This is a continuing activity under COP08. No additional funding was added to this activity and targets

remain the same as in FY2007.

WV 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 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 below narrative from FY2007 has not been updated.

This activity is related to other World Vision activities CT 9157, HBHC 9126 and HKID 9155. WV proposed

4 sites in FY06, but was unable to secure MOH approval for the 4th site, so stayed with 3 PMTCT sites.

WV will continue to provide training and technical support to 3 existing PMTCT sites in rural Zambezia

province, and will increase program coverage to at least 85% of all first-time antenatal attendees in line with

policies and protocols of the MOH. A comprehensive package of integrated PMTCT services, including

routine CT, Nevirapine for seropositive mothers and their exposed newborns, couple counseling, family

planning, and infant feeding education, will be provided. Seropositive mothers will be referred to mother-to-

mother support groups in communities for continuing support and care. All seropositive pregnant women will

be referred to the HIV/AIDS care and treatment services site in Mocuba (or eventually the planned new site

in Gurue) for appropriate care and treatment. WVI will continue to involve churches and community

members in the fight against fear and social stigma which affect seropositive pregnant women and their

children. Back-up supplies of gloves, ITN and IPT, and test kits will be procured. In the communities served

by these PMTCT service sites, WVI also will work with other USG partners to carry out PMTCT primary

prevention campaigns among youth, young people planning to marry, and adult men and women.

Reprogramming August08: Decreased funding by $100,000.

FY08 funding allows for year three of MozARK, a continuing activity under COP08, and the following new

activity.

Community radio programs aimed at Couples: This activity will receive additional funds to create and

broadcast community radio programs aimed at Mozambican couples aged 15-49. Issues to be addressed

can include: multiple, concurrent partnerships, discordance, HIV testing and couples counseling and testing,

disclosure related domestic violence, family planning and condom use, couples communication,

faithfulness, widow cleansing, gender related issues, and positive living. This activity is linked to ABc.

The FY2007 reprogramming narrative below has not been changed.

This funding will support the second year of implementation for World Vision's Mozambique Abstinence and

Risk Avoidance (MozARK) community based AB program in Zambezia, a priority province, and Tete

province. WV MozARK was the successul awardee for the Mission's FY06 AB RFA for ‘Promoting

Abstinence, Faithfulness and Healthy Community Norms and Behaviors'.

This AB activity addresses the gap between knowledge and behavioral practice and aims to increase risk

perception among all members of the community. Youth Groups, Parent Groups and District level

leadership groups will continue to implement AB prevention activities through WV's existing Community

Care Coalitions (CCCs). Youth, especially older youth, single or married, age 15-24, are the primary target

of this program and will receive life skills and an age appropriate HIV education. For older and at risk youth,

this activity will be complemented with MozARK's C&OP funded activities.

This activity aims to involve all members of the community to create local responses to the epidemic by

reducing overall risk. Attention will be placed on youth in the 10-14 year old range, known as the Window of

Hope, and more so on the 15-24 year old age group, in which the majority of new infections occur in

Mozambique. Programs for adults will expand from focusing on adult's roles as protectors of youth to

addressing adult behaviors that increase adult risk (multiple, concurrent partners) and adult behaviors that

increase youth risk (transactional or cross generational sex). WV will continue to build on its existing

networks and other health and HIV related programs in Zambezia and Tete provinces to rapidly scale up life

skills and values-based, gender-sensitive, age-appropriate HIV education programs, and thereby create

lasting impact.

The main emphasis area is in Community Mobilization/Participation. Key legislative issues addressed are

Gender (Male norms and behavior, reducing violence and coercion and increasing gender equity in HIV

programs) and Stigma. This program will weave gender into all programs by raising awareness of the socio

-economic and cultural inequalities faced by women and how these inequalities contribute to the spread of

HIV. Girls and women will gain skills in building negotiating power in relationships and boys and men will

discuss the roles they play in sexual relationships. Stigma will be addressed by creating a greater

recognition of stigma, targeting lessons on the youth/community's definition of stigma and identifying ways

to address it. PLWHA will also be involved in all activities, including positions of program leadership and

facilitation. "B" activities among PLWHA will help address discordant couples and will encourage testing.

This year's funding will also allow for special responsive action in Mopeia district of Zambezia, site of the

Zambezi Bridge Construction project. The town of Chimuara, in Mopeia district, is the site for the new

Zambezi Bridge construction project, estimated for completion in 2009. The bridge will link Caia, Sofala

with Mopeia, Zambezia. Projected studies from Save the Children UK warn of threats of increased child

prostitution, rape and other sexual abuse linked to the influx of mobile workers in rural, impoverished

districts. "Barracas", the informal and privately managed businesses of sleeping quarters, stores and bars

along the river and near the construction, has helped to create a "culture of sexual abuse and exploitation in

the form of child prostitution, as well as wide spreak child labor and This AB activity addresses the gap

between knowledge and behavioral practice and aims to increase risk perception among all members of the

community.

This is a continuing activity under COP08. FY08 funding allows for Year Three of MozARK's activities and

sub-granting to one new sub-partner, Association of Trainers and Consultants of Zambezia (AFORZA).

AFORZA will support MozARK by facilitating C&OP "correct and consistent condom use" training for

Government officials, FBOs, Community Care Coalitions, older youth, and couples. This activity is

complemented with MozARK's AB component.

The FY2007 reprogramming narrative below has not been updated.

MozARK will receive C&OP funding to complement its AB activities, providing a comprehensive ABC

approach to prevention for identified older, at risk youth as well as for adults. While MozARK will not

provide condom service outlets, it will strategically program these funds to have a large impact in the most

at-risk groups and maximize results by integrating with AB activities. This funding will specifically be used in

transport corridor districts, for example, Mopeia district, site of the Zambezi bridge construction where there

are populations of truck drivers and sex workers, and focus on addressing individual risk perception as well

as community norms around the acceptability of multiple concurrent partners, male sexual norms and

behaviors and condom usage.

Reprogramming August08: Funding increase $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, 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.

This activity is related to MTCT 9143, HKID 9155, HTXS 9168 and HVCT 9157.

World Vision implements their palliative care program in close collaboration with their OVC program. The

Community Care Coalitions (CCC) and their selected caregivers called Home Visitors (HV) as well as the

Home Based Care Activists (HBCAs) will continue to work to identify chronically ill persons in their

respective communities and provide palliative care through home-based care (HBC). This work will be

conducted in close coordination with district and provincial offices of the Ministry of Health (MOH).

Caregivers will be charged with making home visits to these ill people (PLWHA stages 1&2 - as defined by

the World Health Organization), providing them with material, psychosocial and spiritual support, and

appropriate nutritional advice and emotional counseling. HBCA will work with the CCCs to help arrange, as

needed, higher levels of palliative care for those clients (PLWHA stages 3&4) who are clearly suffering from

ailments caused by AIDS, including treatment of OI, pain management, referrals to ART, malaria

prevention, etc. In each district a HBC Nurse Supervisor will oversee the HBCAs and provide direct support

to the clients when needed. When possible, legal services to help dying patients prepare wills and burial

arrangements will be arranged by the HV These activities are being carried out by the HVs as part of their

routine work with PLWHA and OVC which also includes protecting the rights of children and promoting the

creation of a memory book as a coping mechanism for the client and family members. The project will

provide psychosocial support for the bereaved family.

Overall, World Vision will be seeking to improve the quality and scope of PLWHA palliative care. One

element in providing for PLWHA support is the sustainability of the community-based organizations (CBOs)

leading the effort. Key to World Vision's sustainability strategy is ensuring that the FBOs, CBOs/CCCs and

their member have the capacity to carry out their important PLWHA care and support activities in the long

term. To this end, World Vision has developed an Organizational Capacity Building (OCB) Guide focused

on strengthening the general organizational capacities (as opposed to solely HIV/AIDS-specific technical

skills) of CBOs/CCCs. The iterative three stage OCB process begins with organizational self-assessment,

followed by selected training based on the results of the assessment, and supplemented with additional

follow-up support. World Vision will apply this new strategy to strengthen 2 local organizations and 40

CCCs.

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.

Through this activity, 5,020 PLWHA will receive HIV-related palliative care and 502 per will be trained to

deliver HIV-related palliative care.

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 continuing activity from COP08.

RITA has focused on increasing the understanding of the continuum of OVC care and support needed and

equipping CCCs/HVs to respond effectively. RITA will continue to provide care and support to OVC

identified in the previous phases, focusing on providing a comprehensive and quality package of services

for OVC and their families. The project plans to reach 43,580 OVC during this 12-month phase with seven

services including: 1) food and nutritional support; 2) shelter and care; 3) protection and legal rights; 4)

health care; 5) psychosocial support; 6) education and vocational training; and 7) economic

opportunity/strengthening. Efforts will be made to expand activities into Tete Province in order to coordinate

efforts with the WV ABY PEPFAR program.

CCCs will continue to be the primary mechanism for providing care and support to OVC, PLWHA and

vulnerable households, as well as for referring people for counseling and testing (CT), PMTCT, ART, and

TBT, where available. The training of all CCCs is ongoing and continuous, and designed to ensure that

CCCs have the capacity needed to be effective as well as the organizational maturity required to function

over the long-term. Training topics have included: impact of HIV and AIDS on the community and families,

needs of OVC, children's rights, building community capacity for OVC support, issues of psychosocial

support, including the impact of HIV and AIDS on children, loss and grief, need of will and memory book,

child abuse and exploitation, counseling for children at different developmental stages, building resilience in

children, and a model of providing psychosocial care. During this fourth phase of RITA, 101 CCCs will

receive additional training for IGA and business management to become more functionally independent and

able to access external funding, thereby, enabling them to continue their activities beyond the life of the

RITA project. Of the 101 CCCs trained, 40 will be trained by the local partner AFORZA, 34 CCC by RITA

Project staff and 27 CCC by a new partner International Relief & Development (IRD).

RITA will take into account contextual factors such as poverty, food insecurity and livelihood insecurity as it

attempts to reduce the vulnerability of households most affected by HIV and AIDS. For the most vulnerable

OVC and PLWHA and their families, emergency food support will be distributed through PEPFAR-

supported World Food Program (WFP) activities to meet immediate food needs. In the event that WFP will

not operate as envisaged, interventions will be implemented jointly with WV agriculture/livestock projects

and other available resources to improve long-term food security. RITA will also work to ensure that

linkages with other existing food-security and micro-finance projects are enhanced. RITA will link those in

need with the Ministry of Women and Social Action whose mandate it is to assist with food among other

support.

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

effort to improve the health of targeted children and family memebers. WV 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.

The Ambassadors Girls Scholarship Program, managed by WV/Rita's sub-partner ADPP, provides tuition

assistance and mentors 2,300 primary school-aged girl OVC supported by PEPFAR in Sofala province.

The below narrative from FY2007 has not been updated

This activity is related to: MTCT 9143; HBHC 9126; HTXS 9168 and HVCT 9157.

World Vision (WV) and sub-partner Aid for Development People to People (ADPP) will continue USG-

supported OVC programs in 13 targeted districts in the Province of Zambezia and 3 targeted districts in

Sofala Province, building on services started in 2004, expanded in 2005 and 2006. Based on this past

experience of providing assistance to over 38,621 OVC, WV will continue to identify and document

promising practices in OVC programming in Zambezia and Sofala Provinces. WV will continue to focus on

OVC affected by HIV/AIDS within the age brackets of 0-5, 6-12 and 13-18 years of age. As all WV projects,

clients will be chosen on the basis of need without regard to religion or ethnic grouping.

World Vision's "RITA" Project will continue to provide care and support to improve the lives of OVC through

the provision of a comprehensive package of six quality services. RITA will also continue to strengthen the

leadership role of communities through the Community Care Coalitions (CCCs) who will continue to be the

primary mechanism for providing care and support to OVC, PLWHA and vulnerable households, as well as

for referrals to essential services available in the community and clinical setting.

Through the CCCs and other local organizations, RITA (WV and ADPP), will ensure the provision of the six

essential services for OVC, as defined by the USG PEPFAR team in Mozambique and the Ministry of

Women and Social Action (MMAS). WV will continue to work closely with the Ministry of Health to provide

preventative and clinical care for infants and older children, especially HIV-infected children and with the

Ministry of Education to ensure that OVC are attending and advancing in school.

For the most vulnerable OVC and PLWHA and their families, emergency food support will be distributed to

ensure food security in the short term. At the same time, interventions will be implemented jointly with WV

agriculture/livestock projects and other available resources to move ahead to food self-sufficiency. RITA

will continue working to ensure that linkages with existing food-security and micro-finance projects are

enhanced. WV will coordinate and collaborate with other NGOs, such us Project Hope, so that CCCs,

networks and organizations whose institutional capacity WV will strengthen will have access to small grants

to better enable them to carry out and expand community-based activities. Additional training will be given

to community-based volunteers (Home Visitors - HV), and WV supervisors and volunteers will work closely

with the MOH personnel to ensure that adequate care is provided to infants and young children who are

part of this program. Also, an added emphasis will be placed on joining with new projects and organizations

to advocate for the needs of OVC and to further build their capacity. The training of all CCCs will be ongoing

and continuous, and designed to ensure that CCCs have the capacity needed to be effective as well as the

organizational maturity required to function over the long-term.

WV will continue to assess the quality of services provided to OVC. In FY06, they have developed

standards that fit with community normative levels. Their assessment tools will now measure if OVC under

Activity Narrative: care are receiving services up to the standard set by the community. They will continue to adopt tools and

methodology to determine how OVC benefit from services provided over the years.

One element in providing for OVC/PLWHA support is the sustainability of the community-based

organizations (CBOs) leading the effort. Key to RITA's sustainability strategy is ensuring that the

FBOs/CBOs/CCCs and their members have the capacity to carry out their important OVC/PLWHA care and

support activities in the long term. To this end, WV has developed an Organizational Capacity Building

(OCB) Guide focused on strengthening the general organizational capacities (as opposed to HIV/AIDS-

specific technical skills) of CBOs/CCCs. The iterative three stage OCB process begins with organizational

self-assessment, followed by selected training based on the results of the assessment, and supplemented

with additional follow-up support. In COP07, WV will apply this new strategy to strengthen 2 local

organizations and 40 CCCs.

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).

COP07 targets include reaching 43,580 OVC with all 6 services and training 2,900 care providers to

oversee the OVC activities in the community and report results to their supervisors.

This is a continuing activity under COP08. The targets and funding levels remain the same as in FY2007.

The activity narrative below from FY2007 has not been updated.

In this activity, WV will continue to support 4 CT sites in Zambezia province (in Mocuba, Namacurra,

Quelimane and Gile) and their 8 Satellites sites (2 per fixed service site) offering counseling and testing

to19,584 people by 12 trained counselors in Zambezia Province. WV will provide supervision and additional

training to strengthen the quality of counseling and to promote couple and family counseling and testing.

This activity is linked with the development of the HIV care and treatment integrated network, including

essential and effective two way referral systems. WV will continue to involve churches, other local partners

and community members in the fight against fear and social stigma related to HIV/AIDS as part of the

outreach and promotion related to CT services.

A second activity builds on a pilot authorized by the Ministry of Health in July 2006 for the implementation of

community-based counseling and testing. World Vision in cooperation with sub-partner, ADPP in Sofala,

will implement community based counseling and testing in Sofala and Maputo provinces expanding upon

lessons learned from the MOH approved community-based counseling pilot phase. In both provinces one

training for 25 counselors will be held and it is expected that 24,000 people will have access to CT services

(12,000 in Sofala and 12,000 in Maputo province) within COP07 implementation.