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.
Salary and travel costs for USAID USPSC HIV/AIDS Prevention Advisor
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention
Total Planned Funding for Program Budget Code: $6,134,670
Total Planned Funding for Program Budget Code: $0
Table 3.3.03:
Salary and travel costs for USAID USPSC HIV/AIDS Prevention Advisor and FSN HIV/AIDS Advisor
Table 3.3.06:
Salary and travel costs for USAID FSN HIV/AIDS Advisor
Table 3.3.08:
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $151,844
Program Area Narrative:
In a report titled "HIV Estimates and Projections for Cambodia 2006-2012," published in 2007, a consensus workshop estimated
that in the absence of antiretroviral therapy (ART), there would be 2,800 HIV-infected children age 0-14 alive in Cambodia in
2008. However, the model used to estimate and project the number of HIV infected children was unable to consider the effects of
ART in its projections of the number of children living with HIV. Therefore, HIV prevalence among children aged 0-14 years is
underestimated. As of June 30, 2008, 2,805 children are currently receiving ART and an additional 1,854 children are under care
for prevention and treatment of opportunistic infections (OI). This rapid scale-up represents the collaborative response of the
National Center for HIV/AIDS, Dermatology and STDs (NCHADS), the Clinton Foundation, which provides pediatric ARVs,
technical assistance, and training to pediatric clinicians, and USG, UNICEF, and Global Fund, which support the service delivery
at both facility and community levels. The national estimated targets for children on ARVs by the end of 2008 and 2009 are 3,000
and 3,500, respectively. Currently, 26 OI/ART sites treat children; this will be scaled up to 49 sites.
In COP 09, USG will continue working with NCHADS, the National Maternal and Child Health Center (NMCHC) and other partners
to increase the coverage of HIV infected children and their follow-up in pediatric health facilities by utilizing similar platforms and
strategies used for adults care and treatment. A particular focus area will be assuring that infected infants are initiated on
treatment as soon as diagnosis is established. Currently, very few children age zero to two years are on treatment, and follow-up
of HIV-infected children after birth has been very challenging. Until 2008, diagnosis of HIV in children could not be reliably
determined until 18 months of age. From birth to 18 months it was difficult to maintain contact with the HIV-affected family and
most exposed infants were lost to follow-up. No systematic transfer of care from Prevention of Mother to Child Transmission
(PMTCT) services to Pediatric AIDS care had been established. In 2008 dried blood spot DNA-PCR testing for early infant
diagnosis (EID) was introduced with funding from Clinton Foundation and with USG technical assistance. It is now possible to
diagnose infants at 6 weeks or at 6 weeks post cessation of breast feeding. USG will focus on strengthening linkages between
PMTCT and Pediatric AIDS care sites to assure close infant follow-up of HIV-exposed infants so that treatment can be initiated as
soon as diagnosis is established. Appropriate training of home based care (HBC) teams, health center (HC) staff as well as
OI/ART pediatric health care providers will be conducted to efficiently implement EID. In addition, USG will continue working with
national technical working groups on the development of guidelines and policies to strengthen OI/ART pediatric services; support
the delivery of quality OI/ART services for pediatric AIDS within the Continuum of Care (CoC) (see uploaded diagram) framework;
support community care services provided through integrated HBC and orphans and vulnerable children (OVC) activities; and
strengthen the referral linkages between both services.
USG will strengthen the quality of OI/ART services for children at CoC sites with emphasis on improving OI prophylaxis coverage
(Cotrimoxazole and Fluconazole) among HIV infected and HIV-exposed children. Activities include training, supervision and
mentoring activities to strengthen drugs and commodity supply systems as well as case management, coordination structures,
referral systems and monitoring systems. Targeted training through a combination of onsite mentoring and formal training will be
provided to physicians. Monthly meeting for children will be supported and used to provide appropriate information and education
on basic care, prophylaxis and nutrition as well as social and psychological support.
At the community level, USG supported pediatric AIDS care services are provided through HBC. HBC teams are trained and
supported in pediatric psychosocial/spiritual support, OI prevention, early recognition of OIs and referral for treatment, adherence
support for ART, education in coping with ART side-effects, and follow-up of HIV-exposed infants. In addition, infected children
will benefit from the comprehensive HBC package provided to people living with HIV/AIDS. The package includes psychosocial
support in the form of counseling, spiritual support, preparation for funerals and providing for surviving family members; and food
support, shelter repair, clothing and mosquito nets.
A growing challenge for People Living with HIV/AIDS in Cambodia is skyrocketing food prices. Over the past year, the cost of
locally produced rice has doubled, as have the prices of fuel and fertilizer, and the cost of meat and fish has increased by as much
as 60%. With 85% of Cambodia's population living in rural areas, of which 20% are already below the food poverty line, this food
shortage is having a significant impact on vulnerable populations, including those affected or infected by HIV/AIDS. The World
Food Program has been providing support to PLHA through USG implementing partners, but continued support is uncertain.
Table 3.3.10:
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $619,071
Voluntary Counseling and Testing (VCT) sites are managed and supervised by the National Center for HIV/AIDS, Dermatology
and STDs (NCHADS) with financial support from bilateral partners (USG, DFID, French Cooperation), UNICEF, Global Fund, and
various NGOs. VCT centers operated by NGOs are accredited by NCHADS and follow national guidelines and reporting
procedures.
VCT is an important entry point to the Continuum of Care (CoC) network (see uploaded diagram). The CoC is the national
network model which links care and support services at all levels, and includes VCT, prevention of mother to child transmission
(PMTCT), opportunistic infections/antiretroviral treatment (OI/ART), and community and home based palliative care. NCHADS
endorses a national algorithm using two rapid tests: the first screening test is highly sensitive (Determine) and the confirmatory
test is highly specific (Uni-Gold, Stat-Pak). NCHADS has also approved the use of a tie-breaker test (Serodia) at reference
laboratories for discordant HIV tests results. NCHADS has a comprehensive and updated national standard VCT training
curriculum, and provides ongoing training to counselors and laboratory technicians in counseling and HIV rapid test protocols and
procedures. A quality control program has been implemented with technical support from USG, the Pasteur Institute of Cambodia
and the Clinton Foundation.
Since the first VCT site was set up in Cambodia in 1995, there has been rapid expansion. As of June 2008, 206 VCT sites were
providing counseling and testing services in all 24 of Cambodia's provinces. The number of people seeking VCT services has
increased from about 65,000 per quarter in 2007 to about 75,000 per quarter in the first half of 2008. Of these, about 4% were
found to be HIV-positive. Women account for 56% of all individuals tested, and 52% of all positive test results. In Cambodia VCT
laboratories also do all PMTCT tests, of which there were about 20,000 per quarter in the first half of 2008. To improve the uptake
of VCT, the MOH has introduced provider-initiated testing and counseling (PITC) and recently piloted the Linked Response
approach which aims to strengthen linkages between HIV and reproductive and sexual health services and community based
programs.
The USG has played a significant role in helping NCHADS expand VCT services by supporting the establishment of over 70
public VCT sites in 14 provinces, and 17 VCT sites operated by the Reproductive Health Association of Cambodia (RHAC), an
indigenous NGO. To this end, USG supported renovation of facilities to create secure and confidential counseling spaces, and
equipment and technical support to ensure quality services were provided. The USG continues to provide technical assistance to
strengthen the capacity of counselors and lab technicians, ensure quality assurance and fund other associated costs to enable
service delivery. Operational costs have been transitioned to the Global Fund and other donors through their support to
NCHADS.
In FY 09, the USG will continue to strengthen the capacity of the national program and NGO partners in their effort to improve the
quality of VCT services and increase accessibility throughout Cambodia. Specific activities include:
Increase utilization: the USG will continue efforts to increase uptake of VCT by most at risk populations (MARPs), couples
(including discordant couples), TB patients, pregnant women and youth through support for new VCT sites, mobile VCT,
education and referral "centers". USG partners will work with community structures, including community and home based care
teams, Village Health Support Groups and community volunteer groups, to mobilize community members to seek HIV testing and
access follow-up services. USG will also support the implementation of NCHADS Linked Response initiative to increase
screening of TB patients and pregnant women at health centers, and support the development of information, education, and
communication (IEC) materials that explain the benefits of early testing and identify mechanisms for transportation and social
support.
Quality improvement: the USG will continue to provide technical assistance to various levels of the health care system to ensure
VCT services are linked to prevention, care, and treatment and other programs that facilitate patient needs under the CoC; work
with the National Institute of Public Health, Pasteur Institute of Cambodia, Clinton Foundation and NCHADS to expand the quality
control system to ensure accurate HIV rapid test results; and strengthen capacity of national and provincial staff in conducting
monitoring and supervision of VCT centers, including use of monitoring data to improve service delivery.
Capacity building: At the national level, the USG and implementing partners actively participate on VCT technical working and
advisory groups as well as provide technical assistance for the development/revision of national policies, strategies, and training
curricula. USG will continue to support primary and refresher training of VCT counselors and laboratory staff as well as regular
regional counselor network meetings. USG will also continue to promote improved couples counseling in an effort to mitigate
negative outcomes related to disclosure, especially those faced by women, and training for counselors to improve the quality of
counseling provided to discordant couples.
Thus far, VCT has been integrated into 50 CoC sites in referral hospitals. Referral linkages have been established between all
VCT sites under the CoC to refer all positive clients for TB screening, OI, and ART treatment. This referral network is coordinated
by the CoC committee and Home Based Care teams. NCHADS, with support from USG and other development partners,
developed Standard Operation Procedures (SOP) to strengthen referral linkages within and between community and health facility
based services. The USG team and its partners participated in the development of the SOP and support its implementation. In
addition, in the 17 USG NGO funded VCT sites an integrated package of services is provided that includes family
planning/reproductive health, Sexually Transmitted Infection (STI) treatment and PMTCT. Through its clinics, RHAC provides
21% of the total national PMTCT screenings of pregnant women and 15% of the national VCT. This is a remarkable achievement,
as there are a total of 99 PMTCT sites and 206 VCT.
Despite the rapid expansion of VCT sites over the past few years, the uptake of these services is still limited due a variety of
factors, including HIV-related stigma and discrimination, poor quality provider behavior and high transportation costs to access
services. Concerns about the quality of services and the delay in supplies from the Center Medical Store remain. An ongoing
challenge is the weaknesses in referral linkages between services provided under the CoC, especially for individuals with a
positive HIV test result. In FY 09, the USG and other donors will continue to work closely with NCHADS and the National AIDS
Authority (NAA) to address these challenges.
Table 3.3.14:
Salary and travel costs for USAID USPSC SI Advisor
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $1,566,468
Cambodia's Second Health Sector Strategic Plan (2008-2015) established the policy framework for improvement of the health
sector; and it stated Mission, "to provide stewardship for the entire health sector and to ensure a supportive environment for
increased and equitable access to quality health services in order that all the people of Cambodia are able to achieve the highest
level of health and well-being," is the scaffold on which all USG programs are fixed.
The national health system, while still relatively weak, has demonstrated it can deliver results in partnership with donors and non-
government players. Particularly notable successes have been achieved in the area of HIV/AIDS. Prevalence has been reduced
to 0.8% of the adult population, over 85% of Cambodians eligible for antiretroviral therapy (ART) are now on treatment and a
vibrant community and civil society network are providing excellent prevention and care services. To its credit, the Royal
Government of Cambodia (RGC) was quick to recognize the severity of the HIV epidemic and establish an effective policy
framework and enabling environment that willingly adopted outside innovations and coordinated internal efforts to scale up
successful initiatives. HIV/AIDS services were established, communities mobilized and continued support for quality surveillance,
research and analysis of Cambodia's HIV epidemic has provided critical information on transmission patterns and guided program
interventions at every step. However, this early and significant success was achieved at the expense of a sector-wide approach.
The National AIDS Program established parallel services and systems which, given adequate resources, were unburdened by the
systemic and chronic problems of the national health system. But parallel practices bring high transactional costs for HIV patients,
donors, and the government and, in the long term, fail to achieve the full benefits of sustainable, accessible and quality services.
In 2007 approximately 3% of Cambodia's HIV/AIDS budget was supported by the government, highlighting the fragility of a
program that relies on donor-funding - primarily the USG and the Global Fund - for over 95% of costs.
The profile of humanitarian assistance and reconstruction projects is finally giving way to long-term sector-wide health
development approaches. USG interventions aim to strengthen and integrate decentralized health care services by
institutionalizing quality and capacity at the provincial and Operational District (OD) levels. Working closely with the Ministry of
Health (MoH) and other health partners, the USG systems approach aims to improve the performance of health providers,
including the establishment of effective performance-based management systems; expand models for health financing; sharpen
quality at the facility level; and increase strategic public-private partnerships. A primary challenge under the Health Strategic Plan
(HSP2) will necessitate the integration of services to achieve more sustainable health outcomes and ensuring that the RGC
increases its political and financial commitment to performance-linked incentive systems and the alignment of planning,
disbursement and monitoring.
The new USG health systems strengthening instrument which will be awarded by December 2008, has been designed to reinforce
and work collaboratively with the Health Systems Support Project (HSSP2), a pooled funding arrangement (supported by the
World Bank, AusAid, DFID, UNFPA, UNICEF, Agence France de Development (AfD) and the Belgian Technical Cooperation
(BTC)) at approximately $100 million over five years. The HSSP2 has four program components: (1) strengthen health service
delivery, (2) improving health financing, (3) strengthening human resources, and (4) strengthening health system stewardship
functions. It contributes towards Cambodia's Rectangular Strategy pillar ‘Capacity Building and Human Resources Development'
that calls for expanding the network of health facilitates, improving access to services by the poor, focusing on maternal and child
health and communicable disease control, and enforcing health laws to ensure quality and safety of health services.
The USG Health Systems Strengthening Project aligns with HSSP2 strategies and both project cut across all USAID health
program areas. As the USAID Health Systems program has not been awarded and the HSSP2 is due to commence 01 January
2009, collaboration structures and details will be worked out over the course of 2009.
In FY 09, HIV/AIDS policy dialogue between the MoH and the USG continues to focus more on technical assistance to the
national program and on how to work together strategically rather than on what activities to fund. Leveraging the USG role in key
public sector institutions and USG participation on national technical working groups that shape health sector priorities and
policies that advance the development of public systems and which address obstacles to the integration of prevention of mother to
child transmission (PMTCT) into existing maternal and child health services and improving the integration of TB and HIV services
are priorities. Identifying and addressing obstructions to improved service delivery, program integration, improved public sector
performance in addition to building consensus on new service delivery modalities will require dedicated time, technical insight, and
political space. Any such reorientation will require increases in RGC ownership and funding in the coming years and will be
fundamentally tied to government-wide Public Financial Management and Civil Service reforms as well as the future directions of
Decentralization and Deconcentration efforts. In FY 2009 the USG will continue to focus on pragmatic steps as part of this longer-
term strategy:
- Strengthening Cambodian's policy, planning and management capacity in the public sector, local non-government sector and
civil society;
- Improving the quality of national surveillance systems and effective use of data for HIV/AIDS policymaking and programmatic
decisions and rebalancing technical assistance towards skill transfer and mentoring;
- Supporting widespread and accessible antenatal care which integrates PMTCT services and addresses the continuing needs of
HIV treatment and care of the mother and baby in the post-partum period;
- Creating demand strategies to engage communities around maternal, newborn health, TB and HIV issues and improving referral
linkages at all levels;
- Strategic support of health financing arrangements (Health Equity Funds, community-based health insurance, work-based health
insurance) within a broader health financing framework, to improve HIV service uptake, particularly by women of reproductive age;
and
- Strengthening human resources in public and private sectors and foster governmental leadership.
Table 3.3.18:
Salary and travel costs for PEPFAR Coordinator, and prorated salary costs for USAID Program and
Finance Office staff
Table 3.3.19:
