct district supervision visits to observe adherence to correct injection safety and medical waste
management practices. Site visit reports will be produced from these visits and challenges will be
addressed both on the district level as well as during coordination meetings for injection safety and waste
management working groups.
Using FY09 funding, the MOH will work to develop a national protocol for the reporting of needle-stick
injuries among health care workers. This national protocol will ensure that all needle-stick injuries are
properly documented, and that exposed health care workers are provided with appropriate treatment and
follow-up. The MOH will submit quarterly, semi-annual, and annual reports to PEPFAR as a part of its M&E
activities.
The MOH will also take the lead in developing and/or finalizing national norms and directives documents in
injection safety and medical waste management. It will ensure the reproduction and dissemination of these
documents to national district health structures, and will enforce their implementation through district
supervisions. More specifically, the MOH will also finalize and disseminate the National Healthcare Waste
Management Plan in conjunction with the Medical Waste Management Working Group. The MOH will also
lead reflection groups and organize quarterly meetings for the national working groups in injection safety
and medical waste management, bringing together implementing partners to harmonize activities, discuss
national strategies, and address challenges in the field. As needed, the MOH will solicit assistance from
Activity Narrative: national and international technical assistance providers.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Construction/Renovation
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $350,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.05:
In pursuit of the Ministry of Health (MOH) objective of universal access to care and (if needed) treatment for
people living with HIV/AIDS (PLWHA), the National HIV/AIDS Care and Treatment Program (PNPEC)
collaborates with other MOH structures to ensure coordination of health-sector HIV/AIDS interventions
through two main strategies: (1) integration and decentralization of HIV/AIDS and other health-care
activities, and (2) implementation and enforcement of national policies, guidelines, norms, and standards.
MOH-supervised medical staff provides care for HIV-infected teachers, staff, and students at school health
centers (SSSU), in collaboration with PEPFAR-supported HIV prevention and care activities conducted by
the Ministry of Education (MEN). With FY09 funding, and building on activities previously implemented by
the MEN, the MOH will work to strengthen the capacities of the National School Health Program (PNSSU)
to better coordinate HIV care and support services for students and teachers in the education sector
through the school health clinics (SSSUs).
Using FY09 funding, the PNSSU will continue to strengthen systems that address the health care needs of
HIV-infected and -affected students and teachers with comprehensive, family-based care in coordination
with the PNPEC's program for the prevention of mother-to-child transmission (PMTCT) and HIV care and
treatment program as well as with the MEN's HIV prevention programs. The PNSSU will advocate for a
holistic approach to care and support and will seek to provide a complete and integrated package of quality
services that includes prevention (counseling and testing (CT), PMTCT, secondary sexual prevention);
adult, child, and family care (ART provision, prevention and treatment for opportunistic infections (OI), and
promotion of "positive living"); psychosocial support; and a continuum of care through links with QUITUS (an
NGO of teachers living with HIV/AIDS), the PNPEC, other ministries, and community organizations. The
PNSSU's approach will rely on linking the clinical adult care and support provided by its medical staff (or
referrals to other providers) to home-based care and support by QUITUS members, peer educators from
student health clubs, and other NGO service providers.
Teachers and other MEN personnel in need of services will be identified through CT centers and other
caretaking centers (maternities, hospitals, NGO, and others). Personnel infected or affected by HIV will be
provided with follow-up care, home visits, and ongoing support through care and treatment partners such as
ACONDA, EGPAF, ICAP-Columbia University, and QUITUS. The PNSSU will support QUITUS mobilization
against stigmatization in schools.
More specifically, the PNSSU will work with the MEN, QUITUS, and implementing partners in FY09 to:
•Provide at least 300 teachers, including 100 QUITUS members and other personnel living with HIV, with
referrals to care for psychosocial support, adherence to treatment, and positive prevention at 30 MEN
intervention sites.
•Acquire and distribute 400,000 condoms to teachers and other personnel at all 47 SSSU sites.
•Train 200 doctors and nurses in CT and care and support for HIV-infected teachers and students.
•Organize 360 meetings or training sessions on HIV/AIDS-related topics for health care workers (12 per
MEN intervention site).
•Equip the SSSUs with CT materials and kits for treating sexually transmitted infections (STI).
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.08:
With funding reprogrammed in April 2009, the MOH will also support translation and printing of materials for
Prevention With Positives activities.
Table 3.3.09:
Students in need of HIV services are identified through counseling and testing (CT) services (such as
SSSUs) and other care centers (such as maternity wards, hospitals, and NGOs). Infected students are
provided with follow-up care, treatment for sexually transmitted infections, and referrals to other forms of
care. To assist with medical care, the MEN has acquired HIV laboratory and office materials for SSSUs that
serve teachers, school administrators, and students at its 20 intervention sites (increasing to 30 sites in
FY09). In FY07, capacity-strengthening workshops in STI treatment and care were conducted, and 60
SSSU physicians were trained in new ARV prescription methods and in tracking and care of STI symptoms.
Using FY09 funding, the MOH's PNSSU will continue to strengthen systems that address the health care
needs of HIV-infected and -affected students and teachers with comprehensive, family-based care in
coordination with the PNPEC's program for the prevention of mother-to-child transmission (PMTCT) and
HIV care and treatment program as well as with the MEN's HIV prevention programs. The PNSSU will
advocate for a holistic approach to care and support and will seek to provide a complete and integrated
package of quality services that includes prevention (counseling and testing (CT), PMTCT, secondary
sexual prevention); adult, child, and family care (ART provision, prevention and treatment for opportunistic
infections (OI), and promotion of "positive living"); psychosocial support; and a continuum of care through
links with QUITUS (an NGO of teachers living with HIV/AIDS), the PNPEC, other ministries, and community
organizations. The PNSSU's approach will rely on linking the clinical adult care and support provided by its
medical staff (or referrals to other providers) to home-based care and support by QUITUS members, peer
educators from student health clubs, and other NGO service providers.
•Provide care and support for children living with HIV, with referrals to care for psychosocial support,
adherence to treatment, and positive prevention at 30 MEN intervention sites.
•Equip SSSUs with CT materials and kits for treating sexually transmitted infections (STI).
Estimated amount of funding that is planned for Human Capacity Development $10,000
Table 3.3.10:
Côte d'Ivoire is facing a dual epidemic of HIV and tuberculosis (TB), with an HIV prevalence of 3.9 %
among adults (UNAIDS, 2008) and a TB prevalence of 116 cases per 100,000 residents (MOH/PNLT,
2007).
The Ministry of Health (MOH) has received $3.8 million and €5.5 million in Global Fund Rounds 3 and 6 to
strengthen its TB-control program. With Global Fund assistance, anti-TB drugs are being provided by the
Global Drug Facility, and the National TB Program (PNLT) is decentralizing sputum smear microscopy by
increasing the number of designated TB centers, increasing human capacity by training health care
workers, developing and producing monitoring and evaluation (M&E) tools, and strengthening supervision.
The number of sputum smear microscopy centers will be increased from 105 (currently) to 115 centers by
the end of FY09.
Through support from PEPFAR, these efforts have been strengthened. Using USG funding, the PNLT has
taken the lead in the response to TB/HIV co-infection, along with the National HIV/AIDS Care and
Treatment Program (PNPEC) and the Institute Pasteur of Côte d'Ivoire. Other PEPFAR implementing
partners such as EGPAF, ACONDA, and Alliance have also contributed to the expansion of TB/HIV
activities throughout the country. The PNLT's response to the TB/HIV epidemic is focused on policies and
guidelines promoting the development of a TB/HIV collaborative framework, improvement in diagnosis of TB
among people living with HIV/AIDS (PLWHA), provision of routine HIV counseling and testing (CT) of all TB
patients, and integration of HIV care and support in all TB clinics. The PNLT expanded services and
improved supervisory activities with PEPFAR support in FY04 and FY05. Using FY07 plus-up funds, the
PNLT improved TB/HIV coordination by setting up a system to collect, store, and transport sputum. In FY08,
the PNLT worked with PEPFAR implementing partners to test 100% of TB suspects and 100% of TB
patients ( 23,000 people) at all nationally recognized TB clinics. The PNLT has strengthened referral
systems and linkages between TB and HIV care by setting up a register of referral in each CATs.
Priorities in FY09 for the PNLT will include:
TB/HIV coordination
•Strengthening collaboration between the national TB and HIV programs (the PNLT and the PNPEC,
respectively) by developing a national TB/HIV coordination committee and ensuring joint planning of TB/HIV
•Promoting the planning and implementation of TB/HIV activities by establishing TB/HIV coordination
mechanisms at the district level.
•Organizing quarterly meetings with TB/HIV partners to plan and review progress of TB/HIV activities.
•Supporting supervisory activities for monitoring of TB/HIV activities from the national level by the PNLT.
Expansion of provider-initiated HIV counseling and testing
•Training trainers for rapid expansion of provider-initiated counseling and testing (PICT) in all TB clinics, in
collaboration with the PNPEC and with support from PEPFAR/CDC. PEPFAR implementing partners will
draw on this pool of trainers to scale up PICT in all PEPFAR-supported TB facilities.
•Ensuring the availability of ARV services at CATs so that co-infected TB patients can be enrolled into HIV
care and treatment at the same facility. This will be implemented in collaboration with the PNPEC and
through the assistance of PEPFAR implementing partners (such as EGPAF, ACONDA, and ICAP-CU).
Intensified TB case finding among HIV-infected persons
•Updating and reproducing the TB screening tool and algorithm for intensified TB case finding among HIV-
infected persons with assistance from EGPAF, ICAP, and other PEFAR partners. The PNLT will work with
the PNPEC to incorporate the TB screening tool into the national HIV patient encounter form.
•Training HIV care providers in TB case finding and care among HIV-infected patients, with support from
PEPFAR/CDC and the PNPEC. The PNLT will also provide tools for collection, storage, and transportation
of sputum specimens for 2,000 HIV-infected patients.
•Producing and disseminating TB/VIH counseling tools in both HIV and TB care and treatment facilities.
•Conducting intensified TB case findings in 10 prisons around the country, and conducting training for
nurses in tools for collection, storage, and transportation of sputum of prisoners.
•Conducting a survey in one CAT on drug resistance among failure and relapse by HIV status.
Strengthening of laboratory capacity
•Continuing to support the collection and transportation of sputum specimens from all national TB diagnosis
and treatment centers, including the 13 CATs and 92 CDTs, to the 3 reference laboratories for rapid TB
liquid culture.
•Providing administrative support for the continued expansion of the availability of diagnostic rapid liquid TB
culture at three or four additional TB facilities in the North and West of the country. This will be provided
through the technical and financial assistance from ASM and EGPAF.
•Using culture for diagnosis of smear-negative TB, in consultation with PEPFAR/CDC and other PEPFAR
partners. Cultures will be made available to all eligible patients free of charge.
•Continuing to reinforce the quality assurance system, including external QA and on-site supervision. With
support from a national TB reference lab (Institute Pasteur-CI), the PNLT will continue to ensure the quality
of sputum smear microscopy throughout the country.
Infection control
•Working with implementing partners to ensure that facility assessments are conducted, and that TB
infection-control facility-level plans are developed and implemented by all PEFAR partners.
•Developing, reproducing, and disseminating norms and standards on infection control in care facilities.
•Providing the CATs X-ray room with air extractors and masks.
•Reproducing and disseminating posters on TB infection control to increase TB prevention sensitization.
•Encouraging CAT and CDT's workers to be tested for HIV.
•Training community workers in management of co-infections.
Strengthening of personnel (PNLT/PNPEC) capacities in co-infection management
•Facilitating the participation of three medical doctors (two from PNLT, one from PNPEC) in an international
TB course in Cotonou.
•Facilitating the participation of two medical doctors (one from PNLT, one from PNPEC) in an international
HIV course in Paris.
•Facilitating the participation of three PNLT medical doctors in a two-week training session on HIV activities
monitoring in Dakar.
•Organizing English training for five staff members of the PNLT.
•Organizing annual coordination meetings on TB infection management for PNLT staff.
•Creating and training a pool of 10 people for laboratory supervision.
Activity Narrative: •Providing logistic support to social workers for home visits to TB/HIV patients.
TB/HIV surveillance
•Building on the Global Fund-supported modification of TB recording and reporting tools to capture HIV
variables, the PNLT will work with PEPFAR partners to ensure that these revised tools are available at all
TB clinics throughout the country.
•Supporting the reproduction and dissemination of TB recording and reporting tools to all CATs and CDTs.
For many years, the PNLT has experimented with a reporting system based on CATs (each CAT collectes
data from CDT during one site supervision). Data are retrieved by fax and computed by the PNLT. These
data will be transmitted quarterly to DIPE who will transmit them to PEPFAR SI team. Each CAT and CDT
transmits quarterly data to the district director according the national reporting system.
Other activities
•Developing TB/HIV training materials to train staff at TB and HIV care sites, in collaboration with the
PNPEC and other PEPFAR partners.
•Collaborating with the Ivorian Network of Journalists and Artists in the Fight Against HIV/AIDS
(REPMASCI) to broadcast 10 radio spots for sensitization of TB/HIV activities.
•Supporting a national TB/HIV Awareness Day to highlight the importance of TB/HIV co-infection as well as
ongoing TB/HIV activities around the country.
•Facilitating access of community-based NGOs to CATs and CDTs in order to strengthen community-based
support for TB and HIV patients, in collaboration with Alliance and other partners.
•Supporting an M&E plan tracking project-specific as well as PEPFAR and national indicators. The PNLT
will report to the USG strategic information team quarterly program results and ad hoc requested program
data. To help build a unified national M&E system, the PNLT will participate in quarterly SI meetings and will
implement decisions taken during these meetings.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15134
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15134 12211.08 HHS/Centers for Ministry of Health, 7056 5301.08 MOH- CoAg $382,781
Disease Control & Côte d'Ivoire #U2G
Prevention PS000632-01
12211 12211.07 HHS/Centers for Ministry of Health 5301 5301.07 MOH- CoAg $500,000
Disease Control & and Population, #U2G
Prevention Cote d'Ivoire PS000632-01
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $200,000
Table 3.3.12:
Since 2006, PEPFAR has supported a twinning partnership between three local organizations providing HIV
counseling and testing (CT) services in Côte d'Ivoire and the Liverpool VCT (LVCT) in Kenya to support
quality scale-up of comprehensive CT services through technical assistance to local partners and other CT
stakeholders. With FY09 funds, responsibility for coordinating the partnership's key activities will be
switched from the American International Health Alliance (AIHA) Twinning Center to the National HIV/AIDS
Care and Treatment Program (PNPEC).
Twinning activities began in April 2007 with the first exchange visit from LVCT to Côte d'Ivoire to meet with
local stakeholders and potential partners. Based on recommendations from the USG team in Côte d'Ivoire
and in collaboration with AIHA and LVCT, three CT sites were identified (Port-Bouet, Lumiere Action, and
AIBEF) to serve as the local partner team and participate in activities with LVCT in collaboration with key
ministries. Key areas of this assistance have included training, supervision, evaluation, policy and standards
development, accreditation, and quality assurance. Through a sub-grant issued by AIHA to LVCT,
exchange trips and meetings were conducted, under the coordination of the National HIV/AIDS Care and
Treatment Program (PNPEC). The USG team and national stakeholders were involved in all activities. AIHA
worked to facilitate significant in-kind contributions of personnel, materials, and financial resources.
In FY07 and FY08, LVCT has worked to build the capacity of the three selected CT centers to be model
centers in the delivery of quality CT services and to provide training to other CT organizations throughout
the country. An assessment of the three CT centers was conducted, and a two-year technical assistance
plan was developed. LVCT provided technical training, partnership exchanges, and on-site mentoring visits
for supportive counseling and supervision.
The technical assistance plan focused on the following areas:
1.Strengthening the technical capacity of the three CT centers in delivering quality CT services. These
capacity-building interventions included quality-assurance activities and supervision visits.
2.Revising the National Guidelines on Counseling and Testing to include rapid testing. Comprehensive CT
policies include registration standards, accreditation, quality assurance, and supportive supervision.
3.Developing training modules related to innovative approaches such as provider-initiated counseling and
testing (PICT) and community-based CT in order to train and coach providers on the delivery of quality CT
services.
With FY09 funds, the PNPEC will continue key activities of the twinning partnership and ensure follow-up of
LVCT technical support to the CI team, including assistance to the two main PEPFAR-supported CT centers
(Port Bouet and Lumière Action). Based on the technical-assistance plan, the PNPEC will support exchange
trips related to LVCT technical assistance. The aim will be to allow LVCT to continue to support quality-
assured scale-up of comprehensive CT to local partners and other CT stakeholders, including supervision,
training, accreditation, and quality assurance. LVCT partners will travel to CI to observe trained supervisors
at the end of their three-month practicum and to complete the third and final phase of the training
FY09 funds will be used to request technical assistance to:
1.Continue implementation of door-to-door CT services around CT sites and develop a progressive
implementation plan for all fixed CT sites.
2.Continue the implementation of accreditation tools.
3.Implement quality insurance activities and provide ongoing support and supervision for newly trained
supervisors.
4.Develop guidelines to train non-medical staff to conduct finger-prick testing and develop an
implementation plan for on-site training.
5.Implement family-centered CT approaches, including couples counseling.
The PNPEC will coordinate the dissemination of partnership results to key stakeholders.
Gender
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.14:
PEPFAR will focus its support on improving the quality of laboratory services nationwide in FY09. In order to
strengthen the lab program and ensure better coordination and leadership of national laboratory institutions,
PEPFAR will support the central Ministry of Health (MOH) institutions through its CDC cooperative
agreement.
PNPEC-DFR
Using FY09 funding, the National HIV Care and Treatment Program (PNPEC) and the MOH Department of
Training and Research (DFR) will organize and coordinate in-service training of laboratory technicians,
pharmacists, physicians, and biologists. A national in-service training plan will be developed to include
PEPFAR training needs, and those of other HIV, tuberculosis (TB), and malaria partners. This plan will
include the development of a national training package for HIV, TB, malaria, and opportunistic infections
(OI) as well as the mentoring of a national pool of trainers in areas such as monitoring and evaluation
(M&E). This will allow the DFR, PNPEC, and PEPFAR partners to assess the impact of in-service trainings
on laboratory service delivery at PEPFAR-supported sites. The DFR will also be funded to support, monitor,
and evaluate in-service training sessions organized by the PNPEC. FY09 funds will be used to purchase
computers for tracking data and to develop training curricula.
INFAS
In 1991, the National Institute for Health Care Worker Training (INFAS) was created with the mission to train
laboratory technicians, nurses, and midwives through three-year post-secondary school programs.
Laboratory technicians may be offered the opportunity to participate in an additional one-and-a-half year
training program to become health care laboratory engineers. Between 1991 and 2000, only 216 lab
technicians and 21 lab engineers were trained. With limitations due to inadequate teaching facility
infrastructure, insufficient laboratory training equipment, and incomplete HIV/AIDS training modules, INFAS
has the official capacity to train only 20 laboratory technicians per year, though the school is now training 38
students per year through implementation of a rotational training schedule. Although there is an attempt to
fill the gap by organizing in-service trainings, there still remain signification challenges in coordination. A
human resource evaluation conducted in 2005 by Abt Associates showed a need for 533 additional
laboratory technicians in order to support the HIV/AIDS national strategic plan goals of 2008. There is an
urgent need for INFAS to improve coordination, evaluation, and monitoring of their pre- and in-service
trainings of health professionals to scale up its training capacity.
In FY09, INFAS will be funded through the CDC-MOH cooperative agreement for the development of
national laboratory human resources to meet the needs of the health system by reinforcing the pool of
trainers and developing the health care educational infrastructure. INFAS will work in collaboration with
Retro-CI to develop and procure a list of materials and equipment for hematology, biochemistry,
microbiology, and immunology laboratories. The school's security system will be enhanced to help protect
the investment in new equipment. In collaboration with Retro-CI, INFAS will develop and procure training
manuals and books, and will support internet service access for the school library.
LNSP
Since 1991, the National Public Health Reference Laboratory (LNSP) has worked toward developing and
implementing laboratory standards to organize, implement, and monitor quality assurance/quality control
(QA/QC) procedures and to regulate laboratory creation and operation. Weak infrastructure and human and
technical resource capacities have been limiting factors in the institution's ability to perform these functions,
in addition to the fact that the LNSP does not have the mandate to coordinate, organize, and supervise the
national laboratory network.
Through PEPFAR support, the LNSP will be better able to coordinate the national laboratory network and
establish national QA/QC standards. Using FY09 funding through the CDC-MOH cooperative agreement,
LNSP infrastructure and human resource capacities will first be improved by renovating the existing
laboratory facility to meet international reference laboratory standards. An assessment of human resource
and training needs will be conducted with the technical assistance of CDC International Laboratory Coalition
partner CLSI. LNSP will also seek assistance from Retro-CI to finalize its five-year strategic plan. All
activities will be conducted in collaboration with the PNPEC, Retro-CI, and other national laboratories.
LNSP will initiate the following activities in FY09:
•Monitor the performance of laboratory sites for the accuracy of HIV testing and ART clinical laboratory
performance.
•Conduct more initial assessments of laboratory staff at new HIV/AIDS care and treatment sites and
periodic on-site supervision at all sites with progressive transfer of competencies to the regional and district
levels.
•Continue the implementation of an external quality assurance (EQA) program for HIV serology.
•Continue the EQA/PT program for CD4 testing in collaboration with CeDReS.
•Pilot a QA program (including EQA/PT) for hematology and clinical chemistry.
•Implement the national guidelines for supervision through developing and implementing standardized
supervision forms and checklists.
•Customize and pilot the CDC/WHO-AFRO checklist for certification of central and regional laboratories.
•Develop and implement a national specimen referral system from sites without laboratories to regional and
district laboratories. This will include a system for the timely reporting of laboratory site results to the
referring to laboratories or clinics.
•Participate in selecting and piloting a laboratory information system.
•Participate in the CDC/WHO-AFRO program for HIV rapid test kit pre-qualification and post-marketing
surveillance.
Estimated amount of funding that is planned for Human Capacity Development $550,000
Table 3.3.16:
Côte d'Ivoire is the country most affected by HIV/AIDS in West Africa with a prevalence of 3.9% (UNAIDS,
2008). Faced with this pandemic, the Ministry of Health (MOH) of Côte d'Ivoire's mission is to provide
appropriate medical care and universal access for people living with HIV/AIDS (PLWHA). However, major
efforts are still needed to strengthen coordination of HIV/AIDS activities in the health sector, particularly in
the realm of strategic information (SI).
To achieve this objective, the MOH aims to strengthen the management information system (GIS) through
the integrated approach of the "PRISM" model developed by Measure Evaluation. This model is based on
three principles: improving the technical quality of procedures and tools data management, increase the
capacity of individual actors to understand and use data, and strengthen the system or the organization to
support the collection and use of data. In previous years, the government (through the DIPE for the MOH
and DPSEEA for the Ministry of AIDS (MLS)) focused on four main components: capacity building of human
resources, creation of a single database, strengthening supervision and quality control data, and
strengthening partnerships. Much of the FY06 and FY07 activities included trainings in collection,
management, communication, and data transmission. Using FY08 funding, the MOH developed a
nationwide longitudinal HIV-positive patient monitoring system, as well as continued the ARV resistance
surveillance initiated in FY07.
FY09 funds will be used to continue these same activities, including:
•Reproducing and disseminating self-evaluation tools for counseling and testing (CT), prevention of mother-
to-child transmission (PMTCT), and adult and pediatric treatment at 16 CT sites, eight PMTCT sites, and six
treatment sites, in preparation for an evaluation exercise.
•Training field providers in the use of data collection tools. A semi-annual supervision visit will follow these
trainings.
•Developing and disseminating reports, including a periodic newsletter/bulletin on HIV/AIDS activities.
•Preparing, validating, and distributing the annual and semi-annual report on the HIV/AIDS monitoring and
evaluation (M&E) indicators.
•Conducting the national antenatal HIV surveillance survey among pregnant women for 2009.
•Implementing second-generation surveillance.
In addition, new priorities for FY09 have been established by the MOH in collaboration with the USG SI
team in Côte d'Ivoire. Activities will include:
1- Strengthening national capacities in human resources by:
•Offering an M&E fellowship program for graduates in statistics, epidemiology, public health, and computer
science.
•Sharing experiences regarding national health information systems with another country (which will include
regional travel for three people from the DIPE and the PNPEC).
•Participating in a regional course in Dakar on Routine Health Information System (two people).
•Training five members of the DIPE in health cartography.
• Organizing training sessions for district level data managers (CSE), health district directorates (SIGVISION
and SIGVIH) in data collection, analysis, and reporting.
2- Developing a single health database by:
•Providing equipment (computer, fax, copier, and phone), software, and appropriate training to the DIPE
personnel. In addition, a Web site will be developed to ensure broad diffusion of data and information, and a
mapping service for HIV indicators will be established.
•Establishing a system to archive and store information. In addition, the DIPE office will receive support for
renovation and equipment.
3- Strengthening the supervision and data quality control by:
•Assessing the districts' capacity to conduct HIV/AIDS M&E activities. Base on this assessment, a
reinforcement plan will be developed.
•Ensuring information system efficiency through a semi-annual data quality audit conducted in collaboration
with PEPFAR partners.
•Organizing a training session with M&E partners on national health information system tools.
•Organizing quarterly supervision visits at the district level. These supervision visits will permit on-site
training on data quality.
4- Establishing a platform for exchange by:
• Organizing quarterly meetings at the regional level for data validation.
•Enabling five staff members of the PNPEC and DIPE to participate in regional/international meetings on
HIV M&E and quarterly SI meetings.
Continuing Activity: 15135
15135 5055.08 HHS/Centers for Ministry of Health, 7056 5301.08 MOH- CoAg $200,000
10421 5055.07 HHS/Centers for Ministry of Health 5301 5301.07 MOH- CoAg $600,000
5055 5055.06 HHS/Centers for Ministry of Health 3604 3604.06 Ministry of $200,000
Disease Control & and Population, Health (TBD
Prevention Cote d'Ivoire new mechanism
Sole source
CoAg)
Table 3.3.17:
Côte d'Ivoire is the country most severely affected by HIV/AIDS in West Africa, with an adult prevalence of
3.9% (UNAIDS, 2008). In pursuit of the Ministry of Health (MOH) objective of providing universal access to
antiretrovirals (ARVs) for all eligible people living with HIV/AIDS (PLWHA), the National HIV/AIDS Care and
Treatment Program (PNPEC) collaborates with other MOH structures to ensure coordination of health-
sector HIV/AIDS interventions through two main strategies: (1) integration and decentralization of HIV/AIDS
and other health-care activities, and (2) implementation and enforcement of national policies, guidelines,
norms, and standards.
FY06 and FY07 PEPFAR funding allowed the MOH to reinforce planning and coordination capacities at
both the central and decentralized levels, with the objective of scaling up HIV/AIDS interventions with the
assistance of PEPFAR partners. Using FY08 funding, the MOH is:
•Updating plans for integrated care and treatment through the development of microplans in nine regions.
•Reproducing and disseminating directives, norms, and standards of quality in the areas of counseling and
testing (CT), prevention of mother-to-child transmission (PMTCT), antiretroviral treatment (ART), pediatric
treatment, and care and support.
•Revising national care and treatment policies in the area of clinical treatment, including pediatric treatment,
CT, management of sexually transmitted infections (STI), PMTCT, palliative care, ARV drugs, nutrition, and
tuberculosis (TB) care for HIV-positive patients.
•Organizing quarterly, semi-annual, and annual coordination meetings of all actors implementing health-
sector HIV/AIDS interventions.
•Elaborating quality-assurance tools and training materials.
•Assessing training needs in collaboration with the Department of Training and Research (DFR).
•Participating in national and international meetings on HIV/AIDS policies and program implementation.
Using FY09 funding, the MOH will focus on scaling up its HIV interventions with the support of implementing
partners through the district approach. PNPEC representation at the district level will be emphasized in
order to strengthen the link between the PNPEC and the districts, and a district-level focal point will be
appointed in each of 10 pilot districts to reinforce district-level empowerment and involvement. The MOH will
continue to build capacities of district health management teams (ECD) to review and follow up their
microplans in collaboration with PEPFAR partners. By providing direct funding to the districts to implement
activities (relating to quality of services, performance-based financing, accreditation process, standards of
excellence, etc.) through sub-grants, the MOH will better achieve its objectives and build from the technical
assistance provided in FY08.
To improve coordination of health-sector interventions, the MOH will use FY09 funding to:
•Revise, reproduce, and disseminate adult care and support training documents for community-based
actors.
•Ensure the quality of services at the decentralized level through collaborations with URC and other
partners.
•Reproduce and disseminate the reference handbook on administrative and financial procedures that was
elaborated in FY08.
•Produce and disseminate a quarterly journal on health-sector HIV/AIDS interventions and primary HIV
indicators.
•Organize quarterly, semi-annual, and annual coordination meetings of all actors implementing HIV/AIDS
interventions in the health sector. This will include meetings of the relevant technical working groups (CT,
PMTCT, palliative care, and treatment). FY09 funds will also contribute to organizing National and World
AIDS Day activities in collaboration with the Ministry of AIDS (MLS).
•Organize postgraduate teaching sessions in the areas of CT, PMTCT, STIs, adult and pediatric treatment,
and care and support.
•Create a national/regional pool of trainers for care and treatment/care and support.
•Provide logistical support to 10 PNPEC focal points.
•Support the National Nutrition Program (PNN) to plan, coordinate, facilitate, and report on activities by
PEPFAR and other partners to provide or improve nutritional care and support for adults and children living
with or affected by HIV/AIDS (including OVC), as well as to build PNN capacity to fulfill these functions.
•Establish a regional pool of trainers on nutrition and HIV. These trainers will be in charge of in-service
training for health workers.
•Participate in regional and international meetings and training.
To promote capacity building (training and human resources), the MOH will develop a training plan for care
providers in collaboration with partners such as the DFR, Abt Associates, and JHPIEGO. The MOH will set
up a tracking system to ensure the effectiveness of this plan. To support training efforts, an online
documentation center will be put in place. The MOH will participate in national and international meetings to
remain relevant and current on HIV/AIDS policies and implementation. More specific capacity building
activities will include:
•Engaging technical assistance from national and international technical assistance providers.
•Conducting appropriate training for PNPEC personnel (in areas such as English, strategic information, and
management).
•Developing a website to ensure a broad diffusion of guidelines and documents.
•Subscribing to international scientific journals to increase access to current HIV/AIDS information.
•Providing PNPEC personnel with the opportunity to obtain online master's degrees.
•Conducting on-site training and coaching with the regional pool of trainers to contribute to improving the
quality of services and accelerate the scale-up of HIV activities.
•Developing a countrywide certification for trainers.
•Conducting training in Ethiopia for five lab managers and a PNEPC lab focal point on laboratory
management.
To improve planning, the MOH will conduct the following activities:
•Adapt the extension plan in collaboration with the districts and partners.
•Assist the districts to develop their microplans.
•Revise the operational plan based on the existing resources within the districts.
Activity Narrative: •Revise the monitoring and evaluation plan with the support of Measure and the DIPE.
To support the Department of Decentralization within the MOH, the Ivorian government passed a law in
2003 that devolved responsibility for various sectors from the central government to local government
authorities. As a result, management of health services became the responsibility of regional and local
councils. Operationalization and decentralization have been challenging tasks because of inadequate
knowledge of actors in the field and poor collaborative practices. As HIV services are further scaled up in
Côte d'Ivoire, the capacity of local and regional authorities to provide management and oversight of care
and treatment programs will be essential. The decentralization unit of the MOH (SASED) has developed a
three-pronged approach, involving regional, district, and local health authorities. In collaboration with Abt
Associates, SASED will train various actors on the implications of decentralization. Subsequent activities
targeting various regions and districts will be proposed depending on the prevailing political climate.
With FY09 funding and assistance from Abt Associates, the MOH will:
•Conduct a rapid analysis of decentralization and the management of social services (health) by
decentralized entities in Côte d'Ivoire.
•Develop a framework for collaboration between MOH and the decentralized units.
•Train MOH staff on the implications of decentralization for priority health programs.
•Collaborate with 10 districts and two regions to elaborate health development plans.
Continuing Activity: 15136
15136 5056.08 HHS/Centers for Ministry of Health, 7056 5301.08 MOH- CoAg $500,000
10372 5056.07 HHS/Centers for Ministry of Health 5301 5301.07 MOH- CoAg $500,000
5056 5056.06 HHS/Centers for Ministry of Health 3604 3604.06 Ministry of $100,000
Estimated amount of funding that is planned for Human Capacity Development $750,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
Table 3.3.18:
