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
WFP's Urban HIV/AIDS Program
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is continuing activity from COP 08. The proposed budgetary increase in COP09 funding is necessary
to mitigate the 40 % rise in world food price. The activities will focus on increased reach to HIV positive
pregnant woman and their newborns at PMTCT clinics in health facilities.
There are an estimated 2.8 million annual deliveries in Ethiopia. Approximately 61,600 HIV-positive women
deliver each year (2008 "single-point" estimate of 2.2). With no intervention, approximately 21,560 would be
expected to have HIV-infected infants annually (assuming a 35% transmission rate).
Overall MNCH coverage is very low, although much higher in urban areas. The 2005 Ethiopia
Demographic Health Survey (DHS) indicates that approximately 28% of pregnant women attend ANC at
least once and an estimated 6% deliver in health facilities. In urban areas, 69% of women attend ANC and
45% deliver in a health facility. In Addis Ababa, nearly 90% of women attend ANC and over 75% deliver in
a health facility. There are currently a total of 1,069 hospitals, health centers and private clinics in Ethiopia.
In addition to preventing transmission from mother-to-child, Ethiopia is working with the Ministry of Health to
provide family-centered treatment and care services for pregnant HIV positive mothers and their newborn
infants.
COP08 ACTIVITY NARRATIVE
This is a continuing activity with new funding available in PMTCT to provide nutritional support to HIV-
positive pregnant women through the ongoing World Food Program (WFP) project titled "Supporting
Households, Women and Children Infected and Affected by HIV/AIDS," also referred to as "Urban
HIV/AIDS." The activity is part of WFP's Protracted Relief and Recovery Operation (PRRO), is a
continuation of activities supported in FY06 and FY07, and is linked to USAID Title II contributions for
nutritional support. Increased funding is requested in 2008 in order to reach larger numbers of food insecure
families and to expand the geographical areas covered by the project. The FY08 funding for the World Food
Program Urban HIV/AIDS program totals $8,600,000 million ($4,000,000 million for palliative care, $3.6
million for OVC and $1 million for PMTCT) which leverages $7 million in food.
This activity will complement PEPFAR resources with food resources leveraged from WFP multilateral
contributions, Title II USAID Food For Peace, and FY07 bilateral donors, including: France ($500,000),
Spain (500,000 Euros), Sweden ($1 million), and Egypt ($100,000), with additional contributions from other
donors to be confirmed. PEPFAR resources will be used to purchase food commodities for HIV-positive
pregnant mothers and their children and to cover the associated logistics costs. Approximately one third of
the proposed budget will be used for food commodities. PEPFAR resources will support improved nutritional
status and quality of life through nutrition assessments and counseling, nutrition education, and household
access to economic-strengthening opportunities. The provision of food and nutritional support through WFP
and partners is complementary with other services for OVC.
This project is currently implemented in 14 of the most populous urban areas in Ethiopia, in four large
regions, (Amhara, Oromiya, Tigray, and the Southern Nations, Nationalities and Peoples Region (SNNPR)),
and two urban administrative areas (Addis Ababa and Dire Dawa). Selection of existing and potential
additional areas for the implementation of this project is done by assessing the level of need in urban areas
and examining the HIV prevalence rate and urban poverty index. Up to 12 additional urban areas will be
selected for the project after assessments conducted by regional HIV/AIDS Prevention and Control Offices
(HAPCO) with participation and support from WFP, and based upon an increased level of contributions from
donors. Regions where the project is implemented have been consistently asserting the necessity for
extending this project to additional urban areas.
The beneficiaries of the project will be HIV-positive mothers identified through referral links from
nongovernmental organizations (NGO), community-based organizations (CBO), and ward-level HIV/AIDS
committees. Household assessments are conducted to ensure that all beneficiaries are food insecure and
require the type of food support provided by WFP. The activity is implemented by town HAPCO and NGO
partners. Each town has a coordination committee that is responsible for the selection of beneficiaries. The
committee is composed of representatives of the town, HAPCO, health-service providers, NGO partners,
and associations for people living with HIV/AIDS (PLWH). Activities include training for partners and
providers of home-based, palliative care and beneficiaries in HIV/AIDS and nutrition. The activities are
aimed at maximizing beneficiaries' abilities to improve their own nutritional status through selection and
preparation of different types of food. In order to ensure the effective consumption of the Corn Soya Blend
(CSB), a blended fortified food rich in micronutrients provided by this project, WFP has produced training
materials and handbooks in preparation and consumption of CSB that are distributed to all beneficiaries.
WFP also strengthens and provides ongoing support to town-level coordination structures by providing
information-technology equipment and training in monitoring and evaluation. Nutritional, health, and hygiene
counseling are integrated into the counseling and home-based care services supported by the project. The
structures of coordination and communication established through the WFP-supported project have had an
overall positive impact on the provision of integrated services in the urban areas where the project is
implemented, beyond the provision of nutritional support.
In order to track the wider impact of the project, WFP uses PEPFAR resources to conduct Results-Based
Management (RBM) Monitoring. Quarterly reports on commodity flow and numbers of beneficiaries
receiving food and nutritional support, as well as on complementary activities, are submitted by partners in
each of the implementation areas. Annual RBM surveys are conducted by WFP and partners to measure
the impact of the project on a range of indicators. WFP also engages in qualitative forms of monitoring and
evaluation, including the identification of best practices in particularly successful towns. It also sponsors
experience-sharing workshops for all partners.
Activity Narrative: WFP will collaborate with PMTCT programs to pursue and implement sustainable food security options
while simultaneously providing food inputs. These sustainable options will focus on increasing household
assets through market-driven economic strengthening activities, such as small business development,
savings and loan schemes, and micro-credit. Partnerships with economic-growth programs will be
established or expanded to provide needed technical expertise and linkage to viable market options. WFP
uses public and private contributions to strengthen partners' ability to implement economic strengthening
options. WFP experience in the area of income-generation for beneficiaries includes provision of small
loans that have led to increased household assets through small business development.
A strategy to stabilize the food security status of HIV-affected households and transition them from food aid
is under development for implementation in FY08. This strategy is being planned with Government of
Ethiopia and other stakeholders. Graduation from food aid will be managed by partners at the town level
and is supported by economic-strengthening opportunities.
New/Continuing Activity: Continuing Activity
Continuing Activity: 18585
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18585 18585.08 U.S. Agency for World Food 7503 3794.08 Urban HIV/AIDS $1,000,000
International Program Program
Development
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $19,500
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $1,458,000
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $22,500
Education
Water
Table 3.3.01:
urban HIV/AIDS Programs
This is a continuing activity from COP08. The proposed increase in COP09 funding is necessary to mitigate
the 40 % rise in world food costs and procurement. As Ethiopia is categorized as a focus country for food
and nutrition, PEPFAR Ethiopia has identified nutrition support as a priority care and support service that is
critical to improve ART adherence and treatment outcomes. The program will continue to expand to more
high risk outlet sites improving the enrollment of severely malnourished PLWH, HIV-positive pregnant
women in PMTCT programs, HIV-positive lactating women in the first six months post-partum, their infants,
and OVC.
COP 08 Narrative:
Related activities (drop down box):
Management Science for Health HIV/AIDS Care and Support project activities in Palliative Care (10647)
and TB/HIV (10400)
PMTCT/Health Centers and Communities (10615)
International Training and Education Center on HIV (I-TECH) technical support for ART scale up (10439)
Johns Hopkins University (JHU) Technical Support for ART Scale-up (10430)
Columbia University Technical Support for ART Scale-up (10436)
University of California San Diego (UCSD) military ART support services (10426)
This is a continuation of a COP06 and COP07 activity that provides nutritional support to food insecure and
malnourished PLWHA, including HIV positive mothers and their children in the ongoing "Urban HIV/AIDS"
project in WFP Ethiopia's Protracted Relief and Recovery Operation (PRRO). Funding has been increased
to reach increased numbers of clinically malnourished and food insecure PLWHA and expand the
geographical areas in the project.
contributions, the USAID Title II Food for Peace Program and bilateral donors. In 2007, these resources
include $US 500,000 from France, 500,000 Euros from Spain, $US 1,000,000 from Sweden, and $US
100,000 from Egypt, with additional contributions from other donors to be confirmed.
PEPFAR resources will cover the logistics costs associated with food delivery and distribution of
commodities to clinically malnourished PLWHA and mothers participating in Prevention of Mother-to-Child
Transmission (PMTCT) programs and their infants. PEPFAR resources will increase the quality and
linkages in the project by supporting an integrated support package designed to improve nutritional status
and quality of life of PLWHA, PMTCT mothers and their infants through nutritional assessments and
counseling, psychosocial support and nutrition education within community and home-based care (HBC)
services. The program will also support linkages with health facility-based pre-ART and ART services,
PMTCT services and capacity development of local HIV/AIDS committees and town HIV/AIDS Prevention
and Control Offices (HAPCO). This activity is linked to other PEPFAR supported programs including
antiretroviral treatment (ART), HBC and Income Generating Activities (IGA). Nutritional support will also be
linked to the new facility based Food by Prescription activity funded by PEPFAR. Malnourished PLWHA,
including women participating in PMTCT receiving Ready-to-use Therapeutic Food (RUTF), will be linked to
longer term community-based food and nutrition and livelihood support, provided by WFP, with leveraged
resources to support family members who may not qualify for support per PEPFAR guidelines. This will help
ensure that severely malnourished PLWHA benefit to the maximum from the RUTF provided, supporting
patients to recover from acute malnutrition in the short term, while the provision of the WFP food basket
ensures longer term nutritional support, and minimizes consumption of RUTF by family members. This
provision of nutritional support is complementary with other HIV/AIDS services, contributing to wider goals
of increasing access to prevention, care and treatment services by creating incentives to access services
and promoting treatment efficacy.
This project is currently implemented in 14 urban and per urban areas where rates of HIV infection are
particularly high and urban poverty is acute. These are located in four regions, Amhara, Oromiya, Tigray
and the Southern Nations, Nationalities and Peoples (SNNP), and two urban administrative areas, Addis
Ababa and Dire Dawa. Selection criteria include the HIV prevalence rate, the urban poverty index, numbers
of patients accessing ART, and the number of PLWHA receiving HBC. Based on similar criteria and in
collaboration with regional HAPCO, in FY08 WFP will initiate activities in up to 12 additional urban and per
urban areas, assuming additional donor funding is forthcoming.
The beneficiaries of the project are PLWHA, including HIV positive women and their infants participating in
PMTCT programs accessing HIV treatment and care services with clinical signs of severe malnutrition as
demonstrated by low Body Mass Index (BMI), and their household members. Beneficiaries are identified
through referral links from hospitals and health centers, PLWHA associations and NGOs providing HBC
services. Household assessments are conducted to ensure that all beneficiaries are food insecure and
require the type of food support provided by WFP. Each site has a coordination committee composed of
representatives of the town, HAPCO, health service providers, NGO partners and PLWHA associations that
is responsible for the selection of beneficiaries. Beneficiaries are monitored through a tracking system that
is managed by the participating NGO, government partners and health service providers. This approach
increases the linkages between clinical and community based care services.
WFP conducts a range of complementary activities that are directly linked to the provision of food support
and are funded by PEPFAR contributions. These activities include training for partners, home-based
palliative caregivers and beneficiaries in HIV/AIDS and nutrition concepts and methods to maximize
beneficiaries' abilities to improve their own nutritional status through selection and preparation of
appropriate foods. For example, in order to ensure effective consumption of the Corn Soya Blend (CSB), a
blended fortified food rich in micronutrients provided by this project, WFP has produced training materials
Activity Narrative: and handbooks in preparation and consumption of CSB that are distributed to beneficiaries.
WFP establishes, strengthens and provides ongoing support to town level coordination structures through
the provision of information technology (IT) equipment and training in monitoring and evaluation. Nutritional,
health and hygiene counseling are integrated into HBC services supported by the project and PLWHA and
HIV-positive PMTCT clients are encouraged and supported to access available services available from
palliative care providers.
To understand the wider impact of the project, WFP utilizes PEPFAR resources to conduct Results Based
receiving nutritional support and complementary activities are submitted by partners in each of the
implementation areas. Annual RBM surveys are conducted to measure the impact of the project on a range
of indicators including the nutritional and self reported health status of beneficiaries and drug adherence of
patients on ART, and the birth weight of infants to born to HIV positive women accessing PMTCT services
and receiving WFP supplementary food. These surveys have shown high rates of ART adherence for
beneficiaries, as well as a perception by beneficiaries that their nutritional status has improved. WFP also
engages in qualitative forms of monitoring and evaluation, including the identification of best practices in
particularly successful towns. These experiences are shared through workshops for all partners.
For pregnant and lactating mothers accessing PMTCT services, nutritional support aims to provide a food
supplement to meet additional nutritional requirements during pregnancy and lactation, support and
facilitate feeding for infants during this period of higher nutritional risk and infection (age 6-24 months), to
support mothers to attend antenatal care (ANC) regularly, utilize PMTCT and follow appropriate
breastfeeding guidelines, and to act as a resource transfer to alleviate economic stress and allow
beneficiaries to spend more on other essential needs.
This activity is directly aligned to support ART services provided by other PEPFAR partners in the
implementation areas, integrating nutrition assessments of PLWHA into pre-ART and ART services. The
activity then provides the additional energy requirements PLWHA need to fight opportunistic infections and
to tolerate ART, The ration also contributes to ensuring that they receive the Recommended Daily
Allowance (RDA) of micronutrients. Standard referral formats are provided to ART service providers and are
used to refer malnourished PLWHA for nutritional support and the provision of complementary HBC,
counseling and training. Nutritional assessments are conducted on a regular basis and linked to a defined
graduation strategy.
IGA support for food insecure PLWHA is an important priority for the Government and other partners in
Ethiopia, supporting long-term sustainability of HIV/AIDS services and the self-reliance of PLWHA. Most
PLWHA have seriously degraded asset bases, as many have lost any savings they had and converted all
household assets to cash. Government food security and poverty programs do not operate in high HIV
prevalence urban areas. PLWHA require additional support in order to be assisted to return to work or
develop sustainable livelihoods through IGA schemes. It is important that physical recovery be linked to
economic security. Equally important is promoting productive and positive images of PLWHA, which assists
in countering stigma and discrimination and helps ensure that PLWHA are fully integrated members of their
communities. WFP utilizes contributions from donors and private individuals to strengthen partners' ability to
support IGA. The IGA content is agreed after a capacity building process of training in life skills and
business management for implementing partners, PLWHA associations and individuals. The proposed IGA
is assessed for economic viability and if approved, seed money in the form of loans is provided.
Graduation from the project is managed by partners based upon access to ART and opportunistic infection
treatment, improved health and nutrition status and access to improved livelihoods for PLWHA. Women
accessing PMTCT are guaranteed to receive nutritional support until their infants reach age two.
Assessments are conducted after patients have been receiving ART and nutritional support for six months.
Continuing Activity: 16681
16681 5774.08 U.S. Agency for World Food 7503 3794.08 Urban HIV/AIDS $4,000,000
10523 5774.07 U.S. Agency for World Food 5520 3794.07 $1,677,539
International Program
5774 5774.06 U.S. Agency for World Food 3794 3794.06 $350,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $66,060
Estimated amount of funding that is planned for Food and Nutrition: Commodities $4,934,233
Estimated amount of funding that is planned for Economic Strengthening $76,224
Table 3.3.08:
Therapeutic Feeding Services for Pediatric Patients
This is a new activity proposed to provide therapeutic feeding services for pediatric patients. Pediatric
patients in World Food Program operational areas will benefit from this program. Referral linkages between
WFP and health facilities will be created and strengthened for effective program implementation.
Children and infants represent almost 15 percent of all new HIV infections worldwide. Despite the large
number of children living with HIV/AIDS, children currently have disproportionately low access to HIV
treatment and care relative to adult populations in most developing countries. Without treatment and care,
approximately 50 percent of all HIV-positive children will die before age two. In addition to preventing
transmission from mother to child, the U.S. President's Emergency Plan for AIDS Relief (Emergency
Plan/PEPFAR) is working with host nations to provide family-centered treatment and care services for
children living with and affected by HIV/AIDS.
In line with the PEPFAR guideline on pediatric care and treatment, this activity will extend support to
strengthen therapeutic feeding services for pediatric HIV patients and OVC and extend these services to
areas of high HIV prevalence. Malnutrition is a severe problem among pediatric HIV patients in Ethiopia and
PEPFAR will support partners experienced in addressing child malnutrition to ensure pediatric HIV clients
and OVC are covered in therapeutic feeding and care services. 15% of the budget for this activity will be
used for pediatric patients.
COP08 NARRATIVE
This is a continuation of a FY06 and FY07 activity that provides nutritional support to food insecure and
malnourished PLWH, including HIV-positive mothers and their children in the ongoing "Urban HIV/AIDS"
project in the World Food Program's (WFP) Protracted Relief and Recovery Operation (PRRO) in Ethiopia.
Funding has been increased to reach increased numbers of clinically malnourished and food-insecure
PLWH and expand the geographical areas in the project. The FY08 funding for the World Food Program
Urban HIV/AIDS program totals $8,600,000 million ($4,000,000 million for palliative care, $3.6 million for
OVC and $1 million for PMTCT) which leverages $7 million in food.
commodities to clinically malnourished PLWH and mothers participating in PMTCT programs and their
infants. PEPFAR resources will increase the quality and linkages in the project by supporting an integrated
support package designed to improve nutritional status and quality of life of PLWH, PMTCT mothers and
their infants through nutritional assessments and counseling, psychosocial support and nutrition education
within community and home-based care (HBC) services. The program will also support linkages with health-
facility-based pre-ART and ART services, PMTCT services and capacity development of local HIV/AIDS
committees and town HIV/AIDS Prevention and Control Offices (HAPCO). This activity is linked to other
PEPFAR supported programs including ART, HBC, and income-generating activities (IGA). Nutritional
support will also be linked to the new facility-based Food by Prescription (FBP) activity funded by PEPFAR.
Malnourished PLWH, including women participating in PMTCT receiving Ready-to-use Therapeutic Food
(RUTF), will be linked to longer-term, community-based food and nutrition and livelihood support, provided
by WFP, with leveraged resources to support family members who may not qualify for support per PEPFAR
guidelines. This will help ensure that severely malnourished PLWH benefit to the maximum from the RUTF
provided, supporting patients to recover from acute malnutrition in the short term, while the provision of the
WFP food basket ensures longer term nutritional support, and minimizes consumption of RUTF by family
members. This provision of nutritional support is complementary with other HIV/AIDS services, contributing
to wider goals of increasing access to prevention, care, and treatment services by creating incentives to
access services and promoting treatment efficacy.
This project is currently implemented in 14 urban and peri-urban areas, where rates of HIV infection are
particularly high and urban poverty is acute. These are located in four regions, Amhara, Oromiya, Tigray,
of patients accessing ART, and the number of PLWH receiving HBC.-based on similar criteria and in
collaboration with regional HAPCO, in FY08 WFP will initiate activities in up to 12 additional urban and peri-
The beneficiaries of the project are PLWH, including HIV-positive women and their infants participating in
through referral links from hospitals and health centers, PLWH associations and nongovernmental
organizations (NGO) providing HBC services. Household assessments are conducted to ensure that all
beneficiaries are food insecure and require the type of food support provided by WFP. Each site has a
coordination committee composed of representatives of the town, HAPCO, health service providers, NGO
partners and PLWH associations that is responsible for the selection of beneficiaries. Beneficiaries are
monitored through a tracking system that is managed by the participating NGO, government partners, and
health service providers. This approach increases the linkages between clinical and community-based care
services.
palliative caregivers, and beneficiaries in HIV/AIDS and nutrition concepts and methods to maximize
Activity Narrative: beneficiaries' abilities to improve their own nutritional status through selection and preparation of
and handbooks in preparation and consumption of CSB that are distributed to beneficiaries.
WFP establishes, strengthens, and provides ongoing support to town-level coordination structures through
health, and hygiene counseling are integrated into HBC services supported by the project and PLWH and
To understand the wider impact of the project, WFP uses PEPFAR resources to conduct results-based
management (RBM) monitoring. Quarterly reports on commodity flow and numbers of beneficiaries
of indicators, including the nutritional and self-reported health status of beneficiaries and drug adherence of
patients on ART, and the birth weight of infants born to HIV-positive women accessing PMTCT services and
receiving WFP supplementary food. These surveys have shown high rates of ART adherence for
implementation areas, integrating nutrition assessments of PLWH into pre-ART and ART services. The
activity then provides the additional energy requirements PLWH need to fight opportunistic infections and to
tolerate ART, The ration also contributes to ensuring that they receive the Recommended Daily Allowance
(RDA) of micronutrients. Standard referral formats are provided to ART service providers and are used to
refer malnourished PLWH for nutritional support and the provision of complementary HBC, counseling and
training. Nutritional assessments are conducted on a regular basis and linked to a defined graduation
strategy.
IGA support for food insecure PLWH is an important priority for the Government and other partners in
Ethiopia, supporting long-term sustainability of HIV/AIDS services and the self-reliance of PLWH. Most
PLWH have seriously degraded asset bases, as many have lost any savings they had and converted all
household assets to cash. Government food security and poverty programs do not operate in high-HIV
prevalence urban areas. PLWH require additional support in order to be assisted to return to work or
economic security. Equally important is promoting productive and positive images of PLWH, which assists
in countering stigma and discrimination and helps ensure that PLWH are fully integrated members of their
communities. WFP uses contributions from donors and private individuals to strengthen partners' ability to
support IGA. The IGA content is agreed after a capacity-building process of training in life skills and
business management for implementing partners, PLWH associations, and individuals. The proposed IGA
treatment, improved health and nutrition status and access to improved livelihoods for PLWH. Women
* Child Survival Activities
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $11,096
Estimated amount of funding that is planned for Food and Nutrition: Commodities $287,992
Estimated amount of funding that is planned for Economic Strengthening $12,084
Table 3.3.10:
Urban HIV/AIDS Nutrition Program
ACTIVITY REMAINS UNCHANGED FROM FY2008.
This is a continuing activity. The proposed budget increase for COP09 is necessary to maintain COP08
beneficiary targets and mitigate the 40% rise in food prices and procurement. The rising costs of food have
intensified the vulnerability of children to malnutrition.
This request is for the orphans and vulnerable children (OVC) component of the ongoing World Food
Program (WFP) project titled "Supporting Households, Women and children infected and affected by
HIV/AIDS", also referred to as "Urban HIV/AIDS". The activity is part of WFP's Protracted Relief and
Recovery Operation (PRRO), is a continuation of activities supported by COP 06 and 07 and is linked to
USAID Title II contributions for nutritional support of OVC. Increased funding is requested in 2008 in order
to reach larger numbers of food insecure OVC and to expand the geographical areas covered by the
project. The FY08 funding for the World Food Program Urban HIV/AIDS program totals $8,600,000 million
($4,000,000 million for palliative care, $3.6 million for OVC and $1 million for PMTCT) which leverages $7
million in food. This activity will complement PEPFAR resources with food resources leveraged from WFP
multilateral contributions, Title II USAID Food for Peace and bilateral donors, including in 2007, 500,000
USD from France, 500,000 Euros from Spain, 1million USD from Sweden and 100,000 USD from Egypt,
with additional contributions from other donors to be confirmed. PEPFAR resources will be used to
purchase food commodities for orphans and vulnerable and to cover the associated logistics costs.
Approximately one third of the proposed budget will be used for food commodities. PEPFAR resources will
support improved nutritional status and quality of life for OVC through nutrition assessments and
counseling, psychosocial support, nutrition education, and household access to economic strengthening
opportunities. The provision of food and nutritional support through WFP and partners is programmed to be
complementary with other services for OVC. WFP also ensures complementarity with other United Nations
(UN) system partners' activities under HIV/AIDS, where OVC programming is done in collaboration with the
United Nations Children's Fund (UNICEF) and the United Nations Educational, Scientific and Cultural
Organization (UNESCO).
regions, Amhara, Oromiya, Tigray and the Southern Nations, Nationalities and Peoples Region (SNNPR),
and two urban administrative areas, Addis Ababa and Dire Dawa, where numbers of orphans are high and
poverty is acute. The selection of existing and potential additional areas for the implementation of this
project is done by assessing the level of need in urban areas, examining the HIV prevalence rate, urban
poverty index and numbers of OVC enrolled in educational and other support programs. Up to 12 additional
urban areas will be selected for the project after assessments conducted by regional HIV/AIDS Prevention
and Control Offices (HAPCO) with participation and support from WFP, and based upon an increased level
of contributions from donors. Regions where the project is implemented have been consistently asserting
the necessity for extending this project to additional urban areas.
The beneficiaries of the project are OVC accessing complementary forms of support funded through
PEPFAR and Global Fund-sponsored activities, including the Save the Children USA implemented Positive
Change: Children, Communities and Care (PC3) project. In particular, OVC identified for food support are
receiving complementary educational support from UNICEF and other partners and are regularly attending
school as a result. Beneficiaries of the project will be linked through referral systems to health sector
partners supporting pediatric care and child survival programs including immunizations. This will be
achieved by linking the nutritional support program through regular referrals to hospitals and health centers
in urban areas participating in the WFP Urban HIV/AIDS activity. Referrals will be followed up by home-
based care (HBC) providers who care for and mentor OVC. When necessary HBC providers will
accompany OVC during visits to hospitals and health centers, particularly in the case of HIV-positive OVC
accessing treatment for HIV/AIDS and related opportunistic infections. OVC beneficiaries are identified
through referral links from nongovernmental organizations (NGO), community-based organizations (CBO)
and ward HIV/AIDS committees. Household assessments are conducted to ensure that all beneficiaries are
food insecure and require the type of food support provided by WFP. The activity is implemented by town
HAPCO and NGO partners. Each town has a coordination committee composed of representatives of the
town, HAPCO, health service providers, NGO partners and people living with HIV/AIDS (PLWH)
associations that is responsible for the selection of beneficiaries.
In order to ensure quality services, WFP will apply newly developed Standards of Services for OVC in
Ethiopia. WFP conducts a range of complementary activities that are directly linked to the provision of food
support and are funded by PEPFAR contributions. These activities include training for partners and home-
based-palliative care providers and beneficiaries in HIV/AIDS and nutrition, aimed at maximizing
beneficiaries' abilities to improve their own nutritional status through selection and preparation of different
types of food. In order to ensure the effective consumption of the Corn Soya Blend (CSB), a blended
fortified food rich in micronutrients provided by this project, WFP has produced training materials and
handbooks in preparation and consumption of CSB that are distributed to all beneficiaries. WFP also
strengthens and provides ongoing support to town-level coordination structures through the provision of
information technology (IT) equipment and training in monitoring and evaluation. Nutritional, health and
hygiene counseling are integrated into the counseling and HBC services supported by the project and OVC
and their caregivers are encouraged and supported to access other forms of support. The structures of
coordination and communication established through the WFP-supported project have had an overall
positive impact on the provision of integrated services in the urban areas where the project is implemented,
beyond the provision of nutritional support.
In order to track the wider impact of the project, WFP uses PEPFAR resources to conduct Results Based
receiving food and nutritional support, as well as complementary activities, are submitted by partners in
Activity Narrative: each of the implementation areas. Annual RBM surveys are conducted by WFP and partners to measure
the impact of the project on a range of indicators including OVC school attendance and drop out rates. WFP
also engages in qualitative forms of monitoring and evaluation, including the identification of best practices
in particularly successful towns. It also sponsors experience sharing workshops for all partners.
WFP will collaborate with OVC programs to pursue and implement sustainable food security options while
simultaneously providing food inputs. These sustainable options will focus on increasing household assets
through market-driven economic strengthening activities such as small business development, savings and
loan schemes, and micro-credit. Partnerships with economic growth programs will be established or
expanded to provide needed technical expertise and linkage to viable market options. WFP uses public and
private contributions to strengthen partners' ability to implement economic strengthening options. WFP
experience in the area of income generation for beneficiaries includes provision of small loans that have
resulted increased household assets through small business development.
A strategy to stabilize the food security status of OVC households and transition them from food aid is under
development for implementation in FY08. This strategy is being planned with Government of Ethiopia and
other OVC stakeholders. Graduation from food aid will be managed by partners at the town level and is
supported by economic strengthening opportunities.
Continuing Activity: 18702
18702 18702.08 U.S. Agency for World Food 7503 3794.08 Urban HIV/AIDS $3,600,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $59,800
Estimated amount of funding that is planned for Food and Nutrition: Commodities $4,466,600
Estimated amount of funding that is planned for Economic Strengthening $69,000
Table 3.3.13:
