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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
- The period of this proposal is for one year.
-The main focus in FY09 will be on consolidating and ensuring the quality of existing activities,
-Institutional support will be provided to the national network of religious leaders ARSIP, with training on
gender sensitivity and an emphasis on greater participation of female community leaders and religious
actors.
- A national BCC training manual adapted for the religious community, including a family approach to HIV
prevention involving parents, will be used by religious, community, and other leaders.
- Efforts will be made to reach more peri-urban and rural areas.
- Supervision visits will be made in collaboration with IRC to health-care providers trained in gender-based
violence (GBV) response in FY05-08. IRC will also be provided a subgrant to extend prevention activities in
the West with a focus on GBV prevention.
- Care will work with the national networks RIP+, COSCI, and ARSIP to create regional NGO coordination
networks in the new hub sites Duekoue and Bouna.
-CARE will leverage existing relationships with migrants in Abidjan and in the CNO zones to conduct
prevention activities.
FY09 NARRATIVE
This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the
expansion of culturally appropriate HIV/AIDS prevention and care interventions that target populations in
northern and western Côte d'Ivoire, where health-care services have been severely disrupted since civil
conflict split the country in 2002. With the socio-political situation now improving, FY09 will see the
increased presence of government actors and health care workers returning to the "CNO" zone.
With FY09 funds, Care will continue to provide sub-grants to Caritas, REMCI, and three other local NGO
prevention partners that promote HIV prevention, including abstinence and faithfulness, through
sensitization activities. These partners will oversee AB activities in five "hub" sites of Bouake, Korhogo,
Man, Bouna, and Duekoue as well as in nine satellite sites targeted by the project, with efforts placed on
also reaching out to more semi-urban and rural areas. CARE will provide the International Rescue
Committee (IRC) with funds to conduct AB prevention activities in the West, with a focus on prevention of
gender-based violence (GBV) and the promotion of girls' rights.
Care will continue to work with regional HIV/AIDS NGO coordination networks, whose main responsibility is
coordinating local NGO actors, to ensure a continuum of HIV care and support. These networks will be
encouraged to work closely with and facilitate the ongoing decentralization of activities by the ministries of
the Fight Against AIDS (MLS), Health (MOH), and Family and Social Affairs (MFFAS).
AB prevention interventions include targeted BCC campaigns involving religious and traditional leaders in
the community as well as teachers and peer educators in schools. Messages are designed to a) encourage
the delay of sexual debut among youth, b) promote mutual fidelity, c) decrease inter-generational sex,
sexual coercion, and gender-based violence, d) decrease multiple sexual partnerships, and e) promote HIV
counseling and testing. Small-group communication methods take place in community settings, schools,
mosques, and churches and are reinforced by radio messages in local languages. A family approach to
prevention will be used by religious, community, and other leaders, meaning efforts will be made to address
issues with both parents and children, using experiences from Hope Worldwide and the new training
module on strategies for teaching parents how to address sexual education with their children.
Institutional support will be provided to ARSIP, with training on gender sensitivity and an emphasis on
greater participation of female religious and community actors. ARSIP will be reinforced with the hiring of
regional representatives for Man, Korhogo, Bouake, and Bouna, who will be based at either REMCI or
Caritas offices and who will focus on the coordination of religious actors in those areas.
Working in areas where the Ministry of Education (MEN) hopes to extend its PEPFAR-supported prevention
interventions for students, Care will continue to collaborate with the MEN to implement the life-skills
curriculum, which delivers age-appropriate abstinence messages to younger children, abstinence-and-
fidelity messages to older children, and educational messages to all children about making smart choices,
gender inequity, and the prevention of GBV.
Adults and older youth with regular partners will be encouraged to get tested as a way to increase
commitment and faithfulness within the couple.
With the help of JHU/CCP, Care partners will use culturally appropriate BCC strategies, and sensitization
materials with AB and gender messages (including gender-role discussions for boys and young men). Peer
education activities will also continue with afterschool health clubs, where prevention messages will be
linked with CT promotion messages and paired with "go and see" visits to local CT sites.
To reach rural populations, Care will ask partners to identify and train community health workers to deliver
BCC interventions. Care will continue to negotiate with local radios to provide lower-cost airtime to allow
regularly scheduled prevention message presentations, which peer education groups will be able to listen
to. Care will work with ANADER to develop a strategy to reach village chiefs, youth leaders, and other
"opinion catalysts" who influence general perceptions and attitudes. An emphasis will be placed on working
with women leaders.
Care will work with IRC to support partners with training on gender sensitivity so they can address cultural
factors that perpetuate the spread of HIV, including GBV. Care will emphasize working with religious
partners and the Fondation Djigui to campaign against female excision, a wide-spread practice in the CNO
zones and a possible source of HIV infection due to the unhygienic conditions under which it is often
practiced. A visit of successful programs in South Africa ("Mutual Monogamy" and GBV prevention) will
inform this campaign. Based on experiences of EngenderHealth, Care will ask IRC to conduct pilot efforts
Activity Narrative: using the Men as Partners (MAP) approach, which consists of workshops with men and mixed groups to
promote gender equality by challenging gender roles that equate manliness with a range of risky behaviors
such as violence, alcohol use, multiple sex partners, and domination over women. Care will encourage
positive male involvement in HIV prevention at the grassroots level through religious and other partners.
The MAP approach will be evaluated and, if effective, will be integrated into other prevention partners'
programs.
Care will also work to consolidate economic support activities put in place in FY08. Target populations will
include young and out-of-school girls and women. Village savings and loan groups, after a minimum of nine
months of successful functioning, will be provided with technical support to implement income-generation
activities to address a root cause of transactional sex and HIV vulnerability. This strategy, in use for 15
years by Care in Niger and Mali, is a crucial element of Care's HIV prevention strategy.
Project activities will be coordinated through national, regional, and district forums, including decentralized
Ministry of AIDS (MLS) units (CTAILs) established in Bouake, Korhogo, and Man. ARSIP will hire regional
coordinators to work specifically to ensure cooperation and planning among religious actors. Project
activities will also be coordinated with other Care projects, including the Global Fund-supported OASIS HIV
project. The joint work plan will be updated to avoid duplication and enhance synergies. In addition, the
PEPFAR-funded CARA project will take over support of some local partners previously supported by the
Global Fund-supported PREMA project to help ensure the continuation of services as the PREMA project
ends and the GF OASIS project continues with only treatment activities.
All Care HIV projects will emphasize the prevention, identification, treatment, and care of malaria among
HIV-affected and -infected populations and to the extent possible will be coordinated with the Round 6 and
Round 8 Global Fund Malaria projects.
Using FY09 funds to consolidate activities with a focus on quality assurance in Bouake, Korhogo, Man,
Bouna, and Duekoue, the project will reach at least 150,000 people with AB prevention messages and train
at least 630 people to provide AB prevention outreach between April 2009 and March 2010. Activities will
include:
1. Provide sub-grants to Caritas, REMCI, and local NGO prevention partners to support school-based AB
activities in 10 previously selected schools per zone (40 schools in Bouake, Korhogo, Man, and Duekoue).
Teachers in schools (80 total) and 10 peer educators per school (400 total) who were trained in FY08 will
receive supervision visits to ensure the quality of age-appropriate interventions using the MEN's life-skills
curriculum.
2. Provide institutional capacity support to ARSIP with an initial evaluation to identify strengths/weaknesses,
an action plan for capacity building outlining technical, administrative, and project management training
needs, plus resources to support representatives in Bouake, Korhogo, Man, and Bouna.
3. Provide a sub-grant to ARSIP to ensure coordination and supervision of religious actors, including 90
religious leaders trained in HIV prevention in FY08; adapt the national BCC training manual for the religious
community; conduct training of 20 more religious leaders per zone (120 total, including Abidjan); and
conduct two coordination meetings for religious leaders. (120)
4. Provide sub-grants to three local NGOs to conduct BCC peer-education sessions that promote AB
messages and strengthen community responses against stigmatization, discrimination, and GBV, including
female excision.
5. Work with JHU/CCP and the MLS to develop campaign materials for use by Caritas, ARSIP, and REMCI
in support of religious partners promoting AB sensitization and teaching tolerance and stigma reduction. At
least 500 more copies of a peer-educator book (developed in FY08) and 8,000 copies of two new posters
will be produced and distributed.
6. Translate and disseminate AB messages in local languages to ensure cultural appropriateness and
visibility, to use on printed IEC material
7. Provide refresher training to at least 30 "promoteurs de groupe" on the village savings and loan
methodology and simple accounting. (30)
8. Conduct formative supervision visits with IRC, UNFPA, and PNSR (the national reproductive health
program) to oversee health-care providers trained in FY08 on GBV response.
9. Conduct supervision visits to 20 health-care providers in the Bouna area trained in FY08 to provide
treatment and care of cases of GBV (rape, incest, abuse, excision).
10. Conduct supervision visits to 10 local police officers in each zone trained in FY08 on how to prevent and
respond to cases of GBV.
11. Conduct joint supervision visits each semester with the MLS and the Ministry of Health's community
health department (DSC) to ensure quality of prevention activities.
Standardized supervision tools will be revised and used by Care staff as part of an emphasis on tracking
improvement in partner capacity. A research expert will focus on monitoring and evaluating the impact of
the project. Care will hire a higher-level subgrants manager who will focus entirely on providing staff the
tools and training necessary to measure institutional capacity-building efforts for local partners.
A final evaluation will be conducted to assess project achievements and impact. Care will pilot behavior
change assessment efforts through KAP questionnaires administered to randomly selected peer-education
Activity Narrative: participants at the beginning and end of each cycle of sensitizations (usually 10 weeks).
Care is working closely with the MOH and MLS to help with the redeployment of their staff in conflict-
affected zones. Care collaborates with CTAILs in the North and is including PNPEC representatives during
joint supervision visits to CT sites and care partners to ensure that they are registered and validated by the
MOH. Care is also supporting district-level health reporting through Internet installation/support and USB
keys.
Care incorporates flexibility into its partnerships with local NGOs to avoid dependency and encourage
autonomy. A strong accent is placed on training of trainers and regular instructive supervision so that
necessary technical skills are transferred to local partner staff. Subgrant managers with financial
backgrounds have been hired and continue to support partners with budgeting and financial justification on
site. Care is also emphasizing the development of project-writing skills so that partners can apply directly for
funding in the future. Institutional capacity building will continue through equipment purchases (including
motorcycles and computers) and linking of partners into the national commodities circuit. Care will also
continue to link local organizations with district health authorities by facilitating quarterly supervision visits
and ensuring that service provision sites are monitored and authorized by national authorities.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15103
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15103 4995.08 HHS/Centers for CARE 7042 5316.08 Rapid $720,000
Disease Control & International Expansion North
Prevention West: RFA
#AAA070 North
&West of CI
9941 4995.07 HHS/Centers for CARE 5316 5316.07 Rapid $450,000
4995 4995.06 HHS/Centers for CARE 3536 3536.06 Rapid expansion $300,000
Disease Control & International North West:
Prevention RFA # AAA070
North & West of
CI
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Health-related Wraparound Programs
* Malaria (PMI)
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $200,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $25,000
Education
Estimated amount of funding that is planned for Education $25,000
Water
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
-The period of this proposal is for one year
- The main focus in FY09 will be on consolidating and ensuring the quality of existing activities.
- Supervision visits will be made to providers and partners trained during FY05-08.
- Care will work with national networks RIP+, COSCI, and ARSIP to create regional NGO coordination
networks in Duekoue and Bouna.
- Support to local partners previously supported by the Global Fund Project PREMA will be added in FY09
(AFESFAC in Korhogo, Jekawili in Bouake, and ODAFEM in Man).
- Care will provide a subgrant to IRC for conducting HIV prevention activities, focusing on GBV prevention
-Community health agents (ASC) will be selected and trained in basic HIV/STI prevention using IEC/BCC
techniques to reach more rural areas.
- Care will reinforce support groups for PLWH/A and help bring groups together to work against
stigmatization.
- Care will build upon its relationship with migrant communities in Abidjan to conduct HIV prevention
activities with populations from Niger, Burkina, Ghana, Guinee, and Nigeria and sex workers in Port Bouet,
Abobo, and Adjame and the CNO zones.
conflict split the country in 2002. With the socio-political situation improving, FY09 will see the increased
presence of government actors and health-care workers returning to the CNO zone.
With FY09 funds, Care will continue to provide sub-grants to local partners that conduct prevention activities
focusing on condom distribution and education and other types of HIV prevention. These "primary" partners
will oversee OP activities in the five "hub" sites of Bouake, Korhogo, Man, Duekoue, and Bouna as well as
in nine satellite sites and rural areas targeted by the project.
In addition, Care will leverage its relationships in Abidjan to add prevention activities within the high-risk
communities of migrant workers from Niger, Nigeria, Burkina Faso, Ghana, and Guinee residing in Port
Bouet, Abobo, and Adjame. While far from home and away from social networks, these workers engage in
high-risk sexual activity, often with professional sex workers, thus placing themselves and their families at
risk of HIV infection. Care has developed strong ties with these communities over the past three years and
will begin using PEPFAR funds to work to support local efforts by the newly created NGO known as the
Angels of the Migrants, a grassroots effort by migrants to begin addressing the health concerns of their
populations. Care will work with peer educators to conduct small-group sensitizations with Imams, women,
community health agents, youth, matrons, and traditional healers or "barbeurs" who often perform
circumcisions in dangerous conditions.
In its primary intervention area (North and West), Care will coordinate with the national networks RIP+
(PLWHA organizations), COSCI (HIV/AIDS organizations), and ARSIP (religious leaders) to create regional
NGO coordination networks in Duekoue and Bouna. Care will work with both new and existing networks to
improve their functioning to ensure a continuum of HIV care and support. These networks will be
encouraged to work closely with and facilitate the decentralization of activities by the ministries of AIDS
(MLS), Health (MOH), and Family and Social Affairs (MFFAS).
OP interventions with FY09 funds will include targeted BCC campaigns involving religious and traditional
leaders in the community as well as teachers and peer educators in schools. Messages will be designed to:
a) Encourage the correct and consistent use of condoms for groups engaging in high-risk behavior
c) Promote HIV counseling and testing, including mutual testing for couples
d) Promote positive prevention for PLWHA
e) Decrease inter-generational sex, sexual coercion, and gender-based violence
Small-group communication methods (peer-education sessions in and out of schools, local leader
sensitizations, and debates/discussions) will be used in community settings, schools, mosques, and
churches. Partners will focus on the gender aspects of prevention, tailoring messages to particular
audiences, and ensuring that girls and women receive appropriate and correct information. To reach rural
populations, Care will continue to identify and train active community health workers to deliver BCC
interventions. Care will be advised by ANADER on the best methods for reaching village chiefs, "queen
mothers," youth leaders, and other "opinion catalysts" who influence general perceptions and attitudes.
Working in areas where the Ministry of Education (MEN) has not yet extended its prevention interventions
for students, Care will continue to collaborate with the MEN to implement the life-skills curriculum (based on
the Peace Corps curriculum), which delivers age-appropriate prevention messages to children and youth,
including instruction on the use of condoms for older, sexually active youth and gender sensitivity training as
part of a comprehensive ABC approach.
With the help of JHU/CCP, Care partners will apply culturally appropriate BCC strategies and sensitization
materials, including condom promotion. Programs focusing on prevention activities with peer educators will
continue in schools (both religious and secular) and will include explanations of strategies for negotiating
sex and condom use as well as gender messages (including gender-role discussions for boys and young
men).
Positive prevention efforts will take a family approach, targeting not only PLWHA but also those in their
immediate environment with prevention education messages, access to condoms, and referral to CT sites.
Activity Narrative: Care will also continue to grow nascent prevention activities with private companies, focusing on coffee and
cocoa plantations in the West, cotton and sugar plantations in the North, and large transport companies in
the center. The Care model for HIV workplace programs involves an HIV committee responsible for
conducting appropriate prevention activities within the company. Prevention activities will focus on areas
surrounding large factories, mines, etc., where transactional sex is frequent. Care and the business
association CECI will work together to coordinate this effort.
Care will work with IRC to introduce programming in response to results of ongoing research on the effects
of gender on HIV vulnerability. Although specific actions will need to be determined based on research
results, likely activities will include targeted prevention and mobilization activities to reduce women's
vulnerability based on socio-economic protective and risk factors; sensitizations of local partners and
leaders on the link between gender and HIV; increasing work with police to improve gender awareness
around issues of domestic violence, excision, and methods to protect the rights of women and girls; and
potential advocacy activities at the national level to reinforce policies that will protect girls' and women's
rights.
Care will also expand efforts to grow the economic self-sufficiency of women and girls through support of
village savings and loan groups put in place by Care's transversal POWER Project in FY07-08. Members of
groups include sex workers, youth, and PVVIH. Village savings and loan groups, once functional for at least
nine months, may be provided with support to identify feasible income-generation activities to allow more
economic independence and thus address a root cause of transactional sex and HIV vulnerability.
Care will also continue to support efforts with FHI to train local prevention partners to provide prevention
services (with psychosocial support and counseling) adapted to sex workers and will facilitate exchange
visits for partners at an FHI-supported site (RSB Bouake) with experience in this area. Care field staff will
supervise peer educators on a monthly basis to provide guidance and feedback on the quality of
sensitization sessions. In addition to working in bus and train stations in Bouake, Korhogo, Ferke, and other
sites, Care will coordinate with PSI to ensure that truck drivers are included in prevention activities by local
partners.
To enhance links between prevention and facility-based services, Care's prevention partners will be
required to conduct regular sensitizations at CT and treatment sites.
Project activities will be coordinated through relevant national, regional, and district forums, including MLS
decentralized coordination units (CTAILs) in each hub site. Activities will be coordinated with other Care
projects, including the Global Fund-supported HIV Round 2 project (OASIS), as well as the Solidarity
Against AIDS Project in Abidjan. The joint work plan will be updated to avoid duplication and enhance
synergies. The PEPFAR-funded CARA project will expand into PREMA sites, with partners that are already
operational, as the PREMA project is ending in early FY09.
HIV-affected and -infected populations and will be coordinated with the Round 6 Global Fund Malaria
project.
Using FY09 funds to consolidate activities in satellite sites around Bouake, Korhogo, Man, Bouna, and
Duekoue zones, the project will reach at least 120,000 people with prevention messages and train at least
835 people on OP-related strategies between April 2009 and March 2010. Activities will include:
1. Provide sub-grants to at least four local NGOs to support school-based ABC activities in 10 new schools
per zone (40 schools). Teachers in schools (80 total) and 10 peer educators per school (400 total) will be
trained to provide age-appropriate ABC information using the MEN's life-skills curriculum (based on the
Peace Corps curriculum).
2. Provide sub-grants to five local NGOs to support prevention activities that focus on highly vulnerable
populations.
3. Train 120 traditional/religious leaders (in urban, rural, and migrant communities) to conduct community-
based BCC sessions/sensitizations that promote OP messages.
4. Train 50 community health agents in an effort to reach more rural areas.
5. Train 30 people to provide Other Prevention outreach with a focus on gender issues.
6. Support 50 (10 per zone) representatives of PLWHA peer-support groups with training and materials to
continue positive-prevention and advocacy activities with their groups.
7. Translate and disseminate OP messages in local languages in collaboration with JHU/CCP to ensure the
visibility and cultural appropriateness of messages in each project site.
8. Provide refresher training for at least 30 "group promoters" on the village savings and loan methodology
and simple accounting, followed by support for the development of group-based income-generating
activities.
9. Follow-up supervision visits to counselors, health workers, and police provided with GBV prevention
training in FY07-08 will be provided through a subgrant to IRC..
10. Continue to provide support to three private companies per zone with HIV prevention-in-the-workplace
efforts, coordinated with CECI. Training will be provided for five persons per company (75 persons in 15
companies).
11. Continue follow-up of 45 condom kiosks.
12. Conduct joint supervision visits each semester with the MLS and the MOH's community health
department (DSC) to ensure the quality of HIV prevention activities.
Care will continue to adapt its M&E plan and evaluate prevention activities, possibly adding new indicators
to help measure quality, based on discussions with PEPFAR and the new PEPFAR partner in this area, and
using national tools. Standardized supervision tools will be revised based on FY08 experiences and will be
used by Care staff as part of an emphasis on tracking the evolution of partner capacity. Care's research
coordinator will focus on evaluating the impact of the project during this last year of the project. Care will
work with PEPFAR to determine the best methods for evaluating the effectiveness of behavior-change
Activity Narrative: efforts. Ideas include training technical assistants to conduct focus-group discussions each quarter to
assess client satisfaction and community response to prevention activities and to use questionnaires to
assess KAP indicators for prevention participants before and after a 10-week cycle of OP peer education.
Care will continue to work closely with national coordination bodies, including the relevant ministries (MLS,
MOH), to help with the redeployment of staff and the reinforcement of activities in the CNO zones.
Supervisory visits will be conducted with MLS and MOH representatives to ensure awareness of project
partners and activities. District-level offices will be supported with Internet capability and USB keys to help
enable the collection and transfer of national health data. Regional and district health directors will continue
to be included in quarterly supervision visits and coordination meetings.
Care will hire a higher-level subgrants manager who will focus on providing staff the tools and training
necessary to measure institutional capacity building. Particular emphasis will be placed on building
administrative capacity among local partners to increase their autonomy as the project nears its end.
Continuing Activity: 15104
15104 5016.08 HHS/Centers for CARE 7042 5316.08 Rapid $435,000
9944 5016.07 HHS/Centers for CARE 5316 5316.07 Rapid $445,000
5016 5016.06 HHS/Centers for CARE 3536 3536.06 Rapid expansion $100,000
* Child Survival Activities
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $100,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
and Service Delivery
Table 3.3.03:
- Particular emphasis will be placed on advocacy with the MOH and on support for reference hospitals to
increase the availability of CD4 tests and other "bilan" tests for PLWHA.
- Refresher training for home-based care providers will focus on OI diagnosis and treatment, ART
adherence, and positive prevention.
- Care will provide increased supervision and support for PLWHA social support groups.
- Care will leverage its relationships with migrant communities in Abidjan to conduct care activities with HIV-
positive people from Niger, Burkina, Guinee, Ghana, and Nigeria and sex workers in Port Bouet, Abobo,
and Adjame
rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target
underserved populations in northern and western Côte d'Ivoire, where health-care and other government
services have been severely disrupted since civil conflict split the country in 2002. With the socio-political
situation improving, government actors and health-care workers are expected to return to the region,
requiring good coordination with civil-society actors who have developed a strong presence since 2002.
Care provides sub-grants and capacity-building assistance to local partners to provide care services in five
hub cities (Bouake, Korhogo, Man, Duekoue, and Bouna/Bondoukou) and nine satellite sites. Care and
support services are provided at the community and home levels by local NGOs and at local health centers
by health-care workers. Care's strategy is to identify and serve care and support clients by ensuring
effective linkages between project care and support partners and public and private HIV and TB treatment,
PMTCT, and testing sites, as well as OVC and HIV prevention partners working in the community, such that
anyone identified as HIV+ will have timely access to the full spectrum of diagnostic and follow-up care.
In FY09, Care will advocate for increasing the availability of CD4 and other "bilan" tests at reference
hospitals to eliminate a major barrier to appropriate care and treatment for PLWHA. According to the
national protocol, a CD4 count is required before ART can begin, and limited availability of CD4 testing
results in high "lost to follow-up" rates. Additional technicians at the regional reference laboratory, increased
availability of additional laboratories, and regular maintenance of lab equipment would contribute to
reducing this barrier.
Care trains health workers and community counselors to provide home-based care and follow-up, including
psychosocial support for patients and family members, ART adherence support, and preventive-care
education and materials (including counseling for positive prevention). Care also provides cotrimoxazole,
water-purification sachets, and insecticide-treated bed nets free of charge to care partners. Care plans to
provide refresher training on the diagnosis and treatment of OIs for home-care providers in FY09.
Wrap-around nutritional support, complemented by nutrition education, will continue to be provided in
partnership with the World Food Program, based on availability of food from WFP.
In FY09, Care will also leverage its relationships in Abidjan to add care and support activities within the high
-risk communities of migrant workers from Niger, Nigeria, Burkina Faso, Ghana, and Guinee residing in Port
Bouet, Abobo, and Adjame. While waway from home and social networks, these workers engage in high-
risk sexual activity, often with professional sex workers, thus placing themselves and their families at risk of
HIV infection. Moreover, this marginalized group faces linguistic, cultural, and social barriers to obtaining
services and accurate information. Care will use its strong ties with these communities to continue efforts
with the local NGO Angels of the Migrants to address the health concerns of their population. Using the
same methods and tools as in its primary intervention areas (North and West), Care will work with
community health workers to conduct home-based care visits and promote access to quality care and
support services and follow-up.
Care will continue to reinforce regional HIV/AIDS NGO coordination networks to ensure a continuum of
care. Care will also continue to facilitate decentralization by the Ministry of AIDS (MLS), the Ministry of
Health, and the social centers and National OVC Program (PNOEV) of the Ministry of Family, Women, and
Social Affairs (MFFAS).
Care and support activities will complement and build on other PEPFAR-funded work, including policy and
guidelines for clinic- and home-based care as well as HIV prevention, care (including OVC care), and
treatment activities by ministries (AIDS, Health, Education, Social Affairs) and other partners (PSI, EGPAF).
District and regional health directors will be asked to take the lead in quarterly supervision visits to ensure
ownership of community care and support activities by MOH officials.
Care, the principal recipient for the 2nd Phase of the Global Fund Round 2 HIV project OASIS, expects to
increase its care and support caseload by linking with newly reinvigorated ART sites, established with GF
and PEPFAR support. Systematic referral for HIV testing of partners and family members of HIV+ clients
will be emphasized.
Care will continue to work with the national PLWHA network (RIP+) to support NGO partners in establishing
PLWHA peer-support groups and village savings-and-loan activities put in place in FY07/08. Peer-support
groups indicating interest will be trained in the savings-and-loan methodology and, after a minimum of nine
months of successful functioning, will be supported with an opportunity to conduct group income-generating
activities, to reinforce their resilience to the effects of HIV on their households.
Activity Narrative: The project will mobilize communities around the use of CT, ART, and STI services and will continue to
ensure the availability of these services at 23 health-care provision sites. Care will support health centers
(NGOs and public) with training, medicines, and other equipment (bed nets, water-purification products,
condoms, etc.). Training will be conducted by the regional pool of trainers using the national palliative care
module, which will include a week of practice with Hope Worldwide. Special attention to addressing gender
issues will help ensure equal access to care and support services.
Training-of-trainer methods were emphasized in FY06-08 to give NGOs the capacity to train community-
care groups, clinic staff, and counselors. A joint supervision visit will be planned each semester with PNPEC
representatives to review the quality of community-based care and support activities.
Project activities will be coordinated with other Care projects, including Phase 2 of the Global Fund-
supported HIV and Malaria projects. The joint work plan will be updated to ensure that projects are
complementary and avoid overlap. The PEPFAR-supported CARA project will begin to support GF Round 5
PREMA project partners in preparation for the end of the project in early FY09. All Care HIV projects will
emphasize the prevention and treatment of malaria among HIV-affected/infected populations and will be
coordinated with the GF Round 6 and Round 8 Malaria Projects.
In coordination with JHU/CCP, Care will support the network of religious leaders (ARSIP) to train religious
leaders and to bring them together each quarter to promote common HIV prevention and care strategies,
including spiritual care for PLWHA and advocacy against stigmatization, based on the spiritual care training
module developed in FY08.
In all, FY09 funds will support care and support services to at least 8,000 people at 23 sites and train 80
people to provide quality care and support between April 2009 and March 2010. Activities will include:
1. Sub-grants to ensure that 23 health structures and local NGOs provide care and support services (five
main partners and three day hospitals in hub cities, plus partners in nine satellite sites, three rural sites, and
three "maisons de transit").
2. Training of 80 health workers on palliative care, OI diagnosis and treatment, and OVC identification,
followed by a week of practicum with Hope Worldwide.
3. Supervision visits to 120 health personnel and trainers trained in FY05-08.
4. Provision of medicines for OI treatment to all 23 health structures and NGOs.
5. Regular supervision with district and regional health authorities and PNPEC for health personnel trained
in care and support in FY05-08.
6. Continued support for village savings-and-loan activities for at least 200 PLWHA and their families.
7. Wraparound nutritional support in partnership with WFP, complemented by nutrition education and food
preparation demonstrations for and by food distributors.
8. Three exchange visits between NGOs and Hope Worldwide to facilitate practical learning of palliative
care techniques and the sharing of best practices.
9. Support for three "transit houses" (in Man, Bouake, and Korhogo) that provide refuge, psychosocial
support, and referral for rural PLWHA in town for doctor consultations or support-group meetings. The
transit house in Man may be constructed on land donated by the local prefect, to ensure sustainability.
11. Participation in a coordinated advocacy effort with PNPEC, Hope WW, and RIP+ (national network of
PLWHA organizations) to promote the harmonization of care and support tools and the availability of
appropriate palliative care drugs.
Care will report to the USG strategic information team quarterly program results and ad hoc requested
program data. To participate in the building and strengthening of a single national M&E system, Care will
participate in quarterly SI meetings and will implement decisions taken during these meetings. A final
evaluation will be conducted at the end of the project to assess overall project achievements.
Care works closely with the MOH and Ministry of AIDS to help with the redeployment of staff in conflict-
affected zones, including joint supervisory visits and support for district-level health reporting staff (CSE)
with USB keys and Internet connections to ensure the collection and transfer of monthly reports.
Standardized supervision tools will be revised based on FY08 experiences and used by Care staff as part of
an emphasis on tracking the evolution of partner capacity in care and home visits. Particular emphasis will
be placed on ensuring that home visits include appropriate medical services. Care's research coordinator
will focus on evaluating the impact of the project, including the possible addition of indicators to measure
quality.
Care will hire a high-level subgrants manager to focus on providing staff the tools and training necessary to
measure institutional capacity building for local partners. Care incorporates flexibility into its partnerships
with local NGOs to avoid dependency and encourage autonomy. A strong accent is placed on training of
trainers and regular instructive supervision so that necessary technical skills are transferred to local partner
staff. Subgrant managers with financial backgrounds have been hired and continue to support partners with
budgeting and financial justification on site. Care is also emphasizing the development of project-writing
skills so that partners can apply directly for funding in the future. Institutional capacity building will continue
through equipment purchases (including motorcycles and computers) and linking of partners into the
national commodities circuit. Care will also continue to link local organizations with district health authorities
by facilitating quarterly supervision visits and ensuring that service provision sites are monitored and
authorized by national authorities.
Continuing Activity: 15105
15105 5040.08 HHS/Centers for CARE 7042 5316.08 Rapid $470,000
9945 5040.07 HHS/Centers for CARE 5316 5316.07 Rapid $300,000
5040 5040.06 HHS/Centers for CARE 3536 3536.06 Rapid expansion $150,000
Estimated amount of funding that is planned for Human Capacity Development $75,000
Estimated amount of funding that is planned for Economic Strengthening $50,000
Estimated amount of funding that is planned for Water $10,000
Table 3.3.08:
- The main focus for FY09 will be on consolidating and ensuring the quality of existing activities by following
national strategies for training local OVC partners.
- Supervision visits will be made with the National OVC Program (PNOEV) to providers and partners trained
during FY05-08.
- Care will work with social centers with the promotion of the platform approach for OVC support
coordination
- Care will leverage its relationships with migrant communities in Abidjan to conduct OVC support activities
with children from Niger, Burkina, Guinee, Ghana, and Nigeria living in Port Bouet, Abobo, and Adjame and
the CNO zones.
- Care will pilot the use of the Child Status Index to assess needs of OVC
- Care will take over support of approximately 3 000 OVC previously supported by Alliance through
subpartners in the CNO zone.
COMPLETE NARRATIVE
services have been severely disrupted since civil conflict split the country in 2002.
Working under the coordination of the National OVC Program (PNOEV), Care provides sub-grants and
capacity-building assistance to local partners to provide OVC identification and care according to national
guidelines in five hub cities (Bouake, Korhogo, Man, Bouna, and Duekoue) and nine satellite sites. In FY09,
Care will add partners (AIPS in Bouake and Afrique Espoir Vie in Man) previously supported by the PREMA
project (Global Fund) and Solidarity Against AIDS Project (EU), both ending this year. Care will also
continue funding certain NGOs previously funded through Alliance CI. With FY09 funds, Care will also
leverage its relationships in Abidjan to include OVC support activities within the high-risk communities of
migrant workers residing in Port Bouet, Abobo, and Adjame. Care will use its strong ties with these
communities to continue efforts by the Angels of the Migrants, a new NGO led by migrants, to begin
addressing the health concerns of their population. Using the same methods and tools as in its primary
intervention area, Care will work with local health care and social workers to identify OVC, assess their
needs, and conduct support and care visits to address specific needs of OVC and host families.
Care's OVC strategy is to identify and serve OVC and their families by ensuring effective linkages between
project partners and public and private HIV and TB treatment, PMTCT, and testing sites, as well as
palliative care and HIV prevention partners working in the community, such that anyone identified as HIV+
will have timely access to the full spectrum of diagnostic and follow-up care, including care and support for
their children. To do this, Care will ensure that a referral sheet with information about local OVC partners is
printed and available at each CT and palliative care site and that the 15 community counselors who are
based at CT sites have the resources to accompany new HIV-positive clients to palliative-care and OVC
partner offices for their initial visit. Care will make sure during regular supevision visits that referral sheets
are available in adequate supply and are used in CT, care, and OVC sites.
Care ensures that NGO partners receive training (based on national training modules produced by the
PNOEV), medicines, and other supplies (mosquito nets, water purification products, etc.) to provide to OVC
and their host families. Trainings will be based on the national training module created by the PNOEV,
which covers the provision of quality psychosocial, nutritional, educational, and judicial support with a
"family approach" and the identification and referral of childhood illnesses (anemia, malaria, malnutrition)
with an emphasis on prevention messages (the importance of clean water, hygiene, and nutrition
education). Care has two staff members, and has supported at least one member of regional training pools,
who are prepared to train others on the national OVC training module. In FY09, particular emphasis will be
placed on the provision of judicial and medical support, which have proved to be areas that need
improvement among partners.
Care will seek technical assistance for training of staff and partners on the use of the Child Status Index
tool, to improve assessment of OVC needs and ensure that priorities for assistance are established for each
individual child.
Care hopes to continue to work with the World Food Program (WFP) to provide wraparound nutritional
support for OVC and host families assessed as food-insecure, although the program may be reduced in
FY09 due to reduced WFP funding in Cote d'Ivoire. OVC requiring medical attention are referred to local
health centers, which have received refresher training in the diagnosis and treatment of childhood illnesses.
NGO social workers conduct school and home visits to assess and monitor the well-being of children. In
FY09, these social workers will receive basic training, based on the national community health worker
(ASC) training module, which includes basic information for diagnosing and care of medical issues, to
facilitate identification of health problems among children.
In FY09, Care will continue to reinforce regional HIV/AIDS NGO coordination networks to ensure a
continuum of care and facilitate the extension of services and coordination by the PNOEV of the Ministry of
Family, Women, and Social Affairs (MFFAS), as well as the Ministry of AIDS (MLS) and the Ministry of
Health's National HIV/AIDS Care and Treatment Program (PNPEC). To implement the PNOEV's "platform"
model of OVC activities coordinated around local social centers, Care's OVC coordinator, hired during
FY08, will work with the PNOEV to support the revitalization of MFFAS social centers in the North and
West, which were closed during the civil conflict. Specific support will be determined with the PNOEV but
could include further rehabilitation of social center structures, provision of materials and supplies (Internet
Activity Narrative: service installation, motorbikes) to allow social workers to effectively coordinate OVC support activities in
their zones, and requiring local NGOs to commit to participating in monthly meetings to discuss OVC
support and agree upon areas of responsibility. Care will place an emphasis on supporting the promotion of
social centers as the official "center" of platform coordination efforts.
Efforts will be made to support local partners in reaching more rural areas through the provision of
motorcycles and more funds to cover transportation costs.
OVC activities will complement and build on other PEPFAR-funded work, including OVC policy and
guidelines as well as HIV prevention, care, and treatment activities by ministries (AIDS, Health, Education,
Social Affairs) and other partners. District health management teams will continue to be involved in planning
and supervision to maximize medical care services for OVCs.
As the principal recipient for the 2nd Phase of the Global Fund Round 2 National HIV Project (OASIS), Care
expects to increase its OVC caseload by linking with new ART sites to be established with GF and PEPFAR
support. Systematic referral for HIV testing of partners and family members of HIV+ clients will be
emphasized. Pediatric HIV care sites are limited, but Care will refer children identified through CT, OVC,
and prevention partners for appropriate care and treatment to the sites that exist and will work to ensure
that needed medical care is available for opportunistic infections and other basic illnesses, including support
for travel costs if required for the treatment of pediatric HIV cases.
Training-of-trainer methods were emphasized in FY07-08 to give partner NGOs the capacity to train and
monitor community-care groups and counselors. A joint supervision visit will be conducted each semester
with PNOEV representatives to review the quality of community-based OVC activities.
Project activities will be coordinated with other Care HIV projects, including the GF Round 2 Phase 2 HIV
project. A joint work plan will be used to ensure that projects are complementary. Care's PEPFAR project
will take over the support of partners previously supported by the Glocal Fund Round 5 PREMA Project, in
preparation for the end of PREMA in early FY09. All Care HIV projects will emphasize the prevention and
treatment of malaria among HIV-affected/infected populations and will be coordinated with the GF Round 6
and 8 Malaria Projects.
In coordination with JHU/CCP, CARE will support the network of religious leaders (ARSIP) to train religious
leaders and to promote common HIV prevention and care strategies, including spiritual care for PLWHA and
OVC and advocacy against stigmatization of OVC.
In support of the PNOEV's "platform" model, expanded funding will also allow the rehabilitation and support
of social centers where government social workers will work with local NGOs and service providers to
ensure that OVC receive appropriate care and support services. "Exchange visits" will be organized so that
social workers can directly observe how the "platform" model operates in other areas.
Care will integrate OVC activities into health promotion work conducted through HIV prevention efforts and
follow-up services at the hospital in Duekoue, with a new NGO partner there. Care will work with local
health authorities to determine the most effective way of ensuring OVC services in the zone.
Care will also continue to work to create "twinning" relationships with organizations conducting similar work
in other zones. "Exchange visits" will be financed by the project to allow project staff and partner
representatives to observe successful OVC care approaches, particularly with Hope Worldwide.
Care will support poverty-reduction and economic-support activities to build self-sufficiency for OVC,
including support for savings-and-loan and income-generating activities (described in AB and Other
Prevention narratives) for child-headed households and host families of OVC, through Care's transversal
POWER project. The project trains "group promoters" from local partners, who guide and support VS&L
groups put in place in FY0708, to help ensure sustainability.
In all, FY09 funds will support services for at least 10,500 OVC by September 2009 and 14,000 OVC by
March 2010, as well as training for at least 175 care providers between September 2008 and March 2010.
Activities will include:
1. Sub-grants and strong technical assistance and supervision to Caritas and seven local OVC partners,
including partners previously supported by Alliance National contre le SIDA.
2. Strengthening of the referral system linking OVC, CT, and prevention, care, and treatment providers, in
collaboration with the PNOEV and social centers.
3. Training or refresher training for 100 social workers and community counselors in OVC identification,
care, and support using a "family approach" and the Child Status Index, as well as in diagnosing HIV
infection and other illnesses in children.
4. Cross-training and use of all local partners' OVC caregivers in provision of palliative care, and vice versa.
5. Wraparound nutrition support with the WFP, as available, and refresher training for food-distribution
teams and care providers in nutrition-education methods and nutrition needs of PLWHA and children.
6. Purchase of drugs and commodities to prevent pneumonia, TB, malaria, and diarrheal disease in HIV-
exposed and HIV-infected children.
7. Provision of water-purification products, mosquito nets, and hygiene kit components to health structures
and NGO partners providing OVC care.
8. Regular supervision visits by PNOEV and Care OVC focal point to support field staff and health
personnel trained in OVC support in FY06-08.
9. Continued support and follow-up for peer-support groups of parents of OVC with village savings-and-loan
and possible income-generating activities.
Care will continue to follow the project M&E plan based on national and PEPFAR requirements and
contribute to the implementation of an integrated national M&E system. A final evaluation will be conducted
Activity Narrative: by an outside research group at the end of the project to assess overall project achievements.
National supervision tools will be revised based on FY08 experiences as part of an emphasis on tracking
the evolution of partner capacity. Care's new research coordinator will focus on monitoring and evaluating
the impact of the project. Care will work with PEPFAR, and the new PEPFAR partner in this area to
determine the best methods for evaluating the effectiveness of project activities. Care will hire a higher-level
subgrants manager who will focus on providing staff the tools and training necessary to measure
institutional capacity building. Particular emphasis will be placed on building administrative capacity among
local partners to increase their autonomy as the project nears its end.
Continuing Activity: 15106
15106 5044.08 HHS/Centers for CARE 7042 5316.08 Rapid $1,233,000
9938 5044.07 HHS/Centers for CARE 5316 5316.07 Rapid $800,000
5044 5044.06 HHS/Centers for CARE 3536 3536.06 Rapid expansion $300,000
Estimated amount of funding that is planned for Education $75,000
Estimated amount of funding that is planned for Water $5,000
Table 3.3.13:
-The period of this proposal is for one year.
- An operational assessment will be conducted in the region covered by Care to establish a "cartography" of
actors and to identify challenges and strategies to increase CT uptake.
-Efforts will be made to reach more peri-urban and rural areas.
- Subgrant to JHPIEGO for quality assurance and supervision visits to providers and partners trained during
FY05-08.
- Training of 80 health workers and counselors (medical and non-medical) on the promotion of CT services.
- Care will work with the national networks RIP+, COSCI, and ARSIP to create regional coordination
- Care will leverage its relationships with migrant communities in Abidjan to promote CT and to facilitate
access to CT services via mobile efforts for populations from Niger, Burkina, Guinee, Ghana, and Nigeria in
Port Bouet, Abobo, and Adjame as well as in the North and West zones.
underserved populations in northern and western Côte d'Ivoire, where health-care services have been
severely disrupted since civil conflict split the country in 2002. With the socio-political situation improving,
FY09 should see the increased presence of government actors and health care workers, which will require
coordination with civil-society actors that have developed a strong presence in the zone since 2002.
In FY09, planned activities will complement and build on other PEPFAR-funded efforts, including clinic- and
home-based care and OVC care, prevention, and treatment activities by ministries (AIDS, Health,
Education, Social Affairs), PSI, and EGPAF. Regular coordination will be pursued with EGPAF and PSI.
District health directors and teams will participate in quarterly formative supervision visits to NGOs and in
quarterly coordination meetings to maximize capacity-building and regular oversight by the Ministry of
Health. Care will also participate in the national process to develop a harmonized system for tracking the
quality of CT services, specifically by advocating for the validation of national supervision tools, which have
remained unofficial for more than two years.
With FY09 funds, Care will sub-grant to existing local partners, who will provide CT services and promotion
in five "hub" sites (Bouake, Korhogo, Man, Bouna, and Duekoue) and nine satellite sites, as well as in
migrant communities in Abidjan. Care will continue to reinforce regional HIV/AIDS NGO coordination
networks, including the creation of networks in Bouna and Duekoue, to ensure the coordination of services
and facilitate the northward extension of efforts by the Ministry of AIDS (MLS), the Ministry of Health's
National HIV/AIDS Care and Treatment Program (PNPEC), and the social centers and National OVC
Program (PNOEV) of the Ministry of Family, Women, and Social Affairs (MFFAS).
Beginning in FY09, Care will leverage its relationships in Abidjan to add CT promotion activities, and
facilitate access via mobile services for the high-risk communities of migrant workers from Niger, Nigeria,
Burkina Faso, Ghana, and Guinee residing in Port Bouet, Abobo, and Adjame. While away from home and
social networks, these workers engage in high-risk sexual activity, often with professional sex workers, thus
placing themselves and their families at risk of HIV infection. Moreover, this marginalized group faces
significant linguistic, cultural, and social barriers to obtaining accurate information. Care's experience with
this population, through EU-funded activities over the past three years, indicates that other projects
(PSAMAO, CORRIDOR) are not adequately reaching these groups. Care will use its strong ties with these
communities to continue efforts with the local NGO Angels of the Migrants to address the health concerns of
their population. Using the same methods and tools as in its primary intervention area (North and West),
Care will work with the local NGO that oversees peer educators to conduct small-group sensitizations with
imams, women, youth, and traditional healers, matrons and "coupeurs d'ongles" to promote the importance
of getting tested. Migrant-adapted services have been established with the Clinique de Confiance (for sex
workers and their partners), which employs translators on certain days to facilitate access to services for
migrants.
Care's CT strategies in FY09 will be to ensure quality of services at 15 existing sites (including client-
friendly reception, counseling, and referral), to ensure that lay personnel have the skills and materials to
conduct rapid testing, and that CT sites provide mobile outreach services as needed.. As the new national
HIV rapid testing algorithm is rolled out, Care will work with the PNPEC and PEPFAR to coordinate training
(including sending trainers to the field to train CT partner staff) and supervision. Care will also focus on
ensuring that lay counselors are at fixed sites to facilitate referrals to care and support service providers. To
avoid clients "lost to follow-up," the use of national referral tools is highlighted as a priority task in all partner
contracts.
Training-of-trainer methods were emphasized in FY07-08 to enable partners to provide continuous training
to their own staff, as well as formative supervision visits to other NGOs receiving sub-grants. To promote
CT services (including, when feasible, CT services delivered by community-based counselors), Care will
work with regional networks and religious and secular prevention partners to conduct mobilization activities
in urban, peri-urban, and some rural sites, focusing on traditional leaders, tradi-practitioners, and religious
actors to promote the use of CT services, especially for families, couples, and groups. Three private
companies per zone (15 total) will be supported to set up HIV committees that will promote prevention and
CT service use among employees.
Project prevention messages delivered through BCC methods are designed to encourage ABC prevention
as well as educate about the importance of using CT services and knowing one's sero-status. Small-group
communication methods (peer education sessions in and out of schools; with sex workers, youth, and truck
Activity Narrative: drivers; and during pre-sermon sensitizations) will be used in community settings, schools, mosques,
churches, train stations, etc. These activities will be reinforced by radio messages in local languages.
To reach rural populations with BCC activities, Care will ask partners to identify and train local community
health workers who will target "opinion catalysts" (village chiefs, imams, etc.) to influence community
perceptions and views on HIV testing. Care will work with ANADER to perfect this strategy.
In FY09, Care will increase testing numbers by working more closely with the national TB program to
ensure that all identified TB cases are tested for HIV. Care will work with regional health directors and
actors to advocate for routine testing at all health facilities. Exchange visits will be conducted between CT
partners in-country (e.g. visits to Clinique de Confiance to observe services targeting sex workers and
migrants) and will serve to review new strategies.
Project activities will be coordinated and planned with the Round 2 Global Fund HIV Project (OASIS) run by
CARE, which will install and support ART and CT sites in the project zones. The joint work plan for these
projects will be updated to avoid overlap. All Care HIV projects will also emphasize the prevention,
identification, treatment, and care of malaria among HIV-affected/infected populations and will be
coordinated with the Round 6 and 8 Global Fund Malaria projects.
FY09 CT activities will continue to support 15 CT service outlets, train 80 people to provide CT services,
and provide CT services to at least 18,000 people between April 2009 and March 2010. Specific activities
will include:
1. Provide sub-grants and technical assistance to local institutions/NGOs to reinforce, consolidate, and
improve quality at 15 existing CT sites, including training and coaching on the new finger-prick algorithm
and reinforcing community mobilization around these sites.
2. Support CT services-promotion in each of the three youth counseling centers put in place in FY07-08.
3. Provide training for 80 health workers (medical and non-medical) at both CT sites and care and support
sites to provide counseling and promotion messages with a focus on promoting couples counseling.
4. Provide technical assistance and supplies to support 18,000 on-site HIV tests with pre- and post-test
counseling.
5. Support the hiring of one person (preferably a PLWHA) at each CT site who will be responsible for
ensuring post-test support to all clients, including immediate referrals to post-test clubs, palliative care, and
OVC services. Post-test counseling for clients with sero-negative results will be emphasized as well.
6. Work with regional HIV/AIDS networks, prevention partners, and ARSIP to conduct mobilization activities
focusing on traditional leaders, tradi-practitioners, and religious leaders to promote the use of CT services,
especially for families, couples, and groups.
7. Conduct three joint "exchange visits" in-country with NGO partner and Care staff to facilitate sharing of
best practices in counseling and testing.
8. Negotiate with the National TB Program (PNLT) to ensure that all TB sites refer clients for CT services if
on-site CT services are not available.
9. Conduct joint supervision visits each quarter with district and regional health directors and each semester
with the National HIV/AIDS Care and Treatment Program (PNPEC) to ensure quality of CT activities. With
Care support, district health teams will be asked to take the lead for these activities, particularly the
oversight of laboratory quality.
Care will continue to adapt and follow the project M&E plan based on national and PEPFAR requirements
and tools and 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, Care will participate in quarterly SI
meetings and will implement decisions taken during these meetings. All CT partners will receive joint
supervision visits to be planned each semester with PNPEC, to review the quality of CT activities, including
lab services. A final evaluation is planned at the end of the project period to assess achievements vs.
expected results. Supervision tools are being revised for use by Care staff as part of an emphasis on
tracking improvement in partner capacity. Care will work to support PNPEC to validate CT supervision tools
and a low-cost training approach for the new finger-prick protocol. Care's research coordinator,will focus on
monitoring and evaluating the impact of the project.
necessary to measure institutional capacity building for local partners. Care incorporates flexibility into its
partnerships with local NGOs to avoid dependency and encourage autonomy. A strong accent is placed on
training of trainers and regular instructive supervision so that necessary technical skills are transferred to
local partner staff. Subgrant managers with financial backgrounds have been hired and continue to support
partners with budgeting and financial justification on site. Care is also emphasizing the development of
project-writing skills so that partners can apply directly for funding in the future. Institutional capacity building
will continue through equipment purchases and linking CT partners into the national commodities circuit, by
ensuring official approval and support by the MOH for community CT sites. Care will also continue to link
local organizations with district health authorities by facilitating quarterly supervision visits and ensuring that
service provision sites are monitored and authorized by national authorities, who should take the lead for
the oversight of public and community CT sites.
CARE will work to ensure that SCMS plans cover procurement of tests for Care CT partners and that
adequate numbers of tests are available at the right time to community-based CT sites.
Continuing Activity: 15107
15107 5047.08 HHS/Centers for CARE 7042 5316.08 Rapid $400,000
9943 5047.07 HHS/Centers for CARE 5316 5316.07 Rapid $400,000
5047 5047.06 HHS/Centers for CARE 3536 3536.06 Rapid expansion $150,000
Estimated amount of funding that is planned for Economic Strengthening $20,000
Table 3.3.14:
