PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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
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:
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.
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.
Continuing Activity: 17190
17190 10109.08 U.S. Agency for Management 7686 3323.08 Basic Health $250,000
10109 10109.07 U.S. Agency for Management 5146 3323.07 Basic Health $200,000
Table 3.3.08:
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.
Continuing Activity: 17194
17194 4387.08 U.S. Agency for Management 7686 3323.08 Basic Health $2,750,000
10203 4387.07 U.S. Agency for Management 5146 3323.07 Basic Health $1,975,000
4387 4387.06 U.S. Agency for Management 3124 3124.06 HS2007 $700,000
International Sciences for
Estimated amount of funding that is planned for Human Capacity Development $300,000
Table 3.3.09:
implement its maternal and child survival, reproductive health, and tuberculosis programs, working through
a network of non-governmental organizations (NGOs) to offer health care services in Haiti: hospitals, health
centers, dispensaries and community networks covering one fourth of the Haitian population. The United
States Government (USG) has taken steps to build on this network to integrate HIV services, including
palliative care basic care. With Fiscal Year (FY) 2008 resources, the USG will continue to expand palliative
care through this network to reach 8,000 people living with HIV/AIDS PLWHAs in linkages with counseling
and testing (CT), ARV, tuberculosis (TB)/HIV and PMTCT services.
BACKGROUND: With FY 2005 and FY 2006 President's Emergency Plan for AIDS Relief (PEPFAR), the
USG has taken a series of steps to wrap around the USAID bilateral integrated health program, in order to
integrate HIV services, including CT, PMTCT, TB/HIV, basic palliative care, and antiretroviral medication
(ARVs) into primary health care services. These NGO points of service are dispersed throughout the 10
regional departments of the country and serve about 25% of the population. As such, they represent a good
network to expand HIV services throughout Haiti. Most of these points of services are currently offering CT
services, and 30% - 40% of them have maternity wards which deliver PMTCT services.
Twenty of the most important MSH health facilities are being reinforced to offer a well structured package of
palliative care. This package includes clinical care to prevent and treat opportunistic infections (OI), to
monitor the optimal time for highly active antiretroviral therapy (HAART) integrated with home-based care,
and psycho-social support services building on the important child survival and maternal health community
network program. As of March 2007, about 5,000 PLWHA have received palliative care services in this
network.
With FY 2008 resources, MSH will continue to build on these efforts to reinforce and expand palliative care
services in existing twenty sites to reach 8,000 PLWHA.
Activity 1: Service Organization:
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:
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
Activity 3: Social support services:
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).
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.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
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:
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
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 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
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.
Continuing Activity: 17191
17191 9676.08 U.S. Agency for Management 7686 3323.08 Basic Health $300,000
9676 9676.07 U.S. Agency for Management 5146 3323.07 Basic Health $100,000
Table 3.3.12:
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.
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.
Continuing Activity: 17192
17192 12421.08 U.S. Agency for Management 7686 3323.08 Basic Health $300,000
12421 12421.07 U.S. Agency for Management 5146 3323.07 Basic Health $625,000
Estimated amount of funding that is planned for Education $50,000
Table 3.3.13:
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.
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.
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.
Continuing Activity: 18959
18959 18959.08 U.S. Agency for Management 7686 3323.08 Basic Health $650,000
Table 3.3.14:
