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.
Years of mechanism: 2008 2009
Integrated Service Strengthening
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a continuing activity from COP 2008. There will be no change to the activity narrative or targets.
This activity is mainly focusing in developing capacity of health care providers to treat the HIV positive
clients using IMAI methodology and the new Ethiopian Comprehensive HIV/AIDS Care and Treatment
guideline.
COP 08 Narrative:
This is a continuing activity from FY 2007. This activity relates to activities in Prevention, Care and Support,
ARV Drugs, ART and laboratory services.
Currently the government of Ethiopia is scaling-up the decentralization of the ART services to health centers
and to date 139 health centers have started to deliver ART services in the country. To support this scale-up,
the World Health Organization (WHO) has conducted trainings on Integrated Management of Adult and
Adolescent Illness (IMAI) for 1384 health professionals from 10 of the 11 regions using USAID, Italian and
Canadian fund.
Critical shortage of human resources particularly physicians and health officers is being observed at the
health centers. Capable nurses are present in relatively larger numbers, though more personnel of all types
are needed. In response to this situation, the MOH has revised the national guideline supporting the nurse-
centered HIV/AIDS services, featuring task-shifting, particularly in the area of ART services. The MOH
HIV/AIDS Prevention and Control Office (MOH/HAPCO) is working with relevant stakeholders including
PEPFAR Ethiopia and WHO on how task shifting is implemented during ART services expansion to the
health center level without compromising the quality of services.
As part of WHO "Treat, Train and Retain" initiative to address shortage of health workers and the response
to AIDS, WHO with PEPFAR Ethiopia partners is assisting the government of Ethiopia on standardization of
task shifting and HIV treatment, prevention, care, support services for health workers. On this line, WHO will
continue to provide technical assistance to MOH on the implementation phase of the "Treat, Train and
Retain".
As per the request of MOH/HAPCO, WHO with relevant PEPFAR Ethiopia partners will support on creating
a national electronic health workforce database (HRIS) which, provide more reliable information on
workforce demographics, training need, migration patterns and workforce capacity. Information such as the
number of health care workers by cadre, credentials, workforce location, training, and age demographics
can assist the country to more accurately assess workforce needs.
This activity will provide technical assistance to the health centers and community based delivery sites to
have more sustainable as well as improved quality of HIV prevention, care and treatment services. The
capacity of health care providers working at the first level health facilities and HIV/ART program at region,
zonal and district level will be strengthen based on the IMCI/IMAI service delivery approach.
Activities will include: adaptation, standardization and dissemination of the IMAI training materials to
address tuberculosis care with TB-HIV co-management, Prevention of Mother-to-Child Transmission of HIV
(PMTCT), reproductive health (RH) and family planning (FP) in partnership with the MOH and other relevant
PEPFAR partners. The integrated management approaches to health system using IMAI will improve the
case management of HIV and tuberculosis co-management, STI management, improved management of
pediatrics ART, improved maternal health services through the expansion of an integrated approach to
PMTCT, and RH/FP. This will ensure that Ethiopia continues to benefit from innovative technical
approaches supporting the integrated health services across the care continuum for patients.
WHO will work with other key PEPFAR Ethiopia partners, notably the MSH Care and Support Contract, at
the health center and community level on trainings based on service delivery approach. The IMAI clinical
training will target the clinical team at the health center (physicians/health officers, nurses, pharmacy
technicians, and case managers); Expert Patient Trainers (EPT); data clerks and health extension workers.
WHO will closely work with the RHB, local universities and regional nursing colleges to create a pool of
trainers in all 11 regions. Intensified training of trainers (TOT) will be conducted for the potential trainers
selected from regional health facilities, public and private local universities/colleges. These will be resource
trainers both in pre-service as well as the in-service IMAI trainings in each region. As sustainability of the
decentralized ART program is very crucial, WHO in partnership with PEPFAR Ethiopia, regional health
bureaus (RHB) and local universities/colleges will focus on the pre-service training. Through this activity, a
cumulative total of 450 health center will provide ART services and 650 health centers implementing
enhanced palliative care services.
WHO is taking a leading role in development of national clinical mentoring guideline and training materials.
With key PEPFAR Ethiopia partners, WHO will continue in supporting the RHB at different levels in
development of regional implementation plan for clinical mentoring, building regional capacity to facilitate
clinical mentoring and train clinical mentors. Potential mentors will be selected from experienced practicing
HIV/ART clinicians (doctors, health officers and nurse-practitioners). Priority will be given to proficient
clinicians who are already treating HIV patients.
WHO will work in improving the quality of the HIV prevention, care and treatment services at the health
center and community level. This will be done by increasing the capacity of the regional, zonal and district
HIV program teams on integrated health service management. WHO with relevant PEPFAR Ethiopia
partners will link the internationally reputable "Health Service Management and Leadership" short courses
with the local universities in order to capacitate the 11 RHB management team at different levels. This will
assist to have a sustainable indigenous institutional capacity to sustain public health approaches at these
Activity Narrative: key levels of health system in Ethiopia.
Furthermore, WHO will keep on providing one week HIV program management training to increase the
supervisory capacity of zonal and district management teams. In the context of improving the quality of HIV
care and treatment services, WHO with key partners will continue providing the necessary technical and
logistic support for RHB at different levels to conduct a regular supervisory site visits (at least 6 times per
year) and organize a quarterly review meeting among health care providers working at the first level health
facilities and HIV program teams at zonal and district level. The IMAI tools for district HIV coordinators
include standardized case management observation and exit interviews that will be included as part of the
routine reports submitted by district HIV coordinators to regional and national offices.
As Health Network Model is crucial for effective HIV prevention, care and treatment, WHO with relevant
PEPFAR partners will closely work on the continuum of care between the health facilities and the
community. By appropriate training of the health extension workers (HEW) and community
promoters/volunteers, the tracking of ART defaulter cases as well as the referral/back referral linkage
between the first level health facilities and community will be improved. With this activity, WHO with relevant
PEPFAR partners will provide in-service as well as pre-service (22 out of the total 36 Technical and
Vocational Education Training Centers) community IMAI training for Health Extension Workers.
Analysis and routine quality assurance for health center and community work: in order to ensure quality of
services, the following activities will be continued. Certification and licensing of the health workers providing
HIV care and ART; analysis of the routine use of IMAI acute care guideline module; treatment validation
studies of acute care guideline; identification, follow-up and management of HIV exposed and infected
children through IMCI-HIV approach; opportunistic infection prevention and management for persons with
HIV (including routine screening for tuberculosis); and integration of HIV prevention in care and treatment
services.
As to the quality of data on patient monitoring, data clerks at the facility level will be trained and the district
HIV coordinators will be supported to fulfill their role to aggregate data from several facilities and to
supervise health workers in the use of this system. Strengthening of the non-ART data on-site and establish
coordinated linkage of HIV related activities (HCT, OI management, TB management and etc.) is very
crucial. This will be done through regular site visits, during which review of recording and reporting forms
will take place.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16613
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16613 5681.08 U.S. Agency for World Health 7481 1264.08 IMAI $1,350,000
International Organization
Development
10412 5681.07 U.S. Agency for World Health 5477 1264.07 $1,125,000
5681 5681.06 U.S. Agency for World Health 3777 1264.06 $500,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $1,062,500
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
ACTIVITY REMAINS UNCHANGED IN FY09
This is a continuing activity from FY 2007. This activity relates to activities in Prevention, Care, and Support,
Currently the Government of Ethiopia (GOE) is scaling-up the decentralization of the ART services to health
centers ,and to date 139 health centers have started to deliver ART services in the country. To support this
scale-up, the World Health Organization (WHO) has conducted trainings on Integrated Management of
Adult and Adolescent Illness (IMAI) for 1,384 health professionals from 10 of the 11 regions using USAID,
Italian, and Canadian funds.
Critical shortage of human resources, particularly physicians and health officers, is being observed at the
are needed. In response to this situation, the Ministry of Health (MOH) has revised the national guideline
supporting the nurse-centered HIV/AIDS services, featuring task-shifting, particularly in the area of ART
services. The MOH HIV/AIDS Prevention and Control Office (MOH/HAPCO) is working with relevant
stakeholders including PEPFAR Ethiopia and WHO on how task-shifting is implemented during ART
services expansion to the health-center level without compromising the quality of services.
to AIDS, WHO, with PEPFAR Ethiopia partners, is assisting the Government of Ethiopia on standardization
of task shifting and HIV treatment, prevention, care, support services for health workers. On this line, WHO
will continue to provide technical assistance to MOH on the implementation phase of the "Treat, Train and
As per the request of MOH/HAPCO, WHO, with relevant PEPFAR Ethiopia partners, will support creating a
national electronic health workforce database (HRIS) which will provide more reliable information on
workforce demographics, training needs, migration patterns and workforce capacity. Information such as the
number of healthcare workers by cadre, credentials, workforce location, training, and age demographics
This activity will provide technical assistance to the health centers and community-based delivery sites to
have more sustainable as well as improved quality of HIV prevention, care, and treatment services. The
capacity of healthcare providers working at the first level health facilities and HIV/ART program at region,
zonal, and district levels will be strengthen based on the IMCI/IMAI service delivery approach.
address tuberculosis care with TB-HIV co-management, PMTCT, reproductive health (RH) and family
planning (FP), in partnership with the MOH and other relevant PEPFAR partners. The integrated
management approaches to health system using IMAI will improve the case management of HIV and
tuberculosis co-management, STI management, improved management of pediatrics ART, improved
maternal health services through the expansion of an integrated approach to PMTCT, and RH/FP. This will
ensure that Ethiopia continues to benefit from innovative technical approaches supporting the integrated
health services across the care continuum for patients.
the health-center and community level on trainings based on service delivery approach. The IMAI clinical
selected from regional health facilities, public, and private local universities/colleges. These will be resource
WHO will work in improving the quality of the HIV prevention, care, and treatment services at the health
key levels of health system in Ethiopia.
logistic support for RHB at different levels to conduct a regular supervisory site visits (at least six times per
year) and organize a quarterly review meeting among healthcare providers working at the first-level health
Activity Narrative: facilities and HIV program teams at zonal and district level. The IMAI tools for district HIV coordinators
As Health Network Model is crucial for effective HIV prevention, care, and treatment, WHO with relevant
studies of acute care guideline; identification, follow-up and management of HIV-exposed and -positive
Health-related Wraparound Programs
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $187,250
Table 3.3.11:
Support to the GFATM Country Coordinating Mechanism
ACTIVITY UNCHANGED FROM FY2008
COP08 Narrative:
The Government of Ethiopia has secured $713,053,234 million from the Global Fund for five years to
address HIV/AIDS (66%), Malaria (26%), and TB (9%). In order to oversee, facilitate, support and monitor
these funds a Country Coordinating Mechanism (CCM) was established in early 2002. The 17 CCM
members include: Ministry of Health (MOH, 4 members including Chair); HIV/AIDS Prevention and Control
Office (HAPCO) (1); Ethiopian Health and Nutrition Research Institute (EHNRI) (1); WHO (1); Joint United
Nation Program on HIV/AIDS (UNAIDS) (1); Health, Population and Nutrition (HPN) Donors' Group (2);
PEPFAR Ethiopia (1); Department for International Development (DfID) (1); Christian Relief and
Development Association (CRDA) (1); Vice Chair Dawn of Hope (Association of PLWHAA) (1); Ethiopian
Chamber of Commerce (ECC) (1); Ethiopian Public Health Association (EPHA) (1); and the Ethiopia Inter-
Faith Forum for Development Dialog for Action (1).
PEPFAR Ethiopia has made major contributions towards implementation of the Global Fund. Some
examples of the depth and scope of PEPFAR's involvement include: active membership on the CCM since
its inception, technical assistance for proposal development, support of the Secretariat since November
2003, and chairing the sub-committee tasked to prepare the mechanism's Terms of Reference (TOR).
During FY05, FY06, and FY07, PEPFAR provided modest funds to support the CCM Secretariat. This USG
contribution leveraged funds from UNAIDS and the Royal Netherlands Embassy, and has been managed
through the WHO Ethiopia Country Office. PEPFAR Ethiopia proposes to continue this modest funding in
FY08 to assure the successful management of Ethiopia's grants in HIV/AIDS, Malaria, and TB.
The performance of the four Global Fund grants is of concern within the donor community. Recognizing the
Global Fund's operating principle of performance, the CCM's TOR state that it is to submit high-quality
proposals and provide oversight of the proper use of the Global Fund through regular monitoring. The TOR
explicitly states: ". . . the CCM/E will provide a monitoring report on fund status, including its progress,
results and organizations with approved funding and their expected total level of funding." The report will be
made available through a wide variety of communication channels. The CCM Secretariat carries out the
administrative activities that allow the CCM to function smoothly, organizing meetings, ensuring that
relevant documents are available, and supporting CCM members in serving on sub-committees with various
functions. The Secretariat also supports key proposal development processes and funding approval
processes. Without the Secretariat, successful management of Ethiopia's grants, the largest total to any
country in the world, would be extremely problematic.
Continuing Activity: 16614
16614 5620.08 U.S. Agency for World Health 7481 1264.08 IMAI $150,000
10411 5620.07 U.S. Agency for World Health 5477 1264.07 $50,000
5620 5620.06 U.S. Agency for World Health 3777 1264.06 $50,000
Table 3.3.18:
