Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3323
Country/Region: Haiti
Year: 2009
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $5,290,000

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

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 hard-to-reach areas (zones ciblées). They will continue to 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: During the period of October 2007 to June 2008, 29,560 pregnant women have been

tested in MSH network. The OPT- OUT strategy for pregnant women is almost well seated in the facility

based PMTCT services that are already exist and will be strengthened. 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.

Community based PMTCT implemented during 2008 will be expanded 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:

Service will be reorganized to provide a full and complete package of PMTCT services at institutional and

community levels.

Activity 1:

-Hire a case manager for all PMTCT centers.

-HIV Counseling and testing (CT) coupled syphilis screening as well as psychosocial support will be offered

to all pregnant women using the opt-out strategy at the 1st antenatal visit; FP counseling will be reinforced

during prenatal services. Birth Plan will be developed and reviewed at each visit to increase adherence to

prophylaxis and treatment. HIV+ pregnant women will be encouraged to deliver at institutional level but

prophylaxis strategy will be adapted based on client specificity. Community Health workers and TBA will

help in pregnant women and newborn tracking and compliance.

-Tuberculosis (TB) screening will be provided to all HIV+ pregnant women with referral as needed for TB

treatment;

-Cd4 count will be available in all PMTCT sites.

-Nutritional assessment and dietary counseling for mothers to make informed choice on infant feeding in the

first six months of life as well as appropriate weaning counseling and education will be provided.

-Continuous on site training for services Providers at institutional and community levels will be provided to

ensure safe obstetrical care.

Activity 2:

-Program retention of HIV-positive pregnant women will be improved by ensuring the cost of institutional

visits and delivery are covered, including fee for transportation. 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. Subsidies will be ensured for TBAs to accompany pregnant

women at risk and institution will be encouraged to let TBAs assist in institutional delivery. TBA will work

closely also with Health agents for active referral of newborns (before 3 days after birth) and their mothers

at the closest HIV care and treatment center.

-MSH will expand the Mothers Clubs Strategy for HIV+ mothers to serve as peer educators and

accompagnateurs.

Activity 3:

-MSH will integrate promotion of PMTCT services into its BCC-MC interventions. All community meetings

will be taken as an opportunity to mobilize women for HIV testing and to promote the importance of PMTCT.

-HIV positive pregnant women will be encouraged to join PLWHA support groups where they will have an

opportunity to access to micro-credit programs for income generating activity.

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17187

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17187 9683.08 U.S. Agency for Management 7686 3323.08 Basic Health $1,275,000

International Sciences for Services

Development Health

9683 9683.07 U.S. Agency for Management 5146 3323.07 Basic Health $655,000

International Sciences for Services

Development Health

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Care: Adult Care and Support (HBHC): $100,000

SUMMARY: The USAID bilateral health program supports Management Sciences for Health (MSH) to

implement its primary health care program including maternal and child health, family planning, and

tuberculosis integrated to HIV, working through a network of non-governmental organizations (NGOs). With

Fiscal Year (FY) 2008 resources, the USG will continue to expand basic care and support through this

network to reach 8,000 people living with HIV/AIDS in linkages with counseling and testing (CT), ARV,

tuberculosis (TB)/HIV and PMTCT services.

BACKGROUND: In the previous years, with PEPFAR resources, MSH has made a lot of local advocacy to

integrate care and support into community based services already in place within Primary Health Care

centers. All supported sites by MSH are surrounded by well organized community based structure providing

a comprehensive and holistic approach for maternal and child health and TB services. This community

based services is being used as a platform for the provision of care and support and reduce stigmatization

and discrimination. A series of steps have been taken to wrap around HIV services in order to integrate all

aspects of services provided. These points of service are dispersed throughout the 10 regional departments

of the country and serve about 43% of the population.

Twenty of the most important MSH health facilities are being reinforced to offer a structured package of

basic care and support. 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 June 2008, about 7535 PLWHA have received palliative care services in

this network.

With FY 2009 resources, MSH will continue to build on these efforts to reinforce and expand palliative care

services in existing twenty sites to reach 10,000 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

nurses to follow PLWAs, psychologists, social workers, counselors, community health workers and PLWAS

to serve a peer accompagnateurs; 2) to support the organization of health services: patient monitoring,

laboratory infrastructure renovation 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 in concertation with the Supply Chain Management System that is

responsible for providing laboratory reagents, commodities and OI drugs. 3) to set up "maison de transit"

around selected ART sites as needed.

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 providers 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

healthcare providers 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. It is expected that MSH will have sufficient funding 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 their families and to

help them to gain access to social support services. All VCT sites will have basic care and 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. PLWHA will be enrolled in support groups who will be

strengthened to organize themselves in Associations. The support groups will serve as a platform to the

provision of community care and support through a family centered approach to increase access to a

broader package of social, nutritional and economical support services.

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

If appropriate funding is provided, MSH will emphasize psychological support to PLWAs and their affected

families 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17190

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17190 10109.08 U.S. Agency for Management 7686 3323.08 Basic Health $250,000

International Sciences for Services

Development Health

10109 10109.07 U.S. Agency for Management 5146 3323.07 Basic Health $200,000

International Sciences for Services

Development Health

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $2,100,000

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. This year MARCH has phased out its health activities in the

Central Plateau and has transferred the management of ARV services in this area over PIH. So the total of

ARV sites actually managed by MSH has been reduced to five.

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 five

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.

With COP 09 resources MSH will strengthen its network of 5 sites with emphasis on monitoring the

outcomes of the program in order to improve its quality. Treatment services will be expanded to a new site,

AEADMA Hospital located in the Grand'Anse department. This expansion will contribute to fill in some

important gaps in a hard to reach area.

ACTIVITY AND EXPECTED RESULTS:

Activity 1: To meet scale needs at the five existing sites and to expand services at the new site, 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. Particular emphasis will be put on the monitoring of treatment outcomes

thru the electronic database system. Poor outcomes will be addressed and corrected.

Activity 4: MSH will establish a referral system between the six 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17194

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17194 4387.08 U.S. Agency for Management 7686 3323.08 Basic Health $2,750,000

International Sciences for Services

Development Health

10203 4387.07 U.S. Agency for Management 5146 3323.07 Basic Health $1,975,000

International Sciences for Services

Development Health

4387 4387.06 U.S. Agency for Management 3124 3124.06 HS2007 $700,000

International Sciences for

Development Health

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $300,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $200,000

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

Activity Narrative: Gender Equity:

The program will target women as well as men. A particular emphasis will be placed on women from the

PMTCT program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17190

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17190 10109.08 U.S. Agency for Management 7686 3323.08 Basic Health $250,000

International Sciences for Services

Development Health

10109 10109.07 U.S. Agency for Management 5146 3323.07 Basic Health $200,000

International Sciences for Services

Development Health

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment

Total Planned Funding for Program Budget Code: $2,485,000

Total Planned Funding for Program Budget Code: $0

Table 3.3.11:

Funding for Treatment: Pediatric Treatment (PDTX): $600,000

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

of nongovernmental organizations (NGOs). This program is being implemented by Management Sciences

for Health, as the main contractor, under the name of Health for Development and Stability in Haiti (HDSH).

Through the President's Emergency Plan for AIDS Relief (PEPFAR), the United States Government (USG)

provided resources to MSH for the SDSH 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 SDSH NGO

institutions, with emphasis on improving the quality of care.

BACKGROUND: Over the last two years, six 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 and

Ouanaminthe in the North East Department. During that time MSH network has enrolled over 1000 patients

in ARV services. USG efforts have been completed by other MSH partners to test children born from HIV +

mothers.

In FY 2009, MSH will create 2 new ARV sites and will implement a new ARV treatment strategy integrated

in Primary Health Centers to improve access to treatment. This approach will ensure formal bidirectional

referral system between these centers and the centers of excellence.

ACTIVITY AND EXPECTED RESULTS:

Activity 1: To meet scale up needs within its network, MSH will continue to reinforce overall service

organization making available a better package of human resources and infrastructure at the clinic and

community levels. Emphasis will be placed on allocating more nurses, psychologists, social and community

health workers to improve the continuum of care from clinics to home based including pediatric treatment

services. Home-based care will be sustained 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 provide transportation fees for tracking of patients and home-based care.

Activity 3: MSH will continue to 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 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17194

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17194 4387.08 U.S. Agency for Management 7686 3323.08 Basic Health $2,750,000

International Sciences for Services

Development Health

10203 4387.07 U.S. Agency for Management 5146 3323.07 Basic Health $1,975,000

International Sciences for Services

Development Health

4387 4387.06 U.S. Agency for Management 3124 3124.06 HS2007 $700,000

International Sciences for

Development Health

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $200,000

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 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

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 (PLWHA) and their families. The coverage area includes all ten geographic departments where

USAID has implemented its bilateral health program.

BACKGROUND: The United States Government (USG) has taken a series of steps to wrap around the

SDSH 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

primary health care services. These non-governmental organization (NGO) points of service are dispersed

throughout the country's 10 regional departments. As such, they represent a good network to expand HIV

services throughout Haiti. Some 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 6 offer ARV treatment services. Most of these HIV palliative care and treatments

sites are offering also TB services with support from Global Funds (GF) 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 8,000 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 (GoH) and other key HIV and TB

implementing partners to adapt 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 in collaboration with Partnership for Supply Chain Management (PFSCM). Based on needs

assessment, the targeted sites will be reinforced with equipment, 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 (CDS) 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 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17191

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17191 9676.08 U.S. Agency for Management 7686 3323.08 Basic Health $300,000

International Sciences for Services

Development Health

9676 9676.07 U.S. Agency for Management 5146 3323.07 Basic Health $100,000

International Sciences for Services

Development Health

Table 3.3.12:

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 organization (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 testing (VCT), and anti-retroviral (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 the

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, kidnapping, and a surge in gang rape have

characterized this area designated by the United Nations as a "hot zone" thus out 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. In 2009, MSH with its

partner organizations (Maison Arc en Ciel and FOSREF) will replicate and expand OVC interventions based

on previous results in the area.

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 the 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 right for those children.

Activity 3

MSH will provide school fees for children 6 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 Maison Arc en Ciel at the "Filles de la Charite Health center" in Cite Soleil.

With these sub grantees 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 which won a "best practice award" in this field has important expertise in

providing shelter for orphans and vulnerable children.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17192

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17192 12421.08 U.S. Agency for Management 7686 3323.08 Basic Health $300,000

International Sciences for Services

Development Health

12421 12421.07 U.S. Agency for Management 5146 3323.07 Basic Health $625,000

International Sciences for Services

Development Health

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $50,000

Water

Table 3.3.13:

Funding for Prevention: HIV Testing and Counseling (HVCT): $515,000

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

of nongovernmental organizations (NGOs). This program is being implemented by Management Sciences

for Health, as the main contractor, under the name of Health for Development and Stability in Haiti (HDSH).

With the President's Emergency Plan for AIDS Relief (PEPFAR) USG provided resources, 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 non NGO institutions

that operate within its network at the periphery of centers of excellence.

BACKGROUND: Over 2008,VCT services have been implemented in 34 of the USAID network NGOs:

From October 2007 to June 2008, they have tested 64759 people with an average of 6,476 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 has yet to reach its

potential due to financial constraints when considering the fact that the sites where the program takes place

are secondary and primary health care centers with significant attendance. VCT has for long evolved in

Haiti as a by-product of the PMTCT program and MSH had already started the opt-out approach in its

network. Therefore the focus in FY09 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, continued efforts will be maintained in FY09

to integrate counseling services in the package offered at the fixed posts coupled with rapid syphilis tests.

Activity 1

Field support to enhance CT services at 34 existing sites with emphasis on integrating fully CT into the

routine clinical services offered to all patients and providing more partner referral services as well as couple

and family counseling including previous children. 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 will serve to cover salaries of current and additional counselors,

phlebotomists, facilitators to provide escort services to patients when they test positive and social workers

at important sites to reinforce the psychosocial support provided to patients after testing.

Activity 2

Expansion of CT services, based on resources available, at selected fixed posts already offering the

package of MCH care. Since the two previous years of SDSH, 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 FY09 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 and ensure that all HIV+ patients are enrolled in support

groups. 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18959

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18959 18959.08 U.S. Agency for Management 7686 3323.08 Basic Health $650,000

International Sciences for Services

Development Health

Table 3.3.14:

Subpartners Total: $0
Comite de Bienfaisance de Pignon: NA
Centre de Santé Lucélia Bontemps: NA
Rosalie Rendu Center: NA
Centers for Development and Health: NA
Foundation of Compassionate American Samaritans: NA
Fondation pour le Developpement de la Famille Haitienne: NA
Haitian Health Foundation: NA
Fondation pour la Sante Reproductrice et l'Education Familiale: NA
Centre de Sante Pierre Payen: NA
Hospital Claire Heureuse: NA
Hopital de Fermathe: NA
Grace Children Hospital: NA
Mission Evangelique Baptist d'Haiti: NA
Hopital Beraca: NA
Konbit Sante: NA
Cross Cutting Budget Categories and Known Amounts Total: $400,000
Human Resources for Health $300,000
Food and Nutrition: Policy, Tools, and Service Delivery $50,000
Education $50,000