Condom Procurement

This is a continuing commodity-procurement activity.

This activity will procure approximately 50.5 million condoms for use in Ethiopia's HIV-prevention and

palliative care program. Approximately 38 millions condoms will be branded for donation to USG

implementing partners for targeted promotion activities. An additional 12 million condoms will be donated for

distribution through PHARMID's national HIV/AIDS commodity logistics system to HIV clinical settings in

public health facilities and 0.5 million to refugee settings.

Based on a provision of 50 condoms per year to persons on care or treatment this activity will serve

approximately 250,000 individuals (upstream). Based on a provision of 80 condoms per year to at-risk

populations this activity will serve approximately 475,000 individuals (upstream).

The USG has been the largest supplier of condoms to Ethiopia since 1996. Since 2004, the USG has

supplied 128 million condoms to a local partner for use in a condom social-marketing program. Based on

new Ethiopian Demographic and Health Survey (EDHS) and antenatal care (ANC) information, the USG is

developing a new, targeted, condom-promotion activity funded with FY06 supplemental funding. The activity

will focus on most at-risk populations. This activity began in FY07. The activity represents a transition from

PEPFAR Ethiopia's previous donation of commodities to a multi-donor condom general social marketing

program based on a shift in prevention strategy to focus fully on most-at-risk populations (MARPs).

Several bilateral donors, (Department for International Development-United Kingdom, Development

Cooperation Ireland, and the Royal Netherlands Embassy) maintain an agreement covering operational

costs and condom donation. In FY06, approximately 40 million condoms were provided under a social-

marketing brand "Sensation," which is marketed as a more expensive, upscale product. The UN Mission to

Ethiopia and Eritrea, a UN peace-keeping mission, provides small donations to the National Defense Forces

of Ethiopia (NDFE). Private donors support small-scale donations to local nongovernmental organizations.

In FY08, we anticipate the USG to remain a major condom donor to support HIV prevention to MARPs

nationwide. A multi-donor, general social-marketing program is expected to function at levels similar to

FY06/07. With a funded, targeted promotion activity, the USG will build on momentum of a new branded

condom product to support outreach and behavior-change communications (BCC) messaging about

correct, consistent, condom use, risk-reduction, HIV burden among young girls, and cross-generational and

transactional sex. In FY08, HIV-prevention activities will continue to expand beyond current programming

approaches to include greater outreach to MARPs. Condom commodities remain a vital aspect of PEPFAR

Ethiopia prevention activities.

This activity has two components:

1) Supplying condoms to HIV clinical settings nationwide in a consistent fashion: Using the national

commodity logistics systems, condom commodities will be cleared and distributed to regional PHARMID

branches and drop points throughout the country. Based on a pre-determined quantification, it will integrate

a percentage of this procurement into the ARV and medical-commodity-logistics system for delivery to

voluntary counseling and testing (VCT), ART, and pre-ART clinics and case managers within the ART

health network, including hospitals and health centers. USG implementing partners in facilities will work with

local authorities to support distribution to clinical settings at facilities.

2) Supplying condoms to USG HIV-prevention activities, including the NDFE and five refugee camps. Using

a TBD Contractor implementing the Targeted Condom Promotion activity, condom commodities will be

distributed in-country alongside behavioral-change activities to increase condom use among MARPs.

Needs quantification is based on support to the NDFE; projected requirements within non-clinical and

clinical settings amount to 44,000,000 units. This procurement will provide approximately 38.7 million

condoms. Additional condoms may carry over from FY07 due to the arrival date of condoms.

The USG envisions substantial collaboration with the uniformed services, refugee camps, and several USG

partners conducting community outreach. Condom procurement is anticipated to occur through the USG

Central Commodities Fund mechanism.

10/8/08

In FY08, this activity will provide technical assistance to implement a Development Credit Authority (DCA)

between the USG and two private banks. This DCA will facilitate private financing of private-sector activities

valued at $500,000 in PEPFAR resources, for a total DCA of $850,000 of USG resources. The DCA

mechanism will support the financing of private hospitals, higher clinics, and private health colleges to

expand capacity to address private-service delivery of HIV/AIDS and TB services and human resource

development of health officers, nurses, laboratory technologists, and pharmacist technicians. Analysis by

the USG identified that an Ethiopia-based DCA would achieve a 12:1 leverage of private capital (i.e., a

$1,000,000 DCA would enable the banking sector to mobilize $12,000,000 in private non-USG resources to

use for financing private-sector health projects as agreed to by the USG and the bank participants). The

DCA is a proven model to expand private-sector capacity through increased financing opportunities and will

provide tangible incentives to expand sustainable HIV/AIDS programs, including ART services at hospitals

and higher clinics throughout Ethiopia. Funds for the DCA were incorrectly assigned to Abt Associates and

are being reprogrammed in Apr'08 to a USAID mechanism.

Based on these findings, PEPFAR Ethiopia believes that, by engaging the private health sector we have the

opportunity to shape the development of the sector to deliver public health services including HIV

counseling and testing, TB diagnosis and treatment, and ART. Interventions to provide business training to

private providers and work with financial institutions to expand health sector lending will greatly strengthen

HIV/AIDS service delivery in the private sector. The USG assessment recommends that the DCA address

the health sector by providing approximately $15 million to assist banks to enter the healthcare market. The

DCA funds will reduce risk and addresse some of the banks' collateral constraints. The Office of

Development Credit estimates that the total subsidy cost of a $15 million guarantee would range from

$1,798,500 to $1,818,000.

This activity will provide the MOH and several RHB with technical support to identify and address the gaps

and obstacles in policy and requirements which may limit the willingness and ability of the private sector to

provide TB or HIV services. This activity will provide support to the overall strategy to decentralize HIV/AIDS

services in urban and peri-urban areas and further multiply entry points for HIV/AIDS care and treatment by

utilizing private-sector clinics.

This activity is linked to activities addressing private-sector providers, including hospitals, higher and

medium clinics, laboratories, and pharmacies. In addition, there is a link between the technical assistance

being provided through "training" partners who are addressing pre-service curriculum adaptation and private

health colleges.

The activity will reach a range of stakeholders in the private sector, including private healthcare providers,

professional associations (e.g., the Medical Association of Physicians in Private Practice-Ethiopia),

business leaders, private-sector medical schools, and training institutes. Strategies to reach these different

groups vary depending on the stakeholder. The primary strategy to reach these stakeholders will be the

creation and facilitation of a working group focusing on private-sector issues related to the provision of

HIV/AIDS and TB services (quality improvement, training, access to commodities, data reporting, financing

mechanisms, etc).

The activity will provide in-service training to host-country government workers and health providers. The

training will focus on policy advocacy and policy experiences with private-sector health service delivery.

This activity will address workplaces by analyzing existing financing mechanisms used for HIV/AIDS

prevention, care, and treatment activities at those sites.

The public-private partnership component of this activity will leverage approximately $10,002,000 in private,

non-USG resources. Furthermore, this activity will receive funding from the USG's non-PEPFAR bilateral

TB and population and reproductive health programs.