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
Recently, the Government of Mozambique (GOM) made a declaration which detailed its commitment to the
strengthening of primary health care through community health workers and enlisting the involvement of the
community to address their most critical health needs. The GOM's commitment to the Agente Polivalente
Elementar (APE) or Community Health Worker (CHW) program is reflected in the MOH's five year health
workforce plan (August 2008) which includes an annex projecting the APE staffing levels, description and
requests to donors. The GOM has made it clear that revitalization of the APE program, which is an
integrated approach to health, is imminent and urgent. The MOH is therefore seeking USG support and
technical assistance to roll out the program on a national basis which current donor and public sector
financing precludes. Mozambique is considered by health experts to have one of the worst human capacity
problems in the world. This activity provides a framework for a set of USAID-financed human capacity
development interventions over a five-year period, in close coordination with other USG agencies, the
Government of Mozambique, othre donors and implementing partners. These interventions will lead to a
rapid scale-up of a revitalized national Mozambican model for community prevention and care.
This integrated health project will support a balanced mix of maternal and child health, reproductive health,
HIV/AIDS and other infectious diseases applying both prevention and curative care measures that directly
respond to the MOH request to reestablish a nationwide community based cadre of community health
workers. The MOH reinvigorated APE plan was outlined in a September 2008 17-point, inter-ministerial
action plan that describes the broad framework for a nationwide community based health system. This
action-plan builds on a September 2007 MOH meeting which articulated the MOH intentions to launch a
nationwide primary health care program which would be anchored at the community level by the APEs.
The 2008 MOH plan calls for four training centers to be set up, master trainers and provincial trainers to be
trained and in place, the issuance of clear MOH guidance to health districts on how to select and recruit
APEs, guidance on the supervisory system and most importantly, establishment of a line item in the Ministry
of Planning and Finance Plan's budget to subsidize the APEs. The APEs as outlined by the MOH will
deliver a defined package of quality preventive and basic health services which matches Mozambique's
health profile, is evidence based and sustainable. The APEs will also supervise and coordinate the
activities of all other community health volunteers (ACSs), mothers' groups, on-site TB volunteers and other
community-based health workers who are currently carrying out a broad range of disease specific
interventions, including distribution of insecticide impregnated bed nets, contraceptives and condoms.
These interventions include family planning, follow-up with tuberculosis and HIV patients on treatment,
organization of vaccination campaigns, growth monitoring and treatment of acute malnutrition and diarrhea.
The APEs will also provide a vital official link between the community-based health information system and
health centers.
This activity is the next logical programmatic step for the USG, following earlier investments and an
upcoming short- term, FY08 PEPFAR-financed, community based human resource and training team
consultancy. This expert planning team is scheduled to complete its work by February 2009. The products
from this consultancy will advise the MOH on the content, length, and scope of the APE curriculum (there
are at least three or four different curricula for training APEs currently in use) and on the development of an
operational plan to launch, train, deploy, and supervise a national APE system. This assessment will also
inform any future procurement.
The MOH APE program is expected to roll out this fiscal year with World Bank funding in a pilot region of
Northern Mozambique. Approved in 2007, this World Bank loan for $46.8 million is designed to strengthen
primary health care systems and build human capacity. The loan includes a pledge of $6.8 million by the
Russian Government for malaria prevention, $17.5 million by CIDA, and $17.5 million from the Swiss
Development Agency. Approximately $8 million were approved in Global Fund (GFTAM) rounds 6 and 8 for
support to APEs, including funds for developing trainers, conducting training, APE salary support for up to
4.5 years and expansion of 3 existing training centers. The U.K. also pledged assistance to the health
sector as part of an international bilateral agreement on joint work in Africa between Prime Minister Gordon
Brown and President George W. Bush in 2007.
The USAID financing of the GOM's APE program will consist of five components which are central to
building a national program over a five-year period, FY 2009 being the first year of this financing. They
include both training, institution strengthening interventions and direct financing support for APE salaries in
the initial two years of the program, procurement of essential medical supplies and equipment, and an
appropriate and sustainable means of transportation and communication between districts and communities
to support a system for supervision which is currently on paper but in practice does not exist outside of large
cities. A community "bright ideas" matching grants fund would also be made available for the best APEs.
1. Operationalize New Training Facilities: Finance and support with expert technical assistance launch of
two of the MOH's four planned community health training centers in two Southern provinces which coincide
with other USG health investments. Train and equip up to 10 master trainers from the designated provinces
in community-based preventive and curative care, supervision, refresher training programs, and support to
the communities who accept the APE program.
2. Finance the First Cadre of APEs: USG provided salary support will be conditioned on the gradual uptake
by the MOH of these community workers onto the MOH or district level payrolls and the assignment of
permanent district level supervisors so that USAID would not be expected to absorb this full five year cost.
3. Train and Equip 400 community and APE supervisors and Provincial Mobile Teams. Furnish motorcycles
and a virtual communication system to launch supportive supervision programs in USG financed provinces.
The existing mobile teams consist of three MOH staff and include a community health supervisor, a
reproductive health specialist and a logistics specialist which is often the driver. Computers, cell phones,
and radios will be purchased for this element of the program.
Activity Narrative: 4. Support the development/revision of APE reporting, refresher training, other APE materials including
audiovisuals for prevention and counseling, community assessment and epidemic control: Based on best
practices from various regions and existing materials, support the MOH health resources and
communications department to assemble an APE prevention/communication education kit. A four year full-
time advisor and short-term advisors across a range of specialty will be assigned to the MOH for this
purpose. The training/materials package must be a product the MOH intends to support in the future.
5. Support local public/private partnerships which strengthen the public health system: Each year, the
APEs that demonstrate exemplary performance in improving public health conditions, will be granted a
small project fund. This could be the Peace Corps seed funds, or an entirely new fund. Funds would be
used for community water and sanitation measures, a famine early warning system, better radio
communication with the provinces or other ideas. These grants would be overseen by a community
leadership council which already exists in many regions. These seed funds would require a 50% match by
the private sector or community.
With FY 09 HVAB funds USAID will support the first year of revitalization of the APE program aimed at
strengthening delivery of community-based prevention. Funds will support the development of APE
materials including audiovisuals for prevention and provide support the MOH health resources and
communications department to assemble an APE prevention/communication education kits for the 7,000
APEs.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
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
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
NEW ACTIVITY
With FY 09 HVOP funds USAID will support the first year of revitalization of the APE program aimed at
communications department to assemble an APE prevention/communication education kits including
condoms for the 7,000 APEs.
Table 3.3.03:
THIS IS A NEW ACTIVITY IN COP 09.
This activity is being funded across several program areas. OVC funding has been allocated to contribute
to a process that will provide greater access to basic health care services for OVC.
According to a 2006 UNICEF report on Childhood Poverty in Mozambique, 17% of children under five years
experience severe health deprivation. These are children who have never been immunized against any
diseases or young children who have had a recent severe episode of acute respiratory infection and did not
receive any medical advice or treatment. The report also cites that poor physical accessibility (one hour
distance to health facility on foot) to health facilities and long waiting times, are barriers to health care which
contribute to high mortality rates and poor health status among Mozambican children. Supporting the
revitalization of the community health worker program is an important component in improving the overall
health status of OVC, as CHW bring the services closer to the children and their mothers, in a more user
friendly environment - the beneficiaries own community.
Recently, the Government of Mozambique (GRM) made a declaration which detailed its commitment to the
Estratégico (APE) or Community Health Worker (CHW) program is reflected in the MOH's five year health
integrated approach to health, is imminent and urgent. The MOH is therefore seeking USAID support and
technical assistance to roll-out the program on a national basis which current donor and public sector
problems in the world. Focused on strengthening community based prevention programs and basic health
care. This activity provides a framework for a set of USAID-financed human capacity development
interventions over a five-year period. These interventions will lead to a rapid scale-up of a revitalized
national Mozambican model for community prevention and care.
HIV/AIDS and infectious diseases applying both prevention and curative care measures to directly respond
to the MOH request to reestablish a nationwide community based cadre of community health workers. The
MOH reinvigorated APE plan was outlined in a September 2008 17 point, inter-ministerial action plan that
describes the broad framework for a nationwide community based health system. This action-plan builds
on a September 2007 MOH meeting which articulated the MOH intentions to launch a nationwide primary
health care program which would be anchored at the community level by the APEs.
APEs, guidance on the supervisory system and most importantly, establishing a line item in the Ministry of
Plan's budget to subsidize the APEs. The APEs as outlined by the MOH, will deliver a defined package of
quality preventive and basic health services which matches Mozambique's health profile, is evidence based
and sustainable. The APEs will also supervise and coordinate the actions of all other community health
volunteers (ASCs), mothers' groups, on-site TB volunteers and community based distributors of insecticide
impregnated bed nets, contraceptives and condoms who are currently carrying out a broad range of disease
specific interventions. These interventions include family planning, follow-up with tuberculosis and HIV
patients on treatment, organization of vaccination campaigns, growth monitoring and treatment of acute
malnutrition and diarrhea. These APEs will also provide a vital official link between the community-based
health information system, health posts and health centers.
upcoming short- term, FY08 PEPFAR-financed, community based human resource and training team. This
expert USAID health training and human resource planning team is scheduled to complete its work by
February 2009. The products from this consultancy will advise the MOH on the content, length, and scope
of the APE curriculum (there are at least three or four different curricula for training APEs currently in use
and an operational plan to launch, train, deploy, and supervise a national APE system. This assessment
will also inform any future procurement.
Northern Mozambique. This World Bank loan for $46.8 million is designed to strengthen primary health care
systems and building human capacity and was approved in 2007. The loan includes a pledge of $6.8
million by the Russian Government for malaria prevention, 17.5 million by CIDA, and $17.5 million from the
Swedish Development Corporation. An October 2008 Global Fund (GFATM) grant, approved by the USG to
strengthen health systems, includes funds for APE salary support and for setting up several training
centers. The U.K. also pledged assistance to the health sector as part of an international bilateral
agreement on joint work in Africa between Prime Minister Gordon Brown and U.S. President George W.
Bush in 2007. Other donor related grants include a broader application of a CIDA financed APE curriculum
that is also currently under review for future financing.
two of the MOH's four planned community health training centers in two Southern regions which coincide
Activity Narrative: in Community based preventive and curative care, supervision, refresher training programs, and support to
2. Finance the First Cadre of APEs: USAID will determine the best mechanism for financing the first groups
of APEs. Options include contributing the Common Fund which many of the European donors utilize to
channel grant and loan funds to the MOH; capitalize on an internal MOH mechanism run by the World Bank
or another UN Agency; contribute to the same mechanism the Global Fund intends to develop and staff
within the MOH; or put the financing into a technical assistance contract and have the contractor pay the
APEs for a limited period of time. Salary support will be conditioned on the gradual uptake by the MOH of
these community workers onto the MOH or district level payrolls and the assignment of permanent district
level supervisors so that USAID would not be expected to absorb this full five year cost.
reproductive health specialist and a logistics specialist which is often the driver. Computers, cell-phones,
4. Support the development/revision of APE reporting, refresher training, other APE materials including
audiovisuals for Prevention and Counseling, community assessment and epidemic control: Based on best
purpose. The package must be a product the MOH intends to support in the future.
APEs that demonstrate exemplary performance on improving public health conditions, will be granted a
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* TB
Table 3.3.13:
This is a new activity under COP09.
sector as part of an internationa l bilateral agreement on joint work in Africa between Prime Minister Gordon
With FY 09 OHSS funds USAID will support the first year of revitalization of the APE program aimed at
strengthening a community health system capable of strengthening the local primary care referral system
and to make an essential link at the community level to provide basic primary services to the vulnerable
members of society who live out of range of fixed health facilities.
Table 3.3.18:
