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.
1. ACTIVITY DESCRIPTION & EMPHASIS AREAS
The role of the TBD is to serve as an umbrella mechanism to build capacity of and provide technical
assistance to smaller local indigenous organizations. These organizations will represent a mix of CBOs,
FBOs, and other organizations and will enable depth and breadth in reaching Kenyans in community and
clinical settings. It will also ensure sustainability as technical and organizational capacity of these
indigenous groups is expanded. The TBD will provide technical leadership in the implementation of
Families Matter and Men as partners. It will spearhead the development and utilization of standard
operating guidelines to assure quality in prevention programs for partners. The TBD will implement a
comprehensive range of prevention activities implemented throughout Kenya, with particular emphasis on
emerging prevention needs such as a focus on geographic areas identified as most in need based on
recent prevalence data as well as an emphasis on most-at-risk populations shown to be driving the
epidemic. The TBD will reach these populations with targeted interventions based on standardized evidence
-based comprehensive packages of services designed for each of the target populations. The partner will
provide training, materials and guidance on integrating priority thematic issues such as addressing gender
norms and attitudes that result in lack of access to services, gender-based violence, engaging men in
prevention, cross-generational sex etc. Additionally, specific AB messages will target adults (both men and
women) to reduce multiple concurrent partners. Strategic geographic areas identified as target areas based
on highest prevalence in Kenya include Nyanza, Nairobi, and Coast; while prevention activities will be
implemented throughout Kenya, the areas listed above will receive particular emphasis. The project will
also target intensifying reach to rural populations. The TBD will also provide leadership in Prevention with
Positives (PwP) activities, which have been identified as a critically important prevention intervention for
Kenya. The TBD will integrate PwP activities across program areas. It will strive to augment meaningful
involvement of people living with HIV/AIDS (MIPA) by, for example, promoting PLHIV as advocates of and
leaders in prevention. The TBD will also support activities which target discordant couples with
standardized prevention interventions uniquely tailored to this specifically vulnerable group. The TBD may
also continue work the CHF began in FY08 in which they play a role in catalyzing an ongoing national
process to develop and implement a PwP Toolkit (including training and implementation materials,
operational guidelines, and M&E tools to inform the roll-out of PwP interventions across clinical and
community settings). This role may include the active and supportive participation in the national PwP
TWG, as well as in the roll-out of national PwP training, implementation and monitoring process. The TBD
will also target in- and out-of-school youth with comprehensive prevention messages; moreover, the TBD
will accelerate prevention initiatives by specifically targeting vulnerable, hard-to-reach and vulnerable youth.
Additionally, this prevention activity will incorporate $600,000 to partner with HIV Free Generation activities
that focus on youth.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
In line the USG Kenya STP program priorities, the TBD will implement comprehensive evidence-based
highly active prevention activities to the general population as well as specific youth and adult targets.
These activities will be implemented through the initiatives of a range of indigenous sub-partners and will
result in 1,200 individuals trained to promote HIV/AIDS prevention through abstinence and/or being faithful
interventions and 270,000 people reached through community outreach that promotes HIV/AIDS prevention
through abstinence and/or being faithful messages. The umbrella TBD's primary mandate is to build the
technical and organizational capacity of local Kenyan organizations, as well as develop quality models for
implementing evidence-based prevention programs. It will also develop materials for use by implementing
sub-partners. Therefore, the TBD contributes significantly toward PEPFAR's 5-Year Strategy of ensuring
sustainability and striving toward increasing Kenyan leadership in the fight against HIV/AIDS.
3. LINKS TO OTHER ACTIVITIES
These activities will link to other sub-partners supported through the Umbrella TBD in other program areas
to ensure that all partners are integrating prevention into programmed activities across each program area.
Strong linkages to counseling & testing will be established so that prevention interventions are based on
knowledge of status and that of one's partner. PwP messages will be infused across all clinical and
community settings where PLHIV are provided with treatment, care and support. Linkages with OVC
programs will also be established to ensure that this group of vulnerable children is provided with
comprehensive prevention messages.
4. POPULATIONS BEING TARGETED
Highly active prevention interventions will target the general population and other vulnerable sub-
populations, especially in geographic areas of highest need. Targeted populations will include in and out-of
school youth, young people, adults, couples, workplace staff, adolescent girls, men, rural populations,
PLWHAs and specific congregates such as faith communities. In areas of high HIV prevalence such as
Nyanza, there are concentrated groups of highly vulnerable groups such as widows and discordant couples
as well as populations thought to be drivers of the epidemic such as fishermen. Community-level activities
will reach these groups with targeted prevention interventions. PLHIV will be reached through a range of
clinical and community PwP interventions; MIPA will be encouraged at all levels. In and out of school youth
will be targeted through a range of prevention activities including those supported through the HIV-Free
Generation.
5. SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS $300,000
This activity will address human capacity development through training lay and community health workers to
provide prevention services in their communities.
New/Continuing Activity: Continuing Activity
Continuing Activity: 19419
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
19419 19419.08 HHS/Centers for Catholic Relief 12006 12006.08 Umbrella $567,750
Disease Control & Services
Prevention
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
ACTIVITY UNCHANGED FROM COP 2008
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to Abstinence/Be Faithful and Counseling and Testing.
2. ACTIVITY DESCRIPTION
indigenous groups is expanded. The TBD will also provide technical leadership in implementing priority
interventions which include Men as Partners, Families Matter, GBV prevention and HIV-free generation
activities among others. The TBD will work with relevant government departments and NGOs to support
Highly-active prevention packages. The TBD will implement a comprehensive range of prevention activities
implemented throughout Kenya, with particular emphasis on emerging prevention needs such as a focus on
geographic areas identified as most in need based on recent prevalence data as well as an emphasis on
most-at-risk populations shown to be driving the epidemic. Vulnerable populations include discordant
couples; adult populations, particularly widows/widowers; and rural populations. In addition, most-at-risk
populations or MARPS (identified as drivers in the Kenyan HIV/AIDS epidemic through recent studies
including the Kenya AIDS Indicator Survey (KAIS) and the Modes of Transmission Study) include
commercial sex workers (CSW), men who have sex with men (MSM), injecting drug users (IDUs), and
fishermen. The TBD will also reach these populations with targeted interventions based on standardized
comprehensive packages of services designed for each of the target populations. Clients of CSWs will be
targeted with specific interventions that focus on consistent condom use and knowing HIV status. MARPS-
focused activities will specifically tackle gender issues by addressing gender norms and attitudes that result
in lack of access to services, gender-based violence, etc. Strategic geographic areas identified as target
areas based on highest prevalence in Kenya include Nyanza, Nairobi, and Coast; while prevention activities
will be implemented throughout Kenya, the areas listed above will receive particular emphasis. The TBD
will also provide leadership in Prevention with Positives (PwP) activities, which have been identified as a
critically important prevention intervention for Kenya. The TBD will integrate PwP activities across program
areas. It will strive to augment meaningful involvement of people living with HIV/AIDS (MIPA) by, for
example, promoting PLHIV as advocates of and leaders in prevention. The TBD will also support activities
which target discordant couples with standardized prevention interventions uniquely tailored to this
specifically vulnerable group. The TBD may also continue work the CHF began in FY08 in which they play
a role in catalyzing an ongoing national process to develop and implement a PwP Toolkit (including training
and implementation materials, operational guidelines, and M&E tools to inform the roll-out of PwP
interventions across clinical and community settings). This role may include the active and supportive
participation in the national PwP TWG, as well as in the roll-out of national PwP training, implementation
and monitoring process. The TBD will also target in- and out-of-school youth with comprehensive
prevention messages; moreover, the TBD will accelerate prevention initiatives by specifically targeting
vulnerable, hard-to-reach and high risk youth. Additionally, this prevention activity will incorporate $500,000
to partner with HIV Free Generation activities that focus on youth.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
In line the USG Sexual Transmission Prevention (STP) team's identified priorities, the TBD will implement
comprehensive, highly active prevention activities in an evidence-based approach of targeting those
populations shown to be most at risk and drivers of the epidemic. Prevention activities targeting MARPS
such as CSW, MSM, discordant couples and widows will be rolled out throughout Kenya, with particular
focus on geographic areas of highest need, in both clinical and community settings. These activities will be
implemented through the initiatives of a range of indigenous sub-partners that the TBD will result in 923
individuals trained to promote HIV/AIDS prevention through other behavior change beyond abstinence
and/or being faithful; 466,100 people reached through community outreach that promotes HIV/AIDS
prevention through other behavior change beyond abstinence and/or being faithful; and 1,252 targeted
condom service outlets. The umbrella TBD's primary mandate is to build the technical and organizational
capacity of local Kenyan organizations. Therefore, the TBD contributes significantly toward PEPFAR's 5-
Year Strategy of ensuring sustainability and striving toward increasing Kenyan leadership in the fight
against HIV/AIDS.
4. LINKS TO OTHER ACTIVITIES
5. POPULATIONS BEING TARGETED
Highly active prevention interventions will target vulnerable and most-at-risk populations, especially in
geographic areas of highest need. Targeted populations will include MARPS (including CSW, MSM, IDU,
discordant couples, widows, and fishermen), PLHIV, and in- and out-of-school youth. CSW and MSM will
be reached through standardized packages of comprehensive services designed to meet the prevention
needs of these hard-to-reach populations. In areas of high HIV prevalence such as Nyanza, there are
concentrated groups of highly vulnerable groups such as widows, discordant couples, fishermen etc.
Community-level activities will reach these groups with targeted prevention interventions. PLHIV will be
Activity Narrative: reached through a range of clinical and community PwP interventions through MIPA. In and out of school
youth will be targeted through a range of prevention activities including those supported through the HIV-
Free Generation.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity helps to increase gender equity in HIV/AIDS programs by ensuring the young women and
young men have equal access to services. It will address male norms and behaviors as well as reduction of
sexual violence and coercion. PwP activities will particularly address stigma and discrimination. Out of
school youth will be assisted to increase their access to income and productive resources through linkages
with livelihood and skills training.
7. EMPHASIS AREAS
Major emphasis area will be community mobilization/participation. Minor emphasis will include development
of a referral network and referral systems particularly to enable youth access HIV care and treatment
services. Information, Education and Communication materials alongside training will be provided to project
partners and community volunteers. The Prime partner will assure quality through establishing standard
operating procedures and guidelines on minimum package of prevention services.
Continuing Activity: 19421
19421 19421.08 HHS/Centers for Catholic Relief 12006 12006.08 Umbrella $75,000
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Table 3.3.03:
1. ACTIVITY DESCRIPTION AND EMPHASIS AREAS
This TBD Umbrella partner will build organizational capacity and provide sub grants to NGOs, FBOs, and
CBOs, resulting in the dissemination of messages for HIV prevention through abstinence, faithfulness in
sexual relationships and where appropriate condom use (ABC). Blood donor mobilizers will be trained to
deliver "healthy life style/ donors love life and safe blood donation" messages to 480,000 potential blood
donors aged 16 - 65 years. It is estimated that only one in four potential blood donors approached actually
become blood donors. This implies that to obtain 120,000 blood units in 2006, about 480,000 persons may
have heard a pre-donation talk. This activity aims to ensure that HIV prevention ABC and healthy living
messages are given at all pre-donation talks through the development of appropriate messages and training
of blood donor mobilizers in the use of ABC/ healthy living messages for HIV prevention. This will promote
awareness of HIV prevention strategies even for persons who do not donate blood. 100 blood donor
mobilizers will be trained and IEC material produced for this activity. The primary implementing partner in
this activity, TBD Umbrella, will build the organizational and financial management capacity of local and
indigenous organizations and provide supportive supervision. Funds granted through TBD Umbrella to sub
partners will be used to disseminate a standard package of ABC messages for HIV prevention,
improvement of community mobilization activities, and referral for counseling and testing whenever
appropriate. This activity includes support to the following sub-recipients for activities integral to the
program: Bloodlink Foundation $250,000; Kenya Red Cross Society $40,000; Africa Society for Blood
Transfusion $150,000. It will expand existing blood safety programs by (Bloodlink Foundation (BLF), Africa
Society of Blood Transfusion, Kenya Chapter (AfSBT) and Kenya Red Cross Society (KRCS), and continue
to place emphasis in HIV prevention through provision of safe blood. Bloodlink Foundation has mobilized
blood donors in work places and mobilized resources for donor recruitment from business organizations
such as Safaricom for the last four years resulting in out - of -school donors increasing from 10% to 40% of
all blood donors. In the work place, 25,000 employees will be educated on HIV prevention, healthy living
and safe blood donation. BLF will also support the establishment of regular blood donor youth support
clubs, similar to Pledge 25 clubs, within the Universities. These clubs will promote HIV prevention amongst
the youth. In addition the National Center for Health Marketing's Global Communication and Marketing
Team (NCHM/GCM) will collaborate with GAP, the National Blood Transfusion Service (NBTS), and BLF to
support a project to increase the number of blood donors who make repeat donations by using mobile
phone SMS technology to support targeted messaging. NCHM/GCM will provide guidance and technical
support in using appropriate mobile technologies and communication principles in designing a program that
utilizes a donor database to send messaging to encourage repeat donations and target donors by blood
type when blood stores are critically low or in times of emergency. Through this activity BLF will support the
procurement of software necessary for full implementation of the communication system. KRCS and BLF,
under guidance from TBD Umbrella will deliver abstinence, be faithful and condom use (ABC) messages for
HIV prevention in blood donor mobilization settings. TBD Umbrella will work with local organizations to
strengthen implementation of their abstinence curriculum. KRCS is mandated to mobilize voluntary non-
remunerated blood donors from high schools and colleges. AfSBT will continue to work with NBTS and
AABB to support and mentor 20 hospital transfusion committees (HTC) at eight provincial hospitals, two
referral hospitals and ten high blood use district hospitals. Through advocacy with hospital management
boards, HTCs will be appointed, trained, and quarterly meetings facilitated for each of the 20 hospitals. The
HTCs will serve to review number of transfusions and sources of blood, determine indications for
transfusion, investigate transfusion reactions, benefits and outcomes, and monitor blood storage and
administration conditions and review policies and procedures regularly. Additionally AfSBT will support
NBTS and AABB in dissemination and monitoring of the implementation of the recently introduced National
Standards on Blood Transfusion. Major emphasis in this program is local organization capacity
development, training and equipping potential blood donors with relevant life skills for HIV prevention and
supportive supervision (through at least 3 sub-grants).
The blood safety program aims to increase its contribution towards averting new HIV/AIDS infections in
Kenya. This will be achieved through delivery of ABC messages during mobilization of blood donors
amongst high school students, out-of school youth and workers to encourage abstinence and secondary
abstinence until marriage; increase faithfulness in monogamous relationships among both youth and the
general population; promote HIV testing to encourage abstinence and fidelity. This activity will train 100
individuals to provide HIV/AIDS programs that promote abstinence and/or being faithful. In addition 480,000
individuals will be reached with HIV/AIDS prevention/ blood mobilization programs that will promote
abstinence and/or being faithful. BLF will mobilize blood donors in work places alleviating blood shortage in
the school holiday months. BLF will further its activities of strengthening private public partnerships (PPP) to
mobilize additional resources for the NBTS. Functional HTC will enhance appropriate blood utilization and
minimize unnecessary transfusions. These activities are consistent with the Kenya 5-Year Strategy which
focuses on HIV prevention. This partner has a key role in building capacity of local organizations so that
these activities can be sustained over the long term.
This activity relates to activities in Blood Safety implemented by National Blood Transfusion Service (NBTS)
American Association of Blood Banks (AABB), Internews and APHIA II HCM. In addition to building the
capacity of sub-grant recipients, an important aspect of TBD Umbrella activities is to support development
of linkages between the organizations they support to implement a variety of HIV prevention and treatment
activities. For example, linkages that have been established during capacity building trainings have led to
improved referrals/linkages of patients. The ABC activities will be linked to other HIV prevention activities
including VCT campaigns and volunteer blood donor mobilization for the prevention of HIV transmission
through blood transfusions.
Training institutions such as schools, universities and colleges; CBOS, FBOs and work places form the
main populations that will be reached with ABC messages. Among the 15-24 year olds, the goal is to
increase their knowledge on abstinence and secondary abstinence options and to reach them with
messages about fidelity and expanded/strengthened "A" and "B" activities. In the younger adults the goal is
to increase the practice of abstinence until marriage among unmarried youth and to decrease infidelity and
Activity Narrative: other harmful behaviors among both youth and adults. Among parents, teachers, community leaders, and
corporate leaders, the goal is to create a supportive environment for the practice of proven HIV prevention
strategies. Health providers will be trained on appropriate blood use.
Continuing Activity: 14762
14762 4862.08 HHS/Centers for Community 6941 348.08 $320,000
Disease Control & Housing
Prevention Foundation
6877 4862.07 HHS/Centers for Community 4221 348.07 $140,000
4862 4862.06 HHS/Centers for Community 3233 348.06 $150,000
Health-related Wraparound Programs
* Malaria (PMI)
* Safe Motherhood
Table 3.3.04:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ Partner will be competitively selected to implement the activity.
+ The activity will place an emphasis on the HIV counseling and testing of children with a focus on provider-
initiated home and community-based testing as an entry for care and support services to children. Using the
opt-out approach; the activity will test 90% of OVC enrolled; targeting approximately 4,500 with testing and
counseling. Of those tested, approximately 360 will be identified as HIV-exposed or infected and enrolled
into facility-based HIV care and treatment services to receive cotrimoxazole (CTX), evaluation for ART
eligibility and other basic HIV care services.
+ In 2009, the activity will support the referral of particularly vulnerable OVC to the Nutrition and HIV/AIDS
Program and ensure that an increased number of OVC requiring food and nutritional services will be
reached with food supplements procured through the NHP.
+ In 2009, the activity will be used to support the development of OVC standards for Kenya and in
supporting quality improvement approaches for monitoring and improving the quality of OVC programs at
the provincial level.
+In 2009, the activity will also focus on establishing appropriate linkages with PMI and ensure that OVC
being supported under this activity to ensure that they are also able to benefit from mosquito nets procured
by PMI.
+ In FY09, the activity will also focus on integrating prevention activities. The activity will link with prevention
programs to support male circumcision and counseling and testing for OVC as well as prevention with
positives for adolescents.
This activity will support key cross cutting attributions of the budget amounting to $15,000 towards
Economic Strengthening through the support of income generating activities to support increased
household food security. The activity will also attribute a portion of its budget to supporting educational
activities targeting OVC enrolled in the program in the amount of $25,000. A further $5,000 will be attributed
to provision of safe water guards for households looking after OVC.
This activity relates to activities in Abstinence/Be Faithful (#6876), Condoms and Other Prevention (#6872),
Counseling and Testing (#6875), Palliative Care: Basic Health Care Support (#6870), Palliative Care:
TB/HIV (#6871), Treatment: ARV services (#6869) and Other/Policy Analysis and Systems Strengthening
(#6873).
TBD Umbrella partner will work with sub-grantees to provide services to 5,000 orphans and vulnerable
children (OVC) and train 500 caregivers to provide OVC care. It will provide primary direct support to 4,000
OVC and 1,000 supplemental support. TBD Umbrella will be awarded a cooperative agreement with CDC to
work with local Non-Governmental Organizations (NGOs), Community Based Organizations (CBOs) and
Faith Based Organizations (FBOs) in Nyanza and other regions in Kenya to build their capacity to
implement community-based HIV services. These services were previously provided by Cooperative
housing Foundation of which their cooperative agreement is coming to an end March 2009.
In FY 2009, TBD Umbrella will expand its scope of activities to include suitable organizations that have on-
going programs for OVC. TBD Umbrella will continue supporting new partners who will be selected through
close collaboration with CDC. An important element in this program is strengthening HIV prevention
education among OVC to equip them with life skills that would reduce their vulnerability to the risk of HIV
infection. Caregivers will be trained to strengthen the family support system and strong linkages will be
established between PLWHAs, HIV-infected children and health care services, including ensuring that
children and their parents or caregivers and other family members affected access appropriate care and
treatment. These programs will work closely with care and treatment partners to ensure that HIV-infected
children receive appropriate psychosocial support and that they have a consistent caregiver to assure
adherence to treatment. The scope of the current programs will be expanded to ensure that they provide a
package of essential services that qualify as primary direct support. All programs will work in close
collaboration with the District Children's Department and will follow guidelines provided by the parent
ministry, alongside PEPFAR guidelines.
Through partnerships with local sub-partners supported, TBD Umbrella will provide 5,000 OVC with access
to essential services, train 500 caregivers, and build the capacity of local, community and faith-based
organizations to meet the needs of OVC in their communities. TBD Umbrella will mainstream the
development of referral mechanisms and linkages among all partner organizations within a geographic
region, ensuring that served OVC link with appropriate services, even if the individual NGO partner does not
provide them.
The OVC and the community will be referred to VCT centers in the health facilities where the activities are
taking place. TBD Umbrella will work with the organizations undertaking home and community support in
the same areas. This activity is linked to activities in the following program areas: CT (#6875); AB (#6876);
OP (#6872); Policy Analysis and Systems Strengthening (#6873) and ART (#6869).
This activity targets orphans and vulnerable children, older OVC, widows/widowers, HIV+ children,
HIV/AIDS affected families and People Living with HIV/AIDS.
This activity helps increasing gender equity in HIV/AIDS programs by ensuring the girl children have equal
access to services, and disaggregating data on girl children. It also addresses the wrap around issues of
food and education.
Activity Narrative: 7. EMPHASIS AREAS
There are six minor emphasis areas in local organization capacity development, human resources, quality
assurance, and development of network linkages/referral system, community mobilization/participation and
training.
Continuing Activity: 14766
14766 4169.08 HHS/Centers for Community 6941 348.08 $500,000
6874 4169.07 HHS/Centers for Community 4221 348.07 $400,000
4169 4169.06 HHS/Centers for Community 3233 348.06 $300,000
* Reducing violence and coercion
Estimated amount of funding that is planned for Economic Strengthening
Estimated amount of funding that is planned for Education
Estimated amount of funding that is planned for Water
Table 3.3.13:
This activity relates to TBD/Umbrella activities in AB, OP, ARV Services, and TB/HIV.
The To Be Determined (TBD) will build the organizational and technical capacity of Kenyan organizations
and provide sub-grants to NGOs, FBOs, and CBOs, resulting in 140,000 people being counseled and tested
for HIV, which will be provided in 80 CT outlets. This will require training of 400 health workers and lay
counselors. The key activities of the TBD will be to develop the organizational and technical capacity of
local, preferably indigenous, organizations and provide supportive supervision. Funds granted through TBD
to sub-partners will be used to provide different models of HIV counseling and testing services including
client initiated and provider initiated approaches in accordance with national and international guidelines.
This will include the support for static and mobile VCT sites, home based CT activities, as well for CT in
health settings. Other activities that the TBD will undertake include expand existing programs and
identifying new sub-partners for capacity building and support. Capacity building activities will include both
strengthening of administrative operations (such as planning and accounting) and technical capacity
(specific technical ability to implement HIV counseling and testing services, logistics and commodity
forecasting, and routine program monitoring and evaluation activities). This activity will include support to
sub-recipients for activities integral to the program.
These activities will contribute to the rapid scale up of CT programs in Kenya, through increased human
resource capacity and through community mobilization at all levels. There will also be support for
strengthening referral from CT to care and treatment. This partner has a key role in building the
organizational and technical capacity of local organizations so that these activities can be sustained over
the long term.
In addition to building the capacity of sub-grant recipients, an important aspect of the TBD's activities is to
support development of referrals/linkages between the TBD-supported organizations and clients to other
HIV prevention and treatment activities.
The primary target population will be patients visiting health facilities, adults and youth in the community,
couples and families as entry point units and the general public. The activity will also target training and
capacity building of public health care workers, mainly doctors, nurses, pharmacists, and laboratory
workers. The activity also targets community-based and faith-based organizations and NGOs.
6. EMPHASIS AREAS
This activity includes emphasis in the areas of local organization capacity development, training, and
increasing gender equity in HIV programs.
Continuing Activity: 16459
16459 16459.08 HHS/Centers for Catholic Relief 12006 12006.08 Umbrella $417,750
Table 3.3.14:
+As the prime partner(s) for this activity remain TBD as of COP 2009 submission, specific sub-partners
supported and their exact activities will be subsequently delineated.
This activity is linked to activities in HTXS (#6945), MTCT (#6949), HVCT (#6941), HVTB (#7001), HVAB
(#6876), HVOP (#6872) and HKID (#6874).
In FY 07, the Cooperative Housing Foundation (CHF) will support five sub-grantees: Kenya Pediatric
Association (KPA), Kenya Association for Prevention of TB and Lung Disease (KAPTLD), Kenya Episcopal
Conference/Kenya Catholic Secretariat (KEC/KCS), Christian Health Association of Kenya (CHAK) and the
Organization of African Instituted Churches of Kenya (OAIC) in systems strengthening and policy issues.
The Kenya Pediatric Association (KPA) is a body of pediatricians that works in policy development, training
and mentorship of health providers. KPA is actively involved in the training of health workers on
comprehensive pediatric HIV care and treatment, and is working on a mentorship program to scale up
pediatric ARVs. With PEPFAR support, KPA will increase the capacity of 200 health facilities and 360 health
care providers to provide pediatric HIV care and treatment. The association will play a key role in the
dissemination of national guidelines and curricula to health workers. KPA will work closely with the National
AIDS and STI Control Program (NASCOP) to develop 5-year National Pediatric HIV Strategic plan,
guidelines for diagnostic testing and counseling (DTC) in children, and to train 360 health workers in
pediatric DTC. Stigma is a major hindrance to the linkage to care and treatment of HIV infected adults and
children. KPA will develop strategies for reducing stigma and discrimination among health workers and
target 360 health providers for training on stigma reduction. CHF support will help to achieve the national
target of initiating 10,000 infected children on ARVs by the end of FY 2007. The second sub-grantee,
KAPTLD is an affiliate of the International Union against TB and Lung Disease (IUATLD) initiated by chest
physicians in private practice in Kenya. The National Leprosy and TB Program (NLTP) and U.S.
Government agencies recognize the private medical practice as a resource that is still underutilized for
TB/HIV work. To promote both public-private partnership and good clinical practice, NLTP and KAPTLD
have established a strong partnership with Emergency Plan support. In FY 2006, KAPTLD began TB/HIV
activities in Nairobi, Mombasa, Nakuru, Eldoret, Kisumu and other towns across Kenya. In FY 2007, CHF
will support KAPTLD administrative operations, supervision of private practitioners, establishment of a
TB/HIV resource center and printing and distribution of TB/HIV reporting tools, guidelines and curricula.
KAPTLD will train 300 health workers to deliver TB/HIV services. Private TB and HIV laboratories will be
supported, through collaboration with CDC's Laboratory Program, the National Public Health Laboratory
Services (NPHLS) and the NLTP to ensure that national standards are achieved and maintained. In
collaboration with the NLTP, KAPTLD will strengthen reporting and patient tracking systems to ensure that
standard TB and HIV care outcomes are accurately reported and integrated in the national data base. The
third sub-grantee, the KEC-KCS is responsible for coordinating and facilitating programs of the Catholic
Church. In FY 2007, the KEC-CS will develop a policy on how to effectively respond to the epidemic,
maximize services, lobby government and advocate for the rights of the infected. KEC-CS will also develop
a workplace policy for staff infected or affected by HIV/AIDS. The three local faith-based organizations,
namely KEC/KCS, CHAK and OAIC will have their organizational capacities strengthened through the CHF
umbrella funding mechanism. They will receive funding to strengthen their HIV/AIDS desks to promote
continued provision of high-quality HIV/AIDS services and treatment by mission hospitals (KEC and CHAK)
and a comprehensive church-sponsored HIV/AIDS community interventions including prevention, OVC
support, home-based care programs and VCT (KEC, CHAK and OAIC). Funds will also be used to better
equip KEC and CHAK to effectively carry foward policy dialogue with the Government of Kenya (particularly
the Ministry of Health) with an ultimate goal of restoring direct GoK support for health care provision at
mission hospitals and health facilities. OAIC support is directed through $50,000 from previously
unallocated funds. CHF will also work with KEC to implement policy for youth prevention programming
throughout their national network.
CHF support to the KPA will facilitate the scale up pediatric HIV care and treatment through capacity
building, on-site mentorship, HIV stigma reduction, pediatric DTC guidelines and dissemination of guidelines
and job-aids. The second component of this activity will strengthen linkages across and among religious
groups working in HIV/AIDS. CHF support to KEC-Catholic Secretariat will facilitate the development of HIV
policies that will guide the HIV/AIDS activities religious groups working in HIV/AIDS. The third component of
this activity will strengthen the delivery of integrated HIV and TB services in the private sector to ensure that
TB/HIV services are in line with national guidelines and good clinical practice.
This activity will strengthen the capacity of health facilities and health workers to provide comprehensive
pediatric HIV/AIDS services to children affected and infected with HIV/AIDS. The activity will also strengthen
the capacity of the religious and the private practice medical sectors to contribute in the provision of high
quality TB/HIV services.
CHF support to the KPA will target children, private and public health care providers (doctors, clinical
officers, nurses, laboratory technicians, pharmacists, nutritionists and counselors) and other MOH staff.
Support to the KEC-CS will target faith-based organizations, religious leaders and people living with
HIV/AIDS. The activities of the KAPTLD will target TB suspects, HIV+ persons, and private and public
health care providers and other health workers.
CHF support to the KPA , KEC-CS and KAPTLD will address stigma and discrimination of HIV/TB infected
adults and children in the health care setting, among health workers and religious groups working in
HIV/AIDS.
Activity Narrative: 7. EMPHASIS AREA
The primary focus of CHF support to the three sub recipients is to build local organization capacity. CHF
support will enhance the association's capacity to develop policies and guidelines to support HIV testing of
children in clinical settings and to address stigma and discrimination of HIV infected persons. CHF will
provide relevant training to the three sub recipients to enhance their capacity to achieve their goals. This
additional support will expand the scope of current activities in the current 07 COP. Three local faith-based
organizations the Christian Health Association of Kenya (CHAK), the Organization of African Instituted
Churches of Kenya (OAIC) and the Kenya Episcopal Conference/Kenya Catholic Secretariat (KEC/KCS)
will have their organizational capacities strengthened through the CHF umbrella funding mechanism. They
will receive funding to strengthen their HIV/AIDS desks to promote continued provision of high-quality
HIV/AIDS services and treatment by mission hospitals (KEC and CHAK) and a comprehensive church-
sponsored HIV/AIDS community interventions including prevention, OVC support, home-based care
programs and VCT (KEC, CHAK and OAIC). Funds will also be used to better equip KEC and CHAK to
effectively carry forward policy dialogue with the Government of Kenya (particularly the Ministry of Health)
with an ultimate goal of restoring direct GoK support for health care provision at mission hospitals and
health facilities. OAIC support is directed through $50,000 from previously unallocated funds. CHF will also
work with KEC to implement policy for youth prevention programming throughout their national network.
Continuing Activity: 14769
14769 4168.08 HHS/Centers for Community 6941 348.08 $950,000
6873 4168.07 HHS/Centers for Community 4221 348.07 $934,500
4168 4168.06 HHS/Centers for Community 3233 348.06 $200,000
Workplace Programs
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $23,930,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The U.S. Government PEPFAR team in Kenya continues to effectively apply Staffing for Results (SFR) principles and other
management and staffing exercises prescribed for development of the 2009 Country Operational Plan (COP). Over the last five
years of planning and implementing the Emergency Plan, the Team has refined and evolved its operational structures and
procedures to optimize efficiency and capitalize on both the unique strengths and limitations of participating agencies. As a result,
we have also been repeatedly called upon to share our models and experience with other focus countries. A schematic of the
current planning structure, uploaded as a supporting document, reflects evidence of the critical thought given to how we are
organized to most effectively manage this important work.
Beginning with preparation of the 2007 COP, the Team anticipated SFR and looked strategically across all participating agencies
to reach interagency decisions on where additions to staffing were most needed. The 2009 SFR exercise provided the opportunity
to look in greater depth and with a longer view at the ideal team that would carry us into the second five years of the Emergency
Plan.
Our SFR vision commits us to identifying and achieving the optimal mix of technical and administrative personnel deployed in
interagency teams and assigned to the most appropriate managing agency to assure continued success of the Emergency Plan in
Kenya.
Responsibility for managing the SFR process was assigned to the Country Coordinator. An early decision was made to use the
latest evolution in the PEPFAR structure in Kenya - the PEPFAR Liaisons Group (PLG) which had been convened in January
2007 - to manage the bulk of work associated with SFR. The PLG consists of representation from the Country Coordination Office
and one designated representative from each of the four participating USG agencies.
Over the course of two months, the PLG mapped existing staffing and operational structures by reviewing agencies' current
organograms, discussed critical staffing gaps across agencies, reached consensus decisions on where strategic staff additions
were most needed, and determined which agency or office could best recruit for and manage new positions. In the process,
agency core strengths were identified and are summarized here.
HHS/CDC: partnership with the Ministries of Medical Services and Public Health and Sanitation in promulgating technical
standards and guidelines, technical direction of partnerships for surveillance, identifying and piloting cutting-edge approaches to
clinical and prevention opportunities (e.g., provider-initiated and home-based testing and counseling, voluntary medical male
circumcision, TB/HIV integration), and informatics (including clinical, lab, and other HMIS). "Platform" CDC country with other
programs and infrastructure to complement PEPFAR in Kenya.
Peace Corps: 40-year history in country and successful implementation of grassroots responses for especially hard-to-reach
populations (e.g., deaf and hearing impaired Kenyans), application of cutting-edge business skills and information technology to
mitigate social/economic impacts of HIV, unique approaches to working with young Kenyans, especially girls.
USAID: in-country contracting capacity and ability to manage very large projects supporting the interagency response (e.g., single
contract for pharmaceuticals), piloting and then rapidly taking to scale and assuring quality of complex clinical and community
interventions, flexible and responsive hiring mechanisms. Historic and successful management of HIV and health social
marketing, behavior change communications, community-based, and mitigation programs. Long standing, positive relationships
with key host government and civil society counterparts/partners, and wrap-around funding from multiple streams.
US Army Medical Research Unit (USAMRU): geographic, civilian and military-to-military focus leveraging robust research
platforms from which to extend comprehensive prevention, care and treatment responses; strong Kenyan leadership; highly
productive relationships with public, private and corporate responders to HIV.
In the process of preparing for COP 2009 and for SFR within that process, Interagency Technical Team (ITT) structures that had
evolved over the previous four years were critically examined for effectiveness, burden on available staff, and capacity to promote
integrated planning across both agencies and technical areas. As a result, teams were consolidated for development of the 2009
COP and will be critically assessed in December and January for possible revision. The 18 budgetary / programmatic "silos" of
PEPFAR were planned for in the Kenya 2009 COP by the following seven teams:
+ Sexual Transmission Prevention (HVAB, HVOP, CIRC, IDUP)
+ Prevention of Mother-to-Child Transmission (MTCT)
+ Community Care and Support Services (HKID, HVTB, PDCS, HBHC community and mitigation services)
+ Clinical Services (HTXD, HTXS, PDTX, HVTB, HLAB, HBHC non-ART clinical services)
+ Systems Strengthening (HMBL, HMIN, OHSS, cross-cutting consideration of logistics, human resources for health and
HCT/training)
+ Counseling and Testing (HVCT)
+ Strategic Information / Informatics (HVSI)
In the course of all of the above, historic and current staffing was critically examined. No redundancies were found and critical
gaps were identified and responded to in the "Program Planning and Oversight Functional Staff Chart" as well as the individual
agency organograms and consolidated database that constitute SFR supporting documents. All planned staff additions are
consistent with agency core strengths summarized above. CDC, DOD, and USAID personnel have each participated in technical
review panels for procurements as well as new hires to be managed by the other agency, and they have been joined by Peace
Corps staff for selection panels for new hires in the Country Coordinating Office. We will continue to use this successful practice
for filling the majority of vacancies in approved positions as well as new positions proposed in the 2009 COP. OGAC's recent
training and guidance to Human Resource offices on the use of PEPFAR Framework Job Descriptions will further contribute to a
harmonized and more streamlined development of new positions across agencies engaged in PEPFAR.
Recommended key innovations this year that strengthened our team work, improved efficiency, and achieved an exponential
increase in the efficiency of COP preparation included two planning retreats, in May and June 2008, and a comprehensive
interagency portfolio review. Building upon last year's strategic planning approach, the PIAT systematically took into
consideration several facets of the Kenya HIV programming landscape for COP 2009 development, through (i) a "Data for
Decision Making" retreat during which we reviewed current Kenya epidemiological data on HIV, overlaid with an assessment of
PEPFAR prevention, care and treatment programming results and gaps in PEPFAR implementation; (ii) an interagency portfolio
review of all PEPFAR prime partners; and (iii) a one-week intensive planning retreat for PIAT senior technical staff, which included
a presentation on the portfolio review and detailed planning on program level activities and targets.
In a departure from previous years, resource allocations were not discussed until the final day of the one-week planning retreat.
Instead, nearly 40 key technical staff of all USG agencies met and focused exclusively on identifying new areas for synergistic
programming across PEPFAR funding streams, critically reviewing our portfolio in light of results of the Kenya AIDS Indicator
Survey (KAIS), and reaffirming our shared vision for PEPFAR in Kenya. Evaluation of the retreat by participants was
overwhelmingly positive and it will be repeated for COP 2010. It has subsequently been noted that hundreds of person hours
usually spent in cross-town traffic or in extended meetings were saved by the concentrated time invested in early - and
interagency - decision making. Time saved by holding the retreat also enabled us to brief host government and health
development partners on the scope and scale of the 2009 COP in a timely fashion.
For the sixth year of the Emergency Plan, Team Kenya has strategically allocated additional time and resources to more effective
management of the response, while remaining well below the 7% ceiling for these vital functions. The PLG has functioned
effectively in managing SFR and will be continuously engaged in its implementation over time.
Table 3.3.19:
