Care and support for PLWHA

This is a continuing activity which began in FY05. The activity is closely linked to the USG food aid program

from dollar resources and food commodities provided under Title II of Public Law 480 of the Agriculture

Trade Development Act of 1954, as amended (PL 480 Title II).

In FY06 Catholic Relief Services (CRS) combined PL 480 Title II and PEPFAR Ethiopia resources for care

and support for PLWH. CRS leveraged 9,442 metric tons (MT) of food, worth $5,642,590, from Title II

resources. CRS used both resources to work with the Organization for Social Services for AIDS (OSSA)

and Missionaries of Charity to provide support to approximately 35,000 PLWH in 18 urban communities in

Addis Ababa, Afar, Amhara, Dire Dawa, Gambella, Oromia, SNNPR, Somali, and Tigray regions. CRS also

used Title II resources to work with Medical Missionaries of Mary (MMM) and OSSA to provide support to

100 PLWH in Dire Dawa and Harari and PEPFAR resources to work with the Ethiopian Catholic Church;s

Social and Development Coordination Branch Office of Adigrat - Mekelle in Mekelle. This work included

both home-based care (HBC) and support, and institutional-based medical care for opportunistic infections

and end-of-life care.

The locations of hospices that provide support for HIV-positive orphans, medical and end-of-life care are the

Asco Children's Home/Hospice and Sidist Kilo in Addis Ababa; Dubti in the Afar region; the Debre Markos

Hospice and Debre Markos Children's Home/Hospice in the Amhara region; Dire Dawa in Dire Dawa

Council; Gambella in Gambella region; Bale, Jimma and Kibre Mengist in the Oromia region; Awassa, and

Sodo in the SNNPR; Jijiga in Somali; and Mekelle, Alamata, Adwa in the Tigray region. Outreach work

providing HBC was associated with these hospices. Additional HBC programs were present in Addis Ababa

and Nazareth.

In FY08, CRS will continue to use its resources to work with the abovementioned partners in collaboration

with the Ethiopian Catholic Church's Social and Development Coordination Branch Office (ECC-SDCOA) of

Adigrat - Mekelle to address basic care and support needs of 26,000 PLWH and their family members—

both in the community and through the hospices and two homes for HIV-positive orphans.

All hospices are located in high-prevalence and highly populated urban areas within the health network

model. This provides a unique opportunity for linking beneficiaries with facility-level ART, PMTCT, and

chronic HIV care services. Many of the hospices are also TB treatment centers ,and during FY08, CRS will

work to strengthen the counseling and referral of PLWH for TB testing and TB patients for HIV testing as

well as the post-test counseling follow-up. This will build on work initiated in FY07

CRS and other PEPFAR Ethiopia implementing partners will provide nutrition support, hygiene education,

counseling, psychosocial, spiritual and medical care, and preventive care including cotrimoxazole

prophylaxis as needed by PLWH both in their homes and through the hospices. Additional educational and

life-skills support will be given to children living with HIV/AIDS. HBC programming partners will undertake

stigma-reduction interventions (information, education and communications) within host communities and

provide counseling and psychosocial support to asymptomatic and symptomatic PLWH.

During FY06 and 07 CRS has been supporting OSSA and ECC-SDCOA-Mekelle to strengthen their

community mobilization; positive living, disclosure and ART adherence counseling; and nutrition, water,

sanitation and hygiene and livelihoods support program components. To facilitate this CRS will involve three

more partners in programming, Alem Tena Catholic Church, Ethiopian Catholic Church - Social and

Development Coordination Office of Harar (ECC-SDCOH) and Progress Integrated Community

Development Organization (PICDO). These partners have previously been programming using CRS private

funds. Cross-learning opportunities have been developed between these organizations and those working

on rural livelihoods, agri-business and nutrition activities.

During FY07, CRS will provide support to OSSA to carry out a strategic planning exercise and develop its

skills as learning organization through identification and documentation of best practice between the branch

offices. FY08 intervention will build on this process and further strengthen OSSA's capabilities to program

strategically.

The program conforms with the PEPFAR Ethiopia five-year-strategy of focusing on the community as the

key actor in the health network for care and promoting a set of palliative care interventions appropriate to

participating communities. Strong referral linkages exist between many community-based care and support

programs, hospices, and facilities. CRS will strengthen these by identifying and referring adults and children

in Missionary of Charity shelters for voluntary counseling and testing (VCT) and other diagnostics necessary

for the provision of HIV/AIDS care and treatment services. Special emphasis will be given to enabling HIV-

positive children to access quality HIV/AIDS care and treatment services. In 2007, this activity will continue

to strengthen these linkages and collaboration with other PEPFAR Ethiopia partners for treatment, high-

quality clinical care.

CRS continues to work with partners to improve their data quality and reporting systems. The program run

by Missionaries of Charity is designed to provide immediate care for the dying and destitute and does not

have a confidential, patient-centered, monitoring system. For this reason many of the homes struggle to

collect the data required for PEPFAR and it is anticipated that the number of homes receiving PEPFAR in

FY08 will therefore decrease.

This is a continuing activity from FY07. The activity is closely linked to the USG food aid program from dollar

resources and food commodities provided under Title II of Public Law 480 of the Agriculture Trade

Development Act of 1954, as amended (PL 480 Title II).

Catholic Relief Services (CRS) combines PL 480 Title II and Emergency Plan resources to support OVC. In

FY07, CRS used these resources to work with Medical Missionaries of Mary, Organization for Social

Services for AIDS (OSSA) and the Missionaries of Charity (MOC) to provide support to OVC in 17 urban

communities in Addis Ababa, Afar, Amhara, Dire Dawa, Gambella, Oromiya, SNNPR, Somali and Tigray

Regions. In addition, CRS used Title II resources to work with the OSSA to provide support to 200 OVC in

Dire Dawa and Harari and Emergency Plan resources to work with the Ethiopian Catholic Church Social

and Development Co-ordination Branch Office of Adigrate in the Tigray region. In COP08, CRS will continue

to use both resource categories to work with these partners to provide PL 480 Title II to an estimated

12,100 OVC and supplement this with PEPFAR financial support for living costs, shelter, school fees and

supplies, and medical care as needed. Local partners will undertake community mobilization and stigma

reduction interventions within host communities and provide counseling and psychosocial support to OVC.

In COP08, CRS will continue to strengthen links between its Track 1 AB youth activity, in Dire Dawa,

Oromiya and Tigray Regions, and its OVC work. CRS will also strengthen the capacity of Counseling and

Testing (CT) centers, OVC counselors and Catholic Church pastoral leaders to respond to the diverse

needs of OVC. Over the last two years, CRS has supported OSSA and ECC-SDCOA-Mekelle to strengthen

their community mobilization, counseling, nutrition, water, sanitation and hygiene and livelihoods support

program components. Under COP08, CRS will involve three more partners in their OVC programming,

Alem Tena Catholic Church, Ethiopian Catholic Church - Social and Development Coordination Office of

Harar (ECC-SDCOH) and Progress Integrated Community Development Organization (PICDO). These

partners have previously received CRS private funds. CRS will develop cross-learning opportunities

between these organizations and those working on rural livelihoods, agri-business and nutrition activities.

Wrap around funds for the business and livelihoods strengthening will be requested from USAID's Assets

and Livelihoods Transition (ALT) program.

CRS will provide support to 12,100 children, providing them with care based on individual needs. The

majority of these children will receive supplementary food and/or medical support through MOC's program

for the dying and destitute or psychosocial and/or educational support where other direct support is not

required. The remaining children will be supported with a holistic package of services such as shelter and

care, protection, healthcare, psychosocial support and education. The program will leverage CRS private

funds and USAID Assets and Livelihoods Transition (ALT) program food and livelihoods support for OVC.

In partnership with other PEPFAR Ethiopia OVC partners, CRS will work with the new PEPFAR APS

recipients to coordinate activities to achieve the most efficient use of resources for OVC in the highest

HIV/AIDS prevalence areas. This includes harmonization on indicators, reporting, and OVC standards of

care in line with Government of Ethiopia national guidelines, policies, OGAC OVC Program Guidance, as

well as achieving quality assurance in OVC programming as described in the draft Standards of Service for

Quality OVC Programs in Ethiopia. Data from the EDHS 2005 and the results of USG Ethiopia mapping will

be used to identify geographic priority areas to increase services in areas of highest prevalence to OVC.

CRS will link MOC with the PC3 OVC Food Support activity (103967) and the FANTA technical expertise

(10571) to facilitate their access and use of Ready to Use Foods (RUTF). CRS will also liaise with the DAI

Urban Agriculture Program for HIV/AIDS affected Women and Children (10486), supporting partners to

access resources where feasible and/or sharing technical expertise and learning.

CRS' exit strategy states that "all the organizations through which CRS/Ethiopia implements its PEPFAR

funded projects have alternative sources of funding. Similarly, CRS' partner organizations are well

established and network with other funding agencies and cooperating sponsors of the USG. This broad

base of donors and networking with other agencies allows the organizations to source alternative funding if

required. Additionally, CRS supports organizations to better understand and work within the USG

regulations and to access US government funding directly.

CRS continues to work with partners to improve their strategic planning, data quality and reporting systems.

During FY08, CRS will build on the current strategic planning exercise with OSSA to further strengthen

OSSA's capabilities to program strategically. The program run by MOC is targeted at the provision of

immediate care for the dying and destitute and does not differentiate children orphaned or made vulnerable

due to HIV/AIDS and those from other causes. For this reason many of the homes struggle to collect the

data required for PEPFAR and it is anticipated that the number of homes receiving PEPFAR funding during

FY08 will therefore decrease.