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
Preventing Mother to Child Transmission of HIV for Refugees and Host Community Populations in Ethiopia
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In FY07 UNHCR identified the need for PMTCT in refugee camps and initiated services through its VCT
program by delivering single-dose Nevirapine to pregnant mothers in the camps when possible and
providing referrals for mothers for treatment in regional hospitals when necessary. In FY08 UNHCR began
to expand services through separate PMTCT funding to include: training of midwives and TBA on safe
delivery and infant feeding; training of counseling and testing staff in testing of all pregnant women
presenting at antenatal sites; training of health clinic staff in provision of PMTCT treatment; and provision of
psychosocial services for mothers testing positive for HIV.
In FY09 UNHCR will expand the geographic scope of this activity to cover refugee and host community
women who test positive in Aw Barre Refugee Camp and the new Sheder Camp in Ethiopia's Somali region
and Asayita Refugee Camp in Ethiopia's Afar region. In addition, per ARRA's current protocols, dual
therapy will be administered in place of Nevirapine in refugee camps where ART treatment is provided.
Since COP planning fro FY08, Ethiopia has experienced a continued influx of Somali refugees, many
fleeing the current political insecurity in Mogadishu. A second camp, Aw Barre, was established in
Ethiopia's Somali Region in July 2007 and a third camp, Sheder, was established in April 2008 to
accommodate this influx. Given the current situation it is expected that this number will continue to rise.
This program links directly to UNHCR's VCT services, which are expected to be expanded in FY09 to cover
the new refugee camps in the Somali region.
COP08 ACTIVITY NARRATIVE
The United Nations High Commission for Refugees (UNHCR) would like to expand, and officially
implement, the PMTCT program in the Fugnido, Kebrebayah, and Afar camps and host populations.
UNHCR will create linkages among existing PEPFAR partners who are operating in the region, including
Columbia University in the Somali Region, Johns Hopkins University in the Gambella region, and the
University of Washington/I-TECH in the Afar region, in order to improve the level of service provided in the
health center and to take advantage of additional government and regional resources.
In 2007, responding to the need for PMTCT, and under the voluntary counseling and testing (VCT) budget,
UNHCR began to bring PMTCT to the refugee and host populations by delivering Nevirapine (NVP) in
camps where possible, and by providing referrals for mothers for treatment in regional hospitals where
necessary. In addition, seven midwives were trained on PMTCT.
In 2008, UNHCR is applying for separate PMTCT funds in order to expand its PMTCT services. In 2008,
training/refresher training will be conducted for new/existing midwives on PMTCT. Counseling and testing
staff will be trained on the provision of testing to all pregnant women who present at antenatal care (ANC)
sites. The staff will also be trained on how to educate the women on the general protocol for PMTCT (which
is currently NVP in the camps), and the importance of using this service. If camp health centers are
identified as ART sites, they will be able to dole out dual therapy. Currently, however, this is not the case,
and NVP remains the prescribed course for PMTCT amongst refugee and host-community populations. All
pregnant mothers will be tested for HIV during antenatal follow-up, and HIV-positive women will be provided
with basic health instruction, including information on prevention of opportunistic infections (OI) and NVP
protocols.
HIV-positive newborns and their family members will receive appropriate care, including ART referral as
required. Midwives and traditional birth attendants (TBA) will be trained on safe delivery, breast health, and
exclusive breastfeeding so that they can provide this information to mothers. This activity will promote safer
infant-feeding for women with HIV because all HIV-positive mothers will receive counseling and support on
infant-feeding practices.
NVP will be provided by the Rational Pharmaceutical Management Plus (RPM+) program and will be given
to women in the camps so that they do not have to travel to regional hospitals for delivery and PMTCT
services.
Trained social workers/psychologists will be hired for each camp and the surrounding host community to
provide psychosocial services to mothers who test positive for HIV. These professionals will either be from
universities, as part of practical experience, or from the professional community. The same social workers
will provide services for all PEPFAR service areas. For example, counselors at VCT clinics can counsel only
on testing, even though some patients might require further assistance. Therefore, patients who test at VCT
sites will be referred to these social workers for psychosocial counseling, as necessary. The same social
workers will also serve other clients (e.g., those in the OVC program, people who have expressed
difficulties with condom negotiation, and rape victims).
The number of trained social workers hired will be determined by the number of camp residents at the time
of implementation.
New/Continuing Activity: Continuing Activity
Continuing Activity: 18267
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18267 18267.08 Department of United Nations 7506 3790.08 $85,600
State / Population, High
Refugees, and Commissioner for
Migration Refugees
Emphasis Areas
Health-related Wraparound Programs
* TB
Refugees/Internally Displaced Persons
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
HIV Prevention Services for Refugees and Host Populations in Ethiopia Condoms and other HI Prevention
Services for Refugees and Host Populations in Ethiopia
UNHCR's FY09 plans reflect reprogramming made to COP 08 activities to expand the geographic target
area for prevention services for refugee and host community populations in Ethiopia to Sheder Refugee
Camp in the Somali region and address the gap in HIV/AIDS services for urban refugees in Addis Ababa.
UNHCR also plans to expand services to Berhale and Asayita Refugee Camps in the Afar region.
Ethiopia is home to approximately 1300 urban refugees from 17 different countries—mainly the Great Lakes
region, Somalia, Eritrea, and Uganda—who have limited access to HIV/AIDS prevention interventions.
Among the problems are: higher HIV prevalence rates in urban areas, exposing urban refugees to a greater
risk of contracting HIV; HIV/AIDS prevention interventions, e.g., media programs, reading materials, health
education, and VCT services are mediated through the local language, alienating urban refugees from
information regarding HIV/AIDS modes of transmission, prevention, stigma and discrimination when they
share the same risk as the local population; HIV/AIDS care and support and prevention with positives
assistance that is available to local populations are accessed through social institutions like "idir" and
administrative structures that are inaccessible to refugees; UNHCR assistance to urban refugees is
insufficient to fulfill the nutritional demands of HIV positive urban refugees who are on ARV drugs and the
medical budget is limited to the provision of basic health services without special allocations for patients
with HIV/AIDS; care takers and families are at high risk of acquiring infection due to lack of funding for
education and training on how to care for HIV/AIDS patients; and, a number of female refugees have been
victims of sexual and gender-based violence such as rape and forced co-existence, increasing their risk of
HIV. It is therefore essential to raise the awareness of urban refugees through information, education and
communication, behavior change communication, and provision of access to VCT in order to minimize
HIV/AIDS transmission and to enable positive living.
At the same time, Ethiopia continues to experience an influx of Somali refugees, many fleeing the current
political insecurity in Mogadishu. A second camp, Aw Barre, was established in July 2007 and a third camp,
Sheder, was established in April 2008 to accommodate this influx. Based on current prevention activities
and experiences in other PEPFAR-funded projects in Ethiopia's six other camps, UNHCR's implementing
partners agreed that initiating the same activities in Sheder would develop a strong prevention and
counseling and testing foundation where one does not currently exist.
As in Kebribeya and Aw Barre, Sheder refugee camp houses displaced Somalis and the level of services is
lower than camps in other regions of Ethiopia. No prevention activities are currently being carried out in
Sheder even though the region is characterized by a general ignorance of HIV/AIDS and its mechanisms of
transmission. That combined with frequent risky behaviors, including the abduction and rape of young girls
and the practice of female genital mutilation in extremely unsanitary conditions, makes Sheder and its host
community an important additional target area for prevention services aimed to reduce HIV transmission by
promoting delayed sexual activity and correct and consistent condom use. Specific prevention activities will
remain the same as those in the original activity description; however, the geographic area is being
expanded to include Sheder camp host community as well as the two camps in the Afar region.
There is a gap in HIV/AIDS services for urban refugees living in Addis Ababa that has largely been ignored
by donors to date. Resources will be used to promote awareness and behavioral change among urban
refugees in Addis Ababa for prevention of HIV/AIDS, including ‘prevention with positives.' An integrated
package of activities will be implemented to increase knowledge, reduce risky behaviors, promote protective
attitudes, develop safe practices, and reduce stigma and discrimination. Specific activities, conducted in
English, French and Swahili, include: conducting workshops and a mass campaign on refugee day on the
very nature of HIV, ways of transmission, methods of prevention focused on correct and consistent condom
use and stigma and discrimination among the refugee community; conducting awareness creation
workshops and education on the benefits of VCT service; training for caretakers on standardized home
based care and prevention; VCT service; and establishing anti-AIDS and support clubs. These activities will
link directly to care and support programs as urban refugees living with HIV/AIDS and their caretakers and
family members of will receive training, counseling and support for appropriate care and provision of
necessary services and materials.
COP08 ACTIVITY NARRATIVE:
Related Activities: These activities, which are programmatically linked to HIV Prevention Services for
Refugees and Host Populations in Ethiopia (10528), Voluntary Counseling and Testing Services for
Refugees and Host Populations in Ethiopia (10527), Assistance to Orphans and Vulnerable Children in
Refugee Camps in Ethiopia (10530), Palliative Care in Refugee Camps in Ethiopia (10572), and Universal
Precautions and Post-Exposure Prophylaxis in Refugee Camps in Ethiopia (10634), are part of a
comprehensive HIV/AIDS program in refugee camps in Ethiopia.
The goal of this activity is to promote correct and consistent condom use in Fugnido, Kebribeyah, Teferiber,
and Afar refugee camps. All activities are coordinated closely with the Government of Ethiopia's Agency for
Refugee and Returnee Affairs (ARRA), which is responsible for providing basic camp health services, and
with our other implementing partners (IP). The United Nations High Commissioner for Refugees (UNHCR)
has developed a working relationship with the local HIV/AIDS Prevention and Control Office (HAPCO) and
will work with other PEPFAR partners to provide appropriate training to staff from ARRA and other IP.
UNHCR's other prevention (OP) programs create a demand for condoms and provide an adequate,
sustainable supply to the public in general and to targeted groups in particular. In refugee camps, the entire
population is considered inherently at-risk to due to transience, vulnerability to sexual exploitation, and lack
of access to information. Intensive condom promotion activities, supported by appropriate information-
education-communication (IEC) materials, and by increasing the number of condom outlets, will be
Activity Narrative: implemented in the camps. Syndromic management of sexually transmitted infections (STI) according to
guidelines will be ensured.
Creating appropriate interventions and materials for the camps will be challenging because they must be
created in all relevant local languages and must accommodate the different learning and communication
styles of each population. Furthermore, implementation in all camps and host communities will require
significant logistical inputs due to the tenuous security situation; intra- and inter-ethnic conflicts frequently
erupt in Gambella region, most notably with the murder of three ARRA officials in December 2003, just ten
miles outside of Gambella town. All trips to Fugnido camp require armed military escort, which adds
considerable cost for simple routine visits. Despite these difficulties, the need for prevention activities is
great. Data from the 2005 Ethiopian Ministry of Health's (MOH) antenatal clinic (ANC) surveillance suggests
an HIV prevalence of 2.8% in Fugnido camp, while the national average for rural communities was 2.2%.
Syphilis prevalence was also significantly higher than the national average; as a result, condom and other
prevention activities described below will meet critical needs.
Implementing prevention programs in Kebribeyah and Teferiber in Somali region poses its own set of
challenges. Although Kebribeyah has housed Somali refugees for more than a decade, the level of services
is much lower than in most other camps. Prevention activities were implemented in Kebribeyah in late 2007.
There is a general lack of knowledge about HIV and how it is transmitted, and the population is engaged in
risky behaviors, including abduction and rape of young girls. Condom usage is extremely low or
nonexistent, and the promotion of correct, consistent condom use will require significant efforts using
various media. Kebribeyah camp abuts Kebribeyah town, and there is frequent interaction between the two.
Interventions will target both refugees and the host communities.
The following activities will be implemented in Fugndio, Kebribeyah, Teferiber, and Afar camps:
UNHCR will procure and distribute condoms in all camps through a variety of mechanisms. The number of
condom outlets within the camps will continue to be expanded to reach a total of 200 in all of the camps.
Wooden condom dispensers were built and made available in 2007, and their presence will be expanded.
Money will be provided for their maintenance in 2008 and dispensers will be placed in the new camps in
Afar and Teferiber. The boxes will be strategically placed in bathrooms within the communities so that men
and women can take the condoms privately. Supervisors, provided with a stipend, will be hired in order to
monitor and restock condom supplies at each of the boxes and condom outlets in the camps and host
communities. This is necessary to ensure that supplies are constantly available.
Twenty four trainers, the senior peer educators, will be trained from all camps in peer education and
condom distribution and education. The trainers will also be trained in the use of penis models for condom
demonstrations. Models will be purchased for each of the new camps and used by peer educators in
demonstrating the importance and use of condoms. Peer educator kits will be purchased for each of the
peer educators so that they can educate their peers on correct condom use. Additional social workers will
be hired in order to effectively monitor peer educators, the population, and provide care and support to
those who need it. The social workers will also promote counseling and testing services, as well as testing
for STI. Condom use is typically not supported within the communities and therefore it is important for peer
educators and social workers to promote condom use and work with local community leaders on
implementing effective messages and tools to raise awareness of, and support for, condom use.
Condom and other prevention activities will work in tandem with the interactive drama groups and anti-AIDS
clubs developed under AB activities. Sports for Life activities will include messages about the importance of
condom use for protection against HIV amongst the older youth served by the activities. In addition,
community conversations and coffee ceremonies will focus on the importance of condom use and the ability
of condoms to help prevent the transmission of HIV and other STI. The activities will target all members of
the communities in general, as well as specific groups such as commercial sex workers.
Health workers in each camp will receive training on STI management and the importance of promoting
counseling and testing when treating and testing patients for STI. Universities working in the regions will
assist in ARRA's training for health workers.
Continuing Activity: 16686
16686 5739.08 Department of United Nations 7506 3790.08 $267,500
10528 5739.07 Department of United Nations 5524 3790.07 $268,200
5739 5739.06 Department of United Nations 3790 3790.06 $32,000
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Human Capacity Development $12,100
Table 3.3.02:
Condoms and other HIV Prevention Services for Refugees and Host Populations in Ethiopia
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
UPDATE
UNHCR also plans to expand services to Berhale and Asayita Refugee Camps in the Afar region. In
addition, UNHCR will run a pilot activity in Shimelba Camp targeting sex workers in the camp and host
community.
While the risk of HIV among sex workers in the refugee camps and surrounding host communities in
Ethiopia is high, many sex workers don't know their status and some prefer not to know it. New activities
focused on creating healthier lives for sex workers, and reversing the growing numbers of women and their
families who are infected with HIV, will be implemented as a pilot in Shimelba Refugee camp. The pilot will
focus on commercial sex workers who work in establishments (small bars, hotels, local drink houses) and
offer other services - such as music, food and drink - in addition to sex work as well as work directly with
owners/managers of the establishments and past, current, and potential clients. Women engaged (current
and past) in sex work will be trained in the use of the newly developed Peer Learning Guide on Commercial
Sex Work developed by Health Communication Partnership. These women will be recruited as peer
educators based on their interest in being an HIV prevention and personal health peer leader, ability to act
as credible sources of practical information for other sex workers, and who can be inspiring and realistic role
models for personal care while doing sex work. Roughly 10 to 20 peer leaders will be identified based on
the above criteria and based on the number of sex workers in the camps and surrounding host
communities. Other key activities to be undertaken by this pilot include: establishing a support system for
sex workers as well as the owners and managers of the establishments where they work; ensuring that both
male and female condom are available free of charge; and ensuring quality health services for sex workers
including HIV pre and post test counseling and STI treatment.
Activity Narrative: COP08 NARRATIVE FOR THIS ACTIVITY:
United Nations High Commissioner for Refugees
implemented in the camps. Syndromic management of sexually transmitted infections (STI) according to
Continuing Activity: 16688
16688 5786.08 Department of United Nations 7506 3790.08 $160,500
10529 5786.07 Department of United Nations 5524 3790.07 $156,500
5786 5786.06 Department of United Nations 3790 3790.06 $7,000
Estimated amount of funding that is planned for Human Capacity Development $10,100
Table 3.3.03:
Universal Precautions and Post Exposure Prophylaxis in Ethiopia's Refugee Camps
In FY09 UNHCR will expand services to cover two new refugee camps—My Ayni in the Tigray region and
Sheder in the Somali region. For camps where this program has been ongoing since FY07, efforts will
focus on refresher training for medical and cleaning staff and maintenance of medical waste incinerators
rather than new staff training and construction, thus making it possible to expand the program to the new
refugee camps while reducing the budget from FY08 levels. Other activities remain the same as those in
FY08.
COP08 NARRATIVE:
Related Activities: This proposal, which is an important piece of a comprehensive HIV/AIDS prevention
intervention, is linked to HIV Prevention Services for Refugees and Host Populations in Ethiopia (10528),
Condoms and Other HIV Prevention Services for Refugees and Host Populations in Ethiopia (10529),
Voluntary Counseling and Testing Services for Refugees and Host Populations in Ethiopia (Reprogrammed
in 2007, formerly 10527), Assistance to Orphans and Vulnerable Children (10530), and Palliative Care for
Refugees (10572).
Universal precautions must be followed in all settings, including refugee settings. The following activities will
enforce universal precautions for the prevention of HIV transmission, including distribution of post-exposure
prophylaxis (PEP) kits for rape victims, complemented by AB, Other Prevention (OP), and voluntary
counseling and testing (VCT) components as part of a comprehensive HIV/AIDS program. This activity
complements prevention projects for refugees living in Fugnido refugee camp in Gambella region,
Kebribeyah and Teferiber camps in Somali, Sherkole camp in Benishangul-Gumuz, Shimelba camp in
Tigray and a new camp in the Afar region. Services will be provided to all camp residents as well as
residents of the surrounding host community.
This proposal was developed with the Government of Ethiopia's Agency for Refugees and Returnee Affairs
(ARRA), which is responsible for providing basic camp health services. All activities are coordinated closely
with ARRA and with other implementing partners (IP). UNHCR has developed a working relationship with
the local HIV/AIDS Prevention and Control Office (HAPCO) and will work with other PEPFAR partners to
provide appropriate training to ARRA health staff, as well as staff from other IP. The number of staff trained,
and the total population served is difficult to estimate in the refugee context. The number of refugees served
in Ethiopia is dependent on the political situation in the adjacent countriesIn addition, the camps listed are
subject to change, based on the political situation both in and out of Ethiopia.
Health clinics within the camps are staffed and administered by ARRA. Although ARRA provides sufficient
basic-health services for large camp populations, they are often under-resourced and lack staff adequately
trained in universal precautions and the provision of PEP. Shortages of supplies (e.g., heavy-duty gloves,
aprons, masks, eye shields, and safety boxes for disposal of sharp materials) or improper use are common.
Cleaning, disinfecting, and sterilization procedures are often inadequate, and most camps do not have
incinerators. The provision of PEP is required for healthcare workers who have possibly been exposed to
HIV through, for example, needle sticks, and for victims of rape and sexual violence. Due to the social
stigma associated with rape and gender-based violence (GBV), incidents of rape are often unreported and
accurate incidence rates are unavailable. Staff working in each camp will closely monitor incidents of
reported rapes.
Staff (including law enforcement) working in the camps (approximately 15 people from each camp) were
trained in 2007 on the importance of reporting of rape within 72 hours so that victims can receive PEP within
the 72 hour timeframe. In 2008, new staff will receive this training and refresher trainings will be provided to
returning staff. The training will be provided by ARRA and by the International Rescue Committee (IRC) in
Shimelba and Sherkole.
In 2007, 40 health staff were given a refresher training on universal precautions to prevent medical
transmission of HIV. In 2008, health staff will again be given refresher training on universal precautions,
including staff working in Afar region. Staff will also be trained on delivery of PEP and the appropriate
clinical response to rape for which UNFPA has developed clinical guidelines. Two trainers from each camp
will be trained on PEP and the trainers will train the remaining health workers in the camps. Linkages will be
made with other PEPFAR partners who can assist ARRA on trainings, including Johns Hopkins University
(JHU), Columbia University, and University of Washington/I-TECH.
Eighteen cleaners were trained on protecting themselves from coming into contact with potentially
contaminated materials. Training will again be provided to staff in 2008. Local staff will be trained or
refreshed on universal precautions and 60 kits will be provided to each camp for the TBA.
A total of eight PEP kits will be provided to each camp - five adult and three pediatric kits. Funds will also
be provided for additional materials, such as syringes, needles, boots, goggles, gloves, aprons, detergents,
and antiseptics (approximately 3,000 birr per camp). The equipment will supplement existing equipment
purchased with 2007 funds, and will be purchased in their entirety for the new camp in Afar. Funding will
ensure the presence of ten pairs of boots, ten goggles, ten aprons and ten pairs of gloves per camp. Funds
will also be provided for the maintenance of the incinerator in order to ensure proper disposal of medical
waste.
Manuals and guidelines, provided by ARRA and/or our university partners, will be provided for staff working
in each of the refugee camps.
Continuing Activity: 16687
16687 10634.08 Department of United Nations 7506 3790.08 $107,000
10634 10634.07 Department of United Nations 5524 3790.07 $68,000
Estimated amount of funding that is planned for Human Capacity Development $1,100
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $435,750
Table 3.3.07:
Palliative Care for Refugees
ACTIVITY UNCHANGED FROM FY2008
UNHCR will expand the FY08 geographic coverage of this activity to provide services to Asayita Refugee
Camp in the Afar region and Sheder Refugee Camp in the Somali region. Ethiopia has experienced an
influx of Somali refugees, many fleeing the current political insecurity in Mogadishu. A second camp, Aw
Barre (formerly Teferiber), was established in July 2007 and a third camp, Sheder, was established in April
2008 to accommodate this influx. Given the current situation in Somali it is expected that this number will
continue to rise. At the same time there is a continued influx of Eritrean refugees entering Ethiopia from the
north necessitating the opening of a second refugee camp for Eritrean Afari refugees in Ethiopia's Afar
region. In FY09 UNHCR plans to expand prevention (both AB and OP outreach activities) as well as VCT
and PMTCT services in the same geographic areas and it is important to provide care and support services
for those testing positive. Additionally, experience has demonstrated that initiating care and support
services in refugee camps in Ethiopia has encouraged the use of VCT services.
In addition to services described in the FY08 activity, UNHCR will initiate income generation and backyard
garden activities for PLWH in FY09. In general, approximately 30-40% of refugee food rations are sold by
refugees to cover non-food items (NFI) and other food needs. As a result, beneficiaries of palliative care
services are asking for more than the current food basket—which includes supplementary feeding items—
and NFI provided under the program. UNHCR plans to fund development of bag and multistory gardens to
provide supplementary food and income to vulnerables in the camp, including individuals receiving palliative
care services, OVC and victims of sexual and gender-based violence.
COP08 NARRATIVE FOR THIS ACTIVITY:
Related Activities: The activity is programmatically linked to HIV Prevention Services for Refugees and
Host Populations in Ethiopia (10528), Condoms and Other HIV Prevention Services for Refugees and Host
Populations in Ethiopia (10529), Voluntary Counseling and Testing Services for Refugees and Host
Populations in Ethiopia (Reprogrammed in 2007—formerly 10527), Assistance to Orphans and Vulnerable
Children in Six Refugee Camps in Ethiopia (10530), and Universal Precautions and Post-Exposure
Prophylaxis in Six Refugee Camps (10634).
This continuing activity will focus on activities for refugees living in Fugnido camps in Gambella region,
Teferiber and Kebribeyah camps in Somali region, and a new camp in Afar region. Services will be provided
to all camp residents and residents from surrounding local communities who avail themselves of services in
the refugee camps. This proposal was developed in consultation with the Government of Ethiopia (GOE)
Agency for Refugee and Returnee Affairs (ARRA).
The entire refugee population is considered inherently at-risk for HIV/AIDS due to their transience,
vulnerability to sexual exploitation, and lack of access to information. Implementing programs in these
regions requires significant logistical and material inputs due to the tenuous security situation. Intra- and
inter-ethnic conflicts frequently erupt in Gambella region, notably with the murder of three ARRA officials in
December 2003, just 10 miles outside Gambella town. All trips to Fugnido camp require armed military
escort, which adds considerable cost and logistical maneuvering for routine visits. Although the security
situation in Kebribeyah is not as bad as in Gambella, this region is historically under-resourced and under
threat of violence due to proximity to Somalia and the frequent conflicts between the Ethiopian military and
local rebel factions.
Not all people living with HIV/AIDS (PLWH) need ART; however all need basic health care and support.
This should include routine monitoring of disease progression and prophylaxis and treatment of
opportunistic infections (OI) and complications of immune suppression. In Ethiopian refugee settings, there
is no comprehensive palliative-care program addressing the needs of people living with the virus. This
project aims to strengthen basic health care services in general, and the diagnosis and treatment of OI in
particular, for PLWH in four refugee camps through capacity building, training of health workers, and
providing essential drugs for OI prevention and treatment. Linkages will be made with existing PEPFAR
partners working in regional health centers throughout the target areas, including Johns Hopkins University
(JHU), University of Washington/I-TECH, and Columbia University.
Working with the refugee communities in Ethiopia is a challenging endeavor. The number of refugees is
dependent upon the political situation of the neighboring countries. In 2008, with the inclusion of services in
a refugee camp in Afar region, new challenges will occur because the population in that region is
traditionally nomadic. Implementing partners will have to be creative in order to get services to this
population and will refer patients for services, such as food distribution, in order to provide care and support
to those who need it.
The following will be undertaken:
Basic palliative-care packages will be provided to all HIV-positive clients. The kits will include pain
medication, vitamins, antiseptics, dressings, gauze, gloves, and soap. The number of kits is difficult to
estimate because work with refugee populations in Ethiopia is ever-changing and depends on the political
situation in the surrounding countries. However, UNHCR will provide palliative care to 300 people living in
the refugee camps. The expansion of counseling and testing activities will increase the number of people
known to need care, particularly when it is expanded into sexually transmitted infections (STI) and
tuberculosis clinics. In order to adhere to the national guidelines, the existing TB program will be
strengthened by technical assistance to health workers. In addition, those who test positive for HIV will be
referred to STI, TB, and health facilities to ensure that they are tested and treated.
In 2007, 28 health workers were trained on palliative care, including ART. In 2008, returning health workers
will receive refresher training while all new staff will be required to undergo the complete training. UNHCR
will also work with university partners in the region to develop and implement trainings for medical staff. The
Activity Narrative: HIV/AIDS Prevention and Control Organization (HAPCO) will train staff on care and support in each camp.
An estimated 28 people will be trained. Palliative care is closely coordinated with universal-precaution
activities, and post-exposure prophylaxis will be provided to rape victims reporting within 72 hours. In 2007,
law enforcement was trained on appropriate responses to rape, and ARRA staff were trained on responding
to rape in a clinical setting.
UNHCR will procure a CD4 counter from UNFPA for a reduced price to be used in refugee camps. This will
limit the number of visits refugees need to make to the regional hospital—visits that are both time-
consuming and costly. Generators will also be procured for health facilities so that CD4 counters can be
used in the hospitals. Two medical staff from each of the camps will be trained on the use of the counter by
university staff. Clients who test positive for HIV will be monitored but referrals will be made to regional
hospitals so that refugees can receive ART. In order to ensure that refugees receive care from these
hospitals, transport and funds will be provided so that they can travel to and stay in the region while they are
receiving their monthly care. This service will be extended to approximately 80 persons. Referrals will be
provided by ARRA.
Home-based care for AIDS patients will be introduced through training and support for care providers from
the community. HAPCO will train social workers on home-based care and support. Implementing partners
(these differ from camp to camp) will hire one social worker for every 2,500 people in each camp; that
person will be trained in provision of home-based care. The cost for this is 350 birr per month per social
worker. The social workers, both male and female, will be from the local communities, including host
populations, and will speak the same language as the population with which they are working.
Essential OI drugs (not including those required for treatment of TB) such as cotrimoxazole, fluconazole,
and acyclovir will be purchased and provided to refugee health centers for treatment of patients. HAPCO
will train new staff on care and support and provide refresher training as needed.
Health-center staff will procure and distribute palliative-care packages to all HIV-positive clients.
Implementing partners will provide material support to HIV-positive patients and their families that includes:
blankets, kitchen sets, clothes, and buckets. New staff involved in the distribution of material support will be
trained on delivery and use of the packages.
In 2007, support was provided to groups of people who had come out as HIV-positive. Implementing
partners assisted them with education, agricultural assistance, and stigma-breaking. In 2008 we will
increase support to these groups so that they can expand and provide further support to other people in the
community who test positive for the virus through our expanded counseling and testing services. Those who
test positive will be referred to and included in these local groups. This activity will be provided to
approximately 300 people.
Continuing Activity: 16689
16689 10572.08 Department of United Nations 7506 3790.08 $107,000
10572 10572.07 Department of United Nations 5524 3790.07 $100,000
Estimated amount of funding that is planned for Human Capacity Development $20,200
Estimated amount of funding that is planned for Economic Strengthening $50,500
Table 3.3.08:
Assistance to Orphans and Vulnerable Children
Ethiopia has experienced an influx of Somali refugees, many fleeing the current political insecurity in
Mogadishu. A second camp, Aw Barre (formerly Teferiber), was established in July 2007 and a third camp,
Sheder, was established in April 2008 to accommodate this influx. Given the current situation, it is expected
that this number will continue to rise. In FY08 NGO medical staff working in Aw Barre Refugee Camp in the
Somali region identified an unusually high instance of mental illness. There is every indication that more
cases exist than have been brought forward for medical attention, including youth. In addition to patients
suffering from psychosis (e.g., bi-polar disorder, schizophrenia), a psychiatrist working in the camp identified
the following clusters of patients exhibiting mental problems that have previously gone untreated: a high
rate (1:100) of mental retardation in Aw Barre — the normal rate is 1:1000; single mothers taking care of
their siblings or children of relatives who suffer from burn-out and conversion disorders, putting the children
under their care at risk; victims of sexual exploitation; and victims of bodily injuries, especially head trauma,
burns and bullet wounds resulting in behavior changes such as aggression and paranoia.
In FY09 UNHCR will expand geographic coverage of services detailed in FY08 to Sheder Refugee Camp in
the Somali Region and Asayita Refugee Camp in the Afar region to meet the needs of these vulnerable
populations. UNHCR will also expand services to provide an expert trainer and continued expert technical
assistance (professional counselor/ psychologist/ psychiatrist) for national staff and refugee social workers
to address unique psychosocial needs of vulnerable children in the camps. To address challenges with
coordination among partners, Child Protection Coordination Groups will be formed to assist OVC, especially
in the provision of quality, timely medical care and receipt of rations.
COP08 NARRATIVE
This continuing intervention will provide OVC care and support in and around Fugnido, Kebribeyah,
Teferiber, and Afar refugee camps. Both Afar and Teferiber are new camps and activities were not
implemented there in FY07. Orphaned and vulnerable children can suffer social, emotional, and economic
consequences. Their problems are not well-addressed, especially in refugee settings. FY07 marked the first
time that the United Nations High Commissioner for Refugees (UNHCR) and implementing partners began
to offer programs for OVC in Ethiopian refugee settings. Using the results from the pilot project, Sudanese,
Somali, and Eritrean OVC living in both the camp and host populations will be supported by strengthening
family and community capacity, providing skills training to older children, and support for younger children.
This program was developed with the Government of Ethiopia's Agency for Refugee and Returnee Affairs
(ARRA). All activities are coordinated closely with ARRA, which is responsible for basic health care in the
camps, as well as all other implementing partners. UNHCR collaborates with the local HIV/AIDS Prevention
and Control Offices (HAPCO) and coordinates with other PEPFAR partners to train ARRA health staff and
staff from other implementing partners (IP).
Implementing programs in these regions will require significant logistical and material inputs due to the
tenuous security situation; intra- and inter-ethnic conflicts frequently erupt in Gambella region, most notably
with the murder of three ARRA officials in December 2003, just ten miles outside Gambella town. All trips to
Fugnido camp require armed military escort, which adds considerable costs and logistical maneuvering for
routine visits. Although the security situation in Kebribeyah and Teferiber is not as bad as Gambella, this
region is historically under-resourced and lies in an area under threat of violence due to its proximity to
Somalia and the frequent conflicts between Ethiopian military and local rebel factions. The population in
Afar region is traditionally nomadic; as a result, implementing programs within that community will be
particularly challenging.
Using best practices and lessons learned from a pilot project implemented in two refugee camps in 2007, IP
will identify OVC using PEPFAR-established criteria and the program developed in 2007 by the International
Rescue Committee. Children determined to be eligible will be enrolled in activities, and will be linked to
existing services within the refugee camps. Camps will need to conduct an initial assessment (which will be
completed by a consultant) in order to determine eligibility in such a way that does not label OVC as such to
the community. OVC who are HIV-positive will be followed closely to ensure that they are receiving
adequate and appropriate medical support. All OVC will be linked to medical services to ensure that they
are receiving the help they require. In addition, children will be referred to psychosocial staff on a case-by-
case basis.
In 2007, peer educators were trained by the Academy for Education Development (AED) in each refugee
camp as an AB activity. Training for new peer educators will be expanded in the new camps for 2008.
Refresher trainings will be provided for peer educators who were trained in 2007. IP will use a percentage of
OVC as peer educators to provide support for identified OVC and link OVC to youth activities, such as
interactive theater and Sports for Life, that are provided in the camps. Additional support will be provided to
OVC using the social workers hired by our IP. One supervising social worker will be hired for each camp to
ensure that the needs of the OVC are being met. Camp social workers will refer OVC to services provided
in the camps, including healthcare, schools, food-distribution sites, and counseling.
As part of a comprehensive approach to HIV and AIDS interventions, parents who test positive for HIV at
counseling and testing sites will be assessed to determine whether children in the household meet the
requirements for consideration as OVC. The same will hold true for youth who test positive at the
counseling and testing facilities. If so, they will receive services provided for OVC. Education materials such
as stationery, books, and school uniforms will be provided to all OVC enrolled by UNHCR and its IP.
UNHCR's IP will also provide life and vocational skills training for older children in their care. Social workers
trained by UNHCR's IP will train OVC caregivers on the care of children with HIV. This training will include
Activity Narrative: information on nutrition, basic hygiene, and healthcare.
Small scale agricultural and gardening programs will be implemented within households of OVC.
Implementing partners who work on community-service projects will initiate these activities with identified
households. Additional vegetables grown can be sold as part of an income-generating project. OVC will also
be provided with kitchen sets to open tea houses within the camps as part of an income-generating project.
Materials will be provided so that they can renovate structures and create the tea houses.
In order to coordinate the activities for OVC which include AB, Other Prevention (OP), and voluntary
counseling and testing (VCT), a coordinator will be hired for each camp to assess and ensure coordination
and linkages across the service delivery areas.
Through these activities, the project aims to reduce the suffering and improve the lives of 600 OVC.
UNHCR, following OVC guidance from the Office of the Global AIDS Coordinator, will develop pertinent
program indicators, and distinguish between direct primary and indirect supplemental services in semi-
annual and annual reports, indicating how they address gender equity in their programs. UNHCR will be
required to come up with an exit strategy to create smooth transition of the program from PEPFAR funding
to community/UNHCR and government support.
Continuing Activity: 16690
16690 10530.08 Department of United Nations 7506 3790.08 $107,000
10530 10530.07 Department of United Nations 5524 3790.07 $100,000
Table 3.3.13:
VCT Services for Refugees and Host Populations in Ethiopia
THIS ACTIVITY HAS BEEN MODIFIED FROM COP08 IN THE FOLLOWING WAYS:
In FY09 UNHCR will expand geographic coverage of this activity to initiate VCT services in Sheder Refugee
Camp in the Somali Region and Asayita Refugee Camp in Afar. Otherwise this activity remains unchanged
from FY08.
COP08 Narrative for this Activity:
Related Activities: This proposal is programmatically linked to Condoms and Other HIV Prevention Services
for Refugees and Host Populations in Ethiopia (10529), HIV Prevention Services for Refugees and Host
Populations in Ethiopia (10528), Assistance to Orphans and Vulnerable Children in Refugee Camps in
Ethiopia (10530), Palliative Care in Refugee Camps in Ethiopia (10572), and Universal Precautions and
Post-Exposure Prophylaxis in Refugee Camps in Ethiopia (10634).
This activity will provide voluntary counseling and testing services to members of the host community in
Fugnido in the Gambella region, in Kebrebayah and Teferiber in Somali region, and a new camp and host
population in the Afar region for Eritrean refugees. In all camps, information-education-community/behavior-
change communication (IEC/BCC) activities that raise awareness and create demand for voluntary
counseling and testing (VCT) services will be conducted. Community-awareness-raising activities, which will
be implemented under AB and Other Prevention (OP) programs, will be linked to this VCT activity in order
to provide a comprehensive approach to HIV/AIDS prevention and care.
Counseling and testing (CT) will serve as a gateway to prevention activities, as well as to care and
treatment services for clients who test positive for HIV. The United Nations High Commissioner for
Refugees (UNHCR) will also create linkages among existing PEPFAR partners who are operating in the
regions, including Columbia University (Somali Region), Johns Hopkins University (Gambella Region), and
University of Washington/I-TECH (Afar Region) in order to improve the level of service provided in the
health center and to take advantage of additional government and regional resources. The number of
refugees served in Ethiopia is dependent on the political situation in the adjacent countries. In addition, the
camps listed are subject to change based on the political situation, both in and out of Ethiopia. The majority
of people testing for HIV will come from Fugnido camp. Testing will be more difficult in the Somali and Afar
regions due to the religious and cultural backgrounds of target populations.
The following activities will be undertaken:
Counselors (1-2 male, 1-2 female, depending on the camp size and makeup) and nurses for counseling and
testing centers will be recruited and trained as needed by an implementing partner (IP). Counselors will be
representative of each ethnic group living in the camps and host communities and will be hired if not already
present in the camps. Staff will be trained in confidentiality, counseling (pre- and post-test), procurement,
and use and storage of rapid HIV test kits. Rapid test kits (Capillus, Determine, and Unigold) and
consumable laboratory materials will be procured and supplied regularly to the counseling and testing
centers. Ten Capillus, seven Determine, and five Unigold rapid testing kits will be purchased.
In-service CT training will be carried out for all healthcare providers. Refresher training will be given to staff
who received training in 2007. Training for providers and counselors will include provider-initiated
counseling and testing (PICT).
Referral linkages to existing public-health institutions will be established and made operational. Testing staff
will refer to those receiving HIV tests to family planning, sexually transmitted infections (STI), and
tuberculosis (TB) clinics. Patients entering STI and TB clinics will be urged to get tested for HIV at the clinic.
ARRA staff working in the clinics will refer those who test positive for HIV to local hospitals so that they can
have a CD4 test and can be monitored and given ART at the appropriate time. If CD4 counters are available
in the camps, the tests will be done in the camps. Palliative-care funds have been requested to purchase
equipment to monitor CD4 counts within the refugee camps so that refugees do not have to make the long
trip to the regional hospital each month. Funds will be provided to the refugees so that they can get to the
regional hospital and receive care.
Testing sites will be expanded to youth centers in order to increase the number of people tested. The new
sites will be established at youth centers so that the youth do not have to go to the health facilities in order
to get tested. This will be implemented first in Fugnido, and an additional nurse will be hired to conduct the
tests, as well as to counsel patients. If this is successful, additional lay counselors will be hired to assist in
the provision of services. In addition, a CT site must be created for refugees in the Afar Camp.
Those testing positive for HIV will be referred to a social worker and to nutritionists working in the camps
who can provide support and information on food preparation. If nutritionists are not available in the camps,
they will be hired by local implementing partners (approximately two per camp). Counseling and referrals
are not limited to those who test positive, but will also be provided to those who test negative so that they
remain negative.
Links will also be made to the groups of people living with HIV/AIDS which were created under OP in order
to provide support and additional services for HIV-positive persons. Children of those testing positive for
HIV will be assessed in order to determine whether or not they require OVC services, as part of OVC care.
As part of AB, community conversations and coffee ceremonies will promote the importance of counseling
and testing. Peer counselors will encourage HIV testing, and the youth programs will implement
components stressing the importance of testing for HIV. At the quarterly conversations with local and
religious leaders listed under AB, IP will stress the importance of CT and will try to encourage local leaders
Activity Narrative: to support the services within the community. Specific outreach will be done at women's groups, amongst
women in the community, and with commercial sex workers to encourage them to be tested for HIV. Testing
days will be implemented at youth centers and at other locations aside from the clinic itself to ensure that
testing is easily accessible to the populations.
Monitoring and evaluation system of the VCT services will be put in place and implemented accordingly.
Continuing Activity: 18200
18200 18200.08 Department of United Nations 7506 3790.08 $128,400
Table 3.3.14:
Strategic Information on HIV/AIDS in Refugee and Host Populations in Ethiopia
ACTIVITY REMAINS UNCHANGED FROM FY08
Monitoring the level and trend of HIV infection is an integral component of a comprehensive HIV response.
Data enable policy makers and planners to appreciate the magnitude of the problem, allocate resources,
and monitor effectiveness of interventions. Unfortunately, in refugee settings in Ethiopia, there is a dire lack
of HIV prevalence and behavioral data. Refugees have not been integrated into national HIV sentinel
surveillance or community-based surveys. The burden of HIV/AIDS amongst refugees is not understood.
Under this project, technical assistance and training will be provided to a cross section of implementing
partners' staff members in Ethiopia through expert consultation, on-site visits, as well as meetings. A
mission will be conducted each quarter to see first-hand the monitoring of PEPFAR programs and the
surveillance systems. Technical assistance will be provided during these visits, as well as throughout the
funding cycle. On-the-job training and supervisory support will be strengthened. A time-limited consultant
will be hired to support healthcare providers and provide technical support to carry out sentinel surveillance.
UNHCR will train implementing partners on data collection systems and the use of indicators.
In 2007, the United Nations High Commissioner for Refugees (UNHCR) trained 150 people on strategic
information (SI). This training will be continued and UNHCR staff will train implementing partners (IP) on
data collection and program monitoring in Addis Ababa and within the camps. The consultant will review
monthly data submissions and will discuss them with IP.
In order to develop and implement a single-point surveillance system, UNHCR will collaborate with
universities working in the regions of Ethiopia. The universities will conduct the surveillance and supply the
data to UNHCR in Addis. Universities will also train partners working in the camps to ensure that they are
well-versed in data collection and use of computers.
UNHCR will synthesize information collected on refugees and manage a database. Information will be
provided by IP and organizations, including the Government of Ethiopia (GOE), working with the refugee
populations in the country. UNHCR will ensure that data is shared with IP, USG, and relevant partners and
interested organizations.
Continuing Activity: 18211
18211 18211.08 Department of United Nations 7506 3790.08 $85,600
Estimated amount of funding that is planned for Human Capacity Development $35,400
Table 3.3.17:
