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
WHO Medical Transmission/Blood Safety
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
WHO supports rapid scale-up of activities in Ethiopia for the establishment of a sustainable, nationally
coordinated Blood Transfusion Service. This project began in FY04 with an assessment of existing blood
transfusion services to determine their capacity for rapid strengthening into the Blood Transfusion Service
infrastructure and program. WHO, assisted by the Federal Ministry of Health (MOH), developed a five-year
strategic plan in collaboration with all key stakeholders for strengthening and restructuring the blood supply
system through the regionalization of key services, including testing and processing. WHO has provided
support in training and development of instruments to improve blood donor recruitment, blood testing, and
the clinical interface, as well as establishment of quality systems in the national blood supply system. This
marked the initiation phase of the program.
In FY06, WHO provided technical support for implementation of the five-year strategic plan. WHO, in
collaboration with the MOH, completed assessments of strategies in blood donor recruitment as well as
quality systems. Following the assessments, roadmaps to address the identified gaps in blood donor
recruitment and quality were developed, and the implementation of these roadmaps is on course. National
Guidelines for Appropriate Clinical Use of Blood were developed and distributed. WHO supported the
initiation of hospital-level transfusion committees and one of them, at Black Lion Hospital, became a pilot
site for the strengthening of aspects of the clinical interface. To date, WHO has trained 831 individuals
involved in blood transfusion services, and four technical staff members have been out-posted in other
countries to gain experience and further professional development.
In FY08, WHO continued to support strengthening of the national blood program by following the roadmaps
developed in FY06. In collaboration with Regional Health Bureaus (RHB) and ERCS, WHO worked to build
capacity and develop partner engagement mechanisms through forums focusing on equity and quality
issues in service provision. WHO also collaborated on development of draft legislation for the blood
transfusion service legal framework and a human resource development plan. Since the inception of the
project, internationally renowned consultants in blood transfusion have been recruited to support activities in
their areas of expertise.
Activities for FY09:
In FY09, WHO will continue to provide technical assistance to expand and consolidate the blood safety
program. The technical assistance will result in the establishment of efficient, sustainable, national blood
transfusion services that can assure the accessibility, quality, safety and adequacy of blood and blood
products to meet the needs of all patients requiring transfusion in Ethiopia. This will be achieved through the
following activities:
1) WHO will offer pre-service training and continuing medical education to 350 individuals involved in
providing vein-to-vein blood transfusion services. International placements and training of technical staff will
be coordinated
2) WHO will support enhanced blood donor recruitment to meet the national requirements for a safe blood
supply. Community mobilization and improved communication methods will lead to an expanded, stable,
base of regular, voluntary, non-remunerated blood donors. WHO will support the training of journalists,
community mobilizers, and staff for improved communication
3) Cost-effective quality testing and processing will be achieved by establishing and strengthening blood
bank laboratory functions, particularly in the regions. This will include scale-up of component production and
cold chain maintenance
4) WHO will support the reduction of unnecessary transfusions in order to prevent adverse transfusion
events and reactions by training staff on appropriate clinical use of blood and safe bedside practices. WHO
will support the requisite training tools, and will continue supporting Hospital Transfusion Committees
5) WHO will strengthen systems for regular monitoring, evaluation, review, and re-planning through training.
WHO will also support improved mechanisms for data collection and management, including the use of
appropriate indicators
6) WHO will support the regionalization/centralization of blood bank functions to enhance cost-effective
service provision while preserving quality service
7) WHO will support strengthening of quality systems through training as part of the roadmap developed in
FY06. Through these trainings, establishment of all quality elements in blood transfusion services is
foreseen
8) WHO will support in strengthening the national coordination by establishing a management structure at
the national level, which would be responsible for planning the finance, data management and routine
operations as well as for coordinating the overall program in the country. The MoH should constitute a
National Blood Committee or Commission to advise and assist in planning and monitoring transfusion
services of a uniform standard throughout the country
9) WHO will assist in establishing regional coordination committees/taskforces accountable to the RHB and
whose composition will ensure representation from the community, political leadership, health services as
well as the blood transfusion service personnel in the region to guide activities at the peripheral level and to
provide policy advice. These committees should monitor activities at the regional level and support the
districts
In FY09, WHO will put particular emphasis on scale-up of services in the regions through human resource
development, mentoring, and regular supportive supervision. Due to inadequate capacity in the country,
both local and international expertise will be engaged in some of the activities.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16560
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16560 5757.08 HHS/Centers for World Health 7469 3793.08 Track 1 $500,000
Disease Control & Organization
Prevention
8098 5757.07 HHS/Centers for World Health 4704 3793.07 Track 1 $400,000
5757 5757.06 HHS/Centers for World Health 3793 3793.06 $676,440
Emphasis Areas
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
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Total Planned Funding for Program Budget Code: $3,466,777
Total Planned Funding for Program Budget Code: $0
Table 3.3.05:
Integerated Service Strengthening
ACTIVITY UNCHANGED FROM FY2008
This is a continuing activity from FY07 and FY08. This is a hospital-level activity related to strengthening of
integrated services at health centers. Integrated health service strengthening—which builds capacity for
decentralized HIV services, including chronic disease management, ART, and prevention—requires good
coordination of clinical care within the health network model and appropriate back-up from zonal, regional,
and university hospitals. The health network model consists of hospitals, health centers, health posts, and
community based health workers. Health center scale-up of HIV prevention, care, and ART is proceeding
very rapidly, along with efforts to link hospitals and health centers through clinical mentoring programs.
Doctors and health officers at hospital level need preparation for their mentoring role with compatible
training materials, and continued support through an ongoing learning program.
Scaling up HIV care and ART requires decentralization and active strengthening of the health network
model, establishment of a consultative referral and back-referral system between community health center
and hospital, and a system of supportive supervision and clinical mentoring. This requires consistent
support and understanding of the planned interventions and the simplified, operationalized, Ethiopia
adapted guidelines for integrated management of adolescent and adult illness (IMAI) and training materials
used at hospital, health center, and community levels. Inconsistencies in approaches will confuse and
undermine attempts to extend HIV prevention, care, and ART. Doctors and health officers will also need
empowering to introduce any new guidelines or interventions, as HIV global normative guidelines and
national policies change.
The World Health Organization's (WHO) IMAI/ Integrated Management of Childhood Illness (IMCI) Second
Level HIV Clinical Learning Program consists of an introductory training course and materials to support
follow-up learning, supporting individual progressive expertise while accommodating new updates.
In this activity WHO will: 1) Continue providing technical assistance (TA) to work with Ethiopian and US
based universities to support the IMAI/IMCI Second Level HIV Clinical Learning Program by supporting
adaptation and further development of training programs. 2) Continue working with Ethiopia and US based
universities on training of trainers, pre-service and in-service training of IMCI/IMAI Second Level HIV
Clinical Learning Program and clinical mentoring. WHO will focus on building the capacity of local
institutions to have a big role in both pre-service and in-service training. 3) Provide TA with career
development, including continuing medical education, certification and licensing, and non-financial schemes
for retention of clinical mentors. 4) Continue development and update of clinical videos to support improved
initial and ongoing learning. 5) Provide TA for supervision of the clinical mentoring program to assure quality
development of functional health network models. Standardized, periodic on-site supportive supervision and
regular clinical mentoring program reviews will be an integral part of this activity. 6) Develop a case library
of actual cases from hospitals and health centers for the training and ongoing learning process. 7) Provide
in-depth opportunities for professional exchanges for government and university senior clinician mentors, in
collaboration with other WHO programs in Africa and elsewhere.
The learning program begins with the second-level in-service course, as well as pre-service training, based
on initial IMAI basic course training. The program then covers material designed specifically for district
doctors. The initial training will be in ART and opportunistic infections (OI), through an interactive approach
with expert patient trainers and hospital and health center visits. The second-level course does not produce
HIV expert physicians or pediatricians, but doctors and medical officers competent at handling first- and
second-line ART, OI, and tuberculosis/HIV co-infection in adults and children, and their common
complications. The course focuses on the most common conditions requiring management at district
hospital level.
The second-level learning program is framed in the public health approach for scaling up access to high
quality HIV care and treatment. There are already more than 30 organizations and 15 countries involved in
the interactive development process, including the US based universities working at hospitals in Ethiopia
(e.g., University of Washington (I-TECH), Johns Hopkins University, Columbia University, and the University
of California San Diego.
Mentoring and follow-up training are integral to the IMAI approach in doctor training. WHO will work with
HIV/AIDS Prevention and Control Offices to standardize the mentoring activity according to
recommendations from the Ethiopian Ministry of Health. Other components of the learning program include
follow-up short courses, preparation for clinical mentoring, ongoing support for mentors, clinical casebook
exercises, and video case presentations. These support doctors to further develop their HIV care skills and
expand their knowledge. The follow-up courses help to solidify existing experience and training, as well as
to expand knowledge about a particular topic, such as pediatric ART or TB/HIV. This will harmonize with the
national approach to training, with substantial benefits for the zonal/district network and the speed and
efficiency of scale-up. This will lead to wider access to higher quality, sustainable HIV care.
Each potential mentor will undergo training on: effective mentoring; adult participatory education skills
(communication skills, active listening, giving nonjudgmental feedback); and effective case review and care
by the clinical team. They will also receive a set of standardized mentoring tools, including reporting forms
and log books. Mentors will be expected to participate in the two-week basic IMAI clinical course in order to
become completely familiar with the clinical and operational protocols used at district hospital and health
center level. Mentors will be trained to use the standardized patient monitoring system (ART follow-up form,
ART, and pre-ART registers) to find and review interesting cases, and to calculate simple indicators which
can be collected easily by the clinic staff or a clinical mentor during an on-site visit in order to identify,
change, and improve inefficient or ineffective clinical practices.
In light of the emphasis on accelerated, decentralized HIV care and ART, the HIV care and treatment scale-
Activity Narrative: up in Ethiopia will follow the guiding principle of "high impact and high yield." The TA will focus on
referral/back-referral linkages, on-going learning programs through clinical mentoring, and routine on-site
supportive supervision based on the existing health network model. As care and treatment programs
expand, and the number of patients on treatment increases, attention must be given to the quality of the
ART services being provided. WHO will work with other relevant PEPFAR Ethiopia partners to strengthen
the zonal and district health networks' abilities to monitor and evaluate programs using the standardized
program indicators.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $972,000
Table 3.3.09:
Strengthening Human Resources, MDR-TB control, and TB Infection Control
I. Strengthening of Human Resource Capacity:
The human resource crisis in the health system is one major rate-limiting problem in Ethiopia. TB/HIV
collaborative activities have faced high staff turnover, which has affected scale-up of collaborative activities
implementation. Plus-up funding from FY07 was used by the World Health Organization (WHO) to provide
additional staff at the Federal Ministry of Health (MOH) and the regional health bureaus (RHB).
Activities for FY08 will include:
1) Providing training to mid-level staff in MOH to develop their skills, so that they can eventually fill higher-
level positions
2) Assessment of the impact of additional staff added in FY07
3) In underperforming regions, staff may be added according to need at RHB
II. MDR-TB:
The TB program in Ethiopia has not yet started managing multi-drug-resistant TB (MDR-TB) cases.
However, plus-up funding from FY07 was allocated to support MOH in the initiation of MDR-TB treatment.
WHO will continue this support in FY08 by providing ongoing MDR-TB training to additional clinicians in St.
Peter's Hospital, the TB specialty hospital in Addis Ababa. This activity will synergize well with support from
the Global Fund for AIDS, Malaria, and Tuberculosis, which will support the cost of second-line drugs for
MDR-TB treatment. WHO will facilitate these activities by closely working with MOH and the HIV/AIDS
Prevention and Control Office (HAPCO).
III. TB Infection Control:
The country urgently needs a TB infection-control strategy. Plus-up funding from FY07 was allocated to do
a baseline assessment of current infection-control practices, to support the national program in developing
national infection-control guidelines, and to implement appropriate infection-control measures in selected
hospitals, including St. Peter's. Activities for FY08 will build on these activities by:
1) Supporting technical assistance from external consultants to improve infection control practices and to
guide implementation
2) Procuring necessary supplies for infection control in hospitals.
WHO will take the lead in assisting the MOH in these activities, in collaboration with relevant stakeholders
and partners. WHO will also organize a review mission to evaluate the status of implementation of the TB
and TB/HIV programs in Ethiopia.
Continuing Activity: 18463
18463 18463.08 HHS/Centers for World Health 7524 3793.08 WHO-CDC $1,395,000
Construction/Renovation
Health-related Wraparound Programs
* Child Survival Activities
* TB
Table 3.3.12:
