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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+The extension of the PMTCT supervisory model from district to lower level facilities (Health centers) to
sustain provider performance through continuous on-the-job (OTJ) cascade training and support
supervision. Subsequently all facility-level supervisors will be encouraged to regularly provide on-the-job
orientation and support to PMTCT frontline workers using a cascade on-the-job (OTJ) approach.
+The activity also strives to strengthen linkages between PMTCT, CCCs and PLHIV support groups in order
to increase access to HIV prevention and ART for adults, adolescents and children who are most likely to
benefit.
+The standards based management and recognition support being provided in four provincial hospitals will
be rolled out to the whole country with ACCESS providing technical support.
COP 2008
The only changes to the program since approval in the 2007 COP are the extension of the PMTCT
supervisory model from district to lower level facilities (Health centers) to sustain provider performance
through continuous OTJ cascade training and support supervision. Subsequently all facility-level
supervisors will be encouraged to regularly provide on-the-job orientation and support to PMTCT frontline
workers using a cascade on-the-job (OTJ) approach. The activity also strives to strengthen linkages
between PMTCT, CCCs and PLHA support groups in order to increase access to HIV prevention and ART
for adults, adolescents and children who are most likely to benefit.
1. LIST OF RELATED ACTIVITIES
This activity relates to activities by NASCOP in Prevention of Mother-to-Child Transmission.
2. ACTIVITY DESCRIPTION
In FY 2008 USAID's ACCESS Project implemented by JHPIEGO supported the DRH to strengthen its
supervisory function, quality assurance program and referral systems to ensure the delivery of high quality
PMTCT services at public sector and faith-based facilities. Because the linkages between PMTCT and
CCCs are still weak, HIV-free survival of infants born to HIV infected mothers cannot be guaranteed. In FY
2009, JHPIEGO will continue to build upon FY 2008 initiatives by further supporting the MOH's Division of
Reproductive Health, to develop the capacity of 16 provincial and 120 district level DRH and NASCOP
officers to oversee the integration of reproductive health (RH) with HIV services and assure better referrals
and linkages between PMTCT and ART services. In FY 2009 the DRH with NASCOP will continue to
provide guidance on how to strengthen PMTCT/FP/ART integration to 500 provincial and district level DRH
and NASCOP officers using the standard-based management and recognition approach and will help rollout
this approach nationally. Through regular support to the district and provincial PMTCT training and
supervision teams, DRH with NASCOP will ensure a coordinated scale up of integrated HIV care and
treatment, family planning, postnatal care including psychosocial support while assuring effective linkages
between PMTCT, PMTCT plus services and HIV care and treatment services for HIV positive women, their
infants and family members. In FY 2009 JHPIEGO will participate in the MOH's Technical Working Group
for PMTCT (jointly led by DRH and NASCOP) to ensure coordination of activities and compliance with MOH
guidelines for service delivery.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
The MOH's division of reproductive health provides leadership, coordination and advocacy for national
reproductive health programs and NASCOP. By supporting the provision of integrated PMTCT/FP/ART
services the DRH will significantly contribute to the PEPFAR goals for primary prevention, care and
treatment. The decentralized training and supervision system will build capacity of provincial and district
DRH and NASCOP officers in managing comprehensive PMTCT with HIV and RH services and universal
access to ARV prophylaxis across provinces. This activity also contributes substantively to Kenya's Five-
Year strategy of availing services, which can reduce mother-to-child infections, and providing critical links to
HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to
integrate testing with other health services and improving the referral links among all of these services.
4. LINKS TO OTHER ACTIVITIES
This activity relates to activities in PMTCT through NASCOP to improve the quality and supervision of
integrated prevention care and treatment services. It also enhances referral linkages within HIV services.
5. POPULATIONS BEING TARGETED
Strategies to improve quality of services will directly target policy makers, National AIDS Control program
staff, other Ministry of Health staff working as program managers in the DRH at provincial and district level.
Service providers such as doctors, nurses, mid wives, other health care workers including clinical officers
and public health officers working in both public and faith based facilities, as well as infants and pregnant
women in rural and urban communities will also benefit from support supervision. The PMTCT TWG works
with faith-based organizations, non-governmental organizations and implementing organizations.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will increase gender equity in programming through PMTCT services targeted towards
pregnant women and their spouses. Increased availability of PMTCT and PMTCT+ services and the BCC
program for infant feeding will increase access and help reduce stigma at community and facility level. This
activity has a wrap around component namely supporting linkages between HIV/AIDS and RH services.
7. EMPHASIS AREAS
The activity includes a major emphasis on quality assurance and supportive supervision. There is a minor
emphasis on development of network/linkages/referral systems and information, education and
communication. The activity will support strategic information through printing and dissemination of data
collection tools.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14857
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14857 4811.08 U.S. Agency for JHPIEGO 6959 3478.08 ACCESS $300,000
International
Development
6925 4811.07 U.S. Agency for JHPIEGO 4239 3478.07 ACCESS $1,082,740
4811 4811.06 U.S. Agency for JHPIEGO 3478 3478.06 ACCESS $250,000
Table 3.3.01:
1. ACTIVITY DESCRIPTION AND EMPHASIS AREAS
In 2009, The ACCESS project implemented by JHPIEGO will disseminate the injection safety and waste
management guidelines in all districts in Rift Valley Province and provide orientation to health workers.
Subsequently these health workers will give service orientation to 12,000 health workers using a cascade
on-the-job approach. This activity will promote awareness of injection safety among health care workers
resulting in improved injection safety and waste disposal practices in Ministry of Health facilities, a vital part
of HIV prevention. JHPIEGO will support the Ministry of Health and National AIDS and STI Control Program
(NASCOP) to develop an orientation package that breaks down the knowledge component of the guidelines
and allows continuing education credit for health workers successfully completing this orientation. This
orientation for health workers helps to improve the quality of injection safety practice. An additional intent is
to develop sustained capacity to continue these programs after the project ends by encouraging ‘‘bundling''
of injectable vaccines, injectable contraceptives and medicines in donor supported programs with single-use
needles and syringes that include re-use prevention features and safety boxes. JHPIEGO will also work
closely with other stakeholders in the area of injection safety including the Ministry of Health Infection
Prevention and Control Committee, the Nosocomial TB/HIV Prevention Unit of NASCOP and John Snow,
Inc./Making Medical Injections Safer (JSI-MMIS). At the planning stage, both central and appropriate
peripheral levels of the Ministry of Health will be involved along with other stakeholders.
This activity has major emphasis on training to impart improved skills, knowledge and attitudes regarding
safe injection practices to health care workers, waste handlers and the community. The Ministry of Health
(MOH) has recently approved the national policy on injection Safety and medical health care waste
management. JHPIEGO will work with MOH and the National Aids and STD Control Program (NASCOP) to
disseminate this policy to stakeholders. This activity will complement training of health care workers in safe
injection practices conducted by JSI-MMIS. Where possible, health delivery facilities will be encouraged to
implement this policy with their own training and procurement resources. The MOH has already committed
to procuring AD syringes and safety boxes. These however are insufficient to meet the national
requirement. This activity will enable the Injection Safety program make a leap towards reduction of HIV
transmission through medical injections.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to reduction in HIV transmission in Kenya. In 2009, dissemination of the
guidelines will strengthen and improve safe injection and waste disposal practices through training of 1,000
trainers of trainers.
3. LINKED ACTIVITIES
The injection safety initiative is linked to the Kenya Expanded Program for Immunization (KEPI), which
already procures non re-use injection devices for its program. Other Kenyan stakeholders in the area of
injection safety have been mobilized including the Ministry of Health Infection Prevention and Control
Committee and the Nosocomial TB/HIV Prevention Unit of NASCOP. A National Injection Safety Steering
Committee has been established at the Ministry of Health chaired by the Deputy Director of Medical
services and Head of Preventive Health Services. Membership to this committee is drawn from all the
programs at the MOH and incorporates the National Environmental Management Authority (NEMA). World
Health Organization (WHO), National AIDS Control Council (NACC), CDC and USAID. The
ACCESS/JHPIEGO injection safety activities will relate to all the other injection safety activities under the
PEPFAR initiative and coordinated by the Ministry of Health, National AIDS and STI Control Program
(NASCOP) and CDC.
4. POPULATIONS BEING TARGETED
This activity targets health care workers, the community, medical waste handlers, and policy-makers.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address GOK and international standards and guidelines for universal precautions. This
activity will contribute to the development of Quality Assurance Standards (the Kenya Quality Model - KQM)
as outlined in the MOH Second National Health Sector Strategic Plan of Kenya, August 2005. This activity
will also contribute to the Kenya National HIV/AIDS Strategic Plan 2005/6 - 2009/10.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.05:
ACTIVITY UNCHANGED FROM COP 2008
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key cross-cutting attributions in human capacity development through its training
program for health workers ($500,000).
The training activities in Eastern, Nairobi and Central Province will link to health workers in JHPIEGO
APHIA II Eastern program in ART, as well as other partners funded in the HTXS and PDTX program areas.
In FY09 USAID'S ACCESS project (implemented by JHPIEGO) will continue to build the capacity of health
workers in Ministry of Health (MOH) facilities in Eastern, Central and Nairobi Provinces in order to initiate
and provide comprehensive HIV/AIDS treatment and care services. In collaboration with National AIDS and
STD Control Program (NASCOP) JHPIEGO will disseminate, train and mentor health workers on the
already developed competency-based orientation materials for comprehensive care, based on MOH
National Guidelines for HIV/AIDS treatment. In FY2006-2007, ACCESS supported the MOH to adapt the
World Health Organization's Integrated Management of Adult and Adolescent Illness (IMAI) training
approach in Kenya. IMAI builds the knowledge and skills of nurses and clinical officers to provide HIV
prevention, care and treatment in first-level health facilities. This highly successful training approach utilizes
people living with HIV as ‘expert patient trainers'. ACCESS assisted the MOH to develop training materials,
developed over 100 trainers at national and provincial level, trained over 500 service providers, trained 56
people living with HIV as Expert Trainers, helped initiate ART services in 92 new sites including pediatric
HIV care and treatment. In FY 2008, ACCESS is building the capacity of providers caring for HIV-infected
persons to integrate family planning (FP) services and management of sexually transmitted infections (STI)
into HIV care and treatment. Additionally, ACCESS reprinted and disseminated Prevention with Positives
(PwP) training materials, and trained PwP TOTs at national, provincial and community level; developed
national Mentorship Implementation Guidelines and trained a first batch of Mentor TOTs.
Reproductive health choices and the unmet need for family planning for people living with HIV remain
largely unaddressed. An integrated approach for ART/FP/STI services will reduce missed opportunities and
narrow the gap for unmet FP needs.
In FY2009, it is envisioned that JHPIEGO will continue to strengthen these services by building on FY2008
activities, completing the ACCESS steps for capacity building in PwP and clinical mentorship in ART. In
addition, capacity building in advanced IMAI for second level service providers (targeting clinical officers
and medical officers to enable them to offer ARV drug substitutions, drug failure, and manage side effects
and opportunities infections) is now thought to be a priority intervention
This activity will contribute to the 2009 Emergency Plan result for increased availability of skilled health
workers to provide care and treatment. It will enable service providers to identify and initiate HIV infected
patients on ART. This activity will increase access to quality treatment services particularly among
underserved. It also contributes to Kenya's 5-year strategy emphases of developing effective linkages
between prevention, care and treatment services within an integrated network.
This activity targets people living with HIV/AIDS, HIV positive infants, HIV positive children. It also targets
other MOH staff including program managers in the NASCOP, and public health care doctors and nurses.
This activity will help to reduce stigma associated with HIV status by increasing the availability of
comprehensive care.
7. EMPHASIS AREAS This activity includes major emphasis on training and development of
network/linkages/referral systems as detailed in the activity description in Section 1 above.
Continuing Activity: 14860
14860 12493.08 U.S. Agency for JHPIEGO 6959 3478.08 ACCESS $500,000
12493 12493.07 U.S. Agency for JHPIEGO 4239 3478.07 ACCESS $1,000,000
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $500,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
The only changes to the program since approval in the 2007 COP are:
+ geographic coverage has been revised and expanded to include Eastern, North Eastern, and Nairobi and
Central provinces
+ to provide Provider Initiated Counseling and Testing.
This activity is related to activities in TB/HIV care activities, HIV/AIDS treatment services, abstinence and be
faithful, OVC, HBHC, other prevention and PMCT.
Since 2005, ACCESS has provided critical support to NASCOP to introduce quality Diagnostic Testing and
Counseling (DTC) and later Provider-Initiated Testing and Counseling (PITC) to meet the Government of
Kenya's priority of expanding access to testing and counseling services through the health system. As part
of this support, state-of-the-art materials in HIV testing and counseling have been developed and
disseminated, 95 trainers have been developed at central and provincial levels, and over 400 service
providers trained on PITC.
ACCESS will build on the successes and lessons learned from FY 2005, FY 2006 and FY 2007 activities to
continue to promote the availability and delivery of high quality HTC services in public Ministry of Health
(MoH) facilities and communities. In FY 2007, ACCESS is supporting the National AIDS and STI Control
Program (NASCOP) to develop new and harmonized HIV testing and counseling guidelines, which includes
client-initiated counseling and testing, provider-initiated testing and counseling, home-based testing and self
testing. Over the next two years, ACCESS will disseminate these guidelines, develop an orientation
package to build skills in testing and counseling in clinical and home settings. Working with the APHIA
provincial partners, selected districts/facilities will be supported to demonstrate the provision of high quality
PITC services and effective referral linkages with HIV-related services such comprehensive HIV care
centres (CCC), psychosocial support services, legal and other services available in the community.
In subsequent years, ACCESS will support efforts in expanding counseling in care for HIV clients and other
emerging priorities in the area of HTC. Currently, most of the testing and counseling services have focused
on identification of HIV-infected persons, an essential component in HIV prevention, care, and treatment.
As more people are identified and brought to care, there is need to build/strengthen the capacity of health
providers to offer continued counseling for infected persons (counseling in care). Counseling in care
addresses the continued support needs of people living with HIV such as psychosocial support, gender
issues, adherence to therapy, child counseling, and couple counseling. The ACCESS steps to building
sustainable training capacity and its comprehensive approach to training will be the foundation in each
priority area.
Activities include
- Dissemination of HTC guidelines
- Develop/adapt training materials including orientation packages and job aids for clinical, home and self
testing
- Development of HTC trainers at provincial level
- Development of supervisors and mentors at provincial level
- Training/orientation of service providers at selected districts
- Orientation of service providers through the cascade / echo approach
- Implement SBM-R approach for quality improvement for HTC
- Assist APHIA II partners to implement the training and orientation of service providers
This activity will contribute to the 2008 Emergency Plan result for increased availability of diagnostic
counseling and testing through training of health workers. It will enable service providers to identify the large
numbers of HIV infected patients who are potential candidates for ART. This activity will increase access to
prevention and treatment services particularly among underserved and high risk populations. It also
contributes to Kenya's 5-year strategy emphases of encouraging Kenyans to learn their status and
developing strong links between counseling and testing and HIV services for those who are HIV positive
and in need of health care.
JHPIEGO/ACCESS activities are focused on trainings and are therefore linked to counseling and testing
activities conducted by the APHIA II partners in counseling and testing in the different provinces: Coast, Rift
Valley, Western, NEP, Eastern, Nairobi/Central, Nyanza. It is also related to NASCOP/MOH counseling and
testing. This activity is also related to JHPIEGO/ACCESS activities in Injection safety.
This activity targets MOH staff including program managers in the NASCOP, public health care doctors and
nurses, other health care workers including community health workers. 4,000 health care workers will be
trained.
This activity will help to reduce stigma associated with HIV status by increasing the availability of routine
testing for diagnosis in medical settings.
This activity includes major emphasis on training and minor emphasis in development of
network/linkages/referral systems as detailed in the activity description in Section 1 above as well as minor
emphasis on policy and guidelines.
Continuing Activity: 14859
14859 4155.08 U.S. Agency for JHPIEGO 6959 3478.08 ACCESS $800,000
6924 4155.07 U.S. Agency for JHPIEGO 4239 3478.07 ACCESS $500,000
4155 4155.06 U.S. Agency for JHPIEGO 3478 3478.06 ACCESS $500,000
Table 3.3.14:
