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
n/a
New/Continuing Activity: Continuing Activity
Continuing Activity: 18644
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18644 18644.08 HHS/Centers for Population 8184 6207.08 Increasing $150,000
Disease Control & Services access HIV
Prevention International C&T/Male
Circumcision
Table 3.3.03:
N/A
Continuing Activity: 18605
18605 11982.08 HHS/Centers for Population 8152 5944.08 Increasing $50,000
Disease Control & Services access to HIV
Prevention International C&T
11982 11982.07 HHS/Centers for Population 5944 5944.07 Increasing $50,000
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $600,000
OVERVIEW
With the advent of the HIV/AIDS and TB co-epidemics, demands on laboratory services in Lesotho have been dramatically
increasing. In the third quarter of 2003, 16,250 laboratory investigations were conducted by the Central Laboratory (CL),
compared with 114,114 in the third quarter of 2006. This 600% increase in investigations and a 91% growth rate in compound
annual testing represents an enormous strain on the current laboratory system and illustrates the need for expanded staff and
facilities. As noted in the TB/HIV narrative, the CL cannot keep up with the demand for TB and HIV laboratory services, and has to
outsource a significant portion of its services to South Africa, which creates delays and additional costs.
In 2008, with strong PEPFAR support, MOHSW developed a National Laboratory Strategic Plan (NLSP) to address the
shortcomings in the current system. The NLSP is designed to address current weaknesses, including lack of financial resources to
meet program needs, inadequate management staff and skills, poor distribution of supplies and reagents, absence of standard
safety guidelines, a human resource shortage at all levels of service, and poor implementation of QA programs. One of the major
challenges to improving lab systems is the lack of human capacity. The National Health Training College (NHTC) is the only
institution in Lesotho that trains laboratory personnel, and it lacks qualified instructors. Once lab personnel are trained, they do not
have a defined career path, and there are no mechanisms for staff retention.
In July, 2008, the Laboratory Director vacated her post, and it will be some time before her position is filled. The Laboratory
Manager is now also filling the role of the acting Laboratory Director. There is an acute shortage of trained laboratory
management staff at the national and district level.
The MCC Compact with GOL, which recently entered into force, includes plans to design and build a new National Reference
Laboratory (NRL) to replace the dilapidated CL at Queen Elizabeth II hospital. This lab will be built on a new site and is not
expected to be completed until at least mid 2010. While this new NRL will certainly strengthen laboratory systems, in the short
term high volumes of laboratory tests are required in the overburdened CL which also currently serves as the National Reference
Laboratory for the District Hospitals.
The District Laboratories which are associated with the hospitals are also grossly inadequate and suffer from many of the same
problems as the CL. MOHSW is exploring a plan to expand laboratory services at Leribe and Mafeteng, creating regional labs for
expansion of TB culture capacity in order to better serve the southern and northern sections of the country. Construction of these
labs has begun with Global Fund money. There is no other funding, however, which targets District or Regional Labs for improved
infrastructure and services.
CURRENT USG PROGRAM
PEPFAR/Lesotho played a key role in the development of the NLSP and has assisted the government in developing a National
Laboratory Policy to meet short and longer term lab systems needs. Through its three lab partners, NICD, ASCP, and APHL,
PEPFAR provides support for in-service and long-term training in quality assurance protocols, supervision/mentoring, SOPs,
chemistry, hematology, CD4 testing, logistics and management. PEPFAR also collaborates with Clinton Foundation and MSH to
identify and resolve problems in service delivery and supply distribution.
In light of the recent departure of the Laboratory Director, PEPFAR/Lesotho is providing technical assistance in leadership and
laboratory management to assist in the transition of the new Acting Director.
USG FY 2009 SUPPORT
Given the critical nature of laboratory systems in Lesotho, and their current weakness, PEPFAR will place more emphasis on
longer term technical assistance and fostering supervisory and mentoring relationships. Therefore, PEPFAR has taken the
strategic decision to recruit a Senior Laboratory Technical Advisor position. This position was approved but unfilled in the FY 2008
COP; in FY 2009, CDC will recruit this as a PSC position, which will improve the chances of recruitment.
In FY 2009, PEPFAR plans to consolidate its work under one lead partner, currently TBD. While this partner is recruited, USG will
support the improvement of laboratory infrastructure for the military facility in Maseru through DOD, and work through its current
partner, APHL, to provide senior public health laboratory professionals such as Directors of US Public Health Laboratories to
mentor the Acting Laboratory Director. APHL will use its corps of active and retired laboratory directors to provide Laboratory
Management Workshops and mentor senior laboratory staff, strengthening abilities and self-reliance; build skills in mentoring
through training and example; provide training; and develop skills of members of technical advisory committees (TACs); and
provide technical assistance to the TACs.
PEPFAR is also working through MSH to strengthen procurement and supply chain of laboratory reagents and supplies to
laboratories in Lesotho.
LEVERAGING AND WRAPAROUNDS
PEPFAR works with MOHSW NTP and HIV/AIDS Directorate to support for the MDR-TB and HIV study, primarily funded by
Global Fund. USG and its partners will work with FIND (Foundation for Innovative New Diagnostics) to increase the capacity for
TB Culture and Sensitivity testing. PEPFAR plans to work closely with MCC to develop the planned new NRL and implement a
Laboratory Information System that is integrated into the developing HMIS.
To review and strengthen pre-service training of medical laboratory technicians, PEPFAR is collaborating with NHTC on phase
one of Pre-Service Curriculum Development.
PROPOSED COMPACT EXPANSION
As PEPFAR/Lesotho moves forward to negotiate a Partnership Compact with GOL, we anticipate further strengthening of
Laboratory activities through human resource development activities including distance learning, training more technicians,
improved mentoring and supervision to implement better quality assurance in both the new Reference Laboratory and the regional
and community labs. As Compact negotiations are only at the early stages, we understand that we may need to revise
expectations, and will be in touch with our core team and DP "friend" as we move forward.
Table 3.3.16:
