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
Rates of malnutrition in Haiti are among the highest in Latin America. According to the Demographic Health
Survey of 2005- 2006, 24% of children less than five years are stunted, 9 % are wasted and 22% are
underweight. 61% of children under five with the highest prevalence in children 12 -17 months and 50% of
pregnant women are anemic. Food insecurity in Haiti has worsened considerably leading to the recent
upheaval of May 2008. In that context, PEPFAR /Haiti is engaged in a prevention and curative approach for
PLWHA as food by prescription , a component of clinical care and treatment at the sites.
Activities and expected results:
Activity 1: Ready to use therapeutic feeding for malnourished children and adults
SCMS will do the procurement of ready to use therapeutic food (Medika Mamba) a locally produced peanut
based high energy product which is expected to have soon UNICEF certification and the distribution to the
PEPFAR sites where it will be stored at the pharmacies and given as a food by prescription to all
malnourished children and adults responding to the criteria and following the guidelines established by the
Ministry of Health.
Activity 2: Fortified blended flour
SCMS will do the procurement and distributions of a fortified blended food from the sources provided by the
World Food Program and do the distribution at the PEPFAR sites. This fortified product which will abide by
international standard will be given as food by prescription to children from 6 months to three years and for
pregnant women, lactating women attended at the sites as a preventive intervention. 3500 pregnant and
lactating HIV+ women and 4000 OVC 6months to 3 years are expected to benefit from that intervention.
Program target:
Number of individuals receiving ART with evidence of severe malnutrition receiving food and nutritional
supplementation during the reporting period:
3000 adults
2000 children
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $5,172,473
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Haiti is the poorest country in the Western Hemisphere with 75% of its 8.5 million people living at or below the absolute poverty
level. Haiti remains the Caribbean country most highly affected by HIV/AIDS, with a prevalence rate of 2.2%. The epidemic is
most appropriately labeled as a ‘mixed' epidemic; heterosexual transmission is the most common HIV/AIDS transmission vehicle.
According to the most recent Demographic Health Survey (DHS) in 2005-2006, Haiti's prevalence rate was listed as 2.2%;
delineating the rate of 2.3% for women, and 2.0% for men. These rates vary by age, rate peaks occur during 30-34 years of age
for women (4.1%), and during 40-44 years of age for men (4.4%).
The most recent DHS highlights that knowledge of HIV/AIDS is very high in Haiti, and while erroneous ideas regarding modes of
transmission persist amongst the general population, knowledge of prevention methods, including abstinence, fidelity, and
condom use is high as well. For women, 93% list fidelity and 84% list abstinence as effective prevention methods; 95% of men list
fidelity and 87% list abstinence. This showcases the successful work accomplished by the MOH, PEPFAR and other HIV/AIDS
prevention implementers in the past several years in Haiti with regards to raising awareness of the virus and methods to protect
oneself from infection through AB messaging. Yet, Haiti has a declining age of sexual debut, more than half of all men report
engaging in sexual activity outside of their committed relationship, and condom use is very low. Data from the Demographic and
Health Survey (DHS) 2005 shows that condom use in Haiti has decreased. Indeed, data indicates that while 98% of never married
women are sexually active, condom use among this group is barely 30%. In addition, condom use among youth (15-24) is even
lower, putting them at risk for both HIV and unwanted pregnancy.
Thus, much work remains to be done in the area of transitioning knowledge into practice in Haiti. In terms of multiple and
concurrent partnership, 29% of women and 62% of men reported engaging in sexual activity with an individual outside of their
committed relationship. This behavior is overwhelmingly common in youth ages 15-19 years with 71% of females and 99% of
males in this age group reported multiple partners in the past 12 months. The percentage drops significantly for women as their
age increases, and also drops for men, but not as dramatically. When engaging in sexual activity outside of their committed
relationship, only 29% of women and 43% of men reported using a condom. Thus, in FY 09, the USG PEPFAR team will continue
to focus on condoms- procurement, distribution, and behavior change. While condoms will be stressed, the USG team will be
focusing on comprehensive ABC programming in FY09, addressing multiple and concurrent partnerships, amongst other topics.
PEPFAR prevention programming in Haiti has complemented the MOH prevention plan in a variety of activities focused on ABC
messages, beginning with efforts within the youth demographic. In 2006, PEPFAR Haiti received a rapid assessment of their
programs during a joint TA from USAID and OGAC. One of the recommendations was to better distribute prevention programming
across the population, reaching beyond youth to adults. A more equal distribution of ABC programming was incorporated in FY08,
as partners reach out to and targeted more activities with adults. This shift will continue in FY09. Another important
recommendation of the TA visit in 2006 stressed to need to perform a mapping exercise of all the prevention programs in Haiti;
this was conducted in May 2007, and displayed the need for expansion of programming in rural and hard to reach areas of Haiti,
including urban areas that have been insecure in recent years. This important expansion geographically was be highlighted
throughout the FY08 prevention plan and carries into FY09 as well.
Regarding abstinence, behavior change activities among the general population remains a vital and critical component of the USG
Teams prevention programming, emphasizing this as the only method to absolutely avoid HIV infection. FY09 will continue to
utilize faith-based organizations as well as a strong network of NGO's to support this programming. "A" messages will be targeted
toward non-sexual active youth, and will stress the importance of abstaining in an effort to halt the declining age of sexual debut.
Organizations such as FOSREF, Plan, and EDC will work with high-risk street youth and will organize ‘secondary abstinence'
clubs. New for FY08, these activities will reach into areas that were not covered in prior years, such as EDC's work in urban ‘hot
spots' (areas of the city unreachable due to insecurity and instability), and MSH's expansion into underserved rural communities
and Nippes; these programs will continue into FY 09.
As the USG Team shifts the prevention portfolio from a mainly youth focused plan to a more balanced approach, B and C
messages will be emphasized, especially among the adult male population. With HIV rates peaking in women age 30-34, and
men 40-44, it is important to put heavy emphasis on the sexually active population in Haiti in order to promote behavior change.
AERDO, FOSREF, MSH, PLAN, and the TBD communications partner will all shift their programs to include more targeting of
adult populations, mainly men, migrant workers, clients of commercial sex workers, with be faithful and condom use behavior
change activities to reduce numbers of sexual partners. ‘B and C' targeted prevention activities will targets adults in rural and
underserved areas as well.
For condoms, the only other source of non-commercial condoms in Haiti besides PEPFAR is United National Population Fund
(UNFPA), which donates 24,000,000 per year for the MOH Family Planning Program. In FY 09, PEPFAR funds will be used to
make up the gap between what UNFPA donates and the projected need for the country. Through a recently established condom
distribution working group at the MOH, collaboration with the UNFPA and the MOH will be strengthened to ensure that sufficient
condoms are available through social marketing outlets, public sector and NGO hospitals and clinics and NGO community support
and care programs. In related activities, PEPFAR will provide funding to TBD partner for social marketing and demand creation
among at-risk populations and to other NGOs that create demand and distribute no-logo condoms.
In FY07, the USG team initiated a PEPFAR Behavior Change Communication Task Working Group (BCC TWG) for all the AB and
OP prevention partners, at the recommendation of the FY06 review. This group is comprised of a member from all organizations
receiving PEPFAR AB and/or OP funds, including Track 1 and the NPI. The BCC TWG meets monthly and provides a forum for
coordination and communication amongst partners. In FY07, the group conducted a mapping exercise to determine the
distribution of prevention programming; information from the mapping process highlighted an unequal distribution in OP
programming between urban to rural areas, as well as the need to direct OP programming toward high risk adult males. These
gaps were addressed in FY08, and will continue to be addressed during FY09. For example, PSI and MSH focused on a more
balanced distribution of condoms throughout the country and created 40 new condom outlets FY08, 4 per department. These
outlets were established in rural and underserved areas of the country. In addition, the TWG serves as a platform to coordinate
programming and messages. Best practices and lessons learned are shared by the partners. The TBD BCC technical assistance
partner will work with this group to develop clear and consistent messages and programs that address hot topics such as multiple
and concurrent partnerships and transactional sex. In addition, the group will make efforts to strengthen referrals and links to other
services including CT, STI, and reproductive health services.
The USG Team's AB program engages adults and youth from diverse community groups, and promotes social norms supportive
of healthy and safer sexual behaviors. This includes mobilizing community support to promote abstinence, mutual monogamy,
and partner reduction, as well as addressing sexual coercion, cross-generational, and transactional sex. Public dialogue on these
topics with community leaders, parents, and clergy, coupled with dissemination of practical, culturally appropriate educational
materials and counseling guides will encourage adults to reduce their own risky sexual encounters with other adults, as well as
with youth. Targeting adults and promoting AB within this population as well as within youth will reinforce safer sexual behaviors
within the general population of Haiti to create a more balance and age diverse program to support behavior modification.
PEPFAR will continue its work among high risk groups. Funding will be provided to POZ to assist them with their MSM prevention,
care and treatment clinics in Haiti. CSW clinics around the country, run by FOSREF, will continue to provide peer to peer
outreach, condoms, counseling and testing, and STI diagnosis and treatment. These clinics also offer educational training courses
for CSW's to build skills in areas other than commercial sex work. In FY09, PEPFAR will focus work with male clients of CSW's,
with outreach to the clients through peer to peer counseling, referrals to USG supported counseling and testing will be provided as
well as condoms. Work with the migrant population will be continued in FY09; migrants will be trained as peer educators on ABC
messages in order to reach more of this high risk population. Additionally, work with the general adult male population will build on
work accomplished in FY08 through partners such as MSH, the TBD BCC partner, and others. This work will stress the
importance of consistent condom use, as well as other ‘B' prevention messages; will integrate behavior change activities into their
programs to move beyond raising knowledge of HIV/AIDS. Referrals to CT will be stressed by all partners.
As the USG Team shifts the prevention portfolio from a high risk youth focused plan to a more balanced approach across
generations, ABC messages will be emphasized, especially among the adult male population. With HIV rates peaking in women
age 30-34, and men age 40-44, it is important to put heavy emphasis on the sexually active population in Haiti in order to promote
behavior change. FOSREF, MSH, PLAN, and the TBD communications partner will all shift their programs to include more
targeting of adult populations, mainly men, migrant workers, and clients of commercial sex workers. In addition, other prevention
messages will focus on risk reduction messages through media messages, and will be reinforced by interpersonal counseling
techniques to encourage personal risk assessment skills among the sexually active.
Target: For FY09, the targets will reflect a more accurate count of persons reached through community outreach, to exclude mass
media and large groups. Additionally, with the USG's efforts to implement balanced ABC programming, the number of those
reached through abstinence (a sub-set of total reached through AB) will be lower than FY09. Additionally, number of individuals
trained to promote HIV/AIDS prevention through abstinence and/or being faithful is significantly lower than FY08 as one AB TBD
partner will restructure its programming tofocus more on follow-up long term training toward behavior change rather then one day
training of tens of thousands of people with little follow-up.
Program Area Targets:
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through abstinence (a subset of
total reached with AB): 1,000
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through abstinence and/or being
faithful: 297,930
Number of individuals trained to promote HIV/AIDS prevention through abstinence and/or being faithful: 3,461
Number of targeted condom service outlets: 700
Number of individuals reached with community outreach that promotes HIV/AIDS prevention through other behavior change
beyond abstinence and/or being faithful: 686,517
Number of individuals trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being:
2699
Table 3.3.02:
Narrative will be modified as follows:
Activity 1: Ready to use therapeutic feeding for malnourished children and adults.
Activity 2: Fortified blended flour.
SUMMARY:
Activities are carried out to guarantee the availability of Opportunistic Infections Drugs and other
commodities needed for the care and support of PLWHAs enrolled in care, including those on ARVs and
around 5% of children. The list of drugs include (i) prophylaxis drugs such as INH and Vitamin B6,
Cotrimoxazole and multivitamins, (ii) other antibiotics, antifungal and anti-parasitic drugs for treatment of the
most common infections in HIV/AIDS patients, (iii) supportive drugs for symptoms such as fever, cough,
diarrhea, headache, and pain. The primary emphasis areas for these activities are commodity procurement
and logistics. Specific target populations include People Living with HIV/AIDS, HIV positive pregnant
women, HIV positive infants and children. The activities will be carried out at all PEPFAR partner sites
across the country in all ten geographical departments.
BACKGROUND:
This activity is part of an ongoing PEPFAR initiative started in FY 2006 by the PFSCM and now working in
over twenty countries including the fifteen PEPFAR focus countries and also working with other non-
PEPFAR and collaborating partners. Haiti is the one country to have a fully established PFSCM office that
offers all services and activities related to the supply chain management of all HIV/AIDS commodities from
forecasting to procurement, storage and distribution with a strong technical assistance component. The
activities are keyed to assist the Haitian MOH in reaching the national objectives of care and support to all
HIV positive patients. The aim is to provide an uninterrupted supply of the required OI and STI drugs for the
sites that are ART and Palliative Care designated sites according to the national norms and guidelines.
PFSCM will train key personnel in the management of those commodities.
A more comprehensive list of drugs, made available in FY2007 through this funding to respond to the
growing needs of palliative care of the HIV positive patients, will be updated on a regular basis through the
HIV/AIDS Drugs Technical Working Group (TWG) established by the USG PEPFAR team in 2007.
ACTIVITES AND EXPECTED RESULTS:
We will carry out five activities in this Program Area:
ACTIVITY 1: Since 2004, PEPFAR and Global Fund have been providing palliative drugs and supplies for
PLWHAs. Through intensive efforts and scale up, a larger number is having access to care and support.
With improved tools for forecasting and need assessment, more persons will benefit from this activity and
more drugs addressing a continuously updated standard list of health problems will be available. We will
also include INH for prophylaxis of tuberculosis for up to 60,000 by September 2009.
ACTIVITY 2: Because the health problems addressed by these drugs are also pathologies seen in non-HIV
patients, the procurement planning and inventory tracking and utilization monitoring are rendered more
complex. SCMS will take every step possible to ensure the adherence to the PEPFAR principles in making
the purchased products available to those intended in the program. Also, we will coordinate with our Global
Fund counterparts in terms of timing of orders and quantities of purchase. The continuing activity will aim to
provide palliative care and OI drugs, taking into account Global Fund stocks, for 125,000 patients by
September 2009.
ACTIVITY 3: Within this activity, SCMS will operate a single coordinated commodity procurement and
management plan with the other stakeholders involved in OI drugs procurement, mainly the Global Fund, in
support of a national system that the MOH is attempting to put in place. Sharing of complete patient data on
each individual treatment site, along with drug budgets and procurement plan will improve the quality of
available information and the management of the supply chain. SCMS will provide technical assistance and
periodic formal training in logistics and stock management with emphasis on HIV commodities. We will also
continue to conduct continuous on site training, assistance follow up to training and supervision of stock
activities. These activities will encompass MOH-managed public sites and NGO-operated sites.
SCMS will provide computerized reports of commodity needs projections for each site, and for the national
level, including all commodity sources. This activity will contribute to improved palliative care and treatment
services throughout all PEPFAR partners supported sites.
Activity Narrative: ACTIVITY 4: PFSCM will implement and operate a single data collection tool for patient and drug
consumption management. Since FY 2006 and in the first part of FY 2007, SCMS/Haiti staff in
collaboration with the software developers and managers at MSH/CPM in Arlington has updated the ADT
software (SIMPLE) to be able to integrate Opportunistic infections Drugs and patient data. It will be
implemented at all new sites during FY 2008. It will allow for accurate and current data on type, frequency
and most frequently used treatments for opportunistic Infections, thus contributing to a better management
of drugs and their availability at all times.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17215
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17215 5471.08 U.S. Agency for Partnership for 7693 3831.08 $150,000
International Supply Chain
Development Management
9333 5471.07 U.S. Agency for Partnership for 5145 3831.07 $2,400,000
5471 5471.06 U.S. Agency for Partnership for 3831 3831.06 $1,315,313
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Estimated amount of funding that is planned for Water $200,000
Table 3.3.08:
Table 3.3.10:
Estimated amount of funding that is planned for Food and Nutrition: Commodities $500,000
Table 3.3.13:
Narrative is unchanged from FY 08
Activities are carried out to provide best quality ARV drugs and other HIV commodities through assessment
of needs, forecasting, purchasing, shipping, warehousing and distribution of the commodities. Infrastructure,
technical assistance and capacity building of clinics in logistics management complete the scope of
activities. The primary emphasis areas for these activities are commodity procurement, logistics and
infrastructure. Specific target populations include People living with HIV/AIDS, HIV positive pregnant
women, HIV positive infants and children, public and NGO health workers, pharmacists and nurses. The
activities will be carried out at selected sites across the country in all ten geographical departments.
This project is part of an ongoing PEPFAR initiative started in FY 2006 and now working in over twenty
countries including the fifteen focus countries and other non-PEPFAR and collaborating partners. Haiti is
the one country to have a fully established PFSCM office and to offer all services and activities related to
the supply chain management from forecasting to procurement, storage and distribution with a strong
technical assistance component. The activities are keyed to assist the Haitian MOH in reaching the national
objectives of care and support to HAART patients. The aim is to provide an uninterrupted supply of ARVs
and related HIV for all designated sites according to the national norms and guidelines. PFSCM will train
key personnel in the management of those commodities.
The need of drugs assessment process through quarterly quantification will be ongoing and a better
determination of the procurement of ARVs and its timing will be improved constantly. The implementation of
new sites will continue and will cover NGO and public clinics, part of the PEPFAR network.
We will carry out three separate activities in this Program Area.
ACTIVITY 1: Procurement of ARVs
PEPFAR has established itself as a major ARV supplier to Haiti's PLWHA along with the Global Fund. The
constant supply of most regimens ensured a better scale up rate and increased the chances of reaching the
nationally set objectives. Some partners are still using a large spectrum of regimens making procurement
planning and inventory tracking more complicated. SCMS will procure only those drugs included in the
national treatment guidelines, are registered in the country and are FDA approved or tentatively approved.
SCMS will make every effort to coordinate timing and quantities of ordering with the Global Fund
counterparts. The Global fund is still moving with its plans to centralize all ARV procurement away from its
sub-recipients to a single purchase and distribution system, using PROMESS, the MOH essential drug
procurement and warehousing program, as their purchasing agent. SCMS will continue to provide a unique,
national forecasting that is updated quarterly and will make every effort to work with the MOH and the
Global Fund systems to have one purchasing, planning and execution system for ARV drugs for the
country. This will facilitate planning, procurement and reduce double reporting on patients, thus decreasing
MOH and donor redundancy. SCMS will purchase ARVs also for pediatric and PMTCT patients using the
revised national norms for both these categories.
This funding will go specifically to support procurement of ARV drugs to adults, children and pregnant
women. This activity will build on PEPFAR's success in maintaining, since 2006, a stock of ARVS sufficient
for the needs of ART patients without interruption. The continuing activity will aim to provide ARVS, taking
into account Global Fund stocks, for 25,000 patients by September 2009.
ACTIVITY 2: Logistics
Within this activity, SCMS will operate a single coordinated commodity procurement and management plan
with the other stakeholders involved in ARV procurement, mainly the Global Fund. Sharing of complete
patient data on each individual treatment site, along with drug budgets and procurement plan will improve
the quality of available information and the management of the supply chain.
SCMS will provide technical assistance to the MOH at the National AIDS Control Program for ongoing
coordination of procurement planning and stock management. We will provide periodic formal training in
logistics and stock management with emphasis on HIV commodities. We will also continue to conduct
continuous on site training, assistance follow up to training and supervision of stock activities. These
activities will encompass public, MOH's, sites and NGO-operated sites with an objective of fifty sites across
the country.
level, including all commodity sources. Quarterly, SCMS will update commodity needs forecasting based on
monthly stock and patient data. This activity will contribute to improved ARV supply chain and treatment
services throughout all treatment centers countrywide.
New technological solutions, developed by PFSCM, pilot tested during FY07 will be implemented on a
larger scale among partners and stakeholders to improve speed, accuracy of the reporting process and
better information sharing on patients and stocks.
One hundred employees- pharmacists, nurses, health workers- in the public and NGO sector will receive
formal training in HIV commodity management as well as training in a computerized inventory management
system.
ACTIVITY 3: Infrastructure
SCMS will continue to provide renovations to the selected sites across the country as well as the necessary
equipment and furniture to warehouses and dispensing areas. Specific activities and the appropriate
funding are listed under the activity narrative: infrastructure.
The central warehouse will be fully operational and will accommodate all ARV drugs for the national
PEPFAR program in accordance with the recommendations from the Fuel and Logistics Group. We will
operate a warehouse with a constant and reliable power supply, safe and controlled environment as well as
adequate cold chain equipment.
Continuing Activity: 17216
17216 4350.08 U.S. Agency for Partnership for 7693 3831.08 $2,560,000
9332 4350.07 U.S. Agency for Partnership for 5145 3831.07 $6,400,000
4350 4350.06 U.S. Agency for Partnership for 3831 3831.06 $7,084,293
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $9,950,000
The Haitian public health laboratory network includes the National Pubic Health Laboratory (NPHL) and clinical laboratories
located at Departmental and District hospitals as well as at public health care facilities throughout the country. In addition, there
are laboratories managed by the private sector, which have well-trained staff and better infrastructure than their public sector
counterparts. Haiti also has strong non-governmental institutions (NGOs) such as the Haitian Group for the Study of Kaposi's
Sarcoma and Opportunistic Infections (GHESKIO) Center, which offer more sophisticated laboratory tests including HIV ELISA,
western blot, automated CD4 counts and viral load determinations and serves as a reference laboratory for the country. The USG
team has been instrumental in linking the NPHL and GHESKIO together in order to provide in-country technical assistance and
expertise to more peripheral elements of the national public health laboratory network.
Overall, laboratory infrastructure in Haiti is very weak. Key barriers to strengthening Haiti's laboratory system include a shortage
of skilled laboratory personnel, lack of laboratory space, inadequate infrastructure and lack of recognition of the value of
laboratory diagnostics. In addition to the above, improvement of Haiti's laboratory infrastructure continues to be a challenge for the
USG team due to 1) lack of reliable, stable electricity, 2) lack of a clean water supply, 3) lack appropriate mechanisms to manage
biological waste, 4) difficulties in ensuring proper equipment maintenance and repair, and 5) low income and lack of professional
stature of lab personnel.
In 2007/2008, under the leadership of a new director and with the assistance of the USG team, the NPHL is taking steps to
become the lead institution for laboratory issues throughout Haiti. With USG assistance, NPHL has neared completion a new 5-
year strategic plan to cover the years 2008-2012. The USG team continues to work closely with NPHL in this effort in order to
provide support to those services and facilities consistent with both the national and PEPFAR strategies. In addition to developing
capacity as a reference laboratory, with help from the USG, the NPHL has taken the lead in several activities, including training of
laboratory personnel, quality assurance and quality control of laboratory testing, and selection, maintenance and repair programs
for laboratory equipment.
By the end of 2008, the USG Haiti Team will have supported the NPHL and 138? healthcare institutions. These include five
reference laboratories; nine departmental hospitals; 69 public and private referral hospitals; 24 healthcare centers; and 27 VCT
centers. In 2007, the USG team supported NPHL by helping to establish the first national QA/QC program for HIV rapid testing, an
activity repeated and expanded from 75 sites in 2007 to 127 sites in 2008. In 2008, the USG team successfully facilitated the
establishment of the polymerase chain reaction technique at both NPHL and GHESKIO for early diagnosis of HIV in infants. In
addition, PEPFAR continued to support the national training center for laboratory science at NPHL. Significant progress has been
made on establishing a Laboratory Information Management System (LIMS) that will interface with information management
systems already in place in Haiti (such as the electronic medical record and the Monitoring Evaluation System Interface (MESI),
the epidemiologic surveillance system used for HIV/AIDS in Haiti). LIMS will be operational in at least 3 sites by the end of 2008.
At the departmental level, PEPFAR continues to support automated CD4s, blood chemistry and hematology testing at sites that
provide anti-retroviral medications (ARVs). Laboratories at centers that provide only palliative care services offer simpler manual
methods for CD4, blood chemistry and hematology, though efforts will be made this year to automate those sites with large HIV+
populations. PEPFAR supports not only the provision of test kits, but also training, supervision, mentoring and monitoring of
laboratory personnel providing these services. In 2007/2008, the USG team supported an energy assessment of several sites,
the results of which have proved useful to correct sites with unreliable electricity.
In 2008/2009, the USG will 1) continue to work with the Partnership for Supply Chain Management (PFSCM) as the sole
procurement agent for laboratory commodities, including reagents and laboratory equipment 2) continue to follow
recommendations made by the USAID Energy Assessment team (see Policy Analysis and Other Systems Strengthening) 3)
develop human laboratory capacity by supporting an "internship" program whereby selected medical technology students will be
given an additional year of hands-on training in selected laboratories throughout the country. In addition, the USG team will
continue to work with the two medical technology schools in country to strengthen their overall curriculum and provide more hands
-on laboratory experience.
The USG will continue support of the overall NPHL QA/QC program for HIV, TB, rapid syphilis testing and CD4 counts. In
addition, the USG team will continue to strengthen bench capacity of the NPHL through it's support of TB culture and drug
resistance monitoring (see TB/HIV program), bacteriology testing and PCR testing for early infant diagnosis. PEPFAR currently
supports a biomedical engineering unit at NPHL to provide equipment repair and maintenance capacity within Haiti.
At the departmental level, no new sites are anticipated. However, major emphasis will be placed on strengthening existing clinical
labs and improving clinical laboratory services relevant to HIV/AIDS care and treatment. PEPFAR, NPHL and GHESKIO will work
together to provide training, refresher courses and supervision to laboratories at all levels. The USG team will work with PFSCM
to ensure that laboratories at all levels have adequate reagents and materials that are not in danger of outdating. Rapid syphilis
testing will be initiated at all levels of HIV testing facilities.
The USG Team coordinates with multiple international donors including World Health Organization (WHO/PAHO in TB/HIV drug
resistance surveillance), the Global Fund (procurement of reagents for HIV rapid testing and ARV drugs), and UNICEF (pediatric
diagnosis of HIV infection).
Table 3.3.16:
Activities are carried out to guarantee the availability of laboratory equipment and commodities including
HIV and syphilis rapid tests, CD4 tests and controls, Hematology reagents and controls, Murex, Enzyme-
Linked ImmunoSorbent Assay (ELISA), Western Blot HIV tests, Polymerase Chain Reaction (PCR) tests as
well as the corresponding supplies needed throughout the above-mentioned integrated program areas. The
list of needed commodities relate to (i) tests, (ii) confirmatory testing, reagents and supplies for diagnosis
and enrollment of patients under the VCT, PMTCT, Pediatric diagnosis, laboratory support for HIV positive
patients enrolled in HAART as well as quality assurance (QA) and quality control (QC), (iii) basic items
needed for laboratory, dispensing and storing infrastructure improvements. Other than the medical
equipment and the HIV commodities, SCMS will provide shelving and storage cabinets as needed. The
primary emphasis area for these activities is commodity procurement including equipment, distribution as
well as managing a central warehouse. This activity targets the general population, those HIV patients
receiving care and treatment and laboratory workers at the Ministry of Health's National Public health
laboratories (NPHL) and individual laboratories and dispensing facilities at approximately eighty selected
United States Government supported sites.
In FY 2006, the University of Maryland was responsible for assessing the needs, quantifying, and procuring
lab commodities. Under a subcontract to PFSCM until September 2007, the International Training and
Education Center for HIV (I-TECH) has been responsible for distribution and providing technical assistance
for the laboratory departments within the health centers throughout the country for the USG Team. The
PFSCM activities are keyed to assist the USG, the MSPP and other PEPFAR partners to reach the
PEPFAR targets by provision of lab equipment, and commodities. The aim is to ensure continuous
availability of rapid tests, other tests, reagents and related essential laboratory commodities and functioning
equipment intended to the target population.
ACTIVITY 1: Procurement of laboratory commodities for the national public health laboratory and its
network as well as the NGO sites supported by the PEPFAR program in Haiti.
In close collaboration with CDC/Haiti and Haiti's National Public Health Laboratory (NPHL), PFSCM will
assess needs, quantify, procure and distribute HIV commodities and basic lab supplies; procure lab
equipment; provide technical assistance for the departmental laboratories and health centers across the
country in managing and rational utilization of their supplies; to train lab technicians across the PEPFAR
sites in HIV commodity management with emphasis on lab tests, reagents and supplies. The lab
commodities will be procured based on targets and program areas that include counseling and testing
(pregnant women, adults, and TB/HIV patients), palliative care for TB/HIV, pediatric care and treatment,
ARV services, and reinforcing the national laboratory infrastructure and systems.
Commodity needs for Counseling and testing for 600,000 individuals (200,000 under the PMTCT activity
and 400,000 under the VCT activity) include HIV and syphilis rapid tests, reagents for HIV and syphilis
QA/QC, general lab supplies, basic lab equipment, infrastructure, and shipment cost.
For pediatric diagnosis, the estimated number of babies to be tested by dried blood spot PCR is 4,000.
PFSCM will procure PCR test kits, general PCR supplies and DBS collection supplies.
PFSCM will procure laboratory equipment to set up a TB culture and drug resistance testing laboratory at
the NPHL. We will also purchase PPD and AFB smear microscopy for the TB/HIV activity.
Palliative Care laboratory activities will include procurement of test kits and supplies to perform 98,000 tests
including CD4 manual tests and controls; basic hematology testing; basic manual chemistry tests such as
SGOT, SGPT, Creatinine and the corresponding controls.
At the ARV sites, which have level III labs, the PFSCM will procure reagents and controls to monitor
HIV/AIDS patients receiving ART. The testing include CD4 (PointCare / FacsCount), hematology (Sysmex),
blood chemistry (Reflotron), AFB, PPD and other simple diagnostic reagents for opportunistic infections.
Five sets of automated lab equipment (PointCare, Sysmex, and Reflotron) will be procured for new ARV
sites.
ACTIVITY 2: Managing a central warehouse for all PEPFAR HIV commodities and operating a distribution
network.
After securing and renovating a central warehouse, corresponding to the accepted standards for such
facility during the COP 2007, SCMS will continue to manage that facility ensuring quality and security for
HIV commodities purchased and stored by PFSCM and maintaining the chain of custody of the
commodities. PFSCM will coordinate and deliver all HIV commodities and basic lab items to USG-supported
laboratories.
ACTIVITY 3: Reporting
SCMS will carry all reporting activities on usage data for all commodities purchased within the SOW of this
program area and share the gathered information with the USG team and other key partners.
Continuing Activity: 17218
17218 10353.08 U.S. Agency for Partnership for 7693 3831.08 $2,900,000
10353 10353.07 U.S. Agency for Partnership for 5145 3831.07 $2,500,000
ACTIVITY UNCHANGED
Activities are carried out to provide planning and strategic tool for the two major stakeholders in the
HIV/AIDS area: The US Government and the Global Fund through its principal recipient in Haiti, the
Sogebank Foundation.
During the 2006 Implementers Conference in Durban SA, members of USG Team (Haiti and Washington,
DC), Global Fund, Sogebank Foundation and SCMS/HQ met and discussed the need for a planning tool to
be used by both stakeholders for their strategic thinking and planning of HIV activities. After analysis of
various options, SCMS was asked to develop the tool.
The first version of the Project Management Information System (PMIS) tool is now available, was
presented to the stakeholders and is ready for use with PEPFAR's data and indicators.
Next steps will address the GF projects' indicators, training of users and decision makers, maintenance of
the tool as well as trouble shooting. Upgrades will be provided based on interaction with users and new
needs identified by the stakeholders.
The PFSCM project is part of an ongoing PEPFAR initiative started in FY 2006 and now working in over
twenty countries including the fifteen focus countries and other non-PEPFAR and collaborating partners.
Haiti is the one country to have a fully established PFSCM office and to offer all services and activities
related to the supply chain management from forecasting to procurement, storage and distribution with a
strong technical assistance component as well as a program management information system. The
activities are keyed to assist the Haitian MOH and the major stakeholders in reaching the national
objectives of care and support to PLWHA. The aim is to provide an integrated Information System to serve
as a planning and strategic tool for the two major stakeholders in the HIV/AIDS area: The US Government
and the Global Fund through its principal recipient in Haiti, the Sogebank Foundation. PFSCM will train key
decision makers in the use of this tool as well as designated personnel at the corresponding organizations
and agencies in data entry and validation.
ACTIVITY 1: UPDATING OF THE PMIS TOOL
The IS Team at SCMS will interact with all users as they start getting familiar with the tool and inputting data
and using it for programmatic reasons. Updates and upgrades will be necessary during COP08 to include
GF/FSGB indicators; to add other stakeholders on request and to create the interface with MESI
ACTIVITY 2: MAINTAINING THE TOOL
The IS Team in DC and in Haiti will carry our maintenance activities such as testing the tool and its
responsiveness, trouble shooting, assisting users when facing functionality problems and installing the tool
at selected locations on demand.
ACTIVITY 3: TRAINING
SCMS/HQ and Haiti will jointly conduct training at two levels:
1.Users: all those that will be asked by their respective organizations to input data and create reports;
2.Decision makers: those who will use the data/ reports to analyze, discuss with other partners and make
strategic decisions.
Continuing Activity: 18849
18849 18849.08 U.S. Agency for Partnership for 7693 3831.08 $200,000
Table 3.3.17:
