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: 2008 2009
Background:
The use of peer educators is important in Cote d'Ivoire's HIV prevention strategy. Peer educators are
particularly important for reaching most-at-risk populations, including vulnerable youth, commercial sex
workers, and men who have sex with men (MSM). Quality standards for peer education, however, have not
been developed. Different programs tend to be of varying quality, and there is a risk of important messages
being missed or diluted by poor programs and inconsistent approaches. To address these problems, URC
will work with the Cote d'Ivoire government (Ministry of AIDS (MLS) the PEPFAR CI strategic information
and prevent teams, partners, and stakeholders (including individuals who act as peer counselors, their
supervisors, and members of communities reached by peer counseling programs) to develop standards and
indicators for peer education programs and to standardize and harmonize the key components of courses
used for training peer educators. The goal of this initiative is to help steer partners and programs into those
activities that are most likely to lead to reductions in HIV transmission.
Objectives:
1. Develop national standards for core competencies of peer counselors
2. Develop national indicators, systems, and tools to measure the outcomes of peer education programs on
targeted audiences
3. Develop national process-level indicators and tools that can be used to supervise staff and improve peer
education programs
4. Develop a consensus protocol, to be used by partners, to assess and standardize peer education
courses
Approach:
1. Program planning
URC will support the MLS to carry out a situation analysis of current peer education programs that will map
out, among other things, target audiences; selection, training, supervision, and incentives for peer
educators; and underlying theories of behavior change. URC will also start to review the national and
international evidence to prepare for the harmonization of core competencies and quality standards.
2. Define core competencies and quality
Following the situation analysis, URC will collaborate with the MLS, the PEPFAR prevention team,
implementing partners, and other international groups to identify and reach consensus on the core
competencies required by peer counselors and the elements that define quality within peer counselor
programs. The first step will be to form a technical working group (TWG) to lead the process. The TWG will
include staff from all stakeholders, including individuals who act as peer counselors and members of
communities who are targeted by peer education programs. URC will organize a workshop to develop draft
core competencies and definitions of quality for peer education program focused on youth, most-at-risk
populations (MARP), and PLWHA, and to develop plans aimed ultimately at the standardization of training
courses.
URC will coordinate the work of the TWG in finalizing the core competencies and definitions of quality,
including dissemination of standards.
3. Develop indicators to capture quality of programs and harmonize approaches to measure outcomes for
behavior change communication (BCC) programs
URC will work with the PEPFAR strategic information and prevention teams, ministries (AIDS, Health,
Youth, Education), and other partners, including community members, to review and recommend indicators
that can be used to monitor peer education programs (in addition to the required PEPFAR indicators). URC
will support the government to develop a common list of indicators that all partners will report to the
government and to PEPFAR. Possible outcomes to be measured will include:
• % of people (disaggregated by age, gender and population group) who know how HIV is transmitted and
prevented
• % of people with multiple concurrent partners
• Median age of sexual debut
In addition to the outcome indicators, URC will work with peer educators, their supervisors, and other
stakeholders to develop process-level indicators that can be used to supervise peer educators and to
improve the quality of services in peer education program. As part of this process, URC will collaborate to
develop common standards for supervising peer educators.
URC will help determine the criteria used to select indicators and will work with PEPFAR and the
government to develop systems to collect data for these indicators, including data quality protocols.
4. Review and harmonize core training content for peer education programs
Once the TWG has developed harmonized core competencies for peer educators and standards for quality,
URC will review with the TWG the curricula of peer education training programs to assess how the
knowledge and skills that build these core competencies are addressed. With the MLS, PEPFAR, and the
TWG, URC will develop a protocol for assessing the training programs. URC will then conduct an
assessment of a number of peer education training programs.
A workshop aimed at harmonizing training courses for peer educator training will be conducted. Because
different programs provide different ranges of services, it may not be possible to develop one standardized
training program for peer educators. URC will instead support stakeholders to standardize the training for
the core competencies identified early in the process.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $50,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
will work with the Cote d'Ivoire government (Ministry of AIDS (MLS)), the PEPFAR CI strategic information
Table 3.3.03:
The Healthcare Improvement Project (HCI) managed by the University Research Co. (URC) provides
technical assistance in support of the National HIV/AIDS Care and Treatment Program (PNPEC) and
PEPFAR implementing partners to optimize health outcomes for people with HIV by improving the
identification and retention of HIV patients and by assuring the quality of care they receive.
Starting work in Cote d'Ivoire in January 2008, URC supported the PNPEC in performing an assessment of
the quality of the clinical care of HIV/AIDS patients at 41 sites, with the involvement of the health districts
and PEPFAR clinical care partners. The assessment served a diagnostic purpose and represents the
starting point of an improvement plan being implemented by PNPEC and partners with technical assistance
from URC.
In the program area of Adult Treatment, the objectives of URC technical assistance are to:
1. Develop the capacity of the PNPEC, partners, supervisors, and facility staff to design and implement a
program to continuously improve the quality of HIV clinical services, including improved skills at all levels in
data management.
2. Implement a demonstration improvement collaborative at 40 sites in three regions of the country
(eastern, central, and southern) that will result in the development and testing of a package of changes and
best practices that can be rapidly spread to all HIV clinical service sites in the country. The collaborative will
especially address the deficiencies identified in the baseline assessment of quality of care.
3. Implement an expansion or spread collaborative covering the remaining (minimum 100) clinical HIV
service sites in the country. The package of changes and best practices developed during the
demonstration phase will be rapidly spread to these new sites. This will be implemented between March
2010 and March 2011.
4. As part of the collaborative, develop and refine a model of chronic care for HIV/AIDS to optimize quality
of life and long-term survival. This will include better community follow up of HIV patients.
5. Demonstrate improved results on indicators of quality of care, both process and outcome, in both the
demonstration and the spread collaborative.
6. Leave behind a sustainable system of quality improvement for HIV/AIDS clinical care.
With FY08 funding, URC is conducting the following activities:
1. Evaluation : The baseline assessment of the quality of HIV/AIDS care and treatment services examined
the identification of HIV-positive people (including women and infants from PMTCT services), their follow
up, retention in care, provision of ART according to standards, laboratory services, drug supply and
outcomes of care. Results were presented and reviewed with the MOH and all partners in October 2008,
and priority problems that the improvement collaborative should address were identified.
2. General quality improvement planning and activities, including a planning workshop in October 2008 with
the PNPEC and partners to develop strategies for rapidly improving the quality of care and for solving
priority quality problems using the improvement collaborative approach. A steering group was formed to
oversee the development and implementation of the improvement work, including the collaborative. This
group is chaired by the DGS and includes staff from PNPEC, DIPE, PEPFAR, and implementing partners
such as ACONDA, EGPAF, and ICAP. The steering group also includes staff from the National Public
Health Pharmacy (PSP), who will provide input on standards for quality of drug procurement, storage, and
distribution at sites. Members of this group and regional/district supervisers are being trained in QI and
implementing collaboratives. The group is leading the selection of indicators of quality of care for the
demonstration collaborative and developing the first package of needed changes.
3. Demonstration collaborative activities, including orientation of participating sites, a series of tri-monthly
two day learning sessions at which teams present the changes they made and the results achieved, and a
series of tri-monthly QI action periods, during which each site develops and tests changes and monitors
indicators of quality. Bi-monthly visits for coaching by supervisors will begin in January 2009) and will focus
on the management of QI teams, the resolution of problems related to implementing the change package,
the management of data, and validation of data being reported. Monthly reporting of quality indicator results
will begin in March 2009, and a national conference to report on the results of the collaborative and to plan
the expansion collaborative is envisioned for March 2010.
With FY09 funding, URC will continue and build on FY08 activities. Specific activities will focus on planning
and training for the expansion/spread collaborative, orientation of spread collaborate sites, and a series of
learning sessions, action periods, monthly coaching visits and reporting, culminating in a national
conference to report on results and plan follow-up QI work (expected in March 2011).
Capacity building in QI and quality data management for the PNPEC, partners, supervisors, and facility staff
will take place throughout the period through participation in collaborative activities and side-by-side
mentoring by URC staff.
URC will measure its progress based on the baseline assessment and measures of quality of care
improvements across all HIV/AIDS care and treatment program areas.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16552
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16552 16041.08 U.S. Agency for University 7221 7221.08 Healthcare $350,000
International Research Improvment
Development Company Project QA/WD
Follow-On
16041 16041.07 U.S. Agency for University 7322 7322.07 URC $500,000
International Research
Development Company
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.09:
Quality OVC care implies that appropriate services and support are provided to ensure that children
affected by HIV grow and develop as valued members of their families and community. Providing such care
is complicated by the numbers of children needing care and the many service areas required. Children need
food and nutrition support, shelter and care, protection, health care, psychosocial support, education and
vocational training, and economic opportunity.
Quality improvement (QI) offers a way to organize and harmonize the provision of care by engaging people
at the point of service delivery to evaluate their own performance and decide how they could organize
themselves to do their jobs better. Experience has shown that it is best to start the QI process by reaching
consensus on a set of desired outcomes and by defining standards for quality care. These standards then
become embodied in training materials, job aids, and supervision tools. These standards are also used to
develop indicators to measure quality. Service providers then use these indicators to identify areas in which
they need to improve and to track the effect of their improvement efforts.
The Health Care Improvement Project (HCI), managed by University Research Co. LLC (URC) has
provided technical assistance to 14 African countries in quality improvement for OVC programs. URC has
provided technical support to individual countries to develop and pilot-test service standards and to build
capacity among "learning groups" of care providers from the community who work together to improve the
quality of their services for OVC. URC has also sponsored capacity-building events and facilitated sharing
of best practices and lessons learned across countries.
URC proposes to support the National OVC Program (PNOEV) to improve the quality of services offered to
OVC and their caregivers. The project will focus primarily on building a consensus among OVC
stakeholders to improve quality at the point of service delivery. The guiding principle of the quality
improvement work is to engage stakeholders to reflect on the essential question: What measurable
differences do OVC programs make in a child's life?
Quality Improvement Road Map
1. Planning for quality improvement for OVC programs (2 months):
• Identify champions from PNOEV and other partners who will provide support for quality improvement and
be involved in the whole process.
• Conduct a situation analysis of quality issues for OVC programming. Identify current best practices and
barriers to quality of OVC programs in Cote d'Ivoire.
• Build constituencies of support among OVC stakeholders by organizing advocacy sessions and sharing
evidence from the situation analysis and international best practices regarding QI for OVC programs. The
objectives of the advocacy sessions will be to 1) nurture a paradigm shift toward quality; 2) develop a
common vision and language; and 3) ensure support at policy level to foster quality improvement for OVC
programs.
• Outline the process and structure for standards development. 1) Identify key stakeholders to be informed
and/or to participate in this process, and 2) determine their roles and expectations. A clear plan will be
delineated to support the revision of current national standards to include dimensions of quality.
• Identify implementing organizations that are interested in participating in the QI initiative and create a
partnership that includes identified actors from the PNOEV and other governmental bodies, implementing
partners, donors, and other OVC stakeholders from civil society and/or professional organizations (teachers'
associations, pediatric associations, etc.)
• Train champions and partners on QI for OVC programs.
• Conduct a youth workshop that allows young OVC to articulate their desired outcomes and key aspects of
OVC services. Their input is a critical component of the standards development process, as children identify
and prioritize desired outcomes differently than OVC program implementers
2. Defining quality using service standards (4 months):
• Organize a technical working group (TWG) on quality of services for OVC to lead the process.
• Organize a three-day workshop to share a framework and process for standards development. These
standards will be developed based on Cote d'Ivoire specific context and national and international evidence
of best practices. Objectives of the workshop will be to reach consensus on desired outcomes per service,
draft a limited number of standards, and develop a work plan for completion of a first draft of service
standards.
3. Communicating quality service standards to the point of service delivery (2 months):
• Develop a communication strategy with OVC stakeholders, identifying best mechanisms for
communicating quality standards nationally all the way to the point of service delivery.
• Develop mechanisms for communication and exchange among stakeholders and implementing partners to
share best practices in putting standards in place.
• Organize a capacity-building workshop for service providers to disseminate service standards and to plan
how to operationalize the standards.
• Develop tailored versions of service standards to disseminate to different levels of stakeholders (service
providers, OVC, guardians, community groups).
4. Engaging service providers in quality improvement processes (ongoing after setting standards):
• Identify organizations that want to participate in QI processes for OVC programs
• Build capacity within the government and implementing partners to support quality improvement processes
at the point of service delivery.
• Organize a workshop with key stakeholders on how to build "learning groups" across organizations. Each
team will work on improvement in its program, and the teams will be brought together every four months to
learn from one another how to best operationalize the standards of care and improve quality.
Activity Narrative: • Assist in identifying and training QI coaches from government and partners who can guide learning
groups.
• Create learning groups in participating organizations.
• Build capacity in learning groups to undertake improvement work.
• Organize and provide coaching support to regular meetings of learning groups.
• Convene coaches meetings on a regular basis for promoting cross-learning.
• Develop a documentation process to capture quality improvement processes and promote sharing of best
practices in operationalizing service standards.
• Build capacity of service providers to measure quality of services (outcome measures such as the Child
Status Index) process indicators, and client satisfaction.
• Support South-to-South exchange among OVC stakeholders participating in quality improvement for OVC
• The development of QI coaches for OVC programs who come from government and partners can be used
to rapidly increase the scale of the program.
Proposed indicators:
The indicators used to measure quality will be a combination of outcome measures (e.g. the Child Status
Index) and process indicators that measure providers' adherence with the standards developed in this
project).
Gender
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Human Capacity Development $120,000
Table 3.3.13:
