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
CONTINUING ACTIVITY - NEW ACTIVITY NARRATIVE
SUMMARY
PHMI will provide ongoing support to the Andhra Pradesh State AIDS Control Society (APSACS) for the
management of the Integrated Counseling and Testing Center (ICTC) system, which is a key piece of the
prevention of mother to child transmission (PMTCT) program in Andhra Pradesh/India. In AP as well as
elsewhere in India, the PMTCT program is relatively new and the public health systems to monitor and
follow-up antenatal women are generally weak. Therefore, it is not surprising that a large number of
pregnant women who test positive are lost to follow up. In 2006, over 4,000 pregnant women in AP were
found to be positive in the government sector (tested at ICTCs). Of these, approximately 42% were
documented as having received Nevirapine prophylaxis. This percentage appears to have increased to 60%
in select USG focus districts in 2007.
BACKGROUND
This ongoing support will place a senior ICTC consultant at APSACS. Secondary support will come from
two other PHMI-supported APSACS consultants who focus on monitoring and evaluation and trainings.
PHMI will also support PMTCT by advocating for new policy initiatives, conducting management and system
strengthening training workshops (especially for district staff), and assisting with field-level assessments.
Most of the budget to support the APSACS consultants is provided under Policy and Systems
Strengthening; however there will be substantial results (particularly indirect results) in this program area as
a consequence of the consultants' activities.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Strengthening the Quality of PMTCT Services and Supportive Linkages
The ICTC consultant will play a leadership role in establishing stronger linkages between antenatal outreach
services and ICTCs where HIV testing is routinely performed. New strategies for reaching antenatal women
and promoting routine HIV testing will be developed in FY09. One possible strategy is to send ICTC teams
to remote primary health centers or sub-centers on select antenatal service days (perhaps once a month).
Another strategy is for APSACS to develop closer relationships with private testing centers to ensure quality
testing, counseling, and patient follow up.
The consultant will ensure that newly-released ICTC operational guidelines (developed by NACO) are
adopted by the state and are made available in all centers, with a goal of standardizing counseling and
testing services. Further the consultant will ensure that the recently created follow-up counseling toolkit is
distributed to all centers and counselors are adequately trained in how to use this important teaching aid for
those testing positive.
PHMI, mostly through the ICTC consultant, will continue to work on ways to improve the rate of Nevirapine
administration to pregnant women identified as HIV positive. Other agencies and APSACS staff are
primarily responsible for this important activity. However, PHMI staff and consultants will remain engaged in
this issue and provide technical support and inputs as required.
ACTIVITY 2: Development of a Positive ANC Tracking Tool
Through another consultant to APSACS, who provides support for data management systems, PHMI will
develop a Positive ANC tracking tool to improve Nevirapine administration rates in the State. This will be
done initially as a paper-based system of positive ANC line-listing that will track and document all positive
mothers from the time of diagnosis till the time of delivery and subsequently follow up the child till s/he is 18
months of age. This will be a very useful tool for counselors, nurses and outreach workers in the field. It can
be used to link women to private providers and 24-hour PHCs.
ACTIVITY 3: Development of Mother-Baby Card
A mother-baby card, in line with NACP-III guidelines on the District AIDS Control Unit, will be developed and
piloted in the state for better follow-up and ease of providers in giving comprehensive services in
collaboration with NRHM, RCH.
ACTIVITY 4: Support to District-Level Teams
The ICTC Consultant will support the district-level teams and government officials who will, in turn, monitor
all HIV CT centers in their respective districts. The ICTC consultant will help develop monthly site visit
checklists, reporting formats, training calendars, review meeting agendas, testing targets, and budget
requirement, for each district team. The consultant will periodically join district team members in their
monitoring visits. He/she may visit the best and worst performing ICTCs in the district to better understand
the factors that directly impact program performance and find solutions to problems.
To support APSACS, PHMI will also work with the district teams on ways to improve the rate of Nevirapine
administration to pregnant women identified as HIV positive. This may include mentorship to the district
teams and other field managers on how to maximize outreach efficiency, track positive antenatal women,
encourage positive deliveries by medical staff, provide infant testing and care protocols, and ensure that
family planning services are made available post-delivery. PHMI will also support the evaluation and review
of PMTCT-related policies and procedures.
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $1,476,497
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Overview: India, with an estimated 2.47 million people infected with HIV/AIDS, has the third largest epidemic in the world. Despite
the large number of infections, India continues to be a concentrated epidemic with a 0.36% national adult prevalence. Prevalence
among most-at-risk populations (MARPs) continues to be high. It is estimated that nearly 5% of female sex workers (FSWs) and
6% of men having sex with men (MSMs) are infected by HIV (NACO report, 2006). HIV prevalence among MARPs in the six high
prevalence states is still higher, being almost double the national average for MARPs. The National AIDS Control Organization
(NACO) has also prioritized truckers and migrants as bridge populations needing HIV/AIDS interventions: HIV prevalence among
long distance truckers is estimated as 2.4%.
In the last two years, NACO has initiated many efforts to streamline HIV/AIDS interventions for MARPs and bridge populations.
Significant achievements include: a) development and dissemination of NGO/Community Based Organizations (CBOs) guidelines
for interventions among MARPs, b) establishing 16 Technical Support Units (TSUs) to support the State AIDS Control Societies
(SACS) for effective roll-out of interventions, c) country-wide mapping of MARPs and migrants, d) introducing a new cadre of link-
workers to reach MARPs in rural areas, e) targeting short-stay single male migrants and long-distance truck drivers and working
with the relevant ministries to integrate HIV/AIDS into their programs, f) contracting a national condom social marketing (CSM)
organization, and g) expanding access to STI treatment by social franchising of STI services through private health care
providers.
NACO is also coordinating with the Ministry of Education and Ministry of Women and Child Development to mainstream HIV/AIDS
programs for interventions among youth and women. The PEPFAR review team visited India this year and endorsed this as an
important strategy for a concentrated epidemic country. The team suggested USG/India shift from supporting direct interventions
amongst women and youth, to working closely with the SACS to mainstream these programs. In response, USG has transitioned
much of its funding for these groups to the relevant ministries, retaining a small supervisory role to ensure the long-term
sustainability of these investments. In 2008, USG also transitioned over 20 NGO projects supporting bridge population
interventions.
Coordination and Other Donor Support: USG programs support and complement NACO's interventions for MARPs and bridge
populations. At the national level, USG coordinates with NACO, multilateral agencies and other international donors to influence
policy, and provide strategic direction and technical assistance. At the state level, USG partners coordinate with the SACS and
other developmental agencies to share data and best practices and support joint initiatives.
The USG and the Bill and Melinda Gates Foundation are the two major agencies supporting programs among MARPs and bridge
populations. UNICEF, UNDP and GTZ support programs on HIV/AIDS among youth and industrial workers and address human
trafficking issues. USG programs continue to leverage millions of dollars for condoms, STI drugs and HIV test kits from the state
governments for its programs. USG-supported prime partners have collaborated with private companies to establish STI clinics
along national highways. They also coordinate with local ministries to link MARPs with various social and development schemes
offered by the state and central government.
Current USG Support: USG programs include field-based interventions and support for policy change. At the policy level, USG
was instrumental in developing the national guidelines for NGO/CBOs engaged in MARPs and bridge population interventions.
They provide a comprehensive understanding of the process of identifying, contracting, capacity building and monitoring of
MARPs and bridge population interventions. USG also provided critical inputs to shaping the national CSM program and finalizing
the strategies and organizations for social franchising of STI clinics. The USG team participates in joint implementation reviews
organized by NACO that assess and strategize on the performance of states.
In line with NACP-III's priorities, USG's role has changed to a mixture of demonstration projects and building the capacity of the
SACS to manage NGO interventions with MARPs, among other programs. This function is carried out by Technical Support Units
(TSUs) set up by NACO to provide strategic support, timely roll-out of programs, coordination, and adherence to national
guidelines and standards; and develop and monitor state and district annual action plans. USG supports TSUs in six states and
thus has a major role in developing strategies and operational plans and streamlining capacity-building initiatives in the state.
In selected districts of Tamil Nadu (TN), Maharashtra and Karnataka, USG supports 80 projects reaching approximately 25% of
MARPs, including demonstration models covering the prevention-to-care continuum. This furthers the national and state mandate
to saturate coverage of MARPs and bridge populations. USG also supports state-level capacity-building initiatives to enhance the
quality of interventions, including mapping MARPs in TN and Karnataka, and migrants in TN. USG also supports mapping of
private healthcare providers who can be contracted to deliver STI services. As noted above, in TN and Maharashtra, USG is also
working with the SACS to transition several interventions to SACS-supported NGOs and government ministries.
Several USG innovations have been adopted for use nationally or by other projects. In Karnataka, USG has pioneered the
concept of reaching rural MARPs through link workers, a model recognized by NACO and used as a learning site for other states.
A USG partner in Andhra Pradesh (AP) developed a risk-assessment tool for prioritizing industries for HIV/AIDS programs, which
is now being used by other USG projects. In TN and AP, USG prime partners are engaging the private medical sector to provide
STI and HIV treatment to MARPs and bridge populations. In Maharashtra, a USG prime partner is taking the lead in migrant
interventions and has been requested by NACO to provide technical support on this approach.
USG programs have also developed communication materials specific to MARPs and bridge populations that have been adapted
by SACS and NACO. In TN, NACO has suggested that a USG prime partner pilot the concept of a unique identity card for MARPs
(using either biomarkers or smart cards). This is being tried primarily to estimate the number of MARPs accessing different
prevention and care services, follow-up MARPs who do not regularly access the services, understand MARPs' mobility patterns,
and avoid double-counting.
Many challenges still persist:
a) Coverage of MARPs, particularly MSMs, is way below the goal of 85%. Only 43% of FSWs (estimated at 1.2 million) and 20%
of MSMs (estimated at 2.35 million) are reached through interventions. Coverage of MARPs in the southern states is slightly
better. However, the changing dynamics of sex work have affected intervention programs. Patterns of client solicitation have
changed. More MARPs operate from streets and homes rather than brothels, and are accessed through mobile phones and
internet. The legal status of sexwork has also affected interventions. The Government of India has recently amended the Immoral
Trafficking (Prevention) Act to penalize clients of sex workers. Similarly Section 377 of the Indian Penal Code continues to
consider homosexuality a criminal offence. These laws have been greatly debated and are the subject of intense lobbying by civil
society. They contribute to the complexity of designing interventions and messages for MARPs, and the need to work closely with
law enforcement agencies and policy makers.
b) The quality of interventions with MARPs and bridge populations and the provision of comprehensive services to them are still
issues. The 2006 Behavior Surveillance Survey among MARPs indicates that only 38% of FSWs have correct knowledge of HIV,
and 50% of FSWs contracted STIs in the last 12 months. With regard to MSMs, correct knowledge of HIV varies from 16% to 75%
across the states and the number of MSMs reporting STIs ranges from 2% to 21%. Timely treatment-seeking behavior and
consistent condom use among MARPs are concerns. Current interventions with MARPs primarily focus on condom promotion,
although other risk reduction options include reduction of the number of sexual partners and promoting periodic medical check-
ups. Similarly, integrating messages on alcohol use and its influence on safe sex, working with children of FSWs to prevent
second-generation sex work and offering alternate livelihood options for FSWs are critical in prevention programs but not given
the required emphasis.
c) Linkages to counselling and testing (CT), care and support, and treatment services for HIV- infected MARPs and bridge
populations are limited. The BSS 2006 reports indicate that less than 40% of female sex workers ever had a HIV test. In the case
of MSMs, this varies from 3% to 69% across states. There is little data on the number of MARPs availing care, support and
treatment and on the quality of services provided to them. This is critical as MARPs are stigmatized populations and HIV-positive
MARPs can be further stigmatized and denied services.
d) Mainstreaming and greater engagement of the community in programs continues to be a challenge. NACO has set an
ambitious plan to support 50% of the planned MARP interventions through CBOs. Response from NGOs and CBOs has not been
encouraging and needs more attention. Similarly, mainstreaming with the different Ministries and Associations will require
considerable handholding for them to own and run the program effectively.
USG FY09 Support: USG will work with the SACS and NACO to address the gaps in interventions and improve the quality and
scale of programs. In FY09, USG will give more emphasis to providing technical and strategic support to NACO and the SACS.
1. Support to National and State TSUs: NACO plans to establish a national-level TSU to provide strategic support to NACO
officers for the effective roll-out of prevention programs. It will coordinate with state TSUs to ensure that interventions are rolled-
out on time, are of high quality, and adhere to national guidelines. USG will support key positions in the national TSU; and will
consolidate important lessons learned from USG programs for dissemination and adaptation. USG will also continue to support
the six state TSUs. They will work with SACS to address the major gaps and challenges in MARPs and bridge population
interventions, evolve appropriate strategies to address these issues; and build the capacity of SACS officers and the District AIDS
Prevention Control Units on effective supervision and capacity-building of NGOs and CBOs, including their capacity to implement
Targeted Interventions.
2. Technical support for project reviews, policies and guidelines: USG will participate in Joint Implementation Reviews and provide
technical and strategic inputs to NACO and SACS to improve prevention and care programs. USG and its prime partners will also
participate in policy and procurement meetings and assist NACO and SACS in evolving appropriate policies, guidelines and
systems. A USG prime partner is the vice-chair for the national Technical Resource Group on interventions among MARPs and
bridge populations which provides strategic oversight to NACO and SACS.
3. Learning sites and documenting best practices: USG will identify potential organizations/projects that have demonstrated high-
quality interventions among MARPs and bridge populations and build their capacity to function as learning sites for the
state/country. USG will also identify best practices and disseminate these experiences across SACS, TSUs and NACO for wider
recognition and adaptability.
4. Human capacity development: There are many gaps in current training programs for sexual prevention and a need to go
beyond training to strengthen capacity. Areas such as gender, project management, CBO formation and management, data
quality assurance, advocacy, community mobilization, provision of balanced ABC messages, and supply chain management need
to be incorporated in a comprehensive approach to sexual prevention. USG will prioritize and support specific training programs to
address these gaps.
5. Mainstreaming models: USG will continue to work with the Ministry of Education, the Ministry of Women and Child
Development, the Ministry of Surface Transport, and the Ministry of Labor to mainstream the Red Ribbon Club, Self Help Group
and public sector workforce interventions. In FY09, there will be an evaluation of the Women's Self-Help Groups program, and the
results can help mainstream the program in other USG focus states.
6. Demonstration programs for MARPs and migrants: In selected high-prevalence districts, USG will continue to support
demonstration models of the prevention-to-care continuum. The models will saturate coverage, offer comprehensive services,
establish strong linkages and follow-up for MARPs to access CT and care, support and treatment services, and demonstrate the
advantage of reaching FSWs and MSM with a composite intervention supported by a single agency. In Maharashtra, USG will
support demonstration models for male migrant interventions, strengthened by technical assistance at the national level. The
experience of piloting a unique ID for MARPs will also be distributed nationally. The USG will also address underlying structural
issues through working with TNSACS to establish a mechanism for dealing with human trafficking issues and supporting the
women lawyers' network to protect human rights abuse of MARPs.
7. CSM: USG will support the national CSM program's efforts to increase access to male and female condoms for MARPs and
bridge populations, including determining the reasons for inconsistent condom use and modifying programs to address these
issues. USG will develop prototypes for CSM communication materials specific to MARPs and bridge populations, and work with
social franchising organizations to ensure private health care providers in the intervention areas are supported.
Table 3.3.02:
Andhra Pradesh State AIDS Control Society (APSACS), the state's nodal agency for HIV control, has
scaled up counseling and testing (CT) services to both rural and urban populations, unlike in other states
where the services are primarily urban and peri-urban. The 677 integrated counseling and testing centers
(ICTCs) offer PMTCT services, CT services and TB-HIV linkages. APSACS also encourages provider
initiated testing by closely linking outpatient clinics and inpatient wards to the ICTC, usually located within
the same building. APSACS has started initiatives to scale up ICTC services in 24 hour primary health
centers, including working with private sector ICTC as a public-private partnership model. In accordance
with NACP-III, efforts have been made by APSACS to decentralize the management process to district
level. Activities are carried out to support expansion of comprehensive CT services through placement of
qualified manpower to support the state CT program.
The Public Health Management Institute (PHMI) will provide ongoing support to APSACS for the
management of the ICTC Program. This support will continue to focus on the placement of a senior ICTC
consultant at APSACS. Secondary support will come from two other PHMI-supported APSACS consultants
who focus on Monitoring and Evaluation (M&E) and training. PHMI will also support counseling and testing
by advocating for new policy initiatives, conducting management and systems strengthening, training
workshops (especially for district staff), and assisting with field-level training needs assessments.
Mediciti SHARE India (SHARE India) is a not-for-profit organization that works in rural communities outside
Hyderabad, Andhra Pradesh, reaching out to about 300,000 rural residents with services including maternal
and child health, immunization, population control, cancer detection and treatment, HIV/AIDS and nutrition
programs. Implementation is coordinated through the SHARE India medical college and hospital located
nearby. SHARE India is also recognized as a research foundation by the Department of Science and
Technology, Government of India.
In 2006, with support from USG, SHARE India established PHMI as a technical assistance and training
organization. PHMI's main objective is to build human resource capacity and strengthen systems for the
public health infrastructure of Andhra Pradesh (AP). This is achieved by developing innovative quality
improvement mechanisms such as accreditation systems and on-the-job training programs. While the
current technical focus is on HIV, in the longer term PHMI envisions a broader role encompassing additional
public health priority areas in AP.
The ICTC concept was developed in 2005 by the Tamil Nadu State AIDS Control Society (TNSACS) with
USG support during a period of rapid scale up of testing services by Tamil Nadu. APSACS went through a
similar scale up and re-structuring process in 2006 and early 2007, with the help of CDC and its partners,
LEPRA, CHAI, and PHMI. These APSACS-funded ICTCs are performing over 1.5 million tests per year, of
which 600,000 are among antenatal women with a positivity rate of 1.25 to 2.5%, and 900,000 are among
walk-in clients and non-antenatal patients (provider-initiated) with a positivity rate of 8-14%. NACO has set
a target of ~2.5 million tests for FY08-09 for Andhra Pradesh, of which 1.5 million tests are to be performed
on non-antenatal populations. This does not include the large number of tests being done in the private
sector (except those few testing sites funded by APSACS such as the APAIDSCON network of private
medical colleges) since those numbers are not reported to APSACS currently.
Almost all ICTCs are located in government medical care facilities (medical colleges, district and sub-district
hospitals, primary health centers) and are therefore designed to link clients to support services, facility-
based palliative care, and ART screening and treatment. The location also encourages provider-initiated
testing by closely linking outpatient clinics and inpatient wards to the ICTC, which is usually located within
the same building.
The state's CT systems are currently managed directly by the USG/PHMI-funded ICTC consultant under the
guidance of the APSACS Project Director and Associate Project Director. The ICTC management systems
have evolved over the past 2-3 years. APSACS has recently placed district-level counseling supervisors in
all 23 districts. USG-supported district management teams (placed in the 10 highest prevalence districts
eight months ago) are providing management support to the ICTCs as an important part of their job
responsibilities. Decentralization of the management to the district level has strengthened the system by
streamlining reporting, quality field supervision, regular review meetings and on-the-job trainings. In FY09,
PHMI will continue to provide support to APSACS for the management of the ICTC Program through the
placement of a senior state-level ICTC consultant.
ACTIVITY 1: Management of the AP State ICTC System
The APSACS-based consultant will continue to play a leadership role in managing the ICTC system and
develop strategies to continuously improve the program structure. This includes: a) strengthening training
programs for counselors, laboratory technicians, and nurse practitioners; b) ensuring annual refresher
trainings are conducted for all field staff; c) improving the supervision skills and procedures for district-level
counseling supervisors and district project managers; d) strengthening supply chain management systems
for HIV test kits; e) using the web-based monitoring system to analyze data and provide ongoing, timely
feedback to district teams and individual ICTCs; f) creating better human resource management systems
including annual performance reviews for all ICTC staff and g) taking steps to mainstream ICTCs into the
general health care delivery system at the district level.
The consultant will also ensure that newly released ICTC operational guidelines (developed by NACO) are
adopted by the state and are made available at all centers, with a goal of standardizing counseling and
distributed to all centers and that counselors are adequately trained in correct use of this important teaching
aid for those testing positive.
Activity Narrative: ACTIVITY 2: Establishing Stronger Linkages between Care Providers and ICTCs
The consultant will play a leadership role in establishing stronger linkages between care providers and
ICTCs, with a continued focus on strong referral systems for patients with active TB or STI. He/she will also
strengthen the referral linkages between ICTCs and community care centers, positive networks, ART
centers, and other PLHA services available in the district. A system to monitor and evaluate these referral
linkages will be developed and pilot tested in FY 09.
ACTIVITY 3: District Level Monitoring and Supervision
District level officers will be supported by the PHMI consultant, who will monitor services at all ICTCs to
provide supervision, technical input and feedback. District level counseling review meetings will be
organized monthly by the district managers in consultation with the consultant.
ACTIVITY 4: Promoting Routine External Quality Assurance
PHMI, mostly through the work of the state-level consultant with oversight from USG, will ensure that
external quality assurance of laboratory HIV testing, as required by NACO guidelines, is routinely conducted
at all ICTCs. The consultant will provide feedback to APSACS on identified and recommend corrective
actions for specific ICTCs in the state.
ACTIVITY 5: Expand HIV Counseling and Testing to High-Risk Populations
PHMI, mostly through the work of the state-level consultant with oversight from USG, will support the
expansion of HIV CT to additional at-risk and high-risk populations (select migrant laborers, commercial sex
-workers and clients, and prison inmates). The consultant will guide the expansion and implementation,
which will be carried out through mobile testing facilities, in line with the NACP-III strategy. These high-risk
populations have traditionally had limited access to HIV CT services specific to their unique needs (such as
extended hours of operation, staff trained to meet their specific needs). PHMI will partner with LEPRA
(another USG partner) in this effort since LEPRA is currently conducting a demonstration project for the
state on mobile testing. The consultant will provide oversight to the expansion of HIV counseling and
testing into primary health centers supported by National Rural Health Mission (NRHM) and private sector
nursing homes, hospital, and industrial hospitals.
ACTIVITY 6: Integration and Sustainabilty
The PHMI CT program and consultant will look for opportunities to link CT services with public-private
partnerships and mainstreamed into other services. State-level planning for scale-up of services in the
private sector is complete. The consultant will also further the goal of integration of CT services with the
National Rural Health System (NRHM), which started with the training of 95 Primary Health Centers that are
part of NRHM. The ICTC consultant has played a vital role in strengthening the quality of services through
training and supportive supervision.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14590
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14590 11505.08 HHS/Centers for Share Mediciti 6880 3978.08 PHMI $15,000
Disease Control & (Umbrella)
Prevention
11505 11505.07 HHS/Centers for Share Mediciti 5622 3978.07 $25,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.14:
The important objectives of program activities are to: 1) partner with the Andhra Pradesh State AIDS
Control Society (APSACS) to provide technical assistance (TA) through placing a Surveillance/Monitoring
and Evaluation (M&E) consultant for the state's HIV interventions at APSACS. The consultant will build
organizational capacity to effectively monitor and evaluate programs, conduct program reviews, collect and
analyze program data for informed planning, and strengthen program evaluation tools; 2) take the lead on
behalf of APSACS in developing and conducting skills-based trainings for the staff of District AIDS
Prevention and Control Units (DAPCUs) established as part of the decentralization of HIV/AIDS
management under the third National AIDS Control Plan (NACP-III). This is expected to build the state's
capacity in improved data generation, collection, collation, analysis and dissemination; and 3) initiate a
human resource information systems strengthening process designed to foster better understanding of the
current health workforce picture in the state of Andhra Pradesh. This will assist decision makers to
effectively plan for recruitment and training.
Mediciti SHARE India (SHARE India) is a not-for-profit organization working in rural communities outside
In 2006, through a cooperative agreement with CDC, SHARE India established the Public Health
Management Institute (PHMI) as a technical assistance and training organization. PHMI's main objective is
to build human resource capacity and strengthen systems for the public health infrastructure of Andhra
Pradesh (AP) state. This is achieved by developing innovative quality improvement mechanisms such as
accreditation systems and on-the-job training programs. While the current technical focus is on HIV, in the
longer term PHMI envisions a broader role encompassing additional public health priority areas in AP.
Strategic Information (SI) support is a component of PHMI's efforts to strengthen HIV programs in the state
of Andhra Pradesh. The SI activities are oriented towards strengthening the government information
system by supporting technical manpower, conducting a review of existing health systems for better
training, manpower and logistics planning, dissemination of scientific information, building capacity of the
state and district-level staff on information management, and assisting local government and non-
government agencies in building their capacity in data management and systems. Consultants are placed
in APSACS, reporting to the APSACS Project Director and mentored by USG and PHMI staff.
The activities have been modified from those in the FY08 COP. The modifications include deletion of three
activities (recorded under the PHMI FY08 COP narrative for use of GHAI funds for SI): Activity 1: Support
for a Patient Information System, specifically support for the T/HIS system at the Government Hospital of
Thoracic Medicine in Tambaram, Chennai; Activity 2: Capacity Development for SI through the Public
Health Field Leaders Fellowship; and Activity 3: Dissemination of HIV-Related Information of Strategic
Importance through workshops. Three new activities have been added: a) Data for Decision Making
(DDM), a structured long- term training program for district level decision makers; b) Human Resource
Information Systems Strengthening; and c)Review of Public Health Trainings and Implemented Programs.
As this is a new activity narrative that combines the GHAI and GAP narratives from FY08, note that all
activities have been renumbered.
ACTIVITY 1: Partnership with Government to Provide Technical Assistance
This is an ongoing activity providing TA to local and state government HIV agencies. PHMI has provided
three full-time technical experts to APSACS to support HIV activities. The consultants are in the areas of
Surveillance/Monitoring and Evaluation, management of Integrated Counseling and Testing Centers
(ICTCT), and training. Their role in FY09-FY10 will be to provide technical and managerial support to the
state's HIV/AIDS interventions and program officers, under the APSACS Project Director and mentored by
USG and PHMI staff. They are responsible for strengthening systems in their specific areas of expertise:
building organizational capacity to effectively monitor and evaluate programs; creating minimum standards
for all training programs; establishing procedures for routine program reviews; advocating and developing
better systems of program supervision, field evaluations, supplies and equipments maintenance; and
developing tools and processes for collecting, consolidating and analyzing data at the state and district
level.
Specific SI activities for these consultants include: 1) building interest in evidence-based program planning
among APSACS staff and district leaders; 2) reviewing counseling and testing (CT) data with APSACS staff,
relevant NGOs, and district government staff; 3) integrating TB/HIV, ART, and sexually transmitted infection
(STI) program data into the ICTC-web-based management information system (WMIS) and linking NACO
and APSACS web-based data; 4) helping APSACS expand the web-based reporting system beyond the
current pilot districts to all the 23 districts; 5) developing evaluation tools for select APSACS-funded training
programs; 6) strengthening ongoing sentinel surveillance in antenatal clinics, STI clinics, TB centers, and
among high risk populations; 7) disseminating and explaining sentinel surveillance and the National Health
and Family Survey (NHFS) findings to Andhra Pradesh to opinion leaders and program managers.
ACTIVITY 2: Training of District AIDS Prevention and Control Units (DAPCUs) Staff
Under NACP-III, DAPCUs are being formed in all districts in the high-prevalence states with the objective of
decentralizing program implementation and management to the district (population: 2-2.5 million). Specific
activities of the DAPCUs will include: 1) ICTC supervision; 2) field-level staff training and mentoring; 3)
technical support to district government officials in charge of health and social programming; 4)
establishment of links between prevention programs, ICTCs, and ART centers; 5) coordination of all district
Activity Narrative: level partners and activities; 6) technical input to communication and condom social marketing campaigns;
and 7) monitoring and evaluation of all district level HIV services.
Recruiting and training DAPCU staff is a tremendous challenge and opportunity. USG and its partners are
experienced in district-level capacity building. USG supported the establishment of district HIV
management teams in 10 districts in AP after which USG and its partners conducted skills-based trainings
for them. PHMI has been USG/CDC's lead partner in DAPCU trainings and will partner with other USG
agencies to implement this activity.
In FY09, PHMI will support training of DAPCU staff on basic public health principles, field management
skills, HIV prevention strategies, HIV care and treatment operational guidelines, and monitoring and
evaluation skills. A strong focus will be on building the DAPCU staff capacity to use local data for decision-
making and to provide timely feedback to field staff on their monthly monitoring reports. The exact training
calendar will be determined in collaboration with each State AIDS Control Society, each technical support
unit, and other technical agencies.
ACTIVITY 3: Training of District Level Managers on "Data for Decision Making"
PHMI initiated a Data for Decision Making (DDM) training program in early FY08. Built on past USG
experience, this new activity will strengthen systems at district level. This will support the planned
decentralization of decision making and management to district level by the National AIDS Control
Origination (NACO) and the National Rural Health Mission (NRHM). Using FY09 funds, PHMI will continue
to improve the quality of the DDM training program curriculum and structure.
PHMI will identify the decision makers and data handlers at the district level and enhance their capacities to
use data effectively in planning, implementing, monitoring, and evaluating health programs in AP state.
Using target audience analysis, PHMI will identify the different cadre of officials at district level, who are
involved in the process of using data for decision making, including those who make decisions, analyze
data and collect data. A decision maker can make sound decisions only if they are supported by valid and
relevant data.
This is an on the job-training program that minimizes the time a participant spends away from his/her job
and produces tangible results to improve existing programs and conditions. The project consists of six core
areas (surveillance; M&E; data collection; data analysis and interpretation; data presentation; decision
making). Each theme area has a basic and an advanced course. The basic course provides conceptual
knowledge and understanding of the subject. The advanced course gives additional hands-on training and
practical experience. Once the target audience matrix is developed, a needs review of the target group is
conducted. The capabilities of the selected target group are then measured to determine trainee needs and
to define the course structure and training methods.
Initially, there will be approximately 25 trainees per course. Each course will be conducted in six contact
workshops. Background reading material will be sent in advance to develop conceptual clarity on the
subject to be addressed and aid in completing the home assignments. The quality of the reading material
will be monitored. Collection of homework, homework review and feedback will be done between the
workshops. The course will have lecture sessions and class room-based group exercises. The duration and
nature of the sessions will be influenced by the needs review. In FY09, 25 fellows and 25 staff will be
trained in DDM through short term trainings.
ACTIVITY 4: Human Resource Information Systems (HRIS)
PHMI and other USG partners conduct regular training programs to build human capacity to fight the
HIV/AIDS epidemic. However, it is difficult to ensure that the right health care providers are receiving the
right training because the HR needs of the work force are not being monitored. A strong HRIS will allow
program leaders and managers to quickly assess key training gaps and redundancies.
The HRIS strengthening process is designed to foster better understanding of the current health workforce
picture in the state of Andhra Pradesh. This will prepare decision makers to effectively plan for recruitment,
training and retention and replacement of health professionals. This system will supplement the current
process of collecting collated data by gathering healthcare workforce data (e.g. demographics, basic
qualification, years of experience, training type and dates) from all staff working in HIV and linking it to the
job description of the person and the training needs.
Proposed systems improvements are based on a thorough technical assessment and consider low-cost
solutions that can rapidly but significantly enhance existing systems and processes in collaboration with the
state government and the local NGOs. This initiative will improve and expand existing systems rather than
replace what is already working at present. Where there is a paper-based system, an electronic register
can be implemented. Where an electronic register is already in place, a simple database can be built.
Where there is a simple database, that database can be progressively strengthened or expanded to meet
the needs of the state.
ACTIVITY 5: Review of Public Health Trainings and Implemented Programs
PHMI will provide technical assistance in review of Public Health Trainings and of implemented programs by
facilitating/participating such reviews for programs funded by USG or GOI.
Continuing Activity: 14593
14593 10121.08 HHS/Centers for Share Mediciti 6880 3978.08 PHMI $100,296
10931 10121.07 HHS/Centers for Share Mediciti 5622 3978.07 $300,000
10121 10121.06 HHS/Centers for Share Mediciti 5399 5399.06 $300,000
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.17:
The Public Health Management Institute (PHMI) was established in 2006 as a means of developing human
resource capacity and systems strengthening within the public health infrastructure of Andhra Pradesh (AP).
The current focus is on developing structured curricula, trainings, mentoring and providing long-term
learning opportunities for the public health workforce, primarily in the area of HIV/AIDS. The main activities
are: in-service training of state level public health managers, district level managers (DLM), District AIDS
Prevention and Control Units (DAPCUs), and other public health personnel (short-term trainings), providing
on-line learning opportunities through virtual learning systems, and opportunities to work in collaboration
with other institutions (South-to-South collaboration). Additional activities include conducting networking and
short-term trainings highlighting activities in the Southern states, providing technical assistance to
mainstream HIV activities into National Rural Health Mission (NRHM) services, and providing technical
assistance as needed to the APSACS Technical Support Unit (TSU).
Hyderabad, Andhra Pradesh, reaching about 300,000 rural residents with services including maternal and
child health, immunization, population control, cancer detection and treatment, HIV/AIDS and nutrition
Management Institute (PHMI) as a technical assistance and training organization. PHMI's main objectives
are to build human resource capacity and strengthen systems for the public health infrastructure of Andhra
Pradesh state (AP). This is achieved by developing innovative quality improvement mechanisms such as
accreditation systems and on the job training programs. While the current technical focus is on HIV, in the
The activities have been modified from those in the FY08 COP. Modifications include deletion of three
activities listed in FY08: Activity 4, HIV Laboratory Accreditation Program; Activity 5, Clinical Accreditation
Program; and Activity 6, AP HIV Consortium. Activity 1: Human Resource Capacity Development through
Public Health Field Leaders Fellowship has been modified. There are six new activities, listed below.
ACTIVITY 1: Human Resource Capacity Development through Public Health Field Leaders Fellowship
The Public Health Field Leaders Fellowship Program (PHFLFP) began in early FY07. It is a one year on-the
-job training program for approximately 25 mid-career NGO and government personnel responsible for
developing or managing HIV related field interventions. It addresses the need for on-the-job public health
trainings for mid-career professionals with limited options for formal courses. The curriculum consists of six
weeks of group contact sessions combined with distance learning modules and field mentorship provided by
PHMI. Significant attention is given to project management skills development, science-based intervention
design, and evidence-based planning. FY08 funds will be used to refine the curriculum, conduct a needs
assessment of the fellows and conduct audience analysis to restructure the fellowship. With FY09 funds,
PHMI will continue the fellowship and collaborate with local institutions to improve the quality of the
curriculum and structure. It also may expand its support of the fellowship to more than one batch per year.
ACTIVITY 2: Partnership with AP Government to Provide Technical Support
This is an ongoing activity providing 3 full-time technical experts to APSACS to support statewide HIV
activities. The consultants support surveillance/monitoring and evaluation, integrated counseling and
testing, and training. They are placed under the APSACS Project Director and mentored by USG/CDC and
PHMI staff. In FY09, the consultants will provide technical support to the State HIV/AIDS interventions and
program officers, many of whom have limited experience. They are responsible for strengthening systems in
their specific areas of expertise: building organizational capacity to effectively monitor and evaluate
programs; creating minimum standards for all training programs; establishing procedures for routine
program reviews; advocating and developing better systems of program supervision, field evaluations,
supplies and equipments maintenance; and developing tools and processes for collecting, consolidating
and analyzing data at the state and district level.
PHMI will work closely with the future AP Technical Support Unit (TSU) for HIV programming (to be
identified and funded by the Bill and Melinda Gates Foundation). Since Gates Foundation programs focus
on high risk prevention only, USG support via PHMI and others will continue to play an essential role in
building HIV prevention and care systems in the state under this new TSU system. As an additional
example, PHMI will coordinate inter-state learning exposure visits for SACS staff/officers.
ACTIVITY 3: Support to NACO
PHMI will work closely with NACO to strengthen the ART delivery systems throughout India. This will
include appointing 2 full -NACO ART consultants, 5 Regional technical consultants at the SACS level,
periodic international consultants and in-country contractors to work on specific ART-related deliverables.
Direct TA will also be provided by CDC/India and CDC/Atlanta. This program will be used by NACO to
establish an ART center accreditation system, a down referral system, and an improved human resource
management system. The ART support package will also be used to assist NACO to establish 10 ART
centers of excellence in care, training, and operational research and to create models for private sector
involvement in ART delivery.
FY08 ACTIVITIES 4, 5, and 6 have been deleted
ACTIVITY 7: Training and TA Support to DAPCUs
Under NACP-III, DAPCUs will be formed in all districts in the high-prevalence states. The objective of
Activity Narrative: building DAPCU capacity is to ensure high-quality performance as program implementation and
management is decentralized to the district level. DAPCU activities will include: 1) ICTC supervision; 2) field
-level staff training and mentoring; 3) technical support to district government officials in charge of health
and social programming; 4) establishment of linkage systems among prevention programs, ICTCs, and the
ART center; 5) coordination of district level partners and activities; 6) technical inputs into communication
and condom social marketing campaigns; and 7) M&E of all district-level HIV services.
experienced in district-level capacity building. USG supported the establishment of district HIV management
teams in 10 districts in AP and conducted skills-based trainings for them. PHMI has been identified as a
lead partner in DAPCU trainings and capacity building, working closely with the TSU, SACS, and other USG
partners and local agencies.
making and to provide timely feedback to field staff on their monthly monitoring reports. PHMI will seek
inputs from other USG partners in designing and conducting DAPCU trainings. The training curriculum and
calendar will be determined in collaboration with APSACS, TSU, and other technical agencies.
ACTIVITY 8: District Level Managers' Training on Data for Decision Making
PHMI initiated the Data for Decision Making (DDM) training program in early FY08 to support systems
strengthening at district level. The DDM training will increase the capacities of district level managers, data
users, and program officials to use program data scientifically and effectively in planning, implementing,
monitoring, and evaluating HIV and health programs in the state of Andhra Pradesh.
This is a on the job-training program consisting of six core areas (surveillance; M&E; data interpretation,
collection and reporting; analysis and Interpretation; presentation skills and decision making). Each theme
area has a basic and an advanced course. Target audience analysis will identify the cadres of officials at
district level (public and private), who are involved in decision making process. The capabilities of the target
groups will be reviewed to help define the course structure and training methods. In FY09 25 fellows and 25
staff will be trained in DDM.
The course modules will be developed by PHMI staff in collaboration with technical support from CDC GAP-
India and each course will be given in 5-6 workshops.
ACTIVITY 9: Strengthening Local Government Institutions
A technical consultant will be placed in the National Rural Health Mission (NRHM) to work with APSACS.
The focus areas for the consultant are: collaborate with APSACS, DAPCUs, RCH, RNTCP and other health
programs on HIV issues at the state and district levels, generate awareness of HIV services, generate
awareness of HIV/STD linkages, increase access to condoms, generate awareness about safe blood,
generate referrals for pregnant women for PMTCT services, and address access issues for routine
opportunistic infections.
ACTIVITY 10: Technical Support to the State Level Supply Chain System
Providing TA to improve and sustain an effective supply chain system for HIV services is an activity that
started at the request of APSACS. The goal is to develop an efficient decentralized supply chain and
logistics system that can ensure a continuous and uninterrupted supply of commodities. Strong
procurement and logistics management from manufacturer to center is thus essential.
The system in use is an on-call/fax/indent system that is random and reactive in nature, with multiplicity in
calling for requests, multiple points of control and confusion in the system. Call charges are not reimbursed;
counselors personally deliver kits to the centers from headquarters. The proposed pull-system would
enhance APSACS's performance in the systematic supply of logistics. PHMI will undertake a review of the
current health sector logistics systems in the state and partner with local logistics management institutes to
look for alternate solutions.
ACTIVITY 11: Technical Workshops
In general, HIV information related to programs and policy is not available to state, district and field staff. In
FY09, PHMI will organize workshops to disseminate timely and important HIV-related reports and
operational research findings from India and especially from AP. The workshops will be run in collaboration
with APSACS and other key agencies and institutions in AP.
PHMI will conduct periodic workshops for stakeholders to share, analyze, and process operational research
findings, surveillance reports, and scientific studies. This will provide a forum for sharing experiences, new
findings from the field, and operational/ technical guidelines. PHMI will advocate with State level policy
makers and program implementers for more and better use of quality strategic information in AP.
ACTIVITY 12: Virtual Platform for Information
Creation of a virtual platform for information and knowledge sharing encourages faculties and trainees to
work collaboratively and learn from each other. The PHFLFP program demonstrated the value of creating a
virtual resource library to build relationship between and among faculty and trainees and provide a platform
for collaboration, exchange, and capacity-building. Developing a virtual platform will provide a lower-cost
option to assist the PHMI faculty to reach trainees, since the faculty is geographically dispersed. A web-
based learning program using UNESCO-recommended free software will be developed and will be
managed by a point person from PHMI. All training material will be posted on the web for the trainees.
Assignments, submissions, and a discussion forum can also be supported through the virtual platform.
ACTIVITY 10: Twinning/South-to-South Collaboration
South-to-South partnerships and peer relationships can create an effective framework for building
sustainable institutional and human-resource capacity through the open exchange of knowledge,
Activity Narrative: information, and professional experience. PHMI will assist state and national level public health workforces
to learn from international field experience - preferably with USG partners in the South - in the areas of HIV
prevention, care, strategic information and systems strengthening components. PHMI will assist health
officers and partners to reflect on their own work, share best practices with others and help replicate
successful models. PHMI will promote faculties' and students' exchange programs between India and other
global South countries and will encourage public health experts to go for study tours, meetings,
conferences, and short-term trainings. It is expected that 4 Indian experts and 4 from Southern countries
would be supported for exchange visits.
Continuing Activity: 14594
14594 10116.08 HHS/Centers for Share Mediciti 6880 3978.08 PHMI $250,000
10909 10116.07 HHS/Centers for Share Mediciti 5622 3978.07 $45,000
10116 10116.06 HHS/Centers for Share Mediciti 3978 3978.06 $45,000
Estimated amount of funding that is planned for Human Capacity Development $346,000
Table 3.3.18:
