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
Targeted Promotion and Community Mobilization for Antenatal Care
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Substantive changes were made in the COP 08 narrative and are as follows: C-Change, through its prime
AED, and core partners CARE, Internews, and the University of Washington's I-TECH, will provide support
to the Federal Ministry of Health with the design and implementation of high impact communication
strategies. The goal is to integrate mass media, interpersonal communication, and community engagement
to empower Ethiopian families to take malaria-related and ANC/MNCH actions that will improve their health
status. C-Change will streamline formative research and pre-testing methods, and create easy-touse, front-
line teaching tools and short skills-based training that can be managed by woreda and kebele level teams.
It will strengthen the capacity of regional, woreda, and kebele structures to create sustainable, cost-effective
interventions that resonate with the key audiences. Key objectives, include:
• Establishing a culture for long lasting insecticidal (LLIN) net culture, including increased demand for LLINs,
increased LLIN ownership and correct and consistent use, especially among the most vulnerable groups:
children under age five and pregnant women.
• Increasing community awareness about the effectiveness of indoor residual spraying (IRS) and facilitate
reduced replastering.
• Improving treatment-seeking behavior (e.g., timeliness, appropriateness).
• Increasing community knowledge regarding malaria diagnosis, treatment, prevention, and control.
• Integrating HIV/AIDS programming with the activities of the President's Malaria Initiative in Ethiopia to
boost antenatal care visits and enroll women in PMTCT services in Amhara and Oromia.
All activities will follow five cross-cutting communication strategies:
Strategy 1: Use research to inform strategy development and programmatic design. Strategy 2: Strengthen
interpersonal communication at the service delivery level. Continue work with UNICEF, the FMOH, and
other partners to fill gaps and ensure all technical information can easily be communicated via a system of
technical job aids. Strategy 3: Actively engage the community. Draw from ongoing programs to design a
methodology and reporting system that facilitates rapid scale-up and allows community leaders to take
ownership. Strategy 4: Use mass media to catalyze, change, and unify programs. Develop a strategic
media mix that uses radio to promote essential actions to families and reinforces success in all aspects of
malaria control and ANC/MNCH. Strategy 5: Strengthen capacity in communication. This will include
mapping with each regional partner an explicit BCC capacity-building strategy that emphasizes on-the-job
training and establishment of a mentoring relationship at all levels.
A Micro-Planning Workshop will be carried out in the first quarter, C-Change will conduct preparatory
meetings with partners to assess the scope of current malaria-related activities, review BCC tools, and
discuss priority communication needs. An important outcome of the Micro-Planning Workshop will be a
revitalized, active BCC Task Force for Malaria that will be managed jointly by the HEC with technical
support from C-Change. Given the urgent need for strengthened communication for PMI and ANC/MNCH
activities, C-Change will work through the task force to jump-start activities by leveraging on-going
programs. If there are important gaps in partners' overall understanding of the malaria-related behaviors
and determinants, C-Change will draw up a priority list of research questions and ensure that a rapid
qualitative survey is carried out. Once the results of the qualitative research are available, C-Change will
organize a follow-on Communication Strategy Design Workshop that will tie together the five core strategies
into one cohesive, comprehensive plan. C-Change will guide the development and production of
communication tools and materials, a flexible community-based approach, and a mass-media component
that includes radio spots and programs that capture and reinforce the success of ongoing efforts. The
programs will be rolled out in 20 highly malarious woredas and at least 20 schools. Other community-based
initiatives will be taken as appropriate.
The overall approach will be to strengthen local networks of organizations, including the private
sector/workplaces, schools, faith-based organizations, and other community-based organizations, while
closely collaborating with the FMOH and the RHB. C-Change will focus on a skills-based competency
approach and will devolve technical and management support roles to key partners over the life of the
project. To help catalyze networks and community-based activity, C-Change will institute a small grants
program. Grants will range from large awards to regional networks, such as faith-based initiatives, to small
awards given to local organizations with innovative ideas.
AED, as C-Change lead, will build on its extensive global and Ethiopian experience in BCC for health
including malaria to provide the overall strategic vision, lead the development and implementation of the
communication strategy, and spearhead capacity-building at all levels. AED also will apply its expertise in
creating assessment and monitoring and evaluation tools specifically for malaria. CARE has experience in
Oromia where it is implementing projects in East Shoa. CARE will manage implementation of the
community-based program in approximately five East Shoa woredas, and manage the small grants program
in the three remaining zones. CARE will collaborate closely and guide the NGOs, CBOs, and FBOs during
the entire grants process, including technical review, approval, and preparations for activity launch.
Internews through its technical trainings and workshops will improve capacity of the local journalists in
understanding and reporting on malaria prevention and treatment, and lead to increased health awareness
and health-seeking behaviors among the Ethiopian population, especially among vulnerable groups. I-
TECH will provide technical support for curriculum development for capacity-building modules on BCC for
malaria and PMTCT for health workers, building on their extensive experience training FMOH health
workers.
To measure the impact of the communication strategy, C-Change will undertake a baseline assessment and
establish indicators for all areas, and then repeat a rapid assessment annually to determine which
intervention or mix of interventions is achieving the desired change most rapidly. C-Change will make mid-
course corrections based on the survey
Activity Narrative: COP08 ACTIVITY NARRATIVE
This is a continuing activity from FY07. This program is a wraparound activity with the Presidential Malaria
Initiative (PMI) to mobilize women to attend antenatal care (ANC) in support of joint goals, enrollment in
ANC/PMTCT services, and provision of a long-lasting insecticide-treated net. The activity will leverage
$900,000 in PMI funding. This activity is implemented in urban and peri-urban areas of Amhara and
Oromiya. This activity reaches women ages 15-45 years old.
Ethiopia's 2005 Demographic and Health Survey found that low ANC attendance and assisted delivery
remain major impediments to progress on PMTCT targets. Fifty-six percent of urban women delivered in
their homes, and 30% of urban women did not receive delivery assistance from a health provider or
traditional birthing attendant. Women who attend ANC are on average 4.2 months along in their pregnancy.
Eighty-eight percent of urban-based pregnant women expressed several factors affecting their decision to
attend ANC or assisted delivery:
1) Concern there may not be a health provider (71%)
2) Concern there may be no one to complete household chores (57%)
3) Getting money for treatment (53%)
The goal of this activity is to increase total ANC enrollment through interpersonal and interactive
communications. As total ANC enrollment increases, the number of unique pregnant women using PMTCT
services will increase throughout selected hospitals and health centers in Amhara and Oromiya. In FY07,
the activity operated in 55 hospitals, health centers, and nongovernmental organization (NGO) clinics in
Amhara and Oromiya regions where the USG has installed PMTCT and ART services.
The activity's objective is to reach pregnant women in communities through interpersonal and mass media
campaigns promoting routine ANC attendance. Mass media activities are in the form of interactive radio
dramas which are coupled with discussion papers distributed to community groups. Interpersonal
approaches focus on community groups where women congregate.
Using USG partner's pre-existing communications platform regarding ANC attendance (i.e., umbrella media
campaigns, low-level road shows, interactive attendance at community group meetings, and household-
level promotion) in regional capitals and towns, the activity will promote ANC attendance and assisted
delivery.
The activity focuses on reaching households and community groups where women congregate in
communities where HIV prevalence remains highest, yet where ANC attendance and assisted delivery
statistics are low. It is anticipated that 50% of Amhara and Oromiya's urban population will be covered. If
this leads to an additional 20% of pregnant women attending ANC or assisted delivery within the health
network, public facilities would increase ANC attendance by approximately 24,600 pregnant women.
Since 2004, NetMark has used USG Malaria funding for communications campaigns to increase knowledge
about and use of insecticide-treated nets (ITN). In addition, NetMark participated in several activities with
the Ethiopian Ministry of Health (MOH) and Amhara regional health bureau (RHB) to improve maternal and
child health (MCH) uptake through targeted subsidy of ITN. NetMark facilitated, through a public private
partnership, several commercial distributors to import, brand, and distribute ITN to improve accessibility.
NetMark provided extensive support to the Amhara and Oromiya RHB and the MOH's Health Education
Center to improve communication materials on ANC attendance and ITN use.
PEPFAR Ethiopia's investment in this activity represents a leveraging of USAID's child survival/malaria
resources. NetMark's activities use interactive and interpersonal communications at the grassroots to
increase demand for ANC services among adult women. Mass media, interactive and interpersonal
communications is anticipated to increase patient flow at ANC clinics.
NetMark's first program component includes targeted promotion through a focus on social organizations,
women's groups, and community-based organizations with household-level activities and interactive
community activities, including road shows. The proposed targeted promotion activity aims to increase
uptake of facility-based maternal health services, which would increase PMTCT service uptake. Targeted
promotion activities reach women and families, educate communities, and improve understanding of
maternal health services, by emphasizing the advantages of ANC and assisted delivery
(ANC/PMTCT/pediatric care services including treatment).
To support this component the following strategies will be used:
1) Leverage existing messages through a multichannel, comprehensive program using mass-media road
shows and community-level and household-level communications to mobilize ANC attendance in/around
selected hospitals and health centers in Oromiya and Amhara
2) Mobilize marketing agents in the community to participate in the communications campaign to increase
ANC service uptake (e.g., district action committees, ward action committees, community malaria agents,
community-based reproductive health agents, health promoters, and traditional birthing attendants)
3) Emphasize household-level and interpersonal communication, dramas, community groups/meetings,
community activations, social mobilization and ANC counseling at health centers. This will also include
training and educational materials for the various expected audiences.
NetMark's second program component includes the targeted subsidy of ITN to ANC attendees. This
component, funded by the PMI, provides a targeted subsidy to ANC attendees to obtain a commercial ITN
product in the nearby community. This is completed through a voucher system distributed by the ANC
provider to pregnant women during routine health-education counseling which includes malaria
transmission and HIV prevention. This is supported by non-PEPFAR resources. To support this component,
ANC providers and commercial sales agents require training, distribution of information-education-
communication (IEC) materials and subsidy vouchers to ANC clinics.
Activity Narrative: In coordination with regional authorities, this activity will target outreach campaigns that promote services to
audiences in peri-urban areas. The partner will coordinate with USG implementing partners to address
capacity issues within ANC clinics and to prepare for increases in ANC attendance. The partner will
collaborate with IntraHealth and US universities to increase the number of women entering the ANC
system.
This activity contributes to the PMTCT program area by providing targeted mass media, interactive and
interpersonal communications campaigns to increase ANC attendance. The use of structured
communication campaigns to attend ANC services in facilities will target urban and peri-urban areas where
HIV prevalence is high. The outcome of this activity is expected to increase the total number of pregnant
women attending ANC services, including PMTCT, in Amhara and Oromiya. This program does not provide
PMTCT services such as the provision of HIV counseling or testing or ART prophylaxis to clients.
This activity is linked to implementing partners providing clinical PMTCT services at the hospital, health-
center, and health-post/community level.
This activity leverages PMI funding for ITN utilization and ITN distribution to vulnerable populations through
ANC service clinics at hospitals and health centers.
New/Continuing Activity: Continuing Activity
Continuing Activity: 18539
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18539 6632.08 U.S. Agency for Academy for 7590 7590.08 Presidential $340,000
International Educational Malaria Initiative
Development Development Wraparound
10569 6632.07 U.S. Agency for Academy for 5542 4135.07 Academy for $300,000
International Educational Educational
Development Development Development/FA
NTA
6632 6632.06 U.S. Agency for Academy for 4135 4135.06 Academy for $300,000
Development Development Development/Ne
tmark
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $200,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Food and Nets for OVC
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
This is a continuing activity from FY08 which will receive OVC funding in FY09 in order to expand the focus
of the project's behavior change communication program. In addition to raising awareness of PMTCT and
ANC services, as noted in the below narrative, this activity will also work to increase the community's
awareness of OVC issues and how they can help support needy children from their towns. Through mass
media and local mobilization efforts, this activity will help community members better understand the
challenges facing orphaned and vulnerable children. It will aim to motivate and link communities to the tools,
resources and organizations working to help OVC.
COP08 Narrative:
C-Change, through its prime AED, and core partners CARE, Inter-news, and the University of Washington's
I-TECH, will provide support to the Federal Ministry of Health by bringing a mix of skills, experience, and
creativity to the design and implementation of high impact communication strategies. Our goal is to integrate
mass media, interpersonal communication, and community engagement to empower Ethiopian families to
take malaria-related and ANC/MNCH actions that will improve their health status. C-Change will streamline
formative research and pre-testing methods, and create easy-to use, front-line teaching tools and short
skills-based training that can be managed by woreda and kebele level teams. We will strengthen the
capacity of regional, woreda, and kebele structures to create sustainable, cost-effective interventions that
resonate with the key audiences to achieve USAID's objectives, including:
All activities undertaken under this award will follow five cross-cutting communication strategies:
To prepare for the Micro-Planning Workshop, a critical activity that will be carried out during the in the first
quarter, C-Change will conduct preparatory meetings with partners to assess the scope of current malaria-
related activities, review BCC tools, and discuss priority communication needs. An important outcome of the
Micro-Planning Workshop will be a revitalized, active BCC Task Force for Malaria that will be managed
jointly by the HEC with technical support from C-Change. Given the urgent need for strengthened
communication for PMI and ANC/MNCH activities, C-Change will work through the task force to jump-start
activities by leveraging on-going programs. If there are important gaps in partners' overall understanding of
the malaria-related behaviors and determinants, C-Change will draw up a priority list of research questions
and ensure that a rapid qualitative survey is carried out. Once the results of the qualitative research are
available, C-Change will organize a follow-on Communication Strategy Design Workshop that will tie
together the five core strategies into one cohesive, comprehensive plan. C-Change will guide the
development and production of communication tools and materials, a flexible community-based approach,
and a mass-media component that includes radio spots and programs that capture and reinforce the
success of ongoing efforts. The programs will be rolled out in 20 highly malarial woredas and at least 20
schools. Other community-based initiatives will be taken as appropriate.
Our overall approach will be to strengthen local networks of organizations, including the private
Partners
Activity Narrative: Inter-news through its technical trainings and workshops will improve capacity of the local journalists in
Monitoring and Evaluation
course corrections based on the survey.
Continuing Activity: 18284
18284 18284.08 U.S. Agency for Academy for 7590 7590.08 Presidential $500,000
* Increasing women's access to income and productive resources
* Increasing women's legal rights
Estimated amount of funding that is planned for Human Capacity Development $455,000
Table 3.3.13:
