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.
plus ups: "Expansion of TB/HIV collaborative services in Ethiopia has occurred in a phased and collaborative manner as follows: 1)establishment of the national TB/HIV advisory committee in late 2001; 2) sensitization/education of policy makers regarding the importance of TB/HIV collaborative services ; 3) initiation of services in nine pilot sites (five hospitals and four health centers); 4) development of TB/HIV implementation guidelines 5) revision of data collection tools; 6) training of health workers; and 7) phased expansion of TB/HIV activities to 340 health facilities nationwide.
In FY07, TB/HIV collaborative activities will be further scaled-up in 131 hospitals and 500 health centers. Provider-initiated HIV counseling and testing (PIHCT) will be strengthened at all levels. Hospital level TB/HIV work will be coordinated with health centers using the health network model.The greatest challenge to implementing TB/HIV collaborative activities successfully in Ethiopia is the human resource constraint and high turnover of trained and skilled staff. " "Activities proposed to address the human resource constraints include strengthening human resources at all levels of the health system, including the Federal Ministry of Health, HAPCO and Regional Health Bureaus. These will include hiring and seconding qualified staff and training more staff. Critical review of TB/HIV activities by experts from international and national organizations is an important component of this activity; and could be led by the World Health Organization. The TB Program in Ethiopia has not yet begun to manage MDR-TB cases. Confirmed MDR TB cases in Ethiopia are often getting second line anti-TB drugs without proof of clinical efficacy through informal channels. If the drugs continue to be unavailable in the control program, the practice of using improper combinations of second line drugs for less than the standard duration through untrained health personnel could potentially lead to the development and spread of extensively drug resistant TB (XDR-TB), which in HIV+ patients has been associated with a 90%+ fatality rate.
" "There exist some initiatives to introduce MDR-TB treatment in Ethiopia through the recently approved Global Fund Round Six grant for TB control. PEPFAR can financially and technically assist the country by leveraging technical expertise and resources to develop scientifically sound proposals in line with international and national TB/HIV guidelines to the Green Light Committee (GLC), train clinical and laboratory staff on management of MDR tuberculosis and diagnosis of MDR and XDR TB, respectively. WHO will facilitate these activities by working closely with HAPCO/MoH. 3) The country urgently needs TB infection control guidelines and implementation plan. The World Health Organization will take the lead in assisting the MOH in development of the infection control guidelines and the implementation plan, in collaboration with relevant stakeholders and partners. . "
Targets
Target Target Value Not Applicable Number of TB patients who are tested for HIV among the registered TB patients Number of service outlets providing treatment for tuberculosis (TB) to HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients given TB preventive therapy Number of HIV-infected clients attending HIV care/treatment services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to 200 HIV-infected individuals (diagnosed or presumed)
Table 3.3.07:
None provided.
Integrated Service Strengthening
This is a continuing activity from FY 2006. To date, the partner has received 100% of FY06 funds and is on track according to the original targets and workplan. WHO has been conducting Integrated Management of Adult and Adolescent Illness (IMAI) based training with Family Health International (FHI) training 402 health professionals from 11 regions. This activity is linked to Prevention, Care and Support, ARV Drugs, ART and Laboratory Services.
Current ART programs in Ethiopia are focused at the hospital level. These programs do not reach patients in rural areas, and existing services are facing problems due to large patient loads and staffing shortages. For this reason, at present Ethiopia is rapidly decentralizing ART services to health center level. This approach will help resolve some of the problems at hospital level, and is expected to enable the country to reach its ambitious treatment target.
To support this scale-up, PEPFAR Ethiopia, through its FY06 supplemental support to FHI and other partners, conducted an assessment of 120 health centers in 10 of the 11 regions. The assessment showed a critical shortage of physicians and health officers at health centers. Highly capable nurses are present in relatively larger numbers, though more personnel of all types are needed. In response to this situation, the MOH is supporting the initiation of nurse-centered HIV/AIDS services, featuring task-shifting, particularly in the area of ART services. PEPFAR Ethiopia has initiated a dialogue with relevant stakeholders, including the MOH HIV/AIDS Prevention and Control Office (MOH/HAPCO), the Regional HAPCO offices at Regional Health Bureaus (RHB/RHAPCO), and the World Health Organization (WHO), on how best to expand ART to the health center level without compromising the quality of services.
This activity will provide technical assistance for health center and community-based delivery of HIV prevention, care and treatment services, with special emphasis on IMAI training for clinical care teams; adaptation, standardization and dissemination of training materials; and facilitation of clinical care mentoring support for selected health centers on ART and chronic HIV/AIDS care.
Activities will include: adaptation of IMAI training materials to address the nurse-centered approach for HIV/AIDS care and treatment; incorporation of updated ART guidelines for adults, adolescents and children; pediatric ART initiation at health center level; ARV prophylaxis and ART for medically-eligible pregnant women; integration of the preventive care package within IMAI modules; adaptation and Amharic translation of IMAI materials for training of health extension workers, community volunteers and outreach workers. WHO will support the printing and dissemination of these materials in partnership with the Government of Ethiopia), the MOH and other relevant PEPFAR partners.
WHO will also take a lead role in the development of a standard national operational plan for clinical mentoring; and the placement of regional coordinators at regional referral hospitals to build regional capacity to facilitate clinical mentoring and train clinical mentors. WHO will closely work with the MOH, RHB and relevant PEPFAR partners to create a pool of mentors. Potential mentors will be selected from experienced practicing HIV/ART clinicians (doctors, health officers and nurse-practitioners). Priority will be given to proficient clinicians who are already treating HIV patients. To fill the gap in the availability of clinical mentors during the initial phase of accelerated ART decentralization, WHO will work with other partners to mobilize experienced external mentors who can be available in country for at least six months.
Each potential mentor will undergo a seven-day course that includes methods for effective mentorship, adult participatory education skills and participatory case review methods. In addition, mentors are expected to participate in the two-week basic IMAI clinical course in order to be familiar with the clinical and operational protocols used at health center level. Mentors will also be trained to use the standardized patient monitoring system (ART follow-up form, ART and pre-ART registers) to find and review instructive cases, and in utilization of simple indicators which can easily be calculated by the clinic staff or a clinical mentor during an on-site visit in order to identify, change and improve inefficient or ineffective clinical practices. A total of 240 heath centers providing ART services and 500
health centers implementing enhanced palliative care services will benefit from this support.
WHO will help ensure that Ethiopia continues to benefit from innovative technical approaches supporting the ART service scale-up. The integrated management approach to health system strengthening through the scale-up of HIV prevention, care and treatment using IMAI will also improve case management of malaria, co-management of HIV and tuberculosis, improved management of childhood illness, through Integrated Management of Childhood Illness (IMCI-HIV training, and improved maternal health services through the expansion of an integrated approach to Prevention of Mother-to-Child Transmission of HIV (PMTCT) with Intrahealth International.
WHO will work with other key USAID/Ethiopia partners, notably FHI and later the Care and Support Contract (previously referred to as BERHAN Care and Support Project), at the health center level to increase the supportive supervisory capacity of zonal and woreda management teams. During FY06, HIV coordinators in 290 districts will be trained for one week in HIV program management.
Furthermore, WHO will partner with other PEPFAR partners at health centers to provide the necessary technical and logistic support for woredas to conduct supervisory site visits immediately after IMAI training, continuing monthly for 3-6 months, and then shifting to quarterly. WHO will work with the MOH, regions, zones and woredas in the adaptation, integration and utilization of IMAI tools for district HIV coordination, including standardized case management observation and exit interviews.
Analysis and routine quality assurance for health center and community work: In order to ensure quality of services, the following activities will be instituted: analysis of the routine use of IMAI acute care guideline module; identification, follow-up and management of HIV exposed and infected children through use of IMCI-HIV approach; opportunistic infection (OI) prevention and management for persons with HIV (including routine screening for tuberculosis (TB); and integration of HIV prevention in care and treatment services. The IMAI tools for district HIV coordination include standardized case management observation and exit interviews that will be included as part of the routine reports submitted by district HIV coordinators to regional and national offices. Quantification of these data in a subset of districts will be done as part of the analysis of quality of care during scale-up of integrated HIV services.
Clinical, zonal and woreda management training and management support after training: District coordinators will be supported to fulfill their role to aggregate data from several facilities and to supervise health workers in the use of this system. This will be done through regular site visits, during which review of recording and reporting forms will take place. Clinical mentors will also support the patient monitoring system, although this is not their primary activity.
Support to the Global Fund Country Coordinating Mechanism
The Government of Ethiopia has secured $645.16 million from the Global Fund for five years through four grants. In order to oversee, facilitate, support and monitor these funds a Country Coordinating Mechanism (CCM) was established in early 2002.
The 17 CCM members include: MOH (4) including Chair; HIV/AIDS Prevention and Control Office (HAPCO) (1); Ethiopian Health and Nutrition Research Institute (EHNRI) (1); WHO (1); Joint United Nation Program on HIV/AIDS (UNAIDS) (1); Health, Population and Nutrition (HPN) Donors' Group (2); PEPFAR Ethiopia (1); DfID (1); Christian Relief and Development Association (CRDA) (1); Vice Chair Dawn of Hope (Association of PLWHA) (1); Ethiopian Chamber of Commerce (ECC) (1); Ethiopian Public Health Association (EPHA) (1); and the Ethiopia Inter-Faith Forum for Development Dialog for Action (1).
PEPFAR Ethiopia has made major contributions towards implementation of the Global Fund. Active membership on the CCM since its inception, technical assistance for proposal development, support of the Secretariat since November 2003, and chairing the sub-committee tasked to prepare the mechanism's Terms of Reference (TOR) are several examples of the depth and scope of PEPFAR's involvement.
During COP05 and COP06, USD 50,000 was provided to support the CCM Secretariat. This funding was supplemented from UNAIDS and the Royal Netherlands Embassy, and managed through the WHO Ethiopia Country Office.
The performance of the four Global Fund grants is of concern within the donor community. Recognizing the Global Fund's operating principle of performance, the CCM's TOR state that it is to submit high-quality proposals and provide oversight of the proper use of the Global Fund through regular monitoring. The TOR explicitly states: ". . . the CCM/E will provide a monitoring report on fund status, including its progress, results and organizations with approved funding and their expected total level of funding."
The report will be made available through a wide variety of communication channels.
