This is a new activity under COP09.

The Community Care Services RFA will cover services Maputo Province, Gaza, Sofala, Manica, and Tete.

This RFA will support facility- and community-based care and support services to 175,565 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 96 sites to a variety of community partners 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.

Community follow-up and support will strengthen facility-based clinical services by reinforcing adherence,

including directly observed therapy (DOT) for patients with poor adherence, and helping follow up defaulting

ART patients. Strengthened linkages between health facilities and the community will also allow for

improved follow up of women enrolled in PMTCT programs and will provide the opportunity to link clients

with PLHIV support groups and other support services available in the community (e.g. income-generating

activities, vocational training). HBC services will also facilitate the early recognition of opportunistic

infections to ensure timely referral to a health facility. HBC will focus on direct family assistance, including

supporting adequate nutrition of PLHIV through counseling and linkages to nutrition/agricultural programs.

Bringing care and support services to the community also provides the opportunity to reduce stigma of

PLHIV and to mobilize communities to care for those infected and affected.

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 that ensure a seamless network of care from the facility to

the home. 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.

Furthermore, the RFA will require prospective applicants to contract to community-based partners for the

implementation of HBC and other community support services. Those awarded the RFA will select its

community partners in conjunction with the DPS/DDS and will collaborate with local health authorities for

the training of community activists and the coordination of their activities. Selected partner(s) will provide

technical and financial services to its community partners to design, implement and monitor community-

based services in partnership with communities and project beneficiaries. Selected RFA awardee(s) will

support its local partners to develop appropriate tools and aids and will provide HBC kits to be used by

volunteers. The financial and administrative capacity of the community partners will also be reinforced to

maximize the sustainability of these services.

SCMS 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.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Increasing women's legal rights

* Reducing violence and coercion

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Public Health Evaluation

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

Estimated amount of funding that is planned for Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water

Table 3.3.08:

This is a new activity under COP09.

Mozambique is recognized as having one of the worst orphans and vulnerable children situations in Africa,

A 2006 UNICEF report on Childhood Poverty in Mozambique estimates that approximately 50% of all

children (5.3 million) are highly vulnerable. Of these children, 1.9 million are considered orphaned, with an

estimated 400,000 (21%) orphaned due to HIV/AIDS. 100,000 children under 15 are living with HIV/AIDS,

and only 6,320 children are on ART. Sofala and Manica have the highest percentages of both maternal and

paternal orphans and dual (both parents deceased) in the country. Over half of all orphans live in

households headed by women.

New, sustainable approaches which strengthen the GRM capacity to cope with this long-term problem is

therefore a key feature of the new PEPFAR Community Services RFA which will provide care and support

services and OVC care in Sofala, Manica, Tete, Gaza, Inhambane & Niassa. The project will support direct

services, institutional development for local government social services, livelihood strengthening and reform

of some key policy measures. The services component will support facility- and community-based care and

support services for up to 24,000 OVCs. This activity will also strengthen local government's (community

councils/district level social welfare ministry) oversight, management and monitoring of social welfare

services carried out by civil society groups. This new activity will support a standard package of services for

OVCs which includes 1) food and nutritional support 2) shelter and care 3) protection 4) health care 5)

psychosocial support 6) education and vocational training 7) economic strengthening. An important area of

emphasis is economic strengthening/livelihoods and "social care" activities which provide greater economic

opportunities for adolescent OVCs and their caregivers including jobs, and locally run savings and loans

programs through the accumulated credit and savings association. This activity will also work with the

GRM to eliminate critical national policy and regulatory barriers which inhibit OVCs from accessing services.

Issues such as outdated inheritance laws will be addressed. The inheritance law currently makes it difficult

for double AIDS orphans to retain title to their homes if the parents pass away. Another systemic barrier is

the outdated vital records information system which is currently unable to produce birth certificates for the

thousands of vulnerable children including OVCs who require these documents to enter school or to receive

other government health and welfare subsidies. Computerizing these records will save time and save lives.

Streamlining other requirements such as the "poverty certificate" will also make it easier for children in crisis

living or affected by AIDS to access services more expeditiously. This new activity will be competitively

awarded for both OVC and Care and Support services and programs for all six provinces regions. Non-USG

implementers provide OVC care and support in the target provinces. The International AIDS Alliance, Help

Age, Red Cross/Cresent of Mozambique and UNICEF all work with NGOs and CBOs to provide direct

services to OVC and UNICEF provides provincial level TA to the social welfare ministry. As such, close

collaboration with current efforts in this field is essential to ensure that interventions are complementary.

Niassa, a new implementation province for PEPFAR in FY08, is also included in this procurement. Family

Health International provided clinical (treatment, testing and PMTCT) services OVC and palliative/home-

based care services in FY08. Though Niassa is one of Mozambique's most underserved provinces for

health care, close collaboration is required with local CBOs and NGOs.

The USAID mission in collaboration with the entire US government team in Mozambique seeks to ensure a

comprehensive package of care to orphans and vulnerable children (OVC) affected or infected by

HIV/AIDS. The objectives of this program are to: 1)To improve the quality of life for orphans and other

vulnerable children by ensuring age-appropriate interventions that provide the seven essential services for

OVC. 2) to strengthen the capacity of the communities to mobilize resources to ensure quality services for

OVC in their communities 3)To provide sustainable, quality OVC programs through the implementation of

best practices in the area of OVC programming adapted to Mozambique's cultural context.

A comprehensive approach in these following strategic areas will be addressed in the implementing

partners' proposal:

1)Strengthen the capacity of families to protect and care for OVC specific needs: The UNAIDS Framework

for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and

AIDS, March 2004, considers families and communities the foundation of an effective scaled=up response

to the OVC crisis. The Framework clearly states that an effective programming response to caring for OVC

recognizes the front-line role of the community-based organization sand includes children and young people

as key partners. Increasing the capacity of a family, whether headed by a single parent, grandparent or

OVC, present the single most important factor in building a protective environment for children who have

lost their parents to AIDS and other causes. Focusing intervention on the family unit and the community -

and not only on the affected child - is usually the best way to promote the best interest of the child.

Generally, the optimal environment for a child to develop is the family/community. Proposals will strive to

increase the capacity of families and communities to provide care and support to children affected by the

epidemic. Activities might include training caregivers, increasing access to education, training teachers to

address the special needs of OVC and to reduce stigma and discrimination in the school setting,

psychosocial support, promoting the use of time- and labor-saving technology, and connecting children and

families to basic health care and other essential services. Yet another focus for implementation could

include income generation activities that link OVC and their families with programs providing economic

opportunities that are based on market assessments and are done with organizations that have a high level

of expertise in these areas. Adequate food and proper nutrition is an issue for OVC, therefore ways to

address sustainable food and nutritional needs should be addressed.

2) Mobilize and strengthen community-based responses: The community provides an important safety net

for children affected by HIV and AIDS. Although informal structures exist in many communities to assist

those most in need a unified entity focusing on the identification, specific needs, calculated response and

monitoring of activities targeted towards OVC is crucial. Taking into consideration the different dynamics of

each of each community an organized response may come from community committees or councils,

mothers associations, parent teacher associations or other groups that are capable of identifying OVC and

monitoring the services they get. NGOs can assist in strengthening these groups to provide quality services

to OVC either through direct support to community efforts, or through building the capacity of local

Activity Narrative: community-based (CBO) non-governmental and faith-based (FBO) organizations. Strengthened

communities can, in turn, support a great number of community initiatives and provide sustainability.

Community support includes, for example, providing mentors for emotional support, resources such as food

and school-related expenses, adequate shelter, household help, child care and farm labor. Programs can

also provide children and their households with legal assistance to protect property rights and protection

from abuses.

3) Increase the capacity of children and young people to meet their own needs through developing

response to address their vulnerability: Addressing children's vulnerability requires ensuring access to

essential services and addressing the added strain of caring for ill parent(s), increased economic and food

insecurity, susceptibility to violence, abuse and exploitation as well as discrimination and marginalization

from activities such as education and recreation. Children are expected to be active participants in

mitigating the pandemic's impact, thus moving beyond the role of mere recipients of assistance. This

participation will increase the best responses to the needs of the child. Possible means for participation

may include involvement in community committees, youth mapping of interventions, input into program

design, involving young people in making home visits to orphan and vulnerable children and helping

HIV/AIDS affected households. Additionally, initiatives should ensure children and adolescents stay in

school, are trained in vocational skills, receive adequate nutrition and access health care. Children can be

involved in discussing what activities are needed in the community and help with the implementation of the

activities.

4) Raise awareness within societies to create an environment that enables support for children affected by

HIV/AIDS (stigma reduction):Projects should include activities to improve the social context for children and

adolescents affected by HIV and AIDS, including providing information and education on the disease,

challenging myths about HIV and AIDS; advocating for basic legal protection and the enforcement of

existing laws regarding issues such as child abuse, sexual exploitation, trafficking, adoption,

institutionalization, inheritance, etc; and transforming the public perception of HIV/AIDS by engaging

community government religious leaders and the media to reach the wider community. Programs should

promote provincial government offices to examine and enforce quality standards for OVC programs and

ensure that children have access to essential services, including basic social services, and create special

protection and care measures for all children.

5) Develop, evaluate, disseminate and apply best practices and state-of-the art knowledge in the area of

quality OVC programming: Given the need to support OVC through their important growth and

development years in order to become contributing citizens and the reality that the OVC population will

continue to expand as infections increase, it is imperative that projects develop innovative approach to

supporting OVC in the community applying best practices and then to evaluate and disseminate these

practices to continue to strive for the highest-quality programming possible at a reasonable cost.

Consideration should be given to community-based group care that provides support and services for OVC

and respite for adults care givers.

6)Strong partnerships with local in-country organizations, local government. Applicants must have proven

experience with local in-country organizations and partners. The provision of mentoring among

organizations (indigenous and international) with skills to share is strongly encouraged to enhance in-

country capabilities and program sustainability. In addition, consortia of service providers that work across

several geographical districts and programmatic area should be considered. Provision of sub-grants and

mentoring activities to community-based and faith-based organizations can enhance service delivery and

sustainability.

7) Comprehensive Programming: Linkages between other aspects of PEPFAR as part of a comprehensive

integrated care and support program are required.. Projects should build on programs that provide home-

based care and support to people living with HIV/AIDS; ones that provide strong prevention messages;

availability of counseling and testing services; and access to treatment when necessary. Supporting

pediatric counseling, testing and treatment is strongly encouraged for OVC programs.

8)Promoting Action on Gender Disparities: Careful attention should be given in conceptualizing and

implementing OVC activities to ensure that differing needs of boys and girls are identified and addressed

appropriate to their developmental stages. Girls and boys living outside of care families often face

additional discrimination and threats with the girl child facing disproportional level of risk and vulnerability to

HIV, sexual abuse, trafficking and burdens of caring for family members. Programs must address this risk

and strive to relive the excessive burden that caring for family members often places on children and youth.

Strategies may include ensuring that girl children have access to schooling including secondary or

vocational level schooling. Other strategies include creating safe social spaces for pre-adolescent and

adolescent girls, such as through youth centers or kids' clubs where they can seek psychosocial support

and age-appropriate learning materials are used. Linking girl heads of households to supportive local

women's groups, FBSA or local NGOs can also provide them with both psychosocial support and

protection.

8)Linking HIV/AIDS Prevention, Treatment and Care Programs

A comprehensive family centered approach to caring for OVC relies upon functioning public sector referral

systems. Children of parents benefiting from PEPFAR programs need referral to OVC programs and vice-

verse. Referring parents to anti-retroviral therapy programs should be a priority. When parents or family

members are terminally ill the other family members including the children need to be prepared for the

upcoming transition. The project should ensure that referral systems work for the families and link to

prevention and child protection programs, because OVC are particularly vulnerable to sexual exploitation

and trafficking and thus risk becoming HIV infected.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* TB

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

Estimated amount of funding that is planned for Economic Strengthening

Education

Estimated amount of funding that is planned for Education

Water

Estimated amount of funding that is planned for Water

Table 3.3.13: