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.
Targeted Promotion and Community Mobilization of ANC/MCH and PMTCT/Pediatric Services
This is a continuing activity from FY06 supplemental. As of August 2006, the partner received 100% of FY06 funds and is on track according to the original targets and work plan. This activity leverages $700,000 from USAID/Ethiopia's malaria resources.
This activity is expected to increase ANC attendance and the uptake of PMTCT/pediatric care services in selected ART health networks. This activity aims to reach women of child bearing age. Utilizing the partner's pre-existing communications platform (i.e. low level road shows and household level promotion) with adapted ANC/assisted delivery messaging throughout regional capitals and secondary towns, PEPFAR Ethiopia will promote ANC attendance and assisted delivery to those living in communities where HIV prevalence remains highest, yet where ANC attendance and assisted delivery statistics are low. It is anticipated that 50 percent of Amhara and Oromia's urban population will be covered. If this results in an additional 20 percent of pregnant women attending ANC or assisted delivery within the health network, approximately 24,600 pregnant women would attend ANC services leading to an entry into PMTCT.
The partner's pre-existing communications platform is a low-level platform conducting road shows and low-level communications to households in many areas. Since 2004, the partner has primed knowledge of and market demand for insecticide treated nets (ITNs) utilizing USAID/Ethiopia's malaria resources. In addition, they have participated in several activities with the Ministry of Health and Amhara regional health bureau to improve MCH uptake through targeted subsidy.
Reviewing the recent EDHS, low ANC attendance and assisted delivery remain major impediments to progress on PMTCT targets. Fifty-six percent of urban women delivered in their home and 30 percent of urban women did not receive delivery assistance from a health provider or traditional birthing attendant. The median duration of pregnancy of those who attended ANC was 4.2 months. Eighty-eight percent of urban-based pregnant women expressed several factors impacting their decision to attend ANC or assisted delivery: 1) Concern there may not be a health provider (71 percent) 2) Concern there may be no one to complete household chores (57 percent) 3) Getting money for treatment (53 percent)
The partner has supported market demand creation of insecticide treated nets since 2004. In addition, the partner has facilitated, through a public private partnership, several commercial distributors to import, brand and distribute ITNs to improve accessibility. In addition, the partner has provided extensive support to the Amhara and Oromia Regional Health Bureaus and the Ministry of Health's Health Education Center to improve communication materials on ITN utilization.
The partner launched an umbrella media campaign in 2005 targeting all socio-economic groups through channels appropriate for each. The campaign took a segmented approach, targeting each group with relevant messages. The targeted subsidy program specifically targets pregnant women through interactive communication and road shows to increase ANC attendance.
Through a targeted subsidy program, approximately 20,000 ITNs were distributed to pregnant women attending ANC. In addition, approximately 200,000 ITNs were commercially sold based on intensive branding and marketing activities. This occurred in an environment where the MOH has committed to distribute free ITNs but implementation remains problematic.
The partner's competency in creating market demand and improving supply is well oriented to assist the PEPFAR Ethiopia program to improve community awareness of ANC and assisted delivery.
COP07 Proposed Activities:
The first component includes targeted promotion through targeted social organizations,
women's groups, and community-based organizations with household level activities and interactive community activities including road shows. The proposed targeted promotion activity aims to increase uptake of facility-based maternal health services, which remains a major impediment to PMTCT service uptake. Targeted promotion activities will reach women and families, educate communities and improve understanding of maternal health services with emphasis on ANC and assisted delivery (ANC/PMTCT/pediatric care services including treatment).
Activities will take place throughout Oromia and Amhara within the health network, where the USG has made prior investments to install PMTCT and ART services. This activity currently operates in 55 hospitals, health centers and NGO clinics in Amhara and Oromia. PEPFAR Ethiopia's investment in NetMark represents a leveraging of USAID's child survival/malaria resources. NetMark's activities utilize interactive and interpersonal communications at the grassroots to prime market demand for ANC services. In addition, NetMark, through a targeted voucher subsidy, builds in a tangible incentive to attend ANC: attendees receive a voucher entitling them to a 70 percent subsidy on an insecticide treated nets. This is anticipated to increase flow through of clients at ANC/MCH clinics. To support this component the following strategies will be utilized:
1) Leverage existing messages through a multi-channeled, comprehensive program utilizing mass media road shows, and house hold level communication to mobilize ANC attendance in/around hospitals and health centers in Oromia and Amhara. 2) Mobilize marketing agents in the community, including Woreda Action Committees and Kebele Action Committees, Community Malaria Agents, Community-Based Reproductive Health Agents, Health Promoters and Traditional Birthing Attendants to support demand creation of ANC services with an existing ITN targeted subsidy program within selected ART Health Networks in Oromiya and Amhara region. 3) Emphasize household level and interpersonal communication, dramas, community groups/meetings, community activations, social mobilization and ANC counseling at health centers. This will also include training and educational materials for the various expected audiences.
The second component includes the targeted subsidy of ITNs to ANC attendees. NetMark's pre-existing targeted subsidy activity will be further expanded to include additional malarious sites within the ART health network. Under this system, ANC attendees are provided with a voucher entitling all mothers to a commercial ITN subsidy, supported under non-PEPFAR resources. To operationalize this activity, public facilities and commercial sales outlets require training, distribution of IEC and vouchers to sites, intensive targeted promotion activities as described in the first component.
In coordination with regional authorities, NetMark will participate in outreach campaigns that promote services to target audiences through offsite campaigns. Following the promotion, regional authorities will ensure support to larger numbers of attendees. The partner will collaborate with IntraHealth and US Universities to increase the number of women entering the ANC system.
Technical Assistance on Nutrition Assessment and Counseling
This is a new activity for FY07. It links to ART Service Expansion at Health Center Level; Care and Support Contract Palliative Care (5616); Care and Support Contract TB/HIV (5749), PMTCT/Health Centers and Communities (5586)and, ITECH technical support for ART scale up (5658); JHU Technical Support for ART Scale-up (5664); CU Technical Support for ART Scale-up (5661) and UCSD military ART support (5666) services.
While the need to address food and nutrition support is great across PEPFAR Ethiopia's programs, a most immediate need is to strengthen nutrition assessment, counseling and support within clinical HIV/AIDS services. COP07 activities will strengthen nutrition support for PLWHA, including HIV+ pregnant and lactating women in PMTCT programs and OVC. In particular, these activities will strengthen the integration of nutrition assessment, counseling and support within clinical care and treatment services (hospital and health center levels), while linking patients to food security and livelihood assistance at the community level. The Academy of Educational Development Food and Nutrition Technical Assistance Project (FANTA) has assisted many countries in Sub-Sahara Africa to formulate policies and technical guidance for HIV/AIDS and nutrition, develop appropriate training curricula and job aids for nutrition support, and establish programs to address directly the nutritional needs of those most vulnerable.
Drawing heavily on this experience and using/adapting materials from other countries, FANTA will provide support to PEPFAR Ethiopia to (1) strengthen and finalize the National Guidelines on HIV/AIDS and Nutrition with local stakeholders; (2) assist in developing plans and participate in a visit by representatives of PEPFAR Ethiopia, MOH/HAPCO, and implementing partners to Nairobi to observe the PEPFAR Kenya-supported Food-by-Prescription (FBP) Program at hospitals and other ART sites and the InstaProducts Ltd. supplementary food production site; (3) provide technical input to PEPFAR Ethiopia for development of specifications for local procurement of appropriate therapeutic and supplementary food(s) for clinically malnourished PLWHA patients, pregnant/lactating women in PMTCT programs, and infants of HIV+ women from early weaning (~6 mo) to 2 years of age; (4) provide technical assistance to PEPFAR Ethiopia partners to support systems for food distribution to clinic sites, inventory control, provision to patients, and record keeping based on the experiences of other programs in the region; (5) work with the university partners responsible for hospital sites, IntraHealth, and CSC responsible for health center sites to establish training and QA approaches to integrate and strengthen nutrition assessment and counseling within all PEPFAR ETHIOPIA-supported sites (including PMTCT); (6) assist the same partners to establish guidelines and protocols for the introduction of food assistance for clinically malnourished PLWHA, PMTCT women and OVC in 20 hospitals and 25 health centers; (7) provide technical assistance to PEPFAR Ethiopia and partners about provision of appropriate daily multi-micronutrient supplements for adult PLWHA, PMTCT pregnant/lactating women and OVC whose diets are inadequate to meet basic vitamin/mineral requirements; and (8) work with SI advisors to develop plans for monitoring and public health evaluation of the nutrition support activities.
Finally, FANTA will share current scientific knowledge and program experience from other countries with PEPFAR Ethiopia and its implementing partners, particularly with regard to linking clinical nutrition support with food security and livelihood assistance, including wraparounds with food aid and MCH/nutrition programming, to address the longer-term food and nutrition needs of PLWHA and their families.
