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.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $700,000
Total Planned Funding for Program Budget Code: $0
Table 3.3.09:
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $194,000
Program Area Narrative:
OVERVIEW
By June 2008, approximately 700 children were receiving treatment for HIV infection. Training, drugs, consumables and
refurbishments have been provided to most of the 110 ART sites and the over 400 PMTCT sites.
Pediatric ART has only recently been introduced and the number of identified treatment-eligible children is low. 95% of infections
are acquired vertically. Specific barriers to access or to providing treatment are not fully understood, but stigma and a lack of
objective information on treatment options (for parents and guardians) are believed to be important as is lack of early infant
diagnosis capacity.
Guidelines for ART and OI management for children are part of the comprehensive existing national guidelines. Although provider
trainings for comprehensive ART services cover children, it appears that, often the latter aspect is not emphasized well enough.
The result is that ART sites at the peripheral levels often refer pediatric HIV cases to the more experienced clinics - nine public
hospitals account for 85% of children in care and 90% of children on ART nationally.
Disease progression may be very rapid in infants with about 30% of them dying in the first year of life, so early infant diagnosis
and early initiation of the treatment is paramount. Recently, the National AIDS Control Program has acquired equipment for early
infant diagnosis. Ordinary antibody testing is hindered by presence of maternal antibodies and therefore infants are tested on the
presence of HIV. Soon, every regional capital will have this equipment and the challenge becomes to develop a logistics system
to ensure timely delivery of infant venal blood to the testing centers and return of the test results to the respective clinics.
Parental/adult support for HIV+ pediatric cases can be lacking or inconsistent leading to a high defaulter, drop out rate. Some
ART sites have CSOs, NGOs, etc., providing needed complementary support (in nutrition, economic empowerment, psycho-social
etc) but this is not existent for most sites and hence limits the capacity of those ART sites to maintain care for affected infants.
There is at least anecdotal evidence that nutrition is the number one problem for HIV-positive infants. Pediatric nutrition
rehabilitation centers see many suspected cases of HIV-positive infants.
KEY INTERVENTIONS:
The USG strategy for pediatric care and treatment is largely the same as applied to adult treatment which is to leverage resources
from the Global Fund for AIDS Tuberculosis and Malaria (GFATM) through targeted reinforcement of the basic scale-up treatment
services. In general, non-USG resources support basic pre-launch site preparation including training and procurement for
comprehensive HIV/AIDS services. USAID partner JSI, through its DELIVER program, puts the basic logistics and management
information systems in place at all sites. In FY08 USAID partner EngenderHealth's Quality Health Partners (QHP) program
targeted a combination of recently launched ART sites or other facilities known to have implementation or quality issues to apply
quality assurance and stigma reduction tools that strengthen services and support more effective operations.
USG FY09 SUPPORT
In calendar year 2009, the QHP agreement will be extended by at least one year. In order to continue the current level of support
and to be able to respond to needs and resources under a Partnership Compact, new awards will be made during this fiscal year.
The approach will highlight creating linkages with nutrition rehabilitation centers and establish effective referral systems between
those and pediatric testing services, as well as systems to ensure that the central early infant diagnostic centers can be accessed.
A new area for FY 2009 is adding a component of nutrition. USAID will task one of its implementers to assess two program
options. The first is the feasibility of providing nutritional support for infants born to HIV-positive mothers (at least until it is clear
whether they are HIV-positive or not) and the second is to add a food-for-prescription component for pediatric ART patients.
LEVERAGING AND COORDINATION
Targeted USG support reinforces the scale-up activities funded by the Global Fund. USG support is being coordinated with NACP
national and regional personnel in activities, and through quarterly technical coordination meetings. Non-USG resources are
supporting the basic pre-launch site preparation including training and procurement for comprehensive HIV/AIDS services, with
USG providing commodity logistics support. Post-launch USG include quality of care issues, stigma reduction, introduction of peer
counselors and the creation of the linkages with community-based programming and case-finding activities. USG has leveraged
non-PEPFAR USG programs such as the Presidential Malaria Initiative which distributes bed nets to eligible PLHA in about a
planned 40 locations.
EXPANSION OF PROGRAM WITH ADDITIONAL COMPACT FUNDING
Under an expanded compact scenario USG supported partner(s) will:
•Expand access - including the specimen logistics - to early infant diagnosis to one site per region
•Provide pediatric specific quality assurance and training to an additional 15 ART sites.
•Collaborate with the National AIDS Control Program (NACP) to expand access of isolated ART providers to continuing education,
mentoring, and remote assistance with management of difficult or unusual clinical problems.
PRODUCTS/RESULTS
2000 early diagnoses facilitated for infants
700 additional infants on ART in USG-supported facilities
500 children supported with nutritional supplements
Table 3.3.10:
Table 3.3.11:
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $382,500
Based on computer modeling, Ghana had an orphan population of 1 million in 2003 and that population is projected to remain
stable until 2010. While there has not been a recent comprehensive assessment of OVC in Ghana, an Early Childhood
Development HIV/AIDS Action Plan for Ghana from April 2004 numbered 755,642 and used figures of 198,000 orphans as a
result of HIV/AIDS. Overall, orphans represent 10% of the Ghanaian population (Children on the Brink, 2004). Ghanaian policy
does not distinguish between AIDS and non-AIDS orphans, giving them the same rights and responsibilities. Child-headed
households are rare in Ghana. Many children are cared for by relatives and are not labeled as orphans. Orphans not cared for by
their relatives live in orphanages (run by the state, churches or others groups), with foster families or under the care of community
associations such as the Queen Mothers, a traditional authority in charge of women and children's welfare. Churches play a
significant role in supporting orphanages where children receive very basic care and support. Despite a national commitment to
community-based care and de-institutionalization of children, orphanages and other facilities are apparently proliferating across
the country with little regulation.
Vulnerable children are not well-defined as a group in Ghana. Child labor and even child trafficking is common in the inland
fishing industry. In the cities, child street vendors are active although most appear able to find shelter at night. The link between
vulnerable children and HIV/AIDS is little known in Ghana. One group thought to be extremely vulnerable is girls in their teens
from the northern part of Ghana who work in the major cities as market porters to finance their marriage. They are widely known
to be involved in transactional sex. A USG-funded counseling and testing project tested 2,000 of these girls and found that 4%
were infected, lower than experts expected. UNICEF supports interventions for the female porters as a particularly vulnerable
group. An additional vulnerability factor in Ghana is the stigma around HIV/AIDS which is exceptionally high. At a national level,
child malnutrition is significant accounting for up to 60 percent of child mortality.
Ghana has a Department of Social Welfare that reaches every district, identifies vulnerable children and looks, as best it can, after
their basic needs. The Government of Ghana (GoG), with support from UNICEF, has completed a draft National Plan of Action
for Orphans and Vulnerable Children, which builds on the existing National Policy Guidelines for Orphans and Other Children
Made Vulnerable by HIV/AIDS (January 2005). The GoG is also working to implement significant social protection programs to
benefit children such as the National Health Insurance Scheme (NHIS), which provides free health insurance to all children under
18, and the Livelihood Empowerment against Poverty (LEAP) which provides direct cash transfers to extremely poor caregivers of
OVC in order to provide support for their basic livelihood needs. More children are enrolling in school and progressing through the
education system due to the abolition of school fees for basic education and the introduction of capitation grants though the
country in the 2005/6 academic year. School feeding programs supported by World Food Program may also account for this.
Annually, there is about $400,000 for orphans in the GoG HIV/AIDS budget but additional resources become available through
district allocations of HIV/AIDS funds and other sources such as FBOs.
KEY INTERVENTIONS
The geographical scope of USG Ghana's efforts in OVC is focused on the 30 USG target districts which were selected on the
basis of HIV prevalence levels, the presence of most-at-risk populations and the presence of Global Fund-supported clinical sites.
USG Ghana focuses on a full package of support for OVC: training and facilitating caregivers' support; distributing food rations for
orphans and caregivers; providing scholarships to promote OVC staying in or returning to school (although limited to older
children); implementing monthly education on a wide range of life skills topics and providing psycho-social counseling. USG
Ghana supports its OVC activities through USAID partner Opportunities Industrialization Centers International's (OICI) HOPE
program. In addition, the Ambassador's Self-Help Fund is being used as a model to support indigenous organizations' provision
of income-generating activities for OVC at the grassroots level, complementing OICI's activities.
CURRENT USG SUPPORT
In FY08, USG Ghana supported 1,726 OVC with a package of care and support, and trained 113 caregivers. Monthly training
sessions on HIV/AIDS life skills provided psycho-social, motivational and vocational counseling individually and in groups to all
OVC. Of the 1,726 OVC, 300 received scholarships to pursue either secondary education or courses in vocational and
entrepreneurial skills. Most will graduate next year after two years of training. The scholarships include a transportation stipend,
as most guardians cannot afford to give a daily allowance to transportation. The scholarships also include exam fees for those in
secondary school. Beneficiaries are required to participate in an industrial attachment or apprenticeship for at least six months to
get on the job experience. They are also encouraged to take the National Vocational Training Institute proficiency examination to
get a level 1 certification. OICI counselors provide vocational counseling, and assistance for self-employment and job placement.
Additionally in FY08, the Ambassador's Self-Help Program continued to serve as a model to select and support income
generation and economic strengthening activities for OVC. Strong preference was given to grassroots efforts and groups that
have demonstrated a financial or in-kind commitment to the activity for which they were seeking funding. Two organizations
working with OVC were strengthened.
Through FY09 support, the USG Ghana program will continue to support OVC and their caregivers through OICI, whose activities
include: vocational training and economic strengthening for OVC; bolstering community structures for OVC care and support, such
as the Queen Mothers Association; and supporting best practices for regulation of and transition from institutional care. OICI
targets 300 OVC who receiving scholarships.
In FY09, USG will also partner with UNICEF to strengthen the Government of Ghana's capacity and response to OVC.
Specifically, activities will focus on the finalization, dissemination and implementation of the draft National Plan of Action for OVC.
Efforts will also go towards building the capacity of the national OVC Committee in their leadership role on issues such as quality
in OVC programming, coordinated care and referrals, and data management. Caregivers will be trained in child care and
parenting skills.
The Ambassador's Self-Help Program will continue to serve as a model to select and support income generation and economic
strengthening activities for OVC. While the exact targets will be determined once the proposals are awarded, the program
estimates it will strengthen an additional two organizations working with OVC and supporting 25 OVC with direct supplemental
support. Strong preference will continue to be given to grassroots efforts and groups that demonstrate a financial or in-kind
commitment to the activity for which they seek funding.
On the military bases, military wives' clubs will be mobilized to identify military widows and OVC from surrounding communities
and assist with linkages to civilian OVC and nutritional programs.
Most USG support for OVC has been in the form of food supplements from the Food for Peace program that is not included in the
HIV/AIDS budget allocations, at a value of $700,000. As was the case reported in the previous mini-COP, the Food for Peace
program is scheduled to be terminated in Ghana in September 2009. Alternative food sources are being created with the
establishment of communal gardens, and USAID and OICI are discussing funding alternative income generating activities funded
with non-HIV/AIDS resources. Also, the additional focus of the Ambassador's Self-Help Fund towards OVC, as discussed above,
will strengthen USG Ghana's coordination of efforts at the grassroots level.
The USG will develop a strong partnership with UNICEF to implement the forthcoming National Action Plan and develop a vision
for joint action for the next fine years.
With Compact funding, the USG agencies will adhere to the requirements of using 10 percent of funds for OVC programming.
Increasing the quality and coverage of OVC programs is one of the four goals stated in Ghana's Partnership Compact Concept
Paper.
With additional Compact funding, USG Ghana will build on the recommendations of a recent OVC and Nutrition technical visit
(September 2008) to expand programming. A primary focus would be increased capacity building and support at the national
level to strengthen the response to OVC. Using as a foundation the forthcoming National Plan of Action, and working in
collaboration with the relevant national bodies (the National OVC Committee, the Department of Social Welfare (DSW), the
Ministry of Women and Children), activities may include the following: supporting national efforts towards an OVC database;
supporting the planned OVC Situational Analysis; promoting promising practices around institutional care and transitioning to
community-based models; and implementing recommendations from the recent capacity assessment of the DSW.
Compact funding would also be used to scale up promising and effective OVC interventions, such as vocational training programs
and community-based OVC care and protection structures like the Queen Mothers Association. Given both the high rate of
malnutrition in Ghana and the phasing out of the Title II food program, attention is needed for the nutritional component of OVC
programs, including links with clinical health services and PMTCT programs and nutrition education. Developing linkages with the
food for prescription activities will be immediately explored once Compact funding is assured.
Partnership with UNICEF established
National coordination mechanisms inaugurated.
300 OVC receiving scholarships through OICI and
25 OVC supported through the Ambassador's fund
The national OVC Action Plan approved
Table 3.3.13:
