Noted April 16, 2008:

CARE will also provide subgrant funding and technical assistance to several subpartners formerly

supported through Alliance National Contre le SIDA.

This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the

expansion of culturally appropriate HIV/AIDS prevention and care interventions that target populations in

northern and western Côte d'Ivoire, where health-care services have been severely disrupted since civil

conflict split the country in 2002. With the socio-political situation now improving, FY08 will see the

increased presence of government actors and health care workers returning to the "CNO" zone.

With FY08 funds, CARE will continue to provide sub-grants to three primary NGO prevention partners that

promote abstinence and faithfulness through sensitization activities. These partners will oversee AB

activities in the three "hub" sites of Bouake, Korhogo, and Man, as well as in nine satellite sites targeted by

the project.

CARE will continue to work with regional HIV/AIDS NGO coordination networks, whose main responsibility

is coordinating local NGO actors, to ensure the continuum of HIV care and support. These networks will be

encouraged to work closely with and facilitate the eventual decentralization of activities by the ministries of

the Fight Against AIDS (MLS), Health (MOH), and Family and Social Affairs (MFFAS).

AB prevention interventions include targeted BCC campaigns involving religious and traditional leaders in

the community as well as teachers and peer educators in schools. Messages are designed to a) encourage

the delay of sexual debut among youth, b) promote mutual fidelity, c) decrease inter-generational sex,

sexual coercion, and gender-based violence, d) decrease multiple sexual partnerships, and e) promote HIV

counseling and testing. Small-group communication methods take place in community settings, schools,

mosques, and churches and are reinforced by radio messages in local languages.

Working in areas where the Ministry of Education (MEN) has not yet extended its PEPFAR-supported

prevention interventions for students, CARE will continue to collaborate with the MEN to implement the life-

skills curriculum, which delivers age-appropriate abstinence messages to younger children, abstinence-and-

fidelity messages to older children, and educational messages to all children about gender inequity and the

prevention of gender-based violence (GBV).

With the help of JHU/CCP, CARE partners will use culturally appropriate BCC strategies, curricula, and

sensitization materials with AB and gender messages (including gender-role discussions for boys and

young men). Peer education activities will continue with student health clubs. To reach rural populations,

CARE will ask partners to identify and train community health workers to deliver BCC interventions. CARE

will work with ANADER to reach village chiefs, "queen mothers," youth leaders and other "opinion catalysts"

who influence general perceptions and attitudes.

CARE will continue to support partners with gender-sensitivity training so they can address the cultural

factors that perpetuate the spread of HIV, including GBV. CARE will emphasize working with religious

partners to campaign against female excision, a wide-spread practice in the CNO zones and a possible

source of HIV infection due to the unhygienic conditions under which it is often practiced. A visit of

successful programs in South Africa ("Mutual Monogamy" and GBV prevention) will inform this campaign. In

collaboration with EngenderHealth, CARE will also begin integrating the Men as Partners (MAP) approach,

which consists of workshops with men and mixed groups to promote gender equality by challenging gender

roles that equate manliness with a range of risky behaviors such as violence, alcohol use, multiple sex

partners, and domination over women. CARE will encourage positive male involvement in HIV prevention at

the grassroots level through community action teams. The MAP approach will be evaluated and, if effective,

will be integrated into other prevention partners' programs.

CARE will also expand economic support activities put in place in FY07. Target populations will include

young and out-of-school girls, including economically vulnerable "filles de ménage." Experienced local

partners will be consulted on how best to identify and engage girls and their parents. Village savings and

loan activities, once functional, will be coupled with income-generation activities to address a root cause of

transactional sex and HIV vulnerability. This strategy, in use for 15 years by CARE in Niger and Mali, is a

crucial element of CARE's HIV prevention strategy.

To enhance links between prevention and facility-based services, CARE's prevention partners will be

required to conduct regular sensitizations at CT and treatment sites supported by PEPFAR partners.

Project activities will be coordinated through relevant national, regional, and district forums. They will also

be coordinated with other CARE projects, including the Global Fund-supported PREMA and HIV Round 2

projects. A joint work plan will be developed to avoid duplication and enhance synergies. The PEPFAR-

funded CARA project will expand into PREMA sites, with partners that are already operational, in

preparation for the end of the PREMA and Phase 2 projects in FY09.

All CARE HIV projects will emphasize the prevention, identification, treatment, and care of malaria among

HIV-affected and -infected populations and will be coordinated with the Round 6 Global Fund Malaria

project.

Using FY08 funds to consolidate activities in satellite sites around Bouake, Korhogo, Man, and extending to

the Bondoukou/Bouna zone, the project will:

1. Provide sub-grants to Caritas, REMCI, and NGO partners to support school-based AB activities in 10

new schools per zone (40 schools). Five teachers per school (200 total) and 10 peer educators per school

(400 total) will be trained to provide age-appropriate interventions using the MEN's life-skills curriculum.

2. Provide sub-grants to three local NGOs to conduct BCC peer-education sessions that promote AB

messages and strengthen community responses against stigmatization, discrimination, and gender-based

violence, including female excision. This activity will also be conducted in 45 villages in the

Duekoue/Bangolo area in western Cote d'Ivoire, where CARE is doing health promotion work through the

EU-funded R&R Project (working to facilitate the return of IDPs).

3. Provide a sub-grant to ARSIP to ensure supervision of 90 religious leaders trained in HIV prevention in

FY07, conduct training of 30 more religious leaders per zone (120 total), and hold four quarterly

Activity Narrative: coordination meetings for religious leaders.

4. Work with JHU/CCP to develop campaign materials for use by Caritas, ARSIP, and local NGOs in

support of AB sensitization. At least 500 copies of a peer-educator book and 8,000 copies of two posters

will be produced and distributed.

5. Translate and disseminate AB messages in local languages in collaboration with REPMASCI (network of

journalists and artists) to ensure cultural appropriateness and visibility. At least 1,000 radio spots will be

broadcast.

6. Train at least 30 new groups (each with 20-30 members) on the village savings and loan methodology

and simple accounting, followed by training in the implementation of small income-generation activities.

7. Conduct formative supervision visits with Save the Children, UNFPA, and PNSR to oversee health-care

providers trained in FY07 on GBV response.

8. Train 20 health-care providers in the Bouna/Bondoukou area to provide treatment and care of cases of

GBV (rape, incest, abuse, excision).

9. Train at least 10 local police officers in each zone on how to prevent and respond to cases of GBV.

10. Conduct joint supervision visits each semester with the MLS and the MOH's community health

department (DSC) to ensure quality of prevention activities.

CARE will continue to adapt and follow its M&E plan based on national and PEPFAR requirements and

tools. Basic questionnaires and focus-group discussions will be conducted each quarter to assess client

satisfaction and community response to prevention activities. CARE will report to the USG strategic

information team quarterly program results and ad hoc requested program data. To participate in the

building and strengthening of a single national M&E system, CARE will participate in quarterly SI meetings

and will implement decisions taken during these meetings.

CARE incorporates flexibility into its partnerships with local NGOs to avoid dependency and encourage

autonomy. A strong accent is placed on training of trainers and instructive supervision so that necessary

technical and management skills are transferred to partner staff. CARE is also emphasizing the

development of project-writing and financial-management skills so that partners can apply directly for and

manage funding in the future. Institutional capacity is being supported through infrastructure rehabilitation

and equipment purchases to increase the long-term capabilities of partners.

CARE will work closely with national coordination bodies, including the relevant ministries, to help with the

redeployment of staff and the reinforcement of activities in the CNO zones. Supervisory visits will be

conducted with ministry representatives to ensure awareness of project partners and their activities. District-

level offices will be supported (with Internet, USB, etc.) to enable them to collect and transfer national health

data. Regional and district health directors will continue to be included in monthly supervision visits, periodic

trainings, and quarterly coordination meetings.

Noted April 16, 2008:

This funding represents a percentage of Alliance CI 's OP funds reprogrammed to CARE International to

provide financial, programmatic, technical and overall capacity building support to subpartners who received

grants in FY 07 to continue providing uninterrupted OP services in the zones CARE is working. Care will

also provide subgrant funding and technical assistance to several subpartners formerly supported through

Alliance National Contre le SIDA.

This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the

expansion of culturally appropriate HIV/AIDS prevention and care interventions that target populations in

northern and western Côte d'Ivoire, where health-care services have been severely disrupted since civil

conflict split the country in 2002. With the socio-political situation now improving, FY08 will see the

increased presence of government actors and health-care workers returning to the "CNO" zone.

With FY08 funds, CARE will continue to provide sub-grants to local partners that conduct prevention

activities focusing on condom distribution and education and other types of HIV prevention. These "primary"

partners will oversee OP activities in the three "hub" sites of Bouake, Korhogo, and Man as well as in nine

satellite sites and rural areas targeted by the project.

CARE will continue to work with regional HIV/AIDS NGO coordination networks, whose main responsibility

is coordinating local NGO actors, to ensure the continuum of HIV care and support. These networks will be

encouraged to work closely with and facilitate the eventual decentralization of activities by the ministries of

the Fight Against AIDS (MLS), Health (MOH), and Family and Social Affairs (MFFAS).

OP interventions with FY08 funds will include targeted BCC campaigns involving religious and traditional

leaders in the community as well as teachers and peer educators in schools. Messages will be designed to:

a) Encourage the correct and consistent use of condoms for groups engaging in high-risk behavior

c) Promote HIV counseling and testing, including mutual testing for couples

d) Promote prevention for PLWHA

e) Decrease inter-generational sex, sexual coercion, and gender-based violence

Small-group communication methods (peer-education sessions in and out of schools, local leader

sensitizations, and debate/discussions) will take place in community settings, schools, mosques, and

churches, reinforced by radio messages in local languages. To reach rural populations, CARE will ask

partners to identify and train community health workers to deliver BCC interventions. CARE will work with

ANADER to reach village chiefs, "queen mothers," youth leaders and other "opinion catalysts" who influence

general perceptions and attitudes.

Working in areas where the Ministry of Education (MEN) has not yet extended its PEPFAR-supported

prevention interventions for students, CARE will continue to collaborate with the MEN to implement the life-

skills curriculum, which delivers age-appropriate prevention messages to children and youth, including

instruction in the use of condoms for older, sexually active youth as part of a comprehensive ABC approach.

With the help of JHU/CCP, CARE partners will apply culturally appropriate BCC strategies and sensitization

materials, including condom promotion. Programs focusing on prevention activities with peer educators will

continue in schools (both religious and secular) and will include explanations of strategies for negotiating

sex and condom use as well as gender messages (including gender-role discussions for boys and young

men).

Prevention will take a family approach, targeting not only PLWHA but also those in their immediate

environment with prevention education and counseling, access to condoms, and referral CT sites.

CARE will also begin prevention activities with private companies, focusing on coffee and cocoa plantations

in the West, cotton and sugar plantations in the North, and large transport companies in the center. The

CARE model for HIV workplace programs involves an HIV committee that is responsible for conducting

appropriate prevention activities within the company. Prevention activities will also focus on areas

surrounding large factories, mines, etc., where transactional sex is frequent.

CARE will also expand economic support activities put in place in FY07. Target populations include sex

workers. Village savings and loan activities, once functional, will be coupled with income-generation

activities to address a root cause of transactional sex and HIV vulnerability. This strategy, in use for 15

years by CARE in Niger and Mali, is a crucial element of CARE's HIV prevention strategy.

CARE will also develop a plan with FHI to train all local prevention partners to provide prevention services

(with psychosocial support and counseling) adapted to sex workers and will facilitate exchange visits for

RSB, the CARE sub-partner in Bouake selected in FY07 to model sex worker-focused services. CARE staff

will visit all peer educators (including sex workers) on a monthly basis to provide psychosocial support and

supervision. In addition to working in bus and train stations in Bouake, Korhogo, Ferke, and other sites,

CARE will coordinate with PSI to ensure that truck drivers are included in prevention activities by local

partners.

To enhance links between prevention and facility-based services, CARE's prevention partners will be

required to conduct regular sensitizations at CT and treatment sites supported by PEPFAR partners.

Project activities will be coordinated through relevant national, regional, and district forums. They will also

be coordinated with other CARE projects, including the Global Fund-supported PREMA and HIV Round 2

projects. A joint work plan will be developed to avoid duplication and enhance synergies. The PEPFAR-

funded CARA project will expand into PREMA sites, with partners that are already operational, in

preparation for the end of the PREMA and Phase 2 projects in FY09.

All CARE HIV projects will emphasize the prevention, identification, treatment, and care of malaria among

HIV-affected and -infected populations and will be coordinated with the Round 6 Global Fund Malaria

project.

Using FY08 funds to consolidate activities in satellite sites around Bouake, Korhogo, Man, and extending to

the Bondoukou/Bouna zone, the project will:

Activity Narrative:

1. Provide sub-grants to at least four local NGOs to support school-based ABC activities in 10 new schools

per zone (40 schools). Five teachers per school (200 total) and 10 peer educators per school (400 total) will

be trained to provide age-appropriate ABC information using the MEN's life-skills curriculum.

2. Provide sub-grants to four local NGOs to support prevention activities that focus on highly vulnerable

populations.

3. Train 80 traditional leaders (in urban, rural, and migrant communities) to conduct community-based BCC

sessions/sensitizations that promote OP messages. This activity will also be conducted (with training for 50

community health agents) in 45 villages in the Duekoue/Bangolo area in western Cote d'Ivoire, where

CARE is doing health promotion work through the EU-funded R&R Project (working to facilitate the return of

IDPs).

4. Support 20 PLWHA peer-support groups with training and materials to continue positive-prevention

activities.

5. Support at least 25 sex workers / peer educators per zone to conduct community-based BCC

sessions/sensitizations that promote OP messages.

6. Translate and disseminate OP messages in local languages in collaboration with REPMASCI (network of

journalists and artists) to ensure the visibility and cultural appropriateness of messages in each project site.

A minimum of 1,000 radio spots will be broadcast.

7. Train at least 30 new groups (each with 20-30 members) on the village savings and loan methodology

and simple accounting, followed by training in developing small income-generating activities.

8. Assist three companies per zone with HIV prevention in the workplace.

9. Continue follow-up for 15 condom kiosks and open 20 new condom kiosks, with training for at least one

vendor per kiosk.

10. Conduct joint supervision visits each semester with the MLS and the MOH's community health

department (DSC) to ensure the quality of HIV prevention activities.

CARE will continue to adapt and follow its M&E plan based on national and PEPFAR requirements and

tools. Basic questionnaires and focus-group discussions will be conducted each quarter to assess client

satisfaction and community response to prevention activities. CARE will report to the USG strategic

information team quarterly program results and ad hoc requested program data. To participate in the

building and strengthening of a single national M&E system, CARE will participate in quarterly SI meetings

and will implement decisions taken during these meetings.

CARE incorporates flexibility into its partnerships with local NGOs to avoid dependency and encourage

autonomy. A strong accent is placed on training of trainers and instructive supervision so that necessary

technical and management skills are transferred to partner staff. CARE is also emphasizing the

development of project-writing and financial-management skills so that partners can apply directly for and

manage funding in the future. Institutional capacity is being supported through infrastructure rehabilitation

and equipment purchases to increase the long-term capabilities of partners.

Noted April 16, 2008:

This funding represents a percentage of Alliance CI 's palliative care funds reprogrammed to CARE

International to provide financial, programmatic, technical and overall capacity building support to

subpartners who received grants in FY 07 to continue providing uninterrupted palliative care services in the

zones CARE is working. CARE will also provide subgrant funding and technical assistance to several

subpartners formerly supported through Alliance National Contre la SIDA.

This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the

rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target

underserved populations in northern and western Côte d'Ivoire, where health-care and other government

services have been severely disrupted since civil conflict split the country in 2002. With the socio-political

situation improving, government actors and health-care workers are expected to return to the region,

requiring good coordination with civil-society actors who have developed a strong presence since 2002.

CARE provides sub-grants and capacity-building assistance to local partners to provide palliative care

services in three hub cities (Bouake, Korhogo, and Man) and nine satellite sites. Palliative-care services are

provided at the community and home levels by local NGOs and at local health centers by health-care

workers. CARE's strategy is to identify and serve PC clients by ensuring effective linkages between project

PC partners and public and private HIV and TB treatment, PMTCT, and testing sites, as well as OVC and

HIV prevention partners working in the community, such that anyone identified as HIV+ will have timely

access to the full spectrum of diagnostic and follow-up care.

Health workers are trained to provide home-based care, including the diagnosis and treatment of OIs,

psychosocial support for patients and family members, pain alleviation, ART referral and monitoring, and

provision of a preventive-care package that includes counseling for prevention for positives, cotrimoxazole,

safe-water products, and insecticide-treated bed nets. Wraparound nutritional support, complemented by

nutrition education, is provided in partnership with the World Food Program.

In FY07, CARE is using PEPFAR funds to support PC services for a target of 4,800 PLWHA through:

1. Sub-grants to 12 local NGOs

2. Training of 87 health workers and supervision of 120 health personnel and trainers trained in FY05-06

3. Provision of OI medicines to NGOs, rural health centers, and outpatient hospitals

4. A workshop to facilitate the sharing of best practices

5. Pilot village savings-and-loan and income-generating activities for 200 PLWHA and their families

6. A "maison de passage" (transit house) in Bouake to provide refuge, psychosocial support, and referral for

PLWHA traveling to town for care or support-group meetings

In FY08, CARE will continue to support its NGO partners to provide PC services and will help them sub-

grant to other partners, ensuring the strengthening of care activities in the three hub and nine satellite sites

as well as extension to two new sites in the underserved northeast (Bondoukou and Bouna). CARE will

continue to reinforce regional HIV/AIDS NGO coordination networks to ensure a continuum of care and

facilitate the northward extension of services and coordination by the Ministry of AIDS, the Ministry of

Health's National HIV/AIDS Care and Treatment Program (PNPEC), and the social centers and National

OVC Program of the Ministry of Family, Women, and Social Affairs.

PC activities will complement and build on other PEPFAR-funded work, including new PC policy and

guidelines for clinic- and home-based care as well as HIV prevention, care (including OVC care), and

treatment activities by ministries (AIDS, Health, Education, Social Affairs) and other partners (PSI, EGPAF).

Regular sharing and coordination will be pursued with Alliance CI. District health management teams will

continue to be involved in planning and supervision to maximize capacity building and coordination.

CARE, the new PR for the Global Fund Round 2 Phase 2 HIV project, expects to increase its PC caseload

by linking with new ART sites to be established with GF and PEPFAR support. In addition, CARE will begin

to train staff at private clinics in how to receive and refer HIV+ patients. Systematic referral for HIV testing of

partners and family members of HIV+ clients will be emphasized. Pediatric HIV care sites are limited, but

CARE will refer children identified through CT, OVC, and prevention partners for appropriate care and

treatment.

In all, FY08-funded PC activities will support PC services to 6,000 people and train 52 people to provide

quality palliative care. Activities will include:

1. Sub-grants to ensure that 23 health structures and NGOs provide PC services (3 main partners and 3

day hospitals in hub cities, 9 partners in satellite sites, 6 new rural sites, 2 new partners in

Bouna/Bondoukou)

2. Provision of medicines for OI treatment to all 23 health structures and NGOs

3. Training in PC service provision for health workers: 12 at six new rural health centers, 20 in Duekoue and

Bangolo hospitals, and 20 in Bouna/Bondoukou

4. Cross-training and use of all local partners' home-based care providers in identification and care of OVC,

and vice versa.

5. Regular supervisions by JHPIEGO for CARE staff and health personnel trained in CT, PC, and OVC

support in FY06/07.

6. Wraparound nutritional support in partnership with WFP, complemented by nutrition education for and by

food distributors and care providers

7. Village savings-and-loan and income-generating activities for 30 peer support groups for PLWHA

8. Three "exchange visits" with NGO partners and organizations working in other zones to facilitate sharing

of best practices

9. Opening of two more "maisons de passage" (in Man and Korhogo) that will benefit 600 PLWHA per year

10. Participation in a coordinated advocacy effort with PNPEC and Hope WW to promote the harmonization

of PC tools and the availability of appropriate PC drugs

CARE will report to the USG strategic information team quarterly program results and ad hoc requested

program data. To participate in the building and strengthening of a single national M&E system, CARE will

participate in quarterly SI meetings and will implement decisions taken during these meetings.

Activity Narrative:

To support sustainability, CARE incorporates flexibility into its partnerships with local NGOs so as to avoid

dependency and encourage autonomy. A strong accent is placed on training, training of trainers, supportive

supervision, and the development of project-writing and financial-management skills. Institutional capacity is

being supported through infrastructure rehabilitation and equipment purchases. CARE works closely with

ministries to help with the redeployment of staff in conflict-affected zones, including joint supervisory visits

and support for district-level statistical staff (CSE) (Internet, USB, etc.) to ensure the collection and transfer

of monthly reports. After initial intensive training and support and one year of follow-up, village S&L groups

will become self-sustainable.

Oct 08: reprogrammed to Care International

In FY08, sub-grantees will be assisted to design and implement OVC project proposals that provide

comprehensive, cost-effective OVC services, including psychosocial, educational, nutritional, legal, and

medical assistance. Community counselors will be trained and supported to deliver both OVC care and

palliative care services through home visits. Referral systems will be established or strengthened to link

OVC activities with health facilities, especially for HIV-positive OVC, who will receive cotrimoxazole

prophylaxis. HIV prevention activities for HIV-positive adults will be delivered while providing palliative care

for children. The partner will help its sub-grantees to develop programs that establish effective linkages

between OVC, palliative care, PMTCT, VCT, ART, and TB treatment sites.

Partnerships with RIP (the national network of PLWHA), EGPAF, ACONDA, ANADER, Save the Children

UK, CARE International, UNICEF, service organizations, and others will be strengthened to promote access

to OVC and related services throughout the country. These linkages will facilitate supervision and support

required to ensure that small grants to N/C/FBOs are used effectively.

The partner will participate in the national technical working group's adaptation of the CSI as a tool for

assessing and monitoring the status of OVC. The partner will train and support its partners to identify OVC

through three main types of entry points for OVC services: health-care facilities (ART, CT, PMTCT, TB,

pediatric clinics), community (families, HIV-positive support groups, OBC), and in institutions (schools,

orphanages, social centers). Under the leadership of the relevant ministries (MFAS, Health, AIDS,

Education), the partner will actively participate in coordination meetings with other PEPFAR and non-

PEPFAR partners to ensure that OVC activities are integrated and linked with other health and social

services.

In FY08, the partner will work in conjunction with national authorities, PEPFAR partners, and other

stakeholders to harmonize interventions and ensure that sub-grantees have access to relevant commodities

for OVC, including impregnated bed-nets, safe-water systems, and educational supplies procured by the

SCMS project. These will be designed to wrap around initiatives such as the WFP's school canteen

program, UNICEF's school-kit program, and other education and OVC initiatives. The partner will provide

OVC kits designed by the national OVC technical committee to meet the needs of underserved populations.

The partner will work with local coordination forums to select and train M&E officers at decentralized levels

to promote data quality and data use at the district level, complementing the data management team

working with the district HIV/AIDS committees. The partner will provide technical assistance to enable sub-

grantees to use existing national OVC tools to report national and PEPFAR indicators (including primary

and supplemental service delivery). The partner will participate in the national process of harmonizing OVC

tools used by the various partners. The partner will encourage and enable its partners to participate actively

in the social center OVC collaboration platforms and will work with the PNOEV and the national OVC

committee to define and implement its strategies improving geographic coverage and data quality.

Sub-grants will support family-oriented HIV education, psychosocial support, support for schooling and

vocational training, help with medical fees, legal and child-protection services (birth certificates, inheritance

rights, rights advocacy, etc.), income-generating activities, and nutritional assessment and support.

Nutritional support will be provided in collaboration with the PNOEV and PEPFAR country team, leveraging

local inputs and other partner donations (WFP, UNICEF) when possible. Emphasis will be placed on

psychological support.

In addition, at least 25 people will receive refresher training in program and financial management,

organizational development, monitoring and evaluation, and provision of OVC and palliative care, building

capacity of local organizations to promote sustainability of community-based OVC services. The partner will

report to the USG strategic information team quarterly program results and ad hoc requested program data.

To participate in the building and strengthening of a single national M&E system, the partner will participate

in quarterly SI meetings and will implement decisions taken during these meetings.

Noted April 17, 2008:

CARE will also provide subgrant funding and technical assistance to several subpartners formerly

supported through Alliance National Contre le SIDA.

This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the

rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target

underserved populations in northern and western Côte d'Ivoire, where health-care and other government

services have been severely disrupted since civil conflict split the country in 2002. With the socio-political

situation improving, government actors and health-care workers are expected to return to the region,

requiring good coordination with civil-society actors who have developed a strong presence since 2002.

CARE provides sub-grants and capacity-building assistance to local partners to provide OVC identification

and care according to national guidelines in three hub cities (Bouake, Korhogo, and Man) and nine satellite

sites. CARE's OVC strategy is to identify and serve OVC and their families by ensuring effective linkages

between project partners and public and private HIV and TB treatment, PMTCT, and testing sites, as well as

palliative care and HIV prevention partners working in the community, such that anyone identified as HIV+

will have timely access to the full spectrum of diagnostic and follow-up care, including care for their children.

CARE ensures that NGO partners receive training, medicines, and other supplies (mosquito nets, water-

purification products, etc.) to provide to OVC and their host families. Training, conducted by the regional

pool of trainers put in place by CARE and based on the national training module, covers the provision of

quality psychosocial, spiritual, nutritional, educational, and judicial support with a "family approach" and the

identification and referral of childhood illnesses (anemia, malaria, malnutrition) with an emphasis on

prevention messages (the importance of clean water, hygiene, and nutrition education). CARE works with

the World Food Program to provide wraparound nutritional support for OVC and host families assessed as

food insecure. OVC requiring medical attention are referred to local health centers, which receive refresher

training in the diagnosis and treatment of childhood illnesses. NGO social workers conduct school and

home visits to assess and monitor the well-being of children.

In FY07, CARE is using PEPFAR funds to support OVC services for 6,300 OVC through:

1. Sub-grants, technical capacity building and supervision for Caritas and five local NGOs providing care

and support to OVC

2. Strengthening of the referral system linking OVC, CT, prevention, and treatment service providers

3. Training or refresher training for 60 social workers and community counselors in OVC care and support

4. Training for NGO and other service providers and caregivers in diagnosing HIV infection in children

5. Training for food-distribution teams and care providers in nutrition-education methods and nutritional

needs of PLWHA and children

6. Purchase of drugs and commodities to prevent pneumonia, TB, malaria, and diarrheal disease in HIV-

exposed and HIV-infected children

7. Regular visits to local partners to ensure the implementation of the project-specific M&E plan based on

national and USG requirements and tools.

In FY08, CARE will continue to support its NGO partners to provide OVC services and will help them sub-

grant to other partners, ensuring the strengthening of care activities in the three hub and nine satellite sites

as well as extension to two new sites in the underserved Northeast (Bondoukou and Bouna). CARE will

continue to reinforce regional HIV/AIDS NGO coordination networks to ensure a continuum of care and

facilitate the northward extension of services and coordination by the Ministry of AIDS, the Ministry of

Health's National HIV/AIDS Care and Treatment Program (PNPEC), and the National OVC Program

(PNOEV) of the Ministry of Family, Women, and Social Affairs (MFFAS). CARE will support the revitalization

of MFFAS social centers, closed during the civil conflict, that are at the center of the PNOEV's "platform"

model for coordinating OVC services.

OVC activities will complement and build on other PEPFAR-funded work, including OVC policy and

guidelines as well as HIV prevention, care (including OVC care), and treatment activities by ministries

(AIDS, Health, Education, Social Affairs) and other partners. Regular sharing and coordination will be

pursued with Alliance CI. District health management teams will continue to be involved in planning and

supervision to maximize capacity building and coordination.

CARE, the new PR for the Global Fund Round 2 Phase 2 HIV project, expects to increase its OVC caseload

by linking with new ART sites to be established with GF and PEPFAR support. In addition, CARE will begin

to train staff at private clinics in how to receive and refer HIV+ patients and their children to appropriate

services. Systematic referral for HIV testing of partners and family members of HIV+ clients will be

emphasized. Pediatric HIV care sites are limited, but CARE will refer children identified through CT, OVC,

and prevention partners for appropriate care and treatment.

Training-of-trainer methods were emphasized in FY06-07 to give partner NGOs the capacity to train and

monitor community-care groups and counselors. A joint supervision visit will be conducted each semester

with PNOEV representatives to review the quality of community-based OVC activities.

Project activities will be coordinated with other CARE HIV projects, including the GF Round 5 PREMA

project and the GF Round 2 Phase 2 Global Fund HIV project. A joint work plan will be developed to ensure

that projects are complementary and avoid overlap. CARE's PEPFAR project will begin to link up with

existing PREMA partners in preparation for the end of the PREMA and Phase 2 projects in FY09. All CARE

HIV projects will emphasize the prevention and treatment of malaria among HIV-affected/infected

populations and will be coordinated with the GF Round 6 Malaria Project.

Expanded funding will support extension of project activities into the underserved Bouna and Bondoukou

areas. Funds will be used to establish a small branch office, which will be shared and co-financed by

Alliance through the Global Fund Phase 2 project. Caritas will be supported to expand its social services to

include OVC identification and support, and CARE will help establish a regional coordination network.

In coordination with Alliance and JHU/CCP, CARE will support the network of religious leaders ARSIP to

train religious leaders and to promote common HIV prevention and care strategies, including spiritual care

Activity Narrative: for PLWHA and OVC and advocacy against stigmatization.

In support of the PNOEV's "platform" model, expanded funding will also allow the rehabilitation, equipping,

and support of social centers where government social workers will work with local NGOs and service

providers to ensure that OVC receive appropriate care and support services. "Exchange visits" will be

organized so that social workers can directly observe how the "platform" model operates.

CARE will integrate OVC activities into health promotion work conducted through the EU-funded R&R

Project (working to facilitate the return of IDPs) in 45 villages in the West. HIV prevention efforts will be

accompanied by OVC and follow-up services at hospitals in Duekoue and Bangolo and possibly with NGOs.

CARE will work with local health authorities to determine the most effective way of ensuring OVC services

in the zone.

CARE will also work to create "twinning" relationships with organizations conducting similar work in other

zones. "Exchange visits" will be financed by the project to allow project staff and partner representatives to

observe successful OVC care approaches.

CARE will support poverty-reduction and economic-support activities to build self-sufficiency for OVC,

including pilot savings-and-loan and income-generating activities (described in AB and Other Prevention

narratives) for child-headed households and host families of OVC.

In all, FY08 funds will support services for 8,500 OVC and training for at least 70 care providers. Activities

will include:

1. Sub-grants and strong technical assistance to six main OVC partners

2. Hiring of an experienced OVC and palliative care focal point

3. Provision of clean-water products, mosquito nets, and hygiene kit components to health structures and

NGO partners providing OVC care

4. Training in OVC identification and the "family approach" for care of OVC for 20 NGO personnel in

Duekoue and Bangolo and 20 NGO personnel in Bouna/Bondoukou, and training for all OVC caregivers in

use of the Child Status Index tool

5. Cross-training and use of all local partners' OVC caregivers in provision of palliative care, and vice versa

6. Regular supervision by JHPIEGO for CARE staff and health personnel trained in OVC support in

FY06/07

7. Wraparound nutritional support in partnership with WFP

8. Village savings-and-loan and income-generating activities for 30 PLWHA peer-support groups.

CARE will continue to adapt and follow the project M&E plan based on national and PEPFAR requirements

and tools and to contribute to the implementation of an integrated national M&E system.

This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the

rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target

underserved populations in northern and western Côte d'Ivoire, where health-care services have been

severely disrupted since civil conflict split the country in 2002. With the socio-political situation now

improving, FY08 looks to see the increased presence of government actors and health care workers, which

will require coordination with civil society actors that have developed a strong presence in the zone since

2002.

With FY08 funds, CARE will sub-grant to existing local partners, who will provide CT services and

promotion in three "hub" and nine satellite sites, and will add a CT site in Bouna. CARE will continue to

reinforce regional HIV/AIDS NGO coordination networks to ensure a continuum of care and facilitate the

northward extension of services and coordination by the Ministry of AIDS, the Ministry of Health's National

HIV/AIDS Care and Treatment Program (PNPEC), and the social centers and National OVC Program of the

Ministry of Family, Women, and Social Affairs.

CT activities in FY06 targeted 5,000 people. In FY07, the project is implementing the following activities to

reach 10,000 people with CT services:

1. Provide sub-grants and technical assistance to local NGOs to reinforce six CT sites and add five new CT

sites.

2. Reinforce training of 60 social workers and community counselors for the promotion of CT uptake.

3. Reinforce training of 60 health personnel and train 30 new personnel and community counselors to

provide counseling and psychosocial services, with a focus on couples and family counseling.

4. Provide supplies and TA necessary to conduct 10,000 HIV tests.

5. Work with regional HIV/AIDS networks to conduct 36 mobilization activities promoting the use of CT

services, especially for families, couples, and groups.

6. Establish mobile teams to expand service coverage to three rural sites

7. Provide training support to help NGOs organize peer-support groups

8. Establish quality-assurance systems for HIV testing with a national reference lab.

In FY08, planned activities will complement and build on other PEPFAR-funded efforts, including clinic- and

home-based care and OVC care, prevention, and treatment activities by ministries (AIDS, Health,

Education, Social Affairs), PSI, Alliance CI, and EGPAF. Regular coordination will be pursued with Alliance

CI and PSI. District directors and teams will participate in monthly formative supervision visits to NGOs and

in quarterly coordination meetings to maximize capacity-building and regular oversight by the Ministry of

Health. CARE will participate in a national process to develop a harmonized system for tracking the quality

of CT services.

CARE's counseling and testing strategy is to ensure quality of services at existing sites (including client-

friendly reception, counseling, and referral) and to ensure that once a revised national testing algorithm

permits the use of rapid tests by lay personnel, all community-based CT sites will provide both on-site and

outreach CT services. CARE's strategy for FY08 also includes a lay counselor who is on-site full time to

facilitate referrals to care. To avoid "loss" of clients, the use of national referral tools is highlighted as a

priority task in all partner contracts.

TOT methods were emphasized in FY07 so that partners can provide continuous training to their own staff,

as well as formative supervision visits to other NGOs receiving sub-grants .

To promote CT services (including, when feasible, CT services delivered by community-based counselors),

CARE will work with regional networks and religious and secular prevention partners to conduct mobilization

activities in urban, peri-urban, and some rural sites, focusing on traditional leaders, tradi-practitioners, and

religious actors to promote the use of CT services, especially for families, couples, and groups. A few

private companies will be supported with prevention funding to begin setting up HIV committees that will

promote CT service use among employees.

Project prevention messages delivered through BCC methods are designed to encourage ABC prevention

as well as educate about the importance of using CT services and knowing one's sero-status. Small-group

communication methods (peer education sessions in and out of schools; with sex workers, youth, and truck

drivers; and during pre-sermon sensitizations) will take place in community settings, schools, mosques,

churches, train stations, etc. These activities will be reinforced by radio messages in local languages.

To reach rural populations with BCC activities, CARE will ask partners to identify and train local community

health workers who will target "opinion catalysts" (village chiefs, imams, etc.) to influence community

perceptions and views. CARE will work with ANADER to perfect this strategy.

In FY08, CARE will increase testing numbers by working more closely with the national TB program to

ensure that all identified TB cases are tested for HIV. CARE will work with regional health directors and

actors to advocate for routine testing at all health facilities.

Once rapid tests are available, CARE will work with the USG team to devise a strategy for training partners

to use them in coordinated, carefully monitored approaches. Exchange visits will be conducted between CT

partners in-country (e.g. visits to Clinique de Confiance to observe services targeting sex workers and

migrants) and will serve to review new strategies once rapid tests are the norm.

Project activities will be coordinated and planned with the Round 5 PREMA and Round 2 Global Fund HIV

Projects run by CARE, which will install and support ART and CT sites. A joint work plan will be developed

to avoid overlap. All CARE HIV projects will also emphasize the prevention, identification, treatment, and

care of malaria among HIV-affected/infected populations and will be coordinated with the Round 6 Global

Fund Malaria project.

FY08 CT activities will support 15 CT service outlets, train 60 people to provide CT services, and provide

CT services to at least 15,000 people. Using FY08 funds to consolidate CT activities in satellite sites in the

major zones of Bouake, Korhogo, Man, and extending to the Bouna zone, the project will:

1. Provide sub-grants and technical assistance to local institutions/NGOs to reinforce, consolidate, and

improve quality at 11 existing CT sites, including training on the expected new algorithm and reinforcing

Activity Narrative: community mobilization around these sites.

2. Add a new CT site in Bouna.

3. Add CT services to each of the three youth/women counseling centers (one per zone) put in place in

FY07.

4. Provide training to 30 health personnel and 30 community counselors to provide counseling and

psychosocial services, with a focus on couples and family counseling.

5. Provide technical assistance and supplies to support 15,000 on-site HIV tests with pre- and post-test

counseling.

6. Support the hiring of one person (preferably a PLWHA) at each CT site who will be responsible for

ensuring post-test support to all clients, including immediate referrals to post-test clubs, PC, and OVC

services.

7. Work with regional HIV/AIDS networks, prevention partners, and ARSIP to conduct mobilization activities

focusing on traditional leaders, tradi-practitioners, and religious leaders to promote the use of CT services,

especially for families, couples, and groups.

8. Conduct three joint "exchange visits" in-country with NGO partner and CARE staff to facilitate sharing of

best practices in counseling and testing.

9. Conduct joint supervision visits each month with district health directors and each semester with the

National HIV/AIDS Care and Treatment Program (PNPEC) to ensure quality of CT activities.

10. Provide support for district-level statistics offices in project zones for the collection and transfer of

national health data (Internet, cle USB, etc.).

CARE will continue to adapt and follow the project M&E plan based on national and PEPFAR requirements

and tools and will report to the USG strategic information team quarterly program results and ad hoc

requested program data. To help build a unified national M&E system, CARE will participate in quarterly SI

meetings and will implement decisions taken during these meetings. All CT partners will receive joint

supervision visits to be planned each semester with PNPEC, to review the quality of CT activities, including

lab services.

To support sustainability, CARE incorporates flexibility into its partnerships with local NGOs so as to avoid

dependency and encourage autonomy. A strong accent is placed on training, training of trainers, supportive

supervision, and the development of project-writing and financial-management skills. Institutional capacity is

being supported through infrastructure rehabilitation and equipment purchases. CARE works closely with

ministries to help with the redeployment of staff in conflict-affected zones, including joint supervisory visits

and support for district statistical offices (Internet, USB, etc.) to ensure the collection and transfer of monthly

reports.