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:
Table 3.3.02:
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
n/a
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $485,000
OVERVIEW
Perhaps 100,000 people in Ghana are thought to be in need of clinical palliative care and 88,000 are in need of ART in Ghana
with approximately 19,000 additional persons who become treatment-eligible annually. By September 2008, approximately 19,000
people were on treatment. There is no reliable national figure of patients received HIV-related clinical care (excluding TB/HIV)
from Ghana's 400 clinics and hospitals providing HIV-related care. Civil society's engagement in clinical care expands the
availability of supportive services for PLHA, with perhaps 200 NGOs and FBOs active in-country. Training, drugs, consumables
and refurbishments have been provided to most of the 400 government sites which are funded through a $97 million, five year
grant from the Global Fund which runs through 2011.
USG Ghana's primary health care and support objective is to provide HIV+ clients with knowledge of and access to the full range
of facility and community-based services that comprise the "continuum of care." Interventions within the package of care and
support services for PLHA include: ART, continuous supportive counseling, prevention and management of opportunistic
infections (OI), effective home-based care (HBC), and prevention of new HIV infections, support for PLHA associations and
greater involvement of PLHA in health care and support.
Overall, the supply of clinical services continues to exceed the demand; there is poor uptake of HIV-related services by PLHA who
often wait until they are severely ill before seeking care because of the stigma attached to HIV/AIDS. The availability of ART is
changing the landscape of HIV infection in Ghana. USG's challenge in FY 2008 continued to be encouraging PLHA to seek
services, adhering to treatment and preparing physically and psychologically for reintegration into society.
Stigma, lack of resources for travel and lack of family support constrain the number of persons seeking treatment. Strong
anecdotal evidence suggests people with AIDS are quietly taken to rural areas to die because of stigma and shame. Human
capacity at clinical sites is also problematic; leadership is sometimes weak, motivation is low and personnel demands for extra
remuneration are high. Some doctors feel training and ongoing mentoring have been insufficient, and stigma problems lead some
staff to refuse to be deployed at ART sites. PMTCT and VCT services, which are available at over 400 sites, face similar problems
with stigma being the overarching factor for low performance.
KEY INTERVENTIONS
The USG Ghana program focuses on a combination of clinical and community activities which are combined into a High-Impact
Package (HIP) to address the entire continuum of care. The clinical and community activities of HIP are reinforced through active
case-finding and referrals. Selected PLHA are trained to support the work at clinical sites.
A key aspect of leveraging and coordination is the strategy of targeting USG support to reinforce the basic scale-up support
coming from the Global Fund for AIDS, Tuberculosis and Malaria (GFATM). 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. USAID partner
EngenderHealth's Quality Health Partners (QHP) program targets a combination of recently launched ART sites and 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. Clinical interventions in 25 Global Fund-supported sites focused on improvement
of quality of care and strengthening linkages within facilities (e.g. with TB care providers) and outside facilities (e.g. with most-at-
risk populations) and the network of 20 clinics and five drop-in centers that provide clinical services for these groups. Some
Peace Corps Volunteers work with PLWA groups to promote better palliative care education and access to ARTs.
CURRENT USG SUPPORT
To reinforce the Global Fund's investment in treatment, USAID partner QHP has institutionalized quality improvement processes
in ART and other HIV/AIDS care and support services at health facilities. QHP applies the COPE (Client Oriented, Provider
Efficient) quality improvement process with a particular focus on HIV treatment and ARV services by implementing stigma
reduction and infection control trainings and by holding community-facility meetings to discuss issues with access and
acceptability of services. COPE is a quality assurance process that occurs at clinical facilities and involves staff at all levels. The
process consists of collectively analyzing strengths and weaknesses of service delivery, defining solutions to identified key
problems, developing a QA action plan and regularly monitoring the action plan's implementation. The method has been
successfully used throughout Africa, particularly in Reproductive Health programs.
The Strengthening HIV/AIDS Partnerships (SHARP) Project and QHP are working directly with facilities to improve the availability
and quality of services and to strengthen referral linkages, both within health facilities and to outside organizations.. Palliative care
interventions include adherence counseling and support for disclosure of HIV status to regular partners. Through community
dialogue, patient groups (including sex workers and MSM) are mobilized to establish PLHA support groups and to access quality
services at patient-friendly sites. 104 PLHA serve as adherence counselors in and around ART clinics.
In addition to providing drug logistics support in FY08, JSI Deliver supported the National AIDS Control Program (NACP) to
assess the stock status of ARVs and drugs for OIs at all the 10 regional medical stores across the country, and developed a draft
laboratory supplies SOP manual which has been reviewed by stakeholders. Field testing of the laboratory LMIS and SOP manual
was conducted in April 2008.
PLHA also receive psycho-social support that encourages positive living, treatment adherence and partner disclosure.
Opportunities Industrialization Centers International (OICI) trains individuals through 10 days of continuous education to become
lay counselors and care givers. Training topics include psychosocial and nutritional counseling, status disclosure, positive living
and infection prevention.
Peace Corps supports in-service training to educate volunteers and their Ghanaian counterparts on the implementation of
community-based health care and support programming. The first trainings with PEPFAR FY07 funds were carried out in
September of 2008. Peace Corps also has a small-grants program to support projects managed by volunteer and community
partners that enhance the quality of life for HIV-infected clients and their families. With FY08 funds, some PLWHA groups gained
basic income generating skills to support their palliative care.
USG FY09 SUPPORT
The SHARP agreement will conclude in calendar year 2009. 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.
In FY09, USAID, through its partner(s) will take on 10 new sites to conduct COPE while continuing follow-up activities at 30 of the
sites initiated in prior years. Strategic updates/refresher training will be organized for the 104 PLHA Peer Adherence Counselors
Trained in FY09.
This assistance will continue support to Data Managers as part of the Quality Assurance Teams. An Early Warning Signs for HIV
Drug Resistance Tool, developed by the Ghana Health Service, will be introduced at all sites as well as the newly adapted
Positive Living toolkit which promotes prevention of HIV infection/re-infection, disclosure, ARV adherence, infection prevention,
self stigma reduction, nutrition, family planning and safe drinking water. Stigma reduction and infection prevention training for
health staff and auxiliary workers will continue as will active case-finding of bedridden PLHA nation-wide.
USAID through its partner(s) will use quality assurance methods to improve referral practices for OIs in 40 facilities including TB
and STIs, and psychosocial support. The exercise will identify issues or gaps regarding referral practices and develop solutions
and action plans to address those gaps. USAID supported teams will follow up with the facilities at three-month intervals for one
year to support successful intervention and will also support improved palliative care by continuing basic care and support
training, including infection prevention, for 900 family members and other non-health worker care-givers at the facility level.
JSI/DELIVER will expand its nationwide logistics support activities to all those clinics that are planning to provide HIV-related
services and strengthen the systems in existing ones. JSI/DELIVER will also design and implement a laboratory logistics
management system.
Peace Corps plans to incorporate the cultivation and use of the ‘Moringa' plant as a nutritional supplementation intervention for
PLHA. USAID, through its implementing partner FANTA, will develop a food for prescription program that targets those newly
initiating ART below a certain body-mass index. The program might also target PLHA with severe malnutrition (with or without TB)
even when they do not qualify yet for ART.
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 also leverages
district government support for PLHA operational costs in its work with this key population. USG has leveraged non-PEPFAR
USG programs such as the Presidential Malaria Initiative which distributes bed nets to eligible PLHA in 40 planned locations.
EXPANSION OF PROGRAM WITH ADDITIONAL COMPACT FUNDING
Under an expanded compact scenario USG supported partner(s) will:
•Develop a national QA program implemented by the Ghana Health Service
•Collaborate with the NACP for ART providers to continuing education, mentoring, and remote assistance with management of
difficult or unusual clinical problems.
•Undertake an assessment of OI diagnostic capacity at the regional and district levels for the purpose of recommending
appropriate and rational improvements in OI diagnostic capabilities at those sites.
•Significantly expand support to the PLHA adherence counselor program
•Significantly expand support to PLHA groups to implement prevention with positives activities and initial screenings for TB.
•Expand DOD support to all 9 medical facilities in the country.
•DOD to conduct genotypic resistance testing as well as TB drug sensitivity testing.
PRODUCTS/RESULTS
Treatment
* 40 health facilities supported to increase the quality of treatment services and reduce stigma, training 600 staff.
* All 9 DOD sites supported to improve care and treatment services.
* ARV procurement and logistics information systems and procurement supported nationally, training 100 trainers and
supervisors;
* 29,000 persons currently on ART at USG-supported sites at the end of FY09 activities, of which 7,000 initiated ART in the year.
* Strategic updates/refresher training organized for 104 PLHA Peer Adherence Counselors at 25 sites.
Care and support
* USG supporting a total of 220 care and support outlets.
* Improved palliative care services at 40 HIV/AIDS facilities, training 900 individuals (family members, health staff, PLHA) HIV
care and treatment and infection prevention.
* 42,000 PLHA provided with care and support services.
* A first 2000 PLHA with symptomatic disease assisted with nutritional support.
* 60 Peace Corps volunteers and their Ghanaian counterparts trained to promote health care and support in their communities.
Table 3.3.08:
