Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8181
Country/Region: Ethiopia
Year: 2009
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $5,800,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $41,200

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

No change to activity. Budget has been adjusted to accommodate potential salary increase.

COP08 ACTIVITY NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff. Detailed narrative of

CDC -Ethiopia management and Staffing is included in programs Area 15-Management and Staffing

HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18716

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18716 18716.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $37,500

Disease Control & Disease Control

Prevention and Prevention

Program Budget Code: 02 - HVAB Sexual Prevention: AB

Total Planned Funding for Program Budget Code: $9,465,291

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

The release of new HIV prevalence surveillance and behavioral data has resulted in a new understanding of the nature of the

epidemic in Ethiopia. In early 2007, the Government of Ethiopia, (GOE) and stakeholders developed consensus single point

estimates of national and regional HIV prevalence that synthesized and reflected all of the available data. That single-point

estimate for HIV prevalence for adults 15-49 stands at 2.1%, with an urban rural difference of 7.7% versus 0.9%. These new

estimates reflect a consistent pattern observed in both the ANC surveillance and the EDHS of a many-fold higher HIV prevalence

in urban settings than in rural settings. Rural HIV prevalence is concentrated primarily along transport corridors and in peri-urban

settings.

Sexual prevention activities will continue to work cooperatively to enhance linkages and to support other key activities under the

Care and Treatment portion of the PEPFAR portfolio as well as to support the overall vision and strategy of PEPFAR in Ethiopia.

This includes a focus on urban and peri-urban areas as well as identified ‘hot spots' for HIV, ensuring targeting of populations

most at-risk of HIV, mainstreaming gender including the expansion of activities that support inclusion of men, sustainability

through transfer of both skills and responsibilities to indigenous organizations and civil society, addressing human resources as a

key characteristic of sustainability, promotion of family centered approaches, enhance quality of services, and data quality and

usage.

As Prevention becomes more of a focus within PEPFAR some key activities have been identified to sharpen the PEPFAR

Prevention approaches and strategies in Ethiopia. The importance of averting new HIV infections is paramount. Key activities will

include a Prevention Summit to increase understanding among PEPFAR partners about current best practices and challenges in

the area of prevention. There will be an increase of PEPFAR partner meetings and forums to focus on various aspects of

prevention i.e. BCC/IEC materials and dissemination, data review and sharing of best practices. There will be increased

interaction between the PEPFAR Prevention TWG and the SI, Care and Treatment TWG to ensure that integration and synergy is

achieved where possible.

Some ways in which prevention will support and complement activities within care and treatment include behavior change

communication approaches that will improve health care seeking behavior and demand creation for services. Prevention

programs will work to strengthen the referral systems in place for HCT, ART, PMTCT and TB/HIV through community level

engagement with indigenous organizations, existing community structures such as Iddir societies, parent teacher associations,

school committees and others.

In FY 09 there will remain a focus on high risk populations with expansion, supported by recent data described below, to include

individuals involved in multiple and concurrent sexual partnerships, which many may not perceive as high risk. This includes

divorced and widowed women who engage in informal transactional sex. Self-identifying sex workers and their clients will also be

more systematically targeted with prevention efforts. Community mobilization and outreach activities under condoms and Other

Prevention (OP) will be implemented in major cities and towns of major regions and emerging regions where there are evidences

of the need for sexual prevention.

Recent data supporting an expansion within these higher risk populations include the HIV/AIDS in Ethiopia, An Epidemiological

Synthesis conducted in partnership by Ethiopia HIV/AIDS Prevention and Control Office, (HAPCO) and the Global HIV/AIDS

monitoring and Evaluation Team, (GAMET) published by the World Bank in April 2008. This report has indicated that the

epidemic may be less severe, less generalized and more heterogeneous than previously believed, with marked regional

variations; the diversity of the HIV epidemic seems to be related to sexual behavior patterns; small towns may be HIV hot-spots

that have had marginal attention in HIV prevention efforts to date; traditional high-risk groups such as sex workers seem to be

reducing some of their risky behaviors. Young populations, most notably never-married sexually active females have the greatest

risk of HIV infection in the country; discordant couples are also a concern as there is need to strengthen uptake of couples

counseling and testing.

Small towns included in the earlier DHS survey exhibited a higher-than expected prevalence of HIV compared to bigger towns.

These small towns may be HIV hotspots that have been neglected in more urban HIV prevention efforts to date. Among the adult

population, a substantial level of unprotected sex was practiced despite presence of knowledge about HIV prevention and self risk

perception of infection with HIV has remained low in spite of continued high risk behavior.

A limited report on sero-epidemiological study conducted on Most at Risk Population (MARP) identified commercial sex workers,

(CSWs), daily laborers, mobile merchants, students and long distance drivers as MARP. The HIV prevalence among these targets

is much higher than the rest of the population. These groups are also serving as bridge populations for HIV sexual transmission.

A Qualitative study of the communities of cross-border towns indicated that the population was highly mobile, and HIV was

considered to be one of the major health problems. The high mobility of these populations coupled with premarital sex, multiple

sexual partnerships, low levels of condom use, widespread commercial sex work, and use of alcohol and substances, has

exacerbated the spread of HIV/AIDS within these towns and from these towns to the center. Low levels of condom use were

ascribed to misconceptions about condoms, coerced unprotected sex, lack of information, and decreased self control after

consumption of drugs. Utilization of VCT was indicated to be rising; however, VCT has not become widespread because of poor

publicity, fear of the stigma linked with being HIV positive, and a lack of care and treatment services for individuals testing

positive.

In many instances, however, data is clearly lacking. The uniformed services, truckers, refugees and displaced people, street

children, daily laborers, students and other mobile populations may be among the most vulnerable groups in the country; however

there is little to no data measuring accurately the recent spread of HIV in these groups and their role in the further spread of HIV

to the general population. Emerging issues include the presence of men having sex with men and possibilities of cross bridging of

the HIV infection and their high risk sexual and health seeking behaviors are important for doing further research and program

consideration. To address the gaps in data PEPFAR will work closely with both the SI TWG and implementing partners to expand

knowledge and to collect data. There will also be a possible rapid assessment of MARP conducted through CDC's I-RARE

project.

In general, very few data are available on sexually transmitted infections, (STI) in Ethiopia. STI surveillance is practically

nonexistent although case reporting is part of the integrated surveillance effort. Available data indicated that the reported number

of STI has increased over the past two decades. Findings of the 6th round national sentinel surveillance study revealed a nearly

double HIV prevalence rate among pregnant women with antibodies against Syphilis infection (HTPA) compared to those without

it (4.9% vs. 2.5%) .

PEPFAR partners will continue to focus on STI prevention and treatment as well as providing appropriate HIV prevention

information at the health facility level in FY09. 200,000 STI treatment kits will be distributed and promotion and demand creation

for STI services will also be supported. In FY09 eight Confidential STI clinics for MARP will be renovated to provide

comprehensive STI services including reproductive health and post exposure prophylaxis services. PEPFAR partners supporting

clinical services in health facilities will provide on site training and technical assistance to improve STI syndromic management

following the national guidelines. Columbia University will also train facility-based peer educators on STI prevention and treatment

for PLWA enrolled in HIV/AIDS care and treatment. For individuals testing positive, health providers will be trained to provide

comprehensive positive prevention education, including information on disclosure, discordance, condom use, and referral to family

planning services.

Specific partner activity highlights in FY90 include:

MSH's Care and Support Program will use non-medical Case Managers in health centers to support consistent primary ABC and

secondary prevention communications with PLWA. The project will also train Health Extension Workers and community outreach

volunteers to support health centers in tracking HIV-Positive clients and providing outreach counseling at the household level.

Outreach volunteers will play an active role in broader community and family-based counseling, including distribution of GOE and

PEPFAR IEC/BCC materials.

CCP/ARC which will improve and expand many of its user services functions as well as continue to provide support and capacity

building to both national and regional HAPCO. As in years past, the center will also continue its support to national HAPCO in

developing and implementing activities for special events, including World AIDS Day. The Wegen hotline will continue to provide

HIV prevention information and risk reduction counseling. The MARCH partners which mainly address uniformed services (Police

and Military) and university students will continue and scale up of the print serial drama and linked reinforcement activities will

continue. The Men as partners, OGAC initiative, has been mainstreamed in the scripts of the print serial drama and reinforcement

activities; technical assistance for this activity is being rendered by EngenderHealth and CCP.

In FY09 PEPFAR Ethiopia will support risk-reduction counseling on alcohol and khat use in the context of HIV/AIDS prevention.

Activities include providing accurate information on HIV/AIDS and alcohol and training of health care workers on personal risk

assessment and behavioral skills. Alcohol and khat interventions will also be linked with other services, including screening for

sexually transmitted infections and referral to psychiatric services.

There are a number of continuing programs on sexual prevention that use IEC/BCC materials and mass media to educate

Ethiopians about HIV/AIDS. JHU/CCP will develop new IEC materials under FY09 to address gaps in current materials, such as

prevention for positives materials, and will continue to attempt to fill gaps in needed materials. The AIDS Resource Centers will

disseminate critical prevention materials and information, and will begin using the space for drop-in risk reduction counseling, as

well as providing community space for other prevention providers to use.

Several current partners are shifting focus in order to better respond to the epidemiological data. Population Council will develop

Men's Clubs to compliment their work with young girls and better address male norms that lead to the increased vulnerability of

young girls in Amhara. EngenderHealth will provide technical assistance on gender issues to help prevention partners' better

address male behaviors. JHU/HCP will widen their scope of work to reach adults with an interactive, module-based HIV

prevention curriculum that will include messages about abstinence, fidelity, condoms, and partner reduction.

USAID will launch two new activities that will address MARP in Ethiopia. One to be implemented by EngenderHealth that will

introduce a comprehensive package of HIV prevention services for adults and young people involved in or at risk for transactional

sex., and a second implemented by World Learning that will work in collaboration with the private company Astar Advertising

(Astar), and the government's Ethiopia Electric Power Corporation (EEPCo), the Ethiopian Roads Authority (ERA) and the

Ministry of Water HIV Task Force (MOW) to support and institutionalize the design, implementation and evaluation of HIV

prevention interventions and services that address the risks associated with transactional sex in urban centers and "hotspots,"

particularly in large-scale construction sites and surrounding communities. PEPFAR Ethiopia will implement community outreach

activities to address the current epidemic in the smaller towns and hotspots of Amhara region and Gambella through a TBD

partner. This activity will include community outreach in other emerging regions as well where community level activities lack.

USAID will use an APS to for solicitation of new indigenous partners to expand the range of activities targeting MARPS.

PEPFAR Ethiopia will procure $2.5 million worth of condoms to support the public sector, refugee camps, and the Targeted

Condom Promotion program which will target sexually active youth and adults engaged in high-risk sexual behavior. PEPFAR

Ethiopia will expand workplace interventions to reach new adult populations including faculty in university settings, migrant

workers in agribusiness sectors and communities/employees involved in the tourism industry.

The prevention program will continue to focus on youth and students with HCP, JHU/CCP, YMCA, Addis Ababa University and

the new EVOLVE education program to support HIV prevention education in 24 Teachers' Colleges.

USG PEPFAR will continue to coordinate and monitor prevention activities through quarterly partner meetings and biweekly USG

PEPFAR Prevention Technical Working Group meetings. PEPFAR sits on Federal HAPCO's newly formed Prevention Task Force

which aims to harmonize all prevention efforts across Ethiopia. PEPFAR will continue to support the seconding of a Prevention

Advisor to Federal HAPCO as well as a BCC Specialist to the Health Education and Extension Center (HEEC) to improve the

agencies' ability to coordinate and manage HIV prevention programs among multiple donors. USG-funded sexual prevention

programs support the national prevention priorities laid out in the Accelerated Access to HIV/AIDS Prevention, Care and

Treatment in Ethiopia Road Map 2007-2008.

Table 3.3.02:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $17,060

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

No change to activity. Budget has been adjusted to accommodate potential salary increase.

This activity represents the direct technical assistance which is provided to partners by CDC staff. The

amount represents the salary and benefit costs for CDC Ethiopia local technical staff. Detailed narrative of

CDC-Ethiopia Management and Staffing is included in Program Area 15 - Management and Staffing

HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18717

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18717 18717.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $53,200

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $68,240

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

No change to activity. The previous position holder is transferred to other program area and the position is

vacant for some time and replaced recently with starting salary.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC staff. The

amount represents the salary and benefit costs for CDC Ethiopia local technical staff. Detailed narrative of

CDC-Ethiopia Management and Staffing is included in Program Area 15 - Management and Staffing

HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18722

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18722 18722.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $23,300

Disease Control & Disease Control

Prevention and Prevention

Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety

Total Planned Funding for Program Budget Code: $4,968,200

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

PEPFAR/Ethiopia's past investment in safe blood systems has resulted in improvement in the capacity of the National blood

programs of both civilian as well as uniformed services. As a result, a number of activities are underway aimed at strengthening

the blood transfusion services. These efforts will ensure delivery of safe and adequate supply of blood and blood products to

those in need and contribute towards prevention and control of HIV/AIDS and other Transfusion Transmissible Infections (TTIs).

The Ministry of Health (MOH) of the Federal Democratic Republic of Ethiopia is the responsible body for National Blood

Transfusion Service (NBTS) in Ethiopia with regulatory, coordination and oversight roles. Based on technical assistance from the

World Health Organization (WHO) Ethiopia now has a national blood policy and a five year strategic plan which is a road map for

implementation of blood safety activities in the country.

During FY07 (2008 data not yet compiled), Ethiopian Red Cross Society (ERCS) efforts were underway to promote blood

collection from low-risk voluntary donors in order to decrease the existing dependence on family and replacement donations

throughout the country. Total blood collections increased from 25,004 units of blood in 2004 to 32,442 units in 2007. All (100%)

donated blood was tested for HIV, Syphilis, Hepatitis B and Hepatitis C. The prevalence of disease markers amongst blood

donors has shown decreasing trends over the years: HIV from 3.7% in 2004 to 3.4% in 2005, 2.4% in 2006 and 2.03% in 2007.

Similar trends have been observed for other markers of infections transmitted by blood transfusion (ERCS data 2007). This

situation is expected to improve further in FY09 with improvement in quality testing and regular supply of test kits in the country

under PEPFAR.

Implementation of blood safety activities in FY08 did not go as planned because most were contingent on finalization of the

renovation of the 16 blood banks. This is still underway using PEPFAR funding and money leveraged from the Global Fund

addressing the gaps due to escalation of cost of building materials. In FY09, PEPFAR will continue to support the 26 blood banks

through personnel, training, equipments, supplies and logistics.

The US Department of Defense in collaboration with the Ethiopian National Defense Forces has established The National

Defense Blood Bank Center, Bella Defense Referral Hospital for collection, processing, storage, distribution of safe blood, and

training. Procurement of equipment, consumables, and controlling and tracking systems for distributed and stored processed

blood and components are finalized. The Defense HIV/AIDS Prevention Program (DHAPP) in collaboration with the blood safety

technical team from Naval Medical Center in San Diego Blood Bank has completed the initial training of 11 core staff personnel

assigned at the Center and has provided continuing support and training. Additionally, they have and also conducted lectures for

health care workers, medical technologists, and physicians at the Defense Health Sciences College, the Armed Forces Teaching

Hospital, and the Bella Defense Referral Hospital in different aspects of blood transfusion service. In FY09 an ENDF donor

recruitment plan will be developed and implemented. By the end of FY09 three more military hospital based blood banks will be

established.

PEPFAR has been supporting the government of Ethiopia focusing on Infection Prevention in healthcare settings in general, and

the prevention of unsafe medical injections in particular, throughout the rapidly expanding ART health network. These infection

prevention programs have been operational since FY04 and will continue to be strengthened and expanded at the ART health

networks in FY09.

John Snow Inc.'s Making Medical Injections Safer (MMIS) program is cross-cutting in supporting PEPFAR clinical activities in

blood safety, voluntary counseling and testing (VCT), PMTCT, palliative care, TB/HIV, and ARV services. The core components of

the MMIS program include: (1) commodity procurement and management; (2) training and human capacity building; (3) behavior

change and advocacy; (4) standardizing systems for proper waste management practices; (5) addressing private providers and

the informal sector; (6) policy development; and (7) monitoring and evaluation.

In FY08, MMIS trained 1438 health workers drawn from various health facilities in injection safety, logistics and waste

management. Along with the training and supervision, this program procured and distributed syringes, safety boxes, thousands of

waste management commodities and PPE's for waste handlers. Since the start of the program, 1347 facilities have been covered

with training and commodity supply.

In COP09, MMIS will continue its training and commodity supply activities and include additional 100 health centers and 500

health posts in its program. National level advocacy to implement injection safety interventions that add to the quality and

comprehensiveness of existing service package will be undertaken. MMIS will also provide TA to local organizations that are

producing injection safety commodities so as to ensure it meets the required international standards.

In FY08 and previous years, JHPIEGO supported the Ethiopian governmental hospitals in proper implementation of

recommended infection prevention (IP) practices and processes. JHPIEGO has organized on-site and off-site IP trainings for

health care workers at different levels. It has also established IP committees at facility level and facilitated procurement of IP

supplies and equipment. Moreover JHPIEGO has played significant role in establishing IP Technical Working Group (TWG) at

national level.

In FY09, TBD partner will continue to give in-service IP training courses to private hospitals and clinics, and support local

Technical and Vocation Education and Training institutions (TVET) to produce low cost, locally customized basic IP supplies, such

as aprons, goggles, antiseptic hand rubs, sharps and waste containers. The first pilot production will be targeted for 20 selected

hospitals, with an emphasis on teaching hospitals supported by PEPFAR.

PEPFAR Ethiopia also worked with the Ethiopian military to train healthcare workers in infection prevention and safe blood

practices at military hospitals and field clinics. The Department of Defense will continue to support the Ethiopian National Defense

Force Injection safety Program. In FY09, building on activities of COP08, the technical support will continue to maintain support at

10 referral hospitals and 31 health centers.

Additionally, through UNHCR, refugees will have access to safer injections and infection prevention practices including the use of

post-exposure prophylaxis for victims of rapes in 6 camps near the Sudanese and Somali border.

Circumcision of men is widely practiced in different regions of Ethiopia and often serves as a rite of passage to adulthood.

According to the 2005 Demographic Health Survey (DHS), 93% of Ethiopian men aged 15-59 are circumcised. With the exception

of men in Gambella and SNNPR, circumcision is nearly universal among men in the other regions. Fewer than one in two men

living in Gambella (46%) are circumcised, while three in four men living in SNNPR (79.6%) are circumcised.

The effect of male circumcision on the risk of HIV infection, and the impact of the practice in the spread of HIV in different

population groups has been a subject of interest. Many studies indicate that circumcised men are less likely to become infected

with HIV than uncircumcised men. Lack of circumcision also increases the chances of infection with other STI, which have been

shown to enhance transmission of HIV. Since male circumcision is indeed an important risk factor for HIV infection, then it merits

consideration as an appropriate intervention in HIV infection control.

From the DHS 2005 Ethiopian figure, the relation between HIV and male circumcision conforms to the expected pattern of higher

rates among uncircumcised men (1.1%) than circumcised men (0.9%). Uncircumcised men in Gambella had the highest HIV

prevalence rate (9.8%)—as compared to the HIV prevalence rate (2.3%) among circumcised men in Gambella. The prevalence of

HIV among uncircumcised men in SNNPR was 0.7% which is higher than 0.3% among circumcised men. Therefore, it is a timely

intervention to plan and offer male circumcision service in those regions in Ethiopia. The service will be supported with intense

communication and advocacy campaigns and will provide patient education materials.

In FY09 PEPFAR partners will continue supporting the two regions to provide training on safe male circumcision service, to

produce information, education, and communications materials on safety and quality of male circumcision services, strengthening

circumcision services healthcare facilities as part of the comprehensive package of prevention services. This activity will also look

for opportunities to provide the services for infants with integration with other reproductive health care services in subsequent

years.

Table 3.3.04:

Funding for Biomedical Prevention: Blood Safety (HMBL): $43,200

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

No change to activity. Budget has been adjusted to accommodate potential salary increase.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff. Detailed narrative of

CDC -Ethiopia management and Staffing is included in programs Area 15-Management and Staffing

HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18719

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18719 18719.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $33,700

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.04:

Funding for Care: Adult Care and Support (HBHC): $14,800

CDC M&S

ACTIVITY MODIFIED IN THE FOLLOWING WAYS

In COP'08 Care and Support program area budget (HBHC) included Adult and Pediatric Care salaries and

benefit of local technical staff. Based on COP'09 guidance, these two program areas have been separated

to reflect local technical staff salary and benefit cost accordingly.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC staff. The

amount represents the salary and benefit costs for CDC Ethiopia local technical staff. Detailed narrative of

CDC-Ethiopia Management and Staffing is included in Program Area 15 - Management and Staffing

HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18725

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18725 18725.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $45,400

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $33,400

CDC M&S

ACTIVITY MODIFIED IN THE FOLLOWING WAYS

In COP08 Care and Support program area budget (HTXS) included Adult and Pediatric Treatment salaries

and benefit of local technical staff. Based on COP09 guidance, these two program areas have been

separated to reflect local technical staff salary and benefit cost accordingly.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC staff. The

amount represents the salary and benefit costs for CDC Ethiopia local technical staff. Detailed narrative of

CDC-Ethiopia Management and Staffing is included in Program Area 15 - Management and Staffing

HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18735

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18735 18735.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $77,300

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $14,800

CDC M&S

ACTIVITY HAS CHANGED IN THE FOLLOWING WAYS

In COP08 Care and Support program area budget (HBHC) included Adult and Pediatric Care salaries and

benefit of local technical staff. Based on COP'09 guidance, these two program areas have been separated

to reflect local technical staff salary and benefit cost accordingly. This activity represents the direct

technical assistance which is provided to partners by CDC Staff. The amount represents the salary and

benefit cost for CDC Ethiopia local staff. Detailed narrative of CDC -Ethiopia management and staffing is

included in program Area 19 - Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18725

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18725 18725.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $45,400

Disease Control & Disease Control

Prevention and Prevention

Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment

Total Planned Funding for Program Budget Code: $7,569,597

Total Planned Funding for Program Budget Code: $0

Table 3.3.11:

Funding for Treatment: Pediatric Treatment (PDTX): $30,900

CDC M&S

ACTIVITY HAS CHANGED IN THE FOLLOWING WAYS

In COP'08 Treatment program area budget (HTXS) included Adult and Pediatric Treatment salaries and

benefit of local technical staff. Based on COP'09 guidance, these two program areas have been separated

to reflect local technical staff salary and benefit cost accordingly. This activity represents the direct

technical assistance which is provided to partners by CDC Staff. The amount represents the salary and

benefit cost for CDC Ethiopia local staff. Detailed narrative of CDC -Ethiopia management and staffing is

included in program Area 19 - Management and Staffing HVMS.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC staff. The

amount represents the salary and benefit costs for CDC Ethiopia local technical staff. Detailed narrative of

CDC-Ethiopia Management and Staffing is included in Program Area 15 - Management and Staffing HVMS

New/Continuing Activity: Continuing Activity

Continuing Activity: 18735

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18735 18735.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $77,300

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $33,400

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Budget has been adjusted to remove local expenses related to the TB/HIV USDH.

COP08 ACTIVITY NARRATIVE:

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff and benefit cost for

direct hire staff. Detailed narrative of CDC -Ethiopia management and Staffing is included in program Area

15-Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18738

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18738 18738.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $265,451

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $44,900

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

Budget has been adjusted to remove local expenses related to the TB/HIV USDH.

COP08 ACTIVITY NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff and benefit cost for

direct hire staff. Detailed narrative of CDC -Ethiopia management and staffing is included in program Area

15-Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18731

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18731 18731.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $61,900

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $279,912

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

No change to activity. Budget has been adjusted to accommodate potential salary increase.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff and benefit cost for

direct hire staff. Detailed narrative of CDC-Ethiopia Management and Staffing is included in Program Area

15-Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18741

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18741 18741.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $215,051

Disease Control & Disease Control

Prevention and Prevention

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $17,853,500

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

PEPFAR Ethiopia—in collaboration with several other major donors (e.g., The Global Fund to Fight AIDS, Tuberculosis and

Malaria and the World Bank)—has undertaken several activities which address important elements in a comprehensive SI

approach. Specifically, PEPFAR Ethiopia support has focused on surveillance, monitoring and evaluation, and Health

Management Information System's (HMIS). PEPFAR has supported the establishment, strengthening and expansion of

HIV/AIDS/STI/TB-HIV surveillance systems; provided significant support to the development and implementation of monitoring

and evaluation systems related to HIV/AIDS/STI/TB-HIV prevention, treatment, and care interventions; supported the integration

of available data capturing, reporting and dissemination systems; and strengthened the overall comprehensive HMIS master plan,

currently being implemented in Ethiopia by the Federal Ministry of Health (MOH). As its goal of providing technical assistance to

all SI programs and program implementing partners, PEPFAR SI has been designing and implementing SI programs that

generate information and data to help them in target setting, program monitoring and evaluation and reporting including

Semiannual and Annual program reports. PEPFAR Ethiopia SI has also been assisting its partners in the design and conduct of

programs and public health evaluations

The Federal Ministry of Health (FMOH) is in charge of coordinating Ethiopia's evolution through one national health monitoring

evaluation system. The Planning and Programs Department of the FMOH (PPD) determines the country's health information

management systems' vision and set strategic plans to achieve this vision. The operation matters are shared by other FMOH

entities. Notably HAPCO is in charge of the HIV/AIDS monitoring and evaluation systems for HIV/AIDS prevention care and

treatment programs that are implemented by the non-health partners including community level interventions. The Ethiopian

Health and Nutrition Research Institute (EHNRI) coordinates HIV/AIDS and related disease surveillance systems and the design

and conduct of surveys.

Establishment, strengthening and expansion of national HIV/STI/TB Surveillance Systems: PEPFAR Ethiopia supported the

design and piloting of surveillance systems related to TB/HIV and STI/HIV co-infections. Surveillance systems to monitor the

prevalence of HIV among blood donors and commercial sex workers were designed and preparatory works for piloting and

implementation started. PEPFAR support was provided for the implementation of and generation and utilization of quality data

from the 2007 round of ANC based HIV surveillance. Surveys to look at the prevalence of HIV and risk behavior among most at

risk populations (MARPS) were conducted. Strategic information generated from these activities was disseminated to and used by

policy makers, program designers and managers, health service providers and the public at large.

Development and implementation of monitoring and evaluation systems: In past COP years, the M&E system was strengthened

through M&E support provided to the Federal HAPCO, Regional Health Bureaus, Zonal and Wereda Health Departments and

health facilities implementing HIV/AIDS/STI/TB-HIV prevention, treatment, and care interventions. PEPFAR Ethiopia support for

the development and implementation of a sustainable Health Monitoring and Evaluation system included the MSc level training in

M&E by Jimma University, short term trainings in M&E and surveillance programs, Leadership in Strategic Information (LSI) and

Field Epidemiology and Laboratory training programs (FELTP) and a new HMIS certificate program. PEPFAR Ethiopia also

supported HAPCO in the design and piloting of M&E systems that capture and generate strategic information related to HIV/AIDS

interventions in the non-health sectors including Education and Women.

Integration of available data capturing, reporting and dissemination systems: PEPFAR supported the dissemination of general

strategic information through different channels to a variety of users including to PEPFAR implementing partners to assist them in

making evidence based decisions related to programs. The second national M&E report was published and the information was

used by decision makers and partners. Through this support, program managers, data managers and clerks and health service

providers at different levels of the health care system were able to capture, generate, analyze and interpret strategic information

related to their programs.

Strengthening of the overall comprehensive HMIS master plan: PEPFAR Ethiopia, as one of the leading Government of Ethiopia's

partners, provided technical and financial support for the development of the national HMIS. Support included development of

health indicators, HMIS pre-service training curriculum, development and piloting of an integrated electronic medical record

systems and the piloting of HMIS in different health facilities and regions. HIVQUAL, a service quality improvement program, has

also been integrated into the electronic medical record (EMR). As part of PEFAR support to the HMIS, the design of a data

warehouse that incorporates the Geographic Information Systems was completed. PEPFAR support for the development of the

local area network (LAN) of the FMOH, EHNRI, RHBs and RHAPCOs was also one the successful achievements in previous

COP years. As part of the government's initiative to deploy 8,000 health information specialists and to train 45,000 health workers

by 2010, to date PEPFAR has supported the training of 500 new health information technicians (HIT) and 2,000 health workers.

To facilitate the provision of these trainings, PEPFAR supported the renovation of 11 technical educational and vocational training

schools (TEVTs) so that they can serve as multi-functional training institutions.

However, numerous challenges remain, including ensuring the quality of data and its appropriate use, lack of capacity at regions

and health facility level, high staff turn-over, delay in roll-out of HMIS and the different non-ANC based HIV surveillance systems

and weak monitoring systems for HIV/AIDS intervention outside of the health system.

In COP09, PEPFAR Ethiopia's support will continue to the establishment, strengthening, expansion and implementation of SI

programs that generate, analyze, disseminate and encourage the utilization of quality data and program management information

from the different programs to accurately measure progress toward the in-country Emergency Plan's goals. Support will also

continue to programs that help HIV/AIDS prevention, care, support and treatment program designers and managers, health and

other social services providers at every level and the public at large to make evidence based decisions related to the design and

implementation of HIV/AIDS policy/advocacy and prevention, care, support and treatment programs.

PEPFAR Ethiopia's support will continue to work towards the development and implementation of surveillance systems that focus

on generating information related to the most at risk populations (MARPS) in the country. Support will be continued for expansion

of the ANC based HIV surveillance system to include additional sites from the rural areas to improve the representativeness of the

data. TB/HIV surveillance among TB and HIV patients will also be expanded by including more sites. PEPFAR support will be

provided to the design and conduct of the 2010 round of the Ethiopian Demographic and Health Survey (EDHS+).

In FY 09, PEPFAR Ethiopia will maintain its support to the national HMIS, M&E and Surveillance systems. Support will be

provided for implementation of the paper-based HMIS system in 500 health facilities. The HMIS system with the integrated

Electronic Medical System and HIVQUAL will be implemented in 80 of the 500 health facilities serving as ART centers. As part of

the roll-out of the HMIS system, the Government of Ethiopia has requested Tulane University to provide in-service training on

HMIS to 45,000 health professionals and pre-service training to 8,000 new government-employed HITs by the end of 2010.

However, due to funding constraints in FY09, PEPFAR Ethiopia will only be able to support the training of 3,500 instead of 5,000

health professionals, 700 instead of 1,000 new HITs, and 140 instead of 200 HMIS mentors as was originally planned.

Unfortunately, this will further slow down the rollout and building the sustainability of the national HMIS in Ethiopia. Health care

providers at facilities where PEPFAR partners are supporting the implementation of PEPFAR programs will be supported to

generate, analyze, interpret and utilize data from the M&E/HMIS systems through technical assistance from the implementing

partners. PEPFAR Ethiopia will also continue its support for the printing and dissemination of HMIS training materials in COP09.

However, funding constraints will further limit the availability of TA from partners and HMIS materials.

PEPFAR will focus efforts to build local capacity for SI on public health and educational organizations. Efforts will include

strengthening the capacity of local organizations including EHNRI, MOH, HAPCO, EPHA and regional health bureaus to provide

short term in-service trainings on SI and strengthening the capacity of local universities to provide pre-service trainings to

produce SI professionals for the health system, including continuation of the Masters level trainings in M&E at Jimma University

and the Field Epidemiology and Laboratory Training Programs at Addis Ababa University the sustainability of these programs.

PEPFAR support for the dissemination of strategic information generated by the trainees of these and other health-related training

programs will also be continued in COP09.

Table 3.3.17:

Funding for Strategic Information (HVSI): $602,923

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

No change to activity. In COP'08 the budget of the canceled M&E position is not deducted. In FY'09 the

planned budget reflects positions currently existing. Further note that some of the local benefits for USDH

that are planned in last FY are excluded from this year's planned budget.

COP08 ACTIVITY NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff and benefit cost for

direct hire staff. Detailed narrative of CDC-Ethiopia management and Staffing is included in program Area

15-Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18745

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18745 18745.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $609,001

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $369,223

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

No change to activity. In COP'08 the budget of the canceled M&E position is not deducted. In FY'09 the

planned budget reflects positions currently existing. Further note that some of the local benefits for USDH

that are planned in last FY are excluded from this year's planned budget.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff and benefit cost for

direct hire staff. Detailed narrative of CDC-Ethiopia management and Staffing is included in program Area

15-Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18752

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18752 18752.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $181,251

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.18:

Funding for Management and Operations (HVMS): $4,206,042

CDC M&S

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

No change to activity. In COP'08 the budget of the canceled M&E position is not deducted. In FY'09 the

planned budget reflects positions currently existing. Further note that some of the local benefits for USDH

that are planned in last FY are excluded from this year's planned budget.

COP08 NARRATIVE

This activity represents the direct technical assistance which is provided to partners by CDC Staff. The

amount represents the salary and benefit cost for CDC Ethiopia local technical staff and benefit cost for

direct hire staff. Detailed narrative of CDC-Ethiopia management and Staffing is included in program Area

15-Management and Staffing HVMS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18758

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18758 18758.08 HHS/Centers for US Centers for 8181 8181.08 CDC-M&S $4,196,946

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.19: