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:
Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention
Total Planned Funding for Program Budget Code: $1,949,100
Total Planned Funding for Program Budget Code: $0
Table 3.3.03:
Table 3.3.13:
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $775,000
Program Area Narrative:
OVERVIEW
Ghana's HIV sero-prevalence rate is 1.9% among the adult population (UNAIDS 2008). 2005 and 2006 USG-supported studies
confirm that the epidemic is concentrated in subpopulations with high-risk behaviors: commercial sex workers (38%; with mobile
CSW at 31% and stationary CSW at 45%) and men who have sex with men (26%).
Although this and other strategic information on the epidemic is available, it is not always disseminated or used in Ghana at the
levels of policy, programming, or decision-making. A recent assessment of Ghana's national spending on HIV/AIDS programs
indicates that funding for most at risk populations (MARPs) interventions in 2006 was extremely low—less than 1% of the overall
national budget (combined government, private sector and donor funds).A recent World Bank evaluation questions the quality and
efficiency of the national program.
There are signs of progress in the evolution of the national priorities, however. A recent study funded by the World Bank, now in
draft, confirmed that most-at-risk populations, notably female sex workers (FSW) and men having sex with men (MSM), are
disproportionately higher represented in the HIV infected population and strongly recommended increased financial resources be
dedicated to these populations. The study was well-received by the national Technical Working Group, led by the Ghana AIDS
Commission (GAC).
The USAID-supported Strengthening HIV/AIDS Partnerships Project (SHARP) project has generated evidence-based research on
FSW interventions that have been widely disseminated to national-level stakeholders. Evidence-based research findings related
to MSM communities have not yet been disseminated to a wide audience, for fear of a backlash due to the heavy stigmatization of
this group.
The Ghana Health Service has efficient systems for HMIS and a superb national HIV surveillance system. All USG implementing
partners have existing M&E systems, but some will have to be updated to include all PEPFAR indicators. Ongoing data quality
assessments should be implemented for USG implementing agencies and some partners reporting systems.
A national monitoring and evaluation plan is in place and guidelines exist for data collection and analysis but data from the district
level is often of low quality due to inconsistent record keeping and partial reporting. A recent institutional assessment of the GAC
revealed that there is considerable need to strengthen the M&E component of this commission. Also, further M&E system
concerns exist due to the District level HIV focal points being part-time, and support for these efforts at that level are inconsistent.
KEY INTERVENTIONS
Most SI activities will be implemented at the national level (dissemination of critical information) and within the 30 USG focus
districts with implementing partners and USG implementing agencies (for dissemination, M&E capacity building and data quality
assessments). Through SHARP, the USG has supported the strengthening of the GoG and USG institutions in strengthening
M&E systems, especially at the district level, and in measuring HIV incidence within MARPs. Also through SHARP, USG Ghana
has conducted quick studies to identify promising practices and program bottlenecks, and package and disseminate this strategic
information.
CURRENT USG SUPPORT
Key in the FY 2007 and FY 2008 program was the dissemination and use of existing data and research findings and improving the
data quality by USG partners. By 2007 SHARP completed 18 operations/formative research studies, 5 biomarker studies and 3
evaluations. Out of these, a total of 35 research and program reports, and best practices were packaged and disseminated locally
and internationally.
By the end of FY 2008, SHARP supported 14 sub-grantees working in prevention through grants and technical assistance (TA) to
develop and strengthen their M&E systems, build credible data audit trails and improve data quality and use. This support
included standardization of data collection tools across partners and geographic regions. Technical assistance was given to 20
Ghana Health Service clinics to collect data and report timely on HIV/STI activities. Sixteen USAID-focus districts received TA to
improve their data collection, analysis and management of information generated from the collected data and reports. SHARP
also provided USG partners QHP, GSCP, HOPE, and DELIVER with technical assistance to streamline and standardize data
collection instruments and procedures to ensure that data reported is of high quality.
As a part of the effort to improve data quality, DOD assisted the Ghanaian Armed Forces (GAF) in initiating the process of
recruiting a full-time data entry clerk/analyst to use program data to further focus the military HIV/AIDS program.
USG FY09 Support
In FY 2009 USG Ghana will provide support for improved monitoring of the HIV epidemic and progress in the Ghana response.
USG will facilitate the GAC development of a comprehensive HIV surveillance plan appropriate for the Ghana epidemic, which is
driven to a significant extent by MARPs and high prevalence in several geographic areas. These efforts will also include technical
support for ongoing sentinel and population based biologic and behavioral surveillance efforts as well as program monitoring. To
support the use of the data, further analysis and data use projects will be developed and initiated potentially including secondary
data analysis, multiple data source synthesis, and GIS/mapping efforts to support the national planning needs. This may also
include further efforts to quantify the contribution of most at risk populations to the epidemic.
To improve prevention effort in Ghana, USG Ghana will conduct special MARP studies to answer key questions critical to effective
prevention programming. For example, understanding the geographic areas of concentration and size of at-risk populations. It will
also aim at understanding emerging epidemic drivers such as the role of intravenous drug users (IDU), and understanding the role
that less formal sex work and/or transactional sex plays. All efforts will focus on targeted formative research, with an emphasis on
cost-effectiveness and promoting impact-driven programming.
SHARP had the mandate to support implementing partners in M&E systems development and maintenance. However, the
SHARP project will end in September. Some SI activities, especially the dissemination of information and training at district level,
will become part of a new "health systems strengthening" activity. SHARP will pursue a rigorous dissemination of information
generated over the years as part of its exit strategy, including one national and nine regional close-out conferences.
USG Ghana will continue to strengthen existing USG partners M&E systems with special focus on improving data quality and
dissemination and use of existing information for program management. Specifically, the USG Ghana will follow up on the findings
and recommendations from the internal data quality audit of the USG partners conducted in 2008 to make sure data collected by
the USG partners are of a high quality.
The DOD will complete the process of hiring a data entry clerk/analyst for the GAF preventive medicine program as a part of the
effort to improve the quality of data coming from the program. The allocated funds will also help to provide training in epidemiology
and data analysis to GAF staff, fund travel of GAF staff to present their data if accepted at the implementers' meetings or other
meetings, and for assistance with data analysis.
USG will also support GAC in the development and initiate implementation of a national HIV program evaluation agenda among
partners including priorities regarding HIV prevention programming, HIV care/treatment barriers and linkages, and patient uptake
and retention PMTCT, TB, HIV care.
USG will be providing assistance to the NACP to develop the nation's capacity to carry out HIV-incidence studies which can be
particularly valuable to evaluate the impact of MARP interventions. Initial incidence estimation will be conducted using existing
specimens that are held by the NACP, these potentially include ANC specimens 2006-2008; behavioral survey specimens from
2006 (FSW, MSM). This activity is rolled over from the FY08 workplan.
An assessment of the current HMIS will be supported to determine physical system and human resource gaps and needs, as well
as gaps in information gathered and subsequent opportunities for information use. Areas of potential gaps may include: support
for information systems implementation including EDS at sub-national levels, patient management data systems, laboratory
services, logistics management, human resources, and national program indicators. USG will support the GAC effort to harmonize
data requirements and tools for collection of national M&E indicators contained in National M&E plan including routine data quality
assessment in sub-national M&E systems, and work toward integration of different health and HIV data systems.
Strengthening the USG Ghana SI team is one of the priorities of the M&E agenda for FY09. The USG agencies will individually
work to strengthen their internal M&E teams while working together to coordinate M&E activities for the entire USG Ghana
strategic information team through the leadership of a USG Ghana SI Liaison.
LEVERAGING AND COORDINATION
A major forum for dissemination of information is the National Technical Working Group, as well as subcommittee for M&E of the
GAC, of which USAID is deputy chair. Through leveraged technical assistance from UNAIDS, key District Assemblies staff in 30
districts will be trained in CRIS, an HIV/AIDS data management software. Careful planning will ensure that these initiatives are
synergistic. HIV/AIDS Indicator surveys are carefully planned with the relevant Ministries and Agencies. While USAID will largely
fund the DHS survey, UNICEF, DfID and the Global Fund contribute to other major studies.
EXPANSION OF PROGRAM WITH ADDITIONAL COMPACT FUNDING
If additional funding is available from Compact funds, further SI initiatives will include
•Population estimation and mapping exercise and Behavioral/Biologic surveillance of additional MARPs, potentially including
some of the following FSW, MSM, IDU, prisoners, refugees, specific at-risk youth groups (e.g. female market porters), cocoa farm
seasonal workers, and border site truck drivers.
•Institutionalizing HIV incidence estimation in additional populations.
•Institutionalizing HIV drug resistance surveillance and monitoring.
•Support for the development and implementation of harmonized community-based monitoring systems and linkage to facilities for
data entry and analysis (both NACP and GAC/MLGRD reporting, networks)
COUNTRY-SPECIFIC INDICATORS
With the overarching emphasis on most-at-risk populations in the Ghana program, USG Ghana has adopted country-specific
indicators to monitor its progress over time. All are subsets of PEPFAR indicators.
PREVENTION
# of individuals MARPs (FSW, MSM, PLHA) reached through community outreach that promotes HIV/AIDS prevention through
abstinence or being faithful;
other behavior change beyond abstinence and/or being faithful;
BASIC HEALTH CARE
# of service outlets that provide clinical care for MARPs (FSW, MSM, PLHA) (excluding TB/HIV)
# of individuals MARPs (FSW, MSM, PLHA) receiving clinical care (excluding TB/HIV)
C&T
# of service outlets providing counseling and testing for MARPs (FSW, MSM, PLHA, STI patients) according to national and
international standards
# of individuals from MARPs (FSW, MSM, PLHA, STI patients) who received counseling and testing for HIV and received their
test results.
PRODUCTS AND OUTPUTS
*40 local organizations provided with technical assistance for strategic information activities during the year to provide quality data
that improves district response;
*120 individuals trained in strategic information
*National capacity established to carry out HIV incidence studies.
Table 3.3.17:
