This activity is related to USAID_HVAB_AED_Activity # 9135 for $1,200,000 and USAID_HVOP_FDC_Activity # 9152 for $400,000.

This funding will continue FDC's community and school-based interpersonal communication programs and its Mozambican-led mass media campaigns that nationally advocate for changes in AB behaviors and norms. There are five components:

1. $600,000 AB ESH! SCHOOL & COMMUNITY ACTIVITIES The Schools without HIV/AIDS (Esh!) program operates in 27 districts (roughly 471 communities). School based Esh activities include: student-led peer education; teacher-student-director collaboration for campus lessons and activities on AB prevention; and parent-student-teacher activities to improve parent-child communication on HIV, healthy behaviors, sexuality and broader issues. Community based Esh activities, focused on out-of-school youth, parents and community leaders include: training of traditional leaders on protective, community led alternatives to harmful initiation rituals and on creating enabling environments for delayed sexual debut and other AB behaviors; a traveling information bus that will give isolated, rural communities access to information on HIV and protective AB behaviors, lead skills development trainings for peer educators and adults and facilitate fun and interactive sessions for all community members. As of FY07, this activity will also include FDC's Esh! AB program in Nampula province, formerly funded under State/Public Affairs ($70,000).

2. $1,275,000 MEN'S AND WOMEN'S CAMPAIGNS FDC is Mozambique's leading voice for national promotion of behavior change. This funding will continue the design and production of cutting edge mass media campaigns that reinforce and normalize desired behavior changes and address adult behaviors that increase vulnerability to HIV. Print, radio and television programs will be aimed at different age groups. Miners, a major mobile population in Mozambique, will continue to have a special focus. One mass media strategy is to recruit nationally known Mozambican leaders, sports and music celebrities, as well as youth, to serve as positive role models.

3. $125,000 GENDER

The focus of this component will be on reducing gender based violence and coercion. Additionally, this AB funding will permit FDC to take up legal issues that make it hard for women, especially married women, to protect their families and prevent infection. Male norms and behaviors that increase risk of HIV transmission may also be addressed in this program component.

4. $300,000 WINDOW OF HOPE PROGRAMS This funding will continue FDC's programs for youth under 14. Messages will focus primarily on delay of sexual debut and abstinence for both in and out-of-school youth.

This activity is linked to AB 9112 to support holistic ABC programming by the Foundation for Community Development (FDC). The FDC is the foremost Mozambican NGO dedicated to protection of the family, improvement of the status of women and prevention of HIV/AIDS. Behavior change activities developed by FDC have been cutting edge, and willing to address controversial issues such as older men having sex with young women and the impact of migratory labor patterns on transmission of HIV. This activity will provide support for broad campaigns addressing these gender issues and supporting comprehensive ABC programming. Additionally, this C&OP funding will permit FDC to take up legal issues that make it hard for women, but especially married women, to protect their families and prevent infection. FDC may implement, but is not limited to, a variety of advocacy activities such as press conferences, issues packets of information; IEC activities complementary to AB activities with youth; specific holistic programming with OVC; work with community leaders.

FDC along with JHU/CCP and PSI is a lead partner for communication. This activity will focus on priority behaviors for behavior change including multiple concurrent partner , transactional and cross-generational sex. Plus-up funding will allow FDC to increase C and OP activiites, or to initiate activities with other at risk populations such as MSM.

This activity is related to HVAB 9112, C&OP 9152, HVTB 9127 and HBHC 9131.

In this activity, the Foundation for Community Development (FDC), through local CBO/FBO sub-grantees, will continue to provide a palliative care services to people affected by HIV/AIDS in the Maputo Corridor (Maputo City, Maputo Province, Gaza and Inhambane). This activity will continue to provide support to HBC providers who have received services with previous FY 2004-06 funds, and will extend services in FY07 to reach 12,000 persons with home-based palliative care as defined by the Ministry of Health and the USAID Mission and train 1,200 persons in home-based palliative care.

FDC is the USG's only national NGO partner. FDC started HIV/AIDS activities in the high prevalence area of the Maputo Corridor in 2001 - before PEPFAR. One of the main goals of FDC is to assist community based NGO in managing their own programs and accessing funds from a variety of sources. To this end, they are currently working with 19 sub-partners (including the provision of small grants) who are in turn, supporting 44 other groups and associations members. These CBO and FBO work with community based programs supporting HBC and OVC. To date, FDC and their partners are providing HBC services for 9,600 individuals and trained 302 people in provision of HIV-related palliative care according to MOH guidelines.

FDC work with community based organizations is as varied as are the communities. Most communities in the southern region have some formalized community leadership structure. FDC's sub-partners mobilize, engage and involve leaders of the committees/counsels to support OVC and HIV infected people. Sub-partners work closely with clinic personnel to ensure treatment adherence and refer clients to other clinical services as needed. Community "activistas" are trained in advocacy to access other social programs, such as welfare, emergency food rations, etc. FDC has begun a program on providing psychosocial support for HBC providers to meet their physical, psychological and social needs. Partnering with WFP provides emergency rations for ART patients in treatment adherence.

FDC supports ANEMO (Mozambican Nurses Association), with a sub-grant to provide HBC services directly to the chronically ill in urban barrios. These people have ready access to treatment services and the nurses provide medicines for pain management and open sores, prevalent in the later stages of AIDS. FDC also initiated the Master Training of Trainers Program which is a highly successful method for training HBC trainers from NGOs and CBOs. It is expected that this cadre of 7 Master Trainers will be used for other palliative care training such as treatment adherence, OI and STI trainings.

Under COP07, mechanisms will be put in place to improve the community to clinic linkages. Although, NGOs were encouraged to liaise with local clinics, many volunteers were comfortable working at the community level only. In FY07, volunteers will be required to work along with clinics in caring for PLWHA on ART, with TB patients, patients with OI, STI and other conditions. At least 50% of all HBC clients will need to have a clinic record. Treatment adherence also will be supported by a related USG activity to ensure TB and HIV patients are taking their medicines and not experiencing any overt reactions. In addition, volunteers will be trained to further recognize OIs and to refer clients to the clinic for proper follow-up. Coupons for transport or use of bicycle ambulances will be used to ensure clients attendance. Further training will be held to ensure that HBC supervisors, and volunteers have the necessary skills to handle these new activities.

Under COP07, capacity building of local CBO/FBO will continue with fervor. With a UGS funded AED program, tools and materials will be available for NGOs to use with their nascent CBO in provide quality services and assess and manage outside funding. AED will also provide training on several general topics (on functional organizations, strengthened management, leadership, advocacy, financial management, etc.) which will be open to all NGOs and their partners.

General Information about HBC in Mozambique: Home-based Palliative Care is heavily regulated by MOH policy, guidelines and directives. USG has supported the MOH Home-Based Palliative Care program since 2004 and will continue with the same basic program structure including continued attempts of strengthening quality of services to chronically ill clients affected by HIV/AIDS. In FY02,

the MOH developed standards for home based care and a training curriculum which includes a practicum session. Trainers/supervisors receive this 12 day training and are then certified as trainers during their first 12 day training of volunteers. A Master Trainer monitors this first training and provides advice and assistance to improve the trainers' skills and certifies the trainer when skill level is at an approved level. All volunteers that work in HBC must have this initial 12 training by a certified trainer and will also receive up-dated training on a regular basis. The first certified Master Trainers were MOH personnel. Then ANEMO, a professional nursing association, trained a cadre of 7 Master Trainers who are now training Certified Trainers, most of whom are NGO staff who provide HBC services in the community. In the next two years, ANEMO will train and supervise 84 accredited trainers who will train 7,200 volunteers, creating the capacity to reach over 72,000 PLWHA.

In addition, the MOH designed 4 levels of "kits" one of which is used by volunteers to provide direct services to ill clients, one is left with the family to care for the ill family member, one is used by the assigned nurse which holds cotrimoxazole and paracetamol and the 4th kit contains opiates for pain management which only can be prescribed by trained doctors. The kits are an expensive, but necessary in Mozambique where even basic items, such as soap, plastic sheets, ointment, and gentian violet are not found in homes. USG has costed the kits and regular replacement of items at $90 per person per year; NGOs are responsible for initial purchased of the kits and the replacement of items once they are used up except for the prescription medicine, which is filled at the clinics for the nurses' kits. An additional $38 per client per year is provided to implementing NGOs to fund all other activities in HBC, e.g. staff, training, transport, office costs, etc.

MOH also developed monitoring and evaluation tools that include a pictorial form for use by all volunteers, many of whom are illiterate. Information is sent monthly to the district coordinator to collate and send to provincial health departments who then send them on to the MOH. This system allows for monthly information to be accessible for program and funding decisions.

In FY06, the initial phase of the assessment of home-based care will be completed. Recommendations from this assessment will inform the MOH on how to improve the palliative care services delivered at community level and what is needed to strengthen the caregivers. Training in psychosocial support is beginning to roll out and is meant to support HBC caregivers as well as the clients and their families. In Zambezia, it was reported that 40% of the HBC clients died during a recent 3 month period. This puts a lot of stress on the volunteer caregiver, who needs support to continue to do his/her job faithfully. A pilot project in three locations will support an integrated care system, strengthening relevant government offices as well as NGOs. The more varied resources, such as food, education, legal and other social services, that are available to the chronically ill, the stronger the overall program.

This activity is related to: HBHC activities9207, 9209, 9132, 9133, 9139, 9126; and HTXS activity 8545.

A new activity, which will be initiated during FY07 addresses the need for a more collaborative processes between clinic based and community based palliative care, especially in relationship to treatment adherence for TB and ARV. Although this has been the focus of community based care since the beginning, improvements can be made in the areas of collaboration and communication with NGO partners that are working in both clinic and community sites. Small amounts of funding will be provided to five partners who offer palliative care under the home-based care (HBC) model. HBC volunteers and their supervisors will receive training on treatment adherence for ARV and TB. Columbia University will develop training materials for ARV adherence under a separate USG supported activity and provide hands-on training to HBC volunteers so that they can assist their HBC clients to adhere to treatment drugs and determine if there is some reaction to the treatment regime. In addition, collaboration will occur with the MOH's TB program to ensure that HBC volunteers are correctly trained concerning the DOTS model and the MOH's vision for improving case detection and treatment success rates.

This activity was designed in collaboration with the emphasis in COP07 on improving TB/HIV programming. The activity is deemed important because of the recent information of mutated strains of TB found in neighboring countries that can easily cross the boarders.

Directly funding the NGO partners will help to build their own capacity in ARV and TB adherence support, creating a permanent buy-in to the importance of this effort. Thus it is expected that all HBC providers will receive training and that at least half of the HBC beneficiaries will be recipients of this expanded community-based service on treatment adherence.

This activity is related to: HBHC 9132; HVAB 9112; HVOP 9152; HVTB 9127 and OHPS 9212.

In this activity, the Foundation for Community Development (FDC), through local CBO/FBO sub-grantees, will continue to provide a basic care package of services to OVC in the Maputo Corridor (Maputo City, Maputo Province, Gaza and Inhambane). This activity will continue to provide support to OVC who have received services with previous FY 2004-2006 funds, and will extend services in FY07 to reach 17,770 OVC with the six essential services, as defined by the Mission and the Ministry of Women and Social Action and train 1,185 people to provide services to OVC and their caregivers.

The FDC is the USG 's only national NGO partner. The FDC started HIV/AIDS activities in the high prevalence area of the Maputo Corridor in 2001 - before PEPFAR. One of the main goals of FDC is to assist community-based NGOs in managing their own programs and accessing funds from a variety of sources. To this end, they are currently working with 19 sub-partners (including the provision of small grants) who are, in turn, supporting 44 other groups and association members. These CBOs and FBOs work with community-based programs supporting HBC and OVC. To date, FDC and their partners are providing services for 19,145 OVC, well above their target of 16,900.

The FDC works with community-based organizations that are as varied as the communities. Most communities in the Southern region have some formalized community leadership structure. FDC's sub-partners mobilize, engage and involve leaders of the committees/counsels to support OVC and HIV-infected people. OVC that are found to be on their own, living with a single bed-ridden parent or living with an elderly person are provided with "Reference Families" who are neighbors that accept co-responsibility for the OVC. Sub-partners will work closely with clinic personnel to ensure that free health care is provided to vulnerable infants and children. Community "activistas" will be trained in advocacy and skills to access other safety net programs for which OVC are eligible, such as welfare, emergency food rations, vocational training, etc. FDC has began a program on providing psychosocial support for OVC, especially for child-headed households and those children who are in the "window of hope" age group (10 years and under) through linking with AB activities funded under PEPFAR. The program will also target activities at older widows and widowers who are caregivers for many OVC and empower them to better care for the children and meet their physical, psychological and social needs. Partnering with Habitat for Humanity (a sub-grantee under PEPFAR), FDC has been able to build 8 houses for OVC and their households, while providing training in house building for older OVC as a trade skill. Partnering with WFP allows emergency rations for the very needy children in these drought prone areas; food supplements also benefit ART patients in treatment adherence.

During this past year, FDC, with USG support, provided two technical assistants seconded to the Ministry of Women and Social Action to strengthen ministry personnel in OVC and related HIV/AIDS programs, policy development and monitoring and evaluation. A follow-on to this activity will be continued through another USG-supported mechanism that will include a provincial focus.

During COP07, the FDC will be working in collaboration with the Children and Family Initiative to assist the Ministry with drafting, disseminating and implementing appropriate legislation consistent with international standards for child protection ($30,000). The FDC will also be coordinating and expanding existing programs of non-governmental organizations dealing with child protection and family support in close collaboration with the Child and Family Initiative. ($20,000)