Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 5606
Country/Region: China
Year: 2009
Main Partner: FHI 360
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $686,455

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $175,455

n/a

New/Continuing Activity: Continuing Activity

Continuing Activity: 17509

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17509 17509.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $200,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $52,637

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 $52,637

Water

Table 3.3.03:

Funding for Prevention: Injecting and Non-Injecting Drug Use (IDUP): $70,000

n/a

New/Continuing Activity: Continuing Activity

Continuing Activity: 17512

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17512 17512.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $70,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $21,000

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 $35,000

Water

Table 3.3.06:

Funding for Care: Adult Care and Support (HBHC): $120,000

n/a

New/Continuing Activity: Continuing Activity

Continuing Activity: 17520

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17520 17520.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $10,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $72,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $6,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $24,000

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $55,000

n/a

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $27,500

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $2,750

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $11,000

Water

Program Budget Code: 10 - PDCS Care: Pediatric Care and Support

Total Planned Funding for Program Budget Code: $120,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Of the estimated 700,000 HIV infections in China at the end of 2007, approximately 7,000 (1%) occurred through MTCT. By the

end of June 2008, there were 4,200 cumulative pediatric HIV/ AIDS cases reported in China. Of these, 80% were from six

provinces (Anhui, Guangxi, Henan, Shanxi, Xinjiang, and Yunnan). The majority of pediatric HIV/AIDS cases are reported from

counties supported by China CARES or other government-led HIV/AIDS treatment and care programs.

Pediatric HIV/AIDS care policy is under the "Four Frees and One Care" policy issued by GoC in 2003. Due to limited capacity at

each level in implementing this policy, China initiated a pediatric HIV care program in several China CARES counties in Anhui and

Henan provinces in 2004, and then combined these with pediatric treatment programs (including OI prophylaxis) and expanded to

six GFATM Round 3-supported provinces in 2005 (resulting in the National Free HIV/AIDS Pediatric Treatment Program). By the

end of 2005, approximately 150 HIV- infected children were receiving ART. By August 2008, the program expanded to 22

provinces with approximately 1,200 infected children (ages 0-14 years) receiving ART. Of the children on ART, 91.8% are from

seven provinces: Henan (53.4%); Yunnan (10.6%); Guangxi (9.9%); Hubei (5.3%); Xinjiang (4.4%); Anhui (4.2%); and Shanxi

(4.2%).

Challenges faced by GoC in rolling out pediatric HIV/AIDS care and treatment include: 1) lack of capacity at the county level to

manage pediatric HIV care and support programs; 2) delay in early case finding; 3) poor adherence to medication in mostly rural

counties; 4) lack of linkages between PMTCT and pediatric programs; 5) late diagnosis and other factors leading to the median

age of HIV-infected children in HIV care to be 8 years; 6) lack of family and community support; and 7) stigma and discrimination

in communities and families.

Gaps in the National Free Pediatric AIDS Treatment program include: 1) poor integration of pediatric treatment with local pediatric

health services system; 2) limited cooperation between PMTCT and pediatric HIV treatment programs; 3) lack of capacity at the

county level to manage children infected with HIV; 4) lack of follow-up resulting in many HIV-infected children dying before they

can be put on ART; 5) poor ARV drug adherence for children and their family members, especially in rural areas; 6) lack of funds

for laboratory testing, regular clinical monitoring, and OI management; 7) poor quality of pediatric HIV treatment in Henan

province, where most of the cases are currently located; and 8) limited early case finding and referral for ART, which remains an

issue in high epidemic provinces such as Guangxi, Guizhou, Sichuan, Xinjiang, and Yunnan.

To help address these challenges and gaps, USG will work with Maternal and Child Health (MCH) and CDC systems on

strengthening cooperation between PMTCT and pediatric HIV/AIDS programs, and supporting development of a referral

mechanism between these two critical programs. USG will assist GoC in developing technical guidelines for early infant diagnosis

(EID) and transport of DBS specimens, and implementing the EID guidelines in at least the 333 PMTCT program counties. The

Clinton Foundation is providing regular monitoring, mentoring, and direct program support for pediatric HIV/AIDS care and

treatment in five provinces (Anhui, Guangxi, Henan, Xinjiang, and Yunnan). USG is working closely with the Clinton Foundation in

addressing gaps and barriers in pediatric HIV care and infant diagnosis by polymerase chain reaction (PCR).

USG will work with GFATM Round 3 and 4 offices (including the top six pediatric HIV/AIDS case load provinces) on strengthening

the three-tier health network system and involving families in providing quality care including OI management and medication

adherence support for HIV-exposed and -infected children. At the provincial level, USG will pilot home-based VCT and PITC

approaches in several high epidemic areas (e.g., Xinjiang and Yunnan) for early case detection and enrollment of more needy

children on care and treatment. USG will support all 15 USG-supported provinces in implementing the PwP strategy and

improving case management mechanisms for all HIV-infected children and their families to increase follow-up rates.

USG will continue to support graduates from the Lixin Rural AIDS Clinical Training Center on providing facility-based care and

support (including cotrimoxazole prophylaxis) to HIV-positive children in their respective provinces, including Anhui, Gangsu,

Guizhou, Heilongjiang, Henan, Hunan, Inner Mongolia, Jiangsu, Ningxia, Qinghai, Shandong, Sichuan, Tibet, Xinjiang, and

Yunnan. At least 24 physicians will be trained in pediatric HIV care and treatment each year. USG will also provide technical

assistance to NCAIDS on analysis and utilization of pediatric ART follow-up data.

The second-line ARV program started in Henan province in December 2007, and includes Abacavir (ABC), lamivudine (3TC), and

Kaletra. Tenofovir will become available before the end of 2008. GoC and the Clinton Foundation anticipate that approximately

200 children in five to six provinces will be on second-line therapy by December 2008. One national ARV drug resistance study in

2007 showed that the genotypic resistance to NRTI/NNRTI among HIV- infected children on first-line ARV therapy was quite high.

USG will assist in efforts to improve ARV drug adherence among HIV-infected children and their families.

Table 3.3.10:

Funding for Care: TB/HIV (HVTB): $13,000

n/a

New/Continuing Activity: Continuing Activity

Continuing Activity: 17517

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17517 17517.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $20,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,600

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Testing: HIV Testing and Counseling (HVCT): $100,000

n/a

New/Continuing Activity: Continuing Activity

Continuing Activity: 17515

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17515 17515.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $50,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $30,000

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 $10,000

Water

Program Budget Code: 15 - HTXD ARV Drugs

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Not applicable

Program Budget Code: 16 - HLAB Laboratory Infrastructure

Total Planned Funding for Program Budget Code: $460,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

The USG China Five-Year Strategy for HIV/AIDS (2006-2010) aims to assist GoC in maintaining the HIV/AIDS prevalence below

1 per 1000 or 1.5 million HIV-infected persons nationwide by 2015 (in line with GoC, USG recently updated this to 2015). By the

end of 2007, China established an HIV testing network with 6,918 HIV antibody screening laboratories; and by August 2008, there

were 201 HIV antibody confirmatory laboratories in operation. There are 435 local CDC offices in generally low HIV prevalence

areas with no laboratories for HIV antibody screening.

The National AIDS Reference Laboratory (NARL) in NCAIDS is the HIV/AIDS Reference Laboratory in the China CDC system

and coordinates the network of HIV/AIDS laboratories nationwide. According to the most recent MoH strategy (2008), NARL is

also responsible for hepatitis C virus (HCV) testing, quality assurance/quality control (QA/QC), and syphilis QA/QC in the HIV

laboratory network. Since 2003, CDC China and USG have collaborated extensively on HIV BED incidence testing, HIV-2

diagnosis, and ARV drug resistance testing on DBS. Until recently, USG had limited involvement in other laboratory areas such as

evaluation of rapid test algorithms, rapid test reagent quality, and support for monitoring HIV treatment and care for patients.

In 2007, about 85,000 CD4 tests were conducted in China by laboratories nationwide. In the 24 provinces that have initiated viral

load testing, about 29,000 viral load tests were carried out in 2007. However, there are concerns about the test accuracy and

quality of training received by laboratory technicians in several of the provinces. Along with expanding the National Free ART

Program, by early 2008, 190 and 120 laboratories were equipped with instruments for CD4 and viral load testing, respectively. In

FY 2009, USG will focus on expanding and enhancing the QA/QC for HIV diagnosis and clinical monitoring, including HIV rapid,

CD4, and viral load testing at the provincial, prefecture, and county levels.

Along with the rapid expansion of these testing networks, personnel training and QA are critical for successful implementation at

all levels. At the national level, USG has assisted NARL in participating in a number of international QA networks. At the provincial

level, USG is supporting 15 provincial CDC laboratories to conduct QA twice a year. Since 2004, USG, through NARL, has

supported QA covering 2,987 laboratories, among which 2,927 (98%) were found to be qualified and 60 (2%) unqualified.

In FY 2009, USG will continue to support NCAIDS on the development of the most optimal HIV rapid testing algorithms, and help

implement standardized record keeping at HIV testing sites. In addition, QA elements and practical proficiency testing

approaches, such as the use of dried tube specimens, will be piloted. USG will provide technical assistance for post-marketing

surveillance of test kits to ensure the consistent quality of kits. USG will also work with NCAIDS to improve national CD4 testing

guidelines, and extend a proficiency testing system to the county level. USG will assist NCAIDS to revise and update the National

Guidelines for Detection of HIV/AIDS. In FY 2009, USG will assist NARL in developing national HCV testing guidelines. Along with

expansion of the National Free ART Program (by the end of August 2008, 52,191 persons had been enrolled on ART), USG will

support NARL to enhance the monitoring of drug resistance testing at the national level. At the provincial level, USG will support

Guangdong province and one other province (TBA) as a pilot to establish a network of drug resistance testing, appropriate

specimen transportation, and reporting.

USG has supported the implementation of BED-CEIA for HIV incidence estimation in seven provinces (Chongqing, Guangdong,

Guangxi, Guizhou, Sichuan, Xinjiang, and Yunnan) since 2005. In FY 2009, USG will support the development and

implementation of the national protocol for BED testing, including QA/QC, and extend this technology to one or two more

provinces. USG will focus on capacity building at the provincial and national levels in advanced statistical analysis and estimation

of HIV incidence trends among MARPs using BED data from multiple cross-sectional surveys. These estimations improve

projections of the spread of HIV regionally in China, and provide important feedback on the effectiveness of HIV prevention

programs such as those among IDU in different cities.

To strengthen early infant diagnosis of HIV, USG will support NARL and several provincial CDC laboratories in the use of DNA

PCR on infant DBS. Currently, very few HIV-infected infants in China are diagnosed in a timely manner to start ART in the first

year of life. The average age of children initiating ART in the past three years has been 8 years of age (see Pediatric Care,

Support, and Treatment narrative). As of September 2008, fewer than 10 out of more than 1,000 children on ART (<1%) are

infants. In FY 2009, USG will collaborate with the Clinton Foundation and NARL to develop a workable system for transportation

of specimens and timely return of PCR results to the field. Seventeen technicians in six provinces (Guangxi, Henan, Hubei,

Shandong, Shanghai, and Yunnan) have been trained on performing DNA PCR and the equipment has been installed; in addition,

NARL can provide regular QA/QC for all provincial EID laboratories.

To help achieve the above objectives, a senior laboratory scientist has been recruited and will join the USG China team in

January 2009 to work closely with the NARL, Clinton Foundation, and other partners. CDC Atlanta is assisting NARL to create a

medium- and long-term plan for strengthening HIV/AIDS laboratory capacity in China, and develop an HIV national laboratory

strategic plan for the next five years. In FY 2009, USG support will focus on: training a laboratory scientist on HIV drug resistance

genotyping using DBS; assisting with data analysis and timely delivery of HIV drug resistance data to practicing clinicians;

providing technical assistance on establishing a provincial HIV drug resistance testing network; assisting with BED-CEIA

incidence estimation and QA/QC; implementing new easy-to-use and cost-effective proficiency testing methods for HIV serologic

diagnostic QA; assisting with laboratory information systems; providing guidance to NARL in pursuing accreditation by

international laboratory accreditation agencies; and assisting with an evaluation of HIV rapid test and HCV test algorithms.

Table 3.3.16:

Funding for Strategic Information (HVSI): $83,000

The PHE activity, "Enhanced Evaluation of ART Program in Guangxi Province, China" was approved for

inclusion in the FY09 Mini-COP. The PHE Tracking ID associated with this activity is: CN.07.0012.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17523

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17523 17523.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $10,000

International International

Development

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Estimated amount of funding that is planned for Public Health Evaluation $83,000

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Strategic Information (HVSI): $40,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

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 $2,000

Water

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $1,316,326

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Strengthening health systems within China is essential for sustaining the low prevalence of HIV/AIDS in the country. The Chinese

health infrastructure operates vertically, with each administrative level possessing firm command over the next lower level, from

the national to the provincial, prefecture, county, and township levels. Under this framework, USG-supported HIV/AIDS policy

activities work closely with GoC at all levels to effectively improve China's capacity to control this epidemic. In the USG China Five

-Year Strategy for HIV/AIDS (2006- 2010), a set of principles has been identified to accelerate and complement an effective

national response, which include supporting government policy development, building capacity for policy analysis, and fostering

an enabling environment at the community level.

At the national level, USG supports capacity building activities such as assisting NCAIDS divisions with annual work plans and

providing program management training. In addition, USG supports NCAIDS' efforts to pay close attention to capacity

development at the lower levels. Institutional capacity building of government partners is supported through the development of

management skills which are more participatory, inclusive, and respectful of the community's contribution.

In FY 2008, USG continued successful communication of the PwP strategy to GoC. Additionally, in a multi-year effort to change

the national MMT policy of NCAIDS, USG supported advocacy of recommendations to preferentially enroll PLHA in national MMT

programs. GoC's adaptation of the strategy is reflected in issuing national-level HIV/AIDS indicators that measure the number of

PLHA enrolled in MMT and the number of PLHA receiving palliative care and support. USG also supported NCAIDS in developing

national guidelines for the implementation of rapid testing, TB/HIV co-infection treatment, and ARV adherence. In FY 2009, USG

will initiate dialogue with NCAIDS to discuss how HIV/AIDS is financed in China and develop a plan for policy advocacy to

increase the amount of public financing. Through this effort, a better understanding of total resource mobilization towards

HIV/AIDS programming at the national, provincial, and county levels will result.

At the provincial and county levels, USG has focused efforts to address the lack of trained management and operational

personnel in underserved areas. USG's main strategy is to strengthen the public health system through two training programs to

improve human capacity: 1) the Lixin Anhui Rural AIDS Clinical Training Center, and 2) the Provincial Program Management

Training Program (PPMTP). Both programs are practical internships and provide comprehensive clinical home-based care,

support, and treatment under the mentorship of an HIV/AIDS US-trained clinician.

In its sixth year of operation, the Lixin Anhui Rural AIDS Clinical Training Center program is implemented through partnerships

with the Clinton Foundation, National Division for Care and Treatment, and the Anhui provincial health bureau. At the end of FY

2008, 71 clinicians from 31 provinces had been trained to better care for people with advanced HIV/AIDS. This is the only

practical clinical training program focused on the rural HIV/AIDS epidemic. In FY 2009, the training curriculum will be strengthened

by the involvement of the University of Washington's International Training and Education Center on HIV (I-TECH). The hope is to

double the number of participants by launching a second training center focused on advanced HIV disease among IDU. This

activity will be supported by a consortium of technical resources from the National Division of HIV/AIDS Care and Treatment,

Gates Foundation, and the local implementing unit.

PPMTP supports capacity building through a 6-month practical internship for 16 provincial HIV/AIDS personnel. Trainees identify

specific projects managed by technical experts in NCAIDS and are mentored under individual divisions. Because the Chinese

health system does not permit the transfer of provincial personnel to the national level, this training gives participants the

opportunity to learn from national programs, strengthen their contacts at the national level, improve their skills, and enhance

implementation at the provincial level. In FY 2009, PPMTP will expand the number of participants to include junior- and second-

level managers responsible for implementing HIV/AIDS activities.

USG will continue to assign technical advisors to GoC to better integrate USG efforts with the Chinese national and provincial

needs, ensure USG participation in HIV/AIDS annual provincial planning meetings, participate in strategic planning with the

NCAIDS, support NCAIDS' efforts to implement the "Three Ones" in every province, and assist in the acceptance of rapid testing

at the lower levels.

USG continues to provide technical assistance to GoC and other parties to prioritize and address pharmaceutical management

needs that have been identified to ensure an uninterrupted supply of quality ARV drugs and other pharmaceuticals and

commodities at ARV treatment sites. The ARV distribution system in China operates on five levels - provincial, prefectural,

county, township, and village health center. ARV procurement at the provincial, prefecture, county, and township levels operates

on a pull basis from the next highest level. The lead time needed to obtain drugs is five to 10 days. Village health centers obtain

their ARV supplies on a monthly basis. The system faces challenges as China rolls out ARV drugs on a wider basis; for example,

in Yunnan, 100 of 129 counties are currently providing ARV drugs and diagnostics. Establishment of a framework for appropriate

drug logistics management has become more important as the number of patients on ARV drugs in China rapidly increases.

In FY 2008, USG worked with local stakeholders in Guangxi province to strengthen ART management by providing technical

input, developing or adapting necessary tools and training materials, and providing follow-up support in implementing identified

interventions for ART. In addition, USG, through MSH, worked with WHO and MoH to explore potential technical assistance

needs related to the provision of ARV treatment in the GFATM Round 6 award. Based on an assessment conducted in Yunnan in

early 2007, serious recordkeeping and reporting issues were identified, such as inconsistent recording of inventory transactions;

lack of formal methods to control inventory at all levels; lack of records of consumption figures for ARV drugs; no formal methods

for estimating future needs; and weak monitoring of pharmaceutical management below the county level with no standardized

procedures.

Potential needs for technical assistance and support include: improving drug management information systems (stock

recordkeeping and regular reporting systems); strengthening the flow of information to and from village, township, and county

levels; enhancing methods for drug estimation and inventory control; developing monitoring and supervision systems for ARV

drugs and other medicines; and developing standard operating systems and providing on-the- job training to reinforce proper

procedures. In FY 2009, USG plans to expand the use of technical tools and training materials, while applying lessons learned

from Guangxi province, to strengthen ARV management in Yunnan. Specific proposed activities for Yunnan province include

conducting a stakeholders meeting, a workshop to assist national and provincial staff in introducing standard operating

procedures and tools for ARV management, and a training- of-trainers (TOT) workshop. USG will also provide follow-up support.

USG will focus on improving operational policies to support access to services, protection of rights, and harmonization of HIV legal

frameworks and policies that support community participation, including registration of NGOs. Importantly, USG will reposition

MARPs and PLHA to enable them to meaningfully participate in the policy process by strengthening their advocacy capacity,

supporting community mobilization, and consolidating community structures. All activities are underpinned by a commitment to

ensure the best quality data is driving decision making, and data is used for policy analysis, advocacy, and public consumption.

USG aims to demonstrate, document, and disseminate successful approaches to policy making and implementation that are

supportive of MARP and PLHA. USG works with the Chinese government to advocate that successful approaches to HIV policy

be replicated beyond Guangxi and Yunnan provinces.

In FY 2008, USG efforts at the community level focused on facilitating linkages between current community-level indigenous

organizations and provincial and county CDCs and health bureaus, particularly in Guangxi and Yunnan provinces where USG

supports many CBOs. USG has encouraged CBOs and GoC to engage in increased dialogue with provincial and local CDCs and

health bureaus to influence the policy process.

By providing small grants to regional PLHA networks to work with their national member organizations to transfer policy analysis

skills, USG has increased the ability of county networks to participate in national policy dialogue activities. To complement this

activity, USG assisted newly-formed networks to establish steering committees, and provided training to these groups in

advocacy, organization and financial management, and HIV/AIDS awareness. USG emphasizes the bottom-up approach to build

advocacy skills among local PLHA networks and MARP peer groups. Progress has been made on training and mobilizing them,

and ensuring buy-in and support from local governments to sustain indigenous organizations and link services they provide to

current government and other donor-provided services.

Strengthening local CBOs continues to be a focus of the USG China program. Adaptation of CBO capacity tools to the China

context is being carried out, and USG will use the CBO analysis toolkit to assess group development needs, analyze group

capacity, and assist groups in devising work plans focused on building capacity. Given the unique situation in China where it is not

possible for CBOs and NGOs to register unless they are affiliated with a government partner or agency, USG will simultaneously

build the capacity of government partners to enable them to effectively support these groups, which will require a similar

assessment and capacity building process as well as development of tailor-made tools for these partners. Given the relative

newness of CBOs among MARPs, many groups lack the expertise that could make them more sustainable and improve the

quality of life for their members. To address this situation, USG will begin building their expertise around savings-led, income-

generation options, micro-finance group mobilization and development, business planning, and simple marketing and accounting

skills.

In FY 2009, USG will support a variety of new and continuing efforts to support the strengthening of China's health system at the

national, provincial, county, and community levels. USG will continue its work on reducing stigma and discrimination against

MARPs and PLHA by measuring the extent to which national policies are known and understood. USG will employ MARPs and

PLHA to measure discrimination by health care providers after this year's implementation of the stigma and discrimination

curriculum in Guangxi. USG will measure discrimination among providers who have not been trained, and the range and

effectiveness of current incentives and sanctions for health care providers and public service personnel when discrimination does

occur. Results of this analysis will be incorporated into policy dialogue and advocacy activities.

USG will also work with local PSBs to improve their treatment of IDU and foster partnerships between local PSBs and CDCs to

increase referrals of IDU to MMT, thus complementing and building on the PwP work. USG will create opportunities for PSBs and

CDCs to engage in dialogue and harmonize public health and policing practices. Building on past regional meetings, USG will

convene groups of police and public health officials from the model communities to share emerging "best practices" on

interagency coordination and communication. Through joint efforts with GFATM Rounds 4 and 5, USG will support activities to

reduce stigma and discrimination specifically among MSM.

USG will support ongoing staff development activities and capacity building of local implementing partners in the areas of

advocacy, effective use and dissemination of data, and public relations. USG will support the brokering and provision of grants to

establish ‘twinning' relationships between young organizations and more established and accepted ones. USG will also monitor

developments in the formation of NGOs as the 10-year national poverty alleviation plan explicitly calls for increased NGO

involvement in anti-poverty activities.

USG will also continue to assist local policy makers, planners, and public officials in applying strategic information in planning and

advocacy for adequate HIV/AIDS resources with the A2 project. These types of activities are having tremendous impact, as noted

during a recent MoH presentation in Yunnan province where a decision to realign the HIV/AIDS budget was made after receiving

technical assistance from USG in this area.

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $30,000

n/a

New/Continuing Activity: Continuing Activity

Continuing Activity: 17524

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17524 17524.08 U.S. Agency for Family Health 7772 5606.08 TASC3 $50,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $21,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18:

Cross Cutting Budget Categories and Known Amounts Total: $473,124
Human Resources for Health $52,637
Education $52,637
Human Resources for Health $21,000
Education $35,000
Human Resources for Health $72,000
Food and Nutrition: Policy, Tools, and Service Delivery $6,000
Education $24,000
Human Resources for Health $27,500
Food and Nutrition: Policy, Tools, and Service Delivery $2,750
Education $11,000
Human Resources for Health $2,600
Human Resources for Health $30,000
Education $10,000
Public Health Evaluation $83,000
Human Resources for Health $20,000
Education $2,000
Human Resources for Health $21,000