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
The Infant and Young Child Nutrition (IYCN)
THIS IS A NEW ACTIVITY
LINKS WITH OTHER ACTIVITIES/EMPHASIS AREAS
This new PMTCT activity links to 13-HKID Care: OVC. 08-HBHC Treatment: Adult Care and Support, 10-
PDCS Care: Pediatric Care and Support, food security and child survival activities.
SUMMARY OF KEY ACTIVITIES
The COP09 activity in Ethiopia will (1) conduct a rapid assessment of services, programs, and practices
related to infant and young child feeding in the context of HIV; (2) strengthen the capacity of facility-based
staff to provide quality infant feeding counseling and nutrition services; (3) develop IEC materials on infant
feeding and maternal nutrition in the context of HIV; and (4) integrate and expand infant feeding and
nutrition in the context of HIV in related programs. For all activities, IYCN will work closely with the F-MOH
and partners implementing or supporting PMTCT and HIV and nutrition activities. IYCN will provide
technical assistance and leadership at the national level to strengthen the capacity of health workers to
promote appropriate feeding practices for children and mothers in the context of HIV.
BACKGROUND
The Infant and Young Child Nutrition (IYCN) project is USAID's flagship project to deliver measurable
results at-scale to improve infant and young child growth and nutritional status, HIV-free survival of infants
and young children, and maternal nutrition. IYCN is a globally funded five-year cooperative agreement
(2006-2011) primed by PATH, with partners CARE, the Manoff Group, and URC. IYCN has developed
models to improve infant and young child feeding and maternal nutrition within PMTCT programs in
Lesotho, Ivory Coast, Haiti, and Zambia. These models support MOHs and other key stakeholders to
develop updated policies, guidelines, curricula and BCC tools for staff, community level workers and HIV
support groups; assist with training and supervising staff and identifying successful program approaches
and practices.
In Ethiopia, the national adult HIV prevalence rate is 2.2% . Although the prevalence rate is relatively low,
Ethiopia's population is estimated to be over 80 million , resulting in a substantial number of HIV-infected
individuals. Furthermore, in urban areas the HIV prevalence rate is 7.7%, more than 3 times higher than the
national average and about 7 times the rural rate. Women face an increased risk for HIV, and comprise
about 59% of the HIV-infected population. About 1 million Ethiopians are living with HIV , 68,136 are
children. The number of AIDS-affected orphans is estimated to be about 886,820, leaving them vulnerable
to malnutrition and high-risk behavior. The total number of HIV-infected individuals (both adults and
children) is growing and is expected to be about 30% greater in 2010 than it was in 2006 .
Poor maternal nutrition and suboptimal infant and young child feeding practices increase the risk of mother-
to-child HIV transmission. The nutritional status of Ethiopian women is poor, with 27% percent of all women
chronically malnourished . HIV-positive women are at greater nutritional risk and their nutritional status prior
to and during pregnancy influences their own health and survival, as well as their children's health, survival
and HIV risk. Improving the nutritional status of women living with HIV plays a critical role in preventing
mother-to-child transmission.
Children's nutrition status is also poor in Ethiopia. The 2005 DHS data show that 96% of children are
breastfed. However, although exclusive breastfeeding is recommended for the first 6 months, only one in
three infants in Ethiopia is exclusively breastfed at 4-5 months . This highlights a high level of "mixed
feeding" practice of breastfeeding and giving other foods and liquids at the same time, a practice that
significantly increases the risk of HIV transmission. This high prevalence of mixed feeding makes
appropriate and effective infant feeding counseling especially important for the prevention of mother-to-child
transmission.
In 2007, the F-MOH and Federal HIV/AIDS Prevention and Control Office (HAPCO) developed Guidelines
for Prevention of Mother-to-Child Transmission in Ethiopia and Guidelines for Pediatric HIV/AIDS Care and
Treatment. Both of these documents included guidance on infant feeding in the context of HIV that is
compliant with the WHO 2006 guidelines on HIV and infant feeding. Ethiopia's current draft National
PMTCT Training Package includes updated content on infant feeding that reflects these guidelines. Despite
WHO-compliant IYCF guidelines and training tools, infant feeding counseling in PMTCT programs is limited
in practice. In addition, messages are challenging for health workers to communicate and optimal infant
feeding practices are difficult for mothers to adopt because of pervasive dangerous cultural practices,
stigma, and lack of support for women's feeding choice. Research shows that when HIV-positive women
are counseled and supported, optimal infant feeding rates increase, thus limiting the risk of MTCT.
IYCN will work closely with its partner, CARE, who has significant health and HIV program experience in
Ethiopia. IYCN will benefit from this experience and begin start-up with a clear understanding of Ethiopia's
political, cultural, and social context and strong working relationships with the F-MOH and other NGOs from
multiple sectors.
ACTIVITIES AND EXPECTED RESULTS
The goal of this COP09 activity is to integrate, expand and monitor safe infant feeding practices and
maternal nutrition as essential components of PMTCT services focused on HIV-positive pregnant and
lactating women as well as HIV-exposed infants and young children. IYCN will provide technical assistance
to operationalize the National PMTCT Strategy. IYCN will also strengthen and expand current PEPFAR
partners' activities in Ethiopia to include and strengthen infant feeding. The project will enhance the capacity
of facility-based health staff in PMTCT, ANC and related services to provide appropriate infant feeding
counseling and nutrition assessment to HIV- positive women with links to community-based support
services
Activity Narrative: IYCN will carry out four major activities to reduce the risk of mother-to-child transmission by strengthening
infant feeding counseling and support and to improve the nutritional status of HIV-positive pregnant and
lactating women.
1.) Conduct a rapid assessment. -- IYCN will conduct a rapid assessment of current infant and young child
feeding practices among HIV+ positive women, as well as the quality of infant feeding counseling offered
through PMTCT services. This will include a review of national policies, guidelines, curricula, and materials
related to infant and young child feeding and maternal nutrition in the context of HIV and a review of related
secondary data from programs, assessments, studies and research. As part of the assessment, IYCN will
determine the availability and quality of IYCF counseling as part of PMTCT services and assess the
knowledge and counseling skills of PMTCT, ANC and related service providers, including health extension
workers, and community support group facilitators. IYCN will also assess infant and young child feeding
knowledge, attitudes, and practices among HIV-positive women. IYCN will use the assessment findings to
develop strategic messages and materials that address identified barriers to optimal feeding practices.
IYCN will also identify training and job aids needed to strengthen infant feeding counseling and support
services at the facility and community level.
IYCN will conduct a stakeholders' workshop with the F-MOH; PEPFAR PMTCT HIV and nutrition, and OVC
partners; and child survival and nutrition programs to present the findings from the rapid assessment and
identify ways to address the gaps identified. This workshop will lay the foundation for ongoing TA and
collaboration to integrate and enhance infant feeding and maternal nutrition into current PMTCT activities,
particularly with PEPFAR-supported clinical activities. IYCN will link its IYCF in the context of HIV TA to
OVC, child survival and other programs.
2.) Strengthen the capacity of facility-based staff to provide quality infant feeding counseling and nutrition
services.-- IYCN will review the F-MOH's PMTCT Training Package to strengthen content on infant, young
child and maternal nutrition in the context of HIV. Based on IYCN's initial review of the training package,
IYCN will expand the maternal nutrition content and include a practical session on infant feeding counseling
skills. In addition, IYCN will develop and disseminate a refresher training manual to strengthen the skills of
providers previously trained. IYCN will support training activities for PMTCT staff, especially in urban areas,
due to the comparatively high HIV rates with later expansion to PMTCT staff in rural areas.
To further strengthen health staff capacity, IYCN will review, revise and develop counseling and nutrition
assessment job aids and tools to ensure they are specifically tailored to the needs of HIV-positive women
and exposed children. As a first step, IYCN will update the F-MOH PMTCT job aid (originally developed by
LINKAGES) to reflect the 2006 WHO HIV and infant feeding guidelines and support training service
providers in its use.
To promote quality services, IYCN will assist the F-MOH and partners to assess services and develop
quality improvement strategies with periodic reassessment. Based on this information, IYCN will provide
tools and assist with supportive supervision for facility staff to ensure high-quality infant feeding counseling
is integral to PMTCT services.
3) Develop IEC materials on infant feeding and maternal nutrition in the context of HIV. -- IYCN will provide
TA to develop IEC materials on infant feeding and maternal nutrition in the context of HIV based on the
findings from the rapid assessment. These materials will strategically respond to perceived and existing
barriers to optimal IYCF and maternal nutrition behaviors. IYCN will support sharing and diffusion of these
materials among the F-MOH and PEPFAR partners. They will be disseminated to HIV-positive women and
their families through service providers, HEWs, and support groups. IYCN will provide TA on material and
message development to partners to adapt these materials to meet the needs of the populations with whom
they are working.
4) Integrate and expand infant feeding and nutrition in the context of HIV within related programs. IYCN will
provide TA to PEPFAR nutrition related HIV projects (i.e., the urban gardens and food-by-prescription
projects) to improve outreach staff promotion and support of appropriate IYCF and improved nutrition
behaviors. IYCN will provide TA to incorporate key infant and young child feeding content into both
program's nutrition education activities. IYCN will work in collaboration with PEPEFAR and government
partners to develop training modules, job aids, and BCC materials on infant feeding and HIV for outreach
workers, mothers and their families.
The F-MOH National Nutrition Program (NNP) is implementing Ethiopia's first National Nutrition Strategy.
The NNP is deploying over 30,000 health extension workers as key resources to implement this program.
IYCN will provide TA to the NNP to ensure that infant feeding and nutrition in the context of HIV is
integrated into the program's service delivery and institutional strengthening/capacity building activities.
IYCN will support training for HEWs to strengthen their capacity to provide consistent and correct
information on infant feeding and nutrition for women who are HIV positive, offer adequate support, and
refer them to appropriate services. IYCN will develop a TOT refresher training manual, produce related job
aids that respond specifically to the needs of HEWs, and provide BCC materials that can be disseminated
through current activities.
IYCN will also collaborate with UNICEF's maternal and child activities and USAID-supported child survival
activities in the country to integrate IYCF in the context of HIV into their programs. IYCN will share key
findings from the rapid assessment to ensure that strategic messages for HIV positive mothers are included,
both for maternal nutrition and feeding HIV-exposed children. IYCN will provide TA to review and revise
their current tools, training manuals and materials, as well as share current tools and materials to enhance
support for women who are HIV positive, help increase infant HIV-free survival and strengthen linkages and
referrals for services.
GENDER
IYCN will maintain a gender equity focus through its project approach and empower women to make
Activity Narrative: decisions to improve their own health and that of their children. Key activities include:
1) Health workers will be trained to not only to provide HIV-positive women with information, but will
empower them to make infant feeding decisions based on their individual circumstances. Counseling will
also help HIV-positive women recognize their own nutritional needs during pregnancy and lactation. Health
workers will be trained to counsel and empower women to identify and take action to improve their
nutritional status.
2) Staff assessment and counseling will further help women address situations where she may face stigma
and violence in her home or community. HIV+ women will be linked with formal or informal women's
support groups to help develop skills and confidence and address situations of gender based violence.
3) IYCN will share materials that sensitize men and community leaders to support women's nutritional
needs during pregnancy and lactation, and to support optimal infant feeding. IYCN will adapt resources
such as PATH's Community Sensitization Manual for Improved Infant Feeding and Maternal Nutrition and
share them with partners.
SUSTAINABILITY
IYCN's multipronged approach to sustainability begins by providing TA to existing strategies and programs
being implemented by the F-MOH, implanting partners and NGOs, and focuses on developing staff capacity
and skills in PMTCT, ART, and well-child/MCH clinics. Well-designed training curricula, job aids, counseling
tools, and BCC materials will help maintain high standards over time. IYCN support will build knowledge
and skills on infant feeding and nutrition in the context of HIV that will help sustain optimal nutrition practices
at the facility, community and household levels. IYCN will also support monitoring and evaluation and
develop quality improvement methods and integrate nutrition within PMTCT and increase linkages among
ANC, PMTCT, nutrition and child health services. This approach will facilitate referrals; integrate care,
decrease dropout rates, and increase PMTCT attendance.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Expansion and development of community-based supports for PMTCT
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Activities were formally implemented by Intrahealth.
Substantive changes were made in the COP 08 narrative and are as follows: This activity will provide a
comprehensive and tailored package of quality improvement support, training, supervision and technical
assistance in FY09 to existing community groups, Health Extension workers, (HEW's), Traditional Birth
Attendants, (TBA's), to support and increased uptake of PMTCT services at the community level. In
addition it will provide targeted promotion and community level campaigns to support PMTCT access and
understanding at the community level as well as expansion and scope of the Urban HEW program.
Trainings will be conducted for TBA's, HEW's, and community action facilitators on social mobilization for
PMTCT, referral of pregnant mothers for ANC/PMTCT, and male involvement. This training is an integral
part of a safe motherhood intervention aimed at averting new pediatric infections through linking community
and facility PMTCT endeavors. HEW and TBA are part of the community; they share local customs,
common values and norms, speak the local languages, and often have the trust and respect of the
community. These cadres can help mobilize the community to increase antenatal care-seeking behavior,
reduce stigma and discrimination, and increase male involvement. This activity will ensure collaboration with
EngenderHealth to incorporate Men as Partners activities into their program which are currently at health
posts. This activity will support facilities to significantly increase the number of male partners tested during
ANC visits.
Increasing the capacity of TBA and HEW to render household-level service delivery is vital to overcoming
the prevailing poor uptake of PMTCT services. This activity will work closely with Pathfinder on the new
FP/MCH program to ensure coordination and collaboration of community outreach efforts. The PEPFAR
partners will convene monthly forums with healthcare providers, including HEW, to review the ANC/PMTCT
intervention being executed at the facility and community levels. The HEW and TBA will have their own
mechanism to track referred mothers with community referral cards.
This activity will incorporate Men as Partners (MAP) program in Ethiopia. The program, established in
1996, works with men to promote gender equity and health in their families and communities. The MAP
curriculum will be adapted from two MAP manuals that were developed in Kenya and South Africa - both of
which were PEPFAR funded and have a heavy emphasis on HIV prevention. The four workshop modules
are 1) gender, 2) HIV and AIDS, 3) relationships, and 4) gender-based violence. Each module constantly
examines issues related to HIV prevention, which will encompass an ABC approach. The MAP workshop
reaches participants with 15 hours of interaction on these topics. The objectives of this activity is to provide
tools and technical assistance related to MAP to local partners and to reach communities, especially men
and young boys, with messages about the links between HIV/AIDS, STI, alcohol and ‘khat' chewing, and
gender-based violence. The intervention will primarily target unmarried, out-of-school young men with
multiple partners. This high-risk population is particularly vulnerable to HIV infection/transmission. The MAP
intervention will also target other key beneficiaries including older men, community leaders, parents, and out
-of-school young women.
* Increasing women's access to income and productive resources
* Family Planning
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Human Capacity Development
APRIL REPROGRAMMING
This is an AB/OP shift; originally there was no AB funding. Now it is a 20:80 split
Table 3.3.02:
Prevention APS
ACTIVITY UNCHANGED FROM FY2008:
This is a continuing activity from FY 07.
Objectives and Targeted Program Areas:
This APS is restricted to programs that will strengthen and expand the PEPFAR/Ethiopia Prevention
program in urban, peri-urban, and high prevalence "hotspot" areas by ensuring those at high risk for HIV
transmission have access to a full range of prevention services. The goal of this APS is to provide support
for the design, implementation and evaluation of prevention interventions and services that address the
risks associated with the full spectrum of transactional sex in urban centers and "hotspots." For the
purposes of this APS, transactional sex is defined as the full spectrum of exchanging sex for money or
goods, from a self-identified commercial sex worker in a brothel to a woman who does not identify as a sex
worker, but who occasionally or frequently exchanges sex for necessary goods or luxury goods permitting
upward social mobility.
This APS will focus on reaching adults and young people engaged in transactional sex. The following
venues are illustrative examples of where prevention programs should target their interventions for reaching
women and men engaged in formal & informal transactional sex:
• Bar and disco based
• Café house based
• Street based
• Workplace based, from mobile work settings to government offices
• Brothel based, specifically for formal sex workers
• Marketplaces
• Hotspots near military posts
The targeted program areas will include
• The prevention of HIV transmission in urban settings and "hotspots".
• The development, implementation and evaluation of tailored prevention interventions
• The conduct of rapid and formative monitoring and evaluation of activities to increase the knowledge of
risk behaviors and the context for high risk populations.
Prevention for At Risk Populations in High Prevalence Urban Areas in Ethiopia
THIS IS A NEW ACTIVITY FROM COP08
EngenderHealth and its partners will be implementing this new activity for Prevention for at Risk Populations
in High Prevalence Urban Areas. Ahe team that includes Timret Le Hiwot (TLH), Integrated Services for
AIDS Prevention and Support Organization (ISAPSO), and Addis Continental Institute of Public Health (AC-
IPH). Two resource firms including CHF International and the Nia Foundation will used for specific technical
expertise. This is a three year project and will support increased availability and use of HIV prevention
information and commodities and increased access to HIV counseling and testing (HCT), STI, and care and
treatment services for adults and young people involved in transactional sex. It will also improve networking
and capacity building for sustainable HIV prevention programming. The project will be implemented in major
urban centers and other ‘hotspots' that are identified through rapid mapping and needs assessments and
partner consultation. It will work in close coordination with the HIV/AIDS Prevention Control Organization,
the Ministry of Women and Women's Associations, and the Ministry of Health and Social Welfare as well as
ongoing USG-funded HIV-prevention activities and other national health initiatives outlined in the
Multisectoral Plan of Action for Universal Access to HIV Prevention, Treatment, Care and Support.
Following an initial assessment and planning phase, the project will introduce a comprehensive package of
HIV prevention services for adults and young people involved in or at risk for transactional sex. In Year One
the package will be introduced at 44 venues associated with transactional sex and 20 health clinics in 20
regional/district capitals/zonal towns in Benishangul, Gambella, Afar, Oromiya, Somali, SNNP, Jijiga,
Butajira, and Amhara. The package will include peer education, condom distribution and promotion, stigma
reduction, strengthened HIV/STI service delivery, work with male clients involved in transactional sex, mass
media strategies, mobile testing and counseling, and drop-in centers for hard to reach women and girls. The
comprehensive package will be introduced at an additional 55 venues and 22 health clinics in 22 cities by
the end of the project. This project is expected to reach a total of 104, 250 adults and young people involved
in or at risk for transactional sex work with our comprehensive package of HIV/STI prevention interventions.
The project will collect and analysis data about adults and young people involved in transactional sex to
develop and implement a highly-targeted, evidence-based program that delivers measurable health and
behavioral outcomes. Project partners have strong on-the-ground presence in Ethiopia, serving key most at
risk populations (MARPS) through a wide range of complementary HIV/AIDS programs. To maximize
access to high-quality HIV prevention services and prevent duplication, the project will collaborate with other
recently awarded USG/PEPFAR projects led by Population Services International (PSI) and the Academy
for Educational Development/Health Communication Partnership (AED/HCP) for targeted condom
promotion and outreach. The project will implement a variety of complimentary and evidence-based HIV
prevention and related services.
The project's technical approach is based on special design considerations for accessing hard to reach
populations including addressing intergenerational poverty and sustainable livelihoods, promoting gender
equality, linking alcohol use and HIV risk, and integrating sexual and reproductive health and HIV services.
Key features include maximizing the synergy between existing on-the-ground partners, programs and
networks; planning explicitly for transitioning responsibility for project delivery to the local entities;
capitalizing on combined knowledge, skills, expertise, and resources in other projects and programs;
evidence-based decision-making; and transforming gender roles. To help ensure the sustainability of project
activities participatory, "bottom-up" planning processes will be introduced to build the capacity of partners,
and transfer financial and administrative oversight for key project components, such as drop-in centers, to
local entities.
* Reducing violence and coercion
Muslim Agencies Recharging Capacity for AIDS
This activity will be re-competed in COP08 to support HIV prevention and capacity building in Muslim FBO's
in Ethiopia. The activity will conduct similar activities as described in COP08.
This is a continuing activity. This activity only receives HVAB funding.
COP08 ACTIVITY NARRATIVE
PACT Ethiopia conducts HIV prevention and capacity building through three indigenous Muslim faith-based
organizations. With PEPFAR/Ethiopia funding, in FY06 PACT collaborated with the Ethiopian Muslim
Development Agency (EMDA) to implement abstinence, be faithful (AB) prevention activities in and around
Jimma (Oromiya region), Dire Dawa and Harari. Based on the successes achieved with EMDA, two
additional local partners were engaged: Ogaden Welfare and Development Association (OWDA) based in
Somali region and Rohi Weddu Pastoral Women's Development Organization based in Afar. In total the
project covers several zones where a large percentage of Muslims reside in Oromiya, Harari, Dire Dawa,
Afar, Somali, Amhara and Tigray.
HIV/AIDS is still a major health crisis in Ethiopia. Adult HIV prevalence within the program's geographic
coverage, based on the Ethiopian Demographic and Health Survey (EDHS) 2005 and newer Single Point
Estimated (SPE) 2007 data, is summarized below:
Dire Dawa: ANC/2005: urban 8.0%, rural 0.9%; EDHS/2005: 3.2%; SPE/2007: 4.2%
Jimma (Oromiya): ANC/2005: urban 8.0%, rural 1.3%; EDHS/2005: 1.4%; SPE/2007: not available
Harari: ANC/2005: urban 6.9%, rural 0.5%; EDHS/2005: 3.5%; SPE/2007: 3.2%
Somali: ANC/2005: urban 3.5%, rural 0.7%; EDHS/2005: 0.7%; SPE/2007: 0.8%
Afar: ANC/2005: urban 13.7%, rural 1.7%; EDHS/2005: 2.9%; SPE/2007: 1.9%
According to the EDHS 2005, polygamy accounts for 16% in Jimma and 5.5% in Harari. These are cash
crop areas known for coffee or khat (catha edulis, a stimulant) production. During the harvest season, there
is an influx of migrant workers to rural areas and commercial sex workers to urban areas.
PACT provides technical assistance to institutionally strengthen local partners to effectively plan, manage
and implement HIV/AIDS prevention projects. The project reached 1.2 million people in its first year
(FY05/06) with AB messages. In FY06/07 Pact Ethiopia's local partners reached an additional 707,068
adults and youth. Working through local Imams, youth groups and interested community members, EMDA
facilitated weekly interactive congregational sessions at the mosques, youth groups and community
gatherings to discuss AB prevention, stigma and existing care and treatment services.
In FY08, Pact and its partners will continue to implement capacity building and HIV prevention activities.
Using activity grants through PACT, local partners will implement AB messaging through Mosques to reach
men, community clubs to reach women, youth anti-AIDS clubs to distribute information and education
materials, utilize volunteers to organize public gatherings and support radio broadcast of AB messages.
The geographic scope will be expanded to cover Mekele (Tigray), Bahir Dar and Dessie (Amhara),
Nazareth (Oromiya) and additional urban towns in Afar using the existing Islamic Council and community-
based structures.
Basic HIV transmission, AB and gender training of imams and community leaders supported a greater
consistency of messaging from Muslim leaders and succeeded in challenging taboos and attitudes and
behaviors of religious leaders and their followers. Voluntary counseling and testing (VCT) has also
increased. Some areas went as far as introducing new by-laws to prevent marriages without certificates
from a VCT center.
Pact and its partner organizations promote awareness about and the use of existing public health services
such as VCT, sexually transmitted infections treatment, ART, childhood immunization, family planning, and
other primary health care through provision of technical assistance to clubs and community educators. Pact
collaborates with Johns Hopkins University/Health Communications Program (JHU/HCP) to provide training
and technical assistance to the three local partners on using the Youth Action Kit developed by JHU/HCP.
Pact will foster linkages between local partners and other PEPFAR funded HIV prevention, care and
treatment activities. In addition, Pact will create opportunities for club members to share their Y-CHOICES
experiences (abstinence and be faithful for youth (ABY)) and promote joint out-of-school and local faith-
based association efforts in all project locations of the M-ARCH/EMDA program.
The target population in this program is a) youth between the ages of 10 and 24 reached through clubs and
b) adults of ages between 25 and 49 reached in mosques and through community educators. Individuals
are reached through mosques, community groups and youth anti-AIDS clubs.
This activity addresses male norms and behaviors through the use of training for Imams throughout several
areas of the country. The imams directly address AB messages to Muslims in the area. The majority of
those addressed in mosque are males, offering a structured environment for behavior change messages
and education. PACT has made an effort to increase the number of females included in HIV prevention
programming under this program through girls clubs and married women venues.
PACT builds the organizational and technical capacity of three local subpartners. The Ethiopian Muslim
Development Agency is a national partner operating in all regions of Ethiopia, although the M-ARCH activity
focuses on Amhara, Harari, Oromiya, and Tigray in and around major urban centers. The Rohi Weddu
Activity Narrative: Pastoral Women Development Organization operates in Afar region. The Ogaden Welfare and
Development Association operates in Somali region.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16679
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16679 5594.08 U.S. Agency for Pact, Inc. 7501 604.08 $500,000
International
Development
10520 5594.07 U.S. Agency for Pact, Inc. 5517 604.07 $421,440
5594 5594.06 U.S. Agency for Pact, Inc. 3760 604.06 $400,000
HIV Prevention at Teachers' Colleges
This activity is funded in HVAB $300,000 and in HVOP for $300,000.
This new activity is to prevent and control HIV/AIDS within Ethiopia's 24 teachers' colleges and their wider
community, students, and staff to support AB behavior. It covers both HVAB and HVOP, including
abstinence and fidelity messages, promoting correct and consistent condom use, early treatment of sexually
transmitted infections (STI), uptake of services like voluntary counseling and testing (VCT) and ART, and
prevention strategies on stigma and discrimination towards people living with HIV/AIDS (PLWH).
In Ethiopia, there are currently 24 teachers' colleges, with a student population of more than 50,000 and
about 3,500 academic and administrative staff. Young women constitute about half of the student
population. The teachers' colleges are located in regional capitals and main towns and some of them are
along the high-risk corridor and are hubs for transportation, trucking, and commerce. Due to urbanization,
these students are exposed to HIV/AIDS "hot spots" in their new communities, increasing their exposure to
risk. The students come to these colleges from all over Ethiopia, and the colleges no longer provide housing
to students. As a result, students are forced to live in rented houses in the community surrounding the
campuses. This has exposed the students to high-risk sexual behavior and increased their vulnerability to
HIV/AIDS. Other factors that contributed to high-risk behavior include: absence of immediate parental
control; maturity level and desire for new experiences (most students are aged 17-21 years); peer pressure;
change of environment, particularly for those students coming from rural to major urban areas; and the need
to "fit in" to urban society.
Anecdotal evidence from the teachers' colleges has revealed that many college girls are exposed to
unwanted pregnancy and are prone to aborting, with an adverse impact on their health status. STI are one
of the most common reasons for clinic visits among students. At present there are no interventions by
donors or nongovernmental organizations to address behavior change and curb the transmission of STI,
including HIV/AIDS, at teachers' colleges. Interventions focused on behavior change that promotes safer-
sex behaviors (e.g., abstinence, being faithful, reducing sexual partners, avoiding concurrent or high-risk
partnerships, removing stigma and discrimination, encouraging comprehensive care and support) are very
important, pertinent and timely.
Based on the new prevalence information and behavioral data of the 2005 Ethiopian Demographic and
Health Survey (EDHS), PEPFAR Ethiopia's prevention strategy prioritizes expansion of AB outreach
activities to most-at-risk populations (MARPs), and focuses on expanded/new HIV-prevention activities for
both the general population and high-risk groups in urban areas and along major transpiration corridors.
Prevention for youth and the general population remains a priority, and much has been accomplished
through several existing implementing partners. This activity will work through existing structures to combine
approaches, including life skills for youth, addressing harmful social norms, facilitating community
dialogues, and other outreach activities to support AB behavior. The activity also addresses other
prevention strategies and issues such as stigma and discrimination towards people living with HIV/AIDS
(PLWH), tackling existing gender balances, promoting correct and consistent condom use, early treatment
of STI, and uptake of VCT and ART services. The activity is designed to reduce risky behaviors and
encourage comprehensive care and support in teachers' colleges and the community in the vicinity of the
colleges. It will also promote abstinence and faithfulness among teachers' colleges students and staff.
The objective of the activity is to promote decreased risky sexual behaviors among 50,000 students and
3,500 faculty and administrative staff in 24 teacher training colleges through the provision of life-skills and
knowledge. Illustrative activities include: assessment of HIV services, knowledge, and behaviors in the
teachers' colleges; introduction of the program to stakeholders; development of HIV/ AIDS/STI/tuberculosis
tool kits and information-education-communication (IEC) materials for students, faculty and administrative
staff; and development and production of teaching and learning manuals on HIV/AIDS prevention and care
for primary schools that would be used by prospective graduating teachers when they go to their place of
assignment. The graduates can serve as resource or focal persons and change agents in their schools and
communities. The activity will also promote curriculum review by stakeholders, and implementation of
prevention and care education based on tool kits and behavior-change communication (BCC) /IEC
materials developed through education, entertainment, and interpersonal reinforcement. The activity will
establish and strengthen the ability of HIV/AIDS Resource Centers or liaison offices at the 24 colleges to
fully implement activities to reach students (regular, evening, and summer), faculty, and administrative staff.
It will also assist with the development/design of Teacher Training College HIV-prevention policies and
strategies, including a workplace policy/guideline.
Based on the new prevalence information and behavioral data of the EDHS, PEPFAR Ethiopia's prevention
strategy prioritizes expansion of AB and Other Prevention (OP) outreach activities to MARPs, and focuses
expanded/new HIV-prevention activities for both the general population and high-risk groups in urban areas
and along major transpiration corridors. Prevention for youth and the general population remains a priority,
and much has been accomplished through several existing implementing partners.
The activity directly addresses wraparound activity with other USG education programs in Ethiopia,
including a new teacher-development project entitled Improving Quality of Primary Education Program
(IQPEP), which will be in place in late 2008. It leverages resources with Health Communications
Partnership (HCP), Johns Hopkins University (JHU) to use materials appropriate to youth such as Beacon
Schools, Sports for Life, and the Youth Action Kit; and Y-Choices of Pact. It will also exchange practices
with activities related to supporting Addis Ababa University Students with AB and OP.
The activity targets all community members, students, faculty and administrative staff in 24 teacher training
colleges. It will promote life skills for youth, addressing harmful social norms - linking to male norms,
facilitating community dialogues, and other outreach activities to support AB behavior. The activity also
Activity Narrative: addresses other prevention strategies and issues such as stigma and discrimination towards PLWH,
tackling existing gender imbalances, promoting correct and consistent condom use, early treatment of STI,
and promotion of services like VCT and ART.
Continuing Activity: 18633
18633 18633.08 U.S. Agency for Health 12034 12034.08 HCP $300,000
International Communications
Development Partnership
Estimated amount of funding that is planned for Education
Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention
Total Planned Funding for Program Budget Code: $34,766,924
Total Planned Funding for Program Budget Code: $0
Table 3.3.03:
fully implement activities to reach students (regular, evening, and summer ), faculty, and administrative
staff. It will also assist with the development/design of Teacher Training College HIV-prevention policies and
(IQPEP), which will be in place in late 2007. It leverages resources with Health Communications
addresses other prevention strategies and issues such as stigma and discrimination towards PLWH,
Continuing Activity: 18692
18692 18692.08 U.S. Agency for Health 12034 12034.08 HCP $300,000
This activity is linked with Expansion and development of community-based supports for PMTCT
This activity will provide a comprehensive and tailored package of quality improvement support, training,
supervision and technical assistance in FY09 to existing community groups, Health Extension workers,
(HEW's), Traditional Birth Attendants, (TBA's), to aid in reaching discordant couples as well as to support
and expand PMTCT uptake. Prevention of positives will be an integrated focus. This activity will provide
targeted promotion and community level campaigns to support understanding at the community level living
with HIV and disclosing safely to partners.
ACTIVITY HAS CHANGED IN THE FOLLOWING WAYS
Continuing Activity: 16727
16727 12235.08 U.S. Agency for Engender Health 7526 6125.08 ACQUIRE $350,000
12235 12235.07 U.S. Agency for Engender Health 6125 6125.07 ACQUIRE/Enge $350,000
International nderHealth
Innovations and Gender Leadership
This is a new activity in COP09
The Network of Ethiopian Women's Associations (NEWA) plays a vital role in serving as an umbrella
organization of women's associations in Ethiopia. NEWA is not currently receiving PEPFAR Ethiopia
capacity building support nor is it actively engaged by the US government or USG implementing partners to
assist in advocacy, addressing strategic areas and mainstreaming gender.
NEWA is a constituent membership organization of 42 civil society and non government organizations
(CSO's and NGO's). Its goal includes synchronizing individual activities of women associations into an
integrated collective effort and synergy to realize their common goal for gender equity and equality through
vigorous campaign, advocacy and lobbying for women's rights.
It is engaged in capacity building through training and funding of its members secured from international
and bilateral organizations. The majority of its members work exclusively on gender issues. PEPFAR has
categorized gender related drivers of the epidemic of HIV/AIDS. These include:
•Human and reproductive rights of women
•Gender based violence
•Female genital mutilation (FGM)
•Various Income generation activities for commercial sex workers in many regions
•HIV/AIDS clinical services and family planning
•Early marriage
This proposed activity addresses priorities of OGAC and the PEPFAR Ethiopia team to improve current
programs in gender mainstreaming. This activity will provide capacity building support and technical
assistance to NEWA and its members in policy and advocacy, organizational capacity development
interventions and technical assistance in mainstreaming gender initiatives in the US government's diverse
PEPFAR program with the support of existing implementing partners. NEWA will receive activity,
equipment and personnel grants to engage the Ministry of Health/HAPCO, USG implementing partners and
other bilateral donors.
PEPFAR Ethiopia anticipates that NEWA will address the following issues during the implementation of this
activity:
Initiate dialogue on the equitable access of women and children to HIV/AIDS services;
Provide technical leadership to the Ministry of Health/HAPCO, Regional Health Bureaus and USG
implementing partners in gender mainstreaming activities;
Advocate for greater access by women to legal protection against gender based violence; and
Alongside USG implementing partners improve access to income and productive resources for women
living with HIV/AIDS.
This support marks a commitment by the US government to extend capacity building support to NEWA for
up to three years.
* Increasing women's legal rights
Income Generation for PLWHA (Aid to Artisans
ACTIVITY UNCHANGED FROM FY2008
COP 08 Narratives:
As of April 2007, approximately 130,000 HIV/AIDS care beneficiaries, including 60,000 ART clients, require
broadened care and support activities to stabilize their household livelihoods to increase their adherence to
preventive care and treatment services. Observations during recent site visits including the Core Team
indicate that broad expansion of the ART program has altered the characteristics and needs of beneficiaries
receiving community-based care from palliative care to long-term chronic care and livelihood stabilization.
Late presentation into the HIV/AIDS care and treatment program exacerbate an individual's poverty status
as they shed personal or household assets and migrate to new towns because of ART service availability or
stigma and discrimination. An expansion of income generation activities for those enrolled in care and
treatment services is necessary to provide a continuum of care that graduates individuals to basic clinical
management without other major support services as they are productive and healthy individuals. Each
beneficiary will receive time-limited support to establish income generating activities in parallel to on-going
care and treatment services. Upon graduation the majority of beneficiaries will have a small sustainable
income to support themselves.
PEPFAR Ethiopia proposes to continue and expand an FY 07 activity that contributes GHAI funds into a pre
-existing mechanism funded through USAID/Ethiopia's Office of Business, Environment, Agriculture and
Trade (BEAT) expand income generation activities specific to handicraft production and marketing for
HIV/AIDS care and treatment beneficiaries. PEPFAR Ethiopia proposes to add an additional $500,000 to
continue implementation of the 07 activity and expand this activity to a larger population. PEPFAR Ethiopia
is expected to leverage $1,000,000 of DA and other partner funding as well as technical expertise from the
BEAT Office to implement revenue generating activities for urban/per urban beneficiaries currently enrolled
in the HIV/AIDS care and treatment program.
PEPFAR funding leverages investments by BEAT within a mechanism to introduce or strengthen handicraft
production to urban/per urban persons currently enrolled in the HIV/AIDS care and treatment program in
selected ART health networks.
An international NGO (to be determined) with specific expertise and experience in handicraft development
and marketing will maintain a successful Market Link program to support entrepreneurial skills, product
design, production, business skills and market development. BEAT's activity will focus on 1) development of
market linkages for export to developed markets 2) providing technical trainings in product design and
production and 3) organizing micro-producers to maximize economic efficiency. PEPFAR funds will cover
the cost of HIV/AIDS care and treatment beneficiary inclusion for a time limited period in the program. Upon
graduation from the program the beneficiary will have a small sustainable income to support their
adherence to care and treatment and to maintain a healthy, productive lifestyle to serve as a role model for
their community.
The FY 08 program will continue with implementation of handicraft production and marketing income
generation activities for beneficiaries selected in FY 07 and will select new beneficiaries in FY 08.
Beneficiary selection will occur utilizing existing community-based care structures within local
government/local faith-based associations and local non-governmental organizations. Selected handicrafts
such as leather products, weaving, basketry and pottery-making will help beneficiaries in care and treatment
receives a sustainable income. The activity will enable chronically poor beneficiaries to become micro
producers to participate in the market for an additional 3,000 beneficiaries enrolled in HIV/AIDS care and
treatment services.
Continuing Activity: 18030
18030 12311.08 U.S. Agency for To Be Determined 7603 7603.08
12311 12311.07 U.S. Agency for US Agency for 5475 118.07 $500,000
International International
Development Development
Estimated amount of funding that is planned for Economic Strengthening
Table 3.3.08:
Comprehensive Community Based Pallitive Care
This is a new activity in the TB/HIV section in FY 2009
This activity will leverage investments in USAID's TB program in Ethiopia. This activity will provide
comprehensive community-based palliative care throughout Ethiopia utilizing local civil society
organizations. Previous palliative care efforts were mainly focused on improving access to Hospital and
Health Center-based clinical care and basic psychosocial support services. This activity, combined with
funding in Care and Support, OVC and Treatment Services, will greatly expand access to clinical and non-
clinical services by individuals in the household and community level where access to health facilities is
limited.
Need for engagement of civil societies and community care for TB and TB/HIV collaborative activities in
Ethiopia is apparent given the low PHC coverage and availability of HIV-oriented urban Community and
Home Based Care programs to pilot TB/HIV activities at the community level. The active participation of
communities in TB and HIV control allows people with TB and HIV to be iden¬tified and diagnosed more
quickly, especially among poor or vulnerable groups who do not normally have access to these services.
Upon diagnosis, people receive better-quality care within their communities, and increased awareness
about the disease results in less stigmatization. Treatment outcomes are also improved, and people with
TB/HIV become empowered by the opportunity to make decisions about the type of care that best suits
them and their community.
This program is designed to support health policy-makers - and patients' groups and local partners - in
including community involvement activi¬ties in policy and practice to control TB and integrate TB/HIV
activities at the community level. There is an urgent need to engage and involve people with TB and HIV
and the community as part¬ners in rolling out TB/HIV services using strategies that effectively build
community involvement.
This activity will receive funds for TB/HIV work to 1) improve access to TB suspect (of any HIV status) to be
referred to health facilities for diagnosis of both TB and HIV; 2) improve linkages between community-based
care and public sector TB programs; and 3) improve access and strengthen adherence to TB treatment by
implementing Community DOTS services within community-based HIV/AIDS palliative care programs.
Implementation of Community DOTS services will be implemented by Home Based Care Volunteers under
the supervision of Nurse Supervisors during their provision of care. All clients who are HIV positive will be
monitored for symptoms of TB and referred accordingly. All clients on TB or ART treatment will receive
adherence promotion and monitoring services that exceed the current capability of health care professionals
in the public sector given patient loads.
Anti-TB drugs will be secured from Regional Health Bureaus and local authorities and adequate structures
will be developed to further enhance the implementation of Community DOTS.
The summary and elements are noted below.
Summary
The USG has supported local organizations to provide palliative care services and develop multi-
stakeholder referral networks between community, health center and hospital services since 2001. Using
lessons learned from this experience, the Contractor shall strengthen and expand community-based
palliative care programs in urban and periurban areas. Component 1 focuses on care services delivered at
the community and household level delivering basic and advanced palliative care including community TB
DOTS, adherence promotion, and monitoring utilizing case management methodologies.
Elements and Approaches for Community and Home-Based Care
The Contractor shall work through local civil society organizations by building technical and organizational
capacity to implement community-based care programs. Funding for this activity shall address:
•Work closely with ART treatment sites (hospitals, health centers) to ensure community follow-up of all
enrolled HIV patients
•Ensure the provision of basic and advanced palliative care including complementary commodities, and
psychosocial counseling through laypersons is provided with from the oversight of nurses and social
workers.
•Ensures the availability of basic care commodities and services
•Ensure the provision of adherence promotion and monitoring of clinical therapy in addition to supporting
health facilities trace defaulters.
•Deliver low-cost, evidence-based preventive care and linkages to other public health interventions at the
household level.
•Establishment or transition of Mother Support Groups into community settings.
•providing support to people living with HIV and AIDS (PLWHA) and their families, including home visits,
provision of
•Ensure support to orphans and vulnerable children (OVC), both infected and affected by HIV and AIDS, in
one or more of the six intervention areas identified in the PEPFAR OVC guidance (refer to additional
background documents attached_
USAID requires that CSOs be trained in delivering family-centered palliative care with a focus on the
priorities set by the family through its active participation in identifying problems that compromise its health
and well-being. Other characteristics of such care are team planning, development, and support; and a
focus on outcomes. Interpersonal, interactive including community conversations and other forms of
communications may be utilized to mobile families for behavior change and to clarify misconceptions about
HIV and access to ART services.
Specific TB/HIV activities will include: TB suspect identification and referral; DOTS support; Retrieval of
treatment interrupters; Identification of treatment supporters such as family members or community agents
Activity Narrative: from local NGOs working with local governments in establishing DOTS points for patients residing in urban
areas that have PHC access issues (i.e. overcrowding, understaffing). Community agents may support
CHBC and Health Facility staff by serving as Cough Officers at facility level to ensure that patients with
chronic cough (>3wks) are immediately identified and separated from 'regular' patients and provided with
TB diagnostic work-up as part of the administrative control measures in TB Infection Control. This will be
linked with the IMAI roll-out at health facilities. Many of the TB patients require support for longer periods
from civil society structures that aren't well integrated with the HIV program.
The activity can play major role in promoting PICT at grass root level through IE/BCC, referral of suspects
and linking HIV+ clients to care and support services.
Finally, the activity will result in bottom line improvements in intensified case finding, infection Control and
INH prophylaxis.
Table 3.3.12:
April 2009 Reprogramming:
Additional funds for the Ambassador Girls Scholarship Program.
Scholarships will support vulnerable girls and orphans due to HIV attend primary and secondary school in
various urban araes of Ethiopia.
Additional narrative will be submitted during the August 2009 reprogramming.
Table 3.3.13:
Strengthening Community Safety Nets: Scaling Up Care and Support for Orphans and Vulnerable Children
Affected by AIDS
This project was selected as one of the winning Annual Program Statement, Integrated Community
Systems to Mitigate HIV/AIDS Impact on Children of 2008. The request is to continue to fund the Christian
Children's Fund (CCF) that supports OVC affected by AIDS in Ethiopia through the Strengthening
Community Safety Nets project. Their goal is to promote healthy child development for 50,000 children and
assist 8,500 primary and secondary caregivers in Addis Ababa and Oromia through comprehensive, family
centered, and child-focused care and support services. Proposed project service areas include high
prevalence, underserved urban areas.
The Project will leverage and scale up the Partner's extensive experience developing comprehensive, high
quality services for vulnerable children, PLWHA and their families. The project presently integrates
successful strategies from ongoing programs in other countries, including the PEPFAR-funded Weaving the
Safety Net project in Kenya. They have reached more than 43,500 Kenyan children with comprehensive,
coordinated care in just three years and successful collaboration in the ALERT Hospital in the provision of
comprehensive care and treatment program for over 8,000 adults and children living with AIDS. URC
brings significant experience in improving service quality and coverage through community data collection
and program monitoring systems, including current efforts to improve quality of services for vulnerable
children through strengthening community and facility linkages.
To achieve their goal in Ethiopia, CCF will achieve the following objectives: 1) Increase access to and
utilization of comprehensive, coordinated and family centered care for 50,000 orphans and vulnerable
children. 2) Expand service access and coverage through enhanced collaboration, coordination and
referrals among community, NGO, and government actors serving children. 3) Improve service quality and
coverage through enhanced community data collection and program monitoring systems.
CCF will implement four effective strategic approaches:-1) building on existing foundations that community
groups, HAPCO offices, NGO, C/FBO, CCF-US and CCF-Canada already have in place, the project aims to
help these groups become more effective in mitigating the impact of HIV/AIDS on children and families. 2)
Strengthening family capacity to care for children will increase families' ability to satisfy the immediate
needs of vulnerable children.3) Focusing on Early Childhood will ensure that infants and young children
receive critical, high impact child development services, while enhanced schools and early childhood
development centers will 4) expanding the continuum of care for vulnerable children.
Project activities will rapidly start up in 30 kebeles (Phase 1) with expansion to the remaining 48 over the
next two years (Phase 2), reaching 35,000 children through home based services, 5,000 with Early Child
Hood ( ECD )services, and 10,000 through school based interventions. Three levels of community-based
volunteer networks will support services to orphans and vulnerable children. Community Caregivers will
provide active case management, health promotion and disease prevention education, psychosocial
support, and nutrition assistance. Youth Mentors will provide psychosocial support and life skills education,
while Community Paralegals will promote child protection and provide legal counseling services. Community
based ECD services and child friendly schools will enhance child development, education and child
protection services. An effective strategy for providing Economic strengthening for youth headed
households will be implemented, documented, and scaled up with additional resource mobilization. A
supportive community environment for PLWHA and vulnerable children will be created through community
conversations that promote behavioral change and address children's rights.
Collaborative programming platforms will enhance service linkages and referral relationships through
Vulnerable Child Committees (VCC). Service mapping and updated service referral guides will expand
service coverage and improve coordination. The VCC will also provide an effective entry point for technical
support and managerial capacity building to local partners. Enhanced community data collection systems
will facilitate service collaborative planning and synchronization with national plans and the OVC Standards
of Services. The project will work with local partners to identify and refine tools to improve community level
data collection. Quality Improvement Collaborative (QIC) will involve multiple actors in improving service
quality and documenting effective practices.
The Project Management structure focuses resources at the kebele and community levels, balancing direct
support for fledgling civil society with accountability to PEPFAR and GOE offices. A Project Director (PD),
based in Addis Ababa, will have responsibility for overall project quality, coordination, and accountability. A
Quality Improvement Advisor (QI) will support project staff, implementing partners and front-line service
providers in data collection and QI activities. Two Project Managers, supported by a Finance Officer and an
M&E Officer, will manage project activities in Addis and Oromia, respectively. Nine OVC Project Officers will
support activities in the nine proposed Woredas/Sub-cities, based in existing CCF-US and CCF-C Area
Project Coordination Offices. Finally, 18 Community Mobilizers will support service roll out, data collection
and reporting.
The project design directly responds to the USAID and Government of Ethiopia (GOE) HIV policy priority
areas, as well as the Ethiopian Standards of Service for Orphans and Vulnerable Children. The project will
support evidence based interventions informed by local culture and customs, and engage vulnerable
families and target communities in every stage of the project to reduce stigmatization, and increase impact
and sustainability. Children and youth will be involved in service design, delivery and evaluation, and
participation and support for women and young girls will help to promote gender equality and reduce their
vulnerability to HIV.
At its core, CCF-US's Strengthening Community Safety Nets project builds community members' capacities
to become active agents in their own well-being and survival. Each project beneficiary is a project
participant; all but the youngest children will be challenged with growing their internal and external skills to
Activity Narrative: positively impact their lives and the lives of the people with whom they come in contact. This model for
promoting community action enables even the most distressed communities to devise realistic solutions for
their immediate and long-term physical, emotional, and economic health.
Economic Strengthening of Households Affected by HIV/AIDS
ACTIVITY UNCHANGED FROM FY2008.
This activity is a competitive procurement and the partner will be identified in the coming months.
COP08 NARRATIVE
This will be a continuing FY07 program with activities under HBHC (10499). This activity will link with other
economic strengthening efforts under HKID including ATEP and IntraHealth's MSG program (10503). This
activity will provide analysis and implementation of viable economic strengthening models, specifically
income generation, for persons living with HIV/AIDS and older OVC in urban and peri-urban areas.
As ART access becomes widely available to persons living with HIV in specific urban and peri-urban areas,
the dynamics of community based palliative care and OVC care has evolved. Several need assessment
surveys done among households where persons with HIV reside or households where OVC reside revealed
limited community social support, such as lack of sustainable means to obtain economic resources for food,
shelter and other necessities such as transportation to clinics for ART or related services. Findings from a
recent Network Assessment conducted by Johns Hopkins University indicated that a majority of care and
treatment beneficiaries required community-based social services to increase the security of their
household.
This activity will improve PEPFAR Ethiopia's understanding of viable economic strengthening models for
persons requiring disease management services or long term social support services in a livelihood
insecure setting. Findings from studies in Malawi indicate that the vast majority of orphans, approximately
95%, live with an extended family member. Often these children have limited opportunities to complete
basic education or access health services because extended families are livelihood insecure. This activity
will work closely with USAID's Economic Growth Office to identify and pilot best practices and technical
specialization from other African and Asian countries to strengthen PEPFAR Ethiopia's continuum of care,
specifically social support as the need for income generation grows. This activity's impact will be
disseminated widely to the HIV/AIDS Prevention and Control Office (HAPCO) and PEPFAR partners to
build upon evidence-informed approaches to social support.
An increasing number of households (HH) living with or affected by HIV struggles to meet the most basic
needs of food, shelter, education, health, and protection. Without economic opportunities and sustainable
income, HIV-affected households cannot meet these basic needs, making the children in the home even
more vulnerable to abuse and exploitation. Children from these households who engage in transactional
sex for food or cash risk becoming infected with HIV. This activity, leveraging funds in HBHC, will contribute
to the larger PEPFAR Ethiopia program to reduce economic vulnerability of households affected by or living
with HIV/AIDS through a range of multi-sector responses that build HH assets and mitigate risks. The
spectrum of household conditions as the result of HIV/AIDS will be addressed to include youth or child
headed, chronically ill, elder caregiver, single guardian, female headed, relying on exploitive or risky labor
and with a member on ART. Partnerships with OVC, palliative care, and treatment programs will be central
to this activity to provide access to HIV/AIDS and social services.
The primary objectives for the economic strengthening of households affected by HIV/AIDS program are: 1)
Assess through value chain analysis the economic strengthening options for the spectrum of household
conditions due to HIV/AIDS; 2) Implement models in approximately 10 urban and peri-urban areas highly
affected by HIV/AIDS interventions covering micro-enterprise, micro-finance and/or formal sector vocational
training; and 3) Provide lead technical assistance and linkages with other economic growth activities for
PEPFAR programs undertaking economic strengthening activities.
Key targets for the OVC component are households caring for OVC and the older OVC, ages 15 to 18
years. More than half of the beneficiaries will be women and girls, given the particular vulnerability of female
-headed households. Over 10,000 OVC will benefit from the economic strengthening of households affected
by HIV/AIDS.
An emphasis will be placed on tracking the benefits of household economic strengthening on child
wellbeing. The Child Status Index supported by PEPFAR and the Standards of Services for OVC in Ethiopia
will serve as resources for this tracking as well as informing the implementation of economic strengthening
activities to benefit OVC.
The technical support to OVC programs and the direct implementation of economic strengthening activities
will consider the range of community-based means for improving livelihoods, increasing assets, and
managing household resources relevant to the Ethiopian context. Specific interventions may include:
savings and credit schemes, small business training, development and support, linkages to microfinance
outlets, village banking, vocational training based on labor market forecasting, and networking to expand
relations with private sectors, including business associations. Partnerships will be formed with other USG
investment portfolios in agriculture, health, economic growth, and education to leverage resources,
including the new ATEP program (also funded under HKID). This activity will be coordinated with other
PEPFAR and EGAT funded activities to increase the number of beneficiaries and households as possible.
Examples include Aid to Artisans, Land O'Lakes small scale dairy programs, IOCC and WFP Urban
HIV/AIDS program.
During FY2008, PEPFAR Ethiopia will continue its consultations with the OGAC Public Private Partnership
technical working group. In addition, we envision working with the OGAC OVC technical working group to
disseminate the results of this activity.
Continuing Activity: 16601
16601 10493.08 U.S. Agency for To Be Determined 7478 683.08 *
10493 10493.07 U.S. Agency for Program for 12025 12025.07 $670,000
International Appropriate
Development Technology in
Health
Community Health Information System
The Ethiopian Health Management Information System is undergoing a major overhaul to foster
standardization and appropriate use of tools and the data generated from it. The Ministry of Health through
the financial and technical support from major donor agencies is overseeing the reform. Pilot testing of the
newly designed tools have been completed, and the first phase of the roll-out will begin in September of
2007.
The health management information system (HMIS) primarily deals with data generated at health facilities.
It does not include indicators for health services that happen outside of health facilities, including community
-level activities. Currently in Ethiopia there is no comprehensive community health information system.
Unlike monitoring and evaluation on HIV/AIDS interventions occurring in health facilities, there are no clear
roles and responsibilities for community programs such as those occurring in households and schools. The
lack of effective community health information system compromises the completeness and reliability of data,
which in turn affects the quality of planning, implementation, and evaluation of programs that mainly occur
outside of health facilities including OVC and home-based care services. Together with the HMIS and other
data sources, a functional community health information system will provide a comprehensive picture of
health interventions and services in the country. It will also foster community level ownership of health
activities, and motivates them for more engagement and action.
Major tasks under this program include:
1) Conduct a rapid assessment to identify and review existing community-based health information systems
2) Work with relevant Government of Ethiopia (GOE) offices to map out clear roles and responsibilities on
community level health service data
3) Establish a taskforce composed of key stakeholders to oversee the development and implementation of
the health information system. This is also critical to build consensus among key players
4) Identify all non-health facility health services and develop appropriate indicators, data collection, and
reporting tools and processes
5) Rollout the new system for broader use
Being the frontline workers at the community level, health extension workers will be instrumental during the
design and implementation of the Community Health Information System. This activity will closely
coordinate with the ongoing HMIS reform with the long-term objective of integration. It will also be in line
with the GOE's Health Extension Program.
Designed processes and tools will be pilot tested before wider implementation of the CHIS.
Continuing Activity: 18845
18845 18845.08 U.S. Agency for To Be Determined 7478 683.08 *
Comprehensive support to OVC within Gedeo Zone
Systems to Mitigate HIV/AIDS Impact on Children of 2008. The request is to continue to fund Samaritan's
Purse (SP) which is implementing a comprehensive project in order to improve the wellbeing of 9,923
orphans and vulnerable children (OVC) in six urban areas of Gedeo Zone, SNNPR (Southern Nations,
Nationalities and Peoples Region) Ethiopia. The project is also enhances the ability of families and the
community to care for OVC at home by strengthening the capacity of 3,539 caregivers and mobilizing 4,500
community members.
The Samaritan Purse's implementation strategies include the following:
1) Building on the community based voluntary teams (CBVT) which are established in another existing
USAID-funded Samaritan's Purse project in the selected target towns;
2) Engaging community leaders and members to advocate for OVC;
3) Facilitating a holistic system of care that will address their educational, livelihood, psychosocial,
food/nutrition, health care, legal protection and shelter needs;
4) Providing services through OVC support groups (extensions of the existing teams) by conducting home
visits at a Woreda children's center in each town with the backing of Woreda OVC committees made up of
local leaders from key organizations and disciplines.
The project is managed from an office in Dilla town (the largest of the six targeted towns), with three area
teams, each responsible for two towns, and with social workers based at each town's Woreda children's
center. The staff members train community volunteers, equipping them to serve the OVC, and provide direct
services to project beneficiaries. Sector field officers with expertise in education, livelihoods /economic
strengthening, psychosocial, health/nutrition and legal issues, ensure that the service standards for OVC in
their sector are applied, and support local project staff and volunteers. Particular attention is given to
promoting gender equity and to OVC with special needs. Because there are no services for the many street
children in these urban areas, Samaritan's Purse will pilot transitional night shelters, with intensive six-
month interventions, in the two largest towns. To ensure rapid scale-up, the project will draw upon
Samaritan's Purse existing expertise and materials from its MET (Mobilize, Equip and Train) and Care
Group model programs.
Samaritan Purse builds on the capacity existing in the community leveraging additional services from.
Linkages will also be formed with educational, health care and legal protection resources in the community,
to ensure that OVC can access existing free services or be supported to gain access where there are
barriers. Local level offices of the Ministries of Education, Justice, Health and Women's Affairs will also be
engaged to ensure harmonization with their standards and services.
Because the project will rely heavily on existing but untapped resources as well as building the capacity of
the community and caregivers to provide for OVC, it will be sustainable after USAID funding ends.
Community mobilization and advocacy, which are integral parts of the work plan, will pave the way for a
smooth transition.
APS/Integrated Community Systems to Mitigate HIV/AIDS Impact on Children
This Annual Program Statement (APS) is restricted to programs that will strengthen and expand the
PEPFAR/Ethiopia Orphans and Vulnerable Children (OVC) program in underserved, urban areas with high
HIV prevalence. This activity will maintain partners' programs selected in 2007 and allow PEPFAR Ethiopia
to select additional partners in 2008. The Year One budget for FY08 will support three to five programs
ranging between $500,000 to $2,000,000 per year. The 2008 APS funding will cover the mortgage of
existing 2007 partners and allow PEPFAR Ethiopia to fund additional OVC activities.
Family and community-based responses must be strengthened to meet the age and developmental
appropriate needs of children. Family and community-based responses must ensure that OVC have a
genuine role in defining both their needs and the appropriate solutions. Increased linkages are needed
among OVC programs, child survival, food security, palliative care, and prevention programs. Additionally,
referrals must be strengthened between community-based OVC programs and health facility programs for
counseling and testing, integrated management of child illness (IMCI), ART, nutrition, and general health
services. Given the high rate of under age five child morbidity and mortality, OVC programs must expand
partnerships with child survival programs, especially to improve clinical support for the children made even
more vulnerable due to HIV/AIDS.
To address the above, PEPFAR Ethiopia will solicit applications from prospective partners to reinforce
family and community responses to providing quality, comprehensive, and coordinated care for children
affected by or living with HIV and their families. APS applicants will acknowledge existing service provision
to OVC and present strategies for addressing gaps in the areas of access to education and life skills, food
and nutrition, psychosocial support, economic strengthening, shelter, legal/protection, and referral to health
services (e.g., IMCI services, malaria treatment, immunization, HIV counseling and testing, palliative care,
ART). Achieving sustainable coordinated community care for OVC will include the application of service
standards and approaches to improving and assuring quality of care. APS recipients will need to support
community capacity building and mobilizing of local resources especially through community volunteers,
caregivers, family members, and local Ethiopian organizations. Increasing community linkages between
OVC programs and other PEPFAR and USG partners will be central to the new award. Technical
assistance will be needed to support local OVC programs in developing or improving referral systems to
and from health facilities, government services, and other community child services. Health facilities should
be able to refer HIV-affected OVC to community services supported or strengthened by APS recipients.
Community-based OVC programs under this APS will need to plan and budget in order to absorb the OVC
referred to them. An additional component of the APS will be supporting community data collection to
monitor progress in OVC wellbeing and using data to inform activity modifications. This may require
development and alignment of OVC partner indicators based on service standards and desired outcomes.
Community data management will support and feed into larger GOE efforts to monitor and report on
services to OVC. APS recipients will be expected to provide support to GOE to strengthen capacity in
monitoring information systems.
New partners selected under this APS will be able to utilize the existing tools and forms developed under
the PC3 Program. New partners will apply the Standards of Services for OVC in Ethiopia and PEPFAR's
OVC Programming Guidance, July 2006. New partners will also have access to technical assistance
through Population Council and EngenderHealth to incorporate strategies for addressing gender issues into
OVC programming. Preventing and mitigating impacts of gender-based violence and early marriage will be
emphasized. Achieving wraparounds will other sector activities will be demonstrated by APS recipients,
especially in the areas of food and education. APS recipients will partner with PEPFAR-supported clinical
partners to ensure linkages to health services, especially for HIV-exposed or infected infants and their
families.
During the first year of operation, activities under this APS will provide support to an estimated 250,000
OVC and their families, with an emphasis on filling gaps in provision of household support under PEPFAR.
An estimated 10,000 caregivers and other community members will be trained to provide OVC quality
coordinated care services. New partners will be required to develop sustainable community-based activities
with graduation strategies in place. Recipients will also be monitored to ensure that OVC and their families
are actively engaged in the programs.
Communities and Schools for Children Affected by HIV/AIDS (CASCAID)
ACTIVITY HAS BEEN MODIFIED AS FOLLOWS:
Systems to Mitigate HIV/AIDS Impact on Children of 2008. The request is to continue to fund.
Salesian Missions in partnership with Project Concern International will implement the CARING FOR OUR
YOUTH (CARING) Project in Ethiopia. The main activities will focus on mitigating the impact of HIV/AIDS in
Ethiopia by increasing access to youth orphaned or made vulnerable by HIV/AIDS, and providing holistic
care, community reintegration, and support for 60,000 orphans, street youth and children who have been
made vulnerable due to HIV/AIDS.
The Salesians of Don Bosco in Ethiopia (SDBE) and Project Concern international (PCI), along with their
implementing partners will work towards improving quality of life for children and youth made vulnerable by
HIV/AIDS and their families in Addis Ababa, Makele, Adigrat, Sway, and Debre Zeit, Ethiopia.
To achieve this, the CARING Project will:
1) Increase the number of services to OVC with essential needs for shelter and care by reintegrating OVC
with extended or foster families or their home communities, and by building the capacity of the SDBE
residential rehabilitation program for street children and youth;
2) Increase the number of OVC receiving formal and non-formal educational and development opportunities
by expanding SDBE capacity to provide opportunities for formal and supplementary education, life skills
workshops, and recreational and sports activities, and by providing assistance with school fees, uniforms,
and supplies to effectively reduce barriers to attending school;
3) Improve the economic status among households caring for OVC by providing older OVC with
opportunities for vocational/technical training, and by empowering OVC caretakers, especially women
through a savings-based economic self-help group approach;
4) Increase access to critical, community-based OVC support services, specifically health/medical care,
nutritional support, legal support, and psychosocial support through the CARING Small Grants Program for
local CBOs (Community Based Organizations) and FBOs (Faith Based Organizations) providing crucial
community-based OVC support services; and
5) Increase the practice of abstinence and faithfulness behaviors among targeted youth by training youth
animators and facilitating youth HIV prevention outreach events and workshops based on the successful
Salesians Mission Life Choices methodology.
The presence of Salesians of Don Bosco in Ethiopia in the target communities enables CARING Project
management to rapidly mobilize and launch start-up activities such as hiring support staff, conducting the
baseline survey, identifying and meeting with key stakeholders, and holding start-up workshops. While
implementing the CARING Small Grants Program (CSGP), PCI will provide intensive technical support and
capacity building in small grants management to SDBE in the first two years so that SDBE can assume this
responsibility by the third year of program implementation. This partnership will ensure proper capacity
building and grant management for small, local organizations.
Salesian Mission and Salesians of Don Bosco in partnership with Project Concern International (PCI)
developed the implementation of the CARING Project. Local professionals in Ethiopia staff this project.
The project utilizes the existing infrastructure of the Silesian's Project Development Office, the ongoing
orphans and vulnerable children programs, current and new social workers, youth animators, and
community volunteers. Project Development Office, along with various local partners, will be responsible for
day-to-day project implementation. Salesians of Don Bosco is also responsible for overall project
management and oversight. Salesian Mission's Office for International Programs will provide general
oversight, technical expertise, mechanism for coordination of financial disbursements, and continued local
capacity building to the Salesians of Don Bosco Ethiopia. PCI will provide additional technical advice
assisting Salesians of Don Bosco Ethiopia to strengthen its organizational capacity to incorporate
comprehensive OVC services. These services will strengthening the linkages with OVC services network, to
include adapting the Life Choices Curriculum (using model from South Africa) for the Ethiopian context, and
enhancing older OVC and their caretakers' economic options by implementing PCI's Self Help Groups
(SHG) "Step Up" program. SDBE will strengthen the OVC referral network; and provide overall M&E
support and capacity building for this effort.
Salesians of Don Bosco Ethiopia has a well-established presence in 13 communities across Ethiopia, and
serves over 50,000 youth through the Orphan Sponsorship and Reintegration Program; the Street Children
Rehabilitation Program in Addis Ababa; primary and secondary schools; youth centers; and technical
schools, including the Don Bosco Technical College in Makele. HIV/AIDS prevention education has been
incorporated into the general health education curriculum taught in Salesian schools, and Salesians of Don
Bosco Ethiopia continues to partner with the Catholic Secretariats at different dioceses to implement
HIV/AIDS prevention training activities.
In addition to its considerable in-country experience, Salesians of Don Bosco Ethiopia will draw upon
Salesian Mission experience implementing successful health programs in different settings that mainly
focus on youth, orphans, street youth and other vulnerable youth, in addition to targeting parents,
educators, and community leaders. These programs include: Love Matters, South Africa—2001; Courage
to Love, Peru—2002; and Life Choices, Kenya, Tanzania & South Africa—2005, which is a five-year
PEPFAR Track 1 ABY Program that targets youth with the core messages of abstinence (A) and
faithfulness (B) to prevent HIV infection.
Care Services for HIV-Infected and Affected Orphans and Vulnerable Children
Systems to Mitigate HIV/AIDS Impact on Children of 2008. The request is to continue to fund the
Partnership for Community Action to Support OVC (PICASO) will significantly contribute to that scale up of
OVC services to reach 60,000 children.
PICASO is a collaborative effort of international and local partners, including faith-based organizations
(FBOs) and community-based (CBOs) in a three-tier approach that builds on experience and expertise
developed over considerable time, making best use of resources available, while reaching the community
and family with a coordinated package of quality services. All PICASO partners have extensive experience
working with local communities and structures and will work directly as implementers of the program. Larger
organizations will sub-grant to CBOs in their specific geographical areas to mobilize communities, identify
the most vulnerable children and draw on community assets to respond to the needs of OVC and their
families. Pact will manage the overall grant and provide technical support and guidance to all partners
participating in the program. Larger PICASO implementing partners will play a specific role in capacity-
building, mentoring and technical support for both their partner CBOs as well as community structures in the
urban areas where they have greatest presence. This program will act as a flagship in the promotion and
implementation of Ethiopia's standards of care for OVCs. The program will draw upon the strong existing
presence of all PICASO partners to affect a quick-start response in urban areas with the highest number of
children affected by HIV/AIDS in Ethiopia. PICASO will operate in the urban areas of Addis Ababa, Oromia,
Amhara, SNNPR and Gambella. The project will utilize a specialized approach in the underserved localities
of Jinka, SNNPR and urban Gambella where HIV prevalence is particularly high.
Care in the community will be achieved through a child-centered, family-supported approach that
strategically places economic strengthening at the core and is best illustrated as 1 + 6 (economic
strengthening + six other essential services (psycho-social support, food and nutrition, education, health,
protection, and shelter and care). Local community committee leaders from kebeles, idirs and other
associations will identify children using their existing knowledge of families in their communities and through
a detailed assessment prepared by community volunteers of the needs of the families. Resources will be
used to provide more equitable and fair distribution of services and support to current and new families with
a focus on "family" support to reduce intra-family tensions and enhance the protection of children's rights.
The program will use a clear and strong model with the work of community volunteers at its core. Volunteers
are drawn from the relevant and most active existing formal and non-formal structures at community level.
Additional volunteers will be recruited in order to allow for the scale up of existing OVC programs managed
by partners and the reaching of more than double their current number of children.
Given current poverty levels among those affected by HIV /AIDS, the majority of families will require support
or referral in establishing activities that will strengthen their economic base. The PICASO emphasis on
economic strengthening is expected to enable the family to generate income needed to meet its own needs
in a relatively short period of time. This approach promotes the sustainability sought within the Ethiopia
Strategic Plan and offers families a way out of poverty and dependence. The income generation activities
(IGA) or small businesses started will be managed by a parent, guardian, older child, or by the whole family
working together, as appropriate. The specific type of economic strengthening activity will depend on the
family's own ideas, preferences and capabilities; the locally available resource base; the local market for
small business development and the particular experience and expertise of the partner organizations
involved. Pact and its local Ethiopian partners have extensive experience working with best practice models
on which the program can build. Savings and credit schemes, micro-financing and the formation of
cooperatives are just a few of the examples.
Finally, Pact will draw on its considerable capacity in the field of monitoring evaluation and reporting; data
collection and quality control; and data management systems for OVCs.
Pact's experience in Tanzania, Namibia and South Africa combined with its work in Ethiopia with HAPCO to
strengthen the Health Information Management System (HMIS) will be particularly relevant. NGO and
community partners will be supported to establish a system at community level for collecting, recording and
analyzing the data collected; contributing to the HMIS; and using the data to provide feedback at both the
community and national levels.
As members of the OVC network, PICASO partners will contribute to the growing knowledge, experience
and expertise on best practice models of community coordinated quality care for OVC in Ethiopia.
Care Services for HIV-Infected & Affected Orphans and Vulnerable Children
This project was selected as one of the winning 2008 Annual Program Statement, Integrated Community
Systems to Mitigate HIV/AIDS Impact on Children. The request is to continue to fund the Organization for
Social Services for AIDS (OSSA), which is an indigenous not-for-profit organization working on HIV/AIDS
prevention and control interventions in most parts of the country since 1989. In implementing community-
based projects, OSSA developed richer experiences to work with the grassroots communities and local
structure, using of the services of community volunteers to liaison the organization with the direct project
participants and the community at large.
The project activities are implemented in five regions and two City Administrations of Ethiopia: Oromia,
Amhara, Tigray, SNNPR, Harari, Dire Dawa and Addis Ababa. The direct beneficiaries of the project are
55,000 OVC and their families/guardians as well as 5,500 community volunteer services providers. The
community members of the 32-woredas/ sub cities/towns from where these OVC will be selected also
benefit from the various services of this project
OSSA in coordination with its existing partnership and networks with Community-Based Organizations
(CBOs), Faith-Based organizations (FBOs), kebeles, schools, health facilities, social courts, police offices,
women associations, and government line departments will efficiently integrated their work plan and
activities..
Moreover, OSSA will establish and strengthen steering committees, task forces, and PTA (Parent Teachers
Associations) at each of the project sites, and by employing the following strategies, OSSA hopes to
introduce the family-based approach to OVC infected with and affected by HIV/AIDS. These strategies
include: 1) Enlarge the community's role in supporting family-centred care through involving local
community members and structures; 2) Coordinate with projects such as WFP Urban HIV/AIDS projects,
government's productive safety net programme and micro finance institutions to improve the nutritional,
psychosocial, income, education, health needs families affected by HIV/AIDS; 3) Recruit and deploy
qualified staff stationed both at headquarter and branch offices with the responsibility for achieving the
expected results of the project; 4) Conduct, bi-annual technical review meetings among regional offices to
facilitate exchange of experiences, promising practices, and challenges and prepare annual joint plans; 5)
Support 51,000 children and adolescents infected or affected by the HIV/AIDS to continue their formal
education, life skills training, entrepreneurship and small-scale business management skills for Community
Self Saving Group (CSSG); and 6) train volunteer community based counsellors and guardians' club
members on counselling services on various HIV/AIDS issues for the targeted OVC and their families.
Stake Holders/ Sub partners:
This activity will link to different sectors (education, agriculture, town administrations, traditional community
structures and fait-based institutions).
Community Information Systems to support HIV/AIDS service delivery and referral service management
implemented beyond health facilities.
This is a new activity.
An identified gap in the PEPFAR Ethiopia program is the dearth of standardized information systems
implemented at the community level to support service delivery of non-clinical elements, adherence and
patient management and referrals. Funds are being reprogrammed from multiple activities in HBHC to
respond to fill the gap. A community information system will be collaboratively developed with the HIV/AIDS
Prevention and Control Office and other HIV/AIDS donors.
The system will complement the Health Management Information System (HMIS) and its partial roll-out. At
present the area of community information systems was not previously supported by PEPFAR.
The current tranche of funds will support framework design and implementation on a limited basis. A multi-
year program will support broad-based implementation in COP10 and COP11.
This program will support PEPFAR Ethiopia's ability to report accurately on community-based service
delivery of palliative care, HCT, ARV and TB adherence and OVC portions of the COP.
Table 3.3.17:
Strengthening the HIV/AIDS Component of the Health Extension Package
COP09 ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In FY2008 this activity provided direct support to the Ministry of Health to design and implement the initial
activities of the Urban Health Extension Program. In FY2009 this activity will leverage non-USG funds from
the Bill and Melinda Gates Foundation to support expansion of the Urban Health Extension Program. This
is a continuing activity with narrative changes as follows:
COP08 ACTIVITY WITH MINOR UPDATES:
This continuing activity from COP 2008 supports the MoH to expand health extension worker program into
more densely populated urban areas. The Urban-Health Extension Worker Program (UHEP) is an essential
component of the USAID PEPFAR portfolio response to family centered approaches to HIV/AIDS epidemic
in major cities and towns in Ethiopia. USAID/E will increase funding for this successful activity from
$600,000 in COP 2008 to $1,500,000 in COP 2009. Since 2008, the UHEP has been implemented in
partnership with the Bill and Melinda Gates Foundation leveraging a $14.7 million foundation resources to
implement "the Last 10k" health extension worker program in Ethiopia.
The organizing principle of the UHEP is provision of "household-centered" promotive, preventive, chronic
care and limited curative services with strong referral linkages to health facilities. Given that the health
center is the lowest level service delivery point in cities, Urban HEWs, nurses, will be placed at health
centers to bridge households, communities and clinical services in urban areas. The Urban HEWs will be
recruited from the pool of nurses that have already graduated from colleges (mainly private colleges) and
will be given three month refresher (emersion) training. The newly designed urban health system states
that each health center will serve 40,000 people with one Urban HEP serving 500 households and hence 16
urban HEWs placed within a Health Center. The Urban HEWs in the health center will be supervised by a
Health Officer. In terms of the expected role of the urban HEW, the newly designed system asserts that, as
in the case of the rural HEW, most of their time to be dedicated at household, community, workplace,
marketplace providing promotive, prevention and selected curative services.
This is a continuing activity from COP07.
This activity supports the Federal Ministry of Health's Health Extension Program (HEP) and represents a
bilateral capacity building activity between the Federal Ministry of Health and PEPFAR Ethiopia. This
activity leverages approximately seven million dollars in non-PEPFAR USG resources from the Health,
Population and Nutrition funding of USAID/Ethiopia.
The HEP, as indicated in the MOH's Health Sector Development Plan III (HSDP III) 2006-2010, will train
30,000 Health Extension Workers (HEW) for assignment in 15,000 rural wards where they will serve a
population of approximately 5,000 per ward. In addition, the MOH plans to deploy a similar formal cadre in
urban health offices. A total of 17,000 HEW were deployed to communities in most of the regions in the
country by June 2007. An additional 13,000 HEW are expected to be trained and deployed through 2010.
The HEW is the first point of contact to the community for the formal health care system. The HEW report to
public health officers at the health center and district health office and are responsible for a full range of
primary and preventive services to the community, including provision of basic communicable disease
prevention and control activities.
HEW function as a significant and new link in the referral system and will be able to, through community
counseling and mobilization, move vulnerable and underserved populations into the formal health system.
The HEW promotes essential interventions and services by encouraging community education and dialogue
around health issues, and participation at the community and household level in health care. During
COP07, HEW functioned as the lead at health posts and in the community to provide social mobilization
activities in HIV prevention.
HEW will provide preventive services to community members. This activity will continue to support pre-
service and in-service training of HEW in key HIV/AIDS messages and information, the provision of
counseling to community members on numerous issues such as stigma, symptomatic screening of patients
with opportunistic infections, including active TB, for referral to health facilities for further diagnostic work-up
and management, adherence counseling for ART and TB treatment. In addition, several models have been
developed to support HEW provision of PMTCT services and HCT services at the health post level. This will
continue to be expanded in appropriate areas. HEW are trained to facilitate the referral of clients to inpatient
facilities and to community care services.
Continuing Activity: 16641
16641 5768.08 U.S. Agency for Federal Ministry of 7486 5486.08 MOH-USAID $600,000
International Health, Ethiopia
10435 5768.07 U.S. Agency for Federal Ministry of 5486 5486.07 MOH-USAID $0
5768 5768.06 U.S. Agency for Federal Ministry of 3820 3820.06 $500,000
Table 3.3.18:
Development Credit Authority
This is a continuing activity. This activity has been refocused from leveraging commercial credit to health
providers to build incentives to offer HIV/AIDS services. In COP09 this activity will leverage commercial
credit to address micro credit and micro financing requirements of programs targeting vulnerable women
and HIV-impacted households in urban and peri-urban areas. This activity will improve access to income
and productive resources for women.
There is growing consensus among development and public-health practitioners on the need to bridge
medical treatment and care for families affected by HIV and AIDS with efforts to secure basic subsistence,
promote livelihoods, and increase investments in education and health. Families and households generally
serve as the front-line response to HIV and AIDS and shoulder much of the burden of the epidemic, such as
costly medical and funeral expenses, loss of productive labor or care for extended families. Access to
financial services can help families to cope with the economic repercussions of HIV and AIDS by preventing
the loss of their assets, diversifying their income streams and strengthening their longer term resilience to
crises. Access to financial services, however, is a major constraint for poor families in Ethiopia and
especially for households affected by HIV and AIDS.
Banks and microfinance institutions in Ethiopia face shortfalls in commercial credit and are restricted in their
ability to meet demand for financing. The Development Credit Authority (DCA) guarantee mechanism can
be instrumental in such a context to facilitate lending by financial institutions to poor families - who tend to
be harder hit with the financial impacts of the HIV/AIDS epidemic and are more vulnerable to contracting the
virus in the first place. The DCA's partial guarantee is a proven model to build capacity of the financial
sector and introduce incentives for local financial institutions to lend to communities that traditionally have
limited access to financial services. Given an HIV prevalence rate of over 6 percent, efforts to increase
broader access to financial services among the poor in Ethiopia can have a strong impact in supporting
households who are directly or indirectly affected by HIV and AIDS.
In FY 09, the activity will support the capital requirements for the implementation of a modest DCA between
the USG and two private banks and/or microfinance institutions to lend to poor communities. Banks will
consider taking deposits from households as a step to accessing financial services and building their
confidence to engage in productive enterprises. USAID/Ethiopia will also aim to leverage support from civil
society organizations and health-service providers to offer complementary health prevention information
with the delivery of financial services.
The PEPFAR contribution for FY 09 is valued at $500,000. Analysis by the USG identified that an Ethiopia-
based DCA would achieve a 12:1 leverage private capital ratio (i.e. a $1,000,000 DCA would enable the
banking sector to mobilize $12,000,000 in private non-USG resources to on-lend to poor target
communities, as agreed to by the USG and the bank participants). USAID/Ethiopia anticipates leveraging
funds from USAID/Ethiopia's BEAT Office in addition to the commercial credit leverage. Therefore for each
$1 PEPFAR provides under this activity there is $9 - $15 of non-PEPFAR funded resources.
Supporting Pre-Service Social Worker Training Institutions
This is a new activity responding to growing needs by PEPFAR Ethiopia to support Human Resources for
Health activities. This activity will provide USG support to pre-service social work education and training to
ensure persons living with HIV, those vulnerable to HIV infection and orphans and vulnerable children in
Ethiopia have better access to comprehensive social support services. There is a shortage of trained
professionals in Ethiopia and pre-service institutions have limited organizational or technical capacity to
adequately implement academic and professional programs in their current state of under finance.
Ethiopia adopted decentralized health management and prioritized human resources development with an
emphasis on the expansion of the number of frontline and middle level health cadres including social
workers with community based and task oriented training.
Production and retention of community oriented health cadres including social workers support Ethiopia's
growing population requiring public health services including chronic care. The use of social workers may
improve the accessibility and cost effectiveness of health care services by reaching potentially underserved
communities including those vulnerable to HIV infection and persons receiving HIV/AIDS services.
However, Ethiopia's this requires substantial support for training, management, supervision and logistics.
Addis Ababa University, until recently, was the only higher learning institution providing courses related to
applied sociology. Only 77 individuals have graduated from the school with a Masters in Social Work. In
2006, Addis Ababa University, in collaboration with the University of Illinois, initiated a three-year project to
develop a Doctorate program in Social Development. This innovative PhD program maintains 15 doctoral
students in social development. At present there is no undergraduate program producing bachelors level
graduates ready for social service work including social work in Ethiopia. In addition there is limited ability
for paraprofessionals to receive formal education in the area.
In response to this gap in cadre production the Addis Ababa University School of Social Work is finalizing
preparations to initiate an undergraduate program starting in 2008/2009 with a plan to enroll 50 annually
with the potential to scale this enrollment as the academic program matures. In addition Jimma University
is developing a bachelors program in social work in 2009/2010. Addis Ababa University is receiving
requests from the Government of Ethiopia and local non-governmental organizations to respond to the
shortage of social work cadres given the current absence of this cadre.
Addis Ababa University's newly established program, as any nascent academic program would experience,
has serious obstacles concerning instructors, infrastructure, educational materials and networking for
practicum attachments.
The upcoming implementation of this academic program offers several opportunities for the USG. By
engaging early in the development process the USG can upgrade educational formats and instructor skills
resulting in an immediate improvement in the skills of graduates. Given the strong commitment of the Addis
Ababa University to launch this program the USG is achieving a significant leveraging of domestic
expenditure against its technical assistance funds. The USG's network of international implementing
partners experience significant gaps in capacity in the areas of linking individuals to effective family and
community services for several reasons of which most significantly a lack of technical and management
capacity on the part of local social service organizations to adequately address the needs of orphans and
vulnerable children or persons living with HIV/AIDS.
PEPFAR Ethiopia proposes to solicit a multi-year competitive technical assistance program to support Addis
Ababa University and possibly other local institutions to assist in the development of the Bachelors in Social
Work programs with emphasis on addressing the needs of orphans and vulnerable children and persons
living with HIV/AIDS in the community. PEPFAR is well positioned to provide this support and to
immediately link current students and graduates into the broader network of urban-based prevention, care
and treatment services being provided to beneficiaries through attachment programs.
The initial strategic objectives of this program are noted below. These will be modified through the design
of a competitive solicitation.
Objective #1: To strengthen the institutional capacity of Ethiopian academic institutions to deliver quality pre
-service social work education, with an emphasis on increasing local capacity to delivery social and
psychosocial care services for PLWHA and OVC.
Objective #2: To strengthen the capacity of Ethiopian social work institutions to provide quality in-service
education to community workers and volunteers providing risk reduction or adherence counseling to at risk
populations, persons living with HIV and OVC.
Objective #3: To increase the capacity of social work students to respond to the needs of OVC through
domestic fellowships.
Objective #4: To expose faculty at Ethiopian institutions to different models of delivery of community social
work training.
In FY09, the major activities to meet these objectives are:
1 - Assess the needs of local social work institutions in strengthening instruction and evaluation of social
work programs to support multisectoral HIV/AIDS and other chronic care services
2 - Support pre-service training programs effectively conduct instruction through the instructor upgrading,
support to infrastructure such as educational materials and facilitating attachments to local USG-supported
civil society organizations.
This activity supports the development of effective cadres for addressing HIV/AIDS in Ethiopia where
constraints on the public health system ensure the majority of public health services are delivered outside of
health facilities by family members or through self-care. Ethiopia's current Human Resources for Health
plans, although incomplete and not officially released, do not address the multi-sectoral approaches
required for HIV/AIDS. Social Work and Community Service cadres beyond government employed Health
Activity Narrative: Extension Workers are not adequately addressed by the Ministry of Health's plans to produce thousands of
health science professions. Therefore it is critical for the USG to invest in important cadres not currently
receiving support by the Ministry of Health or other bilateral donors to strengthen the capacity of Ethiopia's
civil society to deliver critical social services.
Estimated amount of funding that is planned for Human Capacity Development $476,250
Supporting Human Resource Development of Health Officers and Clinical Nurses
This is a new activity in COP09.
This activity will leverage approximately $1,500,000 in non-PEPFAR funds from the Presidential Malaria
Initiative and Office of Health annually to address the critical pre-service requirements nursing training
programs at national and private nursing colleges. These human capacity interventions are designed to
train the Ethiopian workforce to sustain the expanded HIV/AIDS program.
Ethiopia has widely adopted task shifting activities which has led nurses to be heavily involved in performing
HIV/AIDS services in addition to their rotations at primary and tertiary health facilities. PEPFAR continues
to support ongoing in-service training to address PMTCT, HCT, STI, TB/HIV and ART services. In addition
there are dramatic retention issues of experienced clinical nurses in Ethiopia's public and private health
system. Many teaching institutions face under-resourced infrastructure, variable quality of teaching with few
classroom instructors prepared to educate, and few clinical instructors and sites available for clinical skills
practice. Graduates often must do much of their learning on-the-job during their rotations, under limited
supervision.
Objective #1: To strengthen the institutional capacity of Ethiopian academic institutions to deliver quality a
broad pre-service nursing education whilst specifically integrating HIV, TB and Malaria modules originating
from national and international guidelines.
Objective #2: To strengthen the capacity of Ethiopian nursing institutions to provide quality in-service
education to clinical nurses on outreach activities to adequately serve at risk populations, persons living with
HIV and OVC.
Objective #3: To increase the capacity of nursing students to respond to the broad needs of persons living
with HIV/AIDS, with emphasis on reproductive health, TB and Malaria co-infection through domestic
fellowships and placements.
Objective #4: To expose faculty at Ethiopian institutions to different models of delivery of nurse training.
The activity, depending on the allocated budget, will support multiple public institutions alongside selected
private institutions that produce large volumes of nursing graduates that lead into careers in the public
health system. The activity will provide equipment and personnel grants to improve the quality of teaching
institutions alongside supporting curriculum adaptation.
Build upon the transition from Carter Center's program to strengthen instruction and evaluation of clinical
health officer programs to support multisectoral HIV/AIDS and other chronic care services
Support pre-service training programs effectively conduct instruction with the donation of basic materials to
strengthen training.
Provide technical and financial support to local institutions for upgrading infrastructure, instruction and
materials
Monitor and evaluate the progress in the implementation of the health officers and clinical nursing
education/training programs
Quality Assurance Program
This activity addressing ongoing issues related to health facility efficiency and quality of care provided to
HIV/AIDS clients. In many health facilities a growing queue of HIV positive clients eligible for ART threatens
the ability to effectively maintain and grow the national ART program.
This activity will bring experiences from other PEPFAR focus countries to address efficiency and quality of
care through the use of treatment and care collaboratives with health workers at key health facilities having
a large population of ART and pre-ART clients.
The Improvement Collaborative approach, adapted from the Institute of Healthcare Improvement in the
U.S., integrates many of the basic elements of traditional health programming (standards, training, job aids,
inputs) with classic QI elements (team work, process examination, monitoring of results, client satisfaction),
resulting in a dynamic modern QI approach in which multiple teams from different sites work together
intensively to share and rapidly scale up strategies for improving quality and efficiency of health services in
a targeted technical area. It empowers local participants to reflect, test, and measure realistic solutions to
their local health care problems that can in turn be shared with fellow collaborative participants and Ministry
of Health (MOH) officials for scale-up. All collaborative activities emphasize developing capacity for basic
quality improvement at the local level with a focus on team-building skills for continuous improvement
through monitoring and analysis of shared indicators. Since local actors themselves develop local solutions,
their ownership of innovative solutions is higher, increasing the likelihood of sustainability and spread to
other sites.
This approach brings systems thinking, a focus on sustainability, understanding the determinants to scale
up and maintaining a focus on equity and inclusion of health providers, administrators and clients.
Assistance to the Network of Ethiopian Womens Associations
organization of women's associations in Ethiopia. NEWA does not currently receiving PEPFAR Ethiopia
(CSOs and NGOs). Its goal includes synchronizing individual activities of women associations into an
vigorous campaign, advocacy and lobbying for women's rights. It is engaged in capacity building through
training and funding of its members secured from international and bilateral organizations. The majority of
its members work exclusively on gender issues which are also the USAID's priority areas identified in
PEPFAR program as gender related drivers of the epidemic of HIV/AIDS. These include:
Human and reproductive rights of women
Gender based violence
Female genital mutilation (FGM)
Various Income generation activities for commercial sex workers in many regions
HIV/AIDS clinical services and family planning
Early marriage
assistance through an international NGO grant management facility to NEWA and its members in policy and
advocacy, organizational capacity development interventions and technical assistance in mainstreaming
gender initiatives in the US government's diverse PEPFAR program with the support of existing
implementing partners. NEWA will receive activity, equipment and personnel grants to engage the Ministry
of Health/HAPCO, USG implementing partners and other bilateral donors.
In FY08, this activity will provide technical assistance to implement a Development Credit Authority (DCA)
between the USG and two private banks. This DCA will facilitate private financing of private-sector activities
valued at $500,000 in PEPFAR resources, for a total DCA of $850,000 of USG resources. The DCA
mechanism will support the financing of private hospitals, higher clinics, and private health colleges to
expand capacity to address private-service delivery of HIV/AIDS and TB services and human resource
development of health officers, nurses, laboratory technologists, and pharmacist technicians. Analysis by
the USG identified that an Ethiopia-based DCA would achieve a 12:1 leverage of private capital (i.e., a
$1,000,000 DCA would enable the banking sector to mobilize $12,000,000 in private non-USG resources to
use for financing private-sector health projects as agreed to by the USG and the bank participants). The
DCA is a proven model to expand private-sector capacity through increased financing opportunities and will
provide tangible incentives to expand sustainable HIV/AIDS programs, including ART services at hospitals
and higher clinics throughout Ethiopia. Funds for the DCA were incorrectly assigned to Abt Associates and
are being reprogrammed in Apr'08 to a USAID mechanism.
Based on these findings, PEPFAR Ethiopia believes that, by engaging the private health sector we have the
opportunity to shape the development of the sector to deliver public health services including HIV
counseling and testing, TB diagnosis and treatment, and ART. Interventions to provide business training to
private providers and work with financial institutions to expand health sector lending will greatly strengthen
HIV/AIDS service delivery in the private sector. The USG assessment recommends that the DCA address
the health sector by providing approximately $15 million to assist banks to enter the healthcare market. The
DCA funds will reduce risk and addresse some of the banks' collateral constraints. The Office of
Development Credit estimates that the total subsidy cost of a $15 million guarantee would range from
$1,798,500 to $1,818,000.
This activity will provide the MOH and several RHB with technical support to identify and address the gaps
and obstacles in policy and requirements which may limit the willingness and ability of the private sector to
provide TB or HIV services. This activity will provide support to the overall strategy to decentralize HIV/AIDS
services in urban and peri-urban areas and further multiply entry points for HIV/AIDS care and treatment by
utilizing private-sector clinics.
This activity is linked to activities addressing private-sector providers, including hospitals, higher and
medium clinics, laboratories, and pharmacies. In addition, there is a link between the technical assistance
being provided through "training" partners who are addressing pre-service curriculum adaptation and private
health colleges.
The activity will reach a range of stakeholders in the private sector, including private healthcare providers,
professional associations (e.g., the Medical Association of Physicians in Private Practice-Ethiopia),
business leaders, private-sector medical schools, and training institutes. Strategies to reach these different
groups vary depending on the stakeholder. The primary strategy to reach these stakeholders will be the
creation and facilitation of a working group focusing on private-sector issues related to the provision of
HIV/AIDS and TB services (quality improvement, training, access to commodities, data reporting, financing
mechanisms, etc).
The activity will provide in-service training to host-country government workers and health providers. The
training will focus on policy advocacy and policy experiences with private-sector health service delivery.
This activity will address workplaces by analyzing existing financing mechanisms used for HIV/AIDS
prevention, care, and treatment activities at those sites.
The public-private partnership component of this activity will leverage approximately $10,002,000 in private,
non-USG resources. Furthermore, this activity will receive funding from the USG's non-PEPFAR bilateral
TB and population and reproductive health programs.
Continuing Activity: 21855
21855 21855.08 U.S. Agency for US Agency for 7594 7594.08 Central $900,000
International International Commodities
Development Development Procurement
HIV/AIDS Costing Activity to support to the PEPFAR Ethiopia.
Activities will support a synthesis of current models on HIV/AIDS service and product costing to support
COP10 development.
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $17,995,493
Program Area Narrative:
PEPFAR Ethiopia achieved most of the desired results, benchmarks, and deliverables in FY 2008. Our operating structure,
including the Executive Council, PEPFAR Ethiopia Coordinator's Office, Collaborative Team, Technical Working Groups, and
agency management were described in detail in the FY 2008 COP submission. Achievements, structural changes, and
challenges for FY 2009 are as follows:
PEPFAR Ethiopia Coordinator's Office (PECO)
oRecent progress has been made in staffing PECO. The SI liaison and program support assistant positions have been filled.
Though the coordinator's position has been vacant for the last year, a candidate has been selected and is in the clearance
process.
oOur COP includes nearly 400 activity narratives. Managing the COP09 development and submission process required a
dedicated special task force, imposing significant responsibility on program staff. Based on this experience, the Ethiopia team
approved the addition of a COP coordinator for PECO. The incumbent will be responsible for coordination of all aspects of the
COP.
Technical Working Groups (TWGs)
oThe TWGs remain a key part of the Ethiopia structure. New TWGs have been proposed for some areas such as OVC,
Laboratory, and Human Resources for Health. A Laboratory TWG has been piloted. The EC will soon make a final decision on
this and other proposed TWGs.
Agency Management: Changes in Key Positions
oHHS/CDC has assigned Dr. Thomas Kenyon to Ethiopia as the Country Director/Chief of Party.
oPeace Corps has selected Ms. Nwando Diallo as the new Director for the Ethiopia Office. She is expected to report in January.
oDoD has selected a new Program Manager, Tesfaye Teka, who will manage the Department's PEPFAR portfolio. Mr. Teka will
also serve on the Collaborative Team and the Prevention TWG.
oUSAID assigned Ms. Meri Sinnitt as the Health Team Lead. The Health Team includes HIV/AIDS, malaria, and other priority
health issues.
oHHS/CDC is reclassifying the TB/HIV position as an Associate Director for Prevention. This decision is based on an assessment
of current priorities.
Action Cable on Interagency Coordination, Best Practices, and Lessons Learned through PEPFAR and PMI Phase I
What makes the interagency process work?
a.There is strong ambassadorial support for PEPFAR in Ethiopia. The Ambassador and DCM are fully engaged.
b.We have a well-defined operating structure. Management and oversight occur through a tiered interagency structure,
composed of TWGs, a Collaborative Team, the Coordinator's Office (representing the DCM and Ambassador), and the Executive
Council. Terms of Reference or tier descriptions have been developed for each level. Decisions are usually made by consensus.
An alternate method seldom used is a majority vote. And on occasion, unilateral decisions are made by the Ambassador. DoD,
DoS, HHS/CDC, Peace Corps, and USAID are the participating USG agencies represented at post.
c.We have accepted that there are cultural and administrative differences among the agencies represented at post. USAID and
CDC management officials met to discuss some differences that have been raised by program staff. The management officials
clearly understood and appreciated the differences. They were helpful in explaining the differences to program staff, emphasizing
that neither approach was wrong.
d.The TWGs are critical to the success our program. Members are USG employees. They conduct joint reviews of
implementation plans, participate in monitoring visits and identify and address programmatic gaps collaboratively. When
appropriate, the TWGs make technical decisions and recommendations for consideration by the Collaborative Team. The TWG
chair positions are designated to specific USG agencies as follows: Prevention - USAID; Care and Support - USAID; Treatment
- CDC; SI - CDC; OPSS - USAID and CDC, and PD - DoS.
e.The Management TWG has not been stabilized. During FY 2009, EC will make a decision on the role of this TWG. Leading the
Staffing for Results initiative may be assigned to this group.
Obstacles and efforts to resolve them:
a.We capitalized on agency core strengths in several areas. For example, the Ethiopia team relies on the expertise within USAID
to lead activities related to orphans and vulnerable children. CDC serves as the lead for laboratory science. PRM works
effectively with refugees. Peace Corps is effective at mobilizing communities at the grass roots level. And DoD has excellent
relations with the uniformed services and uses those relations to move our PEPFAR agenda forward.
b.We have the opportunity to further capitalize on agency strengths to reduce redundancy. There are areas where we have
similar activities being managed by different agencies and their partners. This is primarily due to the fact that we did not capitalize
on core strengths early in the development of our program. We could benefit by designating agency leads by technical area. This
does not mean that one agency would be responsible for all activities or funding in a particular area. A designated lead would be
responsible for developing the strategy for a program area, identifying the appropriate agency (based on core strengths) to
address various components of the strategy, and obtaining interagency support for the overall programmatic strategy, including
leadership for the various components. Different agencies would be responsible for implementing complementary activities rather
than duplicative activities.
c.This approach can also improve our ability to speak and act as "one USG." Based on the agency leadership designations,
spokespersons would be readily identified. The programmatic leads or any other spokesperson would use the approved program
strategy to address inquiries about USG programming.
d.One of the roadblocks to successful implementation of the agency core strengths approach is the tendency for agencies to
focus on having a sufficiently large or even equal "piece of the action/funding" for any new initiative rather than on identifying the
best agency to take the initiative forward. Usually, when new funds become available, they are divided equally between relevant
agencies rather than risk conflict. We need to do a better job on thinking strategically and anticipate progress in this regard.
We recognize the advantages of the agency core strengths approach. After receiving the final OGAC recommendations in this
area, the Executive Council will make specific recommendations for the Ambassador's approval.
PMI and PEPFAR
Malaria and HIV are two important health issues in Ethiopia. While biologic interactions between the two are recognized, there are
still untapped opportunities for synergies. In COP 08, PEPFAR/Ethiopia began collaborating with the President's Malaria Initiative
(PMI) in the areas of laboratory support, training of health professionals, pharmaceutical systems and communication/behavior
change:
a.Laboratory support: To date, most of the laboratory strengthening in Ethiopia has been supported by PEPFAR and GFATM HIV
grants. PMI will build upon the existing structures and mechanisms, developed and established through PEPFAR and GFATM,
support to expand these to include malaria diagnosis. Thus, a previous PEPFAR partner is going to lead the implementation of
malaria laboratory activities under a new PMI award, using many of the systems (e.g. training modules, supervisory checklists,
staff, and equipment) established for the HIV/AIDS activities. Additionally, it is envisaged that, these laboratory activities will also
include USAID/E funding for tuberculosis diagnosis and laboratory strengthening. Such coordination prevents duplication of
systems, materials and fragmentation of laboratory services to support vertical program activities as well as maximize the USG's
investments.
b.Pre-/in-service training: Currently pre- and in-service trainings in Ethiopia are implemented on an ad hoc basis, depending on
programmatic needs and available funding. It is anticipated that training will be integrated addressing the training needs of all
health teams of USAID/E. This will strengthen service delivery by providing trainees with a comprehensive platform of theoretical
and practical knowledge as well as standardize systems and approaches (e.g. training modules for trainees and trainers).
c.Pharmaceutical systems strengthening: PEPFAR supports the development of the country-wide PLMP as well as several
activities strengthening procurement, delivery, storage, dispensary and tracking of HIV and non-HIV drugs. PMI will build upon
these activities, by adding anti-malarial drugs to the scope of work of these activities, enabling tracking of anti-malarial drugs
within the existing system. Again, this will ensure that past, current and future USG investments are maximized and that existing
mechanisms and approaches are not duplicated.
d.IEC/BCC: In collaboration with PEPFAR, PMI supports information education communication / behavior change communication
(IEC/BCC) and mass-media campaigns that include HIV/AIDS and malaria-related interventions. Both PMI and PEPFAR plan to
have IEC/BCC activities that achieve synergy between the programs to increase preventive interventions using a range of
different community- and non-community-based approaches. Through PEPFAR support, community-based IEC/BCC
interventions developed through PMI will be used by the implementing partner to increase ANC attendance as well as
ANC/prevention-of-mother-to-child transmission of HIV service delivery.
e.One of the challenges of integrating PMI and PEPFAR is that PMI targets persons under the age of five years; PEPFAR
prevention efforts generally target persons above five years of age. Also, PMI is limited to one region of the country, while
PEPFAR programming is throughout the country.
Staffing for Results (SfR)
a.Early challenges in the implementation of SfR were addressed through better communication and collaboration among USG
agencies and technical assistance from OGAC.
b.The PEPFAR Ethiopia team shares expertise across USG agencies. The sharing of expertise happens everyday within the
TWGs. In FY 2008, the Ethiopia team started having technical experts review solicitations across agencies and having agency
representation on technical review panels when possible.
c.The primary remaining challenge faced in implementation is the absence of a coordinator and designated management group to
lead this initiative. The new coordinator reports in January. A priority for the EC in FY 2009 is to identify an interagency
management group dedicated to SfR. This group will report to the EC. The group will be responsible for engaging agency
headquarters and experts in refining the Ethiopia SfR process. They will also address LES staff development at a broader
interagency level, submitting an interagency plan for consideration in FY 2010.
d.The FSN compensation package remains a challenge. Continued advocacy from OGAC and the US Mission in Ethiopia to
improve the FSN compensation package to retain and recruit local professionals is needed.
e.Though there is a commitment to SfR by the Ambassador and the DCM, there does not seem to be a consistent commitment
from all agency leadership. The commitment to an interagency approach must be top down.
Remaining unresolved issues
a.The TWGs tend to encounter conflict 1. when the established structure is by-passed, 2. by focusing on partners and funding
rather than thinking strategically to address program gaps and needs through PEPFAR and 3. when agency rather than "one
USG" agendas are pursued at the TWG level. As a result, the TWGs are often unable to resolve conflict within the groups. As we
strive to strengthen our TWGs, attention must be given to orienting them on processes for problem solving and conflict resolution
skills. Effective meeting and leadership skills are other skills development areas for TWG chairs.
b.TWG membership becomes an issue when COP decisions are being made. New members are added to TWGs during that
time. After COP decisions have been finalized, they no longer attend meetings. This is an issue that can be addressed in the
ToRs for the TWGs.
c.Though we have made progress, improved communication and appreciation of varied organizational cultures among USG
agencies at post remains a challenge. The EC is considering various team building opportunities to address this issue. Options
discussed range from a team building retreat to having staff shadow counterparts in other agencies. We will know that we have
been successful in this area when each agency trusts the other to represent USG at various meetings rather than requiring all
agencies (at least USAID and CDC) to be represented.
d.One of the more difficult challenges we face is budget allocation. A priority for the new coordinator will be to assess strategies
used by other programs and make recommendations to the EC. We also need to reorient the entire PEPFAR team's focus away
from budget lines to a more strategic approach.
e.Agency specific evaluation and promotion criteria that involve the size of the budget or workforce managed may also impact
interagency tensions. This should be reviewed at the agencies' headquarters' level.
f.The host government is only involved in the periphery of PEPFAR program planning. PEPFAR supports the host government
plans. Our COP process includes minimal discussions with the host government up front and a presentation to them after it is
completed, leaving little opportunity for their input during the process. More effort to obtain significant input from the host
government upfront may result in a plan that is more supportive of their needs and requires fewer adjustments and emerging
requests during implementation. The host government should have more input in our decision making, while maintaining our
authority.
g.Agency leadership needs to be more engaged. It appears that PEPFAR is not a high priority for some agencies. This is evident
by the fact that some members do not attend meetings regularly and others have designated agency representation to less senior
staff. This impacts SfR, as well as other PEPFAR processes.
h.The host government often goes directly to USG implementing partners to request support for new initiatives. Though we have
emphasized the importance of government to government communications with regards to new requirements, this continues to
happen, placing our partners in a compromising position.
Concerns/ challenges related to funding increases under the reauthorization bill
a.Deliberate efforts to determine strategic priorities;
b.Identifying what approaches are needed;
c.Assessing where additional funding is needed based on the priorities and approaches required
Table 3.3.19:
