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.
Years of mechanism: 2007 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
With FY 09 funds, FHI will build on ongoing programs with technical and financial support while continuing
to provide sub-grants to the implementing ONG of prevention activities in 13 main existing prevention sites
and their satellite sites. The main programmatic focus will be on improving quality of prevention services for
the target population. This will be accomplished by elaboration of new standardized BCC guidelines,
strengthened supervision visits, quality assessment audits in all sites, and piloting of a quality improvement
project in one site.
More specifically, in FY09 FHI will update or carry out new activities:
1. STI/HIV kits will be made available to victims of sexual violence, and a green line (telephone line) will be
opened for reporting sexual violence and receiving referral.
2. Implement a training plan in collaboration with MLS and MSHP. More specifically, FHI will organize in
collaboration with other PEPFAR partners delivering activities for SW, a second national training of trainers'
workshop in 2009.
3. In the area of formative research contributing to public health surveillance, FHI in collaboration with
MSHP and EGPAF, will conduct an evaluation of the compliance and the sexual risk behavior of SW who
are on ART, after analysis of existing data
4. Provide a subgrant to APROSAM for coordination and coaching to improve implementation of activities
conducted by CERBAS and FURBAS. FHI will also apply the same strategy for Espace Confiance which
will mentor ARC-EN-CIEL, a local NGO made of MSM to conduct interventions targeting MSM.
5. Provide technical and financial support to Espace Confiance and ARC-EN-CIEL to develop, implement
and evaluate a minimal package of services for MSM
6. Initiate a female condom social marketing campaign among female sex workers in order to increase
acceptability and use of this HIV prevention resource.
7. Conduct a cost-effectiveness study of both mobile clinics delivering prevention, counseling and testing
and care services for sex workers in Abidjan and San Pedro regions.
COMPLETE NARRATIVE:
In FY08, FHI's Highly Vulnerable Populations Project (PAPO-HVP) supported the strengthening and
expansion of sexual risk-reduction interventions as part of a comprehensive prevention, HIV counseling and
testing (CT), and care package of services targeting transactional sex workers (SW) and their partners.
These interventions have been carried out at 13 main existing sites and their satellite sites delivering
behavior change communication (BCC) interventions targeting highly vulnerable populations (HVP). The
key results achieved at the 13 HVP prevention sites were:
- 1,500,000 male and female condoms distributed
- 40,000 individuals (SW and their partners) reached through community-based BCC messages and
HIV/AIDS prevention sensitization focusing on correct and consistent use of condoms.
- 150 people trained to promote HIV/AIDS prevention among HVP, especially SW and their partners.
During the same period, FHI supported the implementation of BCC Quality Assurance (QA) through the
dissemination of QA tools at the 13 HVP BCC sites and the training of 150 service providers in the use of
these tools. In addition, management and resource mobilization tools were disseminated at the national
level in collaboration with the Ministry of AIDS (MLS). Extension and sustainability plans were revised and
updated at the existing HVP BCC sites to document progress achieved by the NGOs.
The PAPO-HVP project continued to collaborate with other PEPFAR partners such as Alliance-CI for
capacity building and technical assistance to NGOs in the management of the CT mobile units in order to
provide prevention and care services for difficult to reach SW in Abidjan and San Pedro.
In FY08, FHI strengthened ongoing programs with technical and financial support while continuing to
provide sub-grants to the 13 existing implementing NGOs/sites. In addition, FHI expanded PAPO-HVP to 7
new communities through strategically selected sub-partners - providing partners with capacity
strengthening tools to improve the quality of service delivery. New service providers were trained,
supervised, and coached in providing the minimum package of services (MPS) which includes
BCC/prevention through peer education, CT, management of sexually transmitted infections (STI), palliative
care, and antiretroviral treatment (ART).
Through leveraged funding from the Belgian Development Cooperation (BC) in FY09, FHI will support
public health surveillance and scale up program evaluation activities. Technical support provided by FHI
and its partners (the Institute of Tropical Medicine [ITM] and Espace Confiance) to implementing partners
will include training of new service providers, the dissemination and use of quality assurance (QA) and M&E
standardized tools, regular participatory program reviews, and supervision. To this effect, Espace Confiance
will continue to provide practical training sessions and coaching for health care providers in prevention,
care, and treatment at Clinique de Confiance (CdC) site.
The PAPO-HVP project has established links with other PEPFAR partners such as Alliance, CARE, and
EGPAF for the training of clinic service providers to expand beyond the main HVP BCC sites. PAPO-HVP
continues to conduct studies related to condom use and STI prevalence (Activity 19136: Consistent
Condom Use and STI/HIV Prevalence Among Sex Workers Attending Project Clinics in Côte d'Ivoire as
well as capture-recapture techniques for the SW size estimation at various sites (Activity 19137: Estimation
of the Size of Sex Worker Populations). At the regional level, PAPO-HVP has collaborated with ITM to
exchange project experiences achieved in Côte d'Ivoire with those of other HVP projects including a sex
worker program in Kisumu, Kenya.
With FY09 funding, FHI will build onto ongoing programs with technical and financial support while
continuing to provide sub-grants to the 13 existing implementing NGOs/sites. The main programmatic focus
Activity Narrative: will be on improving quality of prevention services for the target population. This will be accomplished by
elaborating new standardized BCC guidelines, strengthening supervision visits, conducting quality
assessment audits in all sites, and piloting a quality improvement project in one site.
More specifically, FHI will conduct the following activities using FY09 funding:
1. Continue to provide technical support to the 13 existing prevention sites implementing sexual risk-
reduction interventions towards HVP, especially SW and their partners in Côte d'Ivoire.
2. Complete the data collection and analysis on SW size estimation. FHI will support the increase of BCC
services coverage by 25% through an increase in coverage of the existing sites by improving quality and
outreach of BCC services to selected sites (e.g. Korhogo to Ferkesedougou, Man to Touba), and if needed
by the opening of new centers in non-covered areas such as Odienné.
3. Continue to improve the mapping of SW. Through the use of GPS tools and the capture-recapture
method, FHI will support quantitative data collection for reliable planning of field activities and a better
appreciation of the coverage of BCC interventions.
4. Continue to provide technical support to reinforce BCC activities prior to mobile CT and care services
offered by Espace Confiance in Abidjan and APROSAM in San Pedro to SW living in difficult-to-reach
areas. FHI will also support availability of condoms in venues such as hotels and bars.
5. Continue to assist sub-partners in the procurement of condoms (male and female), STI kits, and lubricant
gel.
6. Continue to evaluate the acceptability of female condom use among female sex workers.
7. Improve coverage and quality of clinic-based and community outreach prevention and CT-promotion
activities conducted by peer health educators and community workers. Specifically, FHI, in collaboration
with MLS and the Ministry of Health (MSHP), will support the standardization of BCC services for SW in the
project sites through the development and dissemination of standardized tools (such as reference manuals
and Peer Health Educators Tool Kits) and the strengthening of the referral system for prevention of mother-
to-child transmission (PMTCT), orphans and vulnerable children (OVC), and antiretroviral (ARV) programs.
In addition, FHI will also develop practical guidelines to be used by peer health educators in the field and
collaborate with MLS, URC and other prevention partners in harmonizing recommended outcome and
impact indicators for BCC peer education programs.
8. Continue to address stigma and sexual violence by providing HVP-friendly services delivered by staff with
nonjudgmental attitudes and by conducting behavior change communication (BCC) activities with 16,000
other HVP (such as partners of sex workers, clients of sex workers, and bar owners). In addition, quality
assessment tools will be used to measure client satisfaction in areas such as HVP-friendly service, non
stigmatization, and non judgmental staff attitudes.
9. Continue baseline study and capture-recapture studies.
10. Ensure availability of STI/HIV kits to victims of rape and sexual violence, as well as establishing a green
line (telephone line) for reporting sexual violence.
11. Continue to reinforce the operational management of NGOs and existing associations through the
strengthening of administrative and financial management, budgeting, leadership, monitoring and
evaluation, and mobilization of resources. More specifically, FHI will continue to support the capacity
building implementation plans of each NGO.
12. Continue to support the revision, update, and dissemination of quality-assurance tools developed in
2006 and 2008 in collaboration with other partners to better evaluate the quality of services. The system will
be part of the current program management system. Quality evaluation activities will be performed
periodically, in accordance with national guidelines, to improve the quality of BCC and other prevention
services.
13. Conduct at least one quality improvement project. The project and site will be chosen after conducting a
quality evaluation audit at all PAPO-HVP sites. Potential subjects of the quality improvement include:
coverage of BCC activities and client retention rates at the clinic. The FHI Quality Improvement Model,
based on the model of Langley et al., will be used. The model focuses on systems change and team work.
A quality improvement team will be established in order to understand the system, measure performance,
identify changes that target system components, and test system changes. Experiences and results will be
shared with all implementing partners in order to expand the project to other sites.
14. Train health staff and focal points in outreach activities at all sites in the use of quality assurance tools.
FHI will also support the elaboration, review, and implementation of capacity building plans for NGOs and
the revision of tools (elaborated in 2006) for the management and mobilization of funds.
15. Implement a training plan in collaboration with MLS and MSHP. More specifically, FHI will organize a
second national training of trainers' workshop in FY09 for service delivery to SW in collaboration with other
PEPFAR partners.
16. Continue to increase coordination among NGOs and other associations by providing technical
assistance to the national government's working groups, particularly the Sex Work and HIV/AIDS working
group within the MLS, the TWG on BCC, and the TWG on STI (GTT/IST).
17. Support the revision of the PAPO-HVP extension plan following its evaluation. This plan was elaborated
in 2006, and revised in 2007 and 2008 in collaboration with key partners. It includes geographical extension
to zones formerly under control of the nongovernmental New Forces as well as extension of the target
population to occasional sex workers. A revised plan will allow a reorientation of interventions to include
nationwide coverage of primary health services for people living with HIV/AIDS (PLWHA) and PwP.
18. Support an annual evaluation of the sustainability plan of project activities. PAPO-HVP is guided by a
sustainability strategy aimed at reaching the goals of the project while preparing local partners to assume
organizational and technical management functions and continue interventions at the end of the
CDC/Belgian Cooperation funding period.
19. Support ministries (MLS, MJ, MFFAS, MEN, MJDH, MIS) and local organizations (CBOs, FBOs, NGOs)
and associations, in collaboration with partners (PSI, Alliance, Care), to identify and develop strategies for
non traditional sex workers such as transactional sex populations who inconsistently enter sex work;
20. Continue to work with MLS, MSHP, CDC and its partners to design and implement a baseline study on
knowledge, attitude and practices and IST/HIV prevalence among MSM using Respondent Driven
Sampling. FHI will also support an appropriate PAPO-HVP partner to conduct the CT component of that
2008-funded research project on attitudes, practices and access to services among MSM in Abidjan.
21. Support MLS and MSHP, in collaboration with key partners (PSI, Alliance, RIP+) to develop and
implement innovative prevention and care strategies for MSM after the baseline study conducted by CDC
Activity Narrative: and its partners.
22. Support in collaboration with JSI/Measure Evaluation and CDC/RetroCI/SI, MLS/DPPSE and
MSHP/DIPE, in developing strategies (data collection tools, KAP survey) to track behavior change among
SW frequenting HVP clinics to better understand if BCC and other prevention interventions are having an
impact;
23. Conduct a baseline assessment of HIV prevalence and preventive behavior in 4 new service sites in
FY09.
24. In the area of public heath surveillance, FHI in collaboration with MSHP and the Elizabeth Glaser
Pediatric Foundation (EGPAF), will conduct an evaluation on ARV adherence and safe sex behavior of SW
who are on ART.
25. Support the participation of local partners at regional conferences in order to facilitate exchanges of
lessons learned and promising practices.
26. Provide technical and financial support to Espace Confiance and the local NGO Arc en Ciel to develop,
implement, and evaluate a minimum package of services for MSM.
27. Initiate a female condom social marketing campaign among female SW in order to increase acceptance
and use of this HIV prevention option.
28. Conduct a cost-effectiveness study for mobile clinics delivering prevention, CT, and care services for
SW in Abidjan and San Pedro regions.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15117
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15117 4558.08 HHS/Centers for Family Health 7047 5314.08 CoAg FHI/ITM $1,386,529
Disease Control & International (HVP)
Prevention #U62/CCU3244
73
10050 4558.07 HHS/Centers for Family Health 5314 5314.07 CoAg FHI/ITM $1,440,000
4558 4558.06 HHS/Centers for Family Health 3379 81.06 Cooperative $900,000
Disease Control & International Agreement with
Prevention FHI/ITM
(HVP),#U62/CC
U324473
Emphasis Areas
Gender
* Reducing violence and coercion
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $740,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.03:
FHI has two main roles in PEPFAR Côte d'Ivoire's palliative care (PC) program. The first one is the
implementing PC interventions targeting highly vulnerable populations (HVP) including sex workers (SW)
and the second one consists in providing technical-assistance to the Ministry of Health's National HIV/AIDS
Care and Treatment Program (PNPEC) and other partners to improve access and quality of PC services.
Modified activities during the FY 09:
1. Support MSHP/PNPEC and MLS to develop and disseminate to physicians and other related parties a
document summarizing the essential aspects of current regulation on opioïds
2. Support MSHP/PNPEC to promote the use of opioïds for pain management to all physicians
3. Assist the 13 PAPO-HVP sites in STI drugs procurement during "hard period"
4. Subgrants to APROSAM to provide coordination and coaching for the implementation of activities
conducted by CERBAS and FURBAS for Community mobilisation for PMTCT, Education to treatment,
Palliative care.
5. FHI will in collaboration with the national program of cervical cancer strengthen the technical capacities of
Clinique de Confiance in order to set up a pilot program for the screening of cervical cancer in female sex
workers (FSW). FSW are at high risk for developing cervical cancer and don't have easy access to other
health services, including cervical cancer screening. In first instance this program will target all sex workers
visiting the Clinique de Confiance
In FY08, FHI provided technical and financial assistance for the implementation of palliative care (PC)
services at the 13 PAPO-HVP sites. FHI collaborated with other partners to strengthen the NGOs Espace
Confiance and APROSAM in managing mobile PC services. In addition, FHI provided technical, financial,
and organizational assistance to other local NGOs such as Arc en Ciel, CERBAS, and FURBAS to conduct
community based interventions for people living with HIV/AIDS (PLWHA). In order to strengthen the
delivery, quality, and coordination of PC services in accordance with national PC policies and the 2006-
2010 National PC Strategic Plan, FHI worked in close collaboration with the National Care and Treatment
Program (PNPEC) under the Ministry of Health (MSHP), and other PEPFAR partners such as the Ministry
of AIDS (MLS), the National Program for Orphans and Vulnerable Children (PNOEV), Alliance-CI,
Population Services International (PSI), Hope Worldwide, and the Ivorian Network of People Living with
HIV/AIDS (RIP+). With FY08 funds, FHI supported advocacy activities and reinforced service providers'
capacities. FHI supported the training of 21 new trainers to increase the number of trainers in the national
pool to 44. FHI also supported the training of 100 PC service providers. FHI supported direct PC services to
11,500 people including orphans and vulnerable children (OVC).
Using FY09 funding, FHI will work to strengthen the ongoing PC program in the 2 mains domains: clinic-
based PC for highly vulnerable populations (HVP) such as sex workers and their partners, and central level
PC support. FHI will conduct the following activities in the following domains:
a) Interventions at central level and/or focused on adult care
1. Continue to provide technical and financial assistance to the 13 main existing HVP health centers
implementing PC activities as well as to support groups at all sites to provide psychosocial support and
adherence counseling. The standard PC package will include symptomatic pain relief, evaluation of social,
psychological, and spiritual needs, and referral to a system of comprehensive care.
2. Continue to assist (through training, and the provision of documents and tools) the PC mobile units which
target to hard-to-reach sex workers in Abidjan and San Pedro.
3. Strengthen the technical capacities of Clinique de Confiance in order to implement a pilot program for
screening of cervical cancer among female sex workers, who are at a high risk of developing cervical
cancer and often do not have access to other preventative health services.
4. Continue to strengthen the operational management of NGOs, including administrative and financial
management, budgeting, leadership, M&E, and mobilization of resources. FHI will continue to support the
implementation of a quality assurance system (QAS) in collaboration with PEPFAR and other partners
(such as PNPEC, PSI, URC and JHPIEGO).
5. Support the extension of services by introducing PC into the package of services offered to outpatients.
This standard PC package will be available for adults and children including OVC. FHI will work the Supply
Chain Management System (SCMS) for the procurement of condoms and cotrimoxazole tablets for adults in
order to resupply commodities to service providers who will deliver directly to the clients.
6. Continue technical and financial assistance to the national PC technical working group, in collaboration
with Hope Worldwide Côte d'Ivoire and its twinning with the African PC Association (APCA) and other
partners (ACONDA/ANADER, PSI, Alliance CI, CARE International, ARSIP), to conduct sensitization
sessions for stakeholders to promote integration of PC services into the national health system.
7. Support MSHP/PNPEC and MLS to develop and disseminate to physicians and other related parties a
document summarizing the essential aspects of current regulation on opioïds.
8. Provide technical assistance to MSHP/PNPEC and MLS to continue advocacy towards authorities for
opioids. More specifically, FHI will promote the prescription of injectable opioids for more than 7 days and
the prescription of other forms for more than 30 days for pain management. In addition there is a need to
Activity Narrative: authorize prescription of opioïds at all levels (including primary health care level).
9. Facilitate 2 trainings focusing on opioïd prescription for physicians.
10. Provide support to the MSHP/PNPEC and MLS to extend implementation of PC services in 8 new sites
(including HVP healthh centers, OVC platforms, and IRIS sites).
11. Continue to strengthen the collaborative framework among partners supporting or implementing PC.
This collaboration includes the dissemination of policy, norms, and procedures documents.
12. Continue to support the collaborative platform to achieve broader access to PC services through
advocacy and capacity building for service providers and community workers to harmonize and improve the
quality of PC interventions.
13. Assist the MSHP/PNPEC, MSHP/DFR, in collaboration with JHPIEGO and new PEPFAR partner, to
continue the integration of PC into pre-service curricula (UFR/SM, INFAS, INFS, and Centre Technique
Féminin).
14. Improve the quality of PC services by disseminating quality assurance tools and PC guides, and support
the training of 25 PC trainers, 100 PC service providers, and 25 QA focal points including coordinating with
CARE International efforts to target FBOs supported by ARSIP.
15. Continue to support the implementation of a PC quality assurance system by the MSHP and MLS.
16. Provide technical and financial assistance to 4 PC service provider networks for the implementation of
home based services (home visits, care and treatment, community mobilisation for the prevention of mother
-to-child transmission [PMTCT], treatment, and palliative care). Facility based providers and community
based services will be linked through a referral network.
b) Interventions at central level focused on care of children
1. Support the extension of services by introducing a standard PC package, including symptomatic pain
relief, evaluation of social, psychological, and spiritual needs, etc.
2. FHI will support MSHP/PNPEC to promote the use of opioïds (syrup-based formula for children) for pain
management to all pediatricians.
3. Provide support to the MFFAS/PNOEV, MSHP/PNPEC, and MLS to extend implementation of PC
services in 8 new sites (where there are existing OVC platforms).
4. Continue to support to the MFFAS/PNOEV, MSHP/PNPEC, and MLS/CTAIL to disseminate policy,
norms, and procedures documents and guides in pediatric services and OVC platforms.
5. Continue to support broader access to PC services through capacity building for service providers and
community workers in order to harmonize and improve the quality of PC interventions in pediatric services
and OVC platforms.
FHI 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 unified national M&E system, FHI will
participate in quarterly strategic information meetings.
Continuing Activity: 15118
15118 5038.08 HHS/Centers for Family Health 7047 5314.08 CoAg FHI/ITM $415,000
10056 5038.07 HHS/Centers for Family Health 5314 5314.07 CoAg FHI/ITM $300,000
5038 5038.06 HHS/Centers for Family Health 3379 81.06 Cooperative $200,000
Estimated amount of funding that is planned for Human Capacity Development $300,000
Table 3.3.08:
In FY09, FHI will:
1. Assist PNOEV to conduct OVC situation analysis in 12 new sites, in preparation for expanded OVC
platform infrastructure and roll-out of national strategy implementing new social center model. After
competence transfer, PNOEV will be able to take the lead of new situational analysis.
2. Assist PNOEV to extend the implementation of the restructured social center to the 12 sites where a
situation analysis was conducted in FY08.
3. Integrate OVC related issues in the training curricula in INFS and INFAS.
4. Assist PNOEV and DPPH to integrate training curricula in the National institute for the promotion of visual
impaired people (INIPA) and in ECIS (Ivoirian School for the Deaf) by adapting existing approved material
for disadvantaged populations.
5. Contribute to improve the quality of OVC services in collaboration with URC and other partners will assist
PNOEV to develop and implement quality management related to OVC care in OVC platform. In this
purpose, FHI will support PNOEV to train 40 trainers, 140 local actors (community-based and social
workers, rural animators, and staff at vocational and household training centers for women and girls) in
OVC care, palliative care, behavior-change communication, and social mobilization at the 28 newly
identified platform sites.
6. FHI will support PNOEV to finalize and actualize a dissemination plan for OVC communication tool
materials which involve identifying the different technical and implementation partners. FHI will work with
PNOEV, MLS, MSHP JHU/CCP and REPMASCI for national distribution of communication material on OVC
issues created in 2008.
7. In order to improve OVC legal rights, FHI will help PNOEV establish and strengthen OVC legal rights
committees and to reinforce the capacity of their members to support implementation of interventions at the
28 OVC platforms (through advocacy and by creating and maintaining strong links with competent legal
services which are resources for the platforms).
8. Work with PATH to integrate children's nutritional assessment, needs and support responses in the OVC
curricula already integrated at INFS.
9. Assist PNOEV to elaborate a best practices document on San Pedro CSR and to document the
organization of technical groups, meetings and activities in the high-functioning social center in
Yamoussoukro.
10. Assist PNOEV and MFFAS to develop a strategy to share experiences between the social centers and
OVC platforms in order to create sustainable services.
11. Assist PNOEV revise and update coordination and supervision strategy to ensure a better functioning
network of OVC platforms.
12. Contribute with Measure, Retro-CI and other partners to set up an OVC DQA program and assist the
development of a national OVC services and tracking database; plus assist in management of a training
data base tracking human capacity building for OVC care and support
13. Continue to collaborate with REPMASCI (network of journalists and artists) and JHU/CCP channels to
disseminate best practices and lessons learned from the implementation of the different models of care and
coordination for OVC (IRIS, OVC collaboration platform, District Health Coordination and MLS District HIV
Coordination).
14. Continue to assist the CDLS with IRIS strategy in 2 new sites. FHI will not put a technical advisor in
those sites but will assist by using the strength from San Pedro experience.
15. Assist PNOEV in identifying a webmaster to manage the PNOEV link in MFFAS website and provide
technical support to ensure on site training on OVC care through PNOEV link in MFFAS website
16. Assist PNOEV in the training of MFFAS regional Directors, General Inspectors and others directions
involved in the OVC issues in OVC care and support.
17. Continue to strengthen 3 subpartners: ASAPSU (in 3 districts of Abidjan ( Marcory, Koumassi and
Attécoubé), APROSAM with FURBAS and CERBAS (in San Pedro) through grants to provide directs
services (educational, psychosocial, legal, medical and others as necessary) and provide training to
community counselors and family members.
Family Health International (FHI) provides technical assistance to the National Program for Orphans and
Vulnerable Children (PNOEV) of the Ministry of the Family, Women, and Social Affairs (MFFAS) and other
ministries and PEPFAR partners to support the development, evaluation, implementation, and extension of
care services for orphans and vulnerable children (OVC). FHI works to build the technical and
organizational capacities of the PNOEV and supports the elaboration of policies, norms, and procedures for
the care of people living with HIV/AIDS (PLWHA) and OVCs, as well as the strengthening of the national
monitoring and evaluation system.
Activity Narrative: In collaboration with JHPIEGO, FHI provided technical assistance for the integration of OVC curricula in
courses of the Social Workers Training Institute (INFS). In FY08, FHI helped establish a continuing-
education program for community and social workers at INFS. FHI also supported the elaboration and
dissemination of the 2006-2010 OVC National Strategic Plan while continuing to develop the organizational
and managerial capacity of the PNOEV.
Moreover, FHI supported 7 IRIS model sites including San Pedro center and the OVC platforms
surrounding social centers. The IRIS model was extended to 4 newly selected areas, and implementing
OVC platforms and support groups in 28 more departments are currently in place (for a total of 28 platforms
based on the restructured social center and 7 IRIS model sites nationwide by March 2009).
To boost preparations for scaling up OVC services, FHI hired an international consultant to provide further
technical assistance to the PNOEV. The consultant helped the PNOEV to develop and carry out a national
strategic implementation plan that includes:
• Helping develop strategy and action plan for mapping OVC services and partners
• Evaluation of San Pedro centre
• Training workshop for PNOEV staff, platform staff, and NGO partners in rapid qualitative assessment
methods to identify OEV for inclusion in programme
• Implementation of standardized tools and criteria, based on existing international tools and criteria, for
assessment and capacity building of local implementing partners including criteria for graduation to
PEPFAR sub-partner and partner status
• Coordination of implementing the Child Status Index tool, including its integration into the national M&E
system
• Development of a national M&E tracking system with decentralized data entry points and simpler forms for
local partner use
• Development of a specific timeline for continuing implementation and reinforcement of the national
implementation plan
• Coordination among all PEPFAR partners to accomplish the aforementioned tasks
In FY08, FHI worked with the PNOEV to finalize the continued education program on OVC issues for social
workers at INFS. The organization conducted situational analyses in order to implement new OVC
platforms. In addition, FHI worked with PNOEV to implement the following activities:
• Contribute to improving the quality of OVC services by supporting the training of 40 trainers, 210 local
actors (community-based social workers, rural animators, and staff at vocational and household training
centers for women and girls) in OVC care, palliative care, behavior change communication, and social
mobilization at the 12 newly identified platform sites.
• Participate with John's Hopkins University Center for Communication Programs (JHU/CCP), the Ministry of
AIDS (MLS), and other partners in the development of new messages and communication materials on
OVC issues that will be disseminated nationwide.
• Contribute to the establishment of OVC legal rights committees in the 12 OVC platforms.
With FY09 funding, FHI will primarily work towards the sustainability of the different systems it helped to
establish since 2004. More specifically, FHI will:
1Assist PNOEV to conduct OVC situation analysis in 12 new sites, in preparation for expanded OVC
1. Assist PNOEV to extend the implementation of the restructured social center to the 12 sites where a
2. Integrate OVC related issues into the training curricula at INFS and the National Institute of Training for
Healthcare Workers (INFAS).
3. Assist PNOEV and DPPH to integrate a training curriculum at the National institute for the Promotion of
Visual Impaired People (INIPA) and at ECIS (Ivoirian School for Deaf People) for developing appropriate
material for sensory disabled people, particularly for visually impaired OVC.
4. Contribute to improve the quality of OVC services in collaboration with URC and other partners will assist
5. FHI will support PNOEV to finalize and actualize a dissemination plan for OVC communication tool
6. In order to improve OVC legal rights, FHI will help PNOEV establish and strengthen OVC legal rights
7. Work with PATH and FANTA to develop and integrate a child nutrition curriculum into the OVC curricula
already integrated at INFS.
8. Assist PNOEV to elaborate a best practices document on San Pedro CSR and to document the
Activity Narrative: organization of technical groups, meetings and activities in the high-functioning social center in
9. Assist PNOEV and MFFAS to develop a strategy to share experiences between the social centers and
10. Assist PNOEV revise and update coordination and supervision strategy to ensure a better functioning
11. Contribute with Measure, Retro-CI and other partners to set up an OVC DQA program and assist the
12. Continue to collaborate with REPMASCI (network of journalists and artists) and JHU/CCP channels to
13. Assist PNOEV in identifying a webmaster to manage the PNOEV link in MFFAS website and provide
14. Assist PNOEV in the training of MFFAS regional Directors, General Inspectors and others directions
15. Continue to assist the CDLS with the IRIS strategy in 2 new sites. FHI will not put a technical advisor in
those sites, but will assist by using the strengths from San Pedro experience.
16. Continue to strengthen 3 subpartners: ASAPSU (in 3 districts of Abidjan ( Marcory, Koumassi and
FHI will report quarterly program results and ad hoc requested program data to the USG strategic
information team. To participate in the building and strengthening of a unified national M&E system, FHI will
Continuing Activity: 17128
17128 5042.08 HHS/Centers for Family Health 7047 5314.08 CoAg FHI/ITM $900,000
10060 5042.07 HHS/Centers for Family Health 5314 5314.07 CoAg FHI/ITM $800,000
5042 5042.06 HHS/Centers for Family Health 3379 81.06 Cooperative $400,000
Estimated amount of funding that is planned for Human Capacity Development $420,000
Table 3.3.13:
1. Use new data on the size of the sex worker population to increase CT service coverage by increasing
coverage of the existing sites in satellite service centers, improving quality of CT services, promoting
outreach and behavior change communication (BCC) activities of CT services to selected sites (e.g.
Korhogo to Ferkesedougou, Man to Touba), and, if needed, opening new CT centers in non-covered areas
such as Odienné.
2. Conduct at least one quality improvement project. The project and site will be chosen after conducting a
quality evaluation audit in all project sites. Potential subjects of the quality improvement include the
which is based on the Langley et al. model focusing on systems change and team work, will be used. A
quality improvement team, including the target population, will be set up in order to understand the system,
measure performance, identify changes in the target system components, and test those system changes.
Experiences and results will be shared with all implementing partners in order to expand the project to other
sites. FHI will also collaborate with other PEPFAR partners and the MLS in quality assurance and indicator
harmonization efforts for BCC and peer education programs in 2009.
3. Training of 60 PAPO-HP's service providers in IPC. This training, along with the PICT training conducted
using FY08 funds, will be outcome oriented, contributing to increasing the number of clients visiting these
sites and accepting to take an HIV test. The National IPC training modules include elements of family and
couples testing.
4. The NGO network ARSIP is a significant asset in mobilizing support and action in HIV prevention, stigma
reduction and care among religious leaders and communities. FHI will coordinate with CARE International
and other partners in a strategy to reinforce ARSIP's capacity to promote community care, and a network of
community CT activities.
5. Improve supervision of PAPO sites by involving district staff in this activity and follow-up on progress in
capacity improvement plans.
Through its PAPO-HVP project for highly vulnerable populations (HVP), FHI and its partners are
strengthening and expanding HIV counseling and testing (CT) services targeting commercial sex workers
and their partners at 13 sites in the cities of Abidjan, San Pedro, Gagnoa, Yamoussoukro, Guiglo, Bouaké,
Man, Bondoukou, Korhogo, Daloa, and Abengourou. FHI is also providing support to the NGOs Espace
Confiance and APROSAM to extend the coverage of CT services for sex workers through the use of mobile
units.
Voluntary counseling and testing is part of the minimum package of health services offered to female and
male sex workers, their partners, and other HVP clients as outpatients at 13 PAPO-HVP centers. Using
FY08 funding, FHI continued to provide sub-grants and technical assistance to the 13 implementing
NGOs/sites. Technical support provided by FHI and its partners (the Institute of Tropical Medicine and
Espace Confiance) includes training of new service providers, dissemination and training in the use of
standardized quality assurance and M&E tools, regular participatory program reviews, and supportive
supervision in the implementation of a minimum package of services. The minimum package of services
includes BCC aimed at HIV prevention through peer education as well as CT, management of sexually
transmitted infections (STI), palliative care, and antiretroviral (ARV) treatment. Espace Confiance continues
to provide practical training sessions and coaching for health-care providers in HIV prevention, care, and
treatment.
Although project sites use rapid testing with same-day delivery of results, some clients prefer to leave,
saying they will come back later for their results. This often results in loss to follow-up. Since FHI started the
HVP program in 2004, 45,381 HVP (75.6% of the targeted population) have visited HVP clinic sites where
they have been counseled, but only 18,683 (62% of those counseled) have been tested and have received
their test results. FHI is working in consultation with the USG team to increase these rates through provider
initiated counseling and testing (PICT), and developing creative strategies for effective, client-oriented
outreach. In 2008-09, PAPO-HV network sites have been included in training on rapid test (finger prick)
algorithm, which it is anticipated will improve the numbers of people not only tested, but also receiving
results.
With regards to mobile CT, FHI continues to support two CT vans provided by Alliance-CI in March 2007 to
Espace Confiance and APROSAM to serve hard-to-reach HVP in remote areas of Abidjan and San Pedro.
Based on innovative CT approaches initiated in 2007, including PICT for all patients visiting HVP health
centers and a family-based approach, FHI expects to increase its CT targets to 22,000 individuals
counseled and tested using FY09 funding (10% increase from FY08). In addition, FHI will collaborate with
the Ministry of Health (MSHP), the Ministry of AIDS (MLS), and other partners at PAPO sites in order to
update the national directory of services.
Using FY09 funding from PEPFAR and the Belgian Development Cooperation, PAPO-HVP will conduct
baseline studies of condom use and STI prevalence among sex workers. Capture-recapture techniques to
estimate the size of the sex-worker population in at least 5 cities have been initiated and will be continued.
At the regional level, PAPO-HVP will collaborate with the Institute of Tropical Medicine to exchange
information about project experiences in Kenya.
With FY09 funding, FHI will provide ongoing technical and financial support through sub-grants to the 13
existing implementing NGOs/sites. The main programmatic focus will be to improve the quality of CT
services for the target population. This will be accomplished by the dissemination and training in the use of
standardized quality assurance tools, strengthened supervision visits, quality assessment audits at all sites,
Activity Narrative: and piloting of a quality improvement project at one PAPO site.
Specifically, FHI will use FY09 funding to:
1. Continue providing technical support to the 13 existing CT sites and their satellite sites supported in
2008.
2. Use new data on the size of the sex-worker population to increase CT service coverage of the existing
sites, increase outreach BCC activities that promote CT in selected sites (e.g. Korhogo to Ferkesedougou,
Man to Touba), and, if needed, open new CT centers in non-covered areas such as Odienné.
3. Provide technical assistance for the integration of mobile CT services in the package of services aimed at
difficult-to-reach sex workers in Abidjan (with NGO Espace Confiance) and San Pedro (with NGO
APROSAM) in order to expand geographic coverage and improve access to services. Geographic areas
which may be covered include Bassam, Dabou, Ayama, Bingerville for Espace Confiance, and SOGB,
Watté, Adjaméné, and Soubré for APROSAM.
4. Strengthen support for the promotion of CT services for HVP during outreach activities through 165 peer
health educators and community workers among 13 clinic sites.
5. Conduct 3 refresher trainings for peer health educators and community workers on PICT and on the
simplified HIV-test algorithm that is being rolled-out in 2008. FHI will work with the PEPFAR country team
and MSHP to determine the feasibility and pace of CT outreach. Results of these trainings will contribute to
an increase CT uptake from 62% to 70%.
6. Continue providing support to 13 NGOs/sites in support of innovative CT strategies for HVP, including
couples and family counseling, and positive-prevention activities. These subjects are included in curricula
for interpersonal communication (IPC).
7. Support the MLS and the MSHP, in collaboration with key partners (Population Services International
[PSI], Alliance, the Ivorian Network of People Living with HIV/AIDS [RIP+]) to develop and implement
innovative prevention and care strategies for men who have sex with men (MSM).
8. Continue to support the elaboration of the quality assurance system (QAS) for M&E started in 2006, in
collaboration with other partners , such as the National Care and Treatment Program [PNPEC], PSI, and
Project Retro-CI, to better evaluate the quality of health-care services. The QAS will be part of the current
program management system. In 2008, FHI has trained health staff and M&E focal points at its 2 new sites
in the use of these QAS tools; FHI will also support the training of community-based providers in CT and
dried blood spot (DBS) techniques for quality assurance. In addition, FHI will continue standardization of CT
practices at existing sites through the dissemination of standardized tools elaborated at the national level
under the supervision of the PNPEC. Quality evaluation activities will be performed periodically at the 13
existing sites according to national guidelines in order to improve quality of CT services.
9. Conduct at least one quality improvement project. The project and site will be chosen after conducting a
10. Continue to strengthen the internal and external referral systems for people living with HIV/AIDS
(PLWHA) to appropriate services, including care and support groups, palliative care, and services for
orphans and vulnerable children (OVC). One of the main challenges is continuum of care for a mobile
population such as sex workers. FHI will address this issue by providing technical assistance to sub-
partners in areas using the departmental comprehensive care model (IRIS) with the direct involvement of
the district health management team in supervising and reporting activities.
11. Conduct a baseline assessment of HIV prevalence among a representative sample of 500 sex workers
visiting new functional sites at Korhogo, Abengourou, Man, and Abobo.
12. Continue to address stigma and sexual violence by providing HVP-friendly services delivered by staff
with nonjudgmental attitudes and by conducting behavior change communication (BCC) activities with
16,000 other HVP (such as partners of sex workers, clients of sex workers, and bar owners). In addition,
quality assessment tools will be used to measure client satisfaction in areas such as HVP-friendly service,
non stigmatization, and non judgmental staff attitudes.
13. Support the revision of the PAPO-HVP extension plan following its evaluation. This plan was elaborated
population to occasional sex workers. A revised plan will allow for a reorientation of interventions to include
nationwide coverage of primary health services for PLWHA.
14. Continue to support the annual evaluation of a project-level sustainability plan.
15. Support the participation of local partners at regional conferences in order to facilitate exchanges of
16. Training of 60 PAPO-VP's service providers in IPC. This training, along with the PICT training that was
initiated in FY08, is expected to increase CT patient uptake and retention. The National IPC training
Activity Narrative: modules will include elements of family and couples testing.
17. Provide the NGO ARSIP with technical and financial support to promote the network of community CT
activities, as they are a significant player in the domain of community-based care.
18. Provide subgrants to Espace Confiance (Abidjan) and APROSAM (San Pedro) to provide mobile CT
Continuing Activity: 15119
15119 5046.08 HHS/Centers for Family Health 7047 5314.08 CoAg FHI/ITM $300,000
10065 5046.07 HHS/Centers for Family Health 5314 5314.07 CoAg FHI/ITM $300,000
5046 5046.06 HHS/Centers for Family Health 3379 81.06 Cooperative $150,000
Estimated amount of funding that is planned for Human Capacity Development $90,000
Table 3.3.14:
