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: 2010 2011 2012 2013 2014 2015
The Ethiopian Federal Ministry of Health (MOH) was awarded direct funding in COP07 and began implementing its activities in FY08 in collaboration with CDC, PEPFAR partners, and other stakeholders. Due to major reorganization in 2009, all management of HIV/AIDS activities in the health sector moved from the Federal HIV/AIDS Prevention and Control Office (FHAPCO) to the MOH. The FHAPCO remains responsible for multi-sectoral planning, monitoring and evaluation, resource mobilization, and quality assurance. This transition is also underway at the regional level. This has major implications for the future nature of PEPFAR's engagement with the MOH. Direct funding to the MOH through a CoAg improves PEPFAR's working relationships, promotes country ownership, enhances prospects for sustainability, achieves cost-efficiency, and provides flexibility to the MOH for leveraging PEPFAR resources with the Global Fund, GAVI, World Bank, and others.
Funding in COP10 will be similar to COP09 to allow additional time for program and management consolidation, but the MOH will be a target for increased funding in COP11 as other partners are transitioned. The key Directorates for engagement under this activity include the Policy and Planning Directorate (PPD) for the Health Management Information System (HMIS) and Human Resources for Health (HRH); the Medical Services Directorate (MSD) for blood safety, quality assurance, and the chief executive officer (CEO) program (a new TBD); and the Health Promotion and Disease Prevention (HPDP) Directorate for HIV prevention, PMTCT, HCT, TB/HIV, strategic integration of services, and comprehensive care/ART.
Rollout of the MOH's new HMIS is well underway, though challenging in a country as large, complex, and resource-constrained as Ethiopia. With support from PEPFAR, Global Fund, GAVI, and others, 18 million household folders are being printed for distribution by Health Extension Workers (HEWs); health facilities are transitioning to one record room to store the new patient record; new paper-based registers with integrated HIV information for MCH/FP, EPI, ANC/LD, TB, etc are being distributed; and the electronic medical register (EMR) has been adopted as the MOH standard. Tulane remains the lead TA provider at the national level. PEPFAR will continue to do its part to support the HMIS, including greater support and direction to partners in the field to provide more support at the facility level. The HMIS does not adequately capture all facility-based next generation indicators which will need to be the subject of negotiations with the MOH. Federal HAPCO is also working on development and piloting a community information system to capture data for monitoring non-health sectors.
Support for blood safety is addressed under a separate TBD mechanism in COP10 to transition from "Track 1" to a new sole-source CoAg with the MOH. The two CoAgs will then be merged in 2010. The MOH is currently reviewing options for assuming responsibility for the national blood transfusion service due to serious underperformance by the Ethiopian Red Cross. The outcome of this decision will have major implications for future PEPFAR support to blood safety in Ethiopia, which has historically performed poorly. Nonetheless, this is a positive sign indicative of the new reorganization and leadership structure in the MOH.
Support for HCT and TB/HIV will be transitioned from FHAPCO to HPDP in COP10. In fact, this already occurred in late 2009 when the MOH utilized HCT funds from the CoAg to address a funding shortfall for training urban HEWs to provide household VCT. This will also benefit PMTCT effectiveness in urban settings. The MOH will continue to use TB funds to improve TB detection. FHAPCO will also continue supporting the HIV prevention program for by involving the Ethiopian Parliaments. A resource center is being established in the Parliament, whose members mobilize the population they represent and participate in awareness creation forums for HIV prevention.
The major challenge to sustaining the HIV/AIDS response in Ethiopia is the lack of trained health workers to provide the needed services with acceptable quality. This gap has become more evident as services are being scaled up nationwide. An urgent need still exists to train health workers on national scale and then to follow up with continuing medical education (CME). This becomes more important considering the high attrition rate of Ethiopia's health workers, leaving behind a vacuum in service delivery, impeding scale-up, and compromising quality.
The MOH has made a strong commitment to establish ALERT Hospital in Addis Ababa as a National Centre of Excellence for continuing medical education. This center, which serves an impoverished community and has the second largest ART population in Addis Ababa (4,945 patients on ART as of October 2009), would combine clinical training, research, and health service provision and will be much more sustainable in the long-run than "hotel-based" training and the piecemeal approach to in-service training to date. ALERT Hospital is widely recognized as having an excellent regional reputation in research, training, and services, both in the Ethiopian health sector and at the international level. Its existing in-patient and out-patient hospital care, its community outreach program, and its continuing medical education and research institute makes it an ideal site for a high-quality training center.
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Narrative:
This activity has had a significant budget increase. Persons with HIV have to be properly screened for TB to receive directly observed therapy, short course (DOTS) for active TB cases or INH prophylaxis for those free from TB. However, diagnosis of TB in HIV+ persons remains a challenge in Ethiopia, where both diseases are prevalent. Diagnosis of TB is also difficult in children as most cannot produce sputum and a significant number have extra pulmonary TB. Hence, X-ray diagnostic services are very important for diagnosis of TB in children and ruling out active TB in children exposed by household contacts before prescribing INH prophylaxis.
In FY 2009, MOH focused on improving TB diagnostic facilities at the regional level, including expansion of TB liquid-culture capacity, exploration of the feasibility of different diagnostic methods (e.g., florescent microscopy, FNA, Microscopic Observation Drug Susceptibility assay), and improvement of X-ray services. MOH used previous year funds to assess the availability and functionality of chest X-ray machines in PEPFAR- supported hospitals and built the capacity of the RHBs to improve TB diagnosis, train health care professionals on X-ray reading and interpretation, and provide fluorescent microscopy for health facilities with high patient loads. MOH further assessed the availability and functionality of X-ray machines to prioritize and make informed decisions.
In FY 2009, nine hospitals without X-ray machines and those with large number of TB/HIV cases have been provided with the machines, of which one is digital. In COP 2010, MOH will procure ten more X-ray machines including back-up generators for hospitals with outstanding needs identified in the recent assessment. The procurement and distribution will be facilitated by the Pharmaceutical Fund and Supply Agency (PFSA) of the MOH.
COP 2010 activities will include: purchase, distribution and installation of X-ray machines; maintenance of malfunctioning machines; in-service training of technicians and physicians to read and interpret X-rays; and minor renovation of x-ray rooms to meet the Ethiopian Radiation Protection Agency quality standards. MOH being within PEPFAR will play its part in Global Health Initiative (GHI).
