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
With Emergency Plan (EP) funds, BRIDGE will support activities that contribute to an effective PMTCT
program including pre-testing counseling with relevant audiences, consensus-building, and raising
awareness for support of PMTCT with community leaders and other local stakeholders, with particular
emphasis on male involvement. This ensures that the link in health facilities between implemented
activities, and outreach to counseling and testing services related to MTCT, will be strong. These funds will
be used to further develop and disseminate a Hope Kit PMTCT supplement for use at the community level
to encourage increased uptake of PMTCT.
Background
Previous EP funding was used by BRIDGE to develop and disseminate a "Hope Kit" that is a package of
interactive and participatory HIV/AIDS tools and materials that have been used successfully and widely to
guide individuals and community groups to develop personal and appropriate HIV prevention strategies.
Hope Kits have been adapted by several groups including Peace Corps Volunteers (PCVs) who routinely
use them in educational and training sessions in their catchment areas. With this package, partners have at
their disposal, a variety of proven and participatory approaches to operationalize their HIV prevention plans.
The Hope Kit PMTCT Supplement provides additional material which focuses on community support for
prevention of maternal to child transmission of HIV. These activities are also designed to be implemented at
the community level. The material and outreach sessions are designed to increase community and
household acceptance of, and support for, PMTCT services, to reduce sigma surrounding PMTCT services,
promote greater male involvement in PMTCT, and ultimately to increase the uptake of PMTCT services in
the 8 BRIDGE districts (Balaka, Chikwawa, Kasungu, Mangochi, Mulanje, Mzimba, Ntcheu, and Salima).
During the past 12 months, with FY 2006 USG funds, the BRIDGE project was successful in developing the
new Hope Kit PMTCT package of supplemental materials, including identifying new content, conducting
pretest training and facilitation activities, and producing 1600 copies. The BRIDGE project also adapted the
regional Africa transformation tool and filmed 3 new profiles to supplement the package in Malawi. Both
tools are ready for full scale distribution and use during FY 2008.
BRIDGE expects these interventions to result in increased uptake of PMTCT services and improved
practice of basic PMTCT behaviors, including improved nutrition, the use of nevirapine during labor delivery,
and breastfeeding practices appropriate to the circumstances of mother and child.
Activity 1: Increase Use of PMTCT Services in Ante-natal Care Settings
The first activity is to use the Hope Kit PMTCT material in ante-natal care settings at district hospitals and
health care centers (a minimum of 4 per district) in the 8 BRIDGE districts, to support counseling and testing
services for pregnant women and their families through highly interactive sessions held at the ANC waiting
rooms.
This activity will primarily target pregnant women aged 15-49 but also will reach out to the families of
pregnant women particularly their husbands. The activity is an expansion of the PMTCT Hope Kit
developed with FY 2006 USG funding, and the initial Hope Kit outreach sessions that have taken place at
the ANC clinic at Mulanje district hospital since 2006.
Save the Children and district NGOs will assist with activity implementation. Counseling will be conducted
by trained community facilitators with support from ANC nursing staff. Targeted sites will also receive
copies of the "Mwana Wanga" (My Baby) PMTCT video produced in Zambia. The Mulanje experience was
shown to have a profound effect on the uptake of HTC services by pregnant women, more than doubling
the number of women who "opt" for testing as part of their ANC package.
The model of cooperation between local NGOs and the district hospital will support the sustainability of this
initiative beyond the life of the BRIDGE project. Also BRIDGE will work with local teams to explore
expansion of the activity to health centers that offer HTC services, on a district by district basis.
Activity 2: Strengthening Community Awareness of PMTCT
The second activity involves strengthening community awareness and knowledge about PMTCT (including
knowing your status, preventing unwanted pregnancies, safe delivery, and infant feeding options) through
facilitated participatory Hope Kit PMTCT activities in community settings. Eight hundred organizations from
select CBO's, NGO's, District Aids Coordinating Committees (DACC's) will receive training in the usage of
the PMTCT supplement to conduct activities in their areas. Activities will address men and women of
reproductive age as well as those who influence them, in the surrounding communities. Activities
emphasize men's involvement in PMTCT decision making (including the importance for couples to both
know their status, and produce an opportunity to address the issue of discordance). Community PMTCT
activities also address stigma for infant feeding decisions and the importance of facility-based delivery for
the health of mother and child. The activity will include referral to health centers and VCT sites for additional
counseling and information.
Activity 3: Assessment of the Impact of the Hope Kit on PMTCT
BRIDGE will evaluate the PMTCT component of the Hope Kit in FY 2008 to learn more about the impact of
Activity Narrative: this participatory methodology on community and family acceptance and uptake of PMTCT services. This
understanding will be of great value to partners in Malawi and USG Malawi to inform decisions of whether to
scale up Hope Kit style approaches. It will also assist BRIDGE and partners to understand better how the
Hope Kit is used, what features are the most popular, and which elements are most influential to reinforce
new norms and behaviors.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17151
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17151 17151.08 U.S. Agency for Johns Hopkins 7668 5662.08 JHCOM $51,908
International University Center
Development for Communication
Programs
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $5,949,586
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Context
Malawi is a landlocked nation of 13.5 million people facing a severe and generalized, primarily heterosexual HIV epidemic, with
HIV prevalence stabilized at 12%. Of the 900,000 people currently estimated to be infected with HIV, 56% are women. HIV
prevalence peaks in the 30-34 year age group for both men and women. It is anticipated that 90,000 new HIV infections will occur
each year in the absence of stronger prevention efforts. A majority of new adult infections occur within married or cohabitating
partnerships where one partner was infected prior to marriage or during the marriage through multiple concurrent partnerships.
Men with higher levels of income and education have significantly higher HIV prevalence than their poorer counterparts, indicating
that poverty may not be the driving factor in HIV transmission in the Malawian context. Approximately 10% of all couples are sero
-discordant, yet most individuals do not know their partner's status. Transactional sex constitutes another significant risk
behavior, with 70% of sex workers in urban areas infected with the virus. Prevalence is highest in the southern region and in
urban areas; however the bulk of infections are in the rural areas which constitute 80% of the Malawian population.
National leadership in HIV prevention activities has been inconsistent, with the National AIDS Commission (NAC) leading the
effort without a mandate to implement activities. While Malawi launched HIV prevention efforts earlier in the epidemic, the focus
on prevention has waned in recent years due in part to the increased emphasis on treatment programs, and there are no
designated HIV sexual prevention staff within the Ministry of Health (MOH). What prevention efforts do exist, including the
recently-awarded Round 7 GFATM grant which focuses on prevention, heavily emphasize life skills for youth, giving much less
attention to addressing adult sexual behavior, in particular Multiple Concurrent Partnerships (MCPs).
Most prevention messages and national campaigns have not clearly addressed multiple concurrent partnerships (MCP) as the
most important underlying driver of the epidemic in Malawi. And while a massive scale-up of HIV testing, care and treatment
services has occurred in Malawi over the last three years, there has been minimal effort devoted toward reaching HIV-positive
people with highly effective Prevention with Positives (PwP) interventions, including the promotion of condom use within
discordant relationships. Additionally, financial processes which move funds from government to NGOs are highly inefficient.
There is a tremendous need to build the technical, management, and financial capacity of both Malawian NGOs and government
structures which relate to them to enable a prevention response that will be sustainable in the long-term.
Previous USG Support
Prior to the Round 7 GFATM grant, USG was the largest donor for HIV/AIDS prevention in Malawi, prioritizing its limited HIV/AIDS
resources to support this important area of sexual prevention. In FY08 the USG-funded BRIDGE Project strongly contributed to
prevention efforts in Malawi through a national multi-media campaign with various related activities highlighting male role models
and a radio diary program to address stigma surrounding individuals living with HIV. These media activities were closely linked to
and complemented with intensive community mobilization and interpersonal approaches to empower people to take small, doable
actions to reduce their risk of contracting HIV.
USG also supported the Enhanced HIV/AIDS Prevention and Improved Family Health Project (EHAP-IFH) which supports social
marketing of Chishango ("shield") condoms nationally through retail and NGO networks, intensified condom marketing in "hot
zones" where bars and other high risk venues are concentrated, and targeted outreach to key populations engaging in high risk
sexual behavior. A branded, youth-focused communications program which includes Malawi's top-ranked youth radio program,
and a national campaign which promotes delaying first sex as a strategy for girls completing school and achieving goals for the
future, were also implemented.
While both the BRIDGE and EHAP-IFH projects end in 2009, reviews from Malawian communities, governmental structures and
recent independent external evaluations have all been very positive. Although resources have only been sufficient to allow these
two projects to be implemented in parts of 8 of the 28 districts in the country, the two programs have played an important technical
leadership and capacity building role in laying groundwork for HIV prevention in Malawi.
At the district-level, Peace Corps has integrated HIV prevention into its programs in health, education and environment, and has
developed a cadre of more experienced volunteers dedicated to working with other USG and government partners to strengthen
prevention capacity at the district level.
In 2008, NAC requested that USG help build capacity of indigenous organizations implementing prevention programs in order for
these partners to more effectively absorb resources available under GF grants. In response to this request, the PACT Community
Reach program issued an annual program statement in FY08 focused on prevention of sexual transmission and now has 18
indigenous Malawian sub-partners which are implementing prevention activities.
In addition, USG funded activities with the Malawian Defense Force, supporting school-based prevention clubs to promote healthy
behaviors and HIV-related life skills through an age-appropriate "AB" program, integrating HIV prevention activities into the "I-Life"
economic and food security activities, and integrating prevention into family planning and reproductive health activities in eight
districts.
With USG technical assistance, NAC initiated the development of the first National Prevention Strategy in 2008 which will be
completed and launched by early FY09. This strategy will provide the platform for national scale-up of prevention services
throughout the country, and USG is fully committed to supporting these efforts. USG's role in the prevention efforts will become
even more critical in FY09 as Malawi expands successful prevention programs and develops models for prevention activities to fill
existing gaps.
FY09 USG Support
FY09 PEPFAR funding will build on the successes and lessons learned from previous activities, incorporating recommendations
from the MOH, NAC, USG Core Team, and other prevention partners.
i. Expand prevention programs for adults
Given the current emphasis on HIV prevention in youth by the GFATM and other donors, USG support for prevention activities will
be primarily focused on sexual prevention for adults. Before the end of 2008, USG will award and provide initial funding from
FY08 to two new 5-year complementary cooperative agreements, which will work toward the single strategic objective of
increasing adoption of safer sexual behaviors by Malawian adults.
Activities funded under the first agreement ("Sector I") will seek to promote normative change and increase preventive behaviors
among adults in the general population, while those funded under the second ("Sector II") will focus on supporting a
comprehensive package of intensified preventive interventions targeting populations and venues with high prevalence of risky
sexual behavior. Both projects will coordinate closely with one another and harmonize messages, emphasizing the following
approaches: 1) influencing social and gender norms which contribute to the spread of HIV, 2) deepening individual understanding
of HIV risk and increasing self-efficacy to prevent HIV infection, 3) integrating and linking HIV prevention activities with testing,
treatment and care services, and 4) providing technical leadership, coordination, and capacity building for national prevention
efforts.
With FY09 funding, the Sector I program will implement activities in at least 10 of Malawi's highest prevalence and highest
population districts, with the objective of directly reaching most of the people living in these districts with HIV prevention activities.
This effort will reach a larger and different population than that reached by the BRIDGE project, building on the successes and
lessons learned from the former project. The primary foci of the project will be on reducing multiple concurrent partnerships,
promoting mutual faithfulness, increasing individual self-perception of HIV risk and self-efficacy to prevent HIV, emphasizing HIV
testing including knowing partner's status, and mobilizing communities to adopt social norms, attitudes, and values that reduce
vulnerability to HIV. The project will also emphasize linking community-based prevention interventions to other HIV and health
services, with a strong focus on PwP interventions and reaching discordant couples. In order to rapidly start-up, USG has fully
funded a year of activities in FY09 outside of new compact funding and will request a waiver of the 8%-to-one-partner rule.
With FY08 funding, the Sector II agreement will begin in early 2009 with a comprehensive baseline mapping exercise to better
enumerate populations and settings with a high prevalence of risky sexual behavior and describe the dynamics which drive these
behaviors. Based upon this information, the project will utilize FY09 funding in the summer of 2009 to target condom promotion
and risk reduction counseling to high risk populations and venues (including discordant couples), increase the availability of
condoms for both the general population and for high-risk populations, and establish and strengthen linkages for high-risk
populations to comprehensive HIV and other health services.
ii. Build capacity of indigenous partners to implement prevention activities
FY09 funding will be used to expand PACT efforts to build capacity of indigenous organizations to implement prevention efforts.
Pact's partners will implement HIV prevention activities tailored to the specific communities and target groups with whom they
work, and all partners will be closely linked to the Sector I and Sector II programs describe above. These prevention strategies
will include the following: 1) utilizing peer educators and communication approaches to inform individuals about HIV risk and equip
them to engage healthy behaviors, 2) mobilizing communities and stimulating social discourse about HIV, and 3) training and
mentoring service providers in PwP interventions including direct HCT service provision by some partners.
iii. Develop models of youth prevention programming for scale-up with GFATM resources
While a majority of PEPFAR funding will be targeted at adult prevention efforts, successful prevention programs for youth will
continue to be implemented in FY09. Malawi's top-ranked youth radio program, previously funded by USG, will be transitioned to
GF funding. Therefore with PEPFAR support for youth prevention programming will primarily come through Pact's fifteen
implementing partners. These partners will utilize a variety of complementary and targeted approaches to reach in-school and out
-of-school youth including the following: 1) facilitating youth groups to help them provide in-depth IEC on abstinence and
faithfulness and training on specific life skills, 2) training and supporting peer educators and youth patrons to serve as role models
for AB behaviors, share information about HIV, and provide emotional support, as well as equipping parents and community
leaders to do the same, and 3) providing other HIV prevention services for youth, including condoms for sexually active and at-risk
youth over 15 years old, youth-friendly services, and HIV testing and counseling services. Youth prevention activities are linked to
OVC programs for younger and older OVC by Pact's partners working in both areas.
iv. Provide technical leadership to strengthen the national prevention response
USG partners and staff will continue to play an important role in providing technical support to NAC and the GOM to lead the
national response and to other USG partners to implement prevention programs which reflect best practices and incorporate
strategic information. USG will recruit a full-time international prevention expert who will provide technical assistance and capacity
development to the GOM, NAC, and other USG partners and will mentor a local hire USG prevention program officer.
v. Strengthen the evidence-base to inform prevention programming
Both the Sector I and Sector II programs will invest in improving strategic information for prevention to determine whether the
interventions they are implementing are having an effect. They will continue to implement traditional, high quality monitoring
methods and will consider population-based estimates of behavior change and coverage given adequate resources. All
information on effective prevention programming will be shared with GOM and utilized to inform national prevention efforts.
vi. Ensure the Malawi Defense Forces (MDF) access to high quality prevention services
Rather than developing separate agreements with the MDF for prevention, USG will ensure its new prevention partners under
Sector I and Sector II clearly target their prevention programming to the special needs of military populations and surrounding
communities.
Compact Funding Program Plans
GOM and PEPFAR have discussed a framework under which a new partnership agreement will be developed using FY08 and
FY09 Compact funds. In September 2008, a Concept note was submitted to OGAC, and the country team was given approval to
begin developing a partnership Compact with the GOM. Sexual prevention is a priority area under consideration.
Areas of focus for the Compact include: 1) Intensification of comprehensive adult prevention activities in order to achieve wider
and more strategic coverage in areas and populations where the bulk of new infections are occurring, 2) support national scale-up
of PwP activities within the national care and treatment program, 3) assist NAC and the MOH in implementing an innovative data
synthesis and use programs at the district and community-levels and increase the capacity of communities to develop activities
appropriate to their own context, 4) bolster the 2009 DHS+ to collect more comprehensive information about sexual behavior,
gender and cultural practices, as well as oversample for district-level prevalence and incorporate incidence estimation, 5) develop
a cooperative agreement with the MOH to help fully transition management and activities in HIV prevention and other areas to the
government and other local partners, and 6) explore public-private partnerships with faith-based groups which are utilizing
substantial private resources.
Table 3.3.02:
Since FY 2005, BRIDGE has supported a radio diary project featuring the personal testimonies of male and
female PLWAs on six local radio stations. An evaluation shows that the Radio Diaries project which began
FY 2005 reached up to 75% of the listening audience in Malawi and indicated that listening to the radio
diaries is strongly associated with reduced stigma towards people living with HIV/AIDS and more agreement
with attitudes that "people with HIV are just like me." All radio stations report good listener feedback to
these innovative programs and there is widespread recognition of the programs in all eight emphasis
districts as well as in Lilongwe and Blantyre.
In FY 2007, BRIDGE made progress in AB programming through a variety of initiatives targeting youth: the
Nditha! Sports Initiative implemented in four BRIDGE districts; the second season of an HIV radio program
called "Tisankhenji" finalized; and Youth Alert! listening clubs and related activities reaching over 5,400
young people on a weekly basis. Also, BRIDGE is active in the interfaith mobilization of religious
communities via collaboration with the sub-partner Public Affairs Committee (an umbrella group for faith
based organizations) as well as joint youth outreach and seminars for faith leaders.
JHU Bridge's FY 2008 activities to reach youth will continue to focus on youth participation: developing
youth leadership, promoting the delay of sexual debut, increasing youth knowledge of HIV and risky
behavior, and teaching youth skills to adopt and maintain healthy behaviors. Strengthening access to
resources, delivering practical user-friendly tools and interventions targeting youth remain important areas
for BRIDGE.
Activity 1: Youth Alert! Mix
Youth Alert! uses mass media to reach hundreds of thousands of youth across Malawi. Youth Alert! Mix
(YAM!), funded by the USG, was recently named the most popular youth radio program in Malawi drawing
parents as well as youth. It stimulates improved communication within Malawian families on HIV and the
value of delayed sexual debut ("A") and mutual faithfulness ("B") among couples. The BRIDGE Project
supports YAM! through funding for the Listeners' Club program which works to translate and leverage the
popularity of the mass media communication intervention into a powerful interpersonal behavior change
activity by facilitating a weekly guided discussion on YAM's content.
In FY 2008, the YAM! Listener's club activity will include refresher trainings for listening groups, training in
community-based approaches for Youth Alert (YA) staff, and facilitating meetings with NGOs, CBOs and
Youth and Prevention technical sub-committees. The Listener's Clubs provide opportunity for discussion
and reinforcement of social norms around issues of primary and secondary abstinence, HIV counseling and
testing, mutual faithfulness, resisting harmful peer pressure, and building self-esteem and self-worth. The
Youth Alert! team will also participate in other activities sponsored by the BRIDGE project and its partners,
such as district level youth festivals and outreach to faith-based organizations.
Activity 2: Empowering Young Girls through Tisankhenji
In FY 2008, BRIDGE will continue the partnership with Business Eye and Nanzikambe to use entertainment
-education approaches to highlight the stories of dynamic role models as inspirations to young women in
Malawi. This collaboration will use a multi-media approach and activities will include community based
events (that also link to the Nditha! campaign, particularly community theater), radio, and print materials.
The current Tisankhenji radio program features Alinafe - a plucky girl who loves her family, sports, and is
true to her friends. She learns from her mistakes and has confidence in her own decisions regarding
themes such as personal achievement in and out of school, dignity and self-worth, modeling parent-child
communication, delaying sexual debut, resisting sexual pressures and discussing these pressures with a
trusted adult. In addition, Tisankhenji includes radio magazine-style elements that invite listener "talkback",
ideas on the challenges for girls "growing-up" in Malawi, real youth groups profiles, and suggestions for
young women and men to get involved with HIV prevention in their communities (and have some fun!).
Community-based radio listening clubs (currently 10 supported clubs per district) provide a link between the
radio program and community action.
Activity 3: Nditha! Sports
The Nditha! Sports package encourages positive mentoring of young adults by the community (which links
to the Men's Involvement campaign), youth leadership skills, decision making skills, youth involvement in
community activities (especially for girls), goal setting, and placing value on their lives. Through Nditha!
Sports, mentors and coaches assist young people to articulate strategies to delay sexual debut, address
gender challenges, seek advice from trusted adults, build skills to tackle coercion, and develop a positive
and proactive outlook on life. The accessibility of the model has made it popular with teachers, sports
coaches and youth alike. The methodology links sporting skills to life skills, focusing on prevention through
AB as ways to achieve your goals and future aspirations.
In FY 2008, BRIDGE will scale-up this activity.
Activity 4: Young Women's Congress
Activity Narrative: BRIDGE has supported four successful and popular Young Women's Congresses (YWC) over the past four
years. Last year, BRIDGE developed a partnership with the Malawi Girl Guides Association (MAGGA) and
UNFPA to deliver the YWC. This partnership will continue in FY 2008 with additional congresses and
activities offered to young women leaders in all 8 emphasis districts as well as select NGOs and youth
groups outside of the BRIDGE districts.
In FY 2008 there will continue to be a strong emphasis on building leadership skills and engaging the
community while supporting girls' education and promoting female role models to support economic
empowerment and achievement. The content of the congresses also includes HIV prevention basics,
support for delayed sexual debut and mutual faithfulness to one life-partner, the importance of HIV
counseling and testing, and stigma reduction towards PLWA.
In addition, the congress will offer youth leaders a place to explore the social, economic, political, religious
and cultural realities and customs that, joined with biology, make women especially vulnerable to HIV/AIDS.
In sessions, young women will not only focus on the factors that place them at risk, but most importantly
they will identify actions that they can take to reduce these risks, especially those related to gender-based
issues such as sexual coercion and gender-based violence, and cross-generational and transactional
sexual activity.
Activity 5: Mobilizing Faith Communities
Relationships between younger women and older men not only put the young woman at increased risk, but
can have detrimental effects on the man and his family as well. Faith groups play a critical role in
establishing and reinforcing social norms - especially norms of faithfulness and compassion related to
HIV/AIDS. The BRIDGE project will continue to support the Public Affairs Committee (PAC), an interfaith
umbrella organization of faith based institutions, to mobilize FBOs that play an active role in reaching men.
HIV behavior change messages include those related to gender inequities and intergenerational sex, mutual
faithfulness, male involvement in families and communities, risk reduction, and communication to foster
committed relationships.
The Caravan for Life feature of the collaboration between BRIDGE and PAC will continue during FY 2008.
PAC will provide on-going support to a high-visibility traveling "Caravan" of religious leaders demonstrating
their commitment to HIV prevention by providing activities from the Hope Kit and BCC manual as well as an
outlet to discuss themes and tie in teachings from the Bible or Qu'ran. Themes include fighting stigma,
male involvement in HIV prevention (particularly risks posed by alcohol and extra), marital relationships,
mutual faithfulness, raising healthy families, supporting abstinence in children, and alternatives to risky
behaviors.
Activity 6: PLWHA Radio Diaries
In FY 2008, BRIDGE will continue to support the radio diaries project by emphasizing community
mobilization and scale up proven approaches with an emphasis to customize the diary programs to the
unique audience characteristics of each radio station partner and place more emphasis on outreach
activities at the community level by the diarists and PLWA listening groups. In preparation for the next
phase of the diaries, radio partners have already developed proposals for diary programs based off of an
assessment completed by the management partner Galaxy Media that developed an index of topics
covered in all diary programs from inception to date on all partner radio stations.
Activities related to the radio diary project with FY 2008 funds include emphasis on identifying private sector
sponsorship for the programs for sustainability, on-going psycho-social support for the diarists involved
through linkages to positive living support groups, Malawi Network of People Living with HIV/AIDS
(MANET+) and National Association of People Living with HIV/AIDS in Malawi (NAPHAM), meetings with
counselors during program planning retreats, and capacity building for the producers and radio stations.
The radio stations are also being encouraged to develop alternate sponsorship arrangements for longer
term program sustainability. With FY 2008 funds, BRIDGE anticipates stronger involvement of NAPHAM
and MANET+ in project management. Currently, MANET+ has requested additional funding from NAC to
support the diary initiative.
Continuing Activity: 17146
17146 11044.08 U.S. Agency for Johns Hopkins 7668 5662.08 JHCOM $513,140
11044 11044.07 U.S. Agency for Johns Hopkins 5662 5662.07 JHCOM $1,094,230
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.03:
The project will build on the success of earlier activities to emphasize risk and effective "small do-able
actions" to minimize risk, while still supporting self and communal efficacy to act. In particular, BRIDGE will
concentrate on three areas that have wide reaching relevance to the Malawian context:
i. Risk of mother to child transmission of HIV (MTCT)
ii. Risks from alcohol misuse
iii. Particular vulnerabilities of young women to HIV infection through inter-generational relationships
BRIDGE has created a well-integrated list of activities to respond to needs in the "other prevention
category" which includes mass media supported not only by community drama, but also popular road
shows. Experience has shown that this emphasis on outreach personalizes the campaign messages. With
FY 2008 funds, BRIDGE will introduce the innovative African Transformation initiative which lends fresh
perspective on existing gender norms and encourages discussion about how they contribute to the spread
of HIV.
The national media campaign will link with activities already addressing PMTCT and AB at the district and
community level in the eight emphasis districts. The "Young Women's Congress", the Hope Kit updates,
and the PAC "Faith Caravan" activities, among others, will provide further linkages and reinforcement for the
national media messages. BRIDGE collaboration with the National AIDS Commission (NAC), and USG
Partners MACRO, PSI, and other service providers, will also provide audiences with concrete outlets for
HIV Counseling and Testing (HCT), condom services and HCT post-test clubs as recommended based on
risk self-assessment in mass media and community interventions.
Activity 1: Nditha! Mass media
With FY 2008 Emergency Plan (EP) funds, BRIDGE will build on the success of Nditha! to emphasize the
urgency for action by focusing on specific do-able actions, while still supporting self- and communal-efficacy
to act. In particular, BRIDGE will concentrate on the risk of MTCT; risks from alcohol use; and the particular
vulnerability of young women to HIV infection.
Strategic information collected in 2005 indicated an increase in self-efficacy and behavioral intentions to
prevent HIV significantly correlated with campaign exposure. With efficacy strengthened, the time is right to
shift focus to realistic risk self-assessment in order to optimize preventive behaviors. Similar to earlier
phases of the Nditha! national media activities, the risk awareness phase will include radio spots, print
materials and community outreach events. The emphasis on risk (Could it be me?... I can prepare...) will be
linked to Nditha! small do-able actions that people can take to reduce or eliminate the risk.
Special Nditha! risk materials will address issues of prevention with positives, including materials designed
for use in counseling sessions on prevention of transmission and materials to support prevention behavior
in discordant couples. BRIDGE will collaborate closely with NAC, MACRO, Lighthouse and other
counseling providers on the development of these materials. BRIDGE anticipates that NAC will assist with
continued production of these materials after the initial print run.
Activity 2: Experience Momentum (EXP) Outreach
Mass media is further supported by community outreach events which provide a framework for local
activities and decision making. EXP conducted road shows in each of the BRIDGE emphasis districts
during both phases I and II of the Nditha! Campaign, and will continue to do so during this project year. The
road shows have served to personalize the mass media ideas, and get people involved in the places where
they live through a variety of participatory activities. It is these events that have often spurred real
discussion within a community, and have galvanized small-town residents to take action within their area.
Activity 3: Community Drama
Using participatory "theatre for life" techniques, BRIDGE supports Nanzikambe Theatre Company to work in
emphasis communities to develop narratives of risk and accompanying strategic solutions for young
women, as well as to model healthy, equitable relationships with young men. The dramas are performed at
community festivals and typically draw large crowds. Previously BRIDGE has supported actors from
Nanzikambe to train in the "theater for life" methodology, already proven effective in the development of
Tisankhenji itself and also in their work with school drama groups during the Mzimba launch of the
Tisankhenji Radio Program. Nanzikambe's methodology is very participatory and probing and stimulates
dialogue and an immediate modeling of consequences in line with Social Learning Theory elements of
behavior change programming. Drama provides a shelter to give voice to concerns, to raise problems. and
to offer solutions from the safe distance of a character's point of view. The use of drama is also an
opportunity to showcase the skills and talents of young women in the community.
In 2007, Nanzikambe began this initiative by collaborating with community drama activators in four BRIDGE
emphasis districts. With FY 2008 funds this collaboration will be extended to the remaining BRIDGE
emphasis districts allowing a full year for all activators to conduct activities.
Activity Narrative: Activity 4: African Transformation
African Transformation, (AT) enables men and women to explore how traditional and gender norms have
impacted their lives including any resulting barriers to practicing HIV prevention behaviors. It also engages
men and women to work together to overcome those barriers individually, within their families and in the
wider community. Developed with input from throughout Africa, including Malawi, AT is a package of real life
role model profiles and a guide to facilitate community workshops. The Malawi AT package includes a
thought-provoking profile showcasing the consequences of intergenerational sex. The profile encourages
young women, older men, and family members to be aware of the health risks that can result from
intergenerational relationships and to develop strategies to avoid these harmful consequences.
The BRIDGE team already has drafted and pre-tested materials for the mass media materials that will be a
part of the "risk" campaign; it is currently working with EXP to finalize road show content. Nanzikambe's
work in "theater for life" to date puts them in a ready position to expand on this technique with the new
material reflected in the ongoing Tisankhenji series. AT modules have been reviewed by stakeholders and
Malawi-specific additions, particularly reflecting intergenerational sex, are nearly completed.
With the success in building efficacy of the previous phases of the BRIDGE mass media campaign, Nditha!,
the time is right to reinforce the complementary need of realistic risk perception in order for Malawians to be
prepared and able to protect themselves. The Other Prevention activities listed here will contribute to
Malawians' ability to understand access and act on their potential risk of contracting HIV through
participatory methods that include a fresh look at gender roles, traditional norms, and potentially unsafe
Continuing Activity: 17147
17147 5930.08 U.S. Agency for Johns Hopkins 7668 5662.08 JHCOM $105,985
11133 5930.07 U.S. Agency for Johns Hopkins 5662 5662.07 JHCOM $258,265
5930 5930.06 U.S. Agency for Johns Hopkins 3877 3877.06 $186,834
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $250,000
Malawi is in the process of developing a national HIV prevention strategy in a move to both scale up and intensify HIV prevention
efforts. The prevention strategy will address gaps in current prevention efforts and identity new approaches to prevent HIV
transmission. While the majority of this prevention strategy will target the previously neglected area of behavior change to reduce
sexual transmission, prevention of biomedical transmission remains a commitment and will receive ongoing support from
PEPFAR. The focus areas of biomedical prevention in Malawi are blood safety, injection safety, and the development of a male
circumcision policy as part of a larger national HIV prevention package.
i. Blood Safety
USG began supporting activities to improve the safety of blood and blood products to Central and District-level hospitals in FY06.
The aim of this support was to prevent the spread of HIV and other transfusion-transmissible infections by tackling the gaps which
were identified. This support is channeled through the Malawi Blood Transfusion Service (MBTS).
Funding from PEPFAR in FY06 and FY07 supported the improvement of infrastructure and capacity of Central and District-Level
Hospital Blood banks, and promoted appropriate clinical use of blood and blood products. This funding supported rehabilitation of
18 hospital blood banks and provided them with basic lab equipment. Buffer stocks of reagents and consumables were procured
and are stocked by MBTS for distribution during stock outs. With FY06 funding, a training curriculum was developed and used to
train Laboratory Technicians, under-graduate students of biomedical sciences, and nurses. The 5 Ministry of Health Zone
Coordinators and 3 Directors of Clinical Services and Health Technical Support Services were oriented in blood safety and
management. The National Quality Assessment System was established in 14 Hospitals. PEPFAR also trained MBTS' staff in
monitoring and evaluation.
FY07 funding supported the rehabilitation of another 8 Hospital Blood banks and provided them with basic equipment for blood
transfusion. This funding also provided stock buffer supplies of required reagents and consumables to prevent stock-outs and
was used to provide recommendations for better planning and forecasting efforts in 22 hospitals. Another 193 health care
workers were trained. The National Quality Assessment System was established in 8 Hospitals. 58 Clinicians were trained in
Quality Assessment and Standard Operating Procedures (SOPs) were developed and will be implemented in FY09.
In 2009, USG will use PEPFAR funds to build on the milestones achieved with funding from previous years in three main areas:
improvement of the physical infrastructure for blood safety; increasing knowledge and skills of health care workers in blood safety
through in-service and pre-service trainings; and ensuring high quality blood screening and transfusion services.
USG will fund MBTS to renovate existing dilapidated laboratory facilities at 5 District Hospitals to establish appropriate Hospital
Blood Banks (HBBs), and will provide basic lab equipment for blood transfusion, stock buffer supplies of required reagents and
consumables to prevent stock-outs, and provide recommendations for better planning and forecasting efforts.
USG will also support MBTS training both pre-service and in-service health care workers in blood safety. Training and capacity
building will be integrated with the College of Medicine offering undergraduate degree courses for laboratory technicians, and the
Colleges of Health Science and Nurses at both the undergraduate and postgraduate level. Seminars and workshops will be held
for clinical practitioners to promote appropriate use of blood. Training provided will also focus on improving the quality of data
collected at blood banks.
To ensure quality of blood screening and transfusion activities, PEPFAR funds will support MBTS in rolling out the National
Quality Assessment Scheme (NQAS) in all HBBs. The rollout will be implemented after the training of HBB staff to ensure
compliance with technical standards. At the end of FY09, 27 hospital blood banks in the country will be targeted for enrollment in
the NQAS. A total of 210 staff including nurses, doctors and clinical officers, laboratory technicians and undergraduate students
of Biomedical Sciences, will be trained through this effort. Additionally, roll-out of the NQAS will include the development and
implementation of standard operating procedures, development and implementation of a quality assurance monitoring and
evaluation system, and the procurement of supplies and reagents for quality assurance of blood safety activities.
ii. Injection Safety
The National HIV and AIDS policy stipulates that the use of disposable sterilized injections can reduce the risk of HIV infection.
The government has established systems to ensure that disposable materials and sterilizing equipment are in all health facilities.
Dissemination of appropriate and up-to-date information on the dangers associated with unsterilized material is a priority. The
Nurses and Midwives Council of Malawi (NMCM) is the regulatory and coordinating body of injection safety at the national and
district level. Supported by PEPFAR through Pact/Malawi, NMCM has produced post-exposure prophylaxis protocols and
guidelines for use by health care workers. NMCM are implementing most of the areas addressed above as priorities for the
country. Risk reduction is integrated in all services which have any potential risk of HIV transmission through needle stick injuries
or exposure to blood and other body fluids. NMCM's program is linked to the logistics and supply units for essential drugs,
materials, equipment and supplies.
USG had previously funded ACCESS (prime partner JHPIEGO) to implement a Performance and Quality Improvement (PQI)
initiative to improve Infection Prevention practices. ACCESS recently announced that it would close down after completing its
FY08 work-plan. USG will discuss with GOM how the loss of support from ACCESS will impact the Performance and Quality
Improvement (PQI) initiative which was initiated to improve Infection Prevention practices. This program was designed in such a
way that the Ministry of Health (MOH) under the guidance of the National Quality Assurance Technical Working Group
(NQATWG) takes a lead role in ensuring progress and sustainability of Infection Prevention control (IPC) efforts. Infection
Prevention has been incorporated in the annual District Implementation Plans (DIPs), ensuring that all infection prevention
supplies and IPC activities are budgeted for and integrated into the Districts' work plan.
iii. Male Circumcision
Evidence from two decades of observational and clinical studies suggests that male circumcision can significantly reduce HIV
transmission by as much as 60%. In Malawi, data generated from the national DHS survey of 2004 indicated that 20.7% of the
male population aged 15-49 years is circumcised. There is a strong association between male circumcision and religious
affiliation or ethnicity in the country. Fifty-five percent of all circumcised individuals are Muslim. Of all Muslims in Malawi, 93% are
circumcised, compared to less than 25% in other groups. The predominantly Muslim Yao and Lomwe ethnic groups account for
78% of the circumcised population: 86% of Yao and 34% of Lomwe are circumcised. Less than 10% of men in other ethnic
groups are circumcised.
Malawi will not fully implement MC without conducting an acceptability and feasibility study. With PEPFAR support in 2007, the
National AIDS Commission (NAC) in collaboration with the Ministry of Health (MOH) organized a two day national stakeholders'
consultative workshop on male circumcision and HIV prevention. The consensus was that male circumcision should be
considered as part of a comprehensive HIV prevention strategy, with the caution that some critical issues, particularly the
reliability of the data which suggests that there is high HIV prevalence amongst the circumcised Yao and Lomwe groups, need to
be addressed before a national policy on male circumcision is adopted.
In order to address key issues around the acceptability and feasibility of incorporating male circumcision into a national HIV
prevention strategy, NAC will use carry-over FY07 PEPFAR funds to support 4 key areas: Conducting a rapid assessment of
current social and cultural issues which would affect male circumcision in the context of HIV prevention; intensive consultation
with critical constituencies such as traditional and religious leaders and policy makers; the development of an effective
communication strategy; and targeted studies (i.e. operations research) in areas identified by the rapid assessment and
consultations.
It is anticipated that the rapid assessment, which will be adapted from the UNAIDS/WHO situational analysis toolkit, will raise
some questions with regard to gaps in the current knowledge and practice of male circumcision in Malawi. Carry-over PEPFAR
funds will be used in conjunction with other partners to support time-limited operations research that will help answer some of
those questions. For example, through questionnaire driven sampling, efforts would be made to understand confounding factors
for the high prevalence of HIV infections among communities with the highest proportion of male circumcision, the Yao, and the
Lomwe ethnic groups.
Male circumcision in Malawi is deeply rooted in culture, tradition and religion. For male circumcision to be developed in a
culturally appropriate way as part of an HIV prevention package, those who hold cultural influence in the major ethnic groups will
be engaged in all levels of discussion to assist in health intervention planning. USG resources will be used in conjunction with
other partners to convene multiple consultations with these key stake holders. A final consensus meeting which would advise the
MOH on policy development around male circumcision will be convened.
Critical to considering the inclusion of male circumcision as part of a national HIV prevention policy is the need for an effective
communication strategy. USG through PSI will assist the MOH with developing content for communication materials which will be
used in the consultation process targeting different populations. Relevant focus groups will be constituted, messages will be
developed and piloted, and IEC materials will printed and distributed.
begin developing a partnership compact with the GOM. How male circumcision can be considered part of comprehensive
prevention in Malawi is part of the ongoing discussion for the Compact.
Should Malawi move forward towards drafting and implementing a policy on male circumcision (MC), USG would use Compact
funds to support an assessment of Malawi's resources and training needs, skills of health care providers, capacity of health care
facilities to implement an MC intervention, and to support the drafting of a policy and strategic plan.
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. USG will seek to use available Compact funds in conjunction with resources from other partners, in
order to support time-limited operations research to answer some of those questions.
Table 3.3.04:
At the beginning of the project in July 2003, BRIDGE conducted both qualitative and quantitative research
that identified several underlying factors of individual and collective behavior that could enhance HIV
prevention practices - as well highlighted factors that may currently impede the widespread adoption of
healthier behaviors. During early FY05, BRIDGE shared this research with partners at the national and
district level. BRIDGE conducted two additional rounds of quantitative research during FY 2005 and FY
2006 to track change in project related outcomes. During FY 2008, BRIDGE will produce simplified
overviews of the second round midterm research (conducted during FY 2007) and monitoring findings (in
very easy vernacular) for use at the community level to build understanding about behavior change
approaches and to inform local actions.
With USG funding, BRIDGE has conducted periodic (approx. 1-1/2 year intervals), targeted evaluations of
prevention activities using Knowledge, Attitude and Practice surveys and risk perception assessment
frameworks to inform project progress and monitoring shifts in target population norms with respect to HIV
prevention indicators beginning in July 2003.
The BRIDGE survey tool facilitates documenting an association between changes in attitudes and
behaviors with exposure to BRIDGE HIV preventions interventions at the national and community levels.
With FY 2007 funds, an end of project assessment will be supported to determine changes in knowledge,
attitudes and most crucially behaviors related to HIV prevention. This strategic information obtained will be
shared with a wide cross section of stakeholders for use in on-going programs and the development of
future strategies and approaches.
BRIDGE will continue to collaborate with local research partner organizations to track the evolution of
behavioral indicators in Malawi - especially prevention behaviors. In addition to conducting surveys,
BRIDGE will provide training to our partner in data quality assurance, sample design, interviewing skills,
data coding and other related areas.
Activity 1: End of Project Evaluation and Dissemination
Towards the end of FY 2008, BRIDGE will conduct a quantitative, representative sample survey in our
districts to assess change in indicators pertaining to (among others):
-Percent of young people that can correctly identify methods of HIV transmission and reject misconceptions;
-Percent of respondents expressing a willingness to express their HIV status to close friends or family
members if found to be HIV positive;
-Percent of respondents utilizing HTC services;
-Percent of young people (15 to 24) who have never had sex;
-Percent of respondents (15 to 49) who had sex with more than one partner in last 12 months;
-Percent respondents 15 to 49 years old who report using a condom while having sex with a non-marital,
non-cohabitating partner in the last year.
Activity 2: Program Partner Mentoring
BRIDGE will mentor and oversee its 19 program implementing sub-partners on reporting activities at both
the district and central levels to ensure that data is gathered and reported in an accurate and timely manner.
To this end, BRIDGE project officers will train project implementing partners and district coordinators on the
use of the BRIDGE M and Etools to document achievement of training, outreach and capacity building
targets; ensure understanding about the correct use of the tools; and ensure compliance with reporting
requirements. The BRIDGE M and E assistant will review all monthly and quarterly submissions from
partners to check incoming M and E data for reliability & validity; ensure all source documents are properly
coded for easy access and identification; and tabulate data across districts and activities in a secure
database to create summary tables. On a semi-annual basis the BRIDGE staff will conduct training
activities for program officers and counterparts at its 19 implementing partners on data tracking, storage and
management issues. BRIDGE will also conduct site visits to districts to ensure accuracy of M and E data
reported to the office and proper record keeping by the program partner to meet data quality and
performance standards. BRIDGE will supplement its internal trainings through collaborations with Pact's
training initiative. As necessary, based on feedback from USG and other program partners, BRIDGE will
update its M and E tools to support ease and maximum reporting accuracy.
BRIDGE has worked with a local research partner, Salephera, Inc., to gather strategic information since the
beginning of the project. During that time, BRIDGE has built the capacity of the Salephera team, and they,
in turn, continue to show their enthusiasm and abilities with new lessons and techniques. Since working
with BRIDGE in FY04, Salphera has won research and evaluation tasks through competitive procurements
from international NGOs and donor organizations. BRIDGE and Salephera have assembled a baseline
study and two complete mid-term evaluations together.
BRIDGE's on-going data use for decision making is based upon the Risk Perception Attitude (RPA)
framework that posits a behavioral relationship between perceived risk (susceptibility and severity) and
efficacy (including self efficacy and response efficacy). This theoretical construct has guided the
development of program interventions to date, and the new data collected will also contribute to the
Activity Narrative: successful implementation of project activities, as well as informing partners and stakeholders of new
information that will inform and be relevant to their efforts as we work together to harmonize national
strategy.
Continuing Activity: 17148
17148 5979.08 U.S. Agency for Johns Hopkins 7668 5662.08 JHCOM $29,095
11273 5979.07 U.S. Agency for Johns Hopkins 5662 5662.07 JHCOM $100,000
5979 5979.06 U.S. Agency for Johns Hopkins 3877 3877.06 $27,000
Table 3.3.17:
Table 3.3.18:
With FY 2008 Emergency Plan (EP) funds, BRIDGE will provide technical assistance (TA), capacity
building, and social mobilization among district and community HIV/AIDS coordinating committees and
other local organizations to design, implement and evaluate comprehensive HIV prevention initiatives.
BRIDGE will strengthen the capacity of 40 new community level partners while providing on-going guidance
and support to current partners, including community-oriented radio stations, to design, coordinate,
implement and evaluate the impact of HIV prevention initiatives. The work with communities supports and
emphasizes the importance of delay of sexual debut among the youth, mutual faithfulness and the risks
associated with multiple concurrent partners, correct and consistent condom use, and accessing PMTCT
services for HIV-positive pregnant women, and the importance of knowing one's HIV status. BRIDGE
assistance also builds the technical and organizational capacity of local entities to become more self-reliant
in terms of activity planning and monitoring.
Community mobilization is a capacity-building process through which communities, individuals, groups, or
organizations plan, carry out, and evaluate activities on a participatory and sustained basis to improve their
health and other needs, either on their own initiative or stimulated by others. Building capacity and social
mobilization at the community level has been a key component of the BRIDGE project in Malawi since its
inception in 2003.
At the district level, BRIDGE works closely with the District AIDS Coordinating Committees (DACCs) and
their subsidiaries at the community (CAC) and village (VAC) levels. DACCs, CACs and VACs are the front
line of the national HIV and AIDS response, tasked through the National AIDS Commission with
mainstreaming, implementing and supervising HIV and AIDS activities in each district. These structures
provide guidance to NGOs and emergent CBOs at the district level and are often the only response
mechanism in rural and remote areas of Malawi.
During the past three years, BRIDGE supported skills building trainings for a broad-based cross-section of
its district-level partners, including DACCs, CACs, VACs, their Youth and Prevention technical sub-
committees, NGOs, individuals who have influence in the community ("community influentials") and change
agents - such as traditional leaders, healers, and Chief's Councils. To date the BRIDGE project has
facilitated skills-building in over 300 community based groups in eight districts. These groups are able to
independently identify, plan for, and implement HIV prevention activities using nationally available tools and
materials along with initiatives of their own creation. Just a few examples of district activities in the last year
to combat HIV locally, include:
• Community dialogues with traditional and religious leaders on HIV/AIDS and cultural practices
• Youths and women's guild members, including agogo ("grandmothers"), actively conducting outreach and
guidance on HIV prevention
• Local advocacy campaigns combating stigma and discrimination, promoting testing for couples, and
encouraging engagement of local PLWA groups
• Collaboration with the District Assemblies and other partners to implement district level HIV/AIDS
campaigns and strengthen and fund prevention activities in District Implementation Plans (DIPs)
Since FY 2005, the BRIDGE project has supported a radio diary project featuring the personal testimonies
of male and female PLWHAs on six local radio stations. The Malawi Health Sector mid-term evaluation
showed that the Radio Diaries reached up to 75% of the listening audience in Malawi and indicated that
listening to the radio diaries is strongly associated with reduced stigma towards people living with HIV/AIDS
and more agreement with attitudes that "people with HIV are just like me." All radio stations report good
listener feedback to these innovative programs and there is widespread recognition of the programs in all
eight emphasis districts as well as in Lilongwe and Blantyre. The activity is also characterized by strong
partnerships not just with the radio stations, but also with PLWA organizations, specifically Malawi Network
of People Living with HIV/AIDS (MANET+) and National Association of People Living with HIV/AIDS in
Malawi (NAPHAM).
Activity 1: Skills Building at the Community Level
The BRIDGE project partners with DACCs, CACs, and VACs to strengthen their ability to plan, coordinate
and implement HIV prevention activities. Adequately skilled DACCs will oversee and coordinate broad-
based responses to HIV/AIDS district-wide and, through CACs and VACs, reach community change agents.
With FY 2008 EP funds BRIDGE will support the continuation of these capacity building plans in its districts
in partnership with the NAC umbrella grants program, and continue to encourage and support a more
engaged and supervisory relationship between DACC technical subcommittees and district based CACs.
Support includes trainings on components of the community mobilization process, behaviour change skills
building workshops and specific technical assistance to community groups including youth groups, faith
based organization and PLWHA support groups on planning and activity monitoring. BRIDGE support
includes linkages to activities in other area of the EP, such as PMTCT, abstinence/be faithful programs, and
VCT among others.
In FY 2008, this process will be expanded to include additional traditional authority areas in all eight focus
Activity Narrative: districts. To monitor progress, the BRIDGE project will continue to encourage meetings of the BCI technical
subcommittees in the DACCs and CACs. The project will facilitate DACC and CAC review meetings to
provide critical assessments of the activities conducted by these structures. Working with partners in the
DACCs, CACs, and other NGOs, the BRIDGE project will continue to mobilize communities to respond to
the HIV epidemic through the formation of VACs; the strengthening of CBO's; and advocating for the
inclusion of prevention programs to work alongside home-based care and orphan support activities. FY
2008 funds will be used to strengthen 40 VACS to assist DACCs support District Assemblies to ensure
widespread reach of the NAC umbrella grants and district-based forms of financial support.
Continuing Activity: 17149
17149 6002.08 U.S. Agency for Johns Hopkins 7668 5662.08 JHCOM $99,872
11285 6002.07 U.S. Agency for Johns Hopkins 5662 5662.07 JHCOM $547,504
6002 6002.06 U.S. Agency for Johns Hopkins 3877 3877.06 $582,002
