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.
N/A
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $19,500
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $4,473,000
Total Planned Funding for Program Budget Code: $0
Table 3.3.09:
Estimated amount of funding that is planned for Human Capacity Development $9,000
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $460,000
Table 3.3.11:
Estimated amount of funding that is planned for Human Capacity Development $90,000
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $1,125,000
Program Area Narrative:
Swaziland faces a severe shortage of trained laboratory personnel and an inadequate lab infrastructure to deal with the rapidly
growing demand for HIV/AIDS and TB related diagnostic and clinical lab testing. Underlying the capacity deficits are a host of
problems that include a lack of cohesive human resource policy, lack of lab training institutions in country, a history of poor lab
systems management, and lack of career enhancement opportunities. Investments in laboratory services to support HIV/AIDS and
TB program expansion have been neglected at virtually every level, which is crippling the rapidly increasing program (both public
and non-public sector) implementation. There is one referral laboratory covering all lab services (move into a newly constructed
facility likely to be considerably delayed), five regional laboratories, eight health center laboratories and three private laboratories.
These labs are completely overwhelmed by the increasing demand for HIV/AIDS and TB related diagnostic and clinical lab
services, in addition to the other routine services that they are providing. Critical areas are HIV testing, CD4 cell count, DNA PCR
for infant diagnosis and TB sputum microscopy. Periodic stock-outs of lab reagent have been an ongoing problem. As with the
ARVs, some of the lab reagents are procured with Global Fund resources. The National Emergency response Council for
HIV/AIDS (NERCHA) orders these based on requisitions from the Ministry of Health and Social Welfare (MOHSW). However, the
communication within the MOHSW, and between the MOHSW and NERHCA, is far from ideal (see HTXD)
To date, there has not been much laboratory support, apart from PEPFAR. The Italian Cooperation has a limited program to make
renovations to lab infrastructure and to purchase equipment for the existing National Reference Laboratory (NRL) in Mbabane and
for some of the laboratories in VCT and ART centers. Clinton Foundation, together with some of the PEPFAR partners, in an effort
to promote early infant diagnosis and treatment, has been strengthening the collection and transport of DBS samples and
facilitated DNA PCR testing in South Africa.
PEPFAR, and some of its implementing partners, have been collaborating with the MOHSW's National Laboratory Services (NLS)
since 2006. PEPFAR has worked with the World Health Organization (WHO) and other stakeholders to assist the NLS in the
development of a National Laboratory Policy document. Unfortunately, this document has now been in draft for a long time and
has not been finalized. Recently, PEPFAR has moved forward from a short-term assistance plan to facilitating a broad
stakeholder process to develop a five- year National Laboratory Development Plan. This includes a detailed one-year National
Laboratory Action Plan for the first year of implementation. This plan is currently used as the blueprint for the implementation of
much needed improvements across the service. PEPFAR has provided extensive in-service training and on-site mentoring of
existing laboratory personnel on basic laboratory operations, chemistry, hematology, HIV testing, CD4 cell count testing, and TB
microscopy. With PEPFAR support, a new cadre of lab phlebotomists was developed to assist the more senior lab personnel with
phlebotomy services. Some of these phlebotomists were also trained and deployed to perform TB sputum microscopy, which has
started to relieve the pressure on TB diagnostic services. In addition, a pilot program is underway whereby phlebotomists are
deployed to more remote health clinics, without laboratories, to perform a minimum package of basic lab tests, including HIV
testing. PEPFAR is also supporting the development and implementation of systems and protocols for standard operating
procedures, quality assurance, supervision/mentoring, and strengthened laboratory management.
In FY09, the PEPFAR will continue to support the strengthening of the national lab capacity and services through technical
assistance, training and supervision.
1) The American Society of Clinical Pathologists (ASCP) and the Centers for Disease Control and Prevention (CDC) will provide
technical assistance, in collaboration with the WHO, to finalize the existing National Laboratory Policy document (including
national standards) and assist the process of converting it in legislation. ASCP will implement a schedule of periodic reviews to
assess the implementation and adherence to the National Laboratory Policy.
2) ASCP and CDC will provide ongoing assistance with the implementation of the five-year National Laboratory Development
Plan. ASCP will implement a schedule of periodic reviews to evaluate progress on implementation. ASCP will help conduct
meetings of laboratory stakeholders to apprise them of the successes and challenges with the implementation of the development
plan, and will assist in the drafting of the next year's Action Plan.
3) ASCP will begin work on developing clear standards and requirements for certification of laboratory personnel. Standards for
pre-service requirements, scope of practice, and competency assessment will be established. In addition, ASCP will also work
with the MOH to help develop and implement a national continuing education program for laboratory personnel. Standards will be
enforced by the regulatory body of health personnel in Swaziland to certify all individuals working in medical laboratories.
4) ASCP will repeat its three day training workshop in Basic Laboratory Operations that is based on the new CDC task-based
guidelines for best laboratory practices. The training is targeted towards laboratory assistants and laboratory technicians who
must manage themselves under the direction of an on-site medical officer. This training has been conducted previously, with a
‘training of trainers' component. With time, it will be conducted with increasing involvement of four local trainers; the ASCP role will
be gradually reduced to technical oversight only. Refresher training of those previously trained will be considered.
5) PEPFAR will continue to support the training and deployment of lab phlebotomists to perform basic lab functions
•ASCP will continue to conduct its trainings on phlebotomy (including both venipuncture and finger prick). This training has been
conducted previously, with a ‘training of trainers' component. It will be conducted by local trainers; the ASCP role will be limited to
technical oversight only. Refresher training of those previously trained will be considered.
•The National Institute for Communicable Diseases (NICD) will continue the assistance with the training of lab phlebotomists on
TB sputum microscopy using the CDC protocol and teaching guidelines. This training has been conducted previously, with a
‘training of trainers' component. It will be conducted by local trainers; the NICD role will be limited to technical oversight only.
Refresher training of those previously trained will be considered.
•ASCP will continue to conduct its trainings of lab phlebotomists on basic lab tests (including HIV testing). This training has been
conducted previously, with a ‘training of trainers' component. With time, it will be conducted with increasing involvement of four
local trainers; the ASCP role will be gradually reduced to technical oversight only. Refresher training of those previously trained
will be considered.
6) ASCP will continue to help build CD4 testing capacity in Swaziland and further support the CD4 testing sites with technical
assistance and training. ASCP will conduct a CD4 testing training for laboratory professionals, and will provide periodic on-site
mentoring and technical support to 12 testing sites. ASCP will work with instrument vendors to explore emerging technologies in
CD4 testing.
7) NICD will increase its support to build TB diagnostic capacity in Swaziland
•NICD will strengthen capacity for TB sputum microscopy by providing additional training, mentoring and quality assurance at all
sites, a smear microscopy re-checking program and external proficiency testing.. In addition, NICD will gradually upgrade TB labs
(high volume labs first) through the introduction of new technology i.e. the concentration of sputum samples and fluorescence
microscopy
•NICD will provide training, mentoring and quality assurance for TB culture and drug susceptibility testing at the Mbabane NRL.
Performance will be monitored through an external quality assurance program of the South African Medical Research Council
(SAMRC). Once full capacity of current equipment is reached, NICD will provide additional equipment to increase the volume of
tests that can be performed. Depending on feasibility and experience in South Africa and other developing countries, introduction
of line probe identification of drug-resistant TB may be considered.
8) NICD is currently performing the DNA PCR testing for early infant diagnosis in Swaziland (facilitated by Clinton Foundation).
Samples are being sent to South Africa and results take approximately four to six weeks to return. NICD will offer SA-based
training in the performance of DNA PCR to selected lab personnel so that, with time, this test will be made available in Swaziland
so that turn-around times may be reduced.
9) The NICD will continue to assist with the implementation of a comprehensive, and integrated quality management system by
training and supporting the newly appointed NLS Quality Improvement Manager. The Quality Improvement Manager will be
assisted to provide training and on-site mentoring to all laboratories in the country, and a routine supervision system will be
developed to focus on performance assessment and improvement. In addition, NICD will assist with the implementation of
external quality assurance (proficiency testing) for chemistry, CD4, HIV serology. The final stage of their intervention will be
performing of internal audits to determine readiness for accreditation, followed by facilitation of a formal accreditation process.
10) Management Sciences for Health (MSH) will considerably increase its support to the management of laboratory reagents and
equipments for the National Laboratory Services (NLS) more specifically by addressing the following: 1) the improvement of
selection, procurement and storage practices for laboratory reagents and equipments; 2) the development and implementation of
quantification models; 3) the determination of optimized reorder levels for the NLS "clients" and implementation of a monitoring
and evaluation system for commodity management (checks and balances, audit). Moreover, the implementation of the integrated
patient management and drug tracking system by MSH will assist with the estimation of the needs as the tests (CD4 Count, Viral
Load, and others) performed for patients on ART (and other patients) can be recorded.
11) The Department of Defense (DOD) will continue its support to the Umbutfo Swaziland Defense Force (USDF) military clinic
and lab. Laboratory related activities will be funded through non-PEPFAR funds (Foreign Military Financing, approximately
$25,000). Activities will include finalization of laboratory infrastructure improvements, provision of equipment, and technical
assistance.
12) The Southern Africa Human Capacity Development Coalition (SAHCD) will strengthen the management and leadership
capacity within the NLS and assist with the development of a human resources plan. The plan will incorporate strategies to
strengthen mid-level laboratory management capacity through short external training, on-site mentorship, sharing of best practices
and study tours for laboratory management, policy formulation, and budgeting. Furthermore, SAHCD will support the leadership to
advocate for the expansion of the current laboratory workforce, a review of the current conditions of service, and the creation of a
supervisory structure with top management at MOHSW and Public Service.
Products/outputs:
•National Laboratory Policy
•National Laboratory Development Plan, with updated Action Plan
•Laboratory personnel certification program
•Laboratory personnel continuing education program
•Modular training guidelines and local training capacity (BLOT, Phlebotomy, HIV testing, TB microscopy, Basic lab test package)
•Lab management protocols and guidelines
•Site-level standard operation procedures, quality assurance plans with supervisor guidelines, quality assessment tools,
proficiency testing
•National and facility level QA audit reports leading towards accreditation
PEPFAR will continue to be a key donor for improving laboratory services under either budget scenario. However, plans to task
shift, train phlebotomists and expand basic laboratory services into the rural areas are dependent on Compact funding. The roll
out of DNA PCR testing for early infant diagnosis will be much slower with pre-Compact funding levels.
Table 3.3.16:
