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: 2007 2008 2009
HIV Prevention for Most at Risk Populations in Amhara
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a competitive solicitation. The partner, as mentioned in the narrative, should be noted as To Be
Determined and not Family Health International.
This activity has no substantive changes to activities described in the COP08 narrative but the activity will
no longer be limited to Amhara. This is a competitive acquisition and the partner will be named in January
2009.
COP08 ACTIVITY NARRATIVE
This activity will build linkages to additional prevention activities including Family Health International's
HVOP activity in Amhara (10641), Johns Hopkins University (JHU)Health Communications Partnership
(HCP) (10573), Targeted Condom Promotion (10404), Abt Associates Private Sector Project (10374),
Population Council Gender, Early Marriage and HIV Infection in Amhara (10521), JHU CCP AIDS Resource
Center (10592), and AB prevention activities. This activity will also relate to Family Health International's
Community-Level CT and Palliative Care in Amhara (10588, 10574).
Family Health International (FHI) has supported HIV/AIDS prevention, care and treatment activities in
Amhara region for several years. In FY07, FHI undertook a formative assessment in Kunzla and Merawi
that indicated that the establishment of development project sites in both of these towns contributed toward
the increase of high risk behaviors as these project sites attracted the influx of migrant workers, growth of
commercial sex, and increased commerce and trade. Other factors such as increasing interaction between
rural and urban populations, existing misconceptions of HIV/AIDS, and harmful traditional practices were
also shown to increase the vulnerability of these communities to HIV. This project will target at-risk
unmarried youth and commercial sex workers with the aim of reaching 10,000 individuals with
comprehensive ABC prevention education. All targets are counted under the HVOP section.
Under PEPFAR, at the request of the Amhara Regional HIV/AIDS Prevention and Control Office
(RHAPCO), in FY07 FHI initiated prevention activities targeting most at-risk populations (MARP) in Amhara
in FY07. The partner held a consensus building meeting with Amhara stakeholders to prioritize high risk
areas for prevention interventions. Priority high risk areas include Kunzla, Mecha Wereda, Lalibella, Merto
Lemariam, Durbete and Metema. FHI will continue to support this program in FY08 with a focus on building
the capacity of local partners to undertake AB and other prevention activities to reach project site and other
mobile workers, commercial sex workers and their partners and clients, in and out of school youth 15-24,
especially sexually active girls or female students, youth engaged in the tourism industry, and urban males
with multiple partners. AB messages and prevention activities will specifically designed and targeted to in
and out of school youth 18 and under, especially young girls who are vulnerable to HIV due to early
marriage practices and commercial sex.
In FY08, FHI will facilitate additional formative assessments in new selected intervention sites and collect
supplementary data on social networks, social groups and community groups to inform the design of
appropriate HIV/AIDS prevention activities. FHI will continue to use existing community structures to reach
the target populations as a guiding principle.
FHI will build the technical and organizational capacities of government, local NGOs and community groups
in high risk areas to implement and gradually manage their own behavior changes programs targeting
MARP. This will entail management, administrative and resource mobilization training, BCC strategy
development and implementation training, provision of BCC materials and equipment and other supplies for
implementation. FHI will train key management staff of BCC implementing partners in organizational
capacity building.
FHI will facilitate the integration of the community conversation program to enhance the community's own
response to HIV/AIDS issues. Communication conversations take place through dialogue sessions with
community groups facilitated by trained community members. This activity will involve the training of
‘trainers of trainers' (TOT) and facilitators on how to guide discussions on various topics, the development
and/or adaptation of dialogue guides, and the implementation of dialogue sessions. Community
conversations programs will be designed for community members in general and for youth.
FHI will continue to support the Ethiopian Youth Network (EYN) to fulfill its mandate to coordinate HIV
prevention efforts among youth groups in Amhara, particularly among girls clubs. FHI will work with EYN to
design and implement an interpersonal communication and youth peer leadership program for youth in high
risk areas. Trainings on gender will be provided to youth clubs and on assertiveness to the girls clubs to
address issues of gender norms and behavior and coercion and violence. FHI will build the capacity of EYN
to integrate community conversations into its programs.
In addition, selected youth from the EYN will be trained on behavior change communications (BCC)
message development and outreach concepts. Youth conducting community outreaches will disseminate
different messages on community norms that hinder people's ability to make ABC choices and influence
gender violence, early marriage, and early sexual debut. They will target youth under 18 with AB messages
only. These outreaches will take place in marketplaces, tourist settings, bars, hotels, night clubs and truck
stops.
FHI will continue to assist the Amhara Agriculture Bureau and their agriculture development agents (ADA)
to reactivate their prevention program which had been discontinued in 2006 due to the lack of
implementation funds. Based on the program's strategy, ADA in kebeles within high risk weredas will be
trained on basic HIV/AIDS information and BCC message development.
Activity Narrative: FHI will further continue to assist the Amhara RHAPCO and other stakeholders in the design, development
and implementation of a strategic behavioral communication (SBC) campaign to promote positive behavior
change in MARPS in high risk areas. The design of these activities will depend on the findings of the
formative assessments. Activities will include, but not limited to, using and adapting existing BCC materials,
producing culturally appropriate materials addressing identified issues, promoting positive non-stigmatizing
behaviors among target populations, providing correct information on HIV/AIDS and methods of
transmission, promoting safe sex and consistent condom use, increasing self-risk perception, promoting
HIV CT, and working in partnership with the media to support the SBC campaign to reach to those who can
be accessed through the media. FHI will build the capacity of media experts on HIV/AIDS reporting.
FHI will contribute to the rapid scale-up the HIV/AIDS prevention services, including prevention of HIV
among youth through abstinence and behavior change, in areas where communities are highly vulnerable
to HIV. FHI will also contribute to building the capacity of the implementing partners and the community for
effective long term prevention of HIV infection. This will have an impact in the reduction of the high HIV
prevalence in the region. It will also contribute to the promotion of healthy norms and behaviors in
communities where harmful traditional practices are practiced widely.
Linkages to other HIV/AIDS services are important to support behavior change in BCC programs. Working
closely with stakeholders, FHI programs in CT and care and support, and other partner programs, FHI will
assist to establish linkages between BCC activities and the health network through referral systems. FHI's
technical assistance efforts will be developed in close collaboration with PEFPAR and other partners
working in Amhara, including but not limited to, other prevention programs targeting MARP, the Health
Communications Partnership for AB, the Population Council for gender and early marriage issues, Abt for
PSP, and target condom promotion activities.
Gender equity will underscore FHI's HIV prevention activities targeting MARP in Amhara. This includes but
is not limited to assessing and addressing barriers which limit access to HIV prevention for women and girls.
FHI will support the EYN in addressing gender issues through the youth clubs and girls clubs. Community
conversations will also be held on gender-related topics to assist communities to respond to harmful
tradition practices that impact the vulnerability of women and girls to HIV.
To ensure the sustainability of the program, FHI will work to strengthen the organizational and technical
capacities of BCC implementing partners to design, implement and monitor prevention activities. FHI will
provide subgrants to the partners, which will serve as the mechanism through which FHI will build their
capacities in BCC and HIV prevention.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16697
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16697 10594.08 U.S. Agency for Program for 12027 12027.08 $240,000
International Appropriate
Development Technology in
Health
10594 10594.07 U.S. Agency for Program for 12025 12025.07 $200,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
FY 08 ACTIVITY NARRATIVE
Family Health International (FHI) has supported HIV/AIDS prevention, care, and treatment activities in
that indicated that establishing development project sites in both of these towns contributed to the increase
of high-risk behaviors, because these project sites attracted an influx of migrant workers, the growth of
also shown to increase the vulnerability of these communities to HIV. This project will focus on at-risk,
unmarried youth and commercial sex workers, with the goal of reaching 10,000 individuals with
comprehensive ABC prevention education.
(RHAPCO), in FY07 FHI initiated prevention activities targeting most at-risk populations (MARPs) in
Amhara in FY07. The partner held a consensus-building meeting with Amhara stakeholders to prioritize high
-risk areas for prevention interventions. Priority high-risk areas include Kunzla, Mecha, Lalibella, Merto
the capacity of local partners to undertake AB and other prevention activities to reach: project-site and other
mobile workers; commercial sex workers and their partners and clients; in- and out-of-school youth 15-24,
especially sexually active girls or female students; youth engaged in the tourism industry; and urban males
with multiple partners. AB messages and prevention activities will be designed specifically for in- and out-of-
school youth 18 and under, especially young girls who are vulnerable to HIV due to early marriage practices
and commercial sex.
in high-risk areas to implement and gradually manage their own behavior changes programs targeting
‘trainers of trainers' and facilitators on guiding discussions on various topics, developing and/or adapting
dialogue guides, and implementing dialogue sessions. Community conversations programs will be designed
for community members in general and for youth.
FHI will continue to support the Ethiopian Youth Network (EYN) to fulfill its mandate to coordinate HIV-
design and implement an interpersonal communication and youth peer-leadership program for youth in high
-risk areas. Trainings on gender and on assertiveness will be provided to youth clubs and girls clubs,
respectively, to address issues of gender norms and behavior and coercion and violence. FHI will build the
capacity of EYN to integrate community conversations into its programs.
In addition, selected youth from the EYN will be trained on behavior-change communications (BCC)
gender violence, early marriage, and early sexual debut. They will focus on youth under 18 with AB
messages only. These outreaches will take place in marketplaces, tourist settings, bars, hotels, night clubs,
and truck stops.
implementation funds. Based on the program's strategy, ADA in wards within high-risk districts will be
FHI will further continue to assist the Amhara RHAPCO and other stakeholders in the design, development,
change in MARPs in high-risk areas. The design of these activities will depend on the findings of the
formative assessments. Activities will include, but are not limited to: using and adapting existing BCC
materials; producing culturally appropriate materials addressing identified issues; promoting positive
nonstigmatizing behaviors among target populations; providing correct information on HIV/AIDS and
methods of transmission; promoting safe sex and consistent, correct condom use; increasing self-risk
Activity Narrative: perception; promoting HIV counseling and testing (CT); and working in partnership with the media to
support the SBC campaign to reach to those who can be accessed through the media. FHI will also build
the capacity of media experts for HIV/AIDS reporting.
FHI will contribute to the rapid scale-up of HIV/AIDS prevention services, including prevention of HIV among
youth through abstinence and behavior change, in areas where communities are highly vulnerable to HIV.
FHI will also contribute to building the capacity of the implementing partners and the community for effective
long-term prevention of HIV infection. This will have an impact in the reduction of the high HIV prevalence in
the region. It will also contribute to the promotion of healthy norms and behaviors in communities where
harmful traditional practices are practiced widely.
closely with stakeholders, FHI programs in CT and care and support will assist to establish linkages
between BCC activities and the health network through referral systems. FHI's technical assistance efforts
will be developed in close collaboration with PEFPAR and other partners working in Amhara, including, but
not limited to, other prevention programs targeting MARPs, the Health Communications Partnership for AB,
the Population Council for gender and early marriage issues, Abt for private-sector programs, and target
condom promotion activities.
Gender equity will underscore FHI's HIV-prevention activities targeting MARPs in Amhara. This includes but
is not limited to, assessing and addressing barriers which limit access to HIV prevention for women and
girls. FHI will support the EYN in addressing gender issues through the youth clubs and girls clubs.
Community conversations will also be held on gender-related topics to assist communities to respond to
harmful tradition practices that affect the vulnerability of women and girls to HIV.
Continuing Activity: 16698
16698 10641.08 U.S. Agency for Program for 12027 12027.08 $420,000
10641 10641.07 U.S. Agency for Program for 12025 12025.07 $350,000
Table 3.3.03:
Civil society/ Community-level Response to Palliative Care in Ethiopia
ACTIVITY UNCHANGED FROM FY2008
Activity is similar to activities described in COP08. This activity will not be modified in COP09. This is a
competitive acquisition. The partner is To Be Determined. References to an implementing partner are
incorrect in the narrative. OGAC will be advised of the award and Contractor.
COP 08 ACTIVITY NARRATIVE:
Palliative care requirements currently exceed facility-based support. The coverage of families, especially
OVC, is some of the lowest among the fifteen focus countries. Household level support, specifically related
to nutrition, hygiene, psychosocial support, and adherence and OI management does not meet coverage
requirements in FY07. Community based care is restricted to major towns where a substantial number of
individuals are already on treatment and where access to services is high. Community-based care
expansion is required in secondary or market towns where HIV prevalence is high and facility-based uptake
of care and treatment services are low and loss to follow up is notably higher.
This activity will consolidate the provision of palliative care services in major health networks with
standardization, technical oversight, and integration with facility-based care, supporting nutritional, social
and clinical outreach.
Family Health International (FHI) has supported the provision of chronic care services at public health
centers; community-level AIDS care and support; and the development of multi-sect oral referral networks
between community, health center and hospital services. FHI proposes to scale-up home- and community-
based care (HCBC) programs to provide comprehensive palliative and preventative care in high-prevalence
urban and per urban areas. Emphasis will be placed on building the capacity of community and faith-based
organizations (CBO/FBO) to deliver palliative care services and to emphasize community-level ownership of
HIV/AIDS services. To ensure sustainability, FHI will link HCBC programs to a strong network of palliative
care services at health centers, hospitals and community posts.
FHI will work with district and town administrations to strengthen the capacity of CBO and FBO partners to
provide services and mobilize resources to support these services under a framework developed by the
Care and Support Program. This activity will provide the required intensity of community care needed to
improve the quality of life of persons living with HIV and to link OVC to appropriate services.
This activity includes the package of community care to meet the needs of individuals and their families at
various stages: ART and opportunistic infections (OI) adherence support, provision of household contacts
for voluntary counseling and testing (VCT), TB screening, support disclosure to family members, addressing
prevention for positives including condom provision, nutrition counseling, psychosocial and spiritual
counseling, access to safe water, malaria prevention, stigma reduction, and care for OVC.
This activity will develop linkages with external microfinance and income generation activities and address
male norms in the household for sustained behavior change. Community care will focus not only on
providing care to critically ill clients, but also sustain the health status of asymptomatic HIV positive
individuals to prevent the onset of AIDS. This activity is integrated with delivery of the Preventive Care
Package.
Pediatric community care will be strengthened through training of HCBC providers to refer children in
beneficiary households for counseling and testing (CT) and TB screening, child health interventions and
also to identify and refer OVC who are family members of HCBC beneficiaries. Access to family
planning/reproductive health (FP/RH) and PMTCT services will be facilitated to ensure that community care
clients receive appropriate support, including focused FP/RH for couples and PMTCT follow-up for HIV-
positive mothers and their HIV exposed infants. FHI will train HCBC providers to refer the mother and infant
to the health center for palliative care and ART, if needed, and to support the mother in disclosing her status
to her sexual partner and referring him to appropriate HIV/AIDS services.
Under primary health care provision, FHI will continue to train community care providers including new
HCBC volunteers and community-level workers, health extension workers, PLWHA groups, local faith-
based associations, youth groups, and volunteers engaged in HIV prevention programs. The community
level training will build the communication and service delivery skills of HCBC providers and broaden their
understanding of PLWHA needs. To ensure quality and supervision of HCBC services, FHI will work closely
with CBO and FBO to recruit and retain nurse supervisors to whom the HCBC providers will report on a
regular basis.
FHI will work with community partners to strengthen the referral networks at community level and to link
HCBC providers to these networks. The networks will facilitate access to a range of services such as care
and treatment, RH/FP and PMTCT services at health facilities; food and nutrition support from WFP; income
generating activities; psychosocial, education, and legal support; resources for free shelter; and palliative
care support groups. FHI will support the referral networks in mapping services and distributing up-to-date
service directories, and in adopting user-friendly referral systems and tools to track referrals. FHI will train
community-level referral network coordinators to collect, manage and analyze data to improve service
quality and accessibility.
FHI will link community care activities to other USG partners, through case managers, to facilitate access to
care services through a standard referral approach. This activity will strengthen civil society's linkages to
catchment area and regional review meetings of the ART health network to standardize community care,
defaulter tracing and adherence support.
FHI will support greater involvement of persons with AIDS through engaging PLWHA who have successfully
Activity Narrative: received ART to encourage and support treatment adherence in other patients.
FHI will contribute to scaling-up existing palliative care services through a package of care that includes
prevention and positive living activities to support the broadened definition of palliative care. This will be
implemented within the framework of the care continuum, ensuring that both adults and children are
reached through a family-centered approach. FHI will focus on strengthening the community as a key actor
in the provision of care and support services for PLWHA and their families and build their capacity to both
mobilize and manage resources effectively to sustain services. FHI will work with the regional health bureau
(RHB), HIV/AIDS Prevention and Control Office (HAPCO), CBO, FBO and communities themselves to
expand and facilitate access to services at the community level while ensuring strong referral linkages to
health facility-based care.
The palliative care program will provide ARV adherence support at the community level by HCBC providers
and at the health centers by PLWHA who have successfully received and adhered to treatment. It will also
address the increased emphasis on food and nutrition support for PLWHA and their households, including
beneficiaries on ART, by reinforcing referral linkages to other programs providing this type of support, such
as the World Food Program, a partner of FHI.
FHI's technical assistance efforts will be developed in collaboration with PEPFAR and other partners,
including, but not limited to, US universities and MSH for implementation of palliative care services, WFP
and AED for food and nutrition support, IntraHealth for PMTCT, and RPM Plus for logistics and supply
management support.
This activity will target the provision of palliative care to PLWHA and their families, including MARPS. FHI
will work closely with the RHB, HAPCO, CBO, FBO and the communities to distribute communication tools
to promote palliative care services for HIV-positive individuals. PLWHA groups will be supported to
implement advocacy activities to promote positive living, including the benefits of palliative care, and
PLWHA role models to reduce stigma. The target populations will be reached through HCBC providers,
community outreach workers and HEW who will make referrals to HCBC services. At health centers, the
entry point will be counseling and testing (CT), TB/HIV and PMTCT where clients seeking care will be
referred to CBO and FBO for HCBC.
Gender equity will underscore all FHI's palliative care efforts. This includes but is not limited to assessing
and addressing barriers which limit access to general palliative care and support for women and girls with
HIV/AIDS, and ensuring that both male and female HCBC providers are engaged in palliative care.
FHI will build capacity among palliative care providers in the community to provide quality care through both
training, ongoing supportive supervision, and the provision of job aids to facilitate their work. Training for
palliative care services that can be transferred to the community level will be conducted for HCBC providers
and selected patient support group members.
Geographic coverage will be urban areas and per urban towns, either district or market towns, along
transportation corridors outside of the HCT coverage being provided by other USG partners.
FHI will work with RHB and HAPCO to strengthen the organizational capacities of CBO, FBO and
communities to provide quality palliative care services. FHI will provide sub grants to CBO and FBO to
implement HCBC services. The sub grants will be the partnership mechanism through which FHI will build
the technical and organizational capacities of CBO and FBO and institutionalize HCBC services for
sustainability.
Continuing Activity: 16699
16699 10574.08 U.S. Agency for Program for 12027 12027.08 $4,072,040
10574 10574.07 U.S. Agency for Program for 12025 12025.07 $2,090,000
* Increasing women's access to income and productive resources
Table 3.3.08:
Sustainable ART Adherence through Self-Help Groups and Clinic- Community Linkages
This activity will conduct activity similar to those described in COP08. This activity will not be updated. The
partner is To Be Determined as this is new a competitive acquisition. OGAC will be notified upon award.
COP 08 Narrative:
This activity will expand the mechanism designed and initiated in COP07 to address gaps in community and
facility linkage within the health network model.
Recognizing both the public health benefits and risks of rapid rollout of free ART in Ethiopia, key barriers to
ART adherence have been identified: lack of social support; lack of sustainable means to buy food, shelter
and other necessities such as transportation to ART sites; stigma and misconceptions regarding ART; and
cultural and religious beliefs that lead to misconceptions about HIV and AIDS.
In the context of growing caseloads and a severe shortage of health personnel, the traditional clinic-
centered model of ART adherence support is inadequate. Ensuring adherence will be more comprehensive
and successful if shared with the community. Unfortunately, most communities and civil society organization
(CSO) currently lack capacity, as well as systematic and sustainable strategies, to address this challenge
effectively. As the first site in Ethiopia to distribute free ART, the All African Leprosy and Rehabilitation
Training Center (ALERT) is an example of the clinic-community linkages to be supported by this project.
ALERT practitioners discovered that more than 70% of ART patients needed social support, the absence of
which could undermine ART adherence. In response to patient needs, and lack of capacity to meet those
needs at clinic level, ALERT developed links with various civil society organizations in its catchment area.
Over fifty such organizations joined the ALERT network, but even this extended network faces difficulties in
absorbing additional beneficiaries, as most CSO have limited capacity and experience in providing
HIV/AIDS care and ART adherence support. There is a need to build capacity of the CSO partners to
enable them to provide social services to more clients, but also to complement their work by involving
clients in mutual support. Presently, the clinic-community link that characterizes the ALERT model is very
important as an effective health network tool replicable in other parts of the country where such support is
equally needed. It is vital to enhance the clinic-community link, while simultaneously building community
capacity to avoid the CSO overload that occurred in the ALERT network. This project will improve ART
adherence by linking health care services and communities, and by facilitating a community self-help
strategy to reinforce adherence. Key elements of this model include:
1.Identification of CSO (nongovernmental organizations (NGO), PLWHA Associations, faith-based
associations, etc) committed to care and support of PLWHA through home-based or other outreach
activities. The implementation of adherence support builds on the experience of ALERT with identification of
stakeholders both currently engaged and those who could potentially join the ART Network at all levels.
Illustrative activities include development of governance mechanism, creating the environment to enable
influential community members and representatives of key community organizations and inventorying care
and support services available within the network.
2.Placement of "Linkage Coordinators: in ART sites to screen ART clients and link individuals with CSO in
their wards.
3.Building capacity of these CSO by training outreach workers how to support ART adherence.
4.Provision of grants to CSO to form self-help groups among interested ART clients and training groups
5.Training of self-help group members as peer educators, able to reach out to new ART clients as well as
HIV-positive individuals not yet on ART, as members grow stronger due to their adherence to the ART
regimen
6.Mobilize family members of PLWHA to join self-help groups and to support ART adherence
During the "linkage" phase, CSO with existing home-based care programs will be identified for each ART
site. CSO, health center and hospital personnel will attend workshops through which participants learn the
importance of developing and maintaining community-clinic linkages. ALERT representatives will share their
networking experience; participants will learn about the self-help strategy for economic empowerment and
psychosocial support among PLWHA; and all will contribute to the development of action plans for
establishing and maintaining community-clinic links. A "Linkages Coordinator" to support each of the three
ART sites will be hired; these will be trained PLWHA who will receive referrals from the hospital, and link the
clients to CSO. During the "capacity-building" phase, assessments of strengths and needs will be conducted
with the partner CSO. Training will be provided on ART and adherence issues, as well as self-help
methodology. CSO will be supported to incorporate ART-adherence counseling into routine outreach work,
and selected CSO will receive mini-grants to form and provide ongoing technical assistance to self-help
groups.
"Self-help groups" will consist of 15 to 20 ART clients who meet weekly to discuss aspects of positive living,
including: living with HIV and AIDS, ART adherence, prevention of further infection, proper nutrition,
exercise, etc. Groups will also participate in an economic empowerment strategy, in which they begin to
save existing financial resources, however small they may be, rather than receive external material
resources. This financial discipline will eventually enable the group to provide loans to its members for micro
-enterprises. Experience in Ethiopia has shown that this self-help model fosters community self-reliance and
collaboration among very poor participants. The formation of self-help groups is an ideal solution to ART
adherence-barriers for many reasons, including self-sustainability once established; self-help groups
provide a social network of self-reliance, in which members develop positive attitudes and proactive
solutions rather than falling into a sense of fatalism. They are excellent forums for transmission of key
messages, elimination of misconceptions, and adoption of new practices because of strong mutual support
and positive group peer pressure.
The partner will closely monitor implementation of the self-help groups and their impact on ART adherence,
Activity Narrative: self-reliance, stigma mitigation and involvement of family members of PLWHA in adherence support. The
project will be implemented in Bahir Dar zone, Amhara region to create an effective network model involving
six ART health centers: Estie, Durbete, Dangla, Adet, Wereta, Bahir Dar health center and Felege Hiwot
Hospital.
Continuing Activity: 18809
18809 18809.08 U.S. Agency for Program for 12027 12027.08 $240,000
* Increasing women's legal rights
Health-related Wraparound Programs
* Child Survival Activities
Table 3.3.09:
Community-level Response to Palliative Care
This is a continuing activity with a new partner chosen by a competitive acquisition. USAID/Ethiopia will
inform OGAC when the new partner is selected. This activity will extend several clinical care services to
households to adult and pediatric clients by engaging local civil society to expand palliative care programs
in urban areas. Services will be delivered by community volunteers with supervision by nurses. Activities
remain similar to activities described in the COP08 narrative. This activity will not be done in COP09
COP08 NARRATIVE
OVC, is some of the lowest among the fifteen focus countries. Household-level support, specifically related
to nutrition, hygiene, psychosocial support, adherence, and opportunist infections (OI) management does
not meet coverage requirements in FY07. Community-based care is restricted to major towns where a
substantial number of individuals are already on treatment and where access to services is high.
Community-based care expansion is required in secondary or market towns where HIV prevalence is high
and facility-based uptake of care and treatment services is low and loss-to-follow-up is notably higher.
standardization, technical oversight, integration with facility-based care, supporting nutritional, social and
clinical outreach.
centers, community-level AIDS care and support; and the development of multisectoral referral networks
between community, health center, and hospital services. FHI proposes to scale-up home- and community-
urban and peri-urban areas. Emphasis will be placed on building the capacity of community-based and faith
-based organizations (CBO/FBO) to deliver palliative care services and to emphasize community-level
ownership of HIV/AIDS services. To ensure sustainability, FHI will link HCBC programs to a strong network
of palliative care services at health centers, hospitals and community posts.
various stages: ART and OI adherence support; provision of household contacts for voluntary counseling
and testing (VCT); TB screening; support for disclosure to family members; addressing prevention for
positives, including condom provision, nutrition counseling, psychosocial and spiritual counseling, access to
safe water, malaria prevention, stigma reduction, and care for OVC.
This activity will develop linkages with external microfinance and income-generation activities and address
providing care to critically ill clients, but also sustain the health status of asymptomatic HIV-positive
individuals to prevent the onset of AIDS. This activity is integrated with delivery of the preventive care
package.
Under primary healthcare provision, FHI will continue to train community care providers including new
HCBC volunteers and community-level workers, health extension workers, PLWH groups, local faith-based
associations, youth groups, and volunteers engaged in HIV prevention programs. The community level
training will build the communication and service delivery skills of HCBC providers and broaden their
understanding of PLWH needs. To ensure quality and supervision of HCBC services, FHI will work closely
HCBC providers to these networks. The networks will facilitate access to a range of services, such as care
and treatment, RH/FP and PMTCT services at health facilities; food and nutrition support from the World
Food Program(WFP); income-generating activities; psychosocial, education, and legal support; resources
for free shelter; and palliative care support groups. FHI will support the referral networks in mapping
services and distributing up-to-date service directories, and in adopting user-friendly referral systems and
tools to track referrals. FHI will train community-level referral network coordinators to collect, manage, and
analyze data to improve service quality and accessibility.
Activity Narrative: FHI will support greater involvement of persons with AIDS through engaging PLWH who have successfully
received ART to encourage and support treatment adherence in other patients.
in the provision of care and support services for PLWH and their families and build their capacity to both
health-facility-based care.
and at the health centers by PLWH who have successfully received and adhered to treatment. It will also
address the increased emphasis on food and nutrition support for PLWH and their households, including
as WFP, a partner of FHI.
including, but not limited to, US universities and Management Sciences for Health(MSH) for implementation
of palliative care services, WFP and Academy of Educational Development (AED) for food and nutrition
support, IntraHealth for PMTCT, and RPM Plus for logistics and supply management support.
This activity will target the provision of palliative care to PLWH and their families, including most-at-risk
populations (MARPs). FHI will work closely with the RHB, HAPCO, CBO, FBO and the communities to
distribute communication tools to promote palliative care services for HIV-positive individuals. PLWH groups
will be supported to implement advocacy activities to promote positive living, including the benefits of
palliative care, and PLWH role models to reduce stigma. The target populations will be reached through
HCBC providers, community outreach workers and HEW who will make referrals to HCBC services. At
health centers, the entry point will be counseling and testing (CT), TB/HIV and PMTCT where clients
seeking care will be referred to CBO and FBO for HCBC.
An emphasis on gender equity will underscore all FHI's palliative care efforts. This includes but is not limited
to assessing and addressing barriers which limit access to general palliative care and support for women
and girls with HIV/AIDS, and ensuring that both male and female HCBC providers are engaged in palliative
care.
FHI will build capacity among palliative care providers in the community to provide quality care through
Geographic coverage will be urban areas and peri-urban towns, either district or market towns, along
transportation corridors outside of the HIV counseling and testing coverage being provided by other USG
partners.
FHI will work with RHB and HAPCO to strengthen the organizational capacities of CBO, FBO, and
sustainability
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Table 3.3.10:
Community-level counseling and testing service support in Ethiopia
This is a continuing activity. This is a competitive acquisition and the partner is To Be Determined.
References to an implementation partner in the COP08 narrative are incorrect. This activity will extend
several clinical care services to households to adult and pediatric clients by engaging local civil society to
expand palliative care programs in urban areas. Services will be delivered by community volunteers with
supervision by nurses. Activities remain similar to activities described in the COP08 narrative. This activity
will not be d in COP09.
to nutrition, hygiene, psychosocial support, adherence and OI management does not meet coverage
centers; community-level AIDS care and support; and the development of multi-sectoral referral networks
urban and periurban areas. Emphasis will be placed on building the capacity of community and faith-based
Activity Narrative: FHI will support greater involvement of persons with AIDS through engaging PLWHA who have successfully
Geographic coverage will be urban areas and periurban towns, either district or market towns, along
Continuing Activity: 16700
16700 10588.08 U.S. Agency for Program for 12027 12027.08 $2,920,000
10588 10588.07 U.S. Agency for Program for 12025 12025.07 $2,624,000
Table 3.3.14:
