PMTCT Mid-term Program Review

This activity will fund a comprehensive interagency review of progress under the PMTCT program including external consultants, Government of Ethiopia officials, CDC/Atlanta, USAID/W and USAID/East Africa participation.

Based on the recent USG PMTCT TA visit in July 2006, a broad program review of progress was recommended. This funding would allow PEPFAR Ethiopia to contract an international and a local consultant to support the review process in addition to short term technical assistance from the OGAC PMTCT and Pediatric Working Group.

HIV Prevention ABC Annual Program Statement (APS)

This is a continuing comprehensive ABC activity that is linked to activity Annual Program Statement (OP) (10630). As of August 2006, 100% of FY06 funds were obligated to the USG Strategic Objective Agreement with the Ministry of Finance and Economic Development. These funds will be programmed through the Annual Program Statement mechanism in October 2006. In addition, pre-award procurement and financial assessments will be conducted by USAID prior to award.

The Annual Program Statement (APS) will support multiple continuing and new awards up to 200,000 to indigenous organizations to promote abstinence and fidelity programming in TBD urban and peri-urban of Ethiopia. Urban and peri-urban areas that demonstrate HIV prevalence above the national average will be prioritized.

Building on the OGAC guidance on abstinence, be faithful and condom use (ABC), PEPFAR Ethiopia is soliciting innovative ideas for reaching most at risk populations using evidence-based approaches.

Based on a USG HIV Prevention/Sexual Transmission TA visit, several recommendations highlighted the need to utilize community outreach approaches to reach most at risk groups and girls in Ethiopia. The needs of most-at-risk populations are heterogeneous, and therefore the USG will seek to engage more partners in order to support diverse approaches to meeting the needs of these high-risk, yet diverse populations. While the geographic focus of most prevention programs should remain on urban hubs and transport corridors, USG partners will also be supported to work with peri-urban and rural bridging populations. These partners will prioritize interventions that address urban/rural transmission dynamics such as marketplaces, and targeted prevention to mobile/migrant workers and their families.

Girls in Ethiopia have been hard to reach with prevention programs due to cultural norms requiring leaving school earlier than boys due to family responsibility and marriage and working in the home while not in school. Specific programs need to be designed, both for in-school and out-of-school girls which are female only and supported by the family and community.

Priority program areas include: (1) Promoting abstinence and delay of sexual debut in relation to cross-generational sex and coercion among at risk out of school youth up to the age of 24. (2) Promoting partner reduction for males 25 - 40. (3) Normalizing fidelity, reducing sexual partners and avoiding concurrent or high risk partnerships among men in urban areas through outreach and mini-media. (4) Sanctioning male participation in cross-generational and transactional sex.

Materials used will be predominantly pre-existing unless significant gaps are identified. Such gaps can be addressed with existing large prevention partners (i.e. development and production) or addressed through the larger International Annual Program Statement discussed below.

To alleviate confusion, this APS differs from the proposed Interagency Annual Program Statement in the following ways: (1) Awards range between 100,000 - 200,000 for up to two years; (2) Includes a continuation of programmatic activities of FY06 Prevention APS awards; (3) Recipients will partner with existing USG outreach partners co-located in priority geographic areas to leverage their technical knowledge of HIV prevention and program implementation; (4) Specifically targeted to help indigenous organizations graduate from "sub-partner" to prime partner; (5) Annual Program Statement mechanism targeted to indigenous partners with capacity, providing a rapid and flexible mechanism to build capacity; (6) Technical evaluation of concept papers will be within the in-country Prevention Working Group, an interagency unit; and (7) Utilizes the strength of an in-country Contracting and Agreement Officer.

The Interagency Annual Program Statement is an opportunity for international and local non-governmental organizations to apply for PEPFAR funding. Awards are anticipated to be of larger value, for a minimum of three years and to support major program thrusts in AB and OP. This differs with the current activity Prevention APS in the scale of activities, the anticipated types of partners, the complex interagency division of labor and the speed of awarding funds.

This activity represents am external progress review of IOCC/DICAC and PACT/EMDA.

Faith-based involvement in HIV prevention is critical to the success of AB programming. In Ethiopia, both the IOCC and PACT are strong performers in building the capacity of indigenous FBO and providing activity grants to ensure strengthened HIV/AIDS prevention programming. Following several years of both cooperative agreements, PEPFAR Ethiopia would like to assess progress by these FBO through an external review.

This funding will support the cost of a local and international consultant to conduct reviews of the IOCC/Ethiopian Orthodox Church and the PACT/Ethiopian Muslim Development Agency activities in HIV prevention. Output of this external review will be used in supporting development of annual workplan and the design of future HIV prevention FBO procurements.

Annual Program Statement - USAID Specific HIV Prevention ABC Annual Program Statement (APS)

This is a continuing comprehensive ABC activity, linked to activity (10406) Annual Program Statement (OP). As of August 2006, 100% of FY06 funds were obligated to the USG SOAG with the Ministry of Finance and Economic Development. These funds will be programmed through the APS mechanism in October 2006. In addition, pre-award procurement and financial assessments will be conducted by USAID prior to award. See supplemental document entitled HIV prevention in Ethiopia COP07 for program geographic coverage, population density information and health facility coverage. Also review the HIV Prevention APS map to determine targeted geographic areas where partners may be supported.

The APS will offer multiple continuing and new awards to indigenous organizations to promote AB programming in TBD urban and peri-urban areas, prioritizing those with above-average HIV prevalence. Building on the OGAC guidance on abstinence, be faithful and condom use (ABC), PEPFAR Ethiopia is soliciting innovative ideas for reaching most at risk populations using evidence-based approaches.

Based on a USG HIV Prevention/Sexual Transmission TA visit, several recommendations highlighted the need to utilize community outreach approaches to reach at risk groups and girls in Ethiopia. The needs of most-at-risk populations are heterogeneous, and therefore the USG will seek to engage more partners in order to support diverse approaches to meeting needs of these high-risk, yet diverse populations. While the geographic focus of most prevention programs should remain on urban hubs and transport corridors, USG partners will also be supported to work with peri-urban and rural bridging populations. These partners will prioritize interventions that address urban/rural transmission dynamics such as marketplaces, and targeted prevention to mobile/migrant workers and their families.

Girls in Ethiopia have been hard to reach with prevention programs due to cultural norms (leaving school earlier than boys due to family responsibility, marriage and working in the home while not at school). Specific programs need to be designed, both for in-school and out-of-school girls which are female only and supported by the family and community.

Priority program areas include: (1) Addressing coercive sex and gender-based violence and rape against women, building referral networks to address OP services in urban areas and PEP delivery.; (2) Correct consistent condom use among commercial sex workers, their partners and clients; and (3) Addressing social norms on cross generational, transactional and coercive sexual relationship behaviors focused on males 25- 40.

Materials used will be predominantly pre-existing unless significant gaps are identified. Such gaps can be addressed with existing large prevention partners (i.e. development and production) or addressed through the larger International Annual Program Statement discussed below.

To alleviate confusion, this APS differs from the proposed Interagency Annual Program Statement in the following ways: (1) Awards range between 100,000 - 200,000 for up to two years; (2) Includes a continuation of programmatic activities of FY06 Prevention APS awards; (3) Recipients will partner with existing USG outreach partners co-located in priority geographic areas to leverage their technical knowledge of HIV prevention and program implementation; (4) Specifically targeted to support indigenous organizations graduate from "sub-partner" to prime partner; (5) APS mechanism targeted to indigenous partners with capacity, providing a rapid and flexible mechanism to build capacity; (6) Technical evaluation of concept papers will be within the in-country Prevention Working Group, an interagency unit; and (7) Utilizes the strength of an in-country Contracting and Agreement Officer.

The Interagency Annual Program Statement is an opportunity for international and local non-governmental organizations to apply for PEPFAR funding. Awards are anticipated to be of larger value, for a minimum of three years and to support major program thrusts in AB and OP. This differs with the smaller Prevention APS in scale of activities, the anticipated types of partners, the complex interagency division of labor and speed of awarding funds.

Added July 2007 Reprogramming: This activity receives HVAB, HVOP and OVC funds in FY07. Building on the OGAC guidance on abstinence, be faithful and condom use (ABC), PEPFAR Ethiopia is soliciting innovative ideas for reaching most at risk populations using evidence-based approaches. This activity will provide comprehensive HIV prevention programming support to local organizations in selected areas to address at risk youth, specifically older adolescents, at risk of participating in transactional sex. Furthermore, several small grants will be provided to local organizations to support ABC activities.

Based on a USG HIV Prevention/Sexual Transmission TA visit, several recommendations highlighted the need to utilize community outreach approaches to reach at risk groups and girls in Ethiopia. The needs of most-at-risk populations are heterogeneous, and therefore the USG will seek to engage more partners in order to support diverse approaches to meeting needs of these high-risk, yet diverse populations.

While the geographic focus of most prevention programs should remain on urban hubs and transport corridors, USG partners will also be supported to work with peri-urban and rural bridging populations.

These partners will prioritize interventions that address urban/rural transmission dynamics such as marketplaces, and targeted prevention to mobile/migrant workers and their families.

Girls in Ethiopia have been hard to reach with prevention programs due to cultural norms (leaving school earlier than boys due to family responsibility, marriage and working in the home while not at school). Specific programs need to be designed, both for in-school and out-of-school girls which are female only and supported by the family and community. Priority program areas include: (1) Addressing coercive sex and gender-based violence and rape against women, building referral networks to address OP services in urban areas and PEP delivery; (2) Correct consistent condom use among commercial sex workers, their partners and clients; and (3) Addressing social norms on cross generational, transactional and coercive sexual relationship behaviors focused on males 25- 40. Materials used will be predominantly pre-existing unless significant gaps are identified.

Targeted evaluation to assess the IMAI training package

This activity is linked to: Care and Support Contract Palliative Care (5616); Care and Support Contract TB/HIV (5749), PMTCT/Health Centers and Communities (5586) and ART Service Expansion at Health Center Level, WFP- Food and Nutrition support and Promotion Positive Living and Self-Reliance (5774); HRCI (5600), JHU (5618), ITECH (5767), UCSD (5770), CU (5772) palliative care activities and IMAI integrated services training.

Ethiopia adapted the WHO/IMAI models and those utilized by the MOH and PEPFAR Ethiopia partners which operate to train clinical care teams at health centers.

Under this activity, PEPFAR Ethiopia will conduct a targeted evaluation to assess the effect of IMAI training on service quality at various levels in the health network. Existing and potential challenges in the implementation of IMAI will also be closely examined. The evaluation will assess IMAI methodology, training content and quality, at all levels of care. It will also look at how the WHO/IMAI model supports the nurse centered and newly- decentralized treatment centers.

The result of this assessment will inform PEPFAR Ethiopia of the value of IMAI training in HIV/AIDS care activities. It will also shed light on any necessary modifications or improvements in the training package to improve the quality of service provision for PLWHA.

Both quantitative and qualitative assessment methods will be employed. The qualitative techniques include exit interviews to assess client satisfaction, and use "mystery" clients' observations to evaluate the performance of health practitioners in accordance with the IMAI standards. Through key informant interviews the opinions and observations of key stakeholders will be gathered on IMAI implementation. The findings will help PEPFAR Ethiopia to make necessary improvements in the implementation of IMAI for HIV clinical care at health center and hospital levels.

Table 3.3.06:

PLUS UP: As of April 2007, approximately 130,000 HIV/AIDS care beneficiaries, including 60,000 ART clients, require broadened care and support activities to stabilize their household livelihoods to support their adherence to preventive care and treatment services. Observations during recent site visits (including that of the Core Team) indicate that broad expansion of the ART program has altered the characteristics and needs of beneficiaries receiving community-based care from palliative care to long-term chronic care and livelihood stabilization. Late presentation into the HIV/AIDS care and treatment program exacerbate individuals' poverty status as they shed personal or household assets and migrate to new towns because of ART service availability or stigma and discrimination. Expansion of income generation activities for those in care and treatment is necessary to provide a continuum of care that graduates individuals to basic clinical management without other major support services as they become productive and healthy. Each beneficiary will receive time-limited support to establish income generating activities parallel with ongoing care and treatment services. Upon graduation the majority of beneficiaries will have a small sustainable income to support themselves. PEPFAR Ethiopia proposes to contribute GHAI funds into a pre-existing mechanism funded through USAID/Ethiopia's Office of Business, Environment, Agriculture and Trade (BEAT) to expand income generation activities, specifically smallholder dairy production for HIV/AIDS care and treatment beneficiaries. PEPFAR Ethiopia will benefit from and leverage $5,000,000 of DA funding and technical expertise from the ongoing BEAT dairy development project to implement revenue generating activities for urban/peri-urban beneficiaries currently enrolled in the HIV/AIDS care and treatment program. The current BEAT agreement has provided some wraparound but is not able to expand significantly to meet requirements of PEPFAR's care program without additional funding. Furthermore, the partner will provide technical leadership for other PEPFAR partners working on community-based care on agricultural income generation activities. "PEPFAR funding would leverage investments by BEAT within an existing mechanism to introduce or strengthen smallholder dairy production to urban/peri-urban persons currently enrolled in the HIV/AIDS care and treatment program in ART health networks.

Beneficiary selection will utilize existing community-based care structures within local government/Idirs and local non-governmental organizations. The program anticipates establishing smallholder dairy businesses, including dairy production (majority), fodder production, small scale processing, and milk marketing for 10,000 persons enrolled in care and treatment services. Current and additional technical staff would provide technical assistance for all aspects of the dairy operations, mentioned above, including micro-credit, for this target group." Land O'Lakes, an international NGO, is currently implementing a market-driven, private sector led dairy program in Ethiopia focused on increasing productivity of smallholder dairy farmers (1-5 cows) to generate income in urban/peri-urban areas which overlap with several ART health networks containing thousands of ART beneficiaries. Such areas include but are not limited to Gonder, Bahir Dar, Debra Markos and Addis Ababa "milksheds". The program offers technical assistance in all areas necessary for successful smallholder dairy production and marketing: animal nutrition and fodder production, breeding and artificial insemination, animal housing, cooperative strengthening, health and hygiene, veterinarian care, milk marketing, small scale value-added production, business management. "The program has significantly raised milk production and incomes of smallholder farmers. A smallholder dairy farmer with three improved cows, for example, can earn approximately $6-$15 per day from milk sales. The market for raw milk is strong because demand is higher than available supply. Since August 2005, the program has provided training and technical assistance to 25,627 beneficiaries.

Urban and peri-urban areas are within easy distance of milk collection and sales points. Peri-urban smallholders have the added advantage of land area for growing fodder. The high price of dairy livestock fodder is a constraint for urban smallholders without land for raising their own fodder. "

Targets

Target Target Value Not Applicable Total number of service outlets providing HIV-related palliative care  (excluding TB/HIV) Total number of individuals provided with HIV-related palliative care 10,000
(excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative  care (excluding TB/HIV)

Target Populations: People living with HIV/AIDS

Coverage Areas Adis Abeba (Addis Ababa)

Amhara

Oromiya

Table 3.3.06:

Plus ups: As of April 2007, approximately 130,000 HIV/AIDS care beneficiaries, including 60,000 ART clients, require broadened care and support activities to stabilize their household livelihoods to support their adherence to preventive care and treatment services. Observations during recent site visits (including that of the Core Team) indicate that broad expansion of the ART program has altered the characteristics and needs of beneficiaries receiving community-based care from palliative care to long-term chronic care and livelihood stabilization. Late presentation into the HIV/AIDS care and treatment program exacerbate individuals' poverty status as they shed personal or household assets and migrate to new towns because of ART service availability or stigma and discrimination. Expansion of income generation activities for those in care and treatment is necessary to provide a continuum of care that graduates individuals to basic clinical management without other major support services as they become productive and healthy. Each beneficiary will receive time-limited support to establish income generating activities parallel with ongoing care and treatment services. Upon graduation the majority of beneficiaries will have a small sustainable income to support themselves. "PEPFAR Ethiopia proposes to contribute GHAI funds into a mechanism funded through USAID/Ethiopia's Office of Business, Environment, Agriculture and Trade (BEAT) to expand income generation activities specifically handicraft production and marketing for HIV/AIDS care and treatment beneficiaries. PEPFAR Ethiopia is expected to leverage $1,000,000 of DA and other partner funding as well as technical expertise from the BEAT Office to implement revenue generating activities for urban/peri-urban beneficiaries currently enrolled in the HIV/AIDS care and treatment program.

PEPFAR funding leverages investments by BEAT within a mechanism to introduce or strengthen handicraft production to urban/peri-urban persons currently enrolled in the HIV/AIDS care and treatment program in selected ART health networks. "

An international NGO (TBD) with specific expertise and experience in handicraft development and marketing will maintain a successful Market Link program to support entrepreneurial skills, product design, production, business skills and market development. BEAT's activity will focus on 1) development of market linkages for export to developed markets 2) providing technical trainings in product design and production and 3) organizing micro-producers to maximize economic efficiency. PEPFAR funds will cover the cost of HIV/AIDS care and treatment beneficiary inclusion for a time limited period in the program. Upon graduation beneficiaries will have a small sustainable income to support their adherence to care and treatment and to maintain a healthy, productive lifestyle to serve as a role model for their communities. Beneficiary selection will utilize existing community-based care structures within local government/Idirs and local non-governmental organizations. Selected handicrafts such as leather products, weaving, basketry and ceramics will help beneficiaries in care and treatment receive a sustainable income. The activity will enable chronically poor beneficiaries to become micro producers; approximately 3,000 beneficiaries enrolled in HIV/AIDS care and treatment services will benefit.

Targets

Target Target Value Not Applicable Total number of service outlets providing HIV-related palliative care  (excluding TB/HIV) Total number of individuals provided with HIV-related palliative care 3,000
(excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative  care (excluding TB/HIV)

Target Populations: People living with HIV/AIDS

Coverage Areas: National

Table 3.3.07: Program Planning Overview Program Area: Palliative Care: TB/HIV Budget Code: HVTB Program Area Code: 07 Total Planned Funding for Program Area: $ 7,965,000.00

Program Area Context:

According to the WHO Global TB Control Report issued in 2006, Ethiopia ranked 8th out of the top 22 High TB Burden Countries in terms of total number of TB cases notified in 2004, which was 123,127. The estimated incidence of all forms of TB and PTB+ was 353 and 154/100,000, respectively. The case detection rate of PTB+ cases was 36%, nearly half the global target of 70%. Cure rate for PTB+ cases on DOTS was 54% in 2004, falling short of the global target by 31%.

Information on the association between HIV and TB in Ethiopia is very limited. Various studies have been conducted showing a high level of TB/HIV co-infection rates. Recent findings conducted in Addis Ababa in 2000 showed a 45% HIV infection rate among new smear-positive TB patients. Additionally, data compiled from hospitals and health centers implementing TB/HIV collaborative activities show that the HIV infection rate among TB patients is in the range of 40% - 70%. Due to the limitation in the reporting system there is no proper information on the number of TB patients captured from ART clinics.

The TB/HIV activities at site level include 1) screening all HIV+ persons coming to different clinics (ART,PMTCT, STI, etc.) for tuberculosis, 2) provision of TB treatment for those diagnosed with tuberculosis, 3) Isoniazid Preventive Therapy (IPT) for those free from active TB, 4) screening all TB patients at the TB clinic for HIV with provider initiated counseling and testing (PIHCT), 5) provision of Cotrimoxazole Prophylactic Treatment (CPT) for TB/HIV patients, 6) establishing referral linkages to different service areas , and 6) monitoring and evaluation .

PEPFAR Ethiopia continues to collaborate with other donors. The WHO TB/HIV Project centrally-funded by PEPFAR Ethiopia is to be implemented in COP06 and COP07 in 48 hospitals and 84 health centers in six regions. This project works in TB clinics and its targets are: 1) providing CT services to 20,000 TB patients, 2) providing CPT for HIV+ TB patients and 3) providing ART for 5,000 eligible HIV+ TB patients. The coordination between US Universities, the Care and Support Contract (previously referred to as BERHAN) and WHO will be further strengthened in COP07. TB activities in Ethiopia are also supported by a Round 1 Global Fund grant. Key activities include procurement of anti-TB drugs, INH for preventive therapy, laboratory reagents and equipment, training, community-based DOTS and expansion of TB control to include the private sector. Other donors for TB and TB/HIV prevention and control in Ethiopia include UNAIDS, WHO (through regular funding), German Leprosy and TB Relief Agency (GLRA), Italian Cooperation, and the Royal Netherlands Embassy.

In COP06, the major activities conducted in TB/HIV at hospitals and health centers include: 1. Site assessments by USG Universities and FHI throughout the country; 2. Delivery of TB and TB/HIV guidelines, SOPs and resource materials to sites; 3. Development of a minimum package for implementation of TB/HIV activities; 4. Development of a checklist for TB/HIV activities at sites based upon minimum standards; 5. Strengthening TB screening and diagnosis in HIV patients; 6. Participation in national meetings dealing with technical issues like revising the Acid Fast Bacilli (AFB) microscopy manual, including improving the quality control/quality assurance system for AFB, and strengthening the laboratory network system; 7. Increase HIV testing and provider initiated counseling and testing services (PIHCT) in TB clinics; 8. Provision of CPT to all TB/HIV patients; establishing TB/HIV Demonstration Centers in strategically located sites; training of staff in collaboration with TB/Leprosy Control staff at federal and regional levels; situational analysis of pediatric TB/HIV in Ethiopia; 9. Targeted evaluation on pertinent TB/HIV related policy and technical issues; 10. Strategies devised whereby TB as a major OI serves as entry point to broader palliative care and preventive care package services; 11. Establishment of TB/HIV committees as a first critical step in initiating TB/HIV collaborative activities in 126 health centers;

12. Introduction of PIHCT and referral from DOTS clinics for HIV screening in the same health center and for ART related services to hospital at health centers where TB/HIV collaborative activities are officially implemented; and 13. Introduction of TB/HIV recording and reporting formats in all 126 health centers

At work places, 55 companies currently provide TB/HIV services, of which 20 are provided with consumables for AFB smear microcopy, anti-TB drugs, TB/HIV formats and registers from MOH through the PEPFAR Ethiopia funded Private Sector Partnership (PSP) Program. PSP is the lead agency working with MOH and other relevant partners in developing PPM-DOTS Implementation Guidelines and initiating PPM-DOTS services in private clinics in two regions. During COP 07, PSP will expand PPM-DOTS to 50 private higher clinics in urban areas to complement CT services.

The challenges in implementing TB/HIV collaborative activities in Ethiopia include, among others, insufficient coordination, poor implementation of TB/HIV guidelines largely as a result of human resource constraints and high turnover of trained and skilled staff, stigma and fear of disclosure, resistance to screening, lack of appropriate advocacy and communication materials, poorly organized monitoring and evaluation system, and improper recording and reporting system at some sites.

The Ethiopian Strategic Plan for intensifying multi-sectoral HIV/AIDS response issued by MOH/HAPCO in December 2004, clearly states that the prevention and management of OI, including TB is one of the major strategies to improve the quality of life of PLWHA. The third edition of the TB/Leprosy Control Guidelines issued in 2005, contains a chapter on the clinical and programmatic aspects of TB/HIV. The MOH has also issued the first edition of the TB/HIV Implementation Guidelines in 2005. USG agencies and implementing partners were actively involved in the development of these documents. PEPFAR Ethiopia is fully represented in the National TB/HIV Advisory Committee and Private-for-Profit (PPM) DOTS Technical Working Group.

PEPFAR Ethiopia was concerned about reaching the TB/HIV targets during FY06 as there were delays in having the national TB guideline finalized and disseminated as well as delays in the implementation of provider initiated counseling and testing. In FY07, intensive monitoring will be conducted to ensure that each partner is reaching its targets by the end of the reporting period.

During COP07, TB/HIV collaborative activities will be further consolidated in the hospitals and health centers delivering the service. There will be a scale up to include all the ART hospitals (131) and 500 health centers. PIHCT will be strengthened at all levels. Hospital level TB/HIV work will be coordinated with the health center level using the health network model. This will be supported by the four US Universities and USAID local partners. Resources will be leveraged with other initiatives, including the TB/HIV initiative, WHO TB/HIV support provided by PEPFAR. A total of 83,906 registered TB patients will be tested for HIV.

Program Area Target: Number of service outlets providing treatment for tuberculosis (TB) to 673 HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients attending HIV care/treatment services that are 66,807 receiving treatment for TB disease Number of HIV-infected clients given TB preventive therapy 13,685 Number of individuals trained to provide treatment for TB to HIV-infected 3,472 individuals (diagnosed or presumed)

Table 3.3.07:

Skill sets needed for short and long-term: Based on USAID Ethiopia's experience in the first three years of the PEPFAR Initiative, recommended skill sets for short-term success include: program management, budget, finance, acquisition and contracting management, with capacity for rapid implementation of procurement and programs; project formulation informed by evidence-based best practices; strategic planning based on participatory qualitative and quantitative assessments; effective government and donor relations; large-scale capacity building and training; supply chain management; community/stakeholder involvement, including faith-based institutions; expertise in social/behavioral interventions; private sector engagement; and community level health service expansion in multiple sectors. Skill sets for long-term success and sustainability include: capacity building with indigenous partners; economic development; results-based project management with ongoing monitoring and evaluation; administrative support for USAID PEPFAR team staff retention and continuity, and development of long-term transition strategies for continued funding, close-out and hand-over of projects.

Current COP06 USAID Staffing: USAID Ethiopia has structured its PEPFAR team to optimize economy, productivity and organizational effectiveness to ensure high quality technical expertise, enhanced communication, decision-making and responsiveness to reach the aims set forth in the PEPFAR Initiative. USAID Ethiopia's PEPFAR staff includes Susan Anthony, USDH HPN Office Chief (Non PEPFAR Funded); Melissa Jones, USDH HIV Team Leader; James Browder, USDH Technical Advisor with prime responsibility for PSCMS; Brad Corner, TCN, Private Sector Advisor; and Catherine Hastings, PSC, Prevention Advisor. In addition, six Health, AIDS, Population and Nutrition (HAPN) FSN Team Members contribute to HIV/AIDS activities by providing technical leadership and serving as Cognizant Technical Officers and Activity Managers. The Program, Contracting and Financial Management Offices provide support for procurement, budgeting and M&E services. A full-time PEPFAR supported USDH Contracting Officer was hired in FY06.

As with other USG agencies in Ethiopia, USAID Ethiopia is not fully staffed. Three of the six FSN position noted in the above paragraph (two ART monitors and one VCT Advisor) are waiting to be filled. As noted earlier, staff expansion is constrained by the "rightsizing" numbers of the NEC. Senior staff has developed viable alternate solutions, including greater utilization of other staff on the health team, co-locating, and possibly outsourcing some services. Staff retention has been excellent.

Proposed Positions: USAID has identified the following additional positions (a total of eight full-time equivalents) to round out skill sets that are needed to achieve success and sustainability: a quality assurance coordinator; five monitors (two for care, one for prevention and two for supply chain management); a HIV nutrition advisor, and a pediatric care and treatment advisor. In addition, USAID anticipates a need for technical assistance (TA) from USAID--East Africa for PMTCT and pediatric care and TA from USAID Washington for OVC services.

Cost of Doing Business

This activity includes USAID's ICASS fee. USAID will not have a CSCS expense in FY 2007.

Table 3.3.15: