PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
This activity, which is new in the PMTCT program area, represents initial steps for strengthening the
linkages between HIV and malaria prevention, diagnosis and treatment services. Experience from this
activity can be used to create the foundation for improved linkages between HIV and malaria components.
Objectives: A) Strengthen the linkages between HIV and malaria prevention, diagnosis and treatment
services; B) Improve coordination of PMTCT and malaria mitigation activities.
Main Activities will be: (1) Complete HIV and malaria health services assessment, including documentation
of current malaria and HIV prevention, diagnosis and treatment services conducted in PMTCT settings in
selected provinces, with additional focus on linkages between services; (2) Complete analysis of
assessment findings, develop and disseminate recommendations; (3) Develop updated service delivery
guidelines for malaria, HIV/AIDS, and reproductive health; (4) Based upon results of assessment, create
plan for next steps for development/adaptation and pilot test of materials and recommendations for
strengthening of linkages between malaria and HIV prevention, diagnosis and treatment services.
Randomized, controlled trials have now confirmed that male circumcision (MC) reduces the likelihood of
female to male HIV transmission by approximately 60%. MC is, however, only partially protective; men will
need to take other steps, such as abstinence, partner reduction and/or condom use, in order to protect
themselves and their partners against HIV infection.
While MC is a promising intervention that could potentially prevent millions of new HIV infections, it is
important to keep in mind that it is a surgical procedure; and as such, it has risks and benefits. Safe MC
services require well-trained healthcare providers, appropriate infection prevention and control practices,
and sufficient equipment and supplies. In addition to the surgical procedure, other essential elements of MC
services that must be taken into account include informed consent, post-operative care and risk reduction
counseling including the promotion of abstinence, partner reduction being faithful, and a minimum package
of other male reproductive health services, such as sexually transmitted infections (STI) treatment, condom
distribution, and HIV counseling and testing.
Since late 2006, JHPIEGO, a partner of the Forte Saúde Project (funded by USAID), has been working in
close partnership with USAID, CDC, WHO, UNAIDS, PSI, among others, to provide technical guidance to
the Ministry of Health (MOH) and the National AIDS Commission (NAC) to plan and prepare a situational
assessment to identify the MOH capacity for expanding safe MC services for prevention of HIV
transmission.
This proposed activity will build upon the current work and the results of the situational assessment, and
while a new activity under A&B, is linked to MC funding under C&OP and CT. The purpose is to provide
technical assistance to the MOH and NAC to develop and implement a comprehensive educational package
to promote other important HIV prevention strategies such as abstinence and be faithful (A&B).
Objectives of this activity will be to: (a) promote A&B as a key complementary strategy for MC for HIV
prevention; (b) develop and implement a comprehensive educational package to promote A&B; and (c) train
counselors on the new educational package for individual and group counseling.
Main activities will be to:
(a) Develop, field-test, and finalize a comprehensive educational package for individual and group
counseling for use consultation rooms, waiting rooms and at the community level.
(b) Train 50 counselors on MC and on how to use the educational package.
(c) Support and monitor the implementation of the activities at the selected sites (up to 6 sites) where an
expected 30,000 clients or individuals will be counseled in A&B as a complementary strategy for MC.
Since 2004, the MOH, with TA from JHPIEGO, has been implementing a Standards-Based Management
and Recognition approach (SBM-R) to improve IPC practices in hospitals. A comprehensive set of
performance standards were developed covering 9 direct services: sterilization, operating rooms, TB,
emergency departments, inpatient services (medical, surgical, and pediatric wards), dental department,
blood bank, clinical laboratories, and post-mortem care; and 5 support services: administration, health
education, kitchen, laundry and waste management. Using the standards, workers identify and correct
performance gaps, mobilizing resources for Infection Prevention and Control (IPC). The program expanded
from 6 hospitals in 2004 to 13 in 2005, to 23 in 2006, and to 33 (including the Military Hospital in Maputo) in
2007. Compliance with standards ranged from 12 to 45% at baseline and from 52 to 93% in the latest
internal assessments of 2007.
The purpose of activities proposed for 2008 is to continue the support to the MOH for the expansion to a
total of 43 hospitals, and institutionalization of the IPC efforts in health facilities throughout the country.
Key objectives of this activity are to (a) strengthen, expand, and institutionalize the IPC initiative in hospitals;
(b) create a simple surveillance system to measure the impact of the improved IPC practices; and (c)
decrease the risk of medical transmission of HIV/AIDS and of nosocomial TB.
Main activities are to assist the MOH IPC program to:
(a) Develop a system to estimate, order and control the IPC materials and supplies
(b) Conduct one Training of Trainers (TOT) in IPC for 20 new IPC trainers for the 10 new facilities
(c) Conduct three IPC training courses for 100 healthcare workers
(d) Conduct SBM-R training for 90 healthcare workers already involved in IPC activities
(e) Support and monitor IPC training activities in 43 hospitals
(f) Support recognition activities for high performing hospitals in IPC
(g) Develop a simple surveillance system to measure the impact of the improved IPC practices
This program area is comprised of two separate components: (a) Condom use as part of a Male
Circumcision (MC) intervention package, and (b) workplace safety and health including Post-Exposure
Prophylaxis (PEP) for occupational HIV exposures
Proposed funding amount for condom use as part of the MC intervention package: $180,000
In addition to the surgical procedure, other essential elements of MC services that must be taken into
account include informed consent, post-operative care and risk reduction counseling including the
promotion of abstinence, partner reduction being faithful, and a minimum package of other male
reproductive health services, such as sexually transmitted infections (STI) treatment, condom distribution
and use, and HIV counseling and testing. The promotion of condom use is particularly important to be
emphasized for men that are known to be at higher risk for HIV such as men with multiple partners, men
who have sex with men, military populations, truck drivers, miners, etc.
This component will build upon the current work and the results of the situational assessment. It is linked
with MC activities described under A&B, CT, OPSS, and SI parts of the COP08. The purpose is to provide
technical assistance to the MOH, NAC, and stakeholders to identify and work with men at higher risk to
contract HIV and design effective prevention strategies to address it.
Objectives are to, as part of a comprehensive package of MC interventions: (a) Identify men at higher risk of
contracting HIV; (b) design a strategy to promote condom use among the identified population and MC
among non-infected men; and (c) develop educational materials to promote condom use and MC.
Main activities will include to: (a) Develop, field-test and finalize educational materials for individual and
group counseling for use in consultation rooms, waiting rooms and at the community level; (b) train 25
counselors on how to use the educational package within intervention targeting men with risk behaviors and
promoting condom use and MC; (c) support implementation in up to 4 selected sites, reaching an estimated
10,000 clients/individuals counseled in condom use as a complementary strategy for MC; and (d) monitor
the implementation of the activities at the 4 selected sites.
Proposed funding for the second component of this activity is ongoing- Workplace Safety and Health
including Post-Exposure Prophylaxis (PEP) for Occupational HIV Exposures: $200,000
The rapid expansion of the provision of ART and other HIV-related health services is creating a severe
strain on the health human resources situation of Mozambique. The Ministry of Health is trying to cope with
this situation by quickly increasing the production of some critical cadres of health personnel. Additional
support will be needed, however, to ensure: that these new workers acquire the necessary competencies to
perform upon graduation; that they are properly deployed and incorporated in the health system; and that
retention and support strategies, including the protection of the health workforce, are in place to enable their
effective and sustained performance.
The purpose of this component is to support the MOH to continue the implementation of workplace safety
guidelines including the PEP for occupational injuries as a prevention measure for healthcare workers.
Key activity under this component will be to provide training and support for the implementation of the
workplace safety and health guidelines, including PEP, in up to 13 sites in order to achieve gradual
implementation of the workplace safety and health guidelines, including HIV post-exposure prophylaxis in all
central and provincial hospitals.
Continuing Activity:
Various activities related to technical support of MISAU, MMAS and CNCS in systems strengthening
(coordination and referral systems, materials development, M&E, supervision tools, policy development
etc). Includes support of OMM care, support and training
This is a new activity.
Gender-based violence (GBV) is an urgent public health problem worldwide, particularly in the context of
the HIV/AIDS epidemic. WHO (2002) reports that between 10 and 69% of women experience physical
abuse at the hands of a male partner at least once in their lives. When combined with a woman's increased
vulnerability to sexually-transmitted diseases including HIV in any given heterosexual encounter, violence
and other gender-related norms guiding male and female behavior greatly exacerbate the situation.
Since 2006, JHPIEGO has been providing technical assistance to the MOH to update and disseminate PEP
guidelines for HIV occupational exposures; and it is now expanding these guidelines to other vulnerable
groups such as victims of gender-based violence. Particularly in countries such as Mozambique, with an
estimated HIV prevalence of 16.2% and with the main mode of transmission being heterosexual
intercourse, and where women suffer a generally lower status of development than men, gender-based
violence and gender norms that influence women's vulnerability to HIV must be incorporated into the
context of existing HIV programs.
The purpose of this activity is to support the MOH to rapidly address the needs of gender-based violence
clients within the health care service delivery system and to ensure linkages between different levels of
interventions.
Objectives:
1. Provide support to the MOH to expand the concept of gender "mainstreaming" into health care service
delivery, through integration of gender-based violence components into existing HIV programs and
strengthening linkages to services for victims of gender-based violence
Measurable Outcomes:
• Assessment conducted of availability, suitability and coverage of local programs to which victims of gender
-based violence can be referred
• Findings of assessment and corresponding recommendations for strengthening of programs for victims of
gender-based violence disseminated
Main Activities:
• Conduct assessment to determine availability, suitability and coverage of local programs to which victims
of gender-based violence can be referred, and to determine culturally appropriate and relevant interventions
and messages to address gender issues (in Maputo City, Zambezia and Sofala provinces)
This activity sheet is also linked to activity sheets 8587, 8631 and 8637.
This activity is a continuation of South-to-South collaboration with Brazilian experts to support and provide
short-term technical assistance (TA) to the Mozambican National STI (Sexually Transmitted Infections) and
HIV/AIDS Program.
A technical expert for HIV/STI training from Brazil will provide short-term technical assistance for the
validation of the STI training roll-out to HIV/AIDS treatment service sites. In addition, the Brazilian expert will
assist the Ministry of Health (MoH) STI/HIV/AIDS program staff and staff from the MoH training institutes to
review of HIV/STI pre-service training materials, to ensure that HIV counseling and testing, partner
notification and STI treatment for HIV-positive clients are incorporated in pre-service training curricula.
According to WHO, about a third of the people living with HIV/AIDS (PLWHA) worldwide at the end of 2001
are co-infected with TB. The majority of these people are in low-resources countries such as Mozambique.
Because up to half of PLWHA develop tuberculosis and tuberculosis is known to have an adverse effect on
HIV progression, tuberculosis care and prevention should be priority concerns of HIV/AIDS programs; and
HIV/AIDS prevention and care should likewise be priority concerns of TB programs.
Prevention and care interventions should be integrated to tackle tuberculosis among HIV-infected people.
Joint TB/HIV interventions seek to 1) prevent HIV infection, 2) prevent TB, 3) provide care for PLWHA and
4) provide care for people with TB.
The purpose of these activities is to strengthen and expand interventions for HIV care, such as treatment of
other opportunistic infections, and ART for TB patients co-infected with HIV in hospital settings, and
increase the capacity of hospital staff to provide comprehensive care for TB patients. All activities will be
coordinated with the Counseling and Testing efforts supported by the Ministry of Health, and linkages within
the appropriate CT referral systems will be emphasized.
These activities are new and are directly linked to JHPIEGO's Infection Prevention and Control activities.
1. Improve access to HIV treatment for TB patients
2. Improve management of HIV/TB patients in in-patient wards in 10 hospitals
3. Minimize nosocomial TB infection among HIV+ patients and healthcare workers
• WHO Manual on Tuberclosis Care with TB-HIV Co-Management, Integrated Management of Adolescent
and Adult Illness (IMAI) translated and adapted for Mozambique
• Training materials for HIV/TB management in in-patient wards developed based on the IMAI WHO Manual
• 20 TB supervisors trained as trainers in HIV/TB management using the materials developed
• 50 healthcare workers updated in HIV/TB management using the materials developed
• WHO Operational Manual translated and adapted for Mozambique
• Training materials developed based on the WHO Operational Manual
• 20 TB supervisors trained using the materials developed
• TB respirators selected and purchased for up to 10 sites (pending funding availability)
• Training on use of TB respirators conducted for supervisors and providers (pending funding availability)
• Translate and adapt the WHO Manual on Tuberclosis Care with TB-HIV Co-Management, Integrated
Management of Adolescent and Adult Illness (IMAI)
• Develop training materials for HIV/TB management in in-patient wards based on the WHO manual
• Train 20 TB supervisors in HIV/TB management
• Train 50 healthcare workers from 10 hospitals in HIV/TB management
• Translate and adapt the WHO Operational Manual
• Develop training materials based on the WHO manual
• Train 20 TB superviros using the materials developed
• Select and purchase TB respirators for up to 10 sites (pending funding availability)
• Train supervisors and providers to use the respirators (pending funding availability)
This activity sheet describes one activity for a TBD partner to continue support and technical assistance
(TA) for CT in clinical and community settings. The major activity is to identify a TBD and provide continuity
to JHPIEGO's current support for implementation of two strategies to increase the number of Mozambicans
who know their HIV status:
(1) Counseling and Testing (CT) in clinical settings, also known as provider-initiated counseling and testing
(PICT) is a key strategy for identifying HIV-infected persons in hospital settings, such as TB clinics and
inpatient wards (adults and pediatric). In these settings many patients who test positive have advanced HIV
disease and thus are already treatment-eligible, making this an effective strategy to refer HIV-infected
person for care and treatment services.
During 2006, JHPIEGO finalized the training materials, initiated the training activities for the integrated HIV
counseling and testing in the community and in clinical settings, and successfully started the implementation
of integrated counseling and testing activities.
In 2008, support for the implementation of the integrated CT in clinical settings and PICT will continue with
monitoring of the roll-out and training in TB service settings on one hand, and strong emphasis support to
the MOH for the establishment and roll-out of PICT in hospitals especially in-patient wards, that do not
benefit from NGO support for CT service delivery, on the other hand. Results expected in 2008 include 200
healthcare workers trained in clinical CT; 100 health facilities or departments/units providing PICT services;
100,000 individuals counseled and tested in clinical settings; and 50,000 individuals referred into care and
treatment as a result of PICT.
(2) Since 2005, JHPIEGO is working closely with the Ministry of Health (MOH), National AIDS Commission
(NAC), local and international NGOs and FBOs to implement integrated Community-based CT (CCT).
Working with couples and families, this initiative, is increasing the number of women and children accessing
CT and being referred for treatment and care. The CCT is assessing four different models of community-
based CT service provision: "classic" VCT services at non-traditional locations, such as churches and
mosques; satellite CT services at fixed locations (i.e. mobile CT teams providing services at health facilities
where CT services are not yet available on a daily basis); CT campaigns at markets and other non-
traditional locations; and home-based (door-to-door) CT services.
Efforts in the current year of 2007 include the evaluation of the pilot initiative on integrated counseling and
testing in the community and its expansion according to the results of the evaluation. In 2008 the expansion
will include new geographic coverage with current partners as well as new areas and partners such as
World Vision, Samaritan's Purse, HAI, among others. Results expected for CCT in 2008 are: 80 NGO staff
and volunteers trained in CCT;
5 National NGOs/CBOs enabled to start provision of CCT; 60,000 individuals counseled and tested at the
community level: and 30,000 individuals referred to care and treatment as a result of integrated community
CT services.
(3) In conjunction with support for CCT, support for CT in the workplace will be expanded, upon the MOH's
request, and include the establishment of CT services at 11 MOH training institutes where future health
cadres are being trained. At the same time pre-service training curricula will be revised to ensure systematic
and adequate CT training of future health cadres at those training institutes. Results expected in 2008
include: 20 teaching institutions staff trained in CT; 11 training institutions offering CT for their students;
10,000 students counseled and tested in the teaching institutions; and CT training modules adapted for pre-
service institutions.
(4) As part of a comprehensive package of Male Circumcision (MC) activities described also under A&B,
C&OP and SI part of COP08, CT materials will be developed/adapted for comprehensive and integrated
counseling on MC within male reproductive health services.
(5) In addition to the activities mentioned above, technical assistance to the MOH will be continued to
rapidly identify and address the needs of gender-based violence clients within PMTCT and CT services
using Mozambique-specific screening tools and materials for the identification of women that access HIV
testing services and as a result are at risk of sexual and/or domestic violence.
Objectives are to identify women that access HIV testing services and as a result are at risk of sexual
and/or domestic violence; and to propose strategies to address these needs. A strategy to address gender-
based violence clients within PMTCT and CT services will be developed and implemented at 6 selected
health facilities with up to 40 health care workers trained on how to implement the screening tools and
support women at risk of sexual and/or domestic violence
The proposed funding breakdown for the above described activities is: PICT and CCT $925,000; CT
services at training institutions $200,000; CT modules in the pre-service curricula $150,000; CT materials
for comprehensive male RH services including MC $50,000; and gender activity with screening tools to
assess women at risk of sexual and/or domestic violence $80,000.
Continuing Activity with updated Narrative
This program area is comprised of two separate components: Continuation of support for ART site
infrastructure (supported by FY06 Plus Up funds and FY07 funds) and support for a new gender activity.
ART Site Infrastructure: $950,000
One of the major barriers identified by the hospitals to improving infection prevention and control practices
to decrease the medical transmission of blood borne diseases, such as HIV/AIDS, is the lack of adequate
proper instrument processing and infectious waste disposal. Proper isolation systems to prevent nosocomial
transmission of Tuberculosis (TB) are also needed. Lack of appropriate equipment and inadequate physical
structure are among the main causes of these gaps in most of the hospitals. Since 2006, JHPIEGO has
been providing technical assistance to improve sterilization systems and waste management in USG-
supported ART treatment sites, including provision of incinerators.
The purpose of the program area is to continue to support the improvement of instrument processing,
proper isolation systems, and waste management in USG-supported ART treatment sites, to be selected in
coordination with the Ministry of Health and USG.
These activities are continuing and will be complementary to those occurring in FY07.
Objectives are to: (a) Implement instrument processing and sterilization systems in treatment sites; (b)
implement waste management through provision of incinerators in treatment sites; and (c) improve isolation
measures to minimize nosocomial TB infection among HIV infected patients and healthcare workers
Main Activities will be to: (1) Support and improve central sterilization units in at least two selected USG
supported ART facilities, including provision of equipment and rehabilitation; (2) Select and purchase
incinerators for up to four USG supported ART sites; and (3) Design plans for the rehabilitation of isolation
units for infectious TB patients (Maputo, Sofala and Zambezia provinces).
Gender: $97,000
The purpose of this program area is to support the MOH to rapidly incorporate and address the needs of
gender-based violence clients within the health care service delivery system and to ensure linkages
between different levels of interventions.
Key objective of this activity is to provide support to the MOH to expand the concept of gender
"mainstreaming" into health care service delivery, through integration of gender-based violence components
into existing HIV programs and strengthening linkages to services for victims of gender-based violence,
beginning with the review, and updating of current policy and materials.
Main Activities will be to: (1) Conduct a desk review of current policy and materials to determine
appropriateness and coverage of issues relating to identification of, and support and referral for, victims of
gender-based violence; (2) Disseminate and utilize findings in desk review, create recommendations for
updating of policy and guidelines; and (3) Update service delivery guidelines for HIV accordingly, to
incorporate gender-based violence issues.
FY07 Narrative: This activity is linked to Activity 8593 in ARV Treatment Services. Proposed funding would
cover some activities initiated in FY06 and currently supported through a sub-agreement of EGPAF with
Vanderbilt University as well as new activities described below.
Zambezia province is the most populated of Mozambique's 11 provinces and also has the most number of
PLWHAs (est: 211,703). The provincial staff working in Zambezia are also said to face one of the biggest
challenges in delivering quality health services owing to deficient infrastructure and human resources even
by Mozambican standards.
The USG, with its new provinicial focus strategy, will identify one or two implementing treatment partners to
support ongoing ARV treatment activities in Zambezia at 3 existing facilities and to expand services to 6
new sites, thereby reaching 1040 persons on ARV in 9 sites total. Support to these sites will include
infrastructure development through renovation of treatment sites, recruitment and training of staff in the
provision of quality HIV care and treatments service, and provision of clinical advisors for supervision and
mentoring of clinic staff. In addition to offering ARV treatment services, the partner(s) will support training
and human capacity development and also assist in improving the health information system and routine
program monitoring at the MoH Provincial Health Office.
In addition to site-level support for ARV service delivery, funding will be provided for pre-service training of
nurses, medical technicians, laboratory assistants and pharmacy assistants in Zambezia Province to build
human capacity necessary for the scale up of ARV treatment and related HIV services in the province. The
partner(s) will also be expected to develop formal links with community-based groups in Zambezia to
provide adherence and psychosocial support. Finally, communication radios will be procured to improve
communication between provincial and district hospitals with smaller health centres that provide follow up
Activity Narrative: care for patients receiving care and treatment services and that function as down referral sites.
April08 Reprogramming Change: Developing a QA/M&E system for male circumcision efforts ($50,000)
This activity is related to activities 15684.08, 15736.08, and 9064.08, as part of the overall strategy to
support a safe, effective, and scalable approach to expansion of male circumcision services in
Mozambique. In addition to the surgical procedure, other essential elements of MC services that must be
taken into account include informed consent, post-operative care and risk reduction counseling, and a
minimum package of other male reproductive health services, such as sexually transmitted infections
treatment, condom distribution, and HIV counseling and testing. To ensure that all these elements are in
place it is important to establish a QA mechanism to monitor and ensure safe MC services.
Reprogramming August08: Support the use and distribution of the Ministry of Health's Human Resources
plan by summarizing the strategy, developing a document that can be distributed widely, printing that
document and supporting a 1 day workshop for donors, Ministry of Health and implementing partners.
All activities listed under TBD are being reprogrammed as is in this request except for the $258,151 to
support a training center.
this situation by drastically increasing the production of some critical cadres of health personnel. Additional
The purpose of this program area is to support the MOH to rapidly and effectively expand, deploy, and
support its health workforce in order to provide HIV-related and other priority health services. The following
activities are being proposed to support the MOH in accomplishing this purpose:
1. Develop and support the implementation of a nation-wide training information system for pre-service
education to track the production and deployment of human resources. This will be based on the current
Training, Information and Monitoring System being implemented for in-service training
2. Strengthen pre-service education for laboratory technicians in coordination with the American Association
of Public Health Laboratories (AAPHL)
• Web-based training information system for pre-service education developed and tested in two provinces
• Pre-service training materials for laboratory technicians developed, including reference manual, trainer
notes, student learning materials and guidelines according to standards in coordination with the AAPHL
• Develop and test a web-based training information system for pre-service education
• Provide technical support regarding the training methodology of the pre-service curriculum for laboratory
technicians in coordination with the AAPHL, who will provide technical content for the curriculum materials
The following activities are continuing and will complement ongoing FY07 activities.
• Conduct assessment to compare competencies that nurses learned at the training institutions vs what they
currently perform at their workplace, and recommend most appropriate and cost-effective options for
nursing education
• Develop and implement in up to 13 sites a set of performance standards for nursing pre-service education
that can be adapted for different cadres
• Train teams of 5 members (teachers and clinical preceptors) from 13 teaching sites on the performance
improvement process
• Pilot a clinical teaching model where nursing students are closely supervised and mentored at the ward
level in provincial hospitals• Implement in-service training for ancillary workers
• Provide training and support to provincial staff in up to 13 sites for the implementation of the web-based
training and information system
• Develop master guidelines to guide the development and implementation of interventions to improve pre-
service training
Continuation of support for Gender plus up activities ($310,000)
These activities support the plus up activity around developing a system for providing PEP to women who
have been sexually abused in Sofala province. Specifically these activities focus on implementing PEP
guidelines, training of health care providers on how to serve the needs of gender based violence victims
and materials development.
Continuation of support for Male Circumcision ($50,000):
Activities proposed for continuation also include capacity building for the Ministry of Health (MOH), the
National AIDS Council (NAC), and stakeholders in the area of Male Circumcision. As described in other
sections of the COP08 (A&B, C&OP, CT and SI), a comprehensive intervention package will be developed
based on a situational assessment to identify the country's capacity for expanding safe MC services for
prevention of HIV transmission supported through USG FY06/07 funds.
The proposed funding will support a series of workshops and capacity building events that will assist to (a)
continuously up-date government staff and stakeholders on progress of MC activities in-country as well as
internationally/regionally; (b) ensure that data from the assessment are shared with all relevant government
entities and stakeholders, and that a participatory process is in place to ensure a constructive debate
around the results, recommendations and joint planning for the development of the intervention plan and
package; (c) support translation of key MC documents to Portuguese; and (d) support the in-country MC
working group, chaired by MOH staff, with participation from NAC and other stakeholders (including WHO,
UNAIDS, JHPIEGO, DCI, PSI, UNICEF, USG and others) as needed.
NEW Activity: ($258,151)
In an August 22nd meeting with HHS Secretary Leavitt, Mozambique's Minister of Health Garrido identified
the overall shortage of human resources as his number one operational constraint for improving health care
delivery. In their meeting it was proposed that a Lower Level Health Care Worker Training Center be
established in Mozambique to provide Portuguese-language instruction for participants from Lusophone
Africa. These health workers could be prepared through courses lasting only six months or less. Such
Activity Narrative: training could begin with basic technical skills that can serve in a variety of health care settings.
In initial discussions among USG officials following the meeting with the Minister of Health, an existing
facility was considered. On the outskirts of Maputo, there is a training center, the Centro Regional de
Desenvolvimento Sanitario (CRDS), which was developed by the Mozambican Ministry of Health and The
World Health Organization (WHO). The center has classrooms and recently renovated lodging and dining
facilities for participants. Few technical faculty are assigned to the facility; however, there are maintenance
staff. To date, this facility has been under-utilized but could be an ideal location for hosting training for local
Mozambicans and those from other African Lusophone countries. If the emphasis of training were on
gaining technical skills such as laboratory equipment repair, there would be a need to outfit the center with
needed equipment.
Identifying Portuguese-speaking trainers with the needed technical expertise would be important. Drawing
on expertise within each Lusophone country in Africa and partnering with Brazil to provide trainers and other
support for this center would strengthen the effectiveness and sustainability of the center. The proposed
next steps in exploring this idea are to:
1. Share concept paper with Ministry of Health officials in Mozambique.
2. Through a consensus process, revise the concept paper with MOH in Mozambique.
3. Conduct an asset mapping of resources (i.e., training expertise, training or conference center locations,
technical expertise) within each Lusophone country that could be drawn on in developing this training
endeavor.
4. Share concept paper with MOH in Brazil, Angola, Guinea Biseau and Cape Verde to gauge interest level.
5. Assess training needs in participating Lusophone countries.
6. Develop an advisory entity consisting of representatives from key stakeholders.
Deliverables/benchmarks:
• Web-based information system for in-service training available at provincial sites
• Web-based training information management system for pre-service developed
• Training methodologies used in pre-service curriculum for laboratory technicians
• Nursing training institution assessment focusing on what nurses learn in pre-service and what they use in
practice
• Cost effective options for nursing education
• Performance standards for nursing pre-service
• Nursing faculty trained on performance improvement process
• Ward level clinical teaching model at provincial hospitals
• Master guidelines to guide development and implementation of interventions to improve pre-service
education.
Deliverables/benchmarks (gender)
• PEP guidelines implemented
• Health care providers trained around gender based violence
• Materials development.
Deliverables/benchmarks: (male circumcision)
• Assessment data widely shared
• Participatory process around data interpretation
• Translate materials
Deliverable/benchmark: (training center)
• Concept paper for a Lusophone training center
• Asset map of Lusophone countries
• Training needs of each participant country
• Advisory board of key stakeholders
