This activity is related to HKID 9125, HVAB 8232, HVAB 9146 and HVTB 9129.

World Relief will continue to deliver quality care for the chronically ill through its existing cadre of trained care provider volunteers totaling 240 through FY06 increasing the number to 400 in FY07. World Relief works through pastor networks to gather information about the communities and identify the services needed by the PLWHA. World Relief Provincial Coordinators and some supervisors receive Ministry of Health accredited training in home-based care and extend this knowledge to the care provider volunteers. Targeted communities in the highly HIV/AIDS-affected southern provinces are selected based on the performance of the pastor networks and volunteers in identifying and serving their neighbors in need. Coordinators, supervisors and volunteers establish relationships with health facilities in their areas to ensure that PLWHA are referred to the services they need and that they are monitored as advised by the clinical service providers. These home-based care activities are complementary to the USG-funded OVC activities implemented by World Relief in the same communities.

In COP07, World Relief will strengthen is treatment adherence activities through additional training and practicum sessions. Thus the community volunteers will be able to assess ART and TB treatment compliance among their clients in order to identify any complications and make referrals to clinic services for proper follow-up.

World Relief works primarily with pastor groups as their basis for community support. In the beginning these pastors groups were loosely organized. However, over the years they have gained experience in working together to identify and realize goals and objectives for the benefit of the community. Currently World Relief is strengthening 4 Pastor's networks and one local church in Maputo province with leadership and institutional capacity building to improve OVC and HBC services. Based on lessons learned with and from these FBOs, collaboration and expansion to new strategic partners will be feasible in other project provinces as the need for capacity strengthening becomes essential for Mozambican organizations. Each FBO will have the sole responsibility of managing implementation of activities to achieve the targets and project objective. World Relief will directly manage the financial activities in the first year of project. Funds will be disbursed monthly on the basis of justification with receipts for expenses and assist each FBO in the purchase of technical items and materials.

In FY07, 4,000 clients will be reached through home-based palliative care services by World Relief.

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 activities 9207, 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 9139; HVAB 8232 and 9146; HVTB 9130.

World Relief (WR) will continue to work in southern Mozambique to identify needy OVC and provide services for them through the pastor networks and volunteer groups established in 2002. World Relief has continued to use their network of pastor groups as the main community contact in providing leadership in identifying needy OVC. OVC can be inside or outside the church base. Therefore, all religions and ethnic groups have equal access to these services. Services provided to OVC under this program will follow Mozambique and USG guidelines of providing six essential services to each OVC in order to be considered "reached". WR is making a concerted effort under FY06 funding to collaborate with health personnel at USG-supported sites to ensure that adequate health care is provided to infants and children that are part of this program's OVC clients. WR also works with the World Food Program (WFP) to access emergency supplemental foods for the very needy. The geographical areas in which WR works is very prone to droughts and food is often a major barrier in the success of their program out-reach. WR also works with other donors and government entities in the area to provide other services and have been able to get the OVC into schools, start some backyard gardens, plant fruit trees and register OVC for ID cards.

WR is starting to develop data gathering tools that can begin to measure the quality of services and the impact on the OVC. This effort will be continued in FY07 and will provide WR with information that will help them make effective programmatic decisions.

From the start, World Relief has worked closely with a number of local CBO/FBO and continue to strengthen their ability to get funds from other than PEPFAR sources, to manage a comprehensive program and to report back to the donor(s). WR provides very small grants for pastor networks and other local groups to fund community services for OVC. The networks are learning to develop financial management responsibility for these small grants and will one day be able to handle a full grant.

In FY07, WR will continue with their basic community-based structure of identifying and providing services for 20,400 OVC affected by HIV/AIDS and training 1,360 caregivers. They will continue to provide the 6 essential services for OVC. In addition, WR will work closely with its agriculture projects to train OVC and their caregivers in establishing and maintaining community plots both for production for sale and consumption.

With WR assistance, the pastor groups will begin to develop ways for the communities to continue to provide OVC care even after Emergency Plan funding ends. Working with local partners as sub-grantees is a pilot experience with ample opportunity for growth over the period. Four Pastor's network and one local church in Maputo province will be provided with institutional capacity building for OVC and HBC services in this phase of the project. Based on lessons learned with and from these FBOs, collaboration and expansion to new strategic partners will be feasible in other project provinces as the need for capacity strengthening becomes evident for Mozambican organizations. Each FBO will have the sole responsibility of managing implementation of activities to achieve the targets and project objective. WR will directly manage the financial activities in the first year of project. Funds will be disbursed monthly on the basis of justification with receipts for expenses and assist each FBO in the purchase of technical items and materials.

A special emphasis in COP07 will be to coordinate and expand existing programs of non-governmental organizations dealing with child protection and family support in close collaboration with the Child and Family Initiative. ($20,000)

Under this activity, 20,400 OVC are expected to receive the comprehensive package of 6 essential services and 1,360 care providers will be trained or re-trained during FY07.