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: RACHA has been awarded a new
cooperative agreement. It was part of the TBD partner in the COP08 that covered several programs ending
September 2008.
RACHA will provide support to the Ministry of Health (MoH) PMTCT Program to reduce HIV transmission
from mothers to new born babies, through PMTCT services within health facility settings.
RACHA will build capacity and strengthen services for PMTCT. This will include staff capacity training and
procurement of necessary materials for PMTCT and lab services. Capacity-building will include refresher
training for counselors and supportive follow-up with trained staff from national and provincial levels.
Trained staff will use their upgraded skills to provide quality services and improve client understanding of,
and participation in, PMTCT. RACHA will also increase men's involvement with their partners in PMTCT
services. Program training and sensitization of community leaders and villagers will be another focus.
RACHA will also provide support to better implement the activities and processes of the PMTCT National
Standard Protocol and Guidelines, including needs assessment, capacity-building and health facility
renovation.
RACHA will work to ensure that eligible HIV positive mothers and all newborn babies are provided with ARV
prophylaxis/HAART when necessary. Newborn babies will be followed up for at least 18 months after
delivery and receive HIV check-ups and referral to pediatric AIDS care as needed. The program will focus
on strong collaboration and linkages with opportunistic infections (OI) services, related home based care
(HBC) partners, self help groups and MMM (Khmer for Friends Helping Friends), all vital to ensure that HIV
positive clients receive the full package of prevention and care.
PMTCT services are an MoH priority and can serve as an entry point to HIV/AIDS services. RACHA
utilizes the MoH's policies, protocols and guidelines throughout its program. Support focuses on
strengthening institutional capacity, key to sustainability. RACHA is also strengthening village health
support group (VHSG) community networks, training village shopkeepers and supporting the ‘Comedy for
Health' team to share information in the community and create demand for health facility services. HIV
messages, including PMTCT, will be disseminated to communities through outreach activities utilizing the
groups mentioned above. These messages will also be targeted at migrant couples to strengthen
couple/gender relationships. Targeted men and women will be provided with messages on HIV prevention,
the importance of HIV testing, and locations where PMTCT services are available. RACHA's aim to create
demand for services in the community, establish an environment where people can openly discuss
HIV/AIDS issues, support the adoption of HIV prevention practices, and raise awareness about the
importance of people knowing their HIV status.
RACHA maintains strong collaborative relationships with HIV/AIDS partners such as PSI and other NGOs.
RACHA supports the full package of the PMTCT program and also has strong links with OI/ART services
and HBC of related organizations in its focus sites.
In FY 2009 RACHA will work in at least 11 sites in 7 ODs in 4 provinces and the Phnom Penh Municipality.
RACHA will have 3 sites in Pursat, 3 sites in Siem Reap, 1 site in Prey Veng, 3 sites in Koh Kong and 1 site
in Phnom Penh Municipality. Depending on the evolution of the national PMTCT program additional sites
may be added to increase the proportion of pregnant women screened for HIV in the five RACHA project
provinces.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $38,701
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In Cambodia, many rural men and women migrate to find alternative employment. Men away from home
often engage in high-risk behaviors and become infected with HIV. They establish an HIV "bridge" into the
rural community, passing the infection on to their wives and children. Consequently, these migrant couples
(MCs) constitute a key high-risk group in rural communities. Openly talking about sexual health,
reproductive health and HIV prevention among rural married couples can represent a serious breech of trust
and confidence between the husband and wife. When a wife knows her husband is unfaithful while away
from home, she still trusts that he will use a condom when he engages in commercial sex. On returning
home, a husband rejects condom use because this is tantamount to confessing that he cannot be trusted,
and an admission of having been unfaithful. The MC program was designed to improve the relationship
between husband and wife and contribute to the reduction of new HIV infections in rural communities.
Worldwide, rural communities have some form of village shop that sells an array of merchandise, ranging
from basic necessities such as rice, sugar, salt, etc., to various drugs as well (paracetamol, pills, and
condoms for example). Recognizing the great potential of village shops as a health resource in rural
Cambodia, RACHA, in collaboration with the Ministry of Health (MoH), began its Village Shopkeeper
Program to extend the reach of the health facility by using additional means for service delivery and
behavior change communication at the village level in addition to referrals.
RACHA supports the following four areas of community participation and advocacy which complement HIV
prevention activities at the health facility:
Couple/gender relationship-strengthening within the family toward HIV prevention, targeting migrant
couples:
RACHA's MC Program strategy is designed to build couples' basic knowledge about HIV/AIDS, facilitate
self-assessment of infection risk, promote open discussion between husbands and wives about potential
risks of infection, encourage faithfulness, inform couples about ways of preventing HIV infection as well as
provide information on the availability and benefits of voluntary counseling and testing (VCT) and PMTCT
services. These are seen as critical elements leading to behavior change with men taking responsibility for
HIV prevention within MC families. RACHA identifies MCs, village by village, with the assistance of the
village chief. Messages designed to increase awareness about the risk of STD/HIV infection among MCs,
including factors affecting risk of infection and family security are presented. Outreach facilitators lead
discussions in separate groups of men and women with men talking with men and women talking with
women. An important topic discussed with men is the husband's responsibility, as a man, to protect his
family. HIV infection, prevention, and personal risk factors that help the husband and wife assess their own
risk are explained and couples are encouraged to discuss risks and ways to prevent HIV infection. MC
members are recruited as peer educators (PEs) in their own village with usually two PEs per village one
male and one female. PEs reinforce messages about HIV/AIDS infection and prevention. All PEs attend
training courses conducted by RACHA/MoH. To retain PEs (past attrition has been about 30%), continuing
education will be offered every 3 months to motivate and help PEs address issues and difficulties
encountered in their villages. Meetings between PLHAs and MCs are also organized to create opportunities
for villagers to learn how someone became infected and consequently managed their life, including the
support they need from their family and community. This strengthens HIV knowledge among MCs,
encourages them to think about their own risk and start to take action. Other villagers are also encouraged
to join these meetings. Follow-up visits by PEs continue to reinforce messages, to help to solve problems,
and to answer questions related to HIV/AIDS.
Most at Risk Populations (MARPs):
In addition to the community oriented sexual prevention activities listed above, RACHA will expand its
coverage to ensure that targeted activities for MARPs are carried out in Koh Kong and Prey Veng
provinces. Koh Kong borders Thailand and has a burgeoning casino industry and a growth in other
entertainment establishments and Prey Veng borders Vietnam. Both provinces are also along a highway
through southern Cambodia linking Thailand to Vietnam. Program activities will be similar to the peer
education approaches used by other USG partners in other provinces and will help prevent geographic
gaps in coverage for these high-priority groups.
Community Awareness-Raising through ‘Comedy for Health', targeting the general population:
RACHA provides training to community volunteers on comedy performance, HIV information and
community communication skills for behavior change. The ‘Comedy for Health' team translates HIV
messages into comedy scripts and interactive performances.
Community Based Services through Village Shopkeepers:
RACHA works with MoH counterparts at the provincial and operational district (OD) levels to help with
village shop selections based on a preset criteria. The selected shopkeepers are contracted to stock
commodities and display information, education and communications (IEC) materials about birth-spacing,
HIV prevention and oral rehydration salts (ORS) to treat diarrhea. Shopkeepers also agree to record
purchases and sales of reproductive health commodities and provide the data to RACHA and the MoH.
RACHA provides initial training and subsequent follow up to reinforce correct information dissemination to
the community. Training is provided to shopkeepers (sometimes husband and wife) at a central location in
the area. Supporting IEC materials are distributed to shopkeepers to display in a prominent place in their
shop. RACHA and MoH partners visit participating shops on a regular basis, collecting data on
commodities purchased and stock on hand. They also provide additional IEC materials as needed and
check the shopkeeper's knowledge on key messages.
Activity Narrative: Joint Advocacy Campaigns, focused on special events:
RACHA contributes to National, Provincial and OD programs that advocate for HIV Prevention through
special events such as a Candle Light Memory Day, World AIDS Day and the Water Festival.
RACHA works with the national government through the National Center for AIDS, Dermatology and STDs
(NCHADS), the National AIDS Authority (NAA) and the National Maternal and Child Health Center
(NMCHC) at all levels as well as with local authorities, communities and NGOs. In Phnom Penh, RACHA is
a member of the HIV/AIDS Coordinating Committee (HACC) and the NAA mobile population technical
working group. Linkages have also been strengthened between RACHA, health facilities and the
community, both to improve service provision at health facilities and to benefit the community. RACHA is
also linked with local authorities since most of the programs/activities focus on community mobilization and
education. The private sector is RACHA's focus for social marketing (in cooperation with PSI) to ensure
commodities are available at all types of outlets (wholesale and retail).
RACHA's geographic coverage is extensive. HIV prevention among MCs covers 82 health clinics (HCs), 15
operational districts (ODs) in 5 provinces. Community ‘Comedy for Health' performances cover 50 HCs in 4
ODs. The CBS Program through shopkeepers covers 56 HCs in 9 ODs in 4 provinces. These activities will
continue in the five provinces covered under the new RACHA program. Special Events have national
coverage.
Table 3.3.03:
September 2008
RACHA provides support to the Ministry of Health (MoH) to reduce HIV transmission among the general
population through voluntary counseling and testing (VCT) services established within health facility
settings. VCT services are being scaled up all 24 provinces, with at least one VCT site per operational
district. RACHA utilizes MoH policies, protocols and guidelines. Support focuses on strengthening
institutional capacity in an effort to ensure sustainability. In addition, village health support groups (VHSGs),
village shopkeepers and RACHA ‘Comedy for Health' teams provide information in communities to increase
demand for services at health facilities.
RACHA will continue to provide capacity building and strengthening to VCT counselors and lab technicians.
Two VCT counselors and 2 lab technicians in each health facility will receive 5 days refresher training on
HIV counseling and testing. Necessary materials for VCT and lab services will be provided as well as
counseling network meetings and supportive follow-up for staff at all levels. Trained counselors and lab
technicians, as well as other related staff, will use their upgraded skills and experiences to provide higher
quality services for client sensitization and voluntary participation. RACHA will expand the number of sites
that follow the national standard protocol and guidelines. This includes capacity building for VCT
counselors, support teams and other related staff as well as facility renovation to create adequate and
confidential space for appropriate client service delivery.
Clients who are identified as HIV positive will be referred to the nearest OI and home based care (HBC)
services. RACHA maintains strong collaboration and linkages with OI services, related HBC partners, self
help groups and MMM (Khmer acronym for Friends Helping Friends). These links are vital, to ensure that
HIV positive clients are receiving the full package of prevention and care services.
Strong collaboration exists with all related partners - PSI, HBC and other NGOs. Effective collaboration
between partners is a key focus of the MoH strategy. RACHA supports the full VCT package and links with
OI/ART services and organizations offering HBC in its geographic focus areas. All positive cases needing
care or support are referred to OI/ART services and MMM.
In FY 2009 RACHA will provide support for at least 11 sites in 8 ODs in 5 provinces and Phnom Penh
Municipality.
Estimated amount of funding that is planned for Human Capacity Development $29,162
Table 3.3.14:
