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.
During COP09, RPSO provided contracting services Renovation and Construction (Ren/Con) activities recommended by CDC. On December 18, 2009, CDC-E received formal guidance from HHS/CDC that new PEPFAR Ren/Con activities may no longer be procured through RPSO based on requests from CDC. At this point, all new Ren/Con activities must therefore be implemented using non-RPSO mechanisms, ie, CDC-Atlanta issued grants or cooperative agreements, or another PEPFAR implementing agency (USAID or DoD). The new TBD partner will continue to provide existing contracting services required to guarantee the delivery of high quality Outpatient Department Annexes and Regional Laboratories that are, or will be, designed using international standards of acceptance with the goal of improving the standard of health care for HIV/AIDs patients.
In addition to being an important diplomacy tool of PEPFAR, this improvement of infrastructure is essential for the improvement of health care delivery and will directly lead to the Partnership Framework's goal of reducing HIV incidence and AIDS-related mortality while building the health system in a sustainable manner. New comprehensive facilities will reduce the stigma that currently follows HIV patients reluctant to enter "HIV" centers. Providing new outpatient departments (OPDs) in existing hospital settings greatly increase the chance of providing a facility where health care workers and equipment are already available. Existing buildings that will become vacant can be used for storage centers which are also lacking in existing health care facilities. Designing and constructing health facilities according to international design standards will provide longer lasting facilities that Health Workers will be proud to work in, thus reducing maintenance costs while increasing the retention of health care workers.
The mechanism will provide an increased standard of health care quality to areas where concentration of ART patients is the highest. Assessments indicate that the construction of OPDs and Regional Labs for 47 identified government hospitals will provide a new standard of care to the vast majority of all ART patients throughout every region in Ethiopia. These new integrated facilities will also be instrumental in providing greater comprehensive and quality ANC, PMTCT, and TB services.
Although the renovation of some facilities may be possible, most renovation projects are not cost effective with many unforeseen challenges. In light of the many aging and decrepit health facilities in Ethiopia, renovations are only temporary band-aids that have been applied multiple times to the same wound. Renovating one or two building systems may still not provide a safe, hygienic, health facility. One of the main responsibilities of the partners in this IM is to review the assessments already being performed on the existing hospitals and determine the most cost effective means of improving the infrastructure. The TBD partner will be required to follow CDC's technical advice and procure contracts that will provide the greatest improvement within the allowable budget.
This narrative is submitted for review because it includes new construction of Outpatient Annexes and Laboratories. Currently 40 outpatient departments in high-volume hospital outpatient departments, and 7 Regional Laboratories have been assessed and prioritized for CDC-E's Renovation/Construction Program. These 47 sites currently account for 80% of all the ART patients being managed at hospital outpatient departments, which account for 69% of all patients on ART in Ethiopia. Several of these sites have in excess of 10,000 patients in pre-ART care and are operating under difficult conditions and inadequate infrastructure. Appropriate infrastructure improvement will contribute to the delivery of quality care and improve staff morale and patient retention. Integration of HIV services, specifically family-centered treatment in this case, is more challenging for large hospital sites. Substantially more investment is needed at these sites, given their size and complexity. CDC's RenCon partner, RPSO, will be supported with technical assistance from two qualified engineers on the CDC-Ethiopia team. Three sites are nearly completed, two sites are in mid-progress, and work will commence on five additional sites, including two new Regional Laboratories. Other PEPFAR partners will continue to carry out minor to moderate renovationsI in other sites needing infrastructure improvements.
OPD annexes and Regional Laboratories exemplify integrative health service delivery. Ideal-sized exam spaces will promote efficient workflow and staff/patient comfort. High quality, low maintenance laboratories will provide state of the art facilities that will set the standard of excellence for future laboratories in Ethiopia. Internal furnishings, when necessary, will be procured through other funding resources.
