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: 2010 2011 2012
As a key partner to both governments in the first two pillars of the Partnership Framework between the US Government and Government of Malawi (GOM), HIV Prevention and HIV care and treatment, MACRO's ability to provide high-quality HIV Testing and Counseling (HTC) is critical. Malawi has rapidly scaled up all HIV services in the last few years, with over 1,700,000 people tested between July 2008 and June 2009, approximately 30% of whom were pregnant women.
MACRO is the largest non-government provider of HTC in Malawi, providing approximately 10% of all testing nationally; they operate 6 'static' sites in cities across the nation: Karonga, Mzuzu, Kasungu, Lilongwe, Zomba, and Blantyre. Each site provides outreach testing to market places and other public areas, and the three largest sites also operate large mobile testing vans, which serve the remotest areas of underserved districts to directly impact on universal access targets.
The type of HTC available has shifted quite dramatically in the last two years, with increasingly diversified models implemented, including outreach, mobile, and door-to-door testing; In the second quarter of 2009, 27% of all sites reporting to Ministry of Health (MOH) were outreach versus static sites, compared to 21% in the same quarter of 2008. MACRO, a long-standing USG partner who provides approximately 10% of all HIV tests done nationally, reported that by the middle of 2008 approximately 80% of all HIV tests they were conducting were occurring at outreach and mobile sites, showing that a high demand for HTC access in remote and rural areas exists.
MACRO maintains a robust database using Electronic Medical Record Systems (EDS) in collaboration with Baobab Health Trust (another CDC partner). With the dramatic shift in testing models from static to outreach and mobile, the need for portable data entry technology has become clear. MACRO and Baobab intend to work together to develop and pilot a new system which can be used in all settings and provide quality data for basic program evaluation.
MACRO also provides training in HTC, and has employed a model which allows for mentoring 3 months after the completion of training, ensuring that quality HTC services are provided. The recent decentralization of national HIV training to district level lends itself to increasing district-level coverage of highly trained counselors. However, decentralization can potentially reduce the quality of training provided, as training is no longer taking place only in specialty training centers, with well-trained trainers. In recognition of the changing needs of the MOH, there will be an adjustment of the USG partners training model to complement the new national decentralized approach to training. This will likely include more extensive mentoring of both the training process and subsequent HTC implementation by trainees, ensuring the maintenance of high-quality HTC services in Malawi.
Budget Summary PFIP Year 1 Funding - $350,000 PFIP Year 2 Funding - $600,000
Budget Code - HVCT ($600,000.00)
With year 1 funds we expect to implement the following activities, which will continue in year 2, (FY11):
Activity 1: Support for a National CT Training and Post-training Mentoring Center ($100,000)
MACRO's training centers trained 130 HTC counselors in FY08. With FY09 and FY10 funding, the
training center will continue its close linkage with the direct services outlets operated by MACRO and will provide training to 160 health care workers using the national HTC curriculum. Each course will be limited to a maximum of 20 participants and deliberate efforts will be made to ensure fair representation of males and females in each course. The training center will collaborate with district HTC supervisors to mentor newly qualified CT counselors and give feedback on their performance using standard tools developed for this purpose. In districts with no structures for decentralized mentoring, trainers from MACRO will visit each newly trained counselor at least once within the first 6 post-training months.
Activity 2: Improve HTC services and linkages ($100,000)
MACRO will continue training and mentoring new HTC counselors, and meet the staffing needs of their training center to maximize the quality of training provided. In support of the training decentralization of MOH, MACRO will work with District Health Officers to increase the training provided to the public health sector. In this way, the number of people receiving HTC as a direct and indirect result of MACRO's services will increase.
MACRO will also strengthen linkages between HTC and other facility and community services by working with MOH to develop improved referral and follow-up systems for individuals testing HIV positive, including the strengthening of pre-ART services.
Activity 3: Strengthen all M&E activities ($400,000)
MACRO's EDS hardware and software will all be updated in PFIP year 1, including the implementation of a portable data entry solution for the extensive mobile and outreach testing now being conducted. This will mprove the ability to counselors to quickly and accurately collect data and develop risk reduction plans with their clients. Training to support the implementation of this system will be implemented at all levels.
Year 2 funds in this activity will be used to procure hardware that includes the touch-screen systems and other hand-held devices to capture data at both the static sites and during mobile and outreach activities. Funds will also be used to support data entry clerks and statistical analysis of data. The secretariat staff will be recruited to strengthen communication, connectivity, and data storage for all sites and the secretariat. All Human Resource and Accounting systems will be computerized for greater efficiency and accountability.
