Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3323
Country/Region: Haiti
Year: 2008
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $5,620,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,275,000

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

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

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: 36

- Number of pregnant women who received HIV counseling and testing for PMTCT and received their test

results: 53000

- Number of pregnant women provided with a complete course of antiretroviral prophylaxis in a PMTCT

setting: 787

- Number of health workers trained in the provision of PMTCT services according to national and

international standards: 166

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $0

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):

Number of individuals reached through community outreach that promotes HIV/AIDS prevention through

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

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $0

Integrated Activity: This activity is linked to Activity IDs 9683.08, 9791.08, 18959.08, 10109.08, 12421.08,

12430.08, 17789.08, 4347.08 and 9676.08.

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

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. 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

prevention activities. According to the last DHS there is a 12% prevalence rate among Haitian traditional

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.

Emphasis Areas:

Community Mobilization/Participation 20-60

Information, Communication, Education 20-60

Development of Network/Linkages/Referral Systems 10-40

Local Organization Capacity Development 10-40

TARGETS:

# 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

Target Populations:

Street Youth

Out of school youth

Couples

Men

Women

Coverage Areas:

National

Funding for Care: Adult Care and Support (HBHC): $250,000

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.

ACTIVITIES AND EXPECTED RESULTS:

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.

TARGETS:

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.

Funding for Care: TB/HIV (HVTB): $300,000

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

network to expand HIV services throughout Haiti. Most of these points of services are currently offering CT

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.

Funding for Care: Orphans and Vulnerable Children (HKID): $300,000

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.

ACTIVITIES AND EXPECTED RESULTS:

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

Target Populations:

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

Funding for Prevention: HIV Testing and Counseling (HVCT): $650,000

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%

TARGETS:

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 =

Funding for Treatment: Adult Treatment (HTXS): $2,750,000

SUMMARY: USAID Haiti implements an integrated maternal and child survival program through a network

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.

Funding for Laboratory Infrastructure (HLAB): $95,000

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.

SUMMARY:

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.

EMPHASIS AREAS:

Infrastructure51%-100%

Human capacity development10%-50%

TARGETS:

3 Lab technicians hired

3 laboratories to perform HIV-testing and CD4

3 laboratories improved its infrastructure

TARGET POPULATIONS:

People living with HIV/AIDS

Laboratory Workers

COVERAGE AREAS: national

Funding for Health Systems Strengthening (OHSS): $0

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.