Reprogramming August08: Funding decrease $900,000. This funding was originally earmarked for FDC

mass media activities, a continuation of FY07 funding. The Mission met with FDC to understand the

reason for weak progress in their mass media activities through FY07 funds. FDC expressed that mass

media was not a strong technical area for them and that they wished to return to family-centered,

community-driven interpersonal communication activities for prevention. This re-programming will remove

mass media activity #2 MEN'S AND WOMEN'S CAMPAIGNS and will be re-programmed for mass

media/IEC/BCC/IPC between a local public-private-partnership (PPP) and an integrated USAID RFA (HIV,

health, rural livelihoods).

April08 Reporgramming Change: Reduced $100,000.

This is a continuing activity under COP08. The following is a replacement narrative.

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. These activities have an increased focus on adult women and men. Specific interventions to

address cross-generational sex as well as transactional sex will be developed. Alcohol abuse and gender

norms as they relate to HIV risk will be addressed. To address gender issues, FDC will engage civil society

and the government in discussions that challenge norms, attitudes, values, and behaviors that increase

vulnerability to HIV/AIDS of Mozambican women and men of all ages. Stereotypes and expectations on

manhood and womanhood will also be discussed by girls, boys, men and women.

There are five components:

1. 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

focus on out-of-school youth, parents and community leaders and include training of traditional leaders on

protective, community led alternatives to harmful initiation rituals; creating enabling environments for

delayed sexual debut and other AB behaviors; and continuation of a traveling information bus that provides

isolated, rural communities with access to information on HIV and protective AB behaviors, skills

development trainings for peer educators and adults, and facilitates fun and interactive sessions for all

community members.

3. 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. WINDOW OF HOPE PROGRAMS

This funding will continue FDC's programs for youth under 14. AB Messages will focus primarily on delay of

sexual debut and abstinence for in-school youth.

5. REDUCING VULNERABILITY OF OVC TO HIV

Through its work in providing basic home services to OVC, this activity will provide age appropriate

information on prevention, sexual reproductive health and legal rights for OVC.

Targets have been adjusted from COP07 based on FY06 performance and FY07 partner projections.

Reprogramming August08: Funding decrease $200,000. This funding was originally earmarked for FDC

mass media activities, a continuation of FY07 funding. The Mission met with FDC to understand the

reason for weak progress in their mass media activities through FY07 funds. FDC expressed that mass

media was not a strong technical area for them and that they wished to return to family-centered,

community-driven interpersonal communication activities for prevention. This re-programming will remove

mass media activity funds from FDC and will be re-programmed for mass media/IEC/BCC between a local

public-private-partnership (PPP) and an integrated USAID RFA (HIV, health, rural livelihoods).

As this affects mass media, targets for this program area will not change.

This is a continuing activity under COP08, with the following update.

Using its signature community development approach, FDC works with community leaders (traditional,

political, religious, and civil society) to find local solutions to the transmission of HIV. C&OP funding will

continue to support and expand "AloVida", a free hotline which Mozambicans can call to ask questions

relating to HIV/AIDS and sexual health. It is the only such service in the country. It should be noted that

cell phone coverage in Mozambique is quite good, so this approach reaches many at-risk individuals who

could not otherwise be identified or contacted.

C&OP links with FDC programs in home-based care and OVC to provide behavior change communication

and counseling activities to clients and families. PROMETRA, a traditional healers association, is an FDC

partner working to address prevention through behavior change for healers, appropriate treatment of their

clients and leadership in the local communities. Targets have been adjusted to reflect FY07 projections.

(FDC did not have C&OP funding in COP06).

The FY2007 narrative below has not been updated.

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.

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 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.

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

Activity Narrative: 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 under COP08. In FY08, $450,000 in additional funding has been allocated to

FDC to allow them to expand OVC activities, reaching an additional 4,000 OVC with at least three services.

FDC will target increased OVC activities in Inhambane and Gaza provinces where it is noted that existing

HBC activities do not have any linkage to OVC activities. The organization will continue to seek out the most

vulnerable OVC, with a special empahasis on those living with a single, bed-ridden parent or living with an

elderly person, in order to refer them to "Reference Families", neighbors accepting co-responsibility for

OVC. This community-based model of caring for OVC is able to take place as FDC and its Sub-partners,

which are local organizations with extensive cultural understandings of targeted communities, and have a

unique relationship with their communities.

A portion of the increased funding will allow FDC to replicate their income generation project in Maciene

which targets OVC and their caregivers. The current Maciene project in Gaza provides vocational training in

crafts production and basic business management enabling participants to produce high-quality crafts which

are sold at a profit, benefiting OVC and their caregivers. The model has proven successful and resulted in

exportation of goods to neighboring countries in Southern Africa. The model not only benefits the OVC and

their caregivers but provides community members with added income as the mostly organic materials are

purchased locally. $150,000 will be allocated to this activity.

FDC will no longer continue to provide technical assistants seconded to the central Ministry of Women and

Social Action under COP08. This activity will be funded through other donors and NGOs during FY08

allowing the USG to focus TA for MMAS at the provincial level.

The program will 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. In collaboration with PSI, FDC will distribute LLIN and Safe Water Systems

(SWS - "Certeza") to OVC in an effort to improve the health status of children and their families.

The below activity narrative from FY2007 has not been updated.

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)