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
In Mozambique increasing numbers of men are requesting provision of Male Circumcision for HIV
prevention. Military Hospitals currently provide MC but the Mozambican Military Health Directorate does not
have the human capacity or material resources to provide MC at any volume of procedures to improve HIV
prevention efforts. Further, individuals requesting MC are currently required to pay a fee for the service.
While the Mozambican Defense Armed Forces (FADM) appreciates the HIV prevention value of MC they
are unable to meet the demand for this service. Nor do they have a MC comprehensive HIV prevention
package.
To support the FADM's desire to provide more comprehensive HIV prevention programming DOD will work
with FADM to create conditions for safe performance of male circumcision in military health facilities. It will
start with facility improvement to insure adequate clean space for MC, provision of MC related commodities,
training of doctors for MC surgical procedures according to UNAIDS/WHO guidelines and nurses and other
health officers for follow-up care. PEPFAR support will provide funding for incorporation of MC into general
HIV prevention IEC materials and work with FADM to ensure that men undergoing MC also receive VCT,
STI evaluation and care, condoms, and HIV prevention counseling. Both men and women will be informed
about the advantages and the risks of MC. Myths around MC will be addressed. The prevention campaigns
will stress that: abstinence, faithfulness, consistent and constant condom use are still the basic measures to
avoid or reduce the risk of infection.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
Military Populations
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $25,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $12,986,673
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
To increase access, Mozambique initiated a process of rapid geographic expansion and scale up of antiretroviral treatment (ART)
services in September 2006, which continued into 2007. ART services have been rolled out to all 148 districts. In June 2006 there
were 49 sites offering ART services, mostly in Maputo City and Province. By June 2007 this had increased to 193 sites and by
July 2008, 216 health facilities in all 148 districts; patients registered on ART increased proportionally from 44,100 people in
December 2006 to 88,211 patients in December 2007. The September 2008 data from Ministry of Health (MOH) show that
nationally 119496 are receiving ART (36% are from Maputo City and Province). Treatment coverage is estimated to be 31% of
patients in need of ART (~385,200). The national target is 148,500 people on treatment by December 2009; the average monthly
increase has been 4,000 patients. The PEPFAR target for FY09 is 109,904.
USG supports treatment services at 119 of 216 total sites in country and directly supports 59,274 people with ART (SAPR08).
The MOH targets for coverage in 2009 (40%) and 2010 (47%) reflect a steady increase in coverage. The national target for 2013
is 272,871 persons on ART (71% coverage).This trajectory is consistent with the current policy of the MOH to expand enrollment
and improve quality at existing sites while addressing the critical state of human resources and infrastructure that is limiting the
potential for HIV/AIDS services. USG support will comply with the Government of Mozambique request to focus on capacity
building in the health sector to allow expansion of ART on a more gradual basis in the context of a stronger health care system;
this approach is consistent with the paradigm shift of PEPFAR II from emergency scale up to sustainable support. Among women
receiving ARVs for PMTCT, 11% were on ART (SAPR08). Partners will develop in-country targets for pregnant women on ART
for the first time in FY09. The minimum coverage target is anticipated to be 20%. In FY09 efforts will focus on integrated models
of PMTCT and ART services and national level advocacy for changing ART eligibility criteria (currently CD4 <250).
With coverage in all districts in the country, MOH is currently limiting further geographic expansion of treatment sites while
continuing to enroll new patients. The focus is now on improving the quality of services. Some key activities include HIVQUAL,
developing patient monitoring systems for patients on ART and strengthening provincial capacity to manage and monitor HIV
programs. Efforts led by MOH are underway to decentralize HIV services with the expectation that: 1) primary and secondary level
health centers will be strengthened to eventually absorb ART patients referred from higher level facilities, 2) referral systems
between these levels of care will be defined, 3) simplified ART monitoring systems will be put in place, 4) clinical mentoring
systems for all cadres of health workers (but especially clinical officers) will be strengthened, and 5) tertiary and quaternary level
facilities where ART services are not integrated (e.g. the traditional "day hospitals") will provide training and mentoring of service
providers.
Partners provide assistance for ART in all 11 provinces including technical assistance (TA), hiring clinical staff as needed, training,
program monitoring, mentoring and supervision, quality assurance, salary support for key staff (such as lay counselors), provincial
level strengthening (TA for clinical and pharmacy services as requested by the MOH), district level strengthening (coordination,
supervision, monitoring, strengthening referral systems to community adherence, care and support activities) adherence support
and defaulter tracing, and infrastructure improvements.
During FY08, the PEPFAR team redistributed partners to improve efficiency and coordination and clarify roles and responsibilities.
As a result, services and geographic coverage among partners are limited to not more than two clinical partners per province one
clinical services partner per facility. Efficiencies gained from this redistribution should lower costs per target and allow better
analysis of partner performance and cost management. Prior to 2008, PEPFAR Mozambique had never undergone a formal
costing exercise; data from this exercise allowed USG to more accurately compare costs per target and per achievement by
partners. With better tools for comparing performance and using the assumption that partners can reduce costs per target now
that they have made start up investments and can capitalize on economies of scale, USG partners should be able to provide
services for less. In FY09 partners will be funded to consolidate support at existing facilities, broadening assistance to adopt a
district-wide approach and promote sustainability of programs. Minimal expansion to seven new districts is planned resulting in
PEPFAR coverage of 116 districts complementing the coverage from nine international organizations. During FY09, clinical
partners will support treatment services for 134,055 adults (directly) in 183 sites, and training for 1439 health professionals.
USG is working closely with the MOH to economize PEPFAR funding of drugs and commodities. In FY 08, the USG procured
72% of ARVs in the country. As agreed through PEPFAR compact negotiations, USG contribution to HIV commodities will be
reduced by 15% per year for the next 5 years. MOH and USG will leverage other donor and Global Fund funding to ensure full
coverage for drug and commodity needs. This agreement will allow USG to prioritize strengthening of the commodity logistics
system.
The greatest challenges to quality service delivery in Mozambique remains severe shortages of trained human resources and
inadequate physical infrastructure. There is currently no national system for patient tracking. Information on treatment is reported
from sites in two ways: 1) monthly reports sent to the MOH by clinical site 2) pharmacy records submitted to the Central Medical
Stores (CMAM) based on patient pick-up of ARV drugs. There is a growing gap in information reported from these two sources,
suggesting more people registered as receiving ART than those who are documented to have picked up prescriptions, raising
concerns about the quality of services. For pre-ART patients, there is no national reporting of follow-up and poor adherence to
standard procedures for clinical and laboratory follow-up.
PEPFAR-supported clinical care services include diagnosis and treatment of opportunistic infections (OIs), TB/HIV, and sexually
transmitted infections (STIs), and provision of cotrimoxazole. In FY09, a few partners will pilot cervical cancer screening activities.
The national target for OI treatment is 140,000 in 2009, although there is still no national OI monitoring system. In FY08, the
PEPFAR goal was to reach 424,724 PLWHA with palliative care services. Mid-year reports show that about 219,921 PLWHA
were receiving clinic-based palliative care in 99 sites and 37,874, home-based palliative care. Because cotrimoxazole targets are
limited by lack of national data, FY09 targets were set to achieve 50% of those adults on ART, 10% of adults in care, and all
children in care (ART and non-ART).
USG assessed costing per district for OI care to more rationally and equitably distribute resources among partners. Funds will
support the diagnosis and management of OIs; pain management, and management of malaria and diarrhea (for patients on ART
and pre-ART) through training and formative supervision. USG will provide TA to MOH on OIs and assist with establishing policies
and systems to manage and monitor care issues.
HIV- STI co-infection with certain STIs poses an enhanced risk of HIV transmission. Mozambique has among the highest rates of
bacterial STIs in the region. USG assists with IEC and counseling activities; diagnosis, treatment and follow-up;and M&E. FY09
STI funds will cover trainings in syndromic management, rapid syphilis testing, and the updated M&E tools; follow-up
recommendations from the recently completed STI evaluation; pilot innovative interventions to increase partner notification in
Zambézia; and improve syphilis management in Cabo Delgado where prevalence is much higher than the national average (12%-
26% vs.7%).
USG, through the Partnership for Supply Chain Management, will continue to support the procurement, distribution and
management of essential drugs for the prevention and treatment of OIs and related diseases for adults. All OI and other HIV-
related drugs will be procured through suppliers with appropriate certifications to ensure quality. PEPFAR is contributing 50.8% of
overall costs of HIV-related medicines and Clinton Foundation (CHAI) and the Central Medical Stores (CMAM, with Global Fund
and other support) account for the remaining amount.
Stocks of essential medicines have been erratic due to issues with distribution, warehouse management, and insufficient use of
existing MOH funds to support non-PEPFAR needs. SCMS will provide central-level support to CMAM including quantification
training, systems strengthening for warehouse management and distribution, improved systems and tools for tracking OI-related
commodities procured by PEPFAR and strengthening CMAM's capacity to procure non-PEPFAR funded essential medicines.
SCMS will also strengthen systems at the provincial level.
Community Care: For 2009, the national target for HBC is 116,556. In Mozambique, responsibility for medical versus psychosocial
support services is divided between two ministries. The Government of Mozambique is still in the process of defining targets for
total numbers of persons needing and receiving community services. USG funded partners account for about half of the national
target.
A USG-funded survey recently showed that recipients of HBC programs are primarily poorly educated women (80%). Lack of
household income or reduction due to chronic illness are common (75% and 66% respectively). Pain is commonly reported (71%).
Lack of food, lack of transport, and medication side effects are key factors in non-adherence. More training and further policy
development is needed in these areas. Many HBC programs are either entirely composed of HIV-infected individuals or
incorporate PLWHAs in their caregivers groups.
USG support to community care is undergoing a geographic redistribution exercise to streamline assistance for HBC and
community services in provinces. Partners will focus on specific areas and will develop memorandums of understanding with
clinical partners to ensure continuity of care in service delivery networks down to the community. Mapping exercises for
community services will assist in identifying areas of overlap with other donors. The USG will continue support to the MOH central
level HBC program. In FY09, MOH will operationalize indicators for required services; receiving community care is currently
defined as receiving any 3 of clinical, preventive psychological care and ensuring provision of social and spiritual care through
inter-sectoral linkages. OI and pain management training will be offered to all HBC supervisors through ANEMO (Nursing
Association) trainers in FY09. The MOH has asked for USG assistance in developing an operational plan to define who might
serve as a government focal point within health facilities for adherence, psychosocial support and community linkages and are
considering the use of social workers for this purpose.
In FY08 the national HBC monitoring form was fully integrated into the National Health Information System. In FY09 efforts will
continue to improve the quality of national data collection.
USG-funded implementing partners will also be supported to provide more meaningful direct data. At the same time that
individuals are likely being undercounted, some overestimation and some double-counting may occur between clinical care and
HBC in upstream estimates. Also, we can document the number of persons registered in clinical care, but not the number of
patients who are actually currently receiving clinical care.
Linkages: Site graduation models and criteria in development will include both clinical and community-level services; as an
immediate measure, partners are expected to formalize referral systems to ensure that no gaps exist in the continuum of care
from clinic to community. USG provides TA and participates in National MOH coordinated Working Groups (ART, HBC, nutrition
and adherence) with broad partner and donor participation to develop recommendations on related policy, technical and
operational issues. Strengthening referral systems for improved retention of patients is being actively addressed through the
Adherence WG.
In 2008 the World Food Program (WFP) provided nutritional support to 21,149 persons on ART, 5000 receiving OI treatment and
33,000 in HBC with PEPFAR funds through USG partners. In FY08, the Food and Nutritional Technical Assistance project
(FANTA) identified gaps and challenges for integrating nutrition into HIV services. In FY09, FANTA will develop a strategy to more
effectively address these issues. This includes provision of nutritional supplements in coordination with all USG clinical partners
across agencies according to clinical criteria. FANTA will also provide TA to Title II cooperating sponsors to ensure a more
integrated approach.
USG will continue to provide long-lasting insecticide-treated nets (LLIN) and the Safe Water System to all new enrollees on ART
through clinical partners to ensure more focused targeting of patients on ART as well as providing an additional incentive for
returning to the clinic. In FY09, the Basic Care Package will also include condoms, IEC material and cotrimoxazole. In Zambezia
and Nampula, USG resources from health, HIV/AIDS, water and agriculture will strive to improve the overall health, income,
nutritional and food security status of PLWHA and their households through integrated programming.
In FY09, key Positive Prevention (PP) messages will continue to be incorporated into existing materials and activities. Sub-
grantees include PLWHA groups exchange visits between sites. Training of trainers (ToTs) will scale-up for clinical care partners,
HBC and MMAS "para social-worker" trainers and PLWHA groups. Systems and tools for monitoring project outcomes tracking
behavior change are also part of this plan.
Peace Corps Volunteers will be placed with treatment and community care organizations to provide support to PLWHA in
food/nutrition and ART adherence.
Continued work will be done toward better integration of wrap-around programming including coordinating efforts and leveraging
resources from WFP, President's Malaria Initiative, Millennium Challenge Corporation, Global Fund, World Bank and other
international donors.
Table 3.3.08:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
The HIV/AIDS related courses for military staff (doctors, psychologists, lab technicians and nurses) will now
include a pilot south to south training collaboration with Brazil. Partnering with Brazil is a way to take
advantage of the language to train military health staff. 4 medical staff from Maputo, Beira and Nampula
respectively will be trained. Therefore we expect to train 12 people. We are planning on sending some
doctors, psychologists and nurses to the FURJ (Federal University of Rio de Janeiro). Columbia University
(ICAP) will facilitate the connection with this potential service provider.
As we were doing in the past, DOD will continue funding HIV/AIDS related international courses (in San
Diego (NHRC) and in Uganda) for military health care providers. This activity focuses on developing the
capacity of health providers responsible for ARV roll-out at Military Hospitals because, an effective response
to the HIV/AIDS epidemic requires expertise, experience, and training in the prevention and management of
people infected with HIV. Therefore, part of the Mozambican military medical staff will attend the Military
International HIV Training Program (MIHTP) and, the Naval Health Research Center (NHRC) will provide
the operational support through the US Department of Defense (DoD) HIV/AIDS Prevention Program
(DHAPP). By attending this training, military doctors will be taught about clinical related HIV patient
management, epidemiology, and public health. Emphasis is placed on training, consultation, and
operational support for prevention and clinical management of HIV and its complications as well as courses
in epidemiological surveillance and laboratory diagnosis from a clinical physician perspective.The mission of
the Military International HIV Training Program is to provide flexible training in support of prevention of HIV
transmission and management of infected persons in military organizations. The training programs and
projects are developed in collaboration with each military organization to meet specific needs. A large
emphasis is placed on the experiential part of the program to understand the military's policies and
procedures regarding service members with HIV/AIDS.
Other medical staff will attend training courses at the Infectious Diseases Institute (IDI) on the campus of
Makerere University, Kampala, Uganda.
The primary goals of the training program in Uganda are to:
1. Review the latest HIV/AIDS diagnostic and treatment approaches.
2. Discuss major issues concerning comprehensive HIV/AIDS care.
3. Discuss military-specific issues related to HIV/AIDS care.
4. Enhance the clinical skills of practitioners dealing with patients who are infected with HIV and associated
illnesses.
These goals will be accomplished through featured expert speakers on a range of HIV/AIDS topics,
interactive assignments, and practical demonstrations. The lectures will be presented by faculty from
Makerere University as well as one international trainer from the Infectious Diseases Society of America.
The method of instruction will include a combination of lectures, case discussions, journal clubs, and clinical
experience. Lectures will be delivered in a classroom setting to the group as a whole, followed by inpatient
and outpatient clinical sessions that will include bedside teaching rounds, an overview of systematic
HIV/AIDS patient care and management, and exposure to community-based HIV/AIDS care and prevention
programs.
Continuing activity. FY08: During 2007 DOD funded a rehabilitation of a military facility to be converted into
a new day hospital in Tete province. The FY08 funds will be used to train staff who will provide HIV care
and treatment services at this and other DOD supported military facilities.
In addition the funds will be used for the procurement of supplies and equipment for military ART facilities.
Fy07: DOD will fund HIV/AIDS related international courses for military and police health care
providers.This activity focuses on developing the capacity of health providers responsible for ARV roll-out at
the Military Hospital because, an effective response to the HIV/AIDS epidemic requires expertise,
experience, and training in the prevention and management of people infected with HIV. Therefore, part of
the mozambican military medical staff will be trained in San Diego - California through the Military
International HIV Training Program (MIHTP) is a collaboration of the Naval Medical Center San Diego
(NMCSD) and two San Diego, California universities - the University of California, San Diego (UCSD) and
San Diego State University (SDSU). The Naval Health Research Center (NHRC) provides operational
support through the US Department of Defense (DoD) HIV/AIDS Prevention Program (DHAPP).The MIHTP
was established to use the HIV expertise in three closely associated San Diego institutions namely, the
Naval Medical Center San Diego (NMCSD), the University of California, San Diego (UCSD) and San Diego
State University (SDSU). It provides training of medical military personnel actively caring for HIV-infected
patients. Supporting prevention and treatment programs in military forces of countries requesting DOD
assistance, we provide clinical training in HIV-related patient management, epidemiology, and public
health.The mission of the Military International HIV Training Program is to provide flexible training in support
of prevention of HIV transmission and management of infected persons in military organizations. Its top
priority is to train key medical personnel (clinicians in practice) both in San Diego and abroad with the goal
of transferring appropriate knowledge and technology to each country. The training programs and projects
are developed in collaboration with each military organization to meet specific needs. Emphasis is placed
on training, consultation, and operational support for prevention and clinical management of HIV and its
complications as well as courses in epidemiological surveillance and laboratory diagnosis from a clinical
physician perspective. A large emphasis is placed on the experiential part of the program to understand the
military's policies and procedures regarding service members with HIV/AIDS.
The primary goals of the training program in Uganda is to:
4. Enhance the clinical skills of practitioners dealing with patients who are infected with
HIV and associated illnesses.
Activity Narrative: These goals will be accomplished through featured expert speakers on a range of HIV/AIDS topics,
HIV/AIDS patient care and
management, and exposure to community-based HIV/AIDS care and prevention programs.
This is a continuing activity from last year's DOD plan which mostly targeted military doctors and nurses
from the Maputo Military Hospital, intending to increase knowledge of HIV/AIDS care and treatment of the
medical staff selected. This year, responding to the increasing number of uniformed services treatment
facilities DOD will select medical staff from the Ministries of Defense and Interior working in treatment health
facilities located in other provinces, including Sofala where there are military and police hospitals. More
qualified nurses will be able to perform relatively complex tasks without the need of the doctor's presence
which will, therefore have more time to look after the most critically ill patients. The military will train 4
doctors and 6 nurses and the police will train 2 doctors and 4 nurses.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12952
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12952 5215.08 Department of US Department of 6348 3520.08 DOD-DOD- $126,000
Defense Defense GHAI-HQ
8564 5215.07 Department of US Department of 4882 3520.07 DOD-DOD- $100,000
5215 5215.06 Department of US Department of 3646 3646.06 $70,000
Defense Defense
Health-related Wraparound Programs
* Family Planning
* TB
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.09:
THIS IS A NEW ACTIVITY
As accurate behavioral risk data is the basis for good prevention programming, DOD will support the
Mozambican military (FADM) in designing and implementing a KAP-type surveillance survey that targets
instructors from military training camps. The instructors at the recruit training camps are the role models and
leaders for the new recruits; they set and model the behavioral norms. However, there is some concern
that, due to the harshness of recruit training, these recruit training camps put the new recruits at increased
risk for HIV. Therefore, the instructors' HIV risk behaviors need to be assessed so that behaviors which are
counterproductive for HIV prevention can be addressed with new prevention programming.
This activity is extremely important for ensuring that all individuals in the target group know their own HIV
status. Using the information gathered with the survey, we will find out, among other things, about
consistency of condom use, alcohol use, and partner characteristics. All of the collected information will be
provided to the FADM and, together, we will develop/adapt prevention activities to improve HIV prevention
behaviors and the norms which are modeled in these settings.
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
* Malaria (PMI)
Table 3.3.17:
DOD will identify a TBD partner to renovate a military health post in Tete and upgrade it to health center
with the required conditions to also provide ART. The general health services (including ART) will also
benefit the local surrounding community.
Table 3.3.18:
Salary and benefits for 2 FSNs. Travel costs, Trainings, Orientation, Conferences, Exchange visits,
overhead/administration, supplies and other office costs, ICASS.
DOD is planning to hire a new staff member to work as an assistant of the PEPFAR program manager. By
doing this, we will be prepared to respond to the fast growing budget allocated to our agency.
This person will participate in some of the working group meetings, will coordinate with the FADM and
implementing partners all logistic aspects related to travel, seminars, meetings, international trainings, etc...
Part of the M&S funding will be used to cover fuel and maintenance of the DoD PEPFAR vehicle.
[April 2009 Reprogramming]
New Staffing Request: Small Grants Coordinator (This position replaces the program support assistant
requested by the embassy in COP09)
The coordinator administers and manages the Mission's Small Grants Coordination Office, which
incorporates six funds that promote grassroots-level initiatives throughout Mozambique. Job holder
oversees the entire life cycle of the grants, including making recommendations to senior management for
the awarding of the grants to monitoring progress and preparing close-out reporting on completed projects.
Position is also responsible for overseeing end use monitoring for U.S. Government funding provided for
other small projects in Mozambique. Job holder is directly supervised by the Chief, Political-Economic
Section and supervises PEPFAR funded HIV/AIDS Coordinator for the embassy.
Continuing Activity: 12955
12955 8689.08 Department of US Department of 6348 3520.08 DOD-DOD- $250,000
8689 8689.07 Department of US Department of 4882 3520.07 DOD-DOD- $118,000
Table 3.3.19:
