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.
New Activity - MOH HIV/AIDS Unit
Compact goal 4
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.01:
Continuing Activity - GHAI
Sexual prevention compact goal
Table 3.3.02:
Continuing Activity
- Sexual prevention compact goal
Table 3.3.03:
Continuing Activity - MBTS GHAI
Table 3.3.04:
New Activity - CHAM
Compact goal 2
Table 3.3.08:
Table 3.3.09:
Continuing Activity - Howard University
Adult care and treatment
Compact goal 2 - Quality and access of care and treatment services
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $435,000
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
Compact goal 2 - Quality and access...
Continuing Activity - MOH NTP
Compact goal 2 -
Table 3.3.12:
Continuing Activity - MACRO GHAI
Table 3.3.14:
Compact Goal number 4 - systems strengthening
Table 3.3.16:
Continuing activity - Because the GAP account begins FY09 spending in October of 2008, and because
there is insufficient funding in the CDC base for increased management and staffing costs, we have had to
signal our intention of using Compact funds to partially fund year 2 of the Lab Advisor position. Since
recruitment is ongoing at this time, and salaries will not have to be paid for a few months, we have chosen
to use our limited GAP funds for activities that need funding immediately.
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.
This activity is split funded with activity #27133
The new Lab Advisor on the USG Team will provide technical oversight for the expansion of lab services in
support of the Malawian national efforts for treatment and care. The technical lead will oversee and provide
empirical data for monitoring the effectiveness of the interventions during the scale-up phase of the new
partnership.
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $4,243,796
Program Area Narrative:
Overview
Within the National AIDS Framework (NAF), SI encompasses monitoring and evaluation, health management information systems
(HMIS) and surveillance at the national, sub-national and program levels. The data generated through these complementary
systems serve as the cornerstone of evidence-based HIV/AIDS prevention, care and treatment programs throughout the country.
Malawi has taken a leadership role in advancing strategic information systems in Sub-Saharan Africa, particularly in its proactive
use of evidence to guide national strategic planning and resource allocation. However, the country faces many challenges in this
area including the need to increase staffing levels and technical capacity, institutionalize routine supervision of monitoring
activities, upgrade technology and infrastructure to support more advanced data management and communications systems.
USG is playing an integral role in providing the necessary information to effectively scale-up and decentralize services, evaluate
the national response, and monitor changes in epidemic dynamics.
i. Functioning of USG Strategic Information Team
The USG SI team is comprised of an SI Liaison, housed within USAID who serves the entire USG team; two Monitoring and
Evaluation Officers (including a non-PEPFAR funded USAID mission M&E Officer) and an Epidemiologist. The SI Liaison
ensures systems are in place at USG and amongst implementing partners to effectively plan and monitor programs according to
PEPFAR requirements. The Epidemiologist provides technical leadership and program management over all HIV/AIDS
surveillance, public health evaluations and management for a subset of USG partners in SI. The PEPFAR-funded Monitoring and
Evaluation (M&E) Officer provides technical leadership and program management for M&E and HMIS activities with the Ministry of
Health (MOH), which includes strategic planning, routine monitoring and evaluation, capacity building, and data quality
assessments. The non-PEPFAR funded M&E Officer provides technical and capacity building support to civil society partners.
ii. Surveillance and Surveys
USG has a long history of supporting population and sub-population-based HIV biological and behavioral surveillance in Malawi.
In 2009, USG will again be the primary funder of the Malawi Demographic and Health Survey (MDHS), including a behavioral
component, HIV biomarkers, and oversampling for district-level HIV prevalence estimates. Funding and technical assistance for
the implementation, analysis and dissemination of the HIV integrated Behavioral Surveillance Survey (BSS) with HIV and syphilis
biomarkers among key high risk populations has been provided for two previous national surveys. Funding for the design and
methodological revision of the 2009/2010 third round of BSS and strengthened data use will continue to be a primary objective of
USG in the FY09 COP.
To date, Malawi has relied on modeled estimates of new HIV infections based on prevalence data. As the successful national
treatment program reaches almost 70% coverage, prevalence data has become less reliable in identifying where, and among
whom, the bulk of new infections are occurring. In order to increase the information foundation for program planning, particularly
for prevention activities, in-country laboratory and epidemiological training and support for incidence estimation using BED assay
will be provided to the MOH, College of Medicine and partners. Incidence estimates will be conducted among the general
population 2009 MDHS sample as well as in other important sub-populations in Malawi.
Since 2005, USG Malawi has assisted the MOH and WHO in developing and implementing an HIV drug resistance surveillance
system including supporting the national HIV Drug Resistance Technical Working Group, monitoring of Early Warning Indicators,
conducting threshold surveys of transmitted drug resistance, and implementing baseline prospective surveillance of acquired drug
resistance at four high-volume ART sites. The first round of prospective surveillance will be completed in FY09 and a second
threshold survey and continued Early Warning Indicator detection will be implemented. In addition, a National HIV Drug
Resistance Strategy, incorporating both WHO and USG recommendations, will be developed with USG assistance. This
framework will be used to lobby for Global Funds for longer-term drug resistance surveillance support.
With USG support, Malawi has been a global leader in systematically incorporating data into the national decision-making. In
FY09, USG will continue to support national data use activities including data triangulation, modeling national estimates and
projections, and developing data-driven briefings for policy makers. In addition, USG will support the development of an
innovative district and local-level data use model to guide decentralization of prevention, care and treatment programs.
Beyond providing funding for HIV surveillance activities, direct -almost daily - technical assistance to strategic information
activities is fundamental to the Malawi program. The USG Epidemiologist is a member of the MOH Health Impact Study Technical
Working Group, and provides technical support for surveillance activities including ANC sentinel surveillance, drug resistance
surveillance and BSS. In addition, trainings were held on data triangulation, and drug resistance surveillance. BED assay training
will take place in December 2008. Capacity building and documentation activities will continue to be at the forefront of FY09
surveillance activities.
iii. Health Management Information Systems
Health Information Systems are essential for effective monitoring and evaluation and require reliable, standardized data collection.
In 2002, the MOH began to implement the national HMIS to support routine data collection, analysis and dissemination for health
sector data, including indicators on HIV/AIDS, malaria, TB, reproductive health and other health programs. Facility-level HMIS
indicators are aggregated on a quarterly basis at the district level and sent via email or floppy disk to the national level. However,
the accuracy, completeness, and timeliness of data are limited.
Baobab Health, a USG supported Malawi-based trust and NGO, has been addressing this issue for the past eight years by
applying medical informatics principles to resource-poor settings. The core of Baobab's approach is the application of easy-to-use
touch screen clinical workstations at the point of patient care. This system efficiently and accurately guides low-skilled healthcare
workers through the diagnosis and treatment of patients according to national protocols. Baobab Health has deployed Electronic
Data Systems (EDS) at 7 of the largest ART clinics throughout the country. Currently, 16,699 ART patients are captured by this
system - or approximately 13% of Malawi's 121,707 patients who are alive and on treatment. Each deployment has also resulted
in the training of 5 - 20 users To address challenges of data quality, in FY08 the MOH, in partnership with USG and Baobab
Health, initiated a feasibility project of using EDS to capture out-patient registry data in rural health facilities to explore the use of
alternative energy sources (e.g. windmill and solar panels); and remotely transmit data to a newly established central repository
housed within the MOH. The challenge for FY09 will be the conversion of the paper-based record keeping system to the national
scale up of EDS, The EDS scale up will include the development of modules to transfer of patient files and to transfer data to
central repository. In FY09, USG will continue to provide TA support in preparation for the scale up. The only impediment to the
scale up is the availability of resources. In FY09, in order to increase their organizational capacity, Baobab will receive a Pfizer
Global Health Fellow as part of a new public private partnership initiative.
In Malawi there are a number of indicators collected at the national level which do not support program-level information needs.
As a result, many vertical program-specific health information systems are being developed. In FY09, the USG will provide TA
and support to explore potential for integrating systems through the use of national standards. To initiate the process of system
integration, the MOH, WHO and USG conducted a 3-day workshop on standards in order to build consensus around a national
health infrastructure strategy for Malawi, including governance structures, operational policies and processes to promote ongoing
collaboration and coordination between stakeholders. One outcome of this workshop will be the identification of a Standards Task
Force that will play an instrumental role in 1) developing a national framework for data analysis, patient referral and medical
record management, 2) designing a roll-out plan for EDS, 3) harmonizing partner reporting to feed into the HMIS; and 4)
developing specifications for a central data repository. This effort supports the objective of the National M&E Plan as well as the
goal of the ‘Third One'.
iv. Monitoring and Evaluation
To help support the National M&E plan, USG recently identified the need for four staff within the newly formed M&E Unit of the
Ministry of Health, including an M&E TA, an M&E Fellow and two IT Fellows. A new facility on the Community Health Science
Unit (CHSU) campus is also underway to house the HIV/AIDS Unit, the central data repository, and additional rooms to support
trainings and conferences.
In FY08, USG supported assessments for 1) the Touch Screen Electronic Data System (EDS), 2) the Logistics Management
Information System (LMIS) for HIV test kits and ARVs, 3) the integration of the ARV Supply Chain System into Central Medical
Stores (CMS) and its Regional Medical Stores (RMS), 4) the Situational Analysis of HIV services, and 5) M&E Systems for OVC
at the Department of Women and Child Welfare (MOWCD). Within the next two years, recommendations from these
assessments will be incorporated into scale-up and data quality improvement plans for each of these Information Systems. The
EDS will be scaled up to high-burden ARV public and private service delivery sites (approximately 12 per year) and will include
the ability to transfer patient files from one facility to another. The LMIS will fully use standardized ARV recording, reporting and
transaction forms documented in Standard Operating Procedures (SOP). A Training of Trainers on the SOP will result in all
health workers trained at ARV service delivery sites and routinely using the forms. The CMS will have improved quantification
capabilities which will be verified by stock reports from hospitals and facilities using remote reporting systems. USG played a
critical role in planning, data collection and report writing of the 2007 Situational Analysis.
The MOWCD has an M&E plan for OVC which was written in 2007. The plan describes the use of four tools which provide the
basis for data to move from communities to districts and the national level. The tools are: 1) the Household Listing Book; 2) the
OVC Community Register; 3) the OVC Community Quarterly Report; and 4) the Community Based Structures Report. USG will
provide a needed dimension to these M&E activities by supporting GIS mapping to improve coordinated service delivery and
monitoring
In 2008 the USG funded a Human Capacity Review of the MOWCD to assist the Ministry to meet the funding requirements of the
Global Fund Round 5 Phase 2. The MOWCD is in the process of completing a functional analysis of M&E standard operating
procedures as well as all other service delivery activities. The analysis should be completed in 2009.
In FY08, the SI team instituted a Semi Annual Progress Report (SAPR) to promote the use of up-to-date data for program
management and planning. Aggregate summary reports were included in the Portfolio Review template which consolidated
partner specific life-of-project results and were used at the first Inter Agency Portfolio Review. The objectives of the Portfolio
Review were to conduct a situational analysis of partners for past, present and future activities, and identify linkages amongst
USG agencies. From the Portfolio Review four key priority themes were identified and used for planning activities in the Compact
and FY09 COP. In addition, the USG team reviews partner performance after the APRs are received.
In FY08, the USG prioritized improving data quality at the national and partner levels. USG conducted a Data Quality Workshop
for USG Project Managers and Implementing Partners in developing Performance Management Plans (PMP) and conducting
Data Quality Assessments (DQA). At the national level, data quality improvements include a comparison of the results of the
Situational Analysis and data collected by the routine HMIS. Variations will be identified and a data quality plan will be developed.
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. SI is a priority area under consideration.
Should the Compact be approved, additional FY09 compact funds would go towards the full scale up of the EDS by developing
and implementing a roll-out plan (approximately 1 site per month); developing EDS modules for Counseling and Testing, PMTCT
and TB; designing the architecture to transfer patient files from one facility to another; setting up a central repository/data
warehouse within the MOH; and developing policies on governance structures. In addition, Compact funds will be used in
surveillance to train and support laboratory and data analysis needs for BED assay incidence estimation with BSS and DHS
samples; expanding HIV drug resistance monitoring (threshold, early warning indicators and prospective monitoring) to more sites
including urban and rural areas and public and private service providers; developing a pediatric ART drug resistance monitoring
program; and providing technical assistance and support in district-level triangulation of monitoring and evaluation data.
Table 3.3.17:
Continuing Activity - Lighthouse GHAI
Cross cutting compact goal
Continuing Activity - Baobab
Compact goal 2 - Improving quality of and access to care...
Compact goal - cross cutting
Continuing Activity - CDC LES Technical staff salary for data management
Continuing Activity - University of Malawi (College Of Medicine)
Summary
This includes USG-supported activity through CDC's Sustainable Management Development Program
(SMDP) will be implemented through the College of Medicine in 2009
Table 3.3.18:
UPDATED FOR FY09 - Continuing Activity - CDC M&S
This activity is split funded with activity #21376
This narrative describes the CDC Malawi M&S needs for both GHAI and the Global AIDS Program (GAP)
funds. The CDC Malawi M&S budget, including GHAI and GAP funding, has been vetted through the
interagency decision making process and agreed to as presented in the FY09 COP submission.
Malawi is not a PEPFAR focus country but Malawi receives significant resources from the Global Fund for
AIDS, TB and Malaria (GFATM). Because of the very limited human and technical capacity to implement
programs in Malawi, the GFATM depends on the USG to complement their efforts by providing critical
technical staff to assist with program design and implementation. The USG Malawi team's M&S goals
reflect a strategic approach to both addressing the needs of the GFATM programs, and that of the programs
directly supported by the USG. The M&S plan for the HHS/CDC office in Malawi is designed to have
sufficient staff during the FY09 period and beyond, to provide appropriate technical and programmatic
oversight and assistance to all implementing partners in Malawi. The CDC M&S budget in FY09 COP
supports the USG interagency team process of providing technical assistance and monitoring of PEPFAR
activities across a significant array of implementing partners in Malawi. CDC currently has nine cooperative
agreements supporting a broad range of implementing partner activities including GFATM activities in nine
program areas. Upcoming RFA awards will add two new partners in calendar year 2009.
To achieve the goals of effective technical assistance to the Government of Malawi and its implementing
partners, the CDC GAP Office in Malawi had planned for 18 positions in FY09. This is an increase of one
previously approved technical position (Laboratory Advisor), and 3 new LES administrative positions
(Program Management Assistant, Cooperative Agreements Manager and Data Manager) over the previous
year. If funding is available, we plan to be able to fill these positions in FY09.
The FY09 COP, HHS/CDC staffing plan includes 5 USDH that are comprised of the Chief of Party, Deputy
Director, Medical Officer, and Epidemiologist. The Laboratory Advisor was planned for in FY 2007. However
limits in our budget did not permit the addition of this staff member. This position is currently being recruited
for with approved funding made available from reprogramming FY08 Compact resources. The current
HHS/CDC staffing plan also includes two PSC positions; a Monitoring and Evaluation Officer and a
Counseling and Testing Advisor (both are PS contracts through CDC). Additionally we have eight FSNs
which include a Program Management Officer, an Administrative Officer, 2 IT support staff, 3 drivers and 1
custodian.
M&S costs are inclusive of rent for offices, utilities, office operational costs, M&S specific equipment, travel
for M&S staff, training for M&S staff, residential leases and post allowance for the 5 USDH and 2 PSC M&S
positions, and increased communications costs related to enhancement of office communications and
connectivity. This FY09 COP submission does not include HQ TA support in keeping with FY09 COP
guidance that this will be funded through the Headquarters Operational Plan process.
ICASS charges of $400,000 and CSCS charges $200,000 are budgeted separately in their own activities
with the prime partner listed as State as required by FY09 COP guidance.
Table 3.3.19:
