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.
THIS IS A NEW ACTIVITY under COP09.
In FY 09, USG will consolidate its approach to the provision of community and clinical services by
competing out its activities in four provinces - Niassa, Sofala, Manica and Tete Provinces. This includes 7
districts in Niassa, 13 in Sofala, 10 in Manica, and 7 districts in Tete. The agreement will be awarded to one
to four partners, or a consortium of partners, who will subcontract with the DDS and sites to implement a
comprehensive package of services across a continuum of care. Services include PMTCT, counseling and
testing, and adult and pediatric palliative care and ART services at health facilities, and home based care,
OVC, and general follow-care and support at community levels.
This FY09 activity supports the implementation of PMTCT services at 185 health facilities to reach a
144,670 women with HIV counseling and testing services. As prevalence rates vary across provinces and
districts, an estimated 21,701of HIV-infected pregnant women will receive a full course of ARV prophylaxis,
including 10,850 with combination AZT prohylaxis (50% of the total). An estimated 5425 eligible pregnant
HIV-infected women will receive ART for their own health, and 3,255 will receive CTX prophylaxis.
The partner(s) will support the Districtand Provincial Health Authorities to provide and expand the full range
of family-centered PMTCT services at clinic level that include: opt-out counseling and testing of pregnant
women during ANC, syphilis testing, screening for ART eligibility of HIV-positive women through CD4 count
testing and/or clinical assessment, provision of combination ARV prophylaxis for PMTCT for the mother-
infant pair and referral for ART for eligible pregnant women, quality infant feeding counseling based on best
practices, including exclusive breastfeeding for the first six months and weaning based on AFASS, and
reinforced counseling and messages for increasing facility deliveries.
RFA partner(s) will expand and strengthen the provision of combination ARV prophylaxis to more sites, and
will collaborate with the DDS and DPS to ensure PMTCT sites have adequate stocks of prophylactic ARVs
for pregnant women and exposed infants. Funds have been allocated to SCMS to procure ARVs for
PMTCT prophylaxis as well as lab reagents for hemoglobin (Hb) testing for women receiving AZT, CTX for
eligible pregnant women, syphilis test kits, and HIV RTKs. RFA partners will strengthen capacity of sites to
manage their commodities, and will work with SCMS, DPS and DDS to ensure adequate distribution of
supplies. Clinton Foundation/CHAI will provide 100% of exposed infant CTX and DBS PCR testing kits.
PMTCT sites have initiated CD4 sample blood draw on site at the ANC with sample referral to the nearest
CD4 testing center. This approach reduces the lost-to-follow-up of pregnant women and ensures that all
pregnant women identified as HIV positive will be fast-tracked and receive eligibility screening services. The
RFA partner(s) will strengthen and expand this approach by collaborating with the DDS and
District/Provincial Hospitals to establish and/or strengthen the system for CD4 sample referral and
collection.
RFA Partner(s) will support the DDS and sites to strengthen services for HIV-exposed infants including
routine provision of CTX, clinical and growth monitoring, DBS PCR testing, and referral for pediatric
services. To improve adherence to follow-up and reduce lost-to-follow up of exposed infants, partners will
work with sites to organize exposed infant follow-up visits during child vaccination/well-baby services. The
program will continue to foster linkages with the Child at Risk Consult (CCR) as well as treatment services.
The referral system between PMTCT, treatment services, and the CCR will be the first line of approach,
which has broad Governmental support. However, the program will also explore manners to reinforce
testing and treatment linkages with vaccination campaigns, well baby visits, and weighing stations. The
national integrated Child Health Card that includes HIV-related information on the mother/child will facilitate
efforts for linkages and identification of HIV-exposed infants. In addition, RFA partners will introduce and
train health facility staff in the use of a national algorithm for identification of HIV-infected infants and
children (see PDCS and PDTX TBD Central TA to MOH). RFA Partner(s) will ensure the provision of
focused training in exposed infant follow-up, in particular the importance of clinical and grow th monitoring
and referrals for pediatric care. The RFA partners(s) will coordinate with the MOH to ensure sites and
providers have received training in DBS PCR in line with the MOH DBS PCR training strategy and program.
The RFA partners will support the DDS and sites to foster linkages between clinical care and treatment
services and sites and PMTCT and exposed infant follow-up services. This could include support for
weekly or monthly meetings of a multi-disciplinary team of health staff and community liaisons to discuss
issues of adherence and follow-up, linkages between PMTCT and other services, data review, and follow-
up activities to improve service delivery and linkages. RFA partners will also support the DDS and DPS to
strengthen the district network model by funding quarterly district meetings and annual provincial meetings
to discuss challenges with implementation and best practices.
USG/PEPFAR will leverage resources from PMI and Global Fund. PMI will provide LLINs for distribution to
pregnant women while Global Fund procured LLIN's will support both pregnant and lactating women.
However, PEPFAR, through PSI, will provide a buffer stock of LLIN for PMTCT partners to ensure that all
pregnant women receive a mosquito net.
Integration and uptake of family planning (FP) services has been weak in Mozambique, and has not been a
focus of USG Mozambique. Under this agreement, the partner(s) will increase efforts to improve access to
FP services for HIV-infected women, particularly post-partum. In some situations, postpartum visits and FP
are offered on different days and by different providers. RFA partner(s) will work with sites to improve
service delivery and patient flow by organizing FP days around exposed infant visits, and to ensure FP
counseling appropriate to the HIV-infected woman's needs is provided to HIV-infected women during
postpartum FP visits as part of Mozambique's safe motherhood program. To improve data on HIV-infected
women receiving FP services, partners will develop a system for tracking provision of these services.
Testing of male partners in the ANC setting has been a challenge in Mozambique due to the stigma of HIV
and HIV testing and the limited participation of men in supporting women's pregnancy and health. RFA
partners will introduce innovative ways of bringing men to the facility for testing, including provision of
invitation letters for women to bring to their husbands/partners and other family members to come for
Activity Narrative: testing, organization of specific testing days for men
Food and nutrition will be an important component of the program. Partner(s) will provide support to sites in
improving the quality of counseling on infant and young child feeding, including exclusive breastfeeding until
6 months or when replacement feeding is AFASS, and complementary feeding of infants > 6 months.
Partners will receive nutritional supplements for eligible pregnant and lactating mothers who meet national
eligibility criteria for food supplementation, and exposed infants > 6 months through the food and nutrition
commodities award recipient in sites that are not within WFP-mandated provinces. In provinces that are
considered food-insecure based on WFP eligibility, RFA partner(s) will leverage food support from WFP
resources. Partners will leverage additional food support through UNICEF and Clinton Foundation, who
support Plumpy Nut needs for severe malnutrition. A small amount of the budget has been allocated to
support the management of food commodities at sites and districts, including distribution at sites,
procurement of storage materials (ie. pallets or ventilation materials), and for tracking food distribution. This
food support will cover around 25% of the need, based on the assumption that WFP will support a portion
and the Food and Nutrition commodities award recipient will also support a portion but neither source will be
enough to cover the need.
Monitoring and evaluation has been a priority of the Government of Mozambique, and efforts have started
under FY08 to implement a national M&E program for PMTCT through Columbia ICAP support. National,
provincial and district level M&E are dependent on the quality of facility level data. RFA partners will
support the DDS to strengthen the data collection at facilities for PMTCT services, including tracking of
provision and/or outcomes of clinical eligibility assessments in ANC/PMTCT registers, provision of AZT
prophylaxis, and eligibility for HA ART and outcomes. National level TA in M&E for PMTCT through
Columbia ICAP support will result in the revision of PMTCT M&E tools, and RFA partner(s) will collaborate
with ICAP and the MOH in the introduction of these tools and registers once finalized and approved by the
MOH.
RFA partners will also support community activities. For PMTCT, this will include introduction of mothers'
psychosocial support and adherence groups. While this generally takes place within a facility setting, it
reinforces community participation and stigma reduction among community members. In addition to
mothers support groups, RFA partners will continue to provide community based follow-up care and support
to PLWHA, including mother infant pairs, and conduct community participation efforts. Community groups
and PMTCT support groups will carry out community-based outreach and advocacy to promote support to
PLWHA, reduction in violence against women living with HIV, and promotion of male participation and
involvement. OVC and HBC volunteers, as well as APEs will serve as liaisons to the health center for follow
-up adherence care and support, and for reaching pregnant HIV-infected women, their exposed infants, and
family members.
During FY 09, USG is increasing its efforts in overall systems strengthening, supporting decentralization of
activities, and sustainability planning. RFA partners will provide significant support to the DPS and DDS for
implementation of activities. RFA partners will look into subcontracting mechanisms with local health
authorities (DDS and/or DPS) to conduct integrated supervision of clinical services; monitoring and
evaluation, in particular analysis of facility level data for monitoring performance of individual sites, districts
and provinces; financial planning and budgeting; and annual work planning and quarterly monitoring of
implementation of activities. RFA partners will work with the DPS to strengthen existing supervision tools to
ensure the most recent technical updates of the national program have been incorporated. This will be done
in a harmonized fashion with support from the MOH to ensure the use of standardized tools for supervision.
The contracting mechanisms will include key indicators for performance monitoring of DPS and DDS
activities. In addition, RFA partners will work with provincial clinical mentor advisors to ensure that PMTCT
services are integrated into clinical mentoring activities.
This activity addresses the following Programmatic Emphasis Areas: Gender and Health Wraparound
activities, which are described above.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
The Sofala, Manica, Tete & Niassa Clinical Services RFA will support facility-based care and support
services to 158,008 adult PLHIV in FY09. Selected partner(s) will provide a spectrum of comprehensive,
family-centered services that will improve the quality of life of HIV-infected individuals from the time of
diagnosis throughout the continuum of illness. Partner(s) awarded through this RFA will strengthen the
linkages of clinical care and support-services (e.g. ART, PMTCT, CT, prevention and treatment of OIs)
based at 103 sites to a variety of community partners supported through a separate RFA in order to ensure
an uninterrupted continuum of care. Selected partner(s) will work with local health authorities to ensure
that clear, coordinated two-way referral mechanisms are in place at each site to refer clients for home-
based care services. Clinical services will include the diagnosis, treatment and prevention of opportunistic
infections, STIs, and other HIV-related illnesses, including routine provision of cotrimoxazole to eligible
patients and ART eligibility assessment through clinical screening and CD4 count testing. Facility-based
adherence counselors will provide comprehensive adherence and psychosocial support services, including
disclosure counseling, treatment preparation and assisting patients to identify and overcome barriers to
adherence. Clinicians will also be supported to use patient monitoring systems for clinical monitoring,
patient follow-up, and decision-making regarding patient flow and service delivery models.
Selected partner(s) will work directly with health personnel at the provincial and district level (i.e. DPS/DDS)
to implement a coordinated district support model for high quality clinical care. Selected partner(s) will build
the capacity of DPS/DDS to train and supervise clinical care providers at the site level. Successful
applicants to this RFA will also have demonstrated the ability to transfer capacity for the management of
data, commodities and human & financial resources to the district and provincial level in order to increase
Mozambican ownership of HIV care and support services. The selected partner(s) of this RFA will
coordinate closely with partner(s) awarded the community services RFA to ensure a seamless network of
care from the facility to the home.
SCSM will procure all OI drugs, STI drugs and cotrimoxazole for USG partners, and distribution of these
commodities will be through the existing Government supply chain. Selected partners, in collaboration with
SCMS, will provide support to the provinces, sites and districts in tracking consumption and distribution to
ensure a continued supply of these essential drugs.
Table 3.3.08:
The Sofala, Manica, Tete & Niassa Community and Clinical Services RFA will support high-quality anti-
retroviral therapy (ART) to 47,565 PLWHA through 96 sites in FY09. While previous PEPFAR-supported
efforts have focused on rapid geographic expansion and scale up, the activities in this RFA will support
USG and the Mozambican Ministry of Health's renewed focus to improve the quality of services. The
partner(s) selected through this RFA will provide technical and financial assistance to MOH colleagues to
reinforce a district model of integrated HIV care and treatment. This RFA will prioritize the strengthening of
MOH systems at the provincial and district level (DPS/DDS) to design, implement, monitor and sustain ART
services.
Improving the Quality of Service Delivery:
The partner(s) selected through this RFA will strengthen ART service delivery at the 96 sites currently
supported by PEPFAR (additional sites may be supported in Tete Province if MSF withdraws its support).
The selected partner(s) will strengthen the clinical skills of local care providers through provincial ART
trainigns, on-site mentoring and supportive supervision. Partner(s) will enhance both facility- and
community-based adherence support services to adequately prepare patients for ART and to maximize their
retention in care. This RFA will also strengthen Positive Prevention (PP) messages through trainings, on-
site technical support, the inclusion of PP messages into existing IEC materials, and the development of
systems and tools to monitor behavior change.
Selected partner(s) will also strengthen the laboratory capacity of each site as well as the laboratory
network at the provincial level to implement systems for quality control and the servicing/maintenance of
laboratory equipment. Selected partner(s) will support provinces to implement systems to ensure timely
and accurate CD4 counts for all patients. Likewise, the selected partner(s) will work closely with the
DPS/DDS to ensure that the adequate systems, staffing and structures are in place to manage all
commodities. This RFA will also place a greater emphasis on the quality and scale-up of pediatric ART
(please refer to PDTX activity narrative for further information). Selected partner(s) will support improved
diagnosis and management of OIs and pain (both for patients on ART and in pre-ART care) through
trainings and formative supervision. The STI program at each site will also be strengthened through
increased IEC and counseling activities, improved data management systems and intensified technical
assistance to improved diagnosis, treatment and follow-up.
The partner(s) awarded through this RFA will also strengthen the quality of service delivery through
improved data collection and management to inform clinical and programmatic decision making. Partner(s)
will participate in USG-wide efforts to harmonize patient monitoring tools and to promote quality
improvement through the HIVQual program. MOH counterparts will also be mentored in analyzing and
applying data collected to better tailor service delivery models and target technical assistance at all levels of
support.
Promoting Service Integration and Linkages:
This RFA will create the opportunity to promote the continued integration of HIV care and treatment services
into a cohesive primary health care network to provide support along the entire continuum of care. Selected
partner(s) will strengthen linkages and referrals both within the health center (e.g. CT, inpatient wards,
MCH/TH, TB) and the community (e.g. HBC, PLHIV support groups, community education, stigma
reduction). HIV treatment services will be linked to PEPFAR-support nutrition activities including technical
assistance providing through FANTA and the "food for prescription" program. Likewise, safe water will be
promoted through counseling and the distribution of Certeza water sprinkles to patients newly enrolled in
ART. Condoms, IEC materials and insecticide-treated nets (ITNs) will also be included in the basic
package of care. Selected partner(s) will also be encouraged to link up with complementary programs to
enhance food security (e.g. income-generating activities, community gardening). Selected partner(s) will
also be required to coordinate their activities with other donors and programs (e.g. MSF) supporting HIV
services in their area of action.
Strengthening Mozambican Systems and Institutions:
This RFA will emphasize the strengthening of MOH capacity at all levels to design, implement, monitor and
sustain HIV service delivery. Limited support will be transitioned from the Clinton Foundation to PEPFAR
for the MOH at the national level for the coordination of clinical technical assistance, and monitoring and
evaluation. Selected partner(s) will prioritize the provision of technical assistance to each of the four
Provincial Health Directorates (DPS) to maximize their ability to coordinate, supervise and support HIV
interventions in their areas of responsibility. Selected partner(s) will hire four technical support persons who
will be secunded to each DPS to support each of the following areas: clinical care, laboratory,
pharmacy/logistics and strategic information. These technical support personnel with work alongside their
Mozambican counterparts on a daily basis to ensure that the appropriate personnel, systems and resources
are available so that each DPS is able to effectively manage HIV service delivery.
As this RFA will support a decentralized, integrated model with the district serving as the fundamental
service delivery unit, selected partner(s) will work closely with District Health Directorates (DDS) to plan,
implement and monitor HIV services. Partner(s) will build the managerial capacity of DDS in the areas of
health planning, finance & budgeting, transport & logistics and maintenance. The DDS will also be
supported to supervise the activities of all health facilities under their purview, as well as to coordinate their
linkages with community-based initiatives.
Lastly, selected partner(s) will actively participate in the national dialogue on the eventual graduation of HIV
service delivery. This dialogue will include the development of criteria/milestones to monitor a site's and/or
district's progress in its sustainability planning and targeting system strengthening activities to maximize the
Mozambican ownership of HIV services.
This activity contributes to addressing male norms and behaviors and gender equity in HIV/AIDS programs
by strengthening referral networks and linkages for HIV-infected pregnant women and their partners. In
Activity Narrative: addition, the RFA partner(s) will have funding allocated specifically for renovations/infrastructure support for
sites.
Construction/Renovation
Table 3.3.09:
NEW ACTIVITY
The Sofala, Manica, Tete & Niassa Community and Clinical Services RFA will support the USG and the
Ministry of Health's prioritization of pediatric HIV care and treatment services in FY09. Partner(s) awarded
through this RFA will strengthen health systems to decrease HIV-related morbidity and mortality and
improve overall child well-being in the four targeted provinces.
RFA partners will support the provision of a preventive care package at all ART sites in 4 provinces (96
sites) and 195 PMTCT sites. This includes clinical monitoring; access to early infant diagnosis;
cotrimoxazole prophylaxis; prevention, diagnosis and treatment of OIs; infant feeding counseling and
support; pain management at facility level through on-the-job training and supportive supervision. Treated
bed net distribution (LLINs), chemicals for water treatment and food support will be provided at community
level through CBOs working on OVC programs. LLINs will be provided through coordination with the PMI
program and Global Fund.
The activities below are described in two components: exposed infant follow-up and care and support of
HIV-infected children.
Integration of exposed infant follow-up and timely identification of HIV-infected infants:
The timely initiation of ART in HIV-infected children, preferably before six months of age, has clearly been
demonstrated to improve quality of life and to reduce morbidity and mortality. The national treatment
guidelines for children are currently be revised in accordance with WHO recommendations to incorporate
the initiation of ART for all HIV+ children under one year of age and for children exposed to nevirapine
through PMTCT or maternal treatment.
In Mozambique, HIV-exposed infants are followed at high risk consultation clinics (CCR). The CCR provides
care services for all high risk children (very low weight children, in treatment for TB, etc), including HIV
exposed children. The care services include growth and development monitoring, provision of PlumpyNut
for HIV infected children who have weight for height ratio < 80% of the median and provision of
cotrimoxazole for all HIV exposed and infected children following national guidelines.
These clinics are critical points of entry for early identification of HIV in infants through routine clinical and
growth and development monitoring and HIV testing for HIV exposed infants. HIV exposed infants are
referred from PMTCT services to CCRs. The referral is still weak and there is limited data on how pediatric
care services are provided at CCR and how they are linked with ARV services. There is currently no
standardized system for identifying HIV-exposure or infection status of children coming for immunization or
for curative outpatient services. This, combined with slow implementation and expansion of early infant
diagnosis (EID) through PCR dry blood spots (DBS), due in part to a complex and challenging logistics
system and low human resource capacity, has hindered timely identification of HIV infected infants and their
referral for treatment.
Selected partner(s), in partnership with local health authorities (i.e. DPS/DDS), will support health facilities
to strengthen the quality of HIV-exposed infant follow-up at CCRs, as well as to integrate identification and
follow-up of HIV-exposed infants in all pediatric settings, including immunization/well-baby clinics, nutritional
centers, outpatient and inpatient settings, and other points of entry for identification of exposed infants.
Partners will support the DPS and DDS to implement universal use of the updated childhood growth and
immunization card that now includes PMTCT information (mother HIV status, ARV prophylaxis or ART).
This will facilitate health providers in different settings to identify HIV exposure among infants and to provide
appropriate services and referrals. In addition, RFA partners will work with the DDS and MISAU to orient
health staff and to implement the new flow chart and algorithm currently being developed by the National
PMTCT and Child Health technical working groups. This tool helps to link the HIV exposed and infected
infant into care and treatment through referral from PMTCT, immunizations and well child clinic.
Early Infant Diagnosis (EID) is a priority for the Ministry of Health. In order to improve the DNA PCR DBS
logistics the RFA partners will support the DPS and DDS to establish a functional logistics system for the
process of samples collection, transportation and returning of results. Selected partner(s) will support a
focal person for each province to coordinate the logistics for these samples to be processed in a timely
manner. In addition, RFA partners will ensure orientation and implementation on all nationally-developed
EID tools, including training tools, consumption tracking tools and other tools for tracking EID testing that
are developed during FY 08.
RFA partners will support the DPS and DDS to provide enhanced training in line with national training
protocols on exposed infant follow-up and pediatric care, including growth and development monitoring and
provision of cotrimoxazole preventive therapy for HIV-exposed infants, referrals and linkages with ART
clinics and community-based social support services, HIV testing of suspected infants and children, and
family based testing of children, and management of opportunistic infections among children and infants
infected with HIV.
In addition to identification of exposed infants through different entry points, RFA Partners will provide
support to facilities and districts to strengthen clinical diagnostic testing of children and infants, and to
integrate a family based approach of HIV testing into care and treatment settings.
Almost 100% of pediatric cotrimoxazole needs and a portion of the priority OI drugs for pediatrics are being
donated by the Clinton Foundation/CHAI through UNITAID. SCMS will support other OI drug needs. RFA
partners will coordinate with the provincial pharmaceutical logistics and the laboratory advisors in their
provinces to ensure a continuous supply of basic commodities, in particular cotrimoxazole, at district and
facility levels.
Activity Narrative: activities, and sustainability planning. RFA partners will provide significant support and TA to the DPS and
DDS for implementation of activities, with eventual graduation of sites to full DDS support. RFA partners will
subcontract and support the DDS/DPS to conduct integrated supervision of clinical services and the
network model; monitoring and evaluation, in particular analysis of facility level data for monitoring
performance of individual sites, districts and provinces; financial planning and budgeting; and annual
workplanning and quarterly monitoring of implementation of activities. RFA partners will work with the DPS
to strengthen existing supervision tools to ensure the most recent technical updates of the national program
have been incorporated. This will be done in a harmonized fashion with support from the MOH to ensure the
use of standardized tools for supervision. The contracting mechanisms will include key indicators for
performance monitoring of DPS and DDS activities.
In addition, RFA partners will work with provincial clinical mentor advisors to ensure that PMTCT services
are integrated into clinical mentoring activities.
* Child Survival Activities
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $7,486,036
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
improve overall child well-being in the four targeted provinces. These partners will extend pediatric ART to
all existing USG-supported sites currently providing ART in the four provinces (i.e. 96 sites), with the
objective of having 10% of all current ART patients being under the age of 15 (i.e. 4,757 children on ART)
by the end of FY09. This scale-up of pediatric ART will be reinforced through concomitant improvements in
the quality of pediatric HIV service delivery.
through PMTCT or maternal treatment. Selected partner(s), in partnership with local health authorities (i.e.
DPS/DDS), will support local clinicians to implement these guidelines through dissemination of revised
guidelines, trainings, on-site mentoring, and supportive supervision. Selected partner(s) will also support
local healthcare providers to establish identification systems for exposed and infected children, including
through the use of the IMCI algorithm. The introduction of early infant diagnosis through blood spot/DNA
PCR technology in Beira will also promote timely initiation of ART. Selected partner(s) will support a focal
person for each province to coordinate the logistics for these samples to be processed in a timely manner.
Other laboratory services to support pediatric ART clients will be strengthened through the provision of
equipment and the training of staff.
Selected partner(s) will also support psychosocial and adherence services specifically tailored to this target
group. Parents of younger children on ART will be supported through counseling and the production of low-
literacy materials to administer ART, particularly the more complicated syrups. Older ART patients will be
assisted to accept and disclose their status. Likewise, adolescents will receive Positive Prevention (PP)
messages specifically targeted for their age group.
Selected partner(s) will support patient tracking systems to ensure pediatric patient follow-up and retention
of children on ART. These systems will also assist the identification of children of adults enrolled in HIV
care and treatment to come forward for testing and care. These partner(s) will also participate in the
national pediatric HIV program evaluation to help identify best practices and key indicators for pediatric
ART.
Partner(s) awarded through this RFA will work with the DPS/DDS to link pediatric ART services to other HIV
and child welfare services. Linkages with PMTCT services, EPI services and well-child clinics will be
strengthened to reduce drop outs and missed opportunities. RFA awardee(s) will support government
partners to strengthen the links with maternal and child health programs and the child at risk clinics (CCR)
through staff training and the introduction of job aides/algorithms. Linkages between pediatric ART sites will
also be strengthened with community partners providing relevant child support services including
educational support, housing, HBC and legal support (e.g. obtaining birth certificates). Lastly, children
enrolled in ART will benefit from a minimum package of health services including insecticide treated nets
(ITN), sprinkles for water purification and nutritional support.
As with all aspects of this RFA, the primary emphasis of partner intervention will be placed on building the
capacity of provincial and district health authorities to support the integration of pediatric ART into the
district model of care. Selected partner(s) will build the capacity of local clinicians in pediatric ART through
the dissemination of guidelines, on-site mentoring, formative supervision, and the development of relevant
job aides and IEC materials. Selected partner(s) will provide specific training modules on pediatric ART for
lower level clinicians such as Tecnicos de Medicina. Activistas (HIV+ community support personnel
attached to health facilities) will also be supported to provide basic care to pediatric ART patients and to
educate parents on the importance of their children's treatment. Technical support will also be provided to
DPS and DDS to reinforce pediatric-specific aspects of care including the laboratory, pharmacy and
commodity management.
The Sofala, Manica, Tete & Niassa Clinical & Community Services RFA will support quality improvement,
expansion and integration of TB/HIV activities in each of the four targeted provinces. Selected partner(s)
through this RFA will support district and provincial health authorities to implement the "Three I's" approach
of Intensified Case Finding (ICR), Isoniazid Prophylaxis (IPT) and Infection Control (IC) at all HIV treatment
sites. Local clinicians will be mentored in TB/HIV case management (improving case-finding and case-
holding), the application of the national screening tool and information systems, implementation of
standard's measurement for infectious control to reduce the spread of co-infection, and providing IPT and
cotrimoxazole prophylaxis to adults and children in accordance with national guidelines/recommendations.
Furthermore, the partners selected through this RFA will strengthen TB treatment sites to institute provider-
initiated counseling and testing (PICT) for all TB patients (adults & children). Selected partner(s) will
collaborate with local health authorities to strengthen referral protocols for co-infected patients from HIV
sites to TB clinics and vice versa. TB contact tracing will also be strengthened at all sites, along with
improved linkages with complimentary support such as HBC, nutritional support, ITN, safe water and
adherence support. This RFA will require that selected partner(s) emphasize technical support at the
district and provincial levels to ensure that they have the capacity to train, supervise and mentor field staff
as well as to collect and analyze data in relation to the abovementioned areas.
Selected partner(s) will also support community-level TB-DOTS and mobilization activities in their target
areas through joint community planning, the development of culturally and linguistically appropriate
Information, Education and Communication (IEC) materials, participation in World TB days and the
involvement of community leaders and traditional healers. Lastly, this RFA will require that selected partner
(s) coordinate with other stakeholders supporting TB and/or HIV services in their areas of intervention (e.g.
TB CAP, LEPRA, Damien Foundation, AIFO and TLMI)
Table 3.3.12:
The Sofala, Manica, Tete & Niassa Community and Clinical Services RFA will support HIV counseling and
testing (CT) services in accordance with national guidelines/standards for 306,628 persons at a total of 100
sites in 30 districts. The RFA will be awarded to 1 to 4 partners, following a technical assistance model of
one partner per province. Selected partner(s) will directly support targeted districts to ensure that different
options exist for community members to learn their status. The RFA will be awarded to partner(s) that
demonstrate the ability to implement the Mozambican Ministry of Health's policy for the expansion of CT
services and the integration of CT into the primary health care system. Selected partner(s) will also
collaborate closely with local health authorities and community partners to support more advanced outreach
strategies such as community-based CT and to ensure that provider-initiated CT (PICT) is available at all
100 targeted health care facilities. The RFA will place a particular emphasis on couples testing, disclosure
counseling, as well as strengthening linkages with community partners within each district for contact
tracing to ensure that family members and sexual partners are reached for CT. Likewise, selected partner
(s) will strengthen linkages between CT services and prevention, care, treatment and other support services
(e.g. PMTCT, PLHIV support groups, HBC) are available both in health care facilities and the community.
The RFA will emphasize the necessity to build the capacity of local health care providers at the provincial,
district and site levels to ensure that CT services are accessible, integrated and sustainable. Selected
partner(s) will collaborate with provincial and district health authorities (DPS/DDS) to train and supervise the
relevant staff and to ensure compliance to national testing guidelines. Selected partner(s) will work closely
with their MOH counterparts at all levels to ensure that systems are in place to collect and manage data
relevant to CT, and to ensure that a reliable supply chain of quality-controlled test kits are consistently
available.
Table 3.3.14:
THIS IS A NEW ACTIVITY UNDER FY 09.
districts in Niassa, 12 in Sofala, 5 in Manica, and 6 districts in Tete.
The laboratory Technical Advisor based at the XXXX National Office level will be responsible for overseeing
the laboratory component of the Care and Treatment Program within the RFA partners' supported sites and
supporting RFA parter staff in providing supervision of laboratory services within the program. In addition,
(s)he will function as a counterpart for the Provincial Laboratory Technical Advisors based in DPS of each
province.
The Laboratory Advisor will liaise and coordinate activities related to laboratory services with NGO's and
partners assisting the MOH in laboratory issues such as Clinton Foundation, SCMS, and APHL. The
Laboratory Advisor will identify weaknesses in laboratory processes, procedures, and logistics, propose
adequate strategies for improvement, and contribute to a plan towards building capacities at national,
provincial and district levels. He will give specific attention to realities and problems emanating from field
level, communicate needs and priorities identified and channel solutions to adequate forum and authorities.
The work of the laboratory advisor shall be integrated with on-going or new MOH national and provincial
laboratory activities and policies. He shall also respond to priorities identified by the RFA partner team(s) or
other direct implementers in the Province in the lead Provinces. Overall, the RFA Partner Laboratory
Technical Advisor will improve laboratory services as a crucial component of quality care in the provinces
supported by the RFA Partner(s).
This will complement the RFA Partner funding of Provincial Laboratory Advisors to support the organization
and provision of high quality clinical laboratory services through technical assistance to the Direcção
Provincial de Saude (DPS). The Provincial Laboratory advisors will work directly with the Section Chief of
the Provincial Laboratory to improve the quality and coordination of laboratory services in the entire
province. Specific activities include: assistance in planning and implementation of laboratory activities;
technical assistance and supervision to laboratory personnel at district and provincial levels; development of
SOPs and routine work flow, systems for patient registration, increasing access to testing, and reduction in
turn around time for test results, and develop a program for equipment maintenance.
Table 3.3.16:
This is a new activity under COP09.
This is a new activity in that it is organized as its own separate activity, but is a continuation of the
subactivity listed as Activity 8639.08 in COP 08 (Provincial M&E Officers).
Ministry of Health has placed increasing focus on strengthening human and technical resources at the
provincial level to improve the coordination and delivery of services in the province. In FY08, Ministry of
Health developed a standard set of technical advisor positions to be placed at the Provincial level; these
four positions included advisors in Clinical Care, Laboratory, Pharmacy, and Monitoring and Evaluation.
USG was asked to assist with the funding and recruitment of these positions at the provincial level. The
primary partner responsible for providing technical assistance in the area of clinical services in a province
will also be responsible for the recruitment and support of the four technical advisor positions, including this
Monitoring and Evaluation Technical Advisor position.
The M&E Provincial Advisor will provide support in the coordination of routine activities related to monitoring
and evaluation at the Provincial Directorate of Health, giving priority to endemic diseases, including HIV.
This advisor will help to reinforce and support the implementation of the decentralization of HIV services
including related data collection systems. S/he will provide leadership in the supervision and management
of data to ensure the quality of data at the district and site level, help to strengthen the flow of data to the
district, provincial, and central levels. Additionally this person will support the Provincial Directorate of
Health in the analysis and dissemination of data (for example, to the site level, Ministry of Health, and
partners.) This person will sit within the Provincial Department of Planning and Cooperation at the
Provincial Directorate of Health.
This TBD Partner will be asked to place 4 M&E Advisors in Manica, Sofala, Niassa, and Tete Provinces as
part of their overall support to clinical services in these Provinces.
Table 3.3.17:
This activity will be competed through an RFA. This activity will contribute to strengthening health systems
at the site, district and provincial levels with the goal of developing more sustainable health care systems in
the provinces of Sofala, Manica, Tete and Niassa.
The Ministry of Health and the USG are committed to building the technical capacity of Mozambican staff at
all levels to effectively manage high-quality, integrated HIV services. The treatment partner(s) awarded
through this RFA will second one Clinical, one Pharmacy and one Lab advisor to each of the four Provincial
Health Directorates (DPS). These technical support personnel will directly support their colleagues within
the Provincial and District Health Directorates to ensure the quality of HIV service delivery and the
integration of these services within the primary health system through clinical mentoring; joint planning,
supervision & monitoring; and formal & on-the-job training. In addition to focusing on technical capacity
building, the selected partner(s) will strengthen the institutional capacity of its MOH partners in the areas of
monitoring & evaluation and the management of commodities, human resources and finances. In addition,
partners will assist the District Health Directorates (DDS) with district level planning for decentralization
purposes. The lead treatment partner will coordinate with the DDS, other PEPFAR-funded partners and
other donor in the districts to build an annual operational plan in such a way as to promote convergence of
all activities in a given district in support of the government of Mozambique's goals and objectives
($1,309,845)
The PEPFAR program has already made a considerable contribution to infrastructure development in
Mozambique. By July 2008 it had supported the renovation or construction, and equipment, of fifteen
laboratories, forty-eight health centers and maternity units, twenty-five hospital consulting rooms, three staff
houses, and twenty-three administrative offices. In addition, thirty-four transportable pre-fabricated
laboratories and diagnostic facilities had been deployed and equipped. A further fifteen houses, seven
maternity units, five health centers and one rural hospital are scheduled for completion by the fall of 2009.
This work was implemented through PEPFAR's Clinical Treatment and Laboratory Partners. COP09 will, for
the first time, treat infrastructure development as a discrete rather than embedded program area, with
appropriate budgetary provision, and a program structure designed to improve the speed, quality and cost-
effectiveness of implementation. Two new mechanisms will be employed: Direct Contracting (see "RFP for
Infrastructure - contracts direct - training centers, warehouses."), and Centrally Managed (see" RFP for
Infrastructure construction - contract health centers, housing, labs, etc."). These arrangements will relieve
PEPFAR's Clinical Treatment and Laboratory Partners of much of the burden of managing activities
somewhat removed from their primary fields of excellence. However there may still be cases where it is
more efficient and appropriate for these Partners to organize minor building repairs and improvements
locally rather than through the centrally managed mechanism. This activity provides discretionary funding
for partners working in Sofala, Manica, Tete and Niassa Provinces to carry out minor repairs and
improvements in support of their core activities. ($365,000)
Given the urgent need for increasing the number of health care workers at all levels, PEPFAR funds will be
used to pay for course fees associated with attending a pre-service institution. The goal of this activity is to
both increase the production of health care workers and lessen the numbers who drop out due to financial
constraints. Selected treatment partner(s) will manage a fund for each province to support long term
training such as scholarships for health care workers in such areas as public health, administration,
management or epidemiology. ($400,000)
Gap year funding is a means for assuring employment for newly graduated health staff at Ministry of Health
facilities. New graduates will be hired using PEPFAR funds at Ministry of Health salaries and placed at
government health facilities while their recruitment process into the National Health Service is processed.
This typically takes anywhere from 6-12 months. PEPFAR funds for salary support will cease once the
graduate becomes an employee of the National Health Service. It is expected that this gap year funding
will retain graduates at their work while the national health services and other ministries finalize their
recruitment process to transition these new health workers to public servants integrated in the national
health services. ($100,000)
Table 3.3.18:
