Reprogramming August08: Funding decrease $50,000. Reprogramming to support proposed PPP in

Gorongosa Park (activity to be implemented through WV sub ADPP.

This is a continuing activity under COP08 with the same targets and a slightly lower budget then in FY2007.

Under COP08 the program will create new, and utilize existing, community to clinic and clinic to community

referral systems to ensure that PLWHA are accessing treatment and other necessary services, particularly

food, to improve their health status. WFP, in conjunction with PEPFAR treatment partners including PSI,

will work to improve provision of food and nutrition to PLWHA registered at treatment sites based on clinical

and nutritional assessments. This model helps ensure that individuals are accessing health care and

receiving services along with food supplementation. The standard for determining malnutrition will be based

on adult non-preg/lact women patients with a BMI <18.5 at entry into the program. The food supplement

consists of short-term emergency food support. Please refer to the treatment activity sheet for WFP for

funding levels and targets.

The FY2007 narrative below has not been updated.

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

Activity Narrative: 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 is a replacement narrative highlighting changes to WR's activities in FY08 to ensure quality of services.

In FY08 World Relief (WR) will reach 20,707 OVC with the six essential services through activities of 3,400

church-based OVC home visitors (HV).

Church and community leaders will be motivated and sensitized for continued involvement and participation

in the facilitation or provision of OVC care and support services. These leaders will be informed of their role

in the promotion of OVC rights and the available community resources. These leaders will be sensitized,

motivated and encouraged to continue the advocacy and support for OVC. Efforts will be made to increase

the level of advocacy. The Ministry of Women and Social Action (MMAS) will be invited to facilitate debates

on child protection and rights issues, with community participation. WR will ensure that these community

leaders have materials on child rights and protection issues that can serve as reference.

In collaboration with WR's child survival program, MFC-Tshembeka project coordinators and supervisors

will be trained as trainers and will then train HV, religious and community leaders. HV will be provided with

basic HBC information enabling them to make immediate referrals for infected OVC.

OVC in churches and schools will receive structured ABY prevention messages via WR's Mobilizing for Life

program. These OVC will continue to benefit from the age appropriate WR Choose Life program, which

teaches basic life skills. To ensure that HV learning, practices, skills and knowledge remain fresh; WR

project staff will facilitate quarterly refresher trainings. HV monthly meetings will be a forum to share

information and experience from the field as well as address any issues.

In collaboration with HV, religious and community leaders will take the lead in facilitating access to the six

essential services for OVC. Through weekly home visits, HV will encourage OVC to stay in school, and

provide general counsel and oversight as needed. 500 OVC at the secondary school level are targeted to

receive educational support such as school uniforms, shoes, supplies and fees. HV will refer OVC issues to

the appropriate sector with the knowledge and support of the religious or community leader. These in turn

will follow up the case with the relevant government institutions (i.e. MMAS, Ministry of Health) and other

NGOs for the necessary action. OVC that are identified as HIV or TB positive will be referred to WR's home

based care program. Nurses will take on the clinical component of care in line with MOH guidelines. The

HBC volunteer will work the OVC HV to continue additional care and support activities.

In an effort to ensure that OVC are appropriately tracked for services being received, HV will be trained/re-

trained as necessary in record-keeping. HV reports will be submitted monthly, to allow for early detection of

potential gaps in information gathering.

WR will also target child-headed households and OVC between 16 and 17 years old with vocational training

that will help them sustain themselves as they grow into adulthood and beyond the target age for OVC

programs. Carpentry, masonry, bakery, and tailoring are some of the activities that will be taught.

WR will integrate Micro Enterprise Development (MED) activities to provide income-generating opportunities

for older OVC, PWLHA, caregivers and volunteers. In addition to directly benefiting OVC and their

caregivers. 707 people (50% of which will be volunteers) will benefit from MED activities. Including

volunteers in the target group for IGA will help WR address the issue of retention of volunteers, as many

discontinue volunteering due to financial pressures.

WR will continue its virgin coconut oil project in Inhambane funded in partnership with a Zion church partner

in the MFC-Tshembeka project. The activity will expand to include 400 community members who are OVC

caregivers and project volunteers, who will also benefit from HIV prevention messages.

In partnership with Fundo de Credito Comunitario (FCC), a local micro-credit firm, 107 volunteers and OVC

caregivers will receive small loans to expand existing, successful poultry raising projects. Based on lessons

learned in FY07, WR will turn over the business training, management and funding of this micro-credit

scheme to FCC ensuring quality of this activity and allowing WR to focus on program issues. FCC will also

provide loans (at a 2.5% interest rate) in Gaza, Maputo and Inhambane provinces for activities such as cell

phone recharge cards and vegetable sales.

To provide food security for OVC and their caregivers WR will establish community grain banks with

contributions of maize and beans from local farmers, which will later be distributed to OVC and PWLHA in

the community. An agricultural extentionist will be hired to support, supervise and monitor activities in the

field and will have recourse to WR agriculture department for technical assistance and support. The

incentive for community farmers to participate in this activity will be access to better quality seeds and the

opportunity to learn low-cost, efficient farming techniques.

In collaboration with PSI, WR will distribute LLIN and Safe Water Systems (SWS - "Certeza") to OVC in an

effort to improve the health status of targeted children and family members. WR will also partner with WFP

to support the nutritional needs of the most vulnerable OVC and their families through provision of short-

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