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
NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini
-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the
submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon
completion and final approval of the negotiated 5-year Compact between the United States Government
and the Government of Malawi.
Summary
NAC will use FY 2008 Emergency Plan (EP) funds to support monitoring and evaluation (M&E) of ongoing
PMTCT trainings and to support phased introduction of more efficacious combination ARV prophylaxis at a
number of selected health facilities.
Background
The national PMTCT program for Malawi was launched in 2003 but implementation of core activities
remained slow until the end of FY 2006 when the need for accelerating performance was acknowledged
during the National program review. In March of 2007, the National AIDS Commission (NAC)together with
the Ministry of Health (MoH) and other in-country PMTCT partners launched an initiative for accelerating
PMTCT program performance within 18 months. This was a direct result of the high level Global Fund
meeting in February of 2007 convened by the USG PEPFAR team to address bottlenecks in disbursements
from the Global Fund Secretariat and poor grant performance. Using FY 2006 funds, NAC supported the
development of a national PMTCT training package and spearheaded national consultations that led to
approval of a new, more efficacious ART prophylactic regimen for Malawi. These activities were part of a
broader national PMTCT scale up plan that received of the majority of its funding from the Global Fund and
from UNICEF.
With FY 2008 EP funding NAC will support the planned evaluation of National PMTCT training activities and
phased introduction of more efficacious combination ARV prophylaxis for PMTCT that will be carried out as
part of a comprehensive national initiative whose ambitious targets are to be achieved by August 2008. The
National goal is to include the provision of CT as a standard package of ANC services at all 540 ANC and
maternity units in the country, the provision of ARV prophylaxis to 90% of all HIV positive mothers and
exposed infants, and the screening of all HIV-positive mothers for ART eligibility and determination and
recording HIV status of mothers at all delivery units.
The main areas of emphasis for these planned activities are training, logistics for PMTCT communities
including HIV test kits and ARVs, human resources, and infrastructure. Planned activities will include
reviewing policies and strengthening M&E of the PMTCT program. They are therefore linked to OHPS,
HVSI, HVCT and HTXD.
Activity 1: Enhanced Monitoring and Evaluation of National PMTCT Training
The first activity will be to develop materials to assist MoH supervisors in assessing the knowledge and
skills of Health Care Workers (HCWs) trained using the revised national PMTCT curriculum. A standard
support manual on expected knowledge and skills outputs of trained HCWs will be developed for use by
supervisors at national, district and facility level. A system of quality assurance of PMTCT trainings will be
developed and implemented. The final output will be a standard package to monitor and evaluate PMTCT
training at all levels. This package will be integrated into the National PMTCT monitoring system.
Activity 2: Phased Introduction of a more Efficacious Combination ARV prophylaxis for PMTCT
Since the inception of the national PMTCT program in 2003, Malawi has used single dose Nevirapine for
the mother during labour and single dose Nevirapine for the infant within 72 hours of delivery as standard
prophylactic ARV regimen. Other more effective regimens given daily during pregnancy and in combination
are now available.
Malawi has endorsed the introduction of the WHO-recommended more efficacious regimen and gradual
phase out of single dose NVP. The new combination regimen will consist of AZT for mother from 28 weeks
followed by AZT/3TC and NVP in labour then AZT/3TC for 7 days after delivery. Exposed babies will
receive single dose nevirapine followed by AZT twice a day for one week. Combination-ARV prophylaxis
will only be introduced in health facilities with well functioning PMTCT services based on predetermined
minimum criteria including laboratory capacity to monitor Haemoglobin levels, supply management system
to ensure uninterrupted continuous availability of all required antiretroviral drugs, and trained personnel.
Each target health facility will be assessed using a standard tool before being certified for introduction of the
combination ART prophylaxis. A two-day training will be done for qualified PMTCT providers in sites that
meet all other criteria but have no providers trained in combination ARV regimens for PMTCT.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14606
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14606 14606.08 HHS/Centers for National AIDS 6884 3883.08 NAC GHAI $45,000
Disease Control & Commission,
Prevention Malawi
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $15,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
The National AIDS Commission (NAC) of Malawi is responsible for coordinating all HIV and AIDS
responses in the country and works closely with the HIV/AIDS Unit in the Ministry of Health (MoH) in
developing policies and promoting compliance with operating guidelines for all HIV prevention and care
activities. NAC does not directly implement CT program activities but uses funds from multiple sources to
support CT efforts of the MoH and other service delivery organizations. NAC's current program of work
(Integrated Annual Work Plan (IAWP) emphasizes rolling out of CT including supporting a full-time technical
assistant to provide technical and programmatic leadership for the national CT program to which the USG
has responded. With FY 2008 EP funding, the USG will continue to support CT technical assistance (TA) to
the MoH and support National HIV testing week initiative and other innovative strategies aimed at
increasing access to CT by underserved communities.
Through FY 2006 EP funds, the USG placed a full-time technical assistant in the MoH to provide leadership
in National scale up of CT and mentor key MoH staff to assume this leadership role eventually. This TA has
played a key role in increasing CT sites from 236 to 351 while maintaining quality of services through an
intense program of mentoring and supervision of providers. In addition, this TA spearheaded two successful
National HIV Testing week campaigns in July 2006 and July 2007. Malawi has now incorporated this
campaign in the national program as an annual event.
Apart from central level training of trainers and supervisors in CT, all activities planned for FY 2008 funding
are at a national level, and contribute to creating an environment that supports rapid expansion of CT, and
are only associated with indirect targets.
Activity 1: Support for Full-time CT Technical Assistant at the MoH
This is an ongoing activity. The USG will continue to support the salary for a full-time CT Technical
Assistant at the HIV/AIDS Unit of the MoH. The Technical Assistant will work within the Government of
Malawi (GoM) structure providing both technical and programmatic guidance for CT scale up while building
local capacity for coordination of CT activities at National level.
Key responsibilities of the Technical Assistant will include:
• Provision of technical guidance to MoH on CT policy guidelines, CT sites development, and CT training
• Support to MoH in planning, co-ordination and implementation of CT in a variety of settings, including
health care facilities, NGOs, CBOs and private
sector
• Development of national system for CT standardized generic training, Training of Trainers (TOT), and
training of CT Supervisors
• Provision of technical guidance in setting quality standards for CT.
• Assistance to MoH in developing and implementing a national system for CT supervision, M&E, and
reporting
• Conceptualizing and implementing innovative interventions for increasing uptake of CT by underserved
communities
Activity 2: Support for Malawi's National HIV Testing Week Initiative
Following successful implementation of the first National HIV testing and counseling week in 2006, Malawi
has incorporated this activity in its program of work as an annual event. Consequently a second round of
this campaign was conducted in July 2007 and will be followed by similar campaigns every year. Lessons
from first round of the campaign were applied to improve planning and implementation of the second round
resulting in higher achievement. This success has attracted international attention leading to multiple
requests for partnerships from countries seeking to learn from Malawi's experiences. Documentation and
dissemination of permanent records of this important national exercise will be a priority for Malawi in FY
2008 and beyond. Good documentation will create a framework for continuous improvement and learning
over time.
With FY 2008 funding, NAC will improve documentation of this exercise and develop Malawi-specific
guidelines for implementation of future HTC week campaigns. Through this investment, it is envisaged that
Malawi will produce timely technical reports for each campaign and periodically publish its experiences as
case studies to guide other countries.
The HIV Testing and Counseling event is a high profile national campaign involving accelerated community
education on benefits of CT coupled with creation of opportunities for all Malawians to access HIV testing
and counseling. The bulk of services during the weeklong campaign are provided in temporary sites as
outreach to underserved communities. Resources for the exercise including HIV test Kits are provided
largely through Global fund monies programmed for CT. The campaigns increase visibility of CT services
and give every segment of the population an opportunity to be tested for HIV where they live.
EP funding will support the development of standard planning tools, quality assurance system, and data
management guidelines for CT week campaigns. This activity will also include coordination of external
technical assistance in logistics, social mobilization and other priority components of the national campaign.
Activity Narrative: Through these efforts, national coordination of CT activities will be strengthened and country specific
guidelines for planning and implementation of National CT week campaigns will be developed. A framework
for continuous improvement will be created based on documentation of lessons from each CT week
campaign. These efforts will also inform planning of the International HIV testing day(s) initiatives at regional
and global levels.
Continuing Activity: 14603
14603 10711.08 HHS/Centers for National AIDS 6884 3883.08 NAC GHAI $183,000
10711 10711.07 HHS/Centers for National AIDS 5356 3883.07 NAC GHAI $130,000
Estimated amount of funding that is planned for Human Capacity Development $156,934
Table 3.3.14:
NAC will assist with implementing the Behavioral Surveillance Survey (BSS); facilitating the triangulation
workshops; developing an HIV Research Database; conducting situational analysis of non-biomedical HIV
interventions; and supporting the HIVDR Surveillance Task Force. Targeted Operations Research: It is
anticipated that the rapid assessment will raise some questions with regard to gaps in the current
knowledge and practice of male circumcision in Malawi. The USG funds will be used in conjunction with
others to support time-limited operations research that will help answer some of those questions.
NAC is responsible for coordinating all HIV and AIDS responses in the country and works closely with the
HIV/AIDS Unit in the Ministry of Health (MoH) to develop policies and promote compliance with operating
guidelines for all HIV prevention and care activities, including the National M and E plan. NAC uses funds
from multiple sources, primarily the Global Fund, to support SI efforts of the MoH, Ministry of Women and
Child Development (MOWCD) and various line ministries. PEPFAR funding is used strategically to address
gaps in programming that impede the flow of all strategic information (SI) required to effectively combat the
HIV/AIDS epidemic.
NAC will continue to coordinate and implement SI activities to expand and improve the quality and utilization
of SI. NAC will collaborate with USG and key stakeholders including UNAIDS, World Bank, DFID, Norway,
and MoH to strengthen the National HIV and AIDS M&E System and its implementation at national and
district levels.
Activity 1. BSS and Analysis of Findings
The first completed and disseminated BSS report occurred in Malawi in 2004. During FY 2007, the BSS
task force finalized protocol development and survey planning. Data collection was completed in May 2007.
Approximately 5680 individuals were surveyed, of which 4663 were also tested for HIV. The National
Statistics Office (NSO), the implementing partner for BSS, is leading preliminary analysis of this data with
report writing commencing in August 2007. With FY 2008 funds NAC will continue to support quarterly BSS
meetings in order to plan analysis and dissemination of this survey and to begin preparations for the 2009
BSS.
Activity 2. Triangulation Workshops
Malawi has a wealth of data available from routine program monitoring and various research studies. This,
coupled with a culture of data and information sharing, provides the perfect platform for investigating
questions using a data triangulation process. The steps of triangulating data include identifying and
prioritizing questions; identifying and collecting relevant data (both original and non-original); synthesizing
data and developing hypotheses and recommendations; and disseminating results and recommendations.
In FY 2007, the triangulation questions, building on questions from the FY 2006 Triangulation, were, "What
is the coverage and trend in prevention programs and behavior change, possible links in general and target
populations?" and "What is the impact of HIV/AIDS facility based response on morbidity and mortality?"
Key data sources used to answer these questions include ANC Sentinel Surveillance, program data (HTC,
ART, PMTCT, and Blood Transfusion), HMIS national data, hospital specific information systems, DHS
(1996, 2000, 2004), BSS (2004 and 2006 preliminary results), Teachers, private sector employer data, etc.
A report of the triangulation research findings were published and disseminated in August of 2007.
With FY 2008 funding, NAC will sponsor a one day meeting to re-evaluate and prioritize key questions for
the triangulation process. This meeting will include the Impact Assessment taskforce as well as
representatives from development partners, non-governmental organizations, public sector and research
institutions. NAC anticipates 25 individuals will participate in this workshop. Once the key questions have
been identified, NAC will hire two fulltime consultants for 30 days to facilitate data collection. NAC will also
cover expenses for ten days of travel for five task force members who will supervise and assist with the data
collection. The primary purpose of this activity is to update existing data, identify new data sources, and to
conduct new research and/or program monitoring that respond directly to the questions identified for the
triangulation.
After the data collection, NAC will invite 50 people from various research institutions, public and private
sectors, non-governmental organizations, and development partners to synthesize the data, generate
hypotheses supported by the data, and make appropriate programmatic recommendations.
Activity 3. Development of HIV Research Database
As the national HIV/AIDS activity coordinating body, it is essential for NAC to track all HIV related research
conducted in Malawi. A national research database will assist NAC on many activities, including identifying
appropriate research proposals that help address areas of the national response neglected in terms of
research; ensuring a complement in biomedical and non-biomedical research; identifying resources to
include in data triangulation and impact assessments; tracking research activities for annual M&E reports
and reporting regionally to SADC on research activities.
NAC will engage four major research review boards to assist with the on-going data collection: College of
Activity Narrative: Medicine Review Committee (CoMRaC), National Health Sciences Research Committee (NHSRC), Centre
for Social Research (CfSR), and the Malawi National Research Council. The aim is to create a national
database that will assist these institutions in their functions as ethical clearing boards. NAC will harvest this
data on a quarterly basis to update the national research database.
Activity 4. Conduct Situational Analysis of Non-Biomedical HIV interventions
HIV and AIDS programs are often complex and changing. Understanding the situation is an important
component in designing effective intervention programs. Therefore, in FY 2008, a situational analysis of non
-biomedical HIV interventions will be conducted, in conjunction with other USG partners, to help identify
target populations and understand program coverage as they relate to prevention programs (i.e., mass
media campaigns, life skills, impact mitigation programs (IGAs), community based programs, support
groups and OVC programs).
Pact's survey assessment conducted with FY 2007 USG funding will be used to help identify groups
providing prevention services. Data will be collected in a stratified way to improve regional understanding: 2
per zone (2 North, 4 Central, and 4 South). One consultant will be dedicated to this project for 10 weeks (1
week planning, 5 weeks collecting data, 4 weeks writing report).
One outcome of the non-biomedical situational analysis will be to identify a sub-sample of organizations
(including CBOs, NGOs and schools) and focus in-depth on the quality of services provided. Key
intervention areas may include ABCs and/or effectiveness of media campaigns. Qualitative research
methods may be used to glean critical information regarding strengths and weaknesses of prevention
programs.
Activity 5. Support HIVDR Surveillance Task Force
As of June 2007, the Malawi Ministry of Health has initiated over 100,000 people on ART. Because the
national ARV program centers around one standardized first-line therapy, and very limited use of one
standard second line treatment, it is critical to monitor the emergence of HIV drug resistance (HIVDR) so
that the MoH can respond accordingly. Malawi has adopted a three prong approach to monitoring HIVDR:
Threshold Survey to look at transmission of drug resistance, Monitoring Survey to understand the
development of drug resistance under treatment pressure, and Early Warning Indicator reporting to assess
programmatic factors that contribute to the development of drug resistance.
In FY 2008, NAC will support quarterly HIVDR Task Force Meetings. The purpose of the Task Force is to
ensure that these activities are being conducted on an annual/biannual basis and that the results are
interpreted, disseminated, and when appropriate, that the MoH is responding by making necessary changes
to the national program. The HIVDR task force includes 15 members from different divisions of the Ministry
of Health, development partners, and representatives of the survey sites.
Continuing Activity: 14604
14604 5989.08 HHS/Centers for National AIDS 6884 3883.08 NAC GHAI $72,000
9980 5989.07 HHS/Centers for National AIDS 5356 3883.07 NAC GHAI $160,000
5989 5989.06 HHS/Centers for National AIDS 3883 3883.06 $141,500
Table 3.3.17:
