Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3579
Country/Region: Mozambique
Year: 2008
Main Partner: Population Services International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $11,638,454

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,714,000

August 08 Reprogramming: Funding reduction $150K.

This is a continuing activity with an update under COP08. PSI will provide PMTCT services in 22 sites,

increasing the number of pregnant women provided with a complete course of ARV prophylaxix to 6000 and

increasing the number of women tested and receiving their test results to 52,000. The large scale PMTCT

media campaign and promotion launched in FY07 will be continued in FY08 to ensure that pregnant

women, their partners and families, and all relevant groups in the community are aware of and understand

the importance of PMTCT clinical services, and promote a community norm of attendance by pregnant

women early in their pregnancies. Finally, PSI will be the primary source and distributor of Plumpy Nut to

pregnant and lactating women among PMTCT partners in Mozambique. The program will also partner with

WFP to support the nutritional needs of the most vulnerable PMTCT clients through provision of short-term

emergency food support. Please refer to the activity sheet for WFP for funding levels and targets.

The program will continue to foster linkages with the Child at Risk Consult (CCR) as well as treatment

services. The referral system between PMTCT, treatment services, and the CCR will be the first line of

approach, which has broad Governmental support. However, the program will also explore manners to

reinforce testing and treatment linkages with vaccination campaigns, well baby visits, and weighing stations.

Using COP 07 plus up funds, PSI will map existing PEPFAR and non-PEPFAR partner interventions in

PMTCT and overlay this map with mosquito net distribution data from the President's Malaria Initiative (PMI)

and other donors and partners (Malaria Consortium, Government of Japan, the Global Fund, etc). The

assessment will be a gaps analysis of where present activities under PEPFAR, PMI, and other partners are

taking place and where, geographically and programmatically speaking, more concerted and coordinated

action is needed by the consortia of actors. PEPFAR and PMI will leverage each others' resources with

PMI providing the vast amount of LLINs for distribution to pregnant and lactating mothers. However,

PEPFAR, through PSI, will provide a buffer stock of LLIN for PMTCT partners to ensure that all pregnant

women receive a mosquito net. Finally, PMTCT partners will be crucial partners to PMI for the routine

integration of at least two doses (of the recommended three) of SP.

The below narrative from FY2007 has not been updated.

Plus-up change: Utilizing plus up funds PSI will research, develop, and test new IEC and BCC campaign

materials surrounding PMTCT, male involvement in PMTCT, and male testing, emphasizing a family-

centered approach. PSI will also be responsible for creating and reproducing these new campaign

materials for nationwide distribution. Further, PSI will adjust their current PMTCT materials to reflect new

PMTCT policy guidance and reproduce these materials in Portuguese and two other national languages.

the IEC/BCC campaigns are costed at $700,000. This campaign should also be reproduced for nationwide

distribution. Finally, PSI will map existing PEPFAR and non-PEPFAR PMTCT interventions and overlay this

map with mosquito net distribution data from the President's Malaria Initiative (PMI) and other donors and

partners. This assessment will be a gaps analysis of where PEPFAR, PMI, and other partners are

complimentary and where, geographically speaking, more action is needed by the consortia of actors

($150,000).

This activity is related to other PSI activities in C&OP 9150 and CT 9114. PSI will continue to provide

technical support to MOH sites to scale up PMTCT activities in 3 provinces and Maputo City. PSI will deliver

a complete package of PMTCT services in line with MOH policies and protocols, including routine CT,

provision of Nevirapine to seropositive mothers and their newborns, and provision of integrated postnatal

services. PSI will renovate facilities, train counselors, and track seropositive mothers and their infants for 18

months postnatal. Additional focus will be placed on improving the delivery environment to increase the

number of institutional deliveries, and thus the number of seropositive mothers receiving nevirapine. Each

site will counsel and test at least 90% of first-time antenatal attendees. PSI will continue to support the 19

PMTCT sites initiated with USG funding between 2003 and 2006, and will add 3 additional sites through

training of nurses and counselors and in collaboration with the MOH. PSI will continue to implement

community-level activities to reduce fear and social stigma among seropositive pregnant women and

mothers, focusing on key decision-makers in their lives (e.g., husbands, mothers-in-law). Seropositive

pregnant women will be referred to the nearest HIV/AIDS care and treatment site for additional needed

services prior to delivery. PSI will continue to disseminate a package of PMTCT communications materials

developed with, and implemented through, the MOH and all PMTCT implementing partners, and in

coordination with the Johns Hopkins CCP USAID/PMTCT/9162 communication activity. Additionally, the

MOH has set ambitious targets for provision of bednets and IPT for ANC, and PMTCT will benefit from this

program. However, it will take some time for the malaria initiative to get up and running, and for bednets

and IPT to flow to all parts of the country. PSI should plan for a 3-6 month supply of bednets and IPT to

assure that the minimum package of PMTCT includes these malaria interventions.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $550,000

Reprogramming August08: Funding increase $150,000. Reprogrammed funds are part of a mass media

campaign aimed at uniformed services and addressing risks of multiple concurrent partnerships.

This is a continuing activity under COP08.

In addition to the work with military recruits, PSI will expand the media materials available for support of

uniformed services, including translation into Portuguese of existing movies that demonstrate various

HIV/AIDS related issues such as fidelity, risky behaviors, STIs, etc. One example of such movies is the

"Remember Eliphas" 1 & 2 from PSI Namibia. PSI will also locally produce video stories based on the same

issues as above, emphasizing Mozambican cultural specifics and having relevant aspects for the military.

We propose selection of military actors/actresses.

The FY2007 reprogramming narrative below has not been changed.

This activity is the AB component of an ABC behavior change communications activities for uniformed

services.

We know from experience that AIDS is more than a health issue: it is now a global security concern. In

countries like Mozambique, AIDS epidemic proportions, it is devastating whole regions, knock decades off

national development and destroying what constitutes a nation: the communities, the economy, the political

institutions, and even the military and police forces. In many countries the pandemic has affected uniformed

personnel far more than civilian populations.

Every year around 4,000 recruits aged 18-25 are drafted into the Mozambican armed forces for a 2 years

mandatory period of service. The majority of recruits are from rural areas where education about

HIV/AIDS/STI prevention is almost entirely absent. Inadequate information received in high schools, prior to

military service, also explains recruits' poor knowledge of HIV/AIDS/STI and their risky behavior patterns.

Uniformed services, including defense and civil defense forces, are highly vulnerable to sexually transmitted

infections (STIs), mainly because of their work environment, mobility, age and other facilitating factors that

expose them to higher risk of HIV/AIDS infection. It is also known that there is a correlation between low

education, low information and HIV. Those who have more access to information are better protected.

Providing information alone is not enough. There is a need to change attitudes and, the young recruits will

be the agents of this change since they are particularly important in view of their potential role as future

leaders and decision-makers, and as peacekeepers in their own countries and elsewhere. Young soldiers

are also often seen as role models among their peers, and could serve as agents for change not only within

the military/police forces but also in their communities. The behavior of young recruits and the services and

information they receive determine the quality of life of millions of people. Therefore, the military young

recruits will be targeted with mostly AB messages, during the 3 months training period in the two training

centers (Manhiça - Maputo and Montepuez - Cabo Delgado) and when assigned to definitive posts at

various military bases. A specific program will be implemented in the Police Academy (ACIPOL) targeting

the students with messages about Abstinence, Faithfulness during the training period.

During the course of military service soldiers may increasingly be exposed to alcohol and drugs, and

become involved in various forms of risky behavior, such as sex with casual partners, injecting drugs and

alcohol use. This is particularly the case in regions where drug and alcohol consumption are high: industrial

centers, seaports, cities, places with high levels of unemployment, etc. Therefore the activity implementing

partner will also reinforce peer education, BCC, IEC, in # police squadrons along the country and in all

military bases especially the sites targeted during the prevalence and behavioral study. This activity will

include theatre presentations, production & distribution of informative material (pamphlets, booklets,

stickers, etc).

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $4,800,000

Reprogramming August08: Funding decrease $200,000. These funds have been re-programmed to fund

new PPP and RFA activities. They will provide mass media, interpersonal communication and IEC for

health/HIV behavior and social change activities.

This is a continuing activity under COP08.

With an increase of approximately $600,000 over COP07, PSI will expand activities with MARP such as

sexworkers, mobile populations and men in the workplace. The emphasis will be on integration and linking

with services, including counseling and testing, treatment, and clinical services for STI and special

populations. PSI will expand programs in the workplace. The military and police component of this activity

will continue, with the following allocation of funding: $600,000 for military programs; $150,000 for police;

$100,000 for the radio DJ program; and $35,000 for supplementary peer education materials.

The FY2007 narrative below has not been changed.

This activity is linked to PSI activities in CT 9114 and PMTCT 9141. PSI will continue to provide logistics

and technical support for condom social marketing (CSM) targeting most-at-risk groups, within the context

of a number of behavior change communication (BCC) activities targeting youth and adults of reproductive

age in all 11 provinces of Mozambique (including Maputo city). This program is a key element of the

comprehensive BCC program in Mozambique, that includes abstinence, delayed sexual activity for youth,

partner reduction among adults, and promotion of faithfulness. Prevention activities using CSM are closely

linked to PSI's work in PMTCT, CT, and promotion of timely clinical treatment of STIs. The program ensures

wide availability of condoms through large and small commercial outlets and non-traditional outlets,

interpersonal communications for risk reduction, mass media messages, and design, production, and

distribution of print materials for health workers and targeted high-risk populations. PSI will maintain CSM

distribution while increasing coverage in outlets frequented by most-at-risk groups. BCC messages on radio

will encourage sexually active adults to remain faithful to one partner and otherwise to make consistent use

of condoms. Young couples and sexually active youth are encouraged to prevent both unwanted

pregnancies and transmission of STIs, including HIV, through condom use. PSI will continue to implement

program monitoring and assessment activities to ensure that target audiences are responding appropriately

to the BCC and CSM campaigns and reducing the number of high-risk sexual encounters. Channels of

communication include TV and radio broadcasts and print media, selected in different provinces to match

the demographic characteristics of urban and rural populations. Interactive peer education techniques are

used with special target groups including pregnant women, mobile youth, and uniformed services

personnel. PSI has developed several professional teams of local actors who use folk media including

drama and audience participation to achieve behavior change. PSI will continue to implement and expand a

specially targeted BCC strategy utilizing peer educators selected from among young police recruits. These

recruits become mentors and positive role models to male youth in towns and urban areas. In FY07, these

activities will be expanded to three new provinces, chosen in collaboration with the Ministry of the Interior.

The objective of this component is to emphasize the value of male peer support in today's high-risk

environments and to empower young males to help mentor and nurture other male youth to reduce their

risky behavior. Special IEC materials targeting young police will be adapted from similar materials already

developed for the military program. PSI also will support the Ministry of the Interior to develop an HIV

prevention strategy to guide the work with police officers over the next 5 years. In 2007, PSI will intensify an

existing USG-supported BCC program among the military that was initiated in 2004 with DoD funding and

continued with Emergency Plan funding in FY05. Activities include interpersonal peer education and

establishment of HIV/AIDS information resource centers. PSI will work on increasing the Mozambican

military's capacity in continuing peer educator programs, as well as strengthening revising an STI

management program. PSI will continue workplace BCC programming that seeks to provide holistic ABC

programming with linkages and referrals for care and treatment.

Funding for Care: Adult Care and Support (HBHC): $180,000

This is a new activity in COP08.

The military and their families are an important population to reach both in terms of universal coverage of

long life insecticide treated nets (LLIN) and prevention of co-infection with HIV and malaria. PEPFAR

Mozambique will target malaria prevention and reduction of co-infection at military bases identified as both

high prevalence for HIV and for malaria. Data will be used from the Mozambique Armed Forces and

Defense (FADM) HIV prevalence survey and from malaria statistics collected by the FADM in their health

surveillance system. Distribution of the LLIN will be included as a component of the ongoing PEPFAR

program with the military which includes prevention of sexual transmission of HIV, counseling and testing,

treatment and prevention with positives. Behavior change communication activities will add a unit on co-

infection of HIV and malaria, and IEC materials will be developed for all program components related to

malaria and HIV. LLIN will be provided based on participation in any component of the HIV programs rather

than on serostatus. Since military personnel have common sleeping quarters, distribution based on

serostatus alond could lead to stigma. The details of what participation is required in order to be given a

bednet will be worked out in implementation. Although the military is not currently included in the

Mozambique PMI program, discussions between PMI and PEPFAR are ongoing to determine the best way

to reach this population along with their families.

Funding for Care: Orphans and Vulnerable Children (HKID): $925,000

This is a continuing activity under COP08. The program will continue working with USG OVC partners to

distribute 45,000 LLIN to OVC and provide 90,000 OVC with Safe Water Systems (SWS - "Certeza" for 12

months). Targets have not been attributed directly to this program as the distribution is done through other

USG OVC partners and counted as one of the six essential services that OVC receive.

PSI will also provide plumpy nut in a pilot program that will reach 1,500 OVC, who have been clinically

assessed as being malnourished. The partners working with the OVC will address the food insecurity of the

household/OVC by linking the former with food assistance support from WFP, Title II programs etc.

The increased funding and targeted number of OVC being reached under this activity reflects the increase

in targeted numbers of OVC receiving services under PEPFAR funding and the anticipated expansion of

existing USG partners working with OVC.

The FY2007 narrative below has not been updated.

This activity relates to another PSI activity in HIV treatment services, HTXS 9166.

This activity duplicates other activities because water and nets will be provided to currents clients of OVC

and ART services. Therefore, no separate targets are provided.

This activity contains two components: Safe Water Systems (SWS) and Insecticide Treated Nets (ITN).

In FY06, PSI is implementing a successful program to make household-level Safe Water Systems (SWS)

available to 2,208 OVC and their caregivers and 5,000 PLWHA (at $.25 per bottle x 12 bottles per year)

(under the treatment activity). This program will continue in FY07 reaching 4,000 OVC and their caregivers

and 85,000 PLWHA on ART. The SWS consist of small bottle of solution to purify water for a one month

period for a family. The program will reach OVC and PLWHA on treatment and provide them with SWS

through linking in to the HIV/AIDS care and support services available in both clinic and community settings

under the integrated networks (e.g. home-based care, OVC services, PMTCT, ART).

Using PSI traditional social marketing techniques, this activity will scale up marketing and distribution

activities in the six target provinces. As distribution is pushed out through wholesalers and smaller retail

outlets, a series of radio, billboard and other mass media campaigns to increase awareness of this new

product will be launched. This product will be available for anyone to buy on a regular basis.

Simultaneously, the USG NGO partners working in OVC and treatment services specifically aimed at

treatment adherence will be provided with a one-day training. They will learn the essential facts about

diarrheal disease and transmission, its links to HIV/AIDS, the importance of prevention and treatment of

diarrhea, and correct use of the SWS. The social marketing and availability of the product will minimize

stigma and discrimination of those that receive the product free.

The second component will target the distribution of 27,000 ITN's to OVCs under five years of age and their

caregivers in PEPFAR target provinces in addition to 85,000 PLWHA registered at Day Hospitals (at $8 per

net). PSI will implement the program by making the nets available to USG NGO partners implementing

OVC and treatment adherence activities outside of the PMI geographical areas. PSI will provide training in

usage of the nets and in the importance of protecting oneself against malaria. This includes consistent use

of nets, cleaning up around the household and removing all stagnant water from surrounding areas.

The Ministry of Women and Social Action (MAS) supports the use of nets for all children because of their

effectiveness to help ward off the threat of malaria which can be detrimental to children, particularly those

under five years of age. Because of their importance in deterring malaria, MMAS included ITNs as a

requisite item in their OVC costing exercise and encourages NGOs, CBOs, PVOs to assist in the provision

and distribution of nets. This activity will support a mere portion (27,000) of ITNs needed.

Funding for Testing: HIV Testing and Counseling (HVCT): $2,159,954

This is a continuing activity under COP08.

PSI will expand its cousenling and testing sites located in the community and in the workplace and will

include the Counseling for Health Approach. Further, PSI will be chiefly responsible for promoting testing

among a wide variety of demographic groups (youth, men, pregnant women, MAARPS) in a variety of

different languages and in a multitude of forums including radio, billboards, pamphlets, stickers, and

possibly a multi-media event and/or series.

The activity narrative below from FY2007 has not been updated.

Plus-up: Utilizing plus up funds PSI will research, develop, and test new IEC campaign materials

surrounding the new testing and counselling for health strategy (ATS). The materials will also target the

new opt-out and integrated counselling and testing strategy, which is expected to positively enhance scale-

up opportunities. The strategy and approach is currently in the first phase of implementation so materials

will be reproduced on a limited basis to cover those areas where ATS is currently underway.

Original COP: This activity is related to C&OP 9150 and MTCT 9141.

PSI will continue to provide technical support to 27 existing CT sites in MOH health facilities, and will scale

up CT services in approximately 35 satellite sites. Both provider-initiated and client-initiated CT will be

implemented, as MOH staff receive planned training in provider-initiated CT. Satellite expansion will take

place primarily in the populous and high-prevalence Zambezia province. PSI will follow and support the

MOH's new policy, and work with the local health departments to implement a community CT program. PSI

will train counselors, rehabilitate facilities, and deliver a complete package of CT services in line with MOH

policies and protocols. PSI will work to reduce social stigma that affects PLWHA, and will train counselors

and make minor structural adjustments to accommodate "satellite" counseling in rural health facilities.

Through theatrical performances and radio spots, adults including uniformed services personnel and older

youth will be mobilized to take advantage of HIV CT. PSI also will continue to collaborate with the Ministry of

Defense to build capacity for providing CT (as well as other HIV/AIDS services) at military health facilities.

PSI will continue to provide CT services to military personnel at 7 sites established with FY06 funding, in

Maputo, Tete, Sofala, and Manica, Zambezia, Niassa, and Nampula provinces. With FY07 resources, two

new military CT sites will be established, in Cabo Delgado province and one to be determined with the

Ministries of Health and Defense. CT training will be carried out for military nurse-counselors. All military

health facilities also provide services to families of the troops and to civilians in nearby communities, so the

CT services at military sites reach a larger target population than the troops themselves. PSI will also

working with the Ministry of Defense to expand the satellite CT program to approximately two sites out of

each military hospital with a PSI-supported fixed site.

Through these efforts a total of 72 CT outlets will be established, 110,000 people will receive CT and 90

people will be trained.

Funding for Treatment: Adult Treatment (HTXS): $1,309,500

This is a continuing activity under COP08.

PSI will continue to provide treatment partners with approximately 70,000 LLIN for new enrollees as well as

provide Safe Water Systems (SWS - "Certeza") to 100% of those on ART. The USG will now channel all

products through treatment partners to ensure more focused targeting of people on ART as well as

providing a reasonable incentive for people to return to the clinic, thus decreasing loss to follow up. PSI's

new activity centers around the provision of Plumpy Nut to those patients with a BMI of less than 16, which

has been looked upon favorably by the Ministry of Health. Plumpy Nut is a short to medium term solution

until longer term solutions can be implemented in Mozambique, such as implementing FANTA's

recommendations. It is anticipated that approximately 6,000 ART clients will receive plumply nut under

COP08.

The below narrative from FY2007 has not been updated.

This activity relates to HKID 9149 and all HKID and HBHC activities. This activity duplicates other activities

because water and nets will be provided to currents clients of OVC and ART services. Therefore, no

separate targets are provided.

PSI will continue to implement a program to make household-level Safe Water Systems (SWS) available to

4,000 OVC and their caregivers and 39,500 PLWHA on ART (at $.25 per bottle x 12 bottles per year). The

SWS consist of small bottle of solution to purify water for a one month period for a family. The program will

reach OVC and PLWHA on treatment and provide them with SWS through linking in to the HIV/AIDS care

and support services available in both clinic and community settings under the integrated networks (e.g.

home-based care, OVC services, PMTCT, ART).

Using traditional social marketing techniques, this activity will scale up marketing and distribution activities

in the six target provinces. As distribution is pushed out through wholesalers and smaller retail outlets, a

series of radio, billboard and other mass media campaigns to increase awareness of this new product will

be launched.

Simultaneously, the USG NGO partners working in OVC and Treatment services specifically aimed at

treatment adherence will be provided with a one-day training in which they will learn the essential facts

about diarrheal disease and transmission, its links to HIV/AIDS, the importance of prevention and treatment

of diarrhea, and correct use of the SWS.

The activity will also target the distribution of 27,000 ITN's to OVCs under five years of age and their

caregivers in PEPFAR target Provinces in addition to 85,000 PLWHA registered at Day Hospitals (at $8 per

net). The Ministry of Women and Social Action included ITNs in their costing exercise when determining

the average cost per client for caring for OVC and encourages NGOs, CBOs, PVOs to assist in the

provision and distribution of nets. The ITNs help ward off the threat of malaria which can be detrimental to

children, particularly those under five years of age. PSI will implement the program to make the nets

available to USG NGO partners implementing OVC and treatment adherence activities at the same time

providing training in usage and importance of protecting oneself against malaria which includes using nets,

cleaning up around the household and removing all stagnant water from surrounding areas.

Cross Cutting Budget Categories and Known Amounts Total: $900,000
Food and Nutrition: Commodities $250,000
Food and Nutrition: Commodities $150,000
Food and Nutrition: Commodities $500,000