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.
Years of mechanism: 2008 2009
Integrated Activity: This activity is linked to Activity IDs 18959.08, 9791.08, 12421.08, 9937.08, 10109.08,
12430.08, 17789.08, 4347.08 and 9676.08.
SUMMARY: PMTCT is an integral part of comprehensive HIV care and treatment of people living with
HIV/AIDS (PLWHA). Activities described in this narrative will be conducted at 19 non-governmental
organizations (NGO) centers and 28 hard-to-reach areas (zones ciblées) that cover a network of 47 service
delivery sites! They will operate under Management Science for Health (MSH), the USAID contractor for
primary health care, in collaboration with the Ministry of Health (MOH). PMTCT training activities will be
conducted in collaboration with the Ministry of Health (MOH), the Haitian Institute for Community Health
(INHSAC) through I-TECH. At the community level, activities will target traditional birth attendants (TBAs),
community health workers (CHWs), and couples expecting children. Pregnant women and their partners will
be encouraged to attend antenatal clinics (ANC) through community mobilization activities.
BACKGROUND: Resources will be used to support PMTCT services in the MSH network and the sites that
serve populations who live at hard -to-reach areas. Facility-based PMTCT services that already exist at the
11 centers will be strengthened There still is no significant work at the community level to ensure that all
pregnant women are encouraged to be tested for HIV and accompanied to CT centers and that women
enrolled in the PMTCT program follow up with their pregnancy and birth plan.
ACTIVITIES AND EXPECTED RESULTS:
Activity 1: MSH will provide a full package of PMTCT services, as outlined in MOH national guidelines,
including:
• counseling and testing (CT);
• tuberculosis (TB) screening with all pregnant women with TB referred for treatment ;
• sexually transmitted infection (STI) testing and management;
• reproductive health services, particularly family planning counseling for HIV-positive
women including promotion of condoms;
• case management of HIV-positive pregnant women, including eligibility assessment for
ARV treatment with Cluster of Differentiation 4 (CD4) determination and will be
referred for treatment in accordance with national guidelines;
• psychosocial support;
• nutritional assessment and dietary counseling for mother;
• counseling and education for informed choice on infant feeding in the first six months
as well as appropriate weaning and continued feeding of child;
• short-course ARV prophylaxis regimen for HIV-positive women according to national
guidelines;
• prophylaxis of opportunistic infections (OIs); and
• safe obstetric care.
In addition to training in obstetric care, MSH will train staff in delivery techniques that minimize exposure of
the baby to the blood and secretions of the mother (artificial rupture of membranes, episiotomy, and suction
of the mouth of the newborn). Further, personnel will be trained to protect themselves and their patients
against HIV through the use of gloves and protective glasses, the use of sterile instruments, disinfectants
etc. After delivery, HIV-positive mothers and their babies will be referred to HAART centers for clinical care
follow-up. The program will ensure that female healthcare providers are equitably represented in all
trainings and in the implementation of activities.
Activity 2: Program retention of HIV-positive pregnant women will be improved by ensuring the cost of
hospital visits and hospital delivery are covered, including transportation to the hospital. MSH PMTCT sites
will work closely with their network of community health agents and traditional birth attendants (TBA) to
carry out a tracking system for the enrolled pregnant women. Most of the NGOs work closely with
community Mothers Clubs that will be engaged to help ensure that all pregnant women are tested for HIV
Activity 3: MSH will promote PMTCT services via community events including health fairs, face-to-face
communication using a variety of channels such as churches, schools, health facilities, home visits, and the
media and will organize community testing days, on patron saints days, and on special days (i.e.
International AIDS Day, Candlelight Vigil Day, etc.). Promotional activities such as public service
announcements within the targeted communities, banners and street signs will make the population, and
particularly pregnant women, aware of this opportunity. HIV positive pregnant women will be encouraged to
join PLWHA support groups where they will have access to micro-credit programs for income generation
and productive activity creation and interventions against violence and coercion. At community level, the
programs will be supported by the staff of newly designed Community Palliative Care institutions for the
provision of psycho-social support, increase of adherence to prophylaxis and referrals of both HIV+
pregnant women/mothers and their infants.
Activity 4: MSH will provide continuing education sessions for staff to keep them abreast of new
developments in PMTCT, particularly the psychological aspects of post-test counseling of HIV-positive
pregnant women. In collaboration with JHPIEGO and I-TECH/INHSAC training sessions, will be held onsite
to ensure participation of the personnel.
Targets - September 2009:
- Number of service outlets providing the minimum package of PMTCT services
according to Haitian and/or international standards: 47
- Number of pregnant women who received HIV counseling and testing for PMTCT and received their test
results: 40000
- Number of pregnant women provided with a complete course of antiretroviral prophylaxis in a PMTCT
setting: 1000
- Number of health workers trained in the provision of PMTCT services according to national and
international standards: 141
according to Haitian and/or international standards: 36
results: 53000
setting: 787
international standards: 166
Integrated Activity: This activity is linked to Activity IDs 9683.08, 9937.08, 9937.08, 10109.08, 12430.08,
12421.08, 17789.08, 4347.08 and 9676.08.
SUMMARY: Management Sciences of Health (MSH), the institutional contractor for USAID's integrated
health services umbrella mechanism, will receive prevention funds to target at-risk adults and youth with
abstinence and be faithful (AB) prevention messages. These targeted efforts will continue to ensure
sustainable interventions for promoting prevention activities through the local non-governmental
organizations (NGOs) that receive funding under MSH's umbrella mechanism. Umbrella mechanisms
provide the administrative structure and management capacity to build strong local institutions and generate
involvement of local NGOs and CBOs through direct technical assistance and funding by the lead partner.
Building on past investments to strengthen the capacity of the network of health NGOs in Haiti, the USG will
provide support to include HIV/AIDS prevention into the provision of a basic package of health services for
vulnerable groups in Haiti. The NGO sub partners form a network of nearly 100 service delivery sites that
provide access to basic health services to nearly 3.2 million people. Another 30 public sector service
delivery sites are supported under this project to assist the MOH in hard-to-reach communities throughout
the country. This program is 50-50 split funded with AB and OP funds.
BACKGROUND
With last year's successful elections, the new government has signaled a strong desire to improve basic
social services throughout Haiti, including attention to HIV/AIDS prevention. The new government's program
recognizes that in order to respond to basic health needs, more efforts are required to encourage the
involvement of NGOs and the private sector. As a result, the GOH has indicated support for continuing to
forge public private partnerships in the rebuilding of Haiti's health sector and the delivery of basic services.
Many of USAID's existing NGO partners are in a strategic position to better integrate Being Faithful
messages targeted to couples, men engaging in high risk sex with multiple partners, and sexually active
youth between 15-24 years of age. Many of these NGOs already have organized programs through
mother's clubs, father's clubs, youth associations and have expressed interested in incorporating HIV/AIDS
prevention methods. Recent DHS data on HIV prevalence and behavioral determinants point to the need to
target parts of the country with the highest HIV/AIDS prevalence rates, such as Nippes, North and the North
East Regional Departments, the latter on the border with the Dominican Republic, with the most frequently
used border crossing.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: MSH will provide 15 NGOs funding to conduct advocacy activities among community leaders
to change community norms in supporting messages to reduce risky sexual behavior. Community leaders,
church members, adult volunteers and parents will be trained in planning and implementing abstinence and
behavior change programs within their ongoing health and community development programs. Up to 30
adult leaders will be trained (2 from each NGO) who will in turn train up to 20 adults peer educators within
their NGO network for a total of 300 adults trained. Adult peer educators will provide information, education
and communication services to their peers, including: counseling for discordant couples, promoting
messages on mutual fidelity, monogamy, partner reduction and personal risk assessment. Referrals for HIV
counseling and testing (CT) will be promoted so adults can know their status and focus on behaviors to
reduce chances of being infected or transmitting HIV to others. During community events, discussions will
be held around gender based violence, transactional sex, couple communications and messages which
increase community advocacy and support changes in community norms for reducing high risk behavior.
Over 6,000 adults will be reached through this activity.
Activity 2: A special focus will be placed on "Being Faithful" interventions which target men where they
commonly congregate, such as brothels, sporting events, pubs, clubs, community and social events. Again,
efforts will be undertaken to target USAID's network of father's clubs, as well as men through male networks
of local celebrities, entertainers, artisans, and transportation networks, Messages targeting these male
groups will reinforce themes of fidelity, partner reduction, avoidance of commercial sex and linkages to
condom outlets. The needs of HIV discordant couples will be addressed through targeted counseling and
education as well as referrals to CT. Counseling and behavior change education on prevention of
transmission for HIV positive persons, "prevention for positive" will be an integral part of all prevention
efforts. Efforts will be made to train male adult leaders and youth, to better target messages to men in
supporting behavior change and reducing the spread of HIV.
ACTIVITY 3: Support will be given to youth focused NGOs to accelerate abstinence and being faithful
programs for youth, most of them out of school and working in the informal sector. Specifically, up to 20
youth peer/counselors (per 15 NGO/CBOs) will be trained for a total of 300 youth who will target their peers
with be faithful and risk reduction messages. It is anticipated that these youth will be identified from the
existing NGO network receiving funding under MSH, such as youth groups and clubs, local musician
networks, sporting associations, local civic associations and community groups. Many of these networks are
in security "hot spots" (areas inaccessible due to violence and instability in the past few years) and are
targets for USAID's new three-year strategy to support the Government of Haiti in its rebuilding efforts. It is
anticipated that civil society groups will promote youth in the planning, design and implementation of training
and outreach efforts in order to maximize youth ownership and buy-in. Following training, youth peer
educators will conduct outreach activities during community events such as carnival, World AIDS Day,
sporting tournaments, youth camps, music jamborees and activities frequented by youth. It is anticipated
that each peer educator will reach about 50 peers each during the period for a total of 15,000 youth reached
with AB messages. Sexually active youth will be referred to condom outlets, CT, and linkages to other
USAID reproductive health services, including family planning.
ACTIVITY 4- MSH will work with the organized groups of traditional faith leaders to develop and implement
prevention activities. According to the last DHS there is a 12% prevalence rate among Haitian traditional
faith parishioners. MSH will perform an assessment to determine the behaviors that lead to high
transmission rates within this population in order to best develop messages and activities to reach this
group. MSH will work with the leaders to develop HIV/AIDS ABC messaging most appropriate for the
population according to risky behaviors identified within the target population. Know your status messages
will be stressed in this population as well, with referrals to CT locations. It is anticipated that 20 traditional
faith healers will be trained as educators and leaders, and will promote ABC within their communities for a
total of 2000 traditional faith practitioners reached.
Emphasis Areas:
Community Mobilization/Participation20-60
Activity Narrative: Information, Communication, Education20-60
Development of Network/Linkages/Referral Systems 10-40
Local Organization Capacity Development 10-40
TARGETS:
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
abstinence (a subset of total reached with AB):
abstinence and/or being faithful: 23,000
Number of individuals trained to promote HIV/AIDS prevention through abstinence and/or being faithful: 620
Target Populations:
Street Youth
Out of school youth
Couples
Men
Women
Coverage Areas:
National
Integrated Activity: This activity is linked to Activity IDs 9683.08, 9791.08, 18959.08, 10109.08, 12421.08,
SUMMARY: Management Sciences for Health (MSH) was awarded USAID's new basic health services
contract in 2007 for a period of three years, thus allowing them to continue the work of its Non-
governmental Organization (NGO) health service delivery network in prevention education to target groups
at high risk for HIV/AIDS. The NGO sub-partners form a network of nearly 100 service delivery sites that
the country. USG will support these civil society NGOs that can be mobilized to quickly launch condom
outlets and other prevention activities in some of the insecure "hot spots" targeting underserved most at risk
population (MARP) groups. Prevention activities will target parts of the country with the highest HIV
prevalence rates and support NGOs and CBOs in the network to target these high risk groups. The 2005
Demographic and Health Survey (DHS) data suggest that while knowledge in ways to prevent HIV
transmission is high—over 90%, condom use is low—30% and accompanied by high risk sexual activity.
Partners will work with marginalized communes, peri-urban areas and secondary cities where major
pockets of high risk activity take place to institute additional condom outlets. Training of network members
will include building skills in risk self assessment, condom negotiation, counseling and testing and linkages
to CT, raising issues related to gender and sexual violence and changing social norms. In 2008, NGO
partners will sharpen the targeting of prevention efforts to five key MARP groups: sexually active youth
aged 15 to 24; couples; men engaging in high risk sex; migrant/border populations, and traditional faith
leaders. This program is 50-50 split funded with AB and OP funds.
BACKGROUND: Historically there have been only a few strong and widely recognized Haitian NGOs with
the managerial and technical capacity to implement effective prevention and behavior change programs
targeting specific high-risk populations. In FY 2006, PEPFAR leveled the playing field by expanding the use
of the USAID umbrella NGO mechanism, the previous MSH contract, to strengthen the capacity of new
smaller, nascent Haitian NGOs, CBOs, Faith-based Organizations (FBOs) and private sector entities to
contribute to prevention efforts for targeted populations that typically engage in high-risk behavior. With the
recent successful elections, the new government has signaled a strong desire to improve basic social
services throughout Haiti, including attention to HIV/AIDS prevention and supporting public private
partnerships in the rebuilding of Haiti's health sector. The condom activities and other prevention efforts in
this activity are in line with this vision. Sub-partner NGOs working under the USAID umbrella mechanism
will target parts of the country with the highest HIV prevalence rates, such as Nippes, the North and the
North East Regional Departments, the latter on the border with the Dominican Republic, with the most
frequently used border crossing.
ACTIVITIES & EXPECTED RESULTS
Activity 1: Support will be provided for advocacy and education by NGO and CBO partners to address key
prevention themes, such as promotion of correct and consistent condom use, adoption of personal risk
reduction strategies, encouraging HIV CT among MARPs and prevention education for people living with
HIV/AIDS (PLWHA). These themes will be addressed in the following types of activities: 1) training in
advocacy techniques for community leaders, 2) training of peer educators and counselors, 3) emphasis on
"know your status" messages and 4) ensuring that there are effective referral systems between CT services
and other HIV/AIDS care and treatment services for sexually active youth, couples and men. More
aggressive targeting of prevention messages and condom social marketing to MARPs will be done through
USAID civil society networks.
Activity 2: A special focus will be placed on interventions which target men where they commonly
congregate, such as brothels, sporting events, bars, clubs, community and social events. If possible special
efforts will be made to reach unemployed young men, street traders, members of the informal sector, and
divorced men. Efforts will be undertaken to target USAID's network of father's clubs, as well as men through
male networks of local celebrities, entertainers, artisans, and transportation networks. Messages targeting
these male groups will reinforce themes of fidelity, partner reduction, avoidance of commercial sex, gender
violence, alcohol and drug use, as well as condom use. The needs of HIV discordant couples will be
addressed through targeted counseling and education as well as referrals to CT services and HIV care and
treatment counseling on prevention of transmission for HIV positive persons, stigma reductions and
"prevention for positive" will be an integral part of all prevention efforts. Linkages will be made with the
USAID-supported social marketing program to increase condom use among MARP groups. It is anticipated
that each NGO partner will train up to 10 male peer educators each to target up to 50 peers each with
messages to reduce risky behavior and promote condom use, for a total of 7,500 males reached.
Activity 3: Many of these organizations work in socially and politically unstable "hot spots" (areas
inaccessible due to violence and instability in the past few years). As PEPFAR enters its fifth year, efforts
will be made to create synergies with USAID's education, governance, food security and economic growth
initiative to increase prevention messages and positive behavior change among high risk groups. In
particular, linkages will be made with USAID job creation program to target 15-24 year olds. Funds will
support start up, training and materials to target messages to adolescents and youth through youth groups
and clubs; local musician networks, sporting associations, local civic associations and community groups.
Special efforts will be made to better target 15-24 year olds to increase awareness of personal risk, reduce
the number of sexual partners, address gender and transactional sex and increase correct condom use.
Particular focus will be placed on providing women with access to programs that address violence and
sexual coercion. Up to 15 civil society organizations or networks will receive small grants to undertake
condom and other prevention activities. Up to 150 youth peer educators (10 per NGO) will be trained to
reach 50 peers each for a total of 7,500 youth reached with messages on correct and consistent condom
use, if appropriate. Referrals will be made to urge counseling and testing and linkages for care and support.
ACTIVITY 4- MSH will ensure continuous supply of condoms within areas of each department that has
limited condom service delivery available. The first step consists of conducting a situation analysis in the
communities with the involvement of existing MSH community organizations. Results of the situation
analysis will allow MSH and community organizations to search for ways to improve the availability and
accessibility of condoms. MSH will identify community members and organizations willing to become
promoters of condom use and managers of condom outlets. Four condoms outlets will be created in each
underserved area. This initiative will be linked to other PEPFAR partners conducting social marketing of
condoms or free condom distribution and the Ministry of Health (MOH). Those who are willing to become
managers of condom outlets will receive training and technical support to manage the outlets. 40 individuals
from different organizations will be trained, 40 additional condom outlets will be created.
ACTIVITY 5- MSH will work with the organized groups of traditional faith leaders to develop and implement
faith parishioners. MSH will work with the leaders to develop HIV/AIDS ABC messaging most appropriate
Activity Narrative: for the population according to risky behaviors identified within the target population. MSH will perform an
assessment to determine the behaviors that lead to high transmission rates within this population in order to
best develop messages and activities to reach this group. MSH will work with the leaders to develop
HIV/AIDS ABC messaging most appropriate for the population according to risky behaviors identified within
the target population. Know your status messages will be stressed in this population as well, with referrals
to CT locations. It is anticipated that 20 traditional faith healers will be trained as educators and leaders, and
will promote ABC within their communities for a total of 2000 traditional faith practitioners reached.
Community Mobilization/Participation 20-60
Information, Communication, Education 20-60
# of targeted condom service outlets: 40
# of individuals reached through community outreach that promotes HIV/AIDS prevention through other
behavior changes beyond Abstinence and/ or Being faithful: 17,000
# of individuals trained to promote HIV/AIDS prevention through other behavior changes beyond Abstinence
and/ or Being faithful: 360
SUMMARY: The USAID bilateral health program supports Management Sciences for Health (MSH) to
implement its maternal and child survival, reproductive health, and tuberculosis programs, working through
a network of non-governmental organizations (NGOs) to offer health care services in Haiti: hospitals, health
centers, dispensaries and community networks covering one fourth of the Haitian population. The United
States Government (USG) has taken steps to build on this network to integrate HIV services, including
palliative care basic care. With Fiscal Year (FY) 2008 resources, the USG will continue to expand palliative
care through this network to reach 8,000 people living with HIV/AIDS PLWHAs in linkages with counseling
and testing (CT), ARV, tuberculosis (TB)/HIV and PMTCT services.
BACKGROUND: With FY 2005 and FY 2006 President's Emergency Plan for AIDS Relief (PEPFAR), the
USG has taken a series of steps to wrap around the USAID bilateral integrated health program, in order to
integrate HIV services, including CT, PMTCT, TB/HIV, basic palliative care, and antiretroviral medication
(ARVs) into primary health care services. These NGO points of service are dispersed throughout the 10
regional departments of the country and serve about 25% of the population. As such, they represent a good
network to expand HIV services throughout Haiti. Most of these points of services are currently offering CT
services, and 30% - 40% of them have maternity wards which deliver PMTCT services.
Twenty of the most important MSH health facilities are being reinforced to offer a well structured package of
palliative care. This package includes clinical care to prevent and treat opportunistic infections (OI), to
monitor the optimal time for highly active antiretroviral therapy (HAART) integrated with home-based care,
and psycho-social support services building on the important child survival and maternal health community
network program. As of March 2007, about 5,000 PLWHA have received palliative care services in this
network.
With FY 2008 resources, MSH will continue to build on these efforts to reinforce and expand palliative care
services in existing twenty sites to reach 8,000 PLWHA.
Activity 1: Service Organization:
MSH will ensure that all patients testing positive at any of MSH's points of service are enrolled in clinical
palliative care and therefore get access to laboratory, clinical, nutrition, psycho-social assessment and
follow up. Funding will be used: 1) to staff each site with a multi-disciplinary health care team, including
physicians, nurses, psychologists, social workers, counselors, nutritionists, community health workers. and
laboratory technicians (see laboratory narrative); 2) to support the organization of health services: patient
monitoring, laboratory for basic and CD4 testing, dispensation of opportunistic infection treatment and
prophylaxis, pain and symptom management, long-term patient follow-up and prescription of food to
malnourished PLWHA; 3) to refurbish laboratories to enhance workspace , drug storage, and clinical
management. This will be done in concert with the Supply Chain Management System that is responsible
for providing laboratory reagents, commodities and OI drugs
Activity 2: Human capacity building:
MSH will continue training to ensure that the clinical staff maintains skills in the care and treatment of
people infected with HIV/AIDS. The emphasis will be put this year on training health professionals in
nutrition assessment, follow up, and recuperation to make sure that all sites are integrated with nutrition
services. The capacity to provide quality health care at the local level will depend upon the skills maintained
by the medical staff at each health center. More focus will be put this year on training nurses to play a
greater role in clinical management of PLWHA according to norms. To sustain a workforce of the highest
quality, MSH will provide on-going training and technical support on a regular basis.
Activity 3: Social support services:
Special attention will be given to the need for social support for patients enrolled in the palliative care
program. Funding will enable MSH to hire at each site a social work team lead by a social worker that will
be in charge of assessing the social needs of all PLWHA and help them to gain access to social support
services. Direct support will be provided through the sites, for example, fees for services (delivery,
hospitalization, and x-ray) and for transportation to appointments. Patients will be referred to the PLWHA
association and community based organization in charge to provide community palliative through a family
centered approach to gain access to a broader package of social and economical support services (see
Association of Evangelical Relief and Development Organizations, Catholic Relief Services, Family Health
International and Plan activity narratives for palliative care).
Activity 4: Home based care
MSH will increase the number of community health workers to accommodate scale-up at each of its points
of service. The community workers will be in charge of tracking patients (including pregnant women enrolled
in PMTCT and infected and exposed children), providing at home adherence support and health education
on best health and nutrition practices, counseling for positive behavior, distributing care and preventive
commodities such as condom, ORS, pain medications according to the guidelines, and making appropriate
referrals. Community workers will be trained on symptom recognition, and syndromic treatment, particularly
when they have patients experiencing health or psychosocial problems.
Activity 5: Psychological support
Funding will be used to hire psychologists at structured palliative care site to provide support to PLWHA to
reduce denial, assist in psychological assessments, follow up, and on preparedness for HAART and chronic
follow up and treatment. MSH will continue to provide support around each site's PLWHA support groups to
create a supportive environment for treatment adherence and stigma reduction. In addition, local community
leaders, traditional healers, and religious leaders will be incorporated to encourage and enhance support of
patients within the community. MSH will work in collaboration with religious sector to provide spiritual care to
patients.
TargetSept. 2008Feb. 2009Sept. 2009
LPTF 20
PWLHA receiving Palliative Care
8,000
Persons trained in Palliative Care600
Gender Equity:
Activity Narrative: The program will target women as well as men. A particular emphasis will be placed on women from the
PMTCT program.
SUMMARY: The United States Agency for International Development (USAID) bilateral health program
supports a contractor to implement the project for maternal and child survival, reproductive health, and
tuberculosis (TB) programs working through a network of non-governmental organizations (NGOs) to offer
health care services in Haiti. As Management Sciences for Health (MSH) will expand HIV palliative care to
include comprehensive medical services, psychosocial support, and follow-up in this network, it will ensure
that HIV patients get access to tuberculosis (TB) screening, prophylaxis, and treatment and that TB patients
detected in TB wards get access to counseling services and HIV care in this network.. Development of
networks and linkages will be encouraged with other HIV clinical and community-based programs supported
by the President's Emergency Plan for AIDS Relief (PEPFAR) through MSH. The target populations include
people living with HIV/AIDS and their families. The coverage area includes all ten geographic departments
where USAID has implemented its bilateral health program.
BACKGROUND: With Fiscal Year (FY) 2005 and FY 2006 PEPFAR resources, the United States
Government (USG) has taken a series of steps to wrap around the Health System 2007 (HS2007)
integrated health program, to integrate HIV services such as counseling and testing (CT), prevention of
mother-to-child transmission (PMTCT), and TB/HIV, basic palliative care, and antiretroviral (ARVs) into
HS2007's primary health care services. These NGO points of service are dispersed throughout the
country's 10 regional departments and serve about 25% of the population. As such, they represent a good
services and 30% - 40% have maternity wards which are delivering PMTCT services. Twenty of these
institutions are offering clinical palliative care while four offer ARV treatment services. Most of these HIV
palliative care and treatments sites are offering also TB services with support from Global Funds and
USAID. With few resources, efforts were made to integrate TB/HIV activities in MSH network, focusing on
TB screening, prophylaxis, and treatment for HIV patients, on integrating counseling in TB wards and on
establishing referrals between the TB and HIV services at these sites to provide continuum of care to co-
infected patients according to norms..
While MSH is taking steps to expand its network of HIV services to enroll at least 15,000 HIV patients in
care, there is a need to continue expanding the TB/HIV program through this network by improving
screening capacity, reinforcing linkages with TB services for TB treatment as needed, integrating this
program into pediatric care, reinforcing TB infection control measures, and by monitoring TB drug
resistance. In addition, MSH is committed to working in collaboration with the government of Haiti and other
key HIV and TB implementing partners to define national policies and strategies for the program.
EXPECTED RESULTS AND ACTIVITIES
ACTIVITY 1: MSH will continue to reinforce its network of HIV sites to perform TB screening, prophylaxis,
and treatment for HIV positive individuals. Next year, MSH will emphasize HIV positive children as pediatric
care in being expanded through this network. TB infection control measures and TB drug resistance
monitoring will be implemented in this network according to national norms and protocols. Resources will be
used to build human capacity, to reinforce infrastructure (including laboratory) and to ensure adequate
provision of purified protein derivative (PPD) test and related commodities and isoniazid (INH) for
prophylaxis (see SCMS activity narrative). Based on needs assessment, the major hospitals will be
reinforced with chest x-ray capacity, including equipment and related materials and commodities to improve
TB screening. This will complement sputum smear diagnosis capacity implemented at all the TB sites
through the TB/Directed Observed Treatment Short-Course (DOTS) program financed by the Global Fund
to Fight AIDS, Tuberculosis and Malaria (GFATM).
ACTIVITY 2: PEPFAR resources will be used to strengthen human resources and logistics of the MSH Haiti
headquarters and quality assurance/quality improvement (QA/QI) team to work with the MOH's central and
departmental levels and other lead TB NGOs—International Child Care (ICC), Cooperative for American
Relief Everywhere (CARE), and the Centre Pour Le Développement et la Santé and Groupe Haitien d'Etude
du Darcome de Kaposi et des Infections Opportunistes (GHESKIO)—to coordinate and monitor the TB/HIV
program. In addition, health professionals from the MSH network will be trained in TB/HIV at Siguenau
Hospital that is being reinforced thru GHESKIO to become a center of excellence in TB/HIV care and
treatment.
ACTIVITY 3: MSH will participate, along with the Ministry of Health (MOH) and other lead TB NGOs, in
developing and/or updating norms, protocols, and guidelines and training tools for TB/HIV with emphasis on
TB infection control, TB HIV pediatric care and on monitoring of TB drug resistance. MSH will use PEPFAR
resources to disseminate these documents and implement these TB/HIV activities in the MSH network.
SUMMARY:
MSH implements an integrated country-wide maternal and child health program through a network of non-
governmental organizations (NGOs). Since 2006, MSH has brought these services to neglected, remote,
and hard to reach areas. With PEPFAR funding, MSH is also providing services at PMTCT, voluntary
counseling and test (VCT), and anti-retroviral services (ARV) sites. MSH will capitalize on the mobilization
of a vast array of community health workers and traditional birth attendants to develop a tracking system for
enrolled HIV positive pregnant women and their newborns. Families receiving palliative care will be also
identified, and through home visits vulnerable children affected by or infected with HIV will receive a
package of services including access to basic child health services, referral to pediatric AIDS care and
treatment, psychosocial support, support for education and vocational training, facilitation for birth
registration and access to income generating activities for their families. MSH will also work in Cite Soleil, a
slum area of Port au Prince, with a network of NGOs with experience in the prevention, care, and treatment
of HIV infected children and care of orphans and vulnerable children (OVC).
BACKGROUND: The MSH program will identify orphans and vulnerable children from families receiving
palliative care in their network and enroll them in the OVC program. MSH will link new OVC activities with
existing President's Emergency Plan for AIDS Relief (PEPFAR) and maternal and child health interventions
in the targeted area.
Cite Soleil, with a population estimated around 300,000, has been out of reach for health programs for two
years. Political violence, widespread insecurity, random killing, kidnappings, and a surge in gang rape have
characterized this area designated by the United Nations as a "hot zone" thus out of reach of public health
workers. The public health community suspects this area has a high prevalence of sexually transmitted
infection. This slum was stabilized in 2007 and MSH with the support of three NGOs, is funded by PEPFAR
help identify HIV positive adults and newborns, provide access to education, psychosocial support to
adolescents, referrals to pediatric AIDS care and treatment centers for children and adolescents eligible for
anti-retroviral therapy (ART), as well as care for orphans and vulnerable children. MSH with its partner
organizations will strengthen OVC interventions in the area in 2008.
Activity 1. MSH will identify all newborns from HIV positive mothers and enroll them as either exposed or
infected OVC. MSH, which is engaged in maternal and child health (MCH) activities, will provide services
related to immunization, Vitamin A supplementation, and de-worming and other preventive care package
interventions (safe water, ITNs, and ORT supplementation for treatment of acute diarrhea). Through its
community network, MSH will link OVC to clinical care where testing will be performed and access to ART
to those eligible provided. MSH will also work with Title II partners and the World Food Program for the
families with OVC to have access to food.
Activity 2. MSH will provide training for its community workers and health personnel in OVC care. MSH will
provide OVC caregivers training in areas related to psychosocial support for OVC. Prevention messages
and recreational activities will be organized in order to help the children cope with their environment. MSH
will assist OVC to obtain birth registration, a key impediment in obtaining inheritance rights for those
children.
Activity 3. - MSH will provide school fees for children six to 12 years of age to attend primary school. MSH
will focus on gender issues with the goal of having at least 50% of the OVC girls in primary schools. MSH
will also provide access to vocational training for OVC aged 15 to 18 years of age.
Activity 4. MSH will work with FOSREF and Arc en Ciel at the Filles de la Charité Health Center in Cite
Soleil. With these subgrantees MSH will identify newborns from HIV positive women, elder orphans and
vulnerable children and provide them MCH services. Access to ARV will be provided by referrals to a
pediatric AIDS health center. Grace Children's Hospital, a pediatric AIDS center, will offer clinical support.
FOSREF will play a key role in developing prevention and education messages to adolescents infected or
vulnerable. Maison Arc en Ciel has important expertise in providing shelter for orphans and vulnerable
children. This NGO has won a best practice award in this field.
Emphasis Areas
Development of network / Linkages/Referral Systems
Human resources
Needs Assessment
Training
Strategic Information
Target:
Number of OVC served: 3000
Number of providers/caregivers trained in caring for OVC: 300
HIV/AIDS -affected families
Orphans and vulnerable children
People living with HIV/AIDS
Girls (Parent: Children and youth (non-OVC)
HIV positive pregnant women (Parent: People living with HIV/AIDS)
Key legislative issue
Increasing gender equity in HIV/AIDS programs
Stigma and discrimination
SUMMARY: USAID Haiti implements an integrated maternal and child survival program through a network
of nongovernmental organizations (NGOs). This program that used be called the Health Systems 2007 (HS-
2007) has just been renewed for five years on the name of Health for Development and Stability in Haiti
(HDSH). Both HS2007 and HDSH have been and will be implemented by Management Sciences for Health
(MSH) as the main Contractor. With the President's Emergency Plan for AIDS Relief (PEPFAR) USG
provided resources to MSH to add HIV activities that include counseling and testing (CT), PMTCT, palliative
care and anti- retroviral (ARV) services. In 2008, MSH will continue to maintain and reinforce VCT services
in its network institutions with emphasis on opt-out, provider-initiated counseling and testing. Efforts will be
deployed to expand services at institutions that operate at multiple points of service to cover both referral
and peripheral centers.
BACKGROUND: Over the last three years, VCT services have been implemented in 33 of the USAID
network NGOs: From October 2006 to August 2007 they have tested 43,964 people with an average of
3,996 people a month. With 8,28% of people testing positive, the proportion of positive people tested in the
network remains above the national average, indicating that the program covers areas with most at risk
population. The number of people tested by sites through Counseling and Testing outside PMTCT
services have yet to reach its potential (100 people tested per site per month) when considering the fact that
the sites where the program takes place are secondary and primary health care centers with significant
attendance. The reason is that VCT has for long evolved in Haiti as a by-product of the PMTCT program
and has only recently started to gear toward an opt-out approach. Therefore the focus in FY08 will be on
making counseling and testing services widely available to all walk-in and in-ward patients at all the facilities
where the services are offered in the network. Furthermore, since most of the MSH collaborating sub
partners have strived over the years to expand MCH services in their coverage areas through rally and fixed
posts, efforts will be deployed in FY08 to integrate counseling services in the package offered at the fixed
posts.
Activity 1: Field support to CT services at 33 existing sites with emphasis on integrating fully CT into the
routine clinical services offered to all patients and providing more partner referral services and couple and
family counseling. Emphasis will be put on communicating test results the same day and on providing
escort services systematically to positive patients when they are referred within and outside facilities.
Funding should serve to cover salaries of current and additional counselors and phlebotomists, hire
facilitators to provide escort services to patients when they test positive, hire social workers at important
sites to reinforce the psychosocial support provided to patients after testing.
Activity 2: Expansion of CT services at 44 selected fixed posts already offering the package of MCH care:
Since FY07 some of the MSH collaborating partners have expanded C&T services to fixed posts operating
in their neighborhood and providing already the package of maternal and child care services, leveraging
thereby both MCH and PEPFAR resources to open access to services for hard to reach population. In
FY08 emphasis will be on making available at the fixed post resources to provide escort services to patients
and cover their transportation cost at their initial visit when referred for patient care at the referral center.
Attention will also be paid on ensuring that basic information system are in place to collect data from the
fixed posts and aggregate them with those of the parent-organization.
EMPHASIS AREAS:
Community mobilization /Participation20%-50%
Training 20%-50%
Quality assurance/quality improvement/supportive supervision10%-50%
Development of network/linkages/referral systems10%-50%
Information/education/communication10%-50%
Number of service outlets providing counseling and testing according to national or international standards
= 33
- Number of individuals who received counseling and testing for HIV and received their test results =
51,000
- Nb of individuals trained =
of non-governmental organizations (NGOs). This program, which was formerly named the Health Systems
2007 (HS-2007), was recently renewed for five years. Its new project name is Health for Development and
Stability in Haiti (HDSH) and will be implemented by Management Sciences for Health (MSH). Through the
President's Emergency Plan for AIDS Relief (PEPFAR), the United States Government (USG) provided
resources to MSH for the HS-2007 program to wrap around the integrated health program and add HIV
activities, including counseling and testing (CT), PMTCT, palliative care, and anti- retroviral (ARV) services.
MSH will continue to maintain and reinforce ARV services in its network of HDSH NGO institutions, with
emphasis on improving the quality of care.
BACKGROUND: Over the last three years, five USAID network NGOs have implemented ARV services.
The NGOs include, MARCH (Management and Resources for Community Health [MARCH] Hospital in the
Central Plateau; Beraca Hospital in the North West; Grace Children's in the West Department;
Communauté de Bienfaisance de Pignon [CBP] Hospital in the North Department; and Fort-Liberté in the
North East Department. With Fiscal Year (FY) 2007 resources, these services are being expanded to
Ounaminthe Hospital, another NGO institution. With the addition of Ounaminthe, the total number of ARV
sites supported through the MSH network is six. This represents a good start to the 41 ARV institutions that
the USG plans implement by September 2008.
The USG expects to implement the additional targeted ARV sites through existing partners, such as PIH,
GHESKIO, MSPP etc. The USG has provided resources around existing child survival programs at all six
sites to implement the model of ARV care based on good assessments of patients (clinical and laboratory),
regular patient follow up, good pharmacy plans, and community support for adherence to treatment.
Further, the entry to ARV services has been through VCT, PMTCT, palliative and TB care programs that are
being reinforced at these sites. Resources were given to strengthen human resources, enhance
infrastructure, and support minimal social costs for patients. In addition, resources were allocated to Haitian
Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) to support training and
quality assurance as well as quality control (QA/QC/QI) at those which have implemented electronic
medical records (EMR) and automated drug management systems. To date, the MSH network has enrolled
close to 1000 patients in ARV services.
In FY 2008, the USG will integrate the two ARV sites in the North East, the public hospitals in Fort-Liberté
and Ounaminthe, under a new network institution that will be selected through a competitive process that
CDC will launch to issue a cooperative agreement (CoAG) with this institution. This institution should have
experience implementing integrated health programs in public sector hospitals in the North East Department
and should be knowledgeable and capable in addressing cross border issues, as this regional department is
situated on the Dominican border. Additionally, ICC—as the parent institution—will provide Grace Children's
Hospital resources directly from ICC for TB/HIV activities. This approach will ensure better integration of the
USG effort to make Grace Children's Hospital a solid center of excellence for integrated ARV and TB/HIV
care. The USG team expects this action to reduce the MSH network of ARV services to three institutions:
MARCH, BERACA and CBP. This reduction will provide MSH the opportunity to focus in depth on these
three sites to continue aiding them in providing quality ARV services in integration with CT, PMTCT,
HIV/TB, and basic care that will be expanded at these sites.
ACTIVITY AND EXPECTED RESULTS: Activity 1: To meet scale needs at the three targeted sites, MSH
will continue to reinforce overall service organization to make available a better package of human
resources (clinical and community), and better infrastructure at clinic and community levels. Emphasis will
be placed on allocating more physicians, psychologists, and social and community workers, and to
complete necessary infrastructure renovations. The USG team also expects an initiation and/or
improvement in pediatric treatment services. Home-based care will be reinforced to ensure better tracking
of patients and to provide some basic follow up of treatment at home as well as support to people living with
HIV/AIDS (PLWHA) and their families.
Activity 2: MSH will support logistics and provide materials and supplies needed for home-based care and
tracking of patients.
Activity 3: MSH will coordinate the program and provide technical assistance to the sites to ensure that the
services are well organized and are able to respond to the model of care through regular visits. MSH will
also provide onsite training of staff at the sites. MSH will hire and support appropriate staff to oversee this
program and to coordinate with MOH, HIVQUAL, and other stakeholders, the rolling out an improved
system of QA/QI in the network.
Activity 4: MSH will establish a referral system between the three ARV sites and other peripheral CT and
basic care sites to ensure a continuum of care to patients detected at these peripheral sites. In addition,
these ARV sites will be linked to the community-based-organizations and PLWHA support groups to provide
integrated community support for patients enrolled in treatment.
These activities are continuing activities as MSH performed them in a different program--ARV Services.
Integrated Activity: This activity is linked to Activity IDs 9683.08, 9791.08, 9937.08, 10109.08, 12421.08,
12430.08, 18959.08, 4347.08 and 9676.08.
Funds will be used to provide sufficient laboratory working bench space and purchase equipment needed
for improvement of laboratory infrastructure. A functional laboratory is critical to support persons living with
HIV/AIDS (PLWHAs). Laboratory workers will be hired and trained to service the laboratory.
BACKGROUND:
ACTIVITES AND EXPECTED RESULTS:
MSH proposes to carry out the following activities activity in this Program Area.
ACTIVITY 1: MSH will prepare 3 laboratories at its site to provide ARV laboratory services for PLWHAs
under ART. When new testing for example CD4 testing, blood chemistry and hematology will be offered at
ARV laboratory, certain laboratory systems requirements have to be met. MSH will procure basic items
essential for improving laboratory infrastructure. A laboratory will be refitted to provide laboratory bench
space, working hand-wash basin, office space for lab management, storage, and blood collection area.
MSH will procure, install and secure sets of inverters and batteries ensuring constant electrical supply to the
laboratories. MSH will procure and install water tank and water pump to ensure constant water supply. MSH
will subcontract local companies to provide gas tanks, maintain and service gas refrigerators at the
laboratories to make sure that refrigerators are operating well in order to keep essential CD4 and other
laboratory test kits cold. MSH will subcontract local companies in order to implement the tasks described
above.
Activity 2: MSH will hire additional laboratory workers for those ARV laboratories (1 per site) in order to
carry out extra laboratory testing work load for people living with HIV/AIDS. The hired lab technicians will be
trained by the National Public Health Laboratory staff for laboratory testing, QA/QC, good lab practices and
lab management. There will be no cost for training since the NPHL will cover the expenses of training. In
addition, MSH will hire a local laboratory specialist in order to supervise laboratory activities within MSH
network that is supported by PEPFAR.
These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of laboratory
services in order to identify HIV positive persons and increase the number of persons receiving ARV
services.
Infrastructure51%-100%
Human capacity development10%-50%
3 Lab technicians hired
3 laboratories to perform HIV-testing and CD4
3 laboratories improved its infrastructure
TARGET POPULATIONS:
Laboratory Workers
COVERAGE AREAS: national
Summary: Management Sciences for Health will undertake a number of activities under its bilateral contract
with USAID to strengthen systems in the MOH at both the central level and the regional departmental levels
to improve strategic planning, coordination and supervision of the national HIV/AIDS program. Technical
assistance at the central level includes participation in efforts to coordinate donor contributions, carry out
annual budgeting for the HIV/AIDS program, and support the MOH's efforts to promote bi-national
coordination of HIV/AIDS activities with the Dominican Republic. At the regional departmental level, MSH
will provide the Departmental Health Directorates with support to carry out annual planning, implementation,
coordination and supervision of HIV/AIDS activities in their departments.
Background: Management Sciences for Health has a contract with USAID/Haiti to implement an integrated
health program that provides access to basic health care services to over 45% of the Haitian population
through a network of 30 NGO hospitals and clinics and service delivery sites of the MOH in 30 hard to reach
areas around the country. PEPFAR funding into this contract allows MSH to integrate HIV/AIDS activities
and issues into an integrated approach to improving health care. One of the mandates of the MSH contract
is to strengthen the Executive Function of the MOH, which is accomplished through the provision of
technical assistance at both the central and regional departmental levels.
Activity 1: MSH will provide technical assistance to the Unite de Coordination Central (UCC), the MOH
operational unit that coordinates the National AIDS Program, in a number of areas that will strengthen the
UCC's role to provide coordination, supervision and overall strategic direction to the National Program. This
will involve assistance in such endeavors as the development of the annual operational plan, building on the
operational plans for HIV/AIDS programming from the regional health departments; the functioning of the
ministerial working groups on AIDS surveillance and information systems, AIDS care and treatment,
community care and support, prevention of sexual transmission, and prevention of mother to child
transmission; and effective coordination of donor support to the National AIDS Program.
Activity 2: MSH will provide support and technical assistance to the Ministry of Health's initiative to foster
improved coordination with the MOH of the Dominican Republic in HIV/AIDS programming at the political,
policy-making level, the technical normative level and at the local level of service provision. This will involve
support and assistance in planning and implementing bi-national workshops and meetings to harmonize
norms and protocols, to develop cross-border linkages for service provision and to establish information
sharing and exchange procedures for epidemiological surveillance and service statistics.
Activity 3: At the regional departmental level, MSH will provide a technical advisor to each health
directorate that has the role of assisting with strategic and operational planning, supervision, monitoring and
reporting of the health program as a whole. PEPFAR funds will contribute support for these technical
advisors to ensure that HIV/AIDS activities and interventions are integrated into the departmental planning
and implementation functions.
