The overall goal of PLI II is to increase the resilience to shocks and ensure sustainable livelihoods for pastoralists and ex-pastoralists in Somali, Oromiya and Afar regions of Ethiopia. This will be accomplished through: 1) strengthening of the early warning system, 2) strengthening protective livelihood based responses and 3) supporting policy initiatives to pastoral livelihoods. As part of strengthening economic opportunities, The program will aim to promote HIV awareness and prevention activities in the pastoralist communities.

The project is implemented by five consortium organizations (Save the Children USA and UK, CARE, IRC, and Mercy Corps) and operates in urban and rural woredas of Somali (Dollo Ado, Dollo Bay, Aware, Degahabur, Kebribeya, Mullu, Babile, Awbere, woredas), Oromiya (Liben, Arero, Yabello, Moyale, Dire, Dhas woredas) and Afar (Gewane woreda) Regions. It will reach 199,786 direct beneficiaries, 1,677,720 indirect beneficiaries and 15 community-based organizations (CBOs).

To address health system strengthening, the program will work to strengthen CBOs' ability to raise awareness, provide preventive, care and support services to PLWHAAs and OVC and mobile HCT. The program will also engage community leaders and community association to rally their support for HIV/AIDS activities and support. Finally, the consortium will hold consultative and review meetings to identify areas of integration of different health programs. The consortium will coordinate activities with those of other USAID-funded programs such as TransACTIONSs.

The program addresses several cross-cutting issues, including: Increased access to community-based health and HIV/AIDS services, HIV/AIDS prevention, and care and support services for pastoral communities with particular emphasis on orphans and vulnerable children and families affected by HIV/AIDS. Gender is another cross-cutting issue that will be strongly addressed in all different program activities. Special emphasis will be put on men involvement. In addition, child survival will be at the center of all activities; specifically ensuring the availability of prevention, care and support services for OVC. Finally, the program will work to ensure that family planning needs of HIV-positive women are met. This will be done by ensuring that FP services are available at all key contacts with HIV-positive women (PMTCT, Antenatal care). CBOs, religious, clan and community leaders will be relied upon to encourage women to seek these services. Community volunteers will provide FP information and education to women so that they are able to identify appropriate FP methods.

The Monitoring & Evaluation Plan for PLI II is based on lessons learned in PLI I, specifically the need for a more coordinated and harmonized system with shared performance indicators and M&E approaches. A full time M&E officer will lead the M&E working group which will meet monthly during the life of the project to ensure that each of the partners is collecting, analyzing and sharing information that can be used to develop good practice guidelines and inform impact assessment. Consistent with the team's history of working in pastoral areas, participatory approaches to M&E including impact assessments will be undertaken to assess the impact of interventions on the different livelihood groups and in this way to develop an evidence base around selected interventions. The PLI II team will work with Tufts University to develop Participatory Impact Assessment (PIA) approaches. The team will also work with regional and zonal administrators and technical units to build their capacity in establishing and implementing M&E systems.

This continuing activity will focus on providing viable economic strengthening models, specifically income generation, for persons living with HIV/AIDS and OVC in pastoral areas. It targets 10,000 persons (75% women) living with HIV, enrolled in care and treatment services and their families. PLWHA often lack economic resources for food, shelter and transportation to clinics for services. PLI 11 will offer viable economic strengthening models to PLWHA in a livelihoods insecure setting to promote adherence to ARV and other therapies. PLI 11 will support PLWHA associations and CSOs to provide social support, viable IGA and livelihood options to vulnerable members of PLWHA groups in communities, linked to 30 hospitals and network health centers with a high ART load. HIV +ve women attending care and treatment services, especially head of households, widows, divorcees, unemployed or women likely to engage in high risk sex, to generate income, will be targeted. Services will be mapped to facilitate referral linkages within the health network model. The IGA support will provide access to families, to address issues like disclosure of HIV status and referral of other family members for HIV testing/services. PLI 11 will establish a sustainable savings and credit scheme for HIV/AIDS infected and affected persons. Through partner organizations, clients will receive other services like counseling and IEC materials. It will improve ART adherence through adherence counseling among support groups. It will contribute to behavioral change, improved living standards and provide better planning and organizational abilities for IGAs, through training. There will be reduced stigmatization against HIV/AIDS infected and affected persons with increased self reliance among PLWHA and their families. Partnerships will be formed with other USG investment portfolios in agriculture, health, economic growth, and education to leverage resources. This activity will be coordinated with other USAID activities to increase the number of beneficiaries and households. For COP 10, PEPFAR Ethiopia will continue with its consultations with the OGAC Public Private Partnership TWG and disseminate the results of this activity.

PLI II project will promote sexual abstinence and faithfulness among 20,000 youth and adult pastoralists and ex-pastoralists in five impact sites/towns in Somali, Oromiya, and Afar regions of Ethiopia. Both males and females, in and out of school will be targeted.

To encourage abstinence among youth, PLII will teach skills in refusal, negotiation, and planning in a comprehensive approach, promoting abstinence and faithfulness (AB) for sexually active youth. A peer education program will also teach life skills.

Behavior change materials related to AB will be collected or produced and distributed. Age appropriate life skills training of trainers will be conducted for peer educators for youth, both in and out of school: Beacon School (10-13 old), Sports for Life (14-15 old), and Youth Action Kit (16-25 old). Life skills training packages will be used to train peer educators for the different age groups. Both sexes will participate equally as peer educator and beneficiaries. One hundred peer educators for each package will be trained at the five PLI II impact sites/towns. Following life skills training sessions, peer groups will be formed and encouraged to participate in different competitions including soccer, music, drama, quiz and other sport competitions.

Adults will also be targeted by the PLII program, with a focus on faithfulness and becoming good role models for youth. Awareness raising programs will be employed using influential persons in the community and clans, as well as religious leaders. Behavior change communication materials, which will encourage dialogue, will be distributed. In addition, street shows and role plays will be organized to entertain and educate the target population. The program promotes open dialogue between parents and children on sexual and reproductive health issues, including delaying sexual debut.

Monitoring and evaluation tools will be developed and introduced to peer-educators and volunteers. The knowledge, attitudes, and practices (KAP) study done in COP09 will provide base line information. Technical assistance and supervision will be carried out regularly, as will review meetings among peer educators. Activity reports will be collected monthly.

The Pastoralist Livelihoods Initiative (PLI II), which started in COP 2009, addresses target groups, such as at-risk youth who are sexually active with concurrent partners, with other sexual prevention mechanisms like condom promotion. Drivers of the epidemic in PLI II sites located on the Ethio-Djibouti route also include those associated with this transportation route (truck drivers and CSWs). In towns such as Jijiga, the commercial business sector is a driver due to the frequent movement of people in and out of towns.

PLI II will implement condom distribution and education to around 25,000 youth at its impact sites. Peer educators will be trained from among CSWs and youth and provide outreach and education at static information centers. Peer educators have responsibilities of providing leaflets, posters, brochures etc and teach the target groups to protect themselves from acquiring the pandemic. Using syndromic management, volunteer peer educators will encourage target groups to go for testing and treatment services.

Other actors will be tapped to effectively utilize available resources and create a sense of partnership among these organizations and projects. TransACTION, HAPCO, health offices and facilities, Family Guidance Association of Ethiopia (FGAE), DKT, among others are potential partners. Condoms will be bought and distributed from suppliers such as DKT using a social marketing strategy. Hotels will also be encouraged to regularly supply two packets of condoms in the rooms.

PEPFAR and non PEPFAR indicators will be used to monitor progress and evaluate this activity, including the number of condoms distributed, behavior change associated with condom use, and the number of clients accessing STI and other services. Technical supportive supervision will be regularly carried out by the respective organizations of the PLI II consortium. In addition, regular review meetings of peer educators and monthly reports of CBOs will facilitate the monitoring process.

The Pastoral Livelihoods Initiative (PLI) II will work to address the low uptake of PMTCT services among pastoral women by integrating PMTCT activities into its programs in all previously identified intervention sites. The program will conduct a baseline survey to assess PMTCT services.

The CBOs established in COP 2009 and community and religious leaders will be used as community mobilizers to encourage around 5,000 pregnant women and 20,000 women of reproductive age group to receive HIV testing and the PMTCT service package.

PMTCT will be addressed under the comprehensive HIV program strategies of PLI II, which will collaborate with PMTCT implementing hospitals and health centers in its impact sites. It will provide trainings on HIV counseling and testing and PMTCT techniques to health workers at facilities to build and strengthen the capacity of government partners. Volunteers from CBOs, clan leaders, and health extension workers will be trained on PMTCT in order to teach and refer mothers to the health facilities.

Community mobilization events, such as women-to-women support group dialogues will raise participant awareness and increase health seeking behavior. Female health workers will provide education on topics including PMTCT, pediatric breast feeding and nutrition, and condom promotion during the events. Pastoral men will also be targeted to encourage their wives and sisters to receive PMTCT services.

HCT reagents and ART drugs will be supplied to health facilities. Integration of reproductive health services like PMTCT, HCT, family planning, maternal and child health, through review meetings and consultative workshops, would also be one of the core interventions.

PEPFAR and non PEPFAR indicators will be used to monitor the progress of PMTCT services, including the number of women tested for HIV, the number of pregnant women tested for HIV, found positive for HIV and on prophylactic ART, the breastfeeding behavior of mothers with HIV, and the number of babies received prophylactic ART.

Supportive supervision will be carried out by PLI II consortium organizations. Reports from health facilities and CBOs will be collected regularly. Review meetings also will be held with partners on a quarterly basis.