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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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.
Years of mechanism: 2008
Scaling Up of PMTCT through National PMTCT Behavior Change Campaign
PEPFAR aims at providing 80% of HIV+ pregnant women with ARV prophylaxis and reduce infant infection
by 40% in focus countries including Ethiopia by 2009. Of the 2.2 million pregnancies expected in 2008,
there will be up to 79,000 HIV positive women which may lead to 14,000 HIV positive infants if best
strategies to reduce mother-to-child transmission are not in place. The PMTCT coverage of Ethiopia is
estimated at 2%, which is the lowest compared to other 15 PEPFAR focus countries. According to the
Ethiopia DHS 2005, the national ANC coverage is 28% and only 6% of births are delivered by skilled
Despite the expansion of PMTCT services to more than 50% of health facilities providing MNCH services,
the PMTCT uptake remains low at different level. In 2006-2007, of women enrolled in ANC only about 50%
were counseled and tested for HIV and of those women who were HIV positive, only 52% received ARV
The low PMTCT service utilization among pregnant women could be attributed to many factors. Low ANC
coverage, lack of access and/or poor quality of ANC/PMTCT services, services not user friendly, shortage
of man power and other resources at sites, lack of knowledge of the availability and benefits of PMTCT
services among clients, cultural barriers, misconceptions and attitude against the service, stigma and
discrimination (feared and actual) and passive involvement of men in the service utilization are some of the
factors that pull back the effort to reach as much pregnant women as intended..
Strategies for improving uptake of PMTCT services should give special emphasis to increasing awareness
of the benefits of MNCH/PMTCT services and providing quality services. In an effort to improve the PMTCT
uptake, the government of Ethiopia has started rolling out the revised PMTCT guidelines mainly focusing on
providing comprehensive PMTCT services. Although there are efforts to improve the quality, it will be
necessary to implement interventions focusing on changing behaviors of women, their partners and the
community to improve utilization of the existing services.
The need to expand PMTCT services has to be backed up with consolidated effort to improve the
knowledge, attitude and practices of women and men of reproductive age. However, though there are a
number of programmatic initiatives, the activities done in terms of improving the knowledge, attitude and
practice of pregnant mothers and women and men in the age of reproductive health are minimal.
Furthermore, existing cultural practices that undermine health service seeking behavior are playing role in
hindering pregnant women from attending ANC there by challenging PMCT initiative. The rampant harmful
traditional practices with gender inequalities are fueling to this problem.
The objectives of these activities are to scale up PMTCT in Ethiopia through implementing a National
PMTCT Behavior Change Campaign and expansion of outreach PMTCT services.
The BCC initiative will be implemented with the objective of improving PMTCT uptake among pregnant
women tested HIV-positive, by working on and changing certain behaviors that hindered utilization of ANC
and PMTCT services.
The Behavior Change Campaign will focus on attitudinal, knowledge and behavioral features of service
users, service providers and the community that contributed to low PMTCT utilization. The effort fully utilizes
BCC models and theories of BCC to the success of the initiative. This activity will carry out nation wide
Behavior Change Communication to bring about desired behavior favoring ANC, institutional delivery, HIV
testing of pregnant women and utilization of PMTCT services by HIV-positive pregnant women.
Effective PMTCT program require coordination and collaboration of the different stake holders. Pregnant
women need support from their partners, the family and health service providers. The involvement of both
men and women in PMTCT plays crucial role in attaining PMTCT initiative objectives. Hence, there is a
need to catalyze and establish mass root support among men. Considering the situation in Ethiopia, where,
men are the nuclei for the decision making process in seeking medical care, their involvement need to be
improved. They should be oriented in ways that help them adopt behavior supportive to their women partner
in accessing ANC and PMTCT services.
Stigma and discrimination is another barrier leading to low uptake of PMTCT services. Pregnant women,
on the other hand, for fear of stigma do not want to go to CT even though they are attending ANC. Male
partners share the same fear. The deep rooted stigma, that has manifestation of different forms, has
worsening the problem with pregnant women. Health service providers, due to personal behavior, some
times carry out stigmatizing actions against those tested positive pregnant women. This could be during
ANC, labor and delivery. Such behavior need to be addressed systematically in a manner that ensures
sustainability and consistency.
Taking in to account the above factors and reports from National AIDS Resource Center (NARC), it is seen
that efforts should be exerted to work on Behavior Change among men and women of reproductive age,
pregnant women, health service providers and other community members to bring about desired behavior
change that enables pregnant women access and utilize ANC/PMTCT services.
While carrying out the BCC initiative certain components of middle level advocacy works will be carried out
to influence decision makers at Regional Health Bureau level to take measures in working towards
improving the ANC/PMTCT service utilization among pregnant women.
The BCC campaign will make use of opportunities and resources to achieve its objectives. The video
production on PMTCT will be used for the same purpose in a manner that ensures efficiency and
effectiveness. The BCC issues will be drawn from JHPIEGO assessment report on knowledge, perception
and attitude of men and women of reproductive age group and health service providers towards PMTCT.
Arrangements will be made with partner universities working on similar area to avoid duplication and
overlapping of efforts.
The following are targets for the BCC campaign: women and men of reproductive age group, pregnant
women, Health service providers, religious leaders, traditional birth attendants and traditional healers. The
BCC initiative will take place in: MNCH clinics, community (idirs and other social structures, women and
youth associations), religious institutions, transport (stations) and any other relevant service outlets.
The BCC activity will develop targeted messages with indicators, identify channels of communication, Print
Materials; Brochures, booklets (Pocket size) and conduct sensitization workshops.
The main activities include:
1. Development/adaptation of IEC/BCC printed and electronic materials on PMTCT in local languages for
distribution to pregnant women and their families and the community via Health Extension Workers.
2. Development of new, improved posters and visual aids on MNCH/PMTCT services;
3. Development of series of radio and TV spots, in local languages,
4. Targeted use of national and regional mass media including MOE's educational mass media;
5. Distribution and dissemination of print and electronic materials (includes air time costs for TV and Radio)
The BCC campaign will be coordinated and implemented by CDC-Ethiopia's PMTCT and BCC units in
collaboration with PEPFAR PMTCT partners and the government.
PEPFAR Ethiopia in partnership with Ethiopian Health and Nutrition Research Institute (EHNRI), a
significant progress has been made in improving the laboratory services supporting HIV/AIDS care and
treatment program and strengthening of the national laboratory system. There are still gaps in
standardization of clinical microbiology laboratory service including diagnosis of opportunistic infection,
sexually transmitted infection, tuberculosis and malaria, testing and laboratory biosafety. American Society
for Microbiology (ASM), a prime partner in many PEFAR focus countries has been providing technical
assistance in these areas. As of 2008, ASM will also provide technical assistance in improving clinical
microbiology laboratory services. ASM will assess the status of the services, provide assistance in
developing standards in simple diagnostic testing, development of training modules and mentoring, ASM
will work closely with CDC Ethiopia and Ethiopian Health and Nutrition Research Institute (EHNRI) to
establish the national clinical and public health microbiology laboratory at the national and regional labs The
support is gap filling and critical in Ethiopia and will start preliminary activity with the reprogrammed budget
and the activities will continue widely in COP09.
In COP08, the following activities will be covered by ASM
• conduct an assessment of clinical microbiology laboratories in Ethiopia, identify gaps, and develop work
plan based on the priorities
• Preparation of protocols and guidelines for improvement of Clinical Microbiology laboratory services
including, STI, Malaria and other OI diagnosis, QA, development training modules, etc
• Development training modules in clinical microbiology laboratory services (STI and malaria and OIs)
PEPFAR Ethiopia, in collaboration with the Ministry of Health (MOH), is strengthening regional, hospital,
and health center laboratories to support HIV/AIDS prevention, care, and treatment programs. CDC
Ethiopia coordinated and led all laboratory-related services implemented by PEPFAR partners, including
training, laboratory diagnosis and monitoring tests at hospital and health center levels, and referral
diagnostic services (CD4, infant diagnosis, and viral load tests).
In FY07, CDC Ethiopia supported the establishment of a national HIV referral laboratory at Ethiopian Health
and Nutrition Research Institute (EHNRI) to meet national standards. The national referral lab has been fully
networked with information technology equipment and broadband Internet connectivity. This national
laboratory is used as a model facility for training and coordinating laboratory quality assurance in the
country. All ART monitoring analyzers are installed and hence the referral lab was supporting the referral
testing for the ART program. Early infant diagnosis equipment was provided and assisted the referral
laboratory to provide referral infant diagnosis of HIV. The new rapid testing algorithms for HIV have been
made available for use, and training of trainers on rapid HIV testing using the new algorithm has been
In FY07, technical assistance was provided for regional rollout and decentralization of laboratory training in
HIV rapid testing, integrated laboratory training, laboratory management and lab quality system. The
trainings were successful and more than 1,000 laboratory professionals were trained. PEPFAR Ethiopia
also supported the national referral laboratory to conduct the following targeted evaluations: HIV-drug
resistance threshold survey, microscopic-observation of drug susceptibility test for TB, percentage of infant
CD4 determination, single-tube use for CD4 count, and defining the reference ranges of
All the activities started in FY07 will also continue in FY08. The activities include:
(1) Continuing to support all laboratory trainings and implementation of national quality assurance program
at all levels
(2) CDC Ethiopia will lead and coordinate all laboratory activities under PEPFAR support. Technical
assistance will be provided to EHNRI to strengthen the tiered quality laboratory services in the country and
implement the "Master Plan for National HIV/AIDS Laboratory System in Ethiopia".
(3) Support the National HIV laboratory to upgrade the facility to Biosafety Level Three to improve the
containment for some specialized tests as referral center for country
(4)Providing support, including furnishing with basic equipment, to six additional regional laboratories to
serve as regional referral hubs and providing necessary equipment for establishing DNA PCR set-ups at
sub-regional or referral hospital laboratories renovated by university partners at different regions
(5) Supporting the development and printing of laboratory guidelines and standard operating procedures
(6) Facilitating and supporting national and regional laboratory review meetings for PEPFAR-supported
programs and coordinating periodic site-level supportive supervision and mentoring
(7) Providing technical assistance in strengthening tiered laboratory services, referral networking, and
expansion of the LIS to hospital and health center facilities
(8) Supporting monitoring and evaluation of laboratory services, including: standardization of lab forms;
record keeping; and reporting support tools to include laboratory test requests, referral forms, and reporting
forms. Supporting the national and regional database system for laboratory reporting system for laboratory-
based surveillance and detection, typing, and drug susceptibility surveys
Strengthening National HIV/AIDS/STI Surveillance Systems:
CDC-Ethiopia technical staff provides direct technical assistance to the Federal Ministry of Health (MOH) of
Ethiopia, as well its component parts, the Ethiopian Health and Nutrition Research Institute (EHNRI) and the
HIV/AIDS Prevention and Control Office (HAPCO) and the nongovernmental Ethiopian Public Health
Association (EPHA) in the areas of surveillance and blood safety.
In FY07, CDC Ethiopia completed several activities within the scope of technical assistance provision to
MOH, EHNRI, HAPCO and EPHA. CDC Ethiopia's main activities were:
1) Expanding antenatal care-based HIV surveillance through training of national and regional surveillance
officers, antenatal care (ANC) clinic and laboratory staffs, and supervision of data collection at sentinel ANC
2) Conducting site assessments for AIDS Mortality surveillance
3) Technical assistance for the finalization of guidelines for HIV case, tuberculosis (TB)/HIV and sexually
transmitted infections (STI) surveillance
4) Technical assistance for HIV/STI and risk-behavior surveillance among most-at-risk population (MARPs)
and survey to identify the routes of spread of HIV from "hot spots" to rural areas. Findings from these
targeted evaluations will be used to design and implement effective interventions to MARPs and rural areas.
5) Sponsorship of technical assistance visits from international subject-matter experts related to leadership
for strategic information training, TB/HIV surveillance, and HIV case surveillance
These activities have helped PEPFAR Ethiopia and the Government of Ethiopia to generate, capture,
analyze, disseminate, and use quality strategic information to guide the planning, implementation, and
monitoring and evaluation of HIV/AID prevention, care, and treatment programs.
In FY08, CDC Ethiopia will focus on the provision of technical assistance to MOH, EHNRI, Federal HAPCO,
and EPHA in the areas of:
1) Implementing of HIV case surveillance
2) Expansion of the Leadership for Strategic Information Training and its development to the Field
Epidemiology and Laboratory Training (FELTP) and further implementation based on the needs of the MOH
3) Full implementation of TB/HIV surveillance
4) Implementation of ART drug-resistance surveillance
5) Successful completion of public health evaluations (PHE) that focus on all PEPFAR-supported
6) Capture, compilation, analysis, dissemination, and use of data generated from these surveillance
7) Building the capacity of EHNRI and EPHA so that they can provide adequate technical support to
regional health bureaus (RHB), laboratories, and surveillance sites
Through these activities, PEPFAR Ethiopia will strengthen the leadership, technical, and managerial
capacity of EHNRI and RHB to absorb and respond to the increasing needs for evidence-informed
surveillance information for policy- and decision-making on HIV/AIDS in particular. and public health in
Information Communications Technology (ICT) Support:
This is continuing activity from FY07. In FY07, PEPFAR Ethiopia has been supporting the development and
upgrade of the MOH and EHNRI comprehensive information technology (IT) network infrastructure,
including internet connectivity and human-capacity development for sustainable functioning of the system.
In FY07, PEPFAR Ethiopia conducted a system study for deploying a computer network within the RHB and
In FY08, PEPFAR Ethiopia will deploy the computer network and establish the interconnection of five RHB.
PEPFAR will also continue to provide support for MOH and EHNRI on information and communications
technology to meet their new requirements, including expansion of their LAN/WAN system. With this
activity, all seven sites will be supported with the procurement of IT equipment, deployment of LAN/WAN
systems, provision of broadband connectivity, maintenance support, and advanced training for ICT staffs of
the partner organizations. This will ensure that the available communication technologies are sufficient to
enable the health sector to improve services, as well as enhancing the accuracy, quality, and timely flow of
health information (to the Health Management Information System, Human Resources, and Finance, among
This is linked with PEPFAR Ethiopia-supported human capacity development activities aimed at
strengthening the implementation of the Sustainable Management Development Program (SMDP) to
improve the management and training skills of public health management professionals, health service
planners and managers in Ethiopia.
In FY07, CDC Ethiopia, with technical assistance from the SMDP program at CDC Global AIDS Program
(GAP) headquarters, conducted a needs assessment to design strategies for strengthening leadership and
management of HIV/AIDS care and treatment services at health facilities in support of the scale-up of
antiretroviral treatment (ART) in Ethiopia. The needs assessment targeted five PEPFAR-supported
hospitals in the Central and Northern Parts of Ethiopia (Debre Berhan, Dessie, Lalibela, Woldia, and
Zewditu, Hospitals), 2 Regional Health Bureaus (Addis Ababa and Oromiya), and five national
organizations: the federal Ministry of Health (FMOH) and its component HIV/AIDS Prevention and Control
Office (HAPCO), Addis Ababa HAPCO, the Ethiopian Public Health Association (EPHA), the Ethiopian
Health and Nutrition Institute (EHNRI), Addis Ababa University Medical Faculty Public Health Department,
and the Addis Continental Institute of Public Health.
The major objectives of the Needs Assessment were to investigate ways and means of:
1) Improving the planning and management capacities of health facilities, particularly ART cohort hospitals,
FMOH, national HAPCO, and local universities program managers, directors, planners and coordinators in
the implementation of HIV/AIDS and other diseases prevention, care and treatment programs in Ethiopia.
2) Strengthening collaboration with US-based universities and technical agencies through follow-up and
capacity enhancement in the implementation of SMDP trainings at health facilities, local universities, the
Ministry of Health, Regional Health Bureaus (RHB) and HAPCO offices.
The needs assessment included both policy-level and organizational collaboration and practical
organizational operations issues related to the need for leadership and management strengthening in
HIV/AIDS care and treatment facilities. As a result of the needs assessment:
1) EPHA was identified as an institutional home to implement SMDP in Ethiopia.
2) Customized SMDP training curricula for Ethiopia were developed.
3) First Round training of trainers (TOT) program was organized and conducted for trainers drawn from
EHNRI, HAPCO, and health facilities, with the support of the CDC/GAP's SMDP Team and CDC Ethiopia
4) Core trainer teams were established at regional and local facilities level for sustained SMDP
In FY08, further trainings will be designed and provided for 60 public health management professionals
drawn from PEPFAR-supported hospitals, RHB, and HAPCO. The CDC/GAP SMDP Team and Ethiopian
SMDP Team will continue providing technical assistance in building SMDP coordination and management
capacity for EPHA in areas of training. CDC Ethiopia will also follow up on the main SMDP components
such as process improvement/problem solving, Total Quality Management (TQM), healthy planning, and
strategic communications, all in collaboration with FMOH/HAPCO, health facilities, US-based universities
and agencies (Carter Center, Clinton Foundation), local universities, and health-related training institutions
The SMDP approach actively involves all local stakeholders, including health facilities, local universities and
training institutions in human capacity development, planning and management of public health services,
process improvements, and quality assurance mechanisms in an integrated and innovative approach. As
such, the SMDP trainings will be sustained and institutionalized at local health facilities and training
institutions. Accordingly, 20% of the required budget will be expended on training material design and
adaptation with technical assistance from CDC/GAP SMDP, 45% on training material production, delivery
and management, and 35% on follow up of the SMDP training program application at health facilities at
central, regional and local levels.