PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
Nutrition support, an important aspect of comprehensive prevention, treatment, and care services, has been
limited in many PEPFAR-supported programs. In an effort to develop and implement a nutrition strategy and
services for PEPFAR-supported HIV/AIDS programs in Cote d'Ivoire, the USG team significantly increased
its investments, starting with FY07 plus-up funds, to strengthen this area of work.
In FY08, IYCN/PATH received funding in the OVC program area to support the continued development,
evaluation, and implementation of strategies that PATH had been undertaking under a subcontract to other
PEPFAR partners to improve the quality and targeted provision of nutrition support to OVC, including infants
of sero-positive mothers in PMTCT services, as well as pregnant and lactating women.
PATH provides technical support in nutrition and infant feeding in collaboration with national partners (the
national programs for nutrition (PNN), HIV/AIDS care and treatment (PNPEC), child health (PNSI), OVC
(PNOEV), reproductive health (PNSR), and public health (INSP)), as well as the International Baby Food
Action Network (IBFAN-CI), Stratégie Accélerée pour la Survie et le Développement de l'Enfant (SASDE),
PEPFAR partners for PMTCT (EGPAF, ACONDA, and ICAP), and PEPFAR partners for OVC (ANADER,
Care International, Hope Worldwide, the World Food Program, AED/FANTA, RIP+, Le Soutien, FHI,
Geneva Global, and the Ministry of Education). PATH's technical assistance consists of strengthening the
capacity of partners as well as health workers at PMTCT sites to provide:
- Appropriate infant feeding, counseling, support, and follow-up for all HIV-exposed infants and mothers,
along with a package of child-survival and reproductive-health interventions with linkages to HIV prevention,
treatment, and care services.
- Nutritional assessment, counseling, and support as an integrated part of care, including routine
assessment of anthropometric status, nutrition-related symptoms, and diet, with therapeutic or
supplementary feeding support for malnourished clients.
- Linkages to food aid and social services that can assist in the assessment and support of household food
security.
- Training for health workers.
- Wrap-around nutrition support provided as part of PMTCT.
In addition to FY09 funding as a PEPFAR prime partner, PATH/IYCN is expected to receive subgrants from
PEPFAR PMTCT partners (EGPAF, ACONDA, ICAP) to continue to provide technical assistance to PMTCT
sites and OVC care providers as well as to the PNN and the World Food Program (WFP) to develop and
implement nutrition activities. Technical assistance will help strengthen, disseminate, and apply national
nutrition policies and practices for persons living with or affected by HIV/AIDS.
With FY09 prime-partner and subpartner funding, PATH will provide food and nutrition support to 40% of
PMTCT sites (approximately 154/385 PMTCT sites) and training for 150 health workers by September 2009
and reach 60% of PMTCT sites (approximately 300/500 PMTCT sites) and train another 150 health workers
between October 2009 and March 2010. (PEPFAR targets associated with this PATH/IYCN activity are
lower, reflecting only prime-partner funding: 74 PMTCT sites by September 2009, with training for 40
persons, and a total of 110 PMTCT sites by March 2010, with 40 additional persons trained). Specific
activities will include:
• Plan and initiate integrated scale-up of infant feeding and nutrition activities at additional PMTCT sites,
with a goal of achieving 40% coverage of existing and new PMTCT sites by September 2009 and 60%
coverage by March 2010.
By March 2009, PATH will have supported infant feeding and nutrition activities at 68 PMTCT sites
throughout the country. With FY09 funding, PATH will work closely with the PNN and PNPEC to develop
and implement an overall scale-up plan, with objectives and targets, for integrated nutrition and infant
feeding care as an essential component of PMTCT services at new sites. PATH will also work with health
district teams to ensure that nutrition activities are integrated into PMTCT micro-plans in targeted districts.
Revision of relevant national policies and guidelines in accordance with the 2006 WHO Consensus
statement, started in FY08, will be completed by September 2009. IEC materials (counseling cards and take
-home brochures) and clinical tools (algorithms and infant postpartum follow-up forms and routines) used at
demonstration sites will be produced and disseminated on a wide scale to support integrated scale-up. In
addition to its work with EGPAF, ACONDA, and ICAP, PATH will also provide technical assistance and
materials, as needed to help reach target groups of other national, international, and PEPFAR partners.
• Strengthen the capacity of Ministry of Health (MOH) district offices in each of five zones (San Pedro,
Abengourou, Yamoussoukro, Bouake, Man) to integrate and scale up infant feeding and nutrition activities.
Building on FY08 work and a new commitment from national partners to significantly scale up infant feeding
and nutrition interventions as critical components of PMTCT services, IYCN/PATH will move from
demonstration activities at a limited number of sites to support scale-up at existing PMTCT sites and
integration of infant feeding and nutrition care at new sites. PATH will carry out district capacity building
necessary to initiate and carry out high-quality integration and rapid scale-up of nutrition activities, in
coordination with the PNPEC, district medical officers, and the PNN. In each of the five zones, PATH will
work closely with the district health team (ECD) to plan, implement, and coordinate nutrition activities as
part of district micro-plans. Staff from PATH will be assigned to one major health district team and will work
with several surrounding districts:
1. San Pedro (Tabou, Sassandra, Soubre, Lakota, Gagnoa, Issia , Daloa)
2. Abengourou (Agnibilekro, Tanda, Bondoukou, Bongouanou, Agboville, Alepe)
3. Yamoussokro (Daoukro, Toumodi, Dimbokro, Oume, Sinfra, Bouafle, Zuenoula)
4. Bouake (Katiola, Dabakala, Ferke, Korhogo, Boundiali)
5. Man (Biankouma, Touba, Odienne, Danane, Toulepleu, Guiglo)
Additional PATH technical staff based in Abidjan will cover PMTCT sites outside of these five zones and
will follow activities in the field.
Because of the increased scale-up pace proposed for FY09, PATH will use a more streamlined training plan
Activity Narrative: than in FY08. The training plan will include:
- Orienting health district directors and teams in targeted districts
- Training of two health workers from each PMTCT site that has not yet received infant feeding support as
well as one staff member from the health district team using a combination of the six-day revised integrated
course on breastfeeding, nutrition and HIV; a two-day orientation; and/or on-site refresher trainings
- Distributing clinical algorithms, counseling materials, follow-up forms and guides, and posters
Trained staff in each district will serve as trainers and will help with supportive follow-up of all sites covered
by the district.
At new PMTCT sites, essential elements of infant feeding and nutrition will be integrated into initial PMTCT
trainings, and infant-feeding materials will be distributed as part of all PMTCT trainings. In consultation with
the district medical officer, a training plan for each district will be prepared and implemented that will allow
for one staff person per new site to be trained in the six-day revised integrated course, with other staff
receiving a two-day orientation or on-site trainings. Additional staff will be trained in subsequent years, with
prioritization given to sites that have achieved site-specific milestones in improved infant-feeding services.
The specific milestones will be drawn from the new infant feeding/postpartum follow-up forms and routines
and will be determined in consultation with district medical officers. This training and milestone plan will be
finalized with the district medical officers in the identified districts and adapted as needed.
After training, follow-up visits will help ensure that infant follow-up forms and routines are being
implemented appropriately. Additional support materials will be disseminated, and periodic supportive
supervision will monitor and improve quality and uptake at sites. In some cases, distribution of tools and
materials may precede formal trainings, in order to facilitate scale-up and adoption of new routines.
Interventions will also improve service quality and strengthen collaboration among PMTCT, pediatric
treatment, social services, and the community.
• Integrate HIV and Nutrition in pre-service training curricula for health providers (INFAS)
PATH will provide technical assistance to revise national pre-service training curricula for midwives and
nurses (INFAS) in collaboration with the PNN, PNPEC, and FHI.
• Equip PMTCT sites and rural health centers, in collaboration with national programs, ANADER, and other
partners
In collaboration with international partners (UNICEF,WHO) and PEPFAR partners, PATH will support the
national programs (PNN, PNPEC) to adapt national minimum standards for equipment for PMTCT services.
Fifty PMTCT sites and five rural health centers supported by ANADER will be equipped with tools needed to
monitor infant growth (measuring ribbon, infant feeding cup, weight measure, materials for diet
demonstrations) after a situational analysis conducted in collaboration with the PNPEC, PNN, and the
health districts.
• Develop a guide of monthly topics for HIV support groups, in order to expand access to appropriate
services at facilities and encourage good feeding and nutrition practices at home.
Given the importance of psychosocial support and positive living for people infected or affected by HIV,
PATH in FY08 is working to strengthen existing support groups and initiate the creation of new support
groups at PMTCT sites. In FY09,
PATH will collaborate with the PNN, PNPEC, and RIP+ (national PLWHA network to develop monthly
discussion topics for HIV support groups as well as a guide to creating a support group and messages
about the importance of routine follow-up, delivery at health facilities, immunization, cotrimoxazole
prophylaxis, nutrition, and disclosure of HIV status to partners.
PATH will share its work plan with the PNN and PNPEC in order to strengthen collaborative relationships
and to assist in providing coordinated assistance to health care sites. PATH will use its M&E system to
provide timely, accurate reports to national authorities and the USG strategic information team. To help
build a unified national M&E system, PATH will participate in quarterly SI meetings and will implement
decisions taken during these meetings.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $140,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $60,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Nutrition support, an important aspect of comprehensive treatment, palliative care, and OVC services, has
been limited in many PEPFAR-supported programs. In an effort to develop and implement a comprehensive
nutrition strategy and services for PEPFAR-supported HIV/AIDS programs in Cote d'Ivoire, the USG country
team significantly increased their investments, starting with FY07 plus-up funds, to strengthen this area of
work.
With FY08 funding in the OVC program area, IYCN/PATH is supporting the continued development,
PEPFAR partners for improving the quality and targeted provision of nutrition support to OVCs, including
infants of sero-positive mothers in PMTCT services, as well as pregnant and lactating women.
capacity of partners to provide:
treatment, and pediatric care services
supplementary feeding support for malnourished clients
security
- Trraining for social workers, community workers, and OVC caregivers
- Wrap-around nutrition support provided as part of home-based palliative and OVC care.
With FY09 funding, PATH will continue to provide technical assistance to PEPFAR-supported facility- and
community-based OVC care providers as well as to the PNN and WFP to develop and implement nutrition
activities. Under PNN and PNPEC coordination, technical assistance will strengthen, disseminate, and
apply national policies on nutrition for persons living with or affected by HIV/AIDS.
Consistent with the literature on the close relationship between malnutrition and HIV, a situational analysis
published in 2005 in Côte d'Ivoire showed that 25% of OVC are malnourished. Treating malnutrition in
infected infants is a critical component of managing their HIV/AIDS care. Identification of malnutrition in
infants and young children can also be used as an additional entry point for infant testing and early initiation
of HAART.
In collaboration with the PNPEC, PNOEV and PNN, PATH will strengthen the capacity of Stratégie
Accélerée pour la Survie et le Développement de l'Enfant (SASDE, an MOH project) and PEPFAR care
partners (ACONDA, EGPAF, and ICAP) to address this issue by:
• Revising guidelines, policies, training curricula, job aids, and IEC materials (as needed) on palliative care
and clinic-based therapeutic care for malnourished infants
• Strengthening the capacity of government therapeutic nutritional centers (UNTs and CNTs), in
collaboration with national programs (PNN, PNPEC) and international partners (UNICEF,WHO) by:
- Developing a two-day update of UNT and CNT staff regarding malnutrition and HIV
- Adapting the national document on minimum standards for equipment (e.g. measuring ribbon, infant
feeding cup, weight measure, materials for dietary demonstrations, therapeutic food) for UNT and CNT
services to ensure appropriate therapeutic nutrition care.
• Developing guidelines for the identification of malnourished infants in the community, as well as referral
systems for appropriate clinic-based therapeutic care for these infants. Community workers will be involved
in identifying malnourished infants in the community (using measuring ribbons (MUAC) and referring them
to health centers, UNTs, or CNTs), and the infants will be referred for care for malnutrition and HIV testing.
Community agents will also be involved in following nutritional rehabilitation in the community. To avoid lost
to follow-up, links will be created among the community, health and social services, counseling and testing
services, and pediatric care and treatment centers.
To coordinate these activities and assure high quality of services PATH will hire one person to coordinate
its pediatric care activities.
PATH's M&E system will send timely, accurate reports to national authorities and the USG strategic
information team. To help build a unified national M&E system, PATH will participate in quarterly SI
meetings and will implement decisions taken during these meetings.
Estimated amount of funding that is planned for Human Capacity Development $150,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $150,000
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $2,200,000
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
• Integrating HIV and Nutrition into the pre-service training curricula of social workers (INFS and INJS);
• Strengthening the capacity of the national OVC trainers in Nutrition and HIV;
• Using the strategies of other OVC PEPFAR partners to spread sensitization messages to the target
population;
• Provide basic equipment to OVC social centers and community health workers in collaboration with
national programs and other partners;
• Conduct a situational analysis to research food mapping by zones (North, West, East, Center) and
propose adapted recipes appropriate for OVCs 6-24 months of age
• Support the creation and animation of HIV support groups at social centers
COMPLETE NARRATIVE
In FY08, IYCN/PATH received funding to support the continued development, evaluation, and
implementation of strategies that PATH had been undertaking under a subcontract to other PEPFAR
partners for improving the quality and targeted provision of nutrition support to OVCs, including infants of
sero-positive mothers in PMTCT services, as well as pregnant and lactating women.
treatment, and pediatric care services.
- Training for social workers, community workers, and OVC caregivers.
With FY08 funding, PATH in collaboration with national programs and international and local partners is:
• Training 150 health workers from 50 PMTCT and HIV care sites supported by ICAP, ACONDA, and
EGPAF as well as two staff members from PNPEC, four from PNN, and one each from PNSI, PNOEV,
SASDE, INSP, PNSR, and ICAP in infant feeding, nutritional care, and HIV.
• Adapting, disseminating, and supporting the use of clinical support tools (algorithms) and IEC materials
(counseling cards and take-home brochures) at 50 sites.
• Strengthening or introducing systems at 50 PMTCT and HIV care sites to routinely follow up and support
nutritional care of infants (0-2 years) of HIV-positive women (including mechanisms to capture those lost to
follow-up).
• Providing technical support and supervision in nutrition and infant feeding to PMTCT and HIV care sites
through quarterly visits once training is completed.
• Elaborating a minimum package and standards for nutrition services for OVCs.
• Incorporating appropriate information from the infant feeding curriculum, depending on partners' needs,
into existing or planned partner trainings (of social workers, facility-based lay counselors, and/or community
agents).
• Adapting and introducing key community- and home-based support, counseling, and IEC materials for
OVCs (0-5 years), building on materials developed.
• Developing and supporting implementation of referral and counter-referral systems for food and nutritional
care for OVCs to PMTCT, ART, and palliative care services.
• Providing technical support for quality control in food and nutrition activities to OVC partners. This includes
community and home follow-up.
• Working as a member of IRIS and providing technical assistance on nutrition and quality control for
partners involved in IRIS.
• Providing ongoing technical assistance on food and nutrition to the PEPFAR team and national OVC
program, including assistance in determining entry and exit criteria for OVCs for WFP.
• Supporting the development and quarterly meetings of a national nutrition and HIV working group
("Groupe Technique") led by the Government of Côte d'Ivoire.
• Developing and disseminating key nutrition strategies, directives, and technical updates for nutrition and
infant feeding.
• Providing updates to national training courses and technical assistance for trainings as needed.
• Providing technical support and assisted in national consultations to revise the child health card (including
new growth standards).
• Providing technical support and assisting in national consultations to revise post-partum follow-up routines
and forms for infants and OVCs at PMTCT and OVC sites.
• Providing technical support for additional national dialogue and consultation on food and nutrition and HIV
(including the use of fortification foods, fortification of complementary foods, and promotion of exclusive
breast feeding).
Activity Narrative: • Developing new materials and supports (e.g. flip chart and take-home brochure) for feeding of infants 6-24
months (complementary feeding), including appropriate care, recipes, etc.
• Providing high-level advocacy, sensitization, and technical assistance to health professionals, training
institutions, and other donors as needed.
• Negotiating with GAIN to include Cote d'Ivoire as one of the target countries for IYCN/GAIN collaboration.
• Pending selection of Cote d'Ivoire as a target country, working to create and implement an appropriate
business plan for the collaboration, including identification of local private-sector partners and roles.
activities. Technical assistance will strengthen, disseminate, and apply national policies on nutrition for
persons living with or affected by HIV/AIDS.
Building on FY08, PATH will use FY09 funding to apply lessons learned to strengthen and expand activities
with existing and new OVC partners. Activities will be expanded in additional OVC sites proposed by
PEPFAR partners in consultation with the PNOEV. In addition, new activities will be integrated to reach
target groups of other national, international, and PEPFAR partners. New activities will include:
•Integrating OVC-related HIV and Nutrition information and skills into the existing pre-service training
curricula for social workers (INFS and INJS)
The PNOEV has started to introduce the concept of OVC care in the national pre-service training curricula
of social workers through their training schools (INFS). In TY09, PATH will provide technical assistance to
the PNOEV, in collaboration with FHI, to integrate HIV and Nutrition in the national pre-service training
curricula of social workers (INFS, INJS).
•Strengthen the capacity of national OVC trainers to provide in-service training in Nutrition and HIV
Eighty national OVC trainers work in collaboration with the PNOEV through the integrated OVC coordination
platforms (16 existing platforms and 12 planned by the PNOEV for FY08) for social services throughout the
country. In collaboration with the PNOEV, PATH will integrate HIV and Nutrition in the in-service training
curriculum for social workers, which focuses on the minimum package of nutrition services for OVC, defined
collaboratively in FY08. PATH will then train 60 national trainers in HIV and Nutrition. Work to make the
training course and curriculum accessible for social workers began in collaboration with the PNOEV during
FY08. PATH will also work with the PNOEV to adapt these materials to the level of community counselors.
The 60 OVC trainers will then be responsible for integrating HIV and Nutrition issues into routine in-service
training workshops. They will also organize cascade workshops for social workers and community
counselors, as proposed by the PNOEV. The PNOEV will be responsible for cascade training workshops,
with PATH providing occasional TA, support, and supervision.
•Build upon and strengthen strategies of other OVC partners to spread sensitization messages to the target
population
PEPFAR OVC partners use various ways to spread messages to the community, such as community radio,
messages in local language, and discussion groups. PATH will work with these partners to introduce
appropriate messages on nutrition for OVC. The basic technical messages will build upon the minimum
package of nutrition for OVC developed in FY08.
•Provide basic equipment to social services sites
In collaboration with national programs (PNOEV, PNN) and international partners (UNICEF, WHO), PATH
will adapt the minimum standards of equipment (e.g. measuring ribbon, infant feeding cup, weight measure,
materials for diet demonstrations) for social services. This equipment is critical to ensure appropriate and
regular nutrition and growth assessments of infants and young children. PATH will assist in a facility
assessment in social centers, to be conducted in collaboration with the PNN and PNOEV. Based on the
results of this assessment, 28 social centers will be equipped by PATH.
•Conduct situational analysis to research food mapping by geographic zone and propose adapted recipes
for OVC 6-24 months
In FY08, food mapping in Abidjan was used to identify appropriate, locally available foods that could be
used to make complementary foods suitable for OVC aged 6-24 months. With FY09 funds, PATH in
collaboration with the PNN, PNOEV, and PNPEC will conduct a similar food-mapping exercise in other
zones (North, West, East, and Center) of the country. Results of this food mapping will allow PATH to
propose adapted recipes for complementary feeding by zone in order to take into account the available
foods and feeding habits of each zone. PATH will use linear programming tools to propose exact quantities
for each recipe.
• Initiate the creation and animation of HIV support groups at social centers, in collaboration with OVC
PATH will collaborate with the PNOEV, PNN, PNPEC, national networks (RIP+, COSCI), and PEPFAR
nutrition and OVC partners to initiate the creation of support groups with monthly discussion topics through
the OVC platforms at social-services sites. PATH will reproduce one copy of an animation guide for each
OVC partner, and will train them to use it. Each OVC partner will initiate the creation and animation of HIV
support groups at social centers using this guide. This guide will include specific information on how to
manage HIV-positive infants (e.g sensitization after receipt of HIV positive results, how to encourage
compliance with long-term ARV treatment and nutrition advice for infants and young children, etc), as well
as advice for adults.
PATH's emphasis on national guidelines and tools; on training for national, district, and community-level
Activity Narrative: actors, including health and social workers; on researching and using locally available and acceptable
foods; and on strengthening national and district-level technical groups and coordination bodies will all
contribute to sustainability of HIV and nutrition activities.
PATH will participate in PNOEV reviews of OVC activities. These reviews will provide an opportunity to
update and sensitize new OVC partners, as well as to reorient or provide refresher information to existing
partners, in order to strengthen their capacity in nutrition, in collaboration with other nutrition partners.
PATH will share its work plan with the PNN, PNOEV, and PNPEC in order to strengthen collaborative
relationships and to assist in providing coordinated assistance to health and social center sites.
PATH will use its M&E system to provide timely, accurate reports to national authorities and the USG
strategic information team. To help build a unified national M&E system, PATH will participate in quarterly SI
New/Continuing Activity: Continuing Activity
Continuing Activity: 17121
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17121 12219.08 U.S. Agency for Program for 7211 7211.08 Infant and $500,000
International Appropriate Young Child
Development Technology in Nutrition (IYCN)
Health
Project
12219 12219.07 U.S. Agency for Program for 7320 7320.07 PATH $600,000
International Appropriate
Development Technology in
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $350,000
Table 3.3.13:
