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.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: On September 30th, 2009 the USAID
agreement with KHANA will end. An RFP/RFA for an organization to serve as an umbrella supporting a
number of implementing agencies in the areas of prevention and care, and national level advocacy and
leadership will be issued in calendar year 2009. USAID will continue to prioritize the use of Cambodian
entities that have the proven capacity to implement USG programs and are critical components of
Cambodia's health sector. As neither an assessment nor the design has been completed, specific
components have not been identified, but illustrative components are outlined below.
The TBD implementer will target groups with specific abstinence and be faithful messages that emphasize
key areas, such as addressing male norms and behaviors, reducing violence and coercion, and building
gender equity. Programs will include individual and local organization capacity building, with in-service
training, and mentoring and monitoring to raise the capacity of local partners and beneficiaries. Strategic
information, in the form of project monitoring data, case studies, best practices and lessons learned will be
collected regularly.
AB activities will be carried out through focused prevention and integrated care programs. Activities will
target children from 10 years old, unmarried young people between the ages of 15 and 25, including OVC
and youth in the community (in and out of school). Activities will also be aimed at married couples and
PLHA (People Living with HIV/AIDS), both married and unmarried. Targeted audiences will be reached
through a variety of avenues, including peer outreach, group discussions, one-on-one counseling, and
information materials, tailored to respond to the needs of the population. Training workshops for local
partners will reinforce understanding of AB approaches, messages, related life skills and interventions.
Partners will have the capacity to assess which interventions and approaches are most appropriate for each
audience and which messages have the greatest impact.
The TBD implementer will focus on OVC and community youth from the age of 10 upwards. Local partners
will use a variety of activities, such as role plays, youth forums, events, outreach and group discussions,
and provide youth with the life skills and sense of responsibility to make informed decisions. Youth who are
already sexually active will be referred to relevant services. The TBD implementer will refine existing
approaches for working with youth and ensure that local NGOs have the required capacity to respond to the
specific needs of youth in their target areas. Activities to reach youth will be conducted by trained peer
educators through both outreach and facilitated discussion groups. All partners that will carry out these
activities will have experience in reaching communities and will have existing links to OVC and community
youth through current prevention or care and support efforts.
The TBD implementer will also focus on married couples, including couples where one or both individuals
are HIV positive or whose HIV status is unknown. Through a variety of interventions, the TBD implementer
will focus on the importance of counseling and testing, fidelity, the role of religion, culture and society in
sexual relationships, the implications, and possible results of infidelity, gender and responsibility, family
planning and domestic violence. IEC (Information, Education and Communication) materials will be
modified and distributed that best serves the activities and the target groups listed above. The TBD
implementer will work with other agencies, including USG partners to share and modify IEC and BCC
(Behavior Change Communication) materials and interventions that best deliver AB messages.
The new implementer will also collaborate with the NAA (National AIDS Authority), NGOs and other
stakeholders to promote AB messages during special events such as Valentine's Day, Family Day,
International Children's Day and International Women's Day.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education
Water
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
On September 30th, 2009 the USAID agreement with KHANA will end. An RFP/RFA for an organization to
serve as an umbrella supporting a number of implementing agencies in the areas of prevention and care,
and national level advocacy and leadership will be issued in calendar year 2009. USAID will continue to
prioritize the use of Cambodian entities that have the proven capacity to implement USG programs and are
critical components of Cambodia's health sector. As neither an assessment nor the design has been
completed, specific components have not been identified, but illustrative components are outlined below.
In conjunction with Abstinence and Be Faithful (AB) messages, the TBD implementer will conduct other
sexual prevention activities as central features in its HIV prevention program. Groups with other prevention
messages that emphasize key areas such as addressing male norms and behaviors, reducing violence and
coercion, and building gender equity will be targeted. Activities will include capacity building for local
organizations with in-service training, mentoring and monitoring to raise the capacity of local partners and
beneficiaries. Strategic information, in the form of project monitoring data, case studies, best practices and
lessons learned will be collected regularly.
The TBD implementer will work through specialized sub-partners with several Most At Risk Populations
(MARPs) such as Men who have Sex with Men (MSM), direct and indirect sex workers and mobile
populations because they require specific interventions aimed at reducing HIV prevalence, and still face the
stigma and discrimination that affect their use of services, access to information and quality of life. Local
partners will also promote positive prevention in their activities with people living with HIV/AIDS (PLHA) and
their families. High risk populations remain at the centre of the epidemic so it is critical that they receive
continued access to information, support and services to prevent a resurgence in HIV prevalence. It is vital
that service providers, entertainment establishment owners and the police are aware of the challenges
MARPs face in accessing information and services. These gatekeepers will be invited to regular meetings to
sensitize them, and to mobilize their support in helping to reduce violence amongst and towards MARPs,
and to help MARPs access services, information and commodities.
Local NGO partners will reach MARPs with in-depth participatory prevention approaches designed to build
confidence and skills so that these vulnerable individuals can practice less risky behavior. NGOs will
identify and train peer educators who will provide outreach services, referrals to Voluntary Counseling and
Testing (VCT), Sexually Transmitted Infection (STI) diagnosis and treatment, and other health services.
Some at risk individuals also face resistance from their own sexual partners in using condoms, so education
interventions on the correct and consistent use of condoms are always accompanied by exercises in risk
reduction skills building, negotiation, and building trust.
The TBD implementer and its local partners will organize IEC (Information, Education and Communication)
awareness raising and advocacy events in HIV prevention in collaboration with national and provincial
stakeholders. Events will be held on key dates throughout the year. Local partners will also hold social
gatherings for MARPs to strengthen cultures of solidarity and a sense of community in response to
HIV/AIDS and related issues, such as stigma and discrimination. Community involvement (including
parents, faith-based institutions, and commune chiefs) will be crucial in organizing these events and
facilitating the delivery of prevention interventions at community level. Local partners will therefore organize
community mobilization meetings on a regular basis. These partners will also ensure that their beneficiaries
understand that condoms do not eliminate the risk of HIV transmission and discussion and outreach
interventions will also explore the plausibility of reducing high-risk behaviors such as engaging in casual
sexual encounters and alcohol abuse in the context of sexual interactions.
Prevention of virus transmission through education of PLHAs will continue to be a central focus. A peer
education program will encourage and PLHA will be trained to provide information through outreach and
group discussion to peers who might be positive. There will also be group discussions for HIV positive
people and their partners in risk reduction skills building, negotiation skills, condom use and safer sex, and
the benefits of VCT. Referral mechanisms will be established and reinforced that overcome the obstacles
that prevent people from getting tested and all those referred to VCT will be invited to join pre- and post-
test clubs for counseling and prevention education.
The TBD implementer will train its NGO partners and representatives of MARPs in prevention interventions.
While some training workshops will have general themes, such as BCC for prevention, others may focus on
specific issues such as training PLHA on methods to prevent HIV transmission.
Strong links will be made with government and non-governmental institutions, including other USG partners
who are contributing to prevention work carried with MARPs. In order to ensure efficiency and cost
effectiveness, The TBD implementer and its partners will collaborate with other agencies (government
departments, USG partners and others) to develop, modify and share BCC (Behavior Change
Communication) materials and training resources in HIV prevention.
Table 3.3.03:
The TBD implementer will work with local partners to provide risk reduction services to drug users and drug
education to non-drug users. Partner reduction, non-violence and consistent condom use are core
priorities, as is the reduction of illicit substance consumption, given the risks associated with drugs and
sexual behavior. Specific services for injecting drug users will be provided.
Both injecting drug users and non-injecting drug users, primarily methamphetamine users, in areas of
Cambodia which already have a concentration of drug users, will be targeted with risk reduction activities.
There will also be prevention education activities with relevant populations, particularly young people in
known drug ‘hot spots' such as Phnom Penh, Battambang and Banteay Meanchey. Awareness raising and
sensitization activities will target the broader community including key influential people, parents and local
authorities in order to promote awareness of drug-related HIV risk. Local partners will be supported to
provide risk reduction services to drug users and drug education to non-drug users. These partners will
facilitate focus group discussions and implement outreach activities on drug-related HIV prevention. They
will also organize regular meetings to sensitize and mobilize support, reduce discrimination towards drug
users and maintain safe spaces for drug users.
The TBD implementer and its partners will develop and modify existing Information, Education and
Communication (IEC) materials on HIV prevention, including drug-related HIV prevention, to ensure that
they contain behavior change messages and are disseminated widely. Collaboration with other agencies in
order to implement Behavior Change Communication (BCC) efficiently and cost-effectively will be
necessary. Selected staff and local partners will be equipped with the skills to train other organizations in
BCC interventions. Part of the BCC strategy for working with drug users and young people at risk of using
drugs may be to work through sports as well as youth gatherings, which provide a healthy alternative to
drug-related social networking and an opportunity to spread drug prevention and risk reduction messages.
The TBD implementer will support local partners to provide treatment to drug users, including community
therapy and the provision of skills training and opportunities for income generation for recovering drug users
and their families.
The TBD implementer will collaborate with the National Authority for Combating Drugs (NACD), NGOs and
other stakeholders to organize public awareness-raising on the impact of drug use and HIV prevention
during the International Day against Drug Abuse and Illicit Trafficking, World AIDS Day and the Water
Festival. In addition, regular regional meetings with Provincial Drug Control Committees (PDCC) in
selected sites to promote collaboration and to build sensitivity among them in order to enhance an enabling
and supportive environment for work with drug-users may be convened.
Strong links will be made with government and non-governmental institutions, including other USG partners,
who are contributing to prevention work with MARPs. The TBD implementer will be expected to be an
active member of the National Drugs and HIV/AIDS Technical Working Group. At the provincial level, local
partners will strengthen collaboration with Provincial Drug Control Committees in order to create an
enabling environment for drug and HIV prevention services as well as to mobilize their support for the
program.
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $875,360
Program Area Narrative:
In a report titled "HIV Estimates and Projections for Cambodia 2006-2012," published in 2007, a consensus workshop estimated
that in 2008, there would be 58,700 adults (?14 years of age) living with HIV/AIDS in Cambodia. Of these, 30,500 would need
antiretroviral therapy (ART). Cambodia has made remarkable progress in meeting this demand. By July 2008, 29,356 people
living with HIV/AIDS (PLHAs) were receiving ART at government HIV clinics, including 26,551 adults, which is 87% of the
estimated need. An additional 11,112 adults were enrolled at HIV clinics for prevention and treatment of opportunistic infections,
so nearly two-thirds of the country's infected population know their diagnosis and are enrolled in care. This level of scale-up to
meet the country's need is a tremendous accomplishment for the Royal Government of Cambodia (RGC).
Successful care and treatment of PLHAs requires comprehensive clinical services and strong community services as well as
strong links between these clinic based and community based providers of care. To provide a comprehensive package of
services for PLHAs, the RGC developed a Continuum of Care (CoC) Framework (see uploaded diagram) organized at the
operational district (OD) level of government (each of Cambodia's twenty-four provinces is divided into two to seven ODs (76 in
the country). The CoC is a network model encompassing programs including counseling and testing, tuberculosis (TB), Antenatal
Care (ANC), PMTCT, Opportunistic Infection (OI) and ART treatment, and home care within communities. The first CoC was
established in late 2003 and, to date, 50 have been established, of which 18 are supported by the USG.
A growing challenge for PLHA 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.
USG provides technical and financial assistance for care and support in the community aimed at extending and optimizing quality
of life for PLHAs throughout the continuum of illness, as well as facility based care for the prevention and treatment of OIs and for
ART. The following narrative is divided into two parts, the first describing care and support services for adults and the second
describing ART services for adults.
CARE AND SUPPORT:
While Cambodia has experienced an impressive scale-up of HIV treatment services to 50 sites across the country, the geographic
coverage area for each site outside of Phnom Penh is very large, often with very poorly maintained roads connecting villages to
the HIV care clinic site. Without a strong network of community based service providers that can function as the "extenders" of
clinic based services, patients could be cut off from their source of care and be lost to follow-up, or allow symptoms to worsen to
the danger point before seeking care. Clinicians at the HIV Care Clinics have limited time to spend with each patient, and often
insufficient opportunity to deal with the multiple psychological and social issues that confront PLHAs. In response, 244 home
base care (HBC) teams (which cover about 70% of total number of health centers in the country) have been established. More
than one-third of these teams are supported by the USG through NGOs which directly manage and supervise HBC teams. The
approach of HBC has been expanded from medical follow-up and psychological care to drug adherence, prevention for positives,
and counseling/livelihood support for socioeconomic reintegration.
The expansion of CoC is coordinated by the National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases
(NCHADS) and funded by multiple donors, including USG, GFATM, DFID, Asian Development Bank, and UNICEF. In referral
hospitals, OI drugs, ARVs, test kits, and other support (salary supplementation) have been mostly provided by the Global Fund
(round 1, 2, 4, 5 and 7), UNICEF, and DFID. In addition, most USG partners are Global Fund recipients, which has enabled them
to leverage this funding to expand care and support services beyond USG priority provinces.
USG programs strengthen both the technical and managerial capacity of NGOs, including C/FBOs. Long term sustainability is
dependent upon continued donor funding as the RGC provides limited funding for HIV/AIDS programs. Reductions in funding by
donors in the short term could affect sustainability of current investments and successes.
Given limited PEPFAR funding, the USG has focused resources on targeted prevention among MARPs and has scaled back
broad-based care and support implementation. To ensure consolidation and transition, the USG is working with the RGC, the
Global Fund, and other donors to identify additional funding sources and partners. In COP 09, the USG will scale back care and
support services, and instead focus on consolidation, quality improvement, and innovative models of HBC and palliative care at
OI/ART service delivery; and strengthen the referral linkages between OI/ART services (referral hospital and health centers) and
community services (HBC) in USG focus provinces. The need for HBC will be reviewed and redefined in accordance with the
changing needs of PLHA as most now have access to ART. The most vulnerable PLHAs, those who are ill, in pre-ART status, and
malnourished PLHAs will be prioritized for HBC services.
In COP 09, USG will continue to provide a range of care and support services to PLHA in the areas below:
Build capacity to enable the public health sector, NGOs, and communities to assume a greater role in the provision of palliative
care programs by: (1) training health care providers (clinicians, nurse counselors, laboratory staff) to provide high quality
HIV/AIDS care, support, and treatment services, and work to strengthen health systems capacity at targeted referral hospitals and
health centers; (2) providing training, continuing education, and support for community structures (HBC teams, pagoda
committees, and volunteers) to assess needs, provide OI care/follow-up, health/hygiene/nutrition education, and referrals; and (3)
training PLHA self-help groups and leaders in advocacy and self-help approaches.
Direct care and support services: USG will continue to support: (1) the delivery of quality OI prophylaxis and treatment services at
CoC sites within USG focus provinces; (2) the delivery of quality home and community base care services including medical,
physical, and psychosocial support to PLHA and their families, including OVC; (3) hospice care for end-of-life support; and (4)
regular meetings of PLHA (MMM or Friends Help Friends) at referral hospitals with CoC.
At the facility level, USG provides technical and operational support to 18 existing CoC sites to enable referral hospitals and
Operational Districts to provide OI/ART services. Activities include infrastructure renovation; human resources development and
management, training and supervision; setting up case management and coordination structures; improving patient management
and monitoring systems; developing standard operating procedures; conducting targeted capacity building for health care
providers to strengthen service delivery; and strengthening drug and commodity supply systems. The purchase, distribution, and
management of OI drugs is funded by the Global Fund and managed through the existing Central Medical Stores distribution
system of the MoH. However, USG helps in the training of OD and Provincial supervisors to assist in forecasting need and to
assure appropriate ordering of supplies.
At the community level, USG will continue to support existing HBC teams to provide a comprehensive package of services
including psychosocial and spiritual support; symptom and pain management; nutritional counseling and food support; hygiene;
social and economic assistance including vocational training activities; end of life care; and drug adherence support. In addition,
USG partners work with PLHA networks to increase the participation of PLHA in monthly meetings at CoC sites as well as provide
financial support to increase utilization of CoC services by the very poor. Food and other material support for PLHA are provided
by the World Food Program (WFP) through direct agreements with USG implementing partners. The global food security crisis
has made continued WFP support uncertain.
Community mobilization is key to ensuring that PLHAs know about available support, that community stigma is reduced, and that
additional volunteers are recruited to work with HBC teams and to provide encouragement to PLHAs. USG support includes
awareness raising activities and advocacy with local political and religious leaders, school officials, Village Development
Committees, Village Health Support Groups (VHSG), Village Health Volunteers (VHVs), and individual community members as
well as information, education, and communication (IEC) materials dissemination through mass media and community events.
Linkages: A strong referral network is also key to the USG program. To promote better linkages between the facility and
community levels, USG will continue to provide assistance to CoC coordination forums at provincial and district levels, and
actively participate in NCHADS' Linked Response activities. These forums are used to promote discussion and follow up among
facility based providers and HBC teams on patients who are deceased, missing or in need of follow-up. Linkages are made
between HBC services and other services including OI/ART, PMTCT, TB/HIV, STI and VCCT, as well as to income-generation
and vocational training services.
Adult ART SERVICES:
Cambodia has rapidly scaled up ART Services over the last five years with the establishment of 50 HIV treatment facilities in
twenty of Cambodia's twenty-four provinces and municipalities, with at least one OI/ART clinic in 39 of Cambodia's 76 operational
districts. Cambodia was one of only a few countries to exceed the WHO treatment targets for 2005, and since 2005, has
continued to exceed ambitious treatment goals, as reflected in the high percentage of estimated treatment-eligible patients
currently on ART. These accomplishments are a major achievement of the Royal Government of Cambodia and have been
accomplished through strong leadership, a clear strategic plan, the support of civil society and all tiers of government. Bilateral
support has been critical to the success of Cambodia's scale-up of ART services. USG has played a major role. At the national
level, USG has provided technical assistance in the development of the national curriculum for clinicians and treatment guideline
revisions, and continues its technical support serving on working groups updating opportunistic infection guidelines for adults and
children, formulating a protocol for the ordering and interpretation of HIV viral load testing, and developing a continuous quality
improvement program for the OI/ART Clinic sites as well as the entire Continuum of Care.
At the field level, USG partners have played a crucial role in the scale up of treatment by providing support to one-third of the
country's HIV treatment facilities. This support has been targeted to assure that clinicians and counselors maintain their skills and
their professional satisfaction, that patients have the support needed to maintain drug adherence and appointment keeping, and
that critical laboratory tests can be performed in a timely fashion without obstacles due to transport of specimens. This support
includes provision of clinical mentoring, sponsorship of quarterly clinician and counselor network meetings and monthly
Continuum of Care meetings, supervision activities by NCHADS staff, support for regional clinical conferences, coverage of
transportation costs to clinic for impoverished patients, and coverage of transport of blood specimens for CD4 testing and other off
-site laboratory tests. In October 2008, USG will increase the ART treatment sites it is supporting from 16 to 17. These sites
cover 14 ODs in five provinces and two municipalities.
While Cambodia is still finalizing its Continuous Quality Improvement program, preliminary data suggest good retention and low
mortality among those started on ART. At the beginning of 2007, 20,139 patients were on ART. During 2007, an additional 7,927
patients were initiated on ART. Of these 28,066 patients, 819 (2.9%) died and 626 (2.2%) were lost to follow-up.
USG recognizes that the successes achieved in treatment of HIV-infected persons in Cambodia can only be maintained with the
continued provision of high quality care. Over time, as patients develop long term side effects to antiretroviral drugs and more
patients begin to fail first line therapy, treatment decisions will become more complex. As ongoing quality improvement activities
assume a more prominent role in HIV treatment, USG will focus its assistance on helping Cambodia implement such activities,
while simultaneously providing technical support to the national program to assist in the development of sustainable policies to
adequately cope with the increased complexity of care.
Table 3.3.08:
The TBD implementer will support People Living with HIV/AIDS (PLHA) in the five categories specified by
PEPFAR: clinical/physical care, spiritual care, psychological care, social care and integrated prevention
services. Routine collection of strategic information in the form of monitoring data, case studies, lessons
learned and best practices from partners will inform programs, donors and government-led initiatives
(including the universal access targets) will be implemented. All basic health care and support activities will
be carried out through local partners, networks and home care teams (HCTs). To ensure the effectiveness
and sustainability of its programs and activities, the TBD implementer will build partners' capacity through in
-service training.
Comprehensive care and support in community and home-based settings to PLHA beneficiaries will be
provided. The TBD implementer will provide grants to NGO partners to carry out integrated care and
prevention projects at community level. Each partner will support HCTs that operate from local health
centers. These HCTs will make regular home visits to provide basic medical care to PLHA, reinforce efforts
to refer them to relevant health services, such as Opportunistic Infection, TB, Antiretroviral Therapy (ART)
and Prevention of Mother To Child Transmission (PMTCT) and assist them with treatment adherence. For
PLHAs on ART education on side effects, living well on ART and ART adherence and follow-up will be
supported. In addition to basic health care, local partners and the HCTs will provide a comprehensive
range of services to PLHA. These include psychosocial support in the form of counseling, spiritual support,
preparation for funerals and providing for surviving family members; as well as welfare support to those
most in need, shelter repair, clothing and mosquito nets. Welfare support will be provided to PLHA on the
basis of their poverty, health, and family situation.
Referral mechanisms will be established or strengthened for PMTCT and Sexual and Reproductive Health
(SRH) services and to agencies/institutions that can offer PLHA social and economic opportunities. The
TBD implementer will ensure that referral systems are effective and that PLHA are not merely assisted in
reaching these services (for example by providing transport and accompanying beneficiaries if necessary)
but that the actual service was provided. HCTs will be supported to provide counseling to PLHA to help
them maintain the quality of their lives and reduce the risk of onward transmission. Beneficial disclosure
and ethical partner notification will be encouraged at all times.
Self Help Groups will be supported to help PLHA cope with ARV side-effects and treatment adherence, and
to discuss issues that are important for the health and well being of PLHA and their families, such as
nutrition and positive prevention. HCTs, provincial CPN (Child Protection Network) and CoC (Continuum of
Care) Coordinators will be encouraged to engage with PLHA self-help groups to better understand the
needs, concerns and challenges faced by PLHAs and to train the members in crucial issues such as ARV
adherence and positive prevention.
The TBD implementer will implement activities that support to the link between HIV and TB and integrate TB
as a key area of training for HCTs. HCTs will disseminate information about TB within the community, in
particular to PLHAs and their families that detail the signs and symptoms of TB, diagnosis, treatment and
treatment compliance and liaise with TB service providers. Local partners will conduct community meetings
and work with local authorities and faith-based institutions to reduce stigma and discrimination towards
PLHAs and their families.
The challenge now is to address a maturing epidemic, and focus on providing basic AIDS health care
through the CoC framework, with increasing numbers of people requiring care and support services,
particularly in areas where the public health system is weak. Home care teams help provide access to a
wide range of clinical, psychological, spiritual, and social support interventions. They represent the link
between public referral services and the community, and between PLHAs and faith-based support. As
reliance on these teams increases and resources focus more on treatment, the TBD implementer and its
local partners will ensure that team members become proficient in referrals and increase their medical
support role to include monitoring of side effects and drug adherence.
Voluntary Counseling and Testing (VCT) is a major element of the RGC's (Royal Government of
Cambodia's) Strategic Plan for HIV/AIDS and a key element of the CoC. Access to VCT services remains
limited in some areas of Cambodia, particularly in sparsely populated areas where transport costs are high.
The system of referrals to and from VCT needs strengthening. Programs will seek to address low utilization
rates in some sites and limited referral success. Linkages with NGOs specializing in livelihoods skills will be
established to provide income generation opportunities to PLHAs and affected families.
Food security is an important part of the service package for many PLHAs. Lack of access to regular and
healthy food can lead to a general decline in health, decreasing likelihood of adhering to treatment regimes
and a loss of income. Toolkits on food, nutrition, and HIV/AIDS produced in collaboration with various
agencies will be used to support local partners in delivering messages on nutrition for PLHA.
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Economic Strengthening
The TBD implementer will support children living with HIV in the five categories specified by PEPFAR:
clinical/physical care, spiritual care, psychological care, social care and integrated prevention services.
Routine collection of strategic information in the form of monitoring data, case studies, lessons learned and
best practices from partners that will inform programs, donors and government-led initiatives (including the
universal access targets) will be implemented. All basic health care and support activities will be carried out
through local partners, networks and home care teams (HCTs). To ensure the effectiveness and
sustainability of its programs and activities the TBD implementer will build partners' capacity through in-
service training.
Comprehensive care and support in community and home-based settings to children living with HIV will be
provided. Each sub-partner will support home care teams (HCTs) that operate from local health centers.
These HCTs will make regular home visits to provide basic medical care to children, refer them to relevant
health services (such as OI/ART and TB) and ensure that they can complete treatment. For those receiving
ART, education will be provided on side effects, living well on ARV and ARV adherence and follow-up. In
addition to basic health care, local partners and the HCTs will provide a comprehensive range of services to
children living with HIV. These will include psychosocial support in the form of counseling, spiritual support,
schooling, nutrition, and welfare support to those most in need, shelter repair, clothing and mosquito nets.
Welfare support is provided on the basis of poverty, health and their family situation.
Training will be provided to local partners to update their knowledge and skills. Local partners will also
participate in relevant meetings/workshops organized by the national programs for HIV/AIDS and maternal
and child health.
The TBD implementer will implement activities that support the link between HIV and TB and integrate TB
particular to the children living with HIV and their families and caregivers that detail the signs and symptoms
of TB, diagnosis, treatment and treatment compliance and liaise with TB service providers. Local partners
will conduct community meetings and work with local authorities and faith-based institutions to reduce
stigma and discrimination towards PLHAs and their families.
Infected children will be supported to attend school and will be given the necessary materials and uniforms.
HCTs will receive support to provide counseling and psychological support to children infected by HIV and
their families and to refer eligible children to appropriate vocational training opportunities. These children
will also be provided with additional support when parents become terminally ill, such as preparation for
foster care. Other social services will be provided to reduce stigma and discrimination towards infected
children who are most in need.
Health-related Wraparound Programs
* Child Survival Activities
Table 3.3.10:
The TBD implementer will focus on children who are directly affected by HIV and AIDS and other vulnerable
children, and address human and local organization capacity development and in-service training, targeted
evaluation, strategic information and food security.
OVC will be provided support to attend school and will be given the necessary materials and uniforms.
HCTs (Home Care Teams) will receive support to provide counseling and psychological support to children
infected by HIV and their families and to refer eligible OVC to appropriate vocational training opportunities.
These children will also be provided with additional support when parents become terminally ill, such as
preparation for foster care. Other social services will be provided to reduce stigma and discrimination
towards OVC who are most in need.
Community mobilization meetings, including the engagement of local faith-based structures, such as
pagodas to help reduce the stigma and discrimination that is so often experienced by OVC and their
families and to encourage a community response to HIV and AIDS with particular reference to OVCs will be
promoted. Community mobilization is considered particularly important in the case of OVC because the
community has a unique role to play in terms of finding foster care and protecting vulnerable children from
exploitation, including trafficking. Committees of influential people from local communities, faith-based
groups and the Commune Council will be formed to address the issue of child abuse and to support a child
protection framework. Refresher training may be provided to HCTs on responding to the needs of OVC,
child rights and child protection policy, organizing school support, life skills, succession planning, memory
book development, seeking foster care and pediatric ARV.
The OVC program will also offer an integrated package of care and prevention. OVC, as well as community
youth, receive information on the importance of abstinence and being faithful as key HIV prevention
approaches, including life skills education to be able to make their own informed choices. When
appropriate, older OVC will receive education about correct and consistent condom use and all will receive
risk-reduction education so as to help protect themselves from HIV infection and other risks such as drugs,
alcohol, sexual and domestic violence and trafficking. OVC access to vocational training and income
generation schemes will be developed. Building and maintaining linkages with other service providers to
ensure comprehensive packages for addressing the needs of OVC will also be required.
HCTs will collaborate with other service providers, community and religious leaders, local government
representatives and various faith-based organizations, including monks and nuns in the village pagodas.
The TBD implementer will work closely with other government and non-government agencies assisting the
national response to OVC and will become a member of the OVC National Task Force and relevant
technical working groups.
Table 3.3.13:
The focus of strategic information (SI) efforts will be to benefit the national response to HIV and AIDS as a
whole. Monitoring data, lessons learned and best practices will be shared with sub-partners, target groups,
other USAID partners, the government of Cambodia and local, national and international forums. The TBD
implementer will be committed to an ongoing plan of capacity building and improved technical expertise
both for its own staff and sub-partners, in addition to reviewing projects, developing tools and documenting
and promoting best practices among sub-partners and external stakeholders.
The TBD implementer will provide direct and specific training to sub-partner staff for effective data collection
at the field level and assistance in interpretation of monitoring data and results to help them better structure
their programs and their targets. As needed, technical assistance visits and coaching will be provided to
sub-partners and routine monitoring visits by partner program officers.
Besides sub-partners, other institutions, such as the National AIDS Authority (NAA), the National Center for
HIV, AIDS, Dermatology and STIs (NCHADS), Provincial AIDS Offices and the National Agency for
Combating Drugs (NACD) will receive technical assistance from the TBD implementer for their strategic
information activities in the form of training and contributions to their data collection systems.
The TBD implementer will work with the government agencies, sub-partners and other organizations to
identify and address potential areas for operations research. They will also involve the target communities
and the beneficiaries in the design and implementation of evaluations and other research. The TBD
implementer will play a key part in supporting Cambodia's M&E system in the HIV and AIDS sector by
contributing to nationally-set targets, sitting on central M&E coordinating committees, improving SI collection
methods and training civil society and government representatives in reporting and accountability
procedures and techniques.
The TBD implementer will seek to strengthen and expand the impact of its strategic information work
through contributing to the on-going national monitoring system. It is essential that the information the TBD
implementer collects is used not only to inform its own programs but also that of other agencies and the
government of Cambodia. The TBD implementer will contribute to Cambodia's universal access targets
and the other data collection needs of NCHADS, NACD and NAA. It will also support the efforts of national
civil society organizations to coordinate and collect strategic information relevant to Universal Access
Targets and the NAA central reporting system. The TBD implementer will work with media to ensure
HIV/AIDS receives accurate coverage in both printed and broadcast media through facilitating media visits
to sub-partners and beneficiaries.
Table 3.3.17:
Organizational capacity strengthening remains a central strategy of the Cambodia PEPFAR program. The
TBD implementer will build on its partners' technical, organizational and institutional capacities through a
variety of methods, including workshops; follow-up and monitoring visits; one to one technical support visits
and mentoring to partner staff. Other approaches may include project reviews, tools development,
documentation, sharing lessons learned and facilitating partner meetings as a means to provide additional
ways of exposing NGOs to new approaches and best practices.
The program will reflect the varying needs of different partners and plan support according to their needs
based on the capacity assessments. Capacity building will focus on systems strengthening, partnerships,
referral systems and coordination, HIV/AIDS technical capacity, organizational strength (governance,
strategy, structure, human resources, administration, and program and financial management), participation
of People Living with HIV/AIDS (PLHAs) and communities, and involvement in evidence and consultation-
based advocacy.
These activities contribute specifically to health systems strengthening by strengthening the implementation
of the Continuum of Care. This includes working closely with the public health system to strengthen
linkages for referral to a full range of relevant services. At the same time HCT (Home Care Team) activities
strengthen local linkages between public health facilities and the community. The involvement of Health
Centre staff in Home Care Teams ensures that the delivery of home-based care is carried out by a
partnership of the public and NGO sectors at the local level. The capacity of public health staff will be built
through training and mentoring. Skills gained as part of HBC (Home Based Care) are transferable to other
aspects of staff work in the community.
Policy and advocacy issues such as treatment access, provision of counseling and testing, prevention and
care and support for infected people will be addressed. The TBD implementer will strengthen the solidarity
and networking capacity of PLHA groups to advocate for reduced stigma and discrimination and access to
health services.
The TBD implementer will participate in policy development through influencing national government
strategic planning and strengthening advocacy for and by PLHAs and other vulnerable populations and
collaborate with the government and other stakeholders in identifying policy gaps and policies they may
need to be revised.
* Increasing women's legal rights
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $1,074,651
FY 2008 was the first full year that Team Cambodia has worked to implement Staffing for Results (SFR). Significant progress has
been made. Our four technical working groups Prevention, Facility-based Services, Community-based Services, and Strategic
Information, have all completed the initial formation process. Subsequently, the technical working groups have served as a
platform for reviewing accomplishments over the previous year and in setting priorities for the FY 2009 COP.
A particularly successful decision was the hiring of a USG Strategic Information Advisor, hired through USAID with GHCS-State
funds. The incumbent has been critical in working with USG programs, PEPFAR partners, Royal Government of Cambodia
counterparts, and other national and multinational organizations to coordinate SI activities and to ensure that monitoring and
evaluation for PEPFAR is done accurately and consistently among our partners. He has also ensured that our COP targets are
based on evidence and that our annual report is completed accurately and on time. Additionally, the SI Advisor has helped
strengthen interagency learning through his work on PMTCT, highlighting successes of USAID and CDC PMTCT implementation
and facilitating opportunities for cross-fertilization.
One issue experienced in our SFR efforts in FY 2008 has been difficulty in recruiting highly-qualified staff for the USAID
Prevention Advisor position. While we have finally been successful in recruiting for the position, it has taken many months and
lots of effort to find a qualified individual for the job. Once the Prevention Advisor is in place in early 2009, recruitment will have
taken over 10 months. It is anticipated that recruitment in Cambodia will continue to be a challenge. It is difficult to find
experienced, well-qualified personnel locally, and in particular, talented individuals with high-level English-language skills.
Recruiting internationally is possible, but is both expensive and time consuming.
During FY 2009, Team Cambodia will build upon the SFR activities initiated in FY 2008. As Team Cambodia is small and
streamlined, communications between agencies, at both the management and technical levels, is extremely collegial. Staffing
decisions are made jointly with each agency serving on the others recruitment panels. For example, for the USAID Prevention
Advisor Position, the panel consisted of the Director of CDC/Cambodia, the SI Advisor, the PEPFAR Coordinator and the USAID
FSN HIV/AIDS Advisor.
The question of limited annual increases of funding is one that Cambodia has already addressed. Team Cambodia has had to
make the difficult choices required in responding to a decreased budget in FY 2008. As noted elsewhere in the COP, this has
precluded us from funding proposed activities by the Department of Defense, and will limit our ability to include Peace Corps in
PEPFAR activities. So, while we are able to deal with level funding, some incremental increases in funding would pay significant
dividends for Cambodia's PEPFAR program.
HHS/CDC is requesting one new staff position this year. As noted in the activity narratives, there has been an increased focus
over the last year in increasing HIV testing at antenatal clinics and TB clinics, as well as an initiative to bring liquid TB culture to
Cambodia in order to improve TB diagnosis in HIV-infected individuals. Both of these projects will require hands-on training and
supervision at the local level to ensure quality results. HHS/CDC currently has one Lab Analyst working in Battambang who
provides lab technical support and skills-building throughout Banteay Meanchey, Battambang, Pursat and Pailin. The increased
work level justifies creating a second Lab Analyst position to help ensure high quality work and therefore programmatic success.
This would be an LES position.
Turnover will be a major issue during FY2009. Three direct hire positions will turn over, including the CDC Country Director, the
USAID Deputy Health and Population Officer, who serves as the PEPFAR Coordinator, and the CDC Epidemiologist. This will
result in a significant loss of experience, leadership, and institutional memory. These positions will be refilled following standard
practice.
There are also three important contractor positions that will turn over. The USG SI Advisor will be leaving and will be difficult to
replace. CDC's HIV/AIDS Clinical Advisor will be leaving, and will also be difficult to replace. Finally, CDC's Microbiology Lab
Advisor will be leaving, and while the position will probably not be refilled, a program of short-term technical assistance in this area
will be scheduled.
Table 3.3.19:
