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
PMTCT Services at Hospital and Health Center Level by Region
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a continuing activity from FY08. In FY08, ITECH has supported 35 health facilities to provide PMTCT
services in Afar, Tigray and Amhara regions. The partner has been successful in promoting PMTCT
services in these regions. Furthermore, ITECH has been actively involved in the national TWG and
supported the rolling out of the revised national PMTCT Guidelines.
ITECH has faced challenges of underutilization of PMTCT services due to low ANC uptake and low
institutional delivery. There was underreporting of key PMTCT indicators, because the PMTCT registration
books at facility level do not capture data on PMTCT program performance at labor and delivery. High staff
turnover at facility level is another challenge that the partner faced. Deteriorating labor and delivery rooms
that need major renovation and shortage of IP supplies at labor and delivery rooms were also other
challenges in FY08.
In FY 09, ITECH will work to address the above challenges and will also build on FY 08 activities and
continue strengthening the PMTCT program at 42 health facilities in Amhara, Tigray and Afar regions. The
number of service outlets has decreased from the planned COP08 targets, because further assessment
revealed that there were logistic problems, poor infrastructure and low patient load, which does not justify
initiation of the program at these health facilities.
In FY 09 ITECH will scale up the PMTCT program in addition to the FY 08 planned activities by including
the following:
1)Support the transitioning of the national PMTCT program from Federal HAPCO to the Family Health
Department (FHD) of the Federal MOH through active participation in the national PMTCT TWG and also
support integration of PMTCT with MCH services
2)Support regional health bureaus and PMTCT TWG to build PMTCT program management capacity at a
regional level and ensure sustainability. ITECH will second a PMTCT advisor to Amhara Regional Health
Bureau to assist in the scale-up, integration, coordination, quality assurance and oversight of PMTCT
program.
3)Promote the Testing and Counseling Support tools for PMTCT at all PMTCT sites.
4)Expand outreach PMTCT services focusing on higher prevalence areas to reach large number of women
not coming to health facilities for ANC or delivery
5)Support strategies and program plans to coordinate Prevention With Positives (PWP) with PMTCT
6)Expand Mothers' Support Group (MSG) to additional 10 sites
7)Assist to strengthen the PMTCT M&E system: ITECH will assist the national and regional PMTCT
program to improve data collection and reporting on key PMTCT indicators
COP08 ACTIVITY NARRATIVE
This is a continuing activity from FY07. In FY07, the University of Washington/I-TECH-supported PMTCT
services in 35 health facilities in Afar, Amhara, and Tigray regions. Building on programs initiated by other
implementing partners in FY05-FY06, I-TECH expanded and enhanced interventions to prevent perinatal
and postpartum transmission, and to link HIV-positive pregnant women and their families to comprehensive
HIV care and treatment services.
In FY08, I-TECH will extend these services to a total of 50 health facilities, working to dramatically reduce
the number of infants born with HIV in collaboration with the Federal Ministry of Health (MOH) and regional
health bureaus (RHB) of Afar, Amhara, and Tigray. I-TECH will provide PMTCT services at two hospitals
and 16 health centers in Afar, 17 hospitals in Amhara, and 12 hospitals and three health centers in Tigray. I-
TECH uses antenatal care (ANC), maternal/neonatal/child health (MNCH), and PMTCT programs as entry
points to HIV care and treatment for women, children, and families. The Government of Ethiopia has revised
the National PMTCT Guidelines that was published in 2001, and issued the new PMTCT Guidelines in July,
2007. I-TECH in collaboration with JHPIEGO will support roll out of the new PMTCT Guidelines in these
regions. Major areas of emphasis include: integration of PMTCT with MNCH services and HIV prevention,
care and treatment programs; provider-initiated routine opt-out HIV testing and counseling at ANC, labor
and delivery; implementation of more potent and complex PMTCT regimens; prompt clinical and
immunologic staging of HIV-positive pregnant women and rapid initiation of ART for eligible patients;
enhancing the quality of infant feeding initiatives; strengthening systems for PMTCT service delivery; and
supporting human resources by providing high-quality training and clinical mentoring.
I-TECH will work to support PMTCT programming at the national, regional, and site levels. At the national
level, as a member of the National Technical Working Group on PMTCT, I-TECH will contribute to the
development of training material, clinical support tools, guidelines, formats and standards. I-TECH will
continue to provide technical input and guidance to the FMOH and Regional Health Bureaus (RHB),
supporting initiatives to expand PMTCT beyond single-dose nevirapine (SD-NVP) where appropriate,
enhancing PMTCT-plus training, and supporting links between PMTCT programs, HIV care and treatment
programs, and pediatric services.
At the facility level, the I-TECH supported package of PMTCT Plus/family-focused care includes:
1) Support for linkages between healthcare facilities and community-based implementing partners, including
PLWH organizations, to promote uptake of antenatal and PMTCT services and to support follow up of
infants enrolled in early infant diagnosis (EID) programs. I-TECH will continue to work on referral linkages
by using case managers at hospitals, and enhance this system through partnership with other USG
partners. It will continue to strengthen the patient referral/linkage network through the development of tools,
training of health professionals, and on-site mentorship
2) Enhanced linkages between ANC, MNCH, PMTCT, family planning (FP), STI, and HIV care and
Activity Narrative: treatment clinics at the facility level
3) Promotion of partner testing and a family-centered model of care, using PMTCT as an entry point to HIV
services for mothers, children, and families
4) Routine, opt-out HIV testing and counseling at ANC, labor and delivery according to national guidelines
5) Active case-finding within families and households using a simple, validated tool—the Family Enrollment
Form
6) Adherence and psychosocial support and enhanced follow-up and outreach services for pregnant women
testing positive for HIV to encourage retention in care. In collaboration with JHPIEGO, implementation of
peer-educator programs and Mothers' Support Groups (MSG) at selected sites, to maximize adherence to
care and treatment among pregnant HIV-positive women, and to strengthen their links to psychosocial
support and community resources.
7) Provision of a basic care package for all HIV-positive pregnant women, including patient education, TB
screening, prophylactic cotrimoxazole (CTX) when indicated, nutritional support (see below), insecticide-
treated bed nets, condoms, and safe water in coordination with the Global Fund to Fight AIDS, Malaria, and
Tuberculosis (Global Fund) and other partners
8) Routine assessment of all HIV-positive pregnant women for ART eligibility using clinical staging and CD4
testing, and provision of prophylaxis and treatment as appropriate, including ART when indicated
9) Nutritional education, micronutrient (MVI) supplementation, and "therapeutic feeding" for pregnant and
breastfeeding women in the six-month postpartum period
10) Enhanced postnatal follow-up of HIV-positive mothers and HIV-exposed infants
11) Promotion of infant-feeding initiatives and healthy infant-feeding practices by facilitating on-site trainings
and mentoring of MNCH staff (including traditional birth attendants) on safe infant-feeding practices in the
context of HIV, developing infant-feeding support tools, and establishing infant-feeding MSG
12) Linkages of all infants born to HIV-positive women to the HIV-Exposed Infant Clinic to ensure EID by
DNA PCR using dried-blood spot (DBS) testing. Enhanced laboratory capacity for infant diagnosis at
selected facilities and strengthened linkages with regional labs at remaining facilities (see the laboratory
narrative). Initiation and expansion of the clinical and health-management information systems (HMIS)
needed to implement EID services
13) Ensuring that HIV-exposed infants are enrolled in care and receive prophylactic CTX, immunizations,
nutritional support, careful clinical and immunologic monitoring, monitoring of growth and development, and
ongoing assessment of eligibility for ART
14) Determination of infection status at 18 months of age for HIV-exposed infants not found to be HIV-
positive via EID
15) Facilitate availability of supplies for PMTCT services
16) Support for site-level staff to implement national performance standards and the JHPIEGO-supported
Standard-based Management Program
17) Provision of PMTCT-Plus training to multidisciplinary teams at the facility level
18) Provision of ongoing clinical mentoring and supportive supervision in partnership with RHB
19) Ongoing development and distribution of provider job aids and patient-education materials
20) Routine monitoring of PMTCT-plus programs, reporting of progress against targets, and ongoing
assessment of linkages within facilities (from PMTCT to ART clinics, for example) and uptake of services by
family members
21) Support for the availability and correct usage of PMTCT registers and forms, HIV-exposed infant
registers and follow up cards, timely and complete transmission of monthly reports to regional and central
levels, and appropriate use of collected data
22) Minor renovation, refurbishing, and repair (as needed) of ANC, labor and delivery rooms, and maternity
wards at JHU-supported sites
23) Radio and TV outreach campaigns and use of information-education-communication/behavior-change
communication (IEC/BCC) materials in local languages to enhance public awareness and use of ANC,
MNCH, PMTCT and HIV care & treatment services.
Additional narrative to COP08 narrative: This activity will provide support for outreach ANC/PMTCT
services. It will train health care workers to provide ANC and PMTCT services to the hard-to reach rural
communities. Trained nurses based at a hospital and health center and Health extension workers will be
involved to provide outreach PMTCT services. Community level PMTCT activities will be linked to the near-
by Hospital or Health center PMTCT programs through referral linkages and establishment of catchments
area networks. Experiences elsewhere and in Ethiopia (JHU and IntraHealth) have shown that outreach
PMTCT services can effectively be utilized to improve the uptake of PMTCT services. ITECH will be
involved in the expanding outreach PMTCT services in Amhara, Tigray and Afar regions.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16656
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16656 5639.08 HHS/Health University of 7487 3786.08 Rapid expansion $1,100,000
Resources Washington of successful
Services and innovative
Administration
treatment
programs
10465 5639.07 HHS/Health University of 5495 3786.07 aa $310,000
Resources Washington
Services
5639 5639.06 HHS/Health University of 3786 3786.06 $160,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $20,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
APRIL 2009 REPROGRAMMING
Strengthening STI services for MARPs
As a result of the Prevention Portfolio Review, we have determined this activity to have 20% AB component
from the previous 100% OP activity.
Expand access to PLHA and other MARPs to comprehensive STI care and treatment services at 38 sites in
Amhara, Tigray and Afar regions.
Prevention of sexually transmitted infections (STI) among most-at-risk populations (MARPs) and people
living with HIV (PLWH) is a critical activity in preventing new HIV infections and slowing the pace of the
epidemic. During FY07 & FYO8 I-TECH supported STI prevention and control activities at 35 sites in Afar,
Amhara, and Tigray regions. The support included training healthcare providers on syndromic management
of STI, and providing technical assistance to implement the syndromic approach at hospital level. I-TECH
has hired an STI technical officer to spearhead this effort and begin the developing an action plan to initiate
the training and assistance that will be needed to affect heightened awareness and treatment of STI by
clinical practitioners at all I-TECH hospital sites. A recent study by CDC/EPHA in selected urban and rural
areas identified a number of barriers that limit the utilization of STI services in the country, operating at
individual, community, health facility, and policy/program levels. These include: at facility level space
problems, shortage of basic functioning diagnostic equipment, failure to implement syndromic management
guidelines, lack of BCC/IEC materials, poor recordkeeping, lack of confidentiality. At provider level lack of
training; health workers lack basic patient counseling and education skills; health workers are judgmental to
patients with STDs. At patient level urban patients buy STI drugs to treat their disease without consulting
health care; government facilities seen as the last resort; fear of stigma, judgmental clinic staff, breach of
confidentiality, long waiting times seen as barriers to attending clinics. One of the major gaps identified by
the ‘Know your epidemic Know your Ethiopian Episynthesis' is lack of data on STIs with only few cases
being reported from health facilities throughout the country. Therefore, the major focus of FY09 shall include
support for sites for STI syndromic data documentation and reporting and support STI surveillance program
within the health-delivery structure in the specified Regions FY09 activities at the hospital/facility level will
include: 1) Continuation support of STI services for a total of 38 sites supported by I-TECH (including 30
public hospitals, two private hospitals, and six health centers) 2) Providing on-site technical assistance to
improve STI diagnosis and treatment following national syndromic management guidelines 3) Onsite
training, supportive supervision, and mentorship of physicians, health officers, and nurses, on STI
prevention, diagnosis, and treatment. The focus will be on the linkages between STI and HIV infection, as
per national guidelines. 4) Have core T.O.T trained at the regional and Zonal health offices 5) Developing
linkages with the Global Fund for AIDS, Malaria, and Tuberculosis and other PEPFAR funded partners to
ensure adequate supplies of STI drugs at all facilities 5) Developing linkages to HIV counseling and testing
services, promoting a provider-initiated, opt-out approach for all STI patients, and providing linkages to care
and treatment services for those who are HIV positive 6) Providing STI education focused on risk-reduction,
screening, and treatment for patients enrolled in HIV/AIDS care and treatment at the hospitals 7) Providing
condoms and education on how to use them, to patients enrolled in care and treatment. There will be a
special focus on MARPs. 8) Integrating STI services into antenatal and PMTCT services to ensure that all
pregnant women are educated about STIs (including education on preventing STI during pregnancy) and
provided with necessary, according to national STI management and antenatal care guidelines 9)
Developing linkages to community-based organizations that promote risk-reduction and HIV/STI prevention
and early/complete treatment in communities surrounding I-TECH-supported ART sites 10) More
Strengthening of STI data recording and reporting system at all levels .Support sites in documenting and
reporting STI syndromic 11) In FY08, I-TECH was provided with supplemental funding to mainstream and
strengthen IEC and BCC programs with its existing care and treatment activities to conduct outreach
activities and promote services with in and outside the health facility areas in three regions of the country
(Amhara, Tigray and Afar). In FY09, I-TECH will strengthen and continue this activity by expanding the
sexual prevention outreach activity using the ABC strategy in two local universities-Mekelle and Gonder
Universities. In FY09, ITECH will facilitate and coordinate linkages between STI and HIV/AIDS services.
One of the major gaps identified by the ‘Know your epidemic Know your response of Ethiopian Episynthesis'
is lack of data on STIs with only few cases being reported from health facilities throughout the country.
Therefore, the major focus of FY09 shall include support for sites for STI syndromic data documentation
and reporting and support STI surveillance program within health-delivery structure. Others include having
core T.O.T trained at the regional and zonal health offices and providing on-site training.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
Strengthening STI services for MARPS
ACTIVITY MODIFIED IN THE FOLLOWING WAYS
epidemic.
During FY07 & FYO8 I-TECH supported STI prevention and control activities at 35 sites in Afar, Amhara,
and Tigray regions. The support included training healthcare providers on syndromic management of STI,
and providing technical assistance to implement the syndromic approach at hospital level. I-TECH has hired
an STI technical officer to spearhead this effort and begin the developing an action plan to initiate the
training and assistance that will be needed to affect heightened awareness and treatment of STI by clinical
practitioners at all I-TECH hospital sites.
A recent study by CDC/EPHAin selected urban and rural areas identified a number of barriers that limit the
utilization of STI services in the country, operating at individual, community, health facility, and
policy/program levels. These include: at faclility level space problems, shortage of basic functioning
diagnostic equipment, failure to mplement syndromic management guidelines, lack of BCC/IEC materials,
poor recordkeeping, lack of confidentiality. At provider level lack of training; health workers lack basic
patient counseling and education skills; health workers are judgmental to patients with STDs. At patient
level urban patients buy STI drugs to treat their disease without consulting health care; government facilities
seen as the last resort; fear of stigma, judgmental clinic staff, breach of confidentiality, long waiting times
seen as barriers to attending clinics.
One of the major gaps identified by the ‘Know your epidemic Know your Ethiopian Episynthesis' is lack of
data on STIs with only few cases being reported from health facilities throughout the country. Therefore, the
major focus of FY09 shall include support for sites for STI syndromic data documentation and reporting and
support STI surveillance program within the health-delivery structure in the specified Regions
FY09 activities at the hospital/facility level will include:
1) Continuation support of STI services for a total of 38 sites supported by I-TECH (including
30 public hospitals, two private hospitals, and six health centers)
2) Providing on-site technical assistance to improve STI diagnosis and treatment following national
syndromic management guidelines
3) Onsite training, supportive supervision, and mentorship of physicians, health officers, and nurses, on STI
per national guidelines.
4) Have core T.O.T trained at the regional and Zonal health offices
5) Developing linkages with the Global Fund for AIDS, Malaria, and Tuberculosis and other PEPFAR funded
partners to ensure adequate supplies of STI drugs at all facilities
5) Developing linkages to HIV counseling and testing services, promoting a provider-initiated, opt-out
approach for all STI patients, and providing linkages to care and treatment services for those who are HIV
positive
6) Providing STI education focused on risk-reduction, screening, and treatment for patients enrolled in
HIV/AIDS care and treatment at the hospitals
7) Providing condoms and education on how to use them, to patients enrolled in care and treatment. There
will be a special focus on MARPs.
8) Integrating STI services into antenatal and PMTCT services to ensure that all pregnant women are
educated about STIs (including education on preventing STI during pregnancy) and provided with
necessary, according to national STI management and antenatal care guidelines
9) Developing linkages to community-based organizations that promote risk-reduction and HIV/STI
prevention and early/complete treatment in communities surrounding I-TECH-supported ART sites
10) More Strengthening of STI data recording and reporting system at all levels .Support sites in
documenting and reporting STI syndromic
11) In FY08, I-TECH was provided with supplemental funding to mainstream and strengthen IEC and BCC
programs with its existing care and treatment activities to conduct outreach activities and promote services
with in and outside the health facility areas in three regions of the country (Amhara, Tigray and Afar). In
FY09, I-TECH will strengthen and continue this activity by expanding the sexual prevention outreach activity
using the ABC strategy in two local universities-Mekele and Gonder Universities.
In FY09, ITECH will facilitate and coordinate linkages between STI and HIV/AIDS services. One of the
major gaps identified by the ‘Know your epidemic Know your response of Ethiopian Episynthesis' is lack of
support STI surveillance program within health-delivery structure. Others include having core T.O.T trained
at the regional and zonal health offices and providing on-site training.
Continuing Activity: 16642
16642 10648.08 HHS/Health University of 7487 3786.08 Rapid expansion $420,000
10648 10648.07 HHS/Health University of 5488 3786.07 $100,000
* Addressing male norms and behaviors
* Reducing violence and coercion
Table 3.3.03:
Rapid expansion of successful and innovative treatment programs
In FY09, I-TECH will strengthen the prevention with positive efforts by further standardizing healthy living
promotion efforts and encouraging involvement of people living with HIV. For the later, I-TECH will work
closely with Addis Ababa HIV/AIDS Prevention and Control Offices and its sub-partner Organization for
Social Services for AIDS. I-TECH will use its experience of developing prevention with positives training
manual for health workers in further adopting the material for training a PLWH in social support group.
Trained PLWH will facilitate discussion in PLWH support group and mobilize the community in a view
toward creating conducive environment for disclosure of HIV status. I-TECH will also support the
development of a strategic framework on positive prevention through a participatory process with key
stakeholders. I-TECH will also continue its lead in positive prevention roll out and integration of positive
prevention and in the national comprehensive prevention strategy
COP 08 ACTIVITY NARRATIVE:
In FY07 and FY08, the University of Washington/I-TECH is working on palliative care and prevention with
positives activities. In FY06, I-TECH introduced a basic palliative care approach to 31 ART facilities. In
FY07, they expanded this activity to 35 sites in Operational Zone 1 (Afar, Amhara, and Tigray regions).
Initial work included baseline assessment of the palliative care activities at sites, development of pain
management guidelines, and development of palliative care training curriculum in collaboration with relevant
government stakeholders. I-TECH also conducted regular supervision of palliative care activities at site
level. The palliative care curriculum developed by I-TECH was integrated as part of the basic
comprehensive HIV training, including ART. Training and supervision focused on identification of pain and
discomfort among HIV patients, ensuring cotrimoxazole prophylaxis (pCTX) for all eligible patients,
tuberculosis (TB) screening for HIV-positive patients, and targeted elements of the preventive care package
(e.g., multivitamins, nutrition assessments, condoms, and links to programs that distribute insecticide
treated bed nets (ITN).)
As a lead partner in palliative care among US-based university partners, I-TECH, in collaboration with the
Ethiopian Drug Administration and Control Authority and PEPFAR partner organizations, has developed the
National Pain Management guideline to aid proper assessment and management of pain at all levels of
healthcare. As an active member of the National Palliative Care Task Force, I-TECH is working with other
stakeholders in the development of the National Palliative Care Guideline and coordination of palliative care
program implementation at the national level.
In FY07, 5 417 persons received palliative care, and 60 000 tablets of cotrimoxazole (CTX) and 1 000
bottles of CTX were provided to ART sites in the Afar region as emergency support.
In FY08, I-TECH is supporting care and support activities at 46 sites that provide HIV/AIDS care and
treatment (hospitals and emerging region health centers), via a multidisciplinary, family-focused approach to
providing the preventive care package for both adults and children. This approach incorporate best
practices for health maintenance and prevention of opportunistic infections for people living with HIV
(PLWH), slowing disease progression and reducing morbidity and mortality.
I-TECH is assisting hospitals in Afar, Amhara, and Tigray to provide the preventive care package,
complementing the Global Fund for Aids, Tuberculosis and Malaria (GFATM), federal Ministry of Health,
and other PEPFAR Ethiopia-funded activities when possible. I-TECH will focus on provision of the
preventive care package, which for adults includes: pCTX; micronutrient (multivitamin) and nutrition
supplements and counseling; ITN, through links with the Global Fund malaria control program; point-of-use
water disinfectant (wuha agar) at hospital level and health education about safe water use; condoms and
education for prevention among positives; and screening of partners and family members of PLWH, as well
as TB screening and isoniazid (INH) preventive therapy. The preventive care package for children includes:
pCTX to prevent serious illnesses like Pneumocystis carinii pneumonia, TB, and malaria; prevention and
treatment of diarrhea; nutrition and micronutrient supplements; and links to national childhood immunization
programs.
In FY09 I-TECH will continue to work closely with PEPFAR Ethiopia's other US-based university partners to
ensure complementarily of activities in the implementation of national pain management guidelines and the
palliative care training curriculum.
In FY09, I-Techs' support to facilities will be continued or expanded as follows:
1) Strengthen the internal and external linkages required at facility level to identify HIV-positive individuals
and provide them with access to care. Internal linkages include referrals to the HIV/AIDS/ART clinic from
the antenatal clinics, TB clinics, under-5 clinics, inpatient wards, out-patient departments, and voluntary
counseling and testing. External linkages include referrals to and from community-based resources
providing counseling, adherence support, home-based care, and financial/livelihood and nutritional support
2) Provide on-site implementation assistance, including staff support, implementation of referral systems
and forms, and support for monthly HIV/AIDS team meetings to enhance linkages
3) Provide training on palliative care and the preventive care package to multidisciplinary teams
4) Provide clinical mentoring and supervision to multidisciplinary teams related to the care of PLWH,
including those who do not qualify for or choose not to be on treatment, in partnership with regional health
bureaus in the respective regions
5) Continue to develop and distribute provider job aids and patient education materials related to palliative
care and positive living
6) Identify and sensitize community-based groups to palliative care, to the importance of adherence to both
care and treatment for PLWH, and to the palliative care services available at the facility level
7) Improve nutrition assessment at health facilities
8) Promote interventions (pharmacologic and non-pharmacologic) to ease distressing pain or symptoms
Activity Narrative: 9) Continue patient management after hospital discharge if pain or symptoms are chronic
10) Link patients with community resources after discharge
11) Continue to provide safe water interventions like point of use water treatment by disinfectant and
general personal and environmental hygiene for people living with the virus and families.
I-TECH will ensure that all supported sites have reliable stocks of CTX tablets and promote TB screening
and provide INH prophylaxis for HIV-positive adults and children. (See also the activity section on TB/HIV
activities.) Supportive supervision and mentorship will be strengthened to ensure that standard operating
procedures and national guidelines for the provision of CTX and INH prophylaxis are being followed.
Attention will be given to the issue of HIV/malaria co-infection, and the routine provision of ITN in HIV/AIDS
and PMTCT programs in collaboration with the Global Fund. In FY08, I-TECH will continue its national-level
support through active participation in the National Palliative Care Task Force and through organizing
workshops to advocate for the integration of palliative care (including the preventive care package) in the
overall healthcare system. I-TECH will also address the human resource issue by increasing healthcare
worker training through the standardized palliative care curriculum.
In FY08, I-TECH spearheaded the establishment of a Federal HIV/AIDS prevention and Control Office
(FHAPCO) lead prevention with positives core team. The team is working toward standardizing and scaling
up prevention effort targeting PLWH at care and treatment setting. The core team develops strategic
framework outlining activities like training for health workers at different levels; sensitization workshop at
national and regional levels, addressing reproductive health rights and needs of PLWH; harmonizing
behavioral change message at health facility, community and mass media level to maximize the synergistic
effect. I-TECH led the adoption of well piloted prevention with positive training material to be used by health
care providers in care and treatment settings in Ethiopia. The training material was reviewed by experts
drawn from government of Ethiopia, other USG partners and different UN agencies. In FY09, I-TECH will
strengthen the prevention with positive efforts by further standardizing healthy living promotion efforts and
encouraging involvement of people living with HIV. For the later, I-TECH will work closely with Addis Ababa
HIV/AIDS Prevention and Control Offices and its sub-partner Organization for Social Services for AIDS. I-
TECH will use its experience of developing prevention with positive training manual for health workers in
further adopting the material for training a PLWH in social support group. Trained PLWH will facilitate
discussion in PLWH support group and mobilize the community to create a conducive environment for
disclosure of HIV status. At most effort will be exercised to ensure that disclosing status will not incite
violence. The following strategies will be further promoted and implemented to: create enabling
environments for the empowerment of people with HIV; protect and promote human rights and ethical
principles, including the right to privacy, confidentiality, informed consent and the duty to do no harm; and
work with all partners to prevent the stigmatization of PLWH while focusing on their specific needs and
rights. The meaningful involvement of PLWH is instrumental and will be promoted in all prevention-with-
positives activities throughout PEPFAR Ethiopia's care and treatment programs. I-TECH will continue to
implement prevention-with-positives activities which include: promotion and education on the use of
condoms; partner and family screening; education and counseling on positive living; and addressing the full
spectrum of transactional sex, particularly in urban settings. Along with these efforts, some opportunities
may exist for more strategic access to condoms, condom distribution and condom education.
Continuing Activity: 16643
16643 5767.08 HHS/Health University of 7487 3786.08 Rapid expansion $550,000
10501 5767.07 HHS/Health University of 5488 3786.07 $333,000
5767 5767.06 HHS/Health University of 3786 3786.06 $400,000
Table 3.3.08:
April 2009 Reprogramming:
Expansion of HIV/AIDS Pre service Education Problem Statement Ethiopia's goals for expanding access to
HIV/AIDS prevention, care, and treatment services consistently face common and recurring challenges,
particularly when dealing with human resources. These include absolute shortages in terms of numbers, an
inadequate knowledge and skills base which require extensive and expensive in-service training, and poor
distribution and low motivation of those healthcare workers in the system. The crisis in human resources for
health is most severe in emerging regions, where vacancy and attrition rates are nearly double the national
average.
In FY06 and FY07, JPIEGO (PEPFAR partner) worked with seven health professional schools of three
major universities (Addis Ababa University, Gondar University, and Jimma University) to integrate and
strengthen the teaching of HIV/AIDS in pre-service education. Efforts included: consensus-building
workshops with stakeholders; an in-depth needs assessment; faculty updates in HIV/AIDS content areas,
effective teaching skills, infection prevention, etc.; and the development of educational standards specific to
this program and linked with the Higher Education Relevance and Quality Agency (HERQA) standards.
Also, the PEPFAR partner worked with instructors to develop relevant teaching materials for HIV/AIDS and
supported individual departments and schools in introducing these into relevant sections of the curriculum.
The PEPFAR partner also procured teaching equipment, including computers, LCD projectors, screens,
TVs and VCRs, printers, overhead projectors, clinical models, teaching charts, DVDs, videos, etc. for
distribution to each school. As of July 2007, 87 faculty attended training workshops (with many attending a
series involving both HIV/AIDS updates and effective teaching skills), and 349 students received pre-
placement training prior to graduation. The effective teaching skills component, in particular, has led
faculties to re-think and re-design how they deploy students to clinical practice sites (e.g., Jimma), and to
adopt the use of clinical preceptors as a way of maximizing mentoring of students in clinical areas.
In FY08, the PEPFAR partner consolidated its efforts in the three universities and expand to new cadres
within the university. These cadres included laboratory technicians, pharmacists and others. The partner
worked with PEPFAR partners—Strengthening Pharmaceutical Systems (SPS) and a CDC laboratory
partner. The partners worked to update faculty knowledge and skills and revise curricula, and provided
effective teaching-skills training and teaching equipment. The partner also applied the Standards Based
Education Management and Recognition (SBEM-R) approach for strengthening the quality of the pre-
service education. In addition, the partner applied the lessons learned in university settings to regional
health college for diploma-level nursing education. With the assumption that nurses recruited from and
trained in the regions of Gambella and Benishangul are more likely to stay in in the regions for a longer
proportion of their career, the PEPFAR partner strengthened the nursing schools in Gambella and
Benishangul and prepared them to accept larger intakes of students. The focus was on HIV/AIDS content,
but the strengthening will include equipping classrooms and clinical skills labs, ensuring good scheduling of
clinical attachments/internships so that students learn by doing, upgrading faculty skills, etc, and testing
whether the SBEM-R methodology can be effectively applied in such a setting. Core groups of
faculty/tutors will also receive training in effective teaching skills and HIV/AIDS content support, working
with PEPFAR partners to carry out the latter as appropriate. Educational development centers will be
established in large universities and in all participating schools. The partner established a core team of
"Educational Mentors for Health" to build capacity for internal development of instructors and to overcome
the problem of teacher turnover. The PEPFAR partner continued to support the development of printed
materials, tools (question banks, learning resource packages for faculty, clinical attachment logbooks for
students, etc.) and support for other resources, such as teaching supplies/equipment, models, and other
supplies for clinical skills labs, as the curriculum development evolves. The partner shared other resources
that are available to school faculties and leadership, such as the virtual/distance leadership course
established by the Leadership and Management Support project, which is funded by the US Agency for
International Development.
In FY 09 these activities were reprogrammed from JHPIEGO to I-TECH (International Training & Education
Center on HIV, University of Washington) to implement the following activities.
• Ensure that one Academic Development and Resource Center (also known as educational development
centers) is established and strengthened at each of the two universities in the cities of Gonder and Mekele
• Ensure that two skills laboratory are strengthened
• Ensure that competency-based education is promoted and strengthened at the universities in the cities of
Gonder and Mekele
• Educational quality is improved based on the increment in achievement of performance standards through
standards-based educational management and recognition
• 50 instructors will be trained on effective teaching skills
• 50 instructors will be trained on Instructional Design (ID)
• 50 instructors will be trained on student's performance assessment teaching and student performance
assessment will be improved.
• In collaboration with the Ministry of Education, Ministry of Health, the Higher Education Relevance and
Quality Agency, and professional associations, accreditation and licensure processes will be developed and
implemented
• Pre-service HIV/AIDS education strengthening support is expanded to other health science disciplines and
universities
• Practical training sites and their linkages with teaching institutions are strengthened; through training of
preceptors and strengthening the support to practical sites.
Table 3.3.09:
ACTIVITY UNCHANGED FROM FY2008
This is a continuation of activity from FY08.
UPDATE
As of March 31, 2008, 38,146 HIV patients initiated on ART, and 26,353 ART patients were regularly
receiving their treatment from 35 I-TECH supported facilities in three regions of the country (Amhara region,
Tigray region and Afar region). These achievements already exceed the targets set for the reporting period,
with six more months to go before the end of the reporting period for COP 07.
This activity will continue in COP 09, and I-TECH will support the enrollment of new patients and maintain
quality care and treatment of those already taking ART.
I-TECH will provide intensive comprehensive technical support to ART hospitals in Amhara and Tigray
regions, and to ART hospitals and ART health centers in Afar region in partnership with the regions. This
will be done through established regional and field-based teams.
The expanded regional ART teams include a physician coordinator, pediatrician, a lab technician, a
program assistant, a monitoring and evaluation coordinator and a data manager for each of the three
regions. These teams will continue to work in close collaboration with the Regional Health Bureaus (RHB).
There will also be an enhanced focus on the quality of all services in our continuing efforts to strengthen
and focus on positive clinical outcomes. The teams will identify the training needs of the multidisciplinary
teams at the ART sites in the I-TECH supported regions.
I-TECH will work with partners working at health center and community levels to improve the referral system
and the function of the network in its operation zone, so that stable patients will be transferred from
congested, high load ART sites to health center ART sites near to patients' residencies. It will also ensure
delivery of comprehensive, quality care and treatment services to HIV patients through better linkage to
community services. I-TECH will work with partners at health center and community level to coordinate the
different services to HIV patients in order to ensure the continuum of care.
This will contribute to improved patient out-come and retention to care and treatment services. In addition, I-
TECH will continue its support for case management in order to optimize linkages between the different
programs within the facilities, between the facilities in the network, and between the facilities and community
services. It will also involve People Living with HIV (PLWH) and their associations in different activities,
including adherence counseling, patient tracking, and care and support.
I-TECH will provide periodic entry-level training on: providing ART; tuberculosis (TB)/HIV collaborative
activities; and voluntary counseling and testing (VCT), PMTCT and sexually transmitted infections services.
1) In addition to developing "Centers of Excellence" for HIV and infectious disease training at Gondar and
Mekele Universities, I-TECH will continue to support and give technical assistance in upgrading ALERT
Hospital as a demonstration training center by assisting with training curriculum development and modeling
the HIV practice set-up.
2) Trainings of trainers (TOT) will continue to be used for multi-disciplinary training and their roles will be
expanded for training and mentoring at all levels of practice within the hospital setting, including the ART
clinic and the key programs including the VCT, PMTCT and TB programs. Each health facility in I-TECH-
supported regions will have at least one skilled trainer who would be able to train on at least one area.
3) I-TECH will continue to work with its USG partners and the MOH in the primary role of ART training-
related activities, including curriculum review and development, nurse practice training and certification, and
development of new or innovative ART team members.
4) As the demand for ART provider nurses has increased, as a continuation of this activity and to conduct
this training on a broader scale, I-TECH will train & offer TOT for nurse ART providers, and work with US
uiversities throughout the country to prepare them to mentor their own nurse ART providers. I-TECH will
also work with Management Sciences for Health (MSH) to ensure that the nurse trainings and curricula are
made available to the nurse cadre seeing patients at health centers including the development of TOT for
that segment. In addition I-TECH will ensure that standardized site visits to all regions through mentoring of
mentors are conducted in collaboration with MOH, HIV/AIDS Prevention and Control Offices, and US
universities.
5) I-TECH has started and piloted an ART case-management model. In FY07, the National ART Case
Management Model was finalized, ART case-management curriculum was developed, and six case
managers were hired in order to pilot case-management services at six major hospitals in Amhara, Tigray,
and Afar regions. I-TECH will be training more ART case managers, and will work with the MOH, HAPCO
and US universities to expand this activity. It will also provide the training curricula and TOT to MSH in order
to ensure that a standard model of case management exists at both hospitals and health centers supported
by USG.
6) I-TECH will continue to support MOH and Federal HAPCO in the development of different guidelines and
mentoring training manuals in response to HAPCO's request to lead these activities. As a national technical
lead on training, I-TECH will continue to give TA to organizations that implement the ART program at health
centers, particularly in development of curricula and TOT.
Site level:
Activity Narrative: I-TECH site mentors, consisting of a physician for ART support, lab technologist, nurse, and monitoring and
evaluation staff teams, will regularly visit all regional ART sites to: provide system support for clinics,
laboratories, and pharmacies; identify and provide multidisciplinary team training; provide regular mentoring
and case consultation to physicians and nurses; and address issues that are identified as barriers to the
efficient and effective care of ART patients. These mentors will be part of a regional ART team for each of
the three regions and each team will be assigned to assist 3-4 health facilities per team. The ART team will
work in close collaboration with the RHB but will report to the I-TECH medical and country director as
appropriate.
I-TECH will integrate a post-exposure prophylaxis (PEP) protocol and approach for both government
employed clinicians, as well as its own staff at all I-TECH sites. I-TECH will also provide protocols and
training for victims of sexual assault, and ensure that PEP-related drugs are in place in all of its sites.
Victims have virtually no access to information on HIV/AIDS or the preventive services such as PEP; the
need for information, services, and trained practitioners will be met both by site-level training and by
including the training in I-TECH's trainings.
Local Universities Support:
I-TECH will further strengthen the two demonstration sites at Gondar and Mekele Universities as venues for
training and clinical preceptorship for health providers in the Amhara, Tigray and Afar regions. These
demonstration centers will also provide the continuum of care for ART services beyond the hospital,
extending to the community through case managers, palliative care providers, and linkages to health
centers in the major hospital catchments.
Continuing Activity: 16644
16644 10439.08 HHS/Health University of 7487 3786.08 Rapid expansion $9,633,980
Palliative Care
ACTIVITY IS REPLACED ENTIRELY AS FOLLOWS:
In FY07 and FY08, the International Training and Education Center on HIV-University of Washington (I-
TECH) supported the implementation of pediatric care and support as part of the care and support activities,
previously categorized as palliative care. In FY07 and FY08, I-TECH supported basic pediatric care and
support services at 37 facilities. These included: an initial assessment of site-level palliative care activities,
training of the multidisciplinary team, site-level clinical mentoring, enhancement of data collection and
reporting, minor renovations, and supportive supervision pediatric care and support services. Other services
included training and supervision focused on identifying and managing symptoms, pain, and discomfort
among HIV-positive children, and on providing cotrimoxazole prophylaxis (pCTX), tuberculosis (TB)
screening, and key elements of the preventive-care package, such as multivitamins and nutritional
assessments. This program was introduced to the hospitals in Operational Zone 1 (Afar, Amhara, and
Tigray regions).
I-TECH supported all facilities in an effort to ensure facility-based care for HIV-exposed children aimed at
extending and optimizing quality of life for HIV-infected children and their families throughout the continuum
of illness. Clinical care includes
1) Supporting sites to perform early infant diagnosis, preventing and treating opportunistic infections (OI),
excluding TB, and other HIV/AIDS-related complications including malaria and diarrhea
2) Providing access to commodities such as pharmaceuticals, insecticide treated nets, safe water
interventions and related laboratory services
3) Providing pain and symptom relief
4) Providing nutritional assessment and support including the distribution of food.
In FY09, I-TECH will continue to support pediatric care and expand activities in all facilities providing adult
HIV care and treatment via a multidisciplinary, family-focused approach to providing the preventive care
package for children. This approach will incorporate best practices for health maintenance and the
prevention of opportunistic infections for children with HIV slowing disease progression and reducing
morbidity and mortality. I-TECH will continue to participate in the revision of the developed national pediatric
guideline and standard operating procedures for pediatric HIV care as appropriate. In the face of having a
national guideline which adopts WHO recommendations for early diagnosis and initiation of treatment, I-
TECH will work to improve access to early infant HIV diagnostics using Dried-blood spot DNA PCR testing
and networking to avail the service to hospitals and health centers.
I-TECH will continue to provide the preventive care package, complementing the Global Fund for AIDS,
Tuberculosis, and Malaria (Global Fund), the Federal Ministry of Health, and other USG-funded activities
when possible. I-TECH will focus on provisions of the preventive care package for children. The package for
children includes: appropriate prophylaxis and ITN to prevent serious illnesses like Pneumocystis carinii
pneumonia, TB, and malaria; symptom management; prevention and treatment of diarrhea; nutrition and
micronutrient supplements; and linkage to national childhood immunization programs. I-TECH will also
ensure that all HIV-positive children receive careful and consistent clinical, developmental, and immunologic
monitoring to promptly identify those eligible for ART. Orphans and other vulnerable children (OVC) enrolled
in care and treatment will be prioritized for palliative care services and linked to community-based OVC care
programs in order to receive a continuum of care.
I-TECH and the International Center for AIDS Care & Treatment Programs-Columbia University (ICAP-CU)
support to facilities will be continued or expanded as follows. ICAP-CU will:
1) Strengthen the internal and external linkages required at facility level to identify HIV-positive children and
provide them with access to care. Internal linkages include referrals to the HIV/AIDS/ART clinic from
antenatal clinics, TB clinics, under-5 clinics, inpatient wards, out-patient departments, as well as voluntary
providing counseling, adherence support, and financial/livelihood and nutritional support
and forms, and support for monthly pediatric team HIV/AIDS team meetings to enhance linkages
3) Provide training on pediatric care and support and the pediatric preventive care package to
multidisciplinary teams
4) Provide clinical mentoring and supervision to multidisciplinary teams for care of infected children,
5) Continue to develop and distribute pediatric provider job aids and patient education materials related to
pediatric care and support
6) Identify and sensitize community-based groups to palliative care to increase awareness of importance of
adherence to both care and treatment services available at the facility level
7) Improve nutrition assessment of children at health facilities
9) Continue patient management after hospital discharge if pain or symptoms are chronic
10) Link families with community resources after discharge
I-TECH activities will promote prophylaxis (pCTX) and treatment for opportunistic infections in accordance
with national guidelines. Appropriate use of pCTX is an essential element of care for HIV-positive children,
and for HIV-exposed infants, and will be an important component of I-TECH implementation activities,
especially at those sites not yet providing ART. I-TECH will ensure that all supported sites have reliable
stocks of CTX syrup, and will provide emergency supplies when at a time of absolutely necessary to ensure
quality and continuity of care. Similarly, TB screening and isoniazid prophylaxis (IPT) will be promoted and
provided for HIV-positive children. (See TB/HIV narrative). Supportive supervision and the institution of
standard operating procedures (SOP) will improve the use of CTX and IPT.
Activity Narrative: Those sites with "therapeutic feeding-by prescription" will target HIV-exposed or infected infants who are no
longer breastfeeding along with HIV-positive pregnant or breastfeeding women and malnourished patients. I
-TECH will continue to work with Johns Hopkins University which is a leader in hospital-level nutrition
programs. The family of children graduating from therapeutic program will be linked to a food security
program as appropriate.
Table 3.3.10:
ITECH Pediatric Treatment
This is a continuing activity from FY05, FY06, FY07, and FY 08 which has previously been included as a
treatment/ARV services. I-TECH has played the vital role of implementing pediatric ART in Afar, Amhara,
and Tigray, in partnership with the regions. In FY08, JHU-supported sites have initiated 1929 children on
ART, 1530 are currently on ART.
In FY08, I-TECH actively participated in the national pediatric care and treatment activities to update and
enhance national policies, protocols, and guidelines on pediatric HIV. As a national technical lead on
training, I-TECH supported Ethiopia's Ministry of Health (MOH) and Ethiopia's Federal HIV/AIDS
Prevention, Care, and Support Organization (HAPCO) in the development and harmonization of training
materials on pediatric care and treatment for primary healthcare providers working at health centers, and
assisted in the development of different guidelines. I-TECH supported full-spectrum pediatric HIV
prevention, care, and treatment services at 32 hospital and 5 health center networks and is currently on
track in meeting targets for COP08. I-TECH has effectively supported the decentralization of ART services
to health centers in Afar region through training staff from health centers, establishing catchment area
meetings, providing ongoing clinical mentoring, and developing SOPs to facilitate appropriate "down
referral". This enables health centers to follow stable patients or initiate ART services in some cases and
refer complex cases to hospitals (up-referral).
In FY09, I-TECH will strengthen and expand the implementation of pediatric care and treatment at all
facilities providing adult ART services. At the national level, I-TECH will continue to support the Ethiopian
Federal Ministry of Health's (MOH) National Pediatric HIV/AIDS Care and Treatment Program, by
continuing and expanding the following activities:
1) Assist the Government of Ethiopia (GOE) in updating national policies and guidelines on pediatric HIV
2) Expand the national pediatric care and treatment training curriculum and continue widespread distribution
of pediatric support materials
3) Assist with the integration of pediatric monitoring and evaluation into existing care and treatment tracking
systems
4) Provide technical input into the development/revision and implementation of forms, registers, and
charting tools for pediatric care and treatment
5) Support radio and TV campaigns and the use of Information, Education and Communication and
Behavior Change Communication (IEC/BCC) materials in local languages to enhance public awareness of
pediatric HIV care & treatment services
I-TECH will continue to provide technical support in the areas of family-centered HIV care and treatment
and will work with the National ART Program to strengthen the growing Ethiopian PMTCT program and
linkages to pediatric care and treatment services. I-TECH will contribute its experience with treatment of HIV
-exposed and infected infants and children and assist with the expansion of national pediatric treatment
guidelines.
At the regional level, I-TECH will work with Regional Health Bureaus (RHB) in its operational zone and other
partners to build their capacity to effectively design, implement, and evaluate pediatric HIV/AIDS programs.
I-TECH will also work with RHBs to evaluate the clinical, infrastructural, management and informatics needs
of facilities and develop implementation strategies to enable each facility to meet required national
standards for pediatric HIV care and treatment. The need to expand routine treatment of children, which
was a focus point in FY08 and addressed by the hiring of three pediatricians, will be further expanded in
FY09 through working with the sites RHB and MSH to assure referral from health centers to hospitals as
In FY09, emphasis will be placed on increased pediatric ART services at all sites. I-TECH will focus on
improved entry points for children by supporting
1) Family-focused care and family testing
2) PIHCT at under-5 clinic, pediatric inpatient, TB clinic and EPI clinic
3) Linkages with PMTCT service and improved infant follow-up
4) Linkages with orphan and other vulnerable children programs and orphanages
5) Advocacy to create better awareness among health professionals and the community to improve the
attitude towards pediatric care and treatment
In FY09, on-site assistance will be provided to develop medical records for HIV-exposed and infected
children, referral linkages, patient follow-up and adherence support defaulter tracing mechanisms.
Moreover, more frequent site-level clinical mentoring and supportive supervision will be carried out at all
hospitals and health centers providing pediatric care and treatment service in I-TECH supported regions. I-
TECH site mentors, consisting of a pediatrician for ART support, lab technologist, nurse, and monitoring
and evaluation staff teams, will regularly visit all regional pediatric ART sites to
1) Provide system support for clinics, laboratories, and pharmacies
2) Provide regular mentoring and case consultation to physicians and nurses
3) Address issues that are identified as barriers to the efficient and effective care of children on care and
Collaborating with the International Center for AIDS Care and Treatment Programs-Columbia University
(ICAP-CU) and other partners, I-TECH will continue support to all sites in pediatric care, by training
pediatricians and other health workers and integrating pediatric ART into current ART activities. Assessing
and improving quality of service for pediatric care and treatment through a standardized approach in all
operating sites will be one of the core activities in FY09. Through coaching and mentoring visits to hospitals,
I-TECH's field-based clinical teams would work to ensure quality of pediatric care and treatment services in
pediatric service outlets.
I-TECH will emphasize strengthening the internal and external linkages including internal referrals to HIV
care clinics from various points of care and through external referrals to and from community-based
Activity Narrative: resources to identify HIV-infected children. Under the ART health network, ICAP-CU will work to establish
and strengthen links between hospital services, different levels of facilities and community based services,
nongovernmental and faith-based organizations, and communities with other partners working at these
levels. OVC enrolled in care and treatment will be prioritized for treatment services and linked to community
-based OVC care programs in order to receive a continuum of care.
I-TECH will support pediatric ART training, according to national guidelines and curriculum. Additional
training, including training on EID, will be provided to all new sites initiating ART in FY09 and to sites
already providing ART services to fill the gaps created by high staff turnover. This will be supplemented by
refresher trainings, focusing on an integrated multidisciplinary team approach to care and treatment.
Advanced training for clinicians working on pediatric care and treatment will continue to be provided through
an ongoing relationship with Hadassah Medical Center in Jerusalem.
I-TECH will work closely with the MOH, the Global Fund for AIDS, Malaria, and Tuberculosis, the Supply
Chain Management System/RPM+, and RHB to ensure drugs purchased to treat opportunistic infections
(OI) are distributed rationally, and to develop OI drug access for all HIV-exposed and infected children. The
availability of consistent and quality laboratory services including early infant diagnosis at all these sites is
critical to ensure quality comprehensive pediatric care and treatment services.
Table 3.3.11:
TB/HIV Linkage at Hospital Level
FY 08, I TECH has supported TB/HIV collaborative activities in 35 health facilities through providing training
for 189 health care providers, routine HIV counseling and testing at TB clinic, intensified case detection in
ART clinic and provision of IPT and CPT in Operational Zone 1 (Afar, Amhara, and Tigray regions). I TECH
has also supported the establishment of THAC in Tigray region to coordinate the implementation of full
package of TB/HIV activities. More over, I TECH is an active member of national TB/HIV and MDR TB
Technical Working Groups.
In FY09, I-TECH will strengthen its support to MOH in the TB/HIV program implementation in line with
FMOH and OGAC priorities.
TB infection control will be given more emphasis in all HIV care and treatment clinics and wards. Due
emphasis will be given at all facilities in facilitating early detection of infectious TB cases and timely initiation
of treatment and follow up till completion to render them non infectious. Ventilation and lighting will be
considered during renovations and refurbishment of patient examination and counseling rooms, wards and
patient waiting areas. TB infection control measures will be incorporated as part of the hospitals
comprehensive infection control plan. Due attention will be given to prevent spread of TB to other patients
and health care workers at all HIV related clinics through health education, cough triage in the out patient
clinics and isolation of admitted infectious TB patients in the wards.
MDR-TB: As an active member of the national MDR-TB technical working group, I-TECH will participate in
the development and revision of MDR-TB management guideline, protocols and tools. I-TECH will also
support MOH's MDR-TB management initiative both the pilot program at St. Peter's Hospital and the
expansion plan to the regional referral Hospitals.
TB/HIV M&E: Intensive training, supportive supervision and mentorship will be provided to I-TECH
supported facilities to strengthen the TB/HIV information system to generate good quality data. I-TECH will
also assist national and regional TB/HIV review meetings and joint supportive supervisions. A standard
operative procedure will be introduced at the facilities to generate and timely report good quality TB/HIV
data to the national level. The TB/HIV national surveillance sites will given due attention in strengthening
their TB/HIV information system to be able to report on the core TB/HIV activity indicators to the national
level in a sustainable manner.
Pediatric TB/HIV: In FY09, more emphasis will be given during the TB/HIV trainings and site level
mentorship in building the capacity and knowledge of health care workers in pediatric TB diagnosis and
TB/HIV co-management. Pediatric TB and IPT eligibility screening tools will be used to evaluate HIV
exposed and infected children. All eligible TB/HIV co-infected children will be linked to HIV related care and
treatment services through intra-facility and inter-facility referrals. The revised TB/HIV reporting format with
age break down which enables reporting of pediatric TB/HIV activities separately will be used for TB/HIV
activity reporting at all sites.
In FY09, I-TECH will continue to strengthen and expand TB/HIV activities in Operational Zone 1 at the 38
sites. I-TECH will support improved access to high-quality HIV counseling and testing services among
patients at TB clinics by training both providers and on-site lay counselors, as well as providing support for
on-site, rapid HIV testing. In addition, I-TECH will continue to support sites to implement routine, provider
initiated HIV counseling and testing (with an opt-out approach) for all TB patients in I-TECH-supported
hospital and health-center settings. I-TECH will also offer prevention counseling, education, and referral to
I-TECH will strengthen intensified, active case-finding for TB in HIV-positive clients by incorporating
screening for TB symptoms into post-test counseling in a number of venues: voluntary counseling and
testing (VCT) centers, sexually transmitted infections (STI) clinics, and antenatal clinics (ANC). Clients with
symptoms will be linked to the newly trained case managers and peer educators to ensure proper TB
diagnosis and treatment. Case managers and peer educators will also encourage family members of their
HIV-positive clients to be tested for HIV and screened for TB, and will offer home visits to do screenings. In
addition, I-TECH will support efforts to improve adherence to TB therapy through case managers and peer
educators. Through its region-based, clinical mentoring teams, I-TECH will sensitize ART-adherence nurses
to the importance of adherence to TB treatment.
As part of their routine activities, region-based ART clinical mentoring teams will continue working with sites
on appropriate diagnosis and treatment of active TB in HIV-positive persons. I-TECH will also ensure that
HIV-positive patients are appropriately provided with isoniazid preventive therapy (IPT), through regular
supportive supervisory visits by field-based clinical mentoring teams to all 38 hospital sites. ITECH will
support sites in the provision of cotrimoxazole preventive therapy (CPT) for all TB/HIV co-infected patients.
I-TECH will establish and strengthen the multidisciplinary care teams in each facility, with representation
from the TB service to facilitate referral and linkage to care and treatment services. I-TECH's M&E unit
(both field- and Addis-based) will support facilities in monitoring the referral system for co-infected patients,
and regularly evaluate/analyze referral data to inform efforts to improve the current system. As part of its
M&E activities, I-TECH will also offer supportive supervision of ART-clinic-based data clerks and data
managers, and on-site training and mentoring in data collection using TB/HIV data-collection forms.
Activity Narrative: I-TECH will support laboratory TB diagnosis through regular mentoring visits to TB clinics and labs by
laboratory technicians and quality-assurance experts who have experience in TB diagnosis with smear
microscopy. These laboratory-mentors will provide on-site troubleshooting and training, as well as a link to
the regional referral laboratories. I-TECH will support the initiative by MOH, CDC and EHNRI to establish
TB culture facilities at regional levels and facilitate the transport of specimens to regional labs for TB culture
once capacity is available.
I-TECH will also work on developing information, education, and communications materials, and/or reprint
and distribute existing materials on TB prevention and symptom screening at the hospital level.
In 2007, I-TECH assessed the feasibility of TB/HIV collaboration and the prevalence of HIV in TB patients in
pastoralist areas of the country. And in FY08, capacity building was provided in the area of human resource
development and establishing TB/HIV information system. TB/HIV collaborative activity has been initiated at
5 facilities in the Afar region. In FY09 continuous support will be provided to the facilities in the pastoralist
area which have initiated TB/HIV activities through capacity building and close follow up to strengthen and
further scale up TB/HIV services to improve quality of care, information system and service access.
I-TECH will support the MOH, HAPCO, and CDC efforts to purchase and install chest x-ray machines for
hospitals in I-TECH supported regions.
Finally, I-TECH will support feasibility studies (targeted evaluations) planned by CDC and other partners
and will work closely with RHB, hospital ART committees, regional TB/HIV working groups, and MOH in its
focus regions to ensure that TB program representatives are included in program-planning activities and
policy development that addresses the co-morbidity of HIV/AIDS and TB.
Continuing Activity: 16657
16657 5751.08 HHS/Health University of 7487 3786.08 Rapid expansion $441,750
10469 5751.07 HHS/Health University of 5495 3786.07 aa $396,000
5751 5751.06 HHS/Health University of 3786 3786.06 $150,000
Construction/Renovation
* TB
Table 3.3.12:
Activity Narrative: HIV Counseling and Testing Support at hospital
This is a continuing activity and relates to activities in ART (ID 10439 and 10628), TB/HIV (ID 10469 and
10472), Palliative Care (ID 10501), Laboratory (ID10613), SI (ID 10440) , Other Prevention (ID 10629 and
10648) and all HCT activities.
In FY08, the University of Washington/I-TECH provided technical assistance for the implementation of both
client-initiated and provider-initiated HIV testing and counseling services, as well as training of healthcare
providers in the same area for 35 hospitals found in Operational Zone 1 (Afar, Amhara, and Tigray regions).
Midway into 2008, 183 healthcare professionals had been trained on HIV counseling and testing (HCT)—
both client and provider initiated—according to national and international standards. In addition, 35 sites are
providing voluntary counseling and testing (VCT) and 30 sites are providing provider-initiated counseling
and testing (PICT) services.
In FY09 the following activities will be supported by I-TECH :
Considering that HCT is the entry through which the general population can access appropriate HIV
prevention, care, and treatment services, I-TECH would intensify complementary interventions to ensure
quality, client HCT services at 38 health facilities (30 public hospitals, two private hospitals and six health
centers in Afar) within Operational Zone 1 (Afar, Amhara, and Tigray), including referrals of HIV-positive
clients from community-based VCT programs.
In line with the family-centered care approach, which includes testing pediatric age groups, couples would
be encouraged to be counseled, tested, and receive test results together. The notification of partners will be
encouraged in cases where one partner receives positive test results, regardless of the setting in which the
person was tested. Efforts will be made to ensure privacy and autonomy of both individuals and couples.
Informed decisions shall be encouraged among discordant couples to protect the HIV-negative partner and
support the HIV-positive partner, while at the same time encouraging testing of the untested partner.
Appropriate child counseling and testing would be assured as part of diagnostic testing, and family and
couples' counseling.
Considering the high prevalence of HIV among youth and women, efforts also would be made to promote
routine premarital and preconception HCT to family-planning clients.
In FY09, I-TECH will consolidate ongoing efforts to ensure that both client-initiated and PICT services are
readily available at all 35 hospitals in the three I-TECH operation regions. I-TECH will continue to expand
counseling and testing cadres and same hour result models through HIV testing points. All I-TECH sites will
offer routine HIV testing for sexually transmitted infections (STI), tuberculosis (TB), and family planning (FP)
to clients and patients in the inpatient and outpatient departments. Appropriate intra facility referral tools will
be implemented to ensure functional linkage between the different units within a hospital: VCT, ART, STI,
TB, FP, inpatient, and out-patient.
In addition, PICT will be expanded in pediatric inpatient and outpatient departments, as well as in
immunization outlets.
I-TECH will fully assume responsibility for training healthcare providers as fulltime counselors and in the use
of HIV rapid testing in the three operational regions. Gondar and Mekele Universities will continue to be
supported as training sites for counselors. A pool of trainer-of-trainers for healthcare provider training in
HCT techniques would be ensured to sustain local needs to include Health Center staffs as necessary and
to assure regional ownership of the program.
Furthermore, taking into account that the nation suffers most from a severe shortage of trained healthcare
providers, I-TECH will fully support and complement the national effort in scaling up the lay counselors
initiative. I-TECH will also involve people living with HIV/AIDS (PLWH) in this effort throughout the three
operation regions
Through coaching and mentoring visits to hospitals, I-TECH's field-based clinical teams would make sure
that quality HCT services (client- and provider-initiated) are in place in both adult and pediatric service
outlets. Functional hospital HIV committees would be encouraged to foster adherence to quality HCT
standards and enhance the formation of multidisciplinary care teams for all testing sites within the facility.
Hospitals and health centers will be supported to establish functional referral mechanisms and linkages with
private-sector facilities.
Efforts will be made to collaborate with PEPFAR partners to provide outreach and mobile VCT services in
high-risk corridor areas like the Addis Ababa - Djibouti route in Afar area and the Humera region in western
Tigray where there are migrant mobile work forces and commercial sex workers.
Since there is limited space for HCT, and a shortage of human resource because of high turnover of
hospital staff (especially trained counselors), it is important to increase timely access to HIV care and
treatment services. I-TECH will continue to expand counseling and testing services by supporting weekend
VCT services in all of the major hospitals within the regions.
I-TECH provides support to sites implementing outreach services as necessary, in line with the Millennium
AIDS Campaign and local initiatives.
I-TECH supports the establishing of peer-support groups at site level for burnout management and skills
building, and also organizes other burnout-management programs in collaboration with partners.
Activity Narrative: Furthermore, I-TECH will give technical assistance support to the Regional Health Bureaus and sites when
launching National HIV Testing days.
I-TECH will also continue to work closely with national and regional partners and USG agencies to promote
HCT services, training of healthcare providers, and sharing of best practices.
Continuing Activity: 16658
16658 5725.08 HHS/Health University of 7487 3786.08 Rapid expansion $561,000
10468 5725.07 HHS/Health University of 5495 3786.07 aa $468,000
5725 5725.06 HHS/Health University of 3786 3786.06 $200,000
Table 3.3.14:
Site-level Laboratory Support
University of Washington I-TECH in addition to the activities in FY08 will support the facilities to attain
minimum standards set by EHNRI. I-TECH will technically assist for the process improvement including
accreditation of regional laboratories. I-TECH will address integrated laboratory system and will also provide
support for establishment of regional laboratory in Afar, TB culture and viral load testing facilities in regional
laboratories and will work to develop capacity of regional laboratories for sustainability.
In FY08, I-TECH (University of Washington) has provided comprehensive high-quality HIV/AIDS services,
including ART, at 30 public and two private hospital networks in the Amhara, Tigray and Afar regions.
Comprehensive technical assistance and implementation support has strengthened essential elements of
the laboratory system, and improved service quality and consistency. I-TECH has helped to: conduct
assessment of laboratory services, train laboratory staff (via offsite and onsite trainings on equipment
operation, preventive maintenances, and HIV-related laboratory test procedures); establish and strengthen
quality assurance (QA) programs via on-site mentorship and by developing and implementing SOPs,
developing log books and improving documentation and recording; and providing technical and logistic
support for specimen referral linkage between testing hospitals and referring hospitals and health centers. I-
TECH has been doing major infrastructure support to hospital laboratories including improvement of space
in the rooms with in the existing footage, epoxy painting of floor and wall in the testing rooms, standard
furnishing of the labs, and improving the electric line and drainage system. I-TECH renovated two regional
laboratories for establishment of DNA PCR for early infant diagnosis. In collaboration with CU-ICAP, CDC
and EHNRI, I-TECH has provided key technical and implementation support to Early Infant Diagnosis (EID)
program at regional, and site levels.
In FY09, I-TECH will provide its support to 32 hospital networks (30 governments and two private) in the
Amhara, Tigray and Afar regions, enabling each to provide comprehensive high-quality HIV/AIDS services.
In addition, I-TECH will continue supporting 6 health centers in Afar region. Intensive site-level laboratory
support is an essential component of I-TECH's plans, as the availability of consistent and reliable laboratory
services will ensure quality HIV prevention, care, and treatment services. Ongoing training, supervision, and
mentoring of laboratory staff and hands-on implementation support will be provided to all 38 sites. I-TECH
will work directly with the regional, hospital and health center laboratory personnel to implement and monitor
the quality assurance programs at the 38 sites and will support facilities to attain minimum standards set by
EHNRI. I-TECH will provide technical support for process improvement including accreditation of regional
laboratories. I-TECH will continue to provide technical assistance to the rollout of HIV-1 DNA PCR for infant
diagnosis at regional levels.
I-TECH's laboratory support activities in FY09 will include:
(1) Strengthening of site-level laboratory quality systems, with emphasis on initiation and enhancement of
quality assurance programs in partnership with CDC, EHNRI and Amhara, Tigray and Afar regional
reference laboratories. These activities will include the preparation, revision and implementation of standard
operational procedures (SOPs) for HIV disease monitoring (hematology, clinical chemistry, and CD4),
specimen management, laboratory safety, and QA/QC program. I-TECH will also support the preparation
and provision of standard documentation and recording formats including QC forms, lab request forms and
registers. I-TECH technical advisors will provide ongoing supportive supervision and mentorship at all sites,
ensuring the delivery of high-quality laboratory services as well as systems strengthening, skills transfer,
and capacity development. I-TECH in collaboration with CDC, EHNRI and Afar Regional Health Bureau will
support the establishment of the regional laboratory at Afar. In addition, I-TECH will work closely with the
regional laboratories at Amhara and Tigray to build local capacity as this is the exit strategy for partners.
(2) Technical support for uninterrupted laboratory services at all 38 ART site networks. This includes:
assisting with the development, implementation and enhancement of laboratory inventory systems in the
hospital networks and ensuring availability of continued and sufficient reagent supplies; supporting timely
preventive and troubleshooting maintenance services; building regional capacity for essential laboratory
equipment maintenance capability, and supporting human resources by facilitating the availability of
adequately trained laboratory personnel at all sites. These activities will be coordinated with supplies chain
management and regional laboratories and I-TECH regional laboratory advisors will work closely with the
regional lab associates of SCMS
(3) Capacity building and minor renovation of facility level laboratories:
I-TECH will provide regular mentorship of site-level staff focusing on improving laboratory management,
laboratory organization, layout and work flow, specimen management, testing procedures, standard
documentation, record keeping and reporting, and stock and inventory management. The mentorship will
address the integrated laboratory system with emphasis on HIV, TB, OIs and malaria. I-TECH will conduct
periodic site assessments and will provide necessary and appropriate support including: minor renovations
and refurbishment of site labs; laboratory accessories needed for the day-to-day delivery of integrated
laboratory services. I-TECH will also support preventive maintenance of essential integrated laboratory
service equipment and equipment care and management at the facilities and will facilitate the major
equipment maintenance; and support for national laboratory reporting systems.
(4) I-TECH will technically support standardized trainings using nationally approved curricula with special
emphasis on onsite training and mentorship. These site-level and regional-level trainings will include: HIV
rapid test (point of care HIV rapid test training), HIV disease monitoring (hematology, clinical chemistry, and
CD4); laboratory training on integrated diseases including common OI diagnosis. I-TECH will provide
continued onsite training on the new HIV rapid testing algorithm and monitor and evaluate the utilization of
the algorithm at facilities. I-TECH will also support regional and onsite training on TB smear microscopy and
support the implementation of TB smear microscopy EQA manual.
(5) I-TECH will continue to provide technical assistance and implementation support to referral laboratory
Activity Narrative: services. This will strengthen the functioning of the reference labs as they supervise QA activities at lower
tier labs and provide access to more sophisticated diagnostic assays. I-TECH will also support
EHNRI/Regional labs to establish systems for specimen collection at health centers and/or peripheral
hospitals, transportation to appropriate hospital and regional laboratories, patient sample tracking, reporting
of results, and implementing and ensuring that standard guidelines and procedures are followed. I-TECH
will support the monitoring and evaluation activities in all laboratory program areas and will support the
expansion of LIS in the regions
(6) I-TECH will continue to provide key technical assistance to the early infant diagnosis program in the
region. Working at the national, regional, and site levels, I-TECH will support not only HIV DNA PCR testing
capacity in the laboratory, but the clinical systems, HMIS systems, and linkages needed to provide high-
quality services to infants and families. Based on need assessment I-TECH will support the establishment
of HIV DNA PCR testing capacity at two more I-TECH supported sub-regional and hospital laboratories
(Dessie and Gondar University hospital laboratory). I-TECH will also support the establishment of viral load
testing capacity at regional laboratories as planned by EHNRI. These will include minor renovation, epoxy
painting of floor and furnishing with standard laboratory furniture.
(7). Integration of OI diagnosis in the HIV/AIDS laboratory support: I-TECH in collaboration with other
stakeholders working in the laboratory area will establish common OIs and STIs diagnostics testing services
at regional labs and hospitals. This includes training of lab personnel on common OIs and STI diagnosis,
providing TA in setting up of the test services and providing some critical reagents and diagnostic kits. I-
TECH will provide technical support for the establishment and functionality of TB culture at regional
laboratories.
Continuing Activity: 16645
16645 10613.08 HHS/Health University of 7487 3786.08 Rapid expansion $1,000,000
10613 10613.07 HHS/Health University of 5488 3786.07 $300,000
Table 3.3.16:
Support for Site-Level Use of Data
In FY08, I-TECH provided technical support to 43 sites, including assignment of 1-4 data
technicians/managers, distribution of computers, printers, accessories, and facilitating telephone and
internet connections. In addition, I-TECH trained 67 data and health care workers in basic computer skills
and in M&E.
In FY09, ITECH will collaborate with other partners in rolling out and integrating the national HMIS at the
site level. Support to sites for the integration of the national HMIS will include:
• technical assistance with the collection, archiving, retrieval, and reporting of comprehensive HIV services
data on the new forms and the flow of data through the new integrated data system
• technical assistance with the collection and documentation of data on other HIV services in addition to
ART, such as pediatric ART, TB/HIV, PMTCT, VCT, PICT using the appropriate HMIS forms
• routine, data-quality assurance exercises to ensure completeness and accuracy of information on the
HMIS forms
• training on basic monitoring and evaluation
• training on basic computer skills, data management skills, including data entry, data analysis, and on
tabulating and visualizing data using tables, charts, line and bar graphs and other standard methods, and in
technical paper writing and presenting. An emphasis will be placed on analyzing and using data at the site
level for local decision making and program improvement
• on-site supervision and mentorship to enhance the quality and use of data collected
In FY09, I-TECH will focus on building the capacity of sites to fully transition and integrate into the new
HMIS. In accordance with government plans, certain site-level support activities provided in FY08, such as
support for data technicians and managers, and the printing and provision of the HMIS forms and tools, will
be phased out in FY09. I-TECH will work with its sites to build their capacity to fully support the HMIS
themselves.
COP08 NARRATIVE
This is a continuing activity from FY07. The major purpose of this activity is to strengthen the
implementation of the national Health Management Information System (HMIS) for comprehensive
HIV/AIDS services and to optimize the use of data for service and program strengthening in Afar, Amhara,
and Tigray regions.
In FY07, University of Washington/I-TECH supported 26 sites in Operational Zone 1 to collect, manage,
analyze, and use HIV/AIDS services-related data generated at site level for decision-making to improve
clinical and program management. In addition, I-TECH has trained 45 health professionals and data clerks
in monitoring and evaluation (M&E) and assisted regional health bureaus (RHB) to organize experience-
sharing workshops.
In FY08, I-TECH will expand its site-level capacity building in M&E to further improve quality data collection
and maximize data use for continuous service quality improvements I-TECH will:
1) Intensify support for efforts to fully document information for pre-ART and ART patients on the national
HIV care/ART follow-up by:
a) Continuing routine, data-quality assurance exercises to measure completeness and accuracy of
information on follow-up forms
b) Providing support to clinical teams for accurate completion of follow-up forms
c) Supporting efforts to fully document information for PMTCT, tuberculosis (TB)/HIV, voluntary counseling
and testing (VCT), and provider-initiated counseling and testing (PICT) clients on the appropriate national
d) Supporting the integration of HIV/AIDS care and treatment data with national comprehensive HMIS
through technical support at site level in archiving, retrieving, and report aggregation, supported by routine
data-quality assurance assessments
e) Train healthcare providers, data clerks, and HMIS personnel on database use, including how to enter
records, query the databases, and produce routine reports
2) Provide support for M&E support tools developed for the national M&E systems and equipment. I-TECH
will work to ensure availability of computers, computer peripherals, and storage equipment and an
uninterrupted supply of the national M&E tools at all the sites
3) 3) Strengthen supportive supervision and mentorship. On-site supervision and mentorship will be
provided to enhance collection of accurate and complete data. I-TECH will also work with site-level staff to
build capacity in data analysis, and in the use of data to manage and improve program delivery.
4) Support institutions to manage and use data fully and effectively. Sites will continue to be assisted in
tabulating and visualizing their data using tables, charts, line and bar graphs and other standard methods;
optional tabulations will include aggregation of data by patient, clinic, and regional levels. Continued FY08
activities will expand the number of facility-based health providers with basic computer skills and data
management skills, including data entry, data analysis, technical paper writing, and presentations.
5) Support the national laboratory information systems to ensure communication of patient results in an
efficient manner. There will be particular emphasis on communicating results to patients whose specimens
were transported to the hospital from another facility, such as a health center. Furthermore, I-TECH will
assist sites in tracking specimens of patients who need more specialized tests, such as viral load, which are
currently performed only at regional labs.
6) Support biannual, regional review meetings to provide fora where facilities can present their data and
Activity Narrative: share lessons learned. This activity will also continue to support and strengthen the national HMIS
implementation, document best practices, and present findings and experiences at local and international
scientific and programmatic forums. Implementation mechanisms will consist of necessary modeling at site
and RHB levels.
Continuing Activity: 16646
16646 10440.08 HHS/Health University of 7487 3786.08 Rapid expansion $300,000
10440 10440.07 HHS/Health University of 5488 3786.07 $150,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.17:
Strengthening Pre-Service Training for Medical Doctors This is a new activity in response to the critical
need and one of the highest priorities of the Ethiopian Federal Ministry of Health (FMOH) to scale up the
training of medical doctors. Problem statement Recent assessments suggest that the shortage of medical
doctors and other health professionals, poor performance, inequitable distribution of the available health
workforce among regions and health facilities are root causes for poor service delivery of health care. The
FMOH recognizes that with the existing levels of outputs from medical schools of medical doctors, surgical
specialists, anesthesia professionals, midwives, dentists and mental health professionals it will have
difficulties reaching the MDGs by 2020. While the FMOH recognizes the rapid need of medical specialties,
it stated that the existing level of output for health extension workers, health officers, nurses, pharmacists
and paramedics is sufficient and thus no major scale up is required.
The FMOH intends to scale up the number of medical doctors from the current 1,806 to 9,000 doctors in
public service thru a number of ambitious interventions. These are as follows: 1. To expand medical
training by increasing the number of medical schools from currently seven to twenty-one. Up to five teaching
facilities such as hospitals or other medical teaching centers will be attached to each new medical school.
Each of these teaching facilities will have an annual intake of 100 students. Thus, each new medical school
is expected to have an annual intake of up to 500 new students. 2. To introduce a 4 year medical training
program (for BSc holders) in addition to the existing six year program without compromising quality. 3. To
identify hospitals with adequate patient flow to be upgraded as teaching centers. 4. Utilize appropriate
Information Communication and Technology (ICT) to enhance the quality and efficiency of medical
education.
The FMOH has repeatedly requested PEPFAR Ethiopia, both informally and formally, to assist, thru US-
based universities, to scale up the training of medical doctors.
I-TECH (International Training & Education Center on HIV, University of Washington) is a major US-based
university partner for PEPFAR-Ethiopia. The regions in which I-TECH is operational with PEPFAR funding
have currently two medical schools located in the cities of Gondar and Mekele.
Thus, in FY09, major activities for I-TECH are to:
• Conduct needs assessment of Ethiopian public medical education institutions for implementing the
accelerated medical doctors training program.
• Provide technical, material and financial support to the FMOH, MOE, HERQA, and Universities at the
educational facility level in teaching materials development, review, publication and distribution activities as
well as in supply of essential teaching/training materials for medical education.
• Provide, based on needs assessment, limited support where feasible to faculty and infrastructure
development i.e. support to the establishment of training laboratories and learning centers, libraries and the
procurement of teaching materials to accommodate the large scale intake of new medical students.
• Monitor and evaluate the progress in the implementation of the medical doctors' education/training
• Assist in the development, local adaptation and review of curricular/training materials and modules for pre-
service education.
• Assist faculty and program managers in teaching and research, coordination, communication and
networking for medical education in the existing and upcoming public universities providing medical
education in Ethiopia.
• Assist Ethiopian medical education institutions in the development and effective application of different
models of education and training, including community-based team training and information technology for
distance learning-assisted approaches, standards-based education management and recognition, student
assessment and evaluation procedures, faculty development, establishment and/or reinforcement of
academic development centers in the universities/faculties.
• Coordinate all activities with all PEPFAR implementing partners on regional and central levels including
FMOH and HAPCO thru established mechanisms.
Table 3.3.18:
