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.
The YMCA AIDS Volunteerism and Community Engagement (ADVANCE) Program will develop, strengthen and scale-up successful YMCA youth program practices in order to improve the HIV/AIDS knowledge and practices of 50,000 youth and young adults.The ADVANCE Program has two prevention objectives: 1. Improve HIV prevention knowledge and practices of at least 50,000 youth and young adults between the ages of 10-29 in the five target communities through innovative, ageappropriate peer education and community outreach activities by 2010 and, 2. Strengthen cooperation between youth, parents, YMCAs, schools, businesses, government and faith-based groups in the five target communities to improve HIV education and increase youth and young adult access to vital medical and counseling support services by 2010. These activities will take place in 5 underserved urban communities in Addis Ababa and Adama. For the first year of the three year program, YMCA will aim to reach 10,000 youth with AB messages.
In the HIV Prevention program component the YMCA and YWCA will recruit and train 100 volunteer peer educators per branch (500 in total). The peer educators will be segmented into two age groups A) 10-16 and B) 17-29. Their primary function will be to educate other community youth and young adults on basic HIV prevention and care. The peer educators will utilize innovative, youth-friendly service delivery methodologies to attract and educate large numbers of youth and young adults. These include school presentations, sports, recreation, arts, music, anti-stigma campaigns and local mass-media coverage of HIV issues.
The YMCA's approach to health education strongly emphasizes building core values, life skills, gender sensitivity, appreciation for diversity and access to accurate information and advice so that youth and young adults are equipped to make the right decisions. To ensure that peer educators are successful the YMCA will also incorporate a strategy that simultaneously strengthens parent and adult education, community alliances and medical referral services. The YMCA will set up a voucher system with reputable hospitals and clinics to help youth and young adults obtain appropriate, affordable medical testing, counseling and treatment. YMCA will focus abstinence-only messages for 50% of their target populations, for a total number of 25,000 youth between the ages of 10-16 by 2010.
Targets
Target Target Value Not Applicable Number of indigenous organization provided with technical assistance for HIV related policies; Number of individual training in HIV related policies ( this is a sub set of the total number trained); Number of individuals reached through community outreach that 10,000 promotes HIV/AIDS prevention through abstinence (a subset of total reached with AB) Number of individuals reached through community outreach that promotes HIV/AIDS prevention through abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention 500 programs through abstinence and/or being faithful
Table 3.3.03: Program Planning Overview Program Area: Medical Transmission/Blood Safety Budget Code: HMBL Program Area Code: 03 Total Planned Funding for Program Area: $ 3,150,000.00
Program Area Context:
PEPFAR/Ethiopia's past investments in Blood Safety resulted in improvements in the capacity of the uniformed services to have safe blood banks and blood transfusion centers at Bella Defense Hospital and outlying areas. Civilian blood services through the Ministry of Health and Ethiopian Red Cross continue to be strengthened through infrastructure, human resource and functions with technical assistance from the World Health Organization.
According to AIDS in Ethiopia 6th Edition, of 28,000 in eight regions, overall prevalence was 5 percent (4.5 percent among males, 6.7 percent among females). The prevalence for those aged 15 - 19 years was 3 percent. The highest prevalence was registered for donors aged 30 - 39 years. The prevalence rate among donors in Addis Ababa, constituting approximately 63 percent of all donors, was 4 percent. HIV prevalence among blood donors in Addis Ababa for 2005 is less than that in 2003 (6.4 percent).
In FY07, PEPFAR/Ethiopia proposes to capitalize on the progress of the Ethiopian uniformed services, with assistance from the U.S. Department of Defense, to renovate, equip and train staff at four additional blood transfusion centers. Several health providers from the uniformed services will be trained in and out of the country and these trainings will be twinned with the trainings that will be provided by the Ethiopian Red Cross Society for civilian system. PEPFAR/Ethiopia has identified the need for collaboration of civilian and military blood safety programs during planning, implementation & evaluation of activities.
During COP05 and COP06, PEPFAR/Ethiopia supported the Ministry of Health under Track One awards to strengthen blood transfusion services in the country. This program continues to be supported primarily through Track One awards to the MOH and to the WHO. The program is currently supporting 9 existing blood banks through personnel, training, equipments, supplies and logistics. Moreover, it is renovating 16 blood banks. Since this project is implemented though ERCS, it will in the end contribute significantly in developing infrastructure, human capacity and quality systems at ERCS that is critical for sustainability of the program.
The Ministry of Health of the Federal Democratic Republic of Ethiopia is the responsible body for national blood transfusion service in Ethiopia with regulatory, coordination and oversight roles. The Ethiopian Red Cross Society (ERCS) is the main implementer of blood banking services in the country. ERCS is officially delegated to run the operation of blood transfusion service in the country with the responsibilities of undertaking all functions of blood banking including renovations, procurement, personnel recruitment, training and logistics. Currently, much of the blood transfusion services rely on family and replacement donors; hence the need to promote voluntary blood donations to ensure the safety of blood and blood products. Testing for all transfusion transmission infections is not universal except for HIV testing, which uses rapid testing algorithms. Testing for syphilis, hepatitis B and hepatitis C is not universal. Through government efforts and support from PEPFAR, concerted efforts are being made to deliver safe and adequate blood and blood products to cater for the needs of the Ethiopian population.
Other donors such as GFATM Round 4 have awarded funding to support the ongoing efforts to improve the national blood safety and universal precautions program, and ERCS is also providing significant input through resources it mobilizes itself. The World Health Organization, through Track One funding, is providing technical assistance for safe blood transfusion service in Ethiopia.
Program Area Target: Number of service outlets carrying out blood safety activities 45 Number of individuals trained in blood safety 415
Table 3.3.03:
The YMCA AIDS Volunteerism and Community Engagement (ADVANCE) Program will develop, strengthen and scale-up successful YMCA youth program practices in order to improve the HIV/AIDS knowledge and practices of 50,000 youth and young adults.The ADVANCE Program has two prevention objectives: 1. Improve HIV prevention knowledge and practices of at least 50,000 youth and young adults between the ages of 10-29 in the five target communities through innovative, ageappropriate peer education and community outreach activities by 2010 and, 2. Strengthen cooperation between youth, parents, YMCAs, schools, businesses, government and faith-based groups in the five target communities to improve HIV education and increase youth and young adult access to vital medical and counseling support services by 2010. These activities will take place in 5 underserved urban communities in Addis Ababa and Adama. During the first year of the three year project, YMCA will aim to reach 10,000 youth and young adults with comprehensive HIV/AIDS prevention information and behavior change communication activities.
The YMCA's approach to health education strongly emphasizes building core values, life skills, gender sensitivity, appreciation for diversity and access to accurate information and advice so that youth and young adults are equipped to make the right decisions. To ensure that peer educators are successful the YMCA will also incorporate a strategy that simultaneously strengthens parent and adult education, community alliances and medical referral services. The YMCA will set up a voucher system with reputable hospitals and clinics to help youth and young adults obtain appropriate, affordable medical testing, counseling and treatment. YMCA will focus comprehensive HIV prevention messages and information for 50% of their target populations, for a total number of 25,000 older youth between the ages of 17-29 reached by 2010.
Target Target Value Not Applicable Number of STI patients refereed to HIV counseling and testing: Number of individuals involved in alcohol and chat: counseled and tested for HIV Number of personnel trained on risk reduction counseling (alcohol-subtance) Familiarization workshop conducted Development of IEC/BCC materials on alcohol / substance abuse and HIV Number of facilities that link ART adherence intervention with substance use counseling Number of individuals with single STI episode to be treated with prepacked kits Number of health care workers (private sector) trained on syndromic approach Number of peer educators trained at each site Number of facilities to be supported and supervised regularly Number of model clinics to be renovated or constructed Number of condoms distributed to STI patients Number of targeted condom service outlets Number of individuals reached through community outreach that 10,000 promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention 500 through other behavior change beyond abstinence and/or being faithful
Table 3.3.06: Program Planning Overview Program Area: Palliative Care: Basic Health Care and Support Budget Code: HBHC Program Area Code: 06 Total Planned Funding for Program Area: $ 18,400,504.00
Prior to FY06, palliative care support activities in Ethiopia focused mainly on end of life care and distribution of commodities to PLWHA. With the advent of free ART and improved access to HIV/AIDS care services, palliative care is increasingly perceived as a continuum of care. During COP 06 PEPFAR Ethiopia planned to reach 89 hospitals, 267 health centers and 141 community and hospice based service outlets with palliative care. In the first six months of FY06 (October 05-March 06), 129,105 PLWHA received at least one category of service defined in the OGAC palliative care guidance in 79 hospitals, 240 health centers and 45 community and hospice-based outlets. Services included the delivery of clinical care, including OI treatment and symptomatic management; psychological care through peer support groups and psychiatric nurses; spiritual support through linkages with FBOs and delivery of elements of the preventive care package, including long lasting insecticide treated nets (LLITN) to prevent malaria in endemic areas, cotrimoxazole prophylaxis, screening for TB infection, prevention for positive counseling, condoms, referral of household contacts for VCT, safe water and hygiene, nutrition counseling and multivitamin supplementation.
During COP07, PEPFAR Ethiopia will leverage resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the World Bank to deliver care and support to 338,000 PLWHA by September 2008. Focus areas will include providing elements of the preventive care package at all levels of the network, improving pain management and nutritional support for PLWHA, and building the capacity of indigenous organizations to provide palliative care. PEPFAR Ethiopia will also strengthen pediatric palliative care services by increasing detection of pediatric HIV cases through family centered, PMTCT,OVC, TB/HIV, adult palliative care and home based care programs.
In addition to provision of the adult preventive care package, pediatric services will include regular nutrition and growth monitoring, safe infant feeding and therapeutic and supplementary feeding through facility level food by prescription in selected health centers and hospitals, community-based food and nutrition support mechanisms. Infants and children will benefit from existing non-PEPFAR child survival interventions.
While rapidly expanding palliative care services, PEPFAR Ethiopia will ensure provision of quality services by each partner through use of standard guidelines and rigorous monitoring of partners. A person who receives at least one category of services stated under palliative care guidance will be counted as person on care.
Delivering effective palliative care services across the continuum of care is dependent upon a functional and effective health network. In COP07, PEPFAR Ethiopia will continue to strengthen the network of 131 hospitals, 393 health centers and associated catchment communities by deploying case managers who will follow all patients within the ART health network; hospital and health center case managers will collaborate to refer patients within and between facilities, link patients to community services, track patients, and ensure follow-up. PEPFAR Ethiopia will take necessary measures, including service mapping and use of unique patient identifiers, to avoid double counting within and across the health network.
PEPFAR Ethiopia will leverage support from GFATM, the World Bank and other major donors to reach its ambitious COP07 palliative care goals. GFATM will procure OI drugs, including cotrimoxazole, and LLITN. The World Bank, through the multi-sectoral AIDS program II, plans to support social care that includes community mobilization and leadership development of PLWHA.
Ethiopia was recently named a focus country for food and nutrition by the Office of the Global AIDS Coordinator (OGAC). PLWHA in Ethiopia have identified nutrition support as a priority palliative care service that is critical for ART adherence. During COP07, PEPFAR Ethiopia will scale up nutrition support activities to PLWHA. In addition to using funds to wrap around food resources from Title II Food For Peace and the World Food Program, PEPFAR Ethiopia will improve nutrition assessment, counseling and monitoring of
HIV-infected persons at all HIV care, ART and PMTCT service sites in the network. PEPFAR Ethiopia will also provide therapeutic feeding by prescription to malnourished PLWHA, HIV+ pregnant women in PMTCT programs, HIV+ lactating women in the first six months post-partum, their infants and OVC in at least 20 hospitals and 25 health centers in the network.
Currently, Ethiopia does not have a national policy on the use of opioids for pain management. PEPFAR Ethiopia has identified a lead partner, UCSD, to support the Federal MOH and the National HAPCO in the development of a national policy on the use of opioids. PEPFAR Ethiopia will also work with PLWHA to train patients and providers on the value of pain management as a means to improving quality of life. Care Support throughout the Network-Regional and Woreda Support: PEPFAR Ethiopia continues to work with regions and woredas to plan, prioritize and implement HIV/AIDS prevention, care and treatment services. Support at the regional level includes building regional capacity to support, monitor and evaluate the implementation of services, and developing regional based master training teams to train facility level staff to scale up services. Hospital Level: PEPFAR Ethiopia supports hospital level palliative care services through cooperative agreements with four USG universities including Johns Hopkins University, Columbia University, I-TECH (University of Washington), and the University of California San Diego. During COP07, all 131 public, private and workplace hospitals nationwide will receive support for palliative care services, including training, supportive supervision, and clinical mentoring of health care providers; establishment of clinical care teams; provision of elements of the preventive care package; ensuring referrals and linkages to health center and community-based care services through case managers; and monitoring and evaluation of services.
Health Center: In COP07, PEPFAR Ethiopia will support palliative and clinical care services at 393 health centers within the network. FHI/IMPACT has provided palliative care services at health centers since 2004; as the FHI/IMPACT project is ending, a solicitation process for a follow-on contractor(s) is underway. Palliative care support at the health center level will include training, supportive supervision, and clinical mentoring of health care providers; establishment of clinical care teams; provision of elements of the preventive care package; ensuring referrals and linkages to hospitals and community-based care services through case managers; and monitoring and evaluation of services.
Community Level: PEPFAR Ethiopia will continue to work with community-based partners such as International Orthodox Church Charities (IOCC), Save the Children USA (SCUSA), Family Health International (FHI), Catholic Relief Services (CRS), and the World Food Program (WFP) to support home- and community-based palliative care services including nursing, psychological, social and spiritual care, safe water, food and nutrition support. PEPFAR Ethiopia will also collaborate with the GFATM to facilitate the delivery of the following elements of the preventive care package at the community level: LLITN in malaria endemic areas, nutrition counseling, screening for TB, referral of household contacts for VCT, prevention for positives and condom provision.
In COP07, PEPFAR Ethiopia will continue to build the technical and human capacity of indigenous organizations to provide effective palliative care services in high prevalence, well-populated urban areas by offering technical support, sub-grants, and mentorship.
Program Area Target: Total number of service outlets providing HIV-related palliative care (excluding 910 TB/HIV) Total number of individuals provided with HIV-related palliative care 537,012 (excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative care 17,483 (excluding TB/HIV)
Table 3.3.06:
The YMCA AIDS Volunteerism and Community Engagement (ADVANCE) Program will develop, strengthen and scale-up successful YMCA youth program practices in order to improve HIV/AIDS knowledge and practices among youth and young adults, as well as care for children and families affected by HIV.AIDS.The ADVANCE Program has two OVC objectives: 1. Provide vital recreational, educational, and counseling services to at least 5,000 orphans and vulnerable children affected by HIV/AIDS in the five target communities by 2010, and 2. Strengthen youth, young adult and community support for orphans and vulnerable children in the five target communities through volunteer service projects by 2010. The YMCA and YWCA will work with local schools, community leaders, and social service agencies to identify orphans and vulnerable children in need of educational, recreational and psycho-social support. The vulnerable children will include street children and juvenile delinquents in Addis Ababa and Adama.
The OVC will receive free YMCA and YWCA memberships in the target communities and be immediately integrated into other YMCA and YWCA youth education and recreation programs to break down stigma and discrimination. The YMCAs and YWCA will also target the OVC in the HIV prevention and peer education activities listed above. Some of the peer educators in the younger group will be OVC. The YMCA and YWCA will also work with other community-based organizations including schools, hospitals and clinics, faithbased organizations, NGOs and local businesses to mobilize financial and material support for the educational, medical and psycho-social needs of OVC. The YMCA and YWCA will organize community level anti-sigma campaigns to raise awareness and support for OVC. These campaigns and YMCA/YWCA networking efforts will develop new communitylevel collaborations to provide the OVC with additional psychosocial counseling, family reunification, foster care and educational opportunities to develop their self-esteem, social skills, and confidence. In larger YMCA branches like Addis Ketema in Addis Ababa, the YMCA will also provide primary education and meals to OVC in its primary school. In other branches the YMCA and YWCA will work with the local schools, health facilities and faith-based organization to mobilize educational and psycho-social support and charitable assistance (school supplies and clothes) for the OVC. Through the ADVANCE program, the YMCA will be able to strengthen the capacity of the local branches to offer care and programs to OVC in a more sustainable way.
The YMCA and YWCA will organize service learning activities to educate and empower young people to play a positive role in mobilizing compassion and support for OVC. This will be achieved through volunteer service learning activities implemented by the youth and young adult peer educators in collaboration with local government, business, NGO and religious leaders.
Target Target Value Not Applicable Number of OVC served by OVC programs 2,500 Number of providers/caregivers trained in caring for OVC
Table 3.3.09: Program Planning Overview Program Area: Counseling and Testing Budget Code: HVCT Program Area Code: 09 Total Planned Funding for Program Area: $ 14,944,250.00
HIV/AIDS counseling is a crucial component in the response to HIV/AIDS. HIV Counseling and Testing (HCT) is considered a primary entry point to the health network. PEPFAR Ethiopia has been the lead donor in establishment and expansion of HCT services in the country and has assisted the Federal MOH and Regional Health Bureaus since 2001. PEPFAR Ethiopia has supported the strengthening of HIV counseling and testing efforts by: (1) Continued provision of HCT in existing testing services in 131 hospitals, 500 health centers, and 120 workplace and private clinics; (2) Initiating and expanding innovative approaches to scale up HCT services such as mobile, home based VCT, weekend outreach services, campaigns; (3) Introducing a strategic mix of different counseling testing approaches in diverse settings, such as PICT, VCT, Couple counseling, Child and Youth focused C&T; (4) Providing technical and financial support to develop counseling and testing training materials such as VCT, PICT, training curricula and training packages for lay counselors; (5) Supporting the MOH in updating the existing National VCT guidelines to include major policy issues that impede the smooth delivery of the service: age of consent, confidentiality and partner notification; (6) Training of service providers at national, regional level and site level for health workers and lay counselors; (7) Assessing new sites and provision of technical and material support to initiate services; (8) Developing a quality assurance system at the facility level; and (9) Strengthening the linkage between HCT and care and treatment.
The number of HIV testing sites and persons receiving HIV counseling and testing services dramatically increased in the last three years. MOH report showed that during the one year period between July 2005 to June 2006, 564,351 individuals and couples received counseling and testing from 650 sites. The preliminary findings from the national Behavioral Surveillance Survey (BBS) 2005 revealed that the proportion of individuals who reported to ever had HIV test has increased compared to the 2000 BSS result. PEPFAR Ethiopia significantly contributed in supporting more than 85% of the sites and meeting the target. Yet there is a need to test more Ethiopians for HIV. The recent findings of the Ethiopian Demographic and Health Survey (EDHS) 2005 show that, among the adult population age 15-49, only 4 percent of women and 6 percent of men have been tested for HIV at some time. The highest testing rates are observed among urban residents. The proportion of who reported ever had HIV test has increased in BSS round two (2005) compared to the BSS round one (2002).
In support of the he recently launched EMOH plan, Accelerating Access to HIV/AIDS Treatment Road Map 2004 - 2006, PEPFAR Ethiopia expects to reach 100,000 individuals on ART by the end of COP07. PEPFAR Ethiopia will reach 138,300 PLWHA with free ART by the end of Sept. 2008, out of which 40,000 will be new patients. To identify 40,000 new eligible patients for ART therapy, more than 1,038,437 persons should be tested. To accomplish this task PEPFAR Ethiopia will expand support to 131 hospitals (including private institutions) and 500 health centers in the country. Support will also be given to strengthen HCT services in NGO settings, workplace clinics, youth centers, high risk corridors and private clinics. To increase the uptake, PEPFAR Ethiopia will support national campaigns on HIV testing and disclosure. To increase uptake of HCT, PEPFAR Ethiopia will support implementation of different approaches, including mobile, outreach and home and community-based VCT services.
VCT promotion is crucial in creating demand for HCT and reducing stigma against HIV+. In this regard region-focused messages will be developed and intensive efforts will be made in the social marketing of HCT services.
During the first six months of 2006, a total of 136,567 individuals were counseled, tested and received their test result in PEPFAR Ethiopia supported sites. Given the fact that majority of VCT sites nationwide are
supported by PEPFAR Ethiopia, this result indicates that there is a need to rapidly scale up VCT services using various methodologies in addition to existing static services in public health system. The main challenge during FY06 was inconsistent supply of test kits, which led to service interruption and low up take in a number of public facilities. During COP07, through the Supply Chain Management System (SCMS) mechanism, PEPFAR Ethiopia will work closely with the MOH and the GFATM to ensure consistent supply test kits.
During COP07, PEPFAR Ethiopia will give due emphasis to the following areas: child counseling and testing, provider initiated HIV counseling and testing, family center counseling and testing and the utilization of mixed methods, including community based counseling and testing through intensified outreach and mobile VCT. In addition, PEPFAR Ethiopia will provide support through involvement of non-medical or community counselors and introduction of simple techniques including use of capillary samples and Dried Blood Spot (DBS) for HIV testing and quality control.
PEPFAR Ethiopia will continue to use funds to provide technical assistance, minor renovations and procurement of commodities to help reach the target. PEPFAR Ethiopia will work with the Global Fund to leverage test kits and other lab supplies.
Program Area Target: Number of service outlets providing counseling and testing according to 974 national and international standards Number of individuals who received counseling and testing for HIV and 1,079,937 received their test results (including TB) Number of individuals trained in counseling and testing according to national 4,379 and international standards
Table 3.3.09:
