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
ACTIVITY UNCHANGED FROM FY2008
Continuing activity: Replacement narrative
This activity will partially fund the salary and benefits package for the CDC PMTCT/CT Study Advisor who
will work with the Ministry of Health PMTCT staff and stakeholders involved on the finalization of the
assessment of clinical staging performed by PMTCT personnel with comparison to CD4 & TLC (total
lymphocyte count) to determine eligibility for antiretroviral therapy, and dissemination of findings through
presentation of findings to MOH and stakeholders in-country, reproduction and dissemination of the final
report. Please see the Public Health Evaluation Background sheet for more information.
The remainder of this activity funding is requested to support the USG PMTCT program in the following
areas:
1) Travel expenditures for the CDC PMTCT staff facilitating regional and provincial PMTCT trainings, and
participating in PMTCT site supervision and quality assurance, in particular to 2008 focus provinces; CDC
technical staff visits to the PMTCT reference center and satellite units in Nampula Province; and
participation in PMTCT program evaluation activities.
2) Participation of MOH and USG staff in international and/or regional continuing education events relevant
to PMTCT program policy development and management, including staff visits to areas with robust district-
level support activities. Participants to be selected in discussion with the Ministry of Health (MoH)
Community Health, Reproductive Health and PMTCT programs and National AIDS Council (NAC).
3) Exchange visits for MOH and USG PMTCT staff (to be selected in discussion with MoH PMTCT program
and NAC) to countries within the African region to learn from experiences in integration of PMTCT services,
infant and child follow-up, integration of Counseling and Testing, and male partner involvement.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12943
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12943 5252.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $135,748
Disease Control & Disease Control ST
Prevention and Prevention
8638 5252.07 HHS/Centers for US Centers for 4867 3529.07 GHAI_CDC_PO $345,000
5252 5252.06 HHS/Centers for US Centers for 3529 3529.06 GHAI_CDC_PO $166,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Activity modified from FY08:
This activity contributes to salary and benefits for two CDC technical staff:
(1) The STI / Vulnerable Populations Technical Advisor, who oversees, coordinates MOH and other
partners, provides technical inputs, and monitors C&OP activities targeting Most-At-Risk Populations
(MARPS).
Activities include the development or adaptation of a comprehensive intervention package for MARPS,
including C&OP materials and interventions, which are made available to implementing partners working
with MARPS in Mozambique. The Advisor will also lead organization and facilitation of training for staff from
MOH and partner agencies working with MARPS.
(2) The Youth CT/Families Matter Technical Advisor, who will develop and oversee prevention activities
targeting youth and their families. Activities will include working with TBD partners to initiate youth-friendly
CT services for high risk adolescents, and adapt Families Matter, an evidence-based intervention, for
implementation in Mozambique.
In addition some funding under this activity will support in-country travel for both staff for supervision and
training activities, as well as their participation in regional/international continuing education events or study
tours to other projects.
Continuing Activity: 14070
14070 14070.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $59,420
Table 3.3.03:
In Mozambique, there is a lack of information about behavioral risk for HIV aquisition and transmission.
This is particularly true for groups typically defined as most at risk or hidden populations such as men who
have sex with men (MSM) and intravenous drug users (IDU). This new activity would support assessments,
size estimation calculations and mapping exercises to address this information void.
In African countries, there is a generalized denial of the existence of homosexuality. In the few cases where
it is acknowledged, it is typically viewed as an imported behavior from western countries and "not part of
African culture." This attitude hinders the recognition of human rights as well as access to health care and
other services. For example, HIV and other sexually transmitted infections (STIs) are not properly
addressed among African men who have sex with men (MSM) who are likely at an increased risk of these
infections because of their sexual practices. In Mozambique, there is only one civil society organization
(Lambda Group) addressing the rights of and working with female and male gay, bisexual and
transgendered persons. According to this group, there are MSM in all regions of the country, who
transcend social and economic status, religion, and ethnic groups. Nonetheless the organization lacks
information on the actual size of the group and risk behaviors that may place them at risk for HIV and other
STIs. In collaboration with the Lambda Group and other members of the national Most At Risk Populations
(MARPS) Working Group, this activity would support appropriate methodologies to collect additional data on
MSM in Mozambique. An estimated $175,000 will be directed towards this component of the activity in
FY09.
Another unexplored area that may contribute to HIV prevalence in Mozambique is intravenous drug use. A
technical assistance (TA) visit conducted in 2006 found information indicating a rise in trafficking of illicit
drugs from South America and Asia into port cities in Southern and Northern Mozambique. Subsequent to
the TA visit, an International Rapid Assessment and Rapid Evaluation (I-RARE) was conducted in 2007 and
2008 among drug users and sex workers from Maputo, Beira and Nacala port cities. Preliminary results of
this assessment confirms illicit drug trafficking and use in the three cities, including injecting drug use. Drug
users participating in the study mentioned injecting mandrax, crack cocaine, and heroine. They also
reported sharing needles and other equipment to inject drugs as well as inconsistent use of condoms when
under the influence of drugs. Female drug users also said that they exchanged sex for drugs or money to
acquire drugs. The qualitative I-RARE study provides much-needed information about the risk behaviors the
target populations engage in, but a better understanding of the size of IDU needs a broader exploration in
other provinces and a larger sample size. An estimated $175,000 will be directed towards this component
of the activity in FY09.
New/Continuing Activity: New Activity
Continuing Activity:
This activity sheet describes funding for three components in the Adult Care and Support area divided into
Home-Based Care (HBC), Sexually Transmitted Infections (STI)/HIV, and Opportunistic Infections (OIs)
prevention and control.
Salary Support CDC ($367,342):
Included are the partial salary and benefits for the STI / Vulnerable Populations Technical Advisor, who
oversees and coordinates MOH and other partner's activities, provides technical inputs, and monitors
STI/HIV activities targeting the general population as well as Most-At-Risk Populations (MARPS), partial
salary and benefits for the CDC OI Technical Advisor who oversees and coordinates OI related activities
with the MOH and implementing partners, partial salary and benefits of the Care M&E officer who works
within the CDC Care team to support palliative care (home based and clinic based) related program
monitoring activities including: evaluating progress in program implementation, compiling, maintaining and
reporting on data records related to partner reports and proposal submissions; data compilation needed for
routine program monitoring, COP preparation and semi-annual and annual reports, Additionally, these funds
will support the full salary and benefits for the HBC Specialist and the Community Care assistant who work
closely with the Ministry of Health and Ministry of Women and Social Action as well as USG partners in
developing community based HIV care and support programs with the Community Care Assistant focusing
on Food Security and Nutrition related issues in this area.
Home Based Care (HBC) ($30,000): This provides funding for Travel and supportive supervision and TA by
CDC employees to the Ministry of Social Action and the Ministry of Health and a small amount of back-ups
funds for needs that may arise related to materials development, consultancies for technical support and
exchange visits, regional meetings or conferences related to Community Based Care and Support.
Sexually Transmitted Infections (STI)/HIV ($97,000):
Specific activities include TA to support MOH and partners to (a) ($20,000) improve syphilis management
efforts in Cabo Delgado; (b) ($12,000) develop improved partner notification interventions to be piloted in
Zambezia province; (c) ($20,000) support for STI program (MOH) data base development and review; and,
(d) ($30,000) support preparations for STI surveillance (protocol development, training) for 2010.
In addition some funding ($15,000) under this activity will support in-country travel for supervision and
training activities, as well as participation in regional/international continuing education events or study tours
to other projects.
Opportunistic Infections (OIs) prevention and control ($70,000): Activities will center around improvement of
diagnosis and management of OIs (training different cadres of health workers, acquisition of equipment and
supplies, strengthening M&E) and includes the implementation of cryptococcus surveillance together with
the MoH, travel and supervision as well as participation in regional/international continuing education
events.
Continuing Activity: 12944
12944 8637.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $219,920
8637 8637.07 HHS/Centers for US Centers for 4867 3529.07 GHAI_CDC_PO $430,000
* Increasing women's legal rights
* Reducing violence and coercion
Table 3.3.08:
This PHE activity, "Integration of Sexually Transmitted Infection (STI) Prevention, Diagnosis, and Treatment
into Routine HIV Outpatient Clinical Care in Mozambique", was approved for inclusion in the COP. The PHE
tracking ID associated with this activity is MZ.07.0090.
Title: Integration of Sexually Transmitted Infection (STI) Prevention, Diagnosis, and Treatment into Routine
HIV Outpatient Clinical Care in Mozambique
Time and money: Project implementation started in FY06 with the development of study protocol and
coordination with the various stakeholders; in FY07 the study protocol was finalized, submitted for
appropriate approvals, and data and sample collection started; in FY08 data and sample collection will
continue and it is expected to complete the activity by June 2008. FY08 is therefore year 3 of this activity.
The funding provided for this activity in FY06/07 ($250,000) will suffice for completion of the activity and no
additional funds will be requested for FY08.
Local Principal Investigators:
Felisbela Gaspar - STI Program Coordinator, Ministry of Health, Maputo, Mozambique
Rui Bastos - Head of Department of Dermatology and Venereology, Maputo Central Hospital, Maputo,
Mozambique
Elena Folgosa - Head of Department of Microbiology and Parasitology, Medical Faculty, Eduardo Mondlane
University, Maputo, Mozambique
Project Description:
This is a proposal to reduce HIV and STI transmission through integration of STI prevention, diagnosis,
treatment into routine HIV outpatient clinical care at anti-retroviral treatment sites in Mozambique. The
project will assess prevalence of STIs in HIV-infected individuals (syphilis, genital HSV, chancroid,
gonorrhea, trichomonas, and chlamydia for all, genital candidiasis and BV for women) upon entry into HIV
clinical care. Findings will be used to determine if STI syndromic guidelines should be modified for HIV care
settings. Through review of practices and standards of care, investigators will identify other opportunities
for improvement of STI diagnosis and care in this population.
Evaluation Question:
To reduce HIV and STI transmission through the integration of STI prevention, diagnosis, treatment, and
partner services into routine HIV outpatient clinical care.
Specifically to,
1. Assess training needs for HIV outpatient clinical providers in the use of STI syndromic algorithms tailored
to HIV-positive individuals and on the critical importance of early identification of these STIs.
2. Determine patterns of disease in symptomatic HIV-infected individuals for STIs upon entry into HIV
clinical care (syphilis, genital HSV, chancroid, gonorrhea, trichomonas, and chlamydia for all, genital
candidiasis and BV for women)
3. Link STI laboratory data with clinical and behavioral data to understand (1) the burden of STI in HIV-
infected individuals (prevalent infection), (2) the proportion of STI in HIV-infected individuals that is
symptomatic vs. asymptomatic, and (3) provider ability to identify GUD, and vaginal and urethral discharge
in HIV-infected individuals.
4. Determine possible barriers to partner management of HIV positive patients with STIs.
5. Evaluate the need for HIV-infected individuals receiving ongoing HIV care to be periodically assessed for
incident STI.
Study Design and Methodology:
This is a multi-center cross-sectional survey of the prevalence of STIs among individuals utilizing two
selected ART treatment sites in Mozambique. All new patients being registered at the two Day Hospitals will
be invited to participate in the assessment. One ART site (Mavalane General Hospital) will be located in the
city of Maputo and the other will be in the province of Gaza (Xai-Xai Provincial Hospital). The country of
Mozambique has a population of 20 million people, of whom an estimated 16.2 percent are thought to be
HIV positive (1.8 million). We used estimates of the prevalence of the least common STI of interest
(gonorrhea, approximately 4.2%) from a previous study of the prevalence of STIs among females, ages 14
- 49 years, using family planning services. We estimate a need to enroll a total of 500 individuals, 95% CI
(250 from each site). This estimate allows for a 10 percent margin for exclusions due to incomplete surveys
and lost or not quantifiable specimens. We expect that it will take approximately 3 to 4 months to meet
target enrollment at each of the sites, an additional 2 months for laboratory testing, and 4 months for data
analysis report writing.
Planned Use of Findings:
Results from this evaluation will be used to provide the Mozambique Ministry of Health (MOH) with data that
can be used to:
1. Adapt existing national syndromic STI management approaches used for HIV-infected patients;
2. Develop screening guidelines for asymptomatic STIs among HIV-infected patients;
3. Identify and enhance partner management services of partners of HIV-positive patients, by assessing STI
diagnosis, and treatment results in improving HIV testing among partners;
4. Identify gaps in STI management-training for HIV care providers.
Status of the Study:
A study working group has been formed to discuss the various aspects of integrating STI diagnosis,
prevention, and treatment into an HIV care setting. The working group consists of individuals from the MOH
ART treatment and STI programs, clinical and National Health Institute laboratories, Maputo Central
Hospital Senior Clinical Advisors and CDC prevention, treatment and M&E staff.
A study protocol was developed, submitted for appropriate ethical reviews in the US and the Bioethics
Committee in Mozambique. Both boards have approved the protocol and, the Mozambique Ministry of
Health also provided administrative authorization for study implementation.
Activity Narrative: Needs assessment visits were conducted to clinical and laboratory sites at Mavalane and Xai-Xai study
sites. During the visits, orientation meetings were conducted with local health authorities and study site staff
to explain project objectives and methodologies, and to coordinate logistics of implementation.
A technical assistance team from the CDC Atlanta STI division is assisting the country with training for study
staff conducted in September 2007, as well as during the first weeks of data and sample collection in
September/October 2007. Senior staff from the MoH, the Faculty of Medicine, and the National Institute of
Health has facilitated the training and are now supervising study implementation.
Lessons Learned:
It has been valuable to have commitment and involvement from high level MOH staff to appropriately
develop, share and present draft assessment protocol and tools. While participation from the various
agencies may make this process lengthy, it enhances MOH ownership and contributes to highly relevant
and appropriate tools being developed.
In addition, discussions with key MOH stakeholders and staff in preparation for the assessment protocol
have already assisted in raising awareness about the importance of systematic and improved STI diagnosis
and treatment for HIV-positive patients as well as helped to identify major errors in reporting of STI data at
treatment sites that will be worked upon while further preparations for the assessment are ongoing.
Dissemination Plan:
After data collection and analysis, expected to be completed by May 2008, a workshop for dissemination of
study results will be conducted in Maputo city, chaired by the MoH, Medical Faculty, National Institute of
Health investigators, with support from CDC, and participation of stakeholders involved in implementation of
HIV/STI programs in Mozambique. The study report will be widely distributed in country. Additionally,
abstracts and papers will be produced for submission for presentation at regional/international conferences
and peer reviewed journals.
Planned FY08 activities:
The activities for FY08 include the completion of data and sample collection, completion of laboratory tests
including quality control conducted in the US, data entry and analysis, report writing and performance of the
workshop for dissemination of study results.
Budget justification for FY08 monies:
Completion of project will be done using funds from FY06/07; no additional funding is being requested for
FY08. A breakdown of the initial budget is provided below. Some of the expenditures will already have
occurred as supplies have been procured, training has been conducted, and the study is currently ongoing.
Travel & per diem for MOH supervisors: $35,000
Laboratory supplies & equipment: $125,000
Transport of equipment & supplies: $10,000
Training of personnel at study sites: $10,000
Data analysis and feedback meeting: $50,000
Printing and dissemination of the report: $20,000
Continuing Activity: 15696
15696 15696.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $0
This activity has been modified in the following ways:
1. Pediatric treatment specialist no longer funded here
2. Funding for the community Care Linkages specialist is included (new position)
Funding under this activity will be used to support CDC Mozambique treatment related activities that
include: travel, accommodation and expenses for supervision and monitoring of partner supported ART
programs; participation in regional and international HIV related meetings.
An additional component of this activity is partial funding for staff positions that contribute part of their time
in supporting the treatment program as follows:
Laboratory Technical Assistant who provides oversight for a range of broad laboratory related programs and
activities that are carried out by CDC as well as all partners implementing HIV care and treatment. The
basic function of this position is to provide expert advice and guidance for helping to develop and expand
adequate laboratory infrastructure and for establishing and implementing sound laboratory practices.
ART Site Support Assistant; who works within the treatment team to Support care and treatment scale-up at
site level--this involves frequent travel and close linkages with staff from partner organizations in the field as
well as support activities to improve quality of treatment scale-up (e.g. HIVQUAL)
Community Care Linkages specialist: Will work with USG and MoH Working Groups, implementing partners
and other relevant government sectors (such as Women's Affairs and Social Action) to create standard
approaches and systems based on best practice models to assure access to such cross-cutting services as
adherence support, defaulter tracing, psycho-social support, socio-economic support and food and
nutritional interventions that are realistic and appropriate for Mozambique.
Continuing Activity: 15787
15787 15787.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $357,020
Table 3.3.09:
This PHE activity, "Evaluation of cost and cost-effectiveness of HIV treatment to support resource planning",
was approved for inclusion in the COP. The PHE tracking ID associated with this activity is MZ.07.0077
PHE/Continuing activity - Activity ID # (from COP 07): 8639
Title of study: Evaluation of cost and cost-effectiveness of HIV treatment to support resource planning
Time and money summary: FY 2007 (292,000). There are no funds being requested for FY 2008. The initial
activities will start in September 2007, with an initial planning trip from the Atlanta based team to
Mozambique.
The local co-investigators are: Dr Americo Assane Chief of Department of Medical Assistance,
Mozambican Ministry of Health; Dr. Florindo Mudender, Department of Medical Assistance, Mozambican
Ministry of Health. Dr Francisco Mbofana, National Institute of Health, Mozambican Ministry of Health.
This activity proposes a public health evaluation to measure the costs of comprehensive HIV treatment in a
sample of PEPFAR-supported facilities, and to evaluate the cost-effectiveness of these programs. This
project builds upon and complements concurrent evaluations to assess treatment program outcomes and
cost-effectiveness and contributes to a national ART program evaluation. The evaluation will facilitate USG
and partner program planning and resource allocation by assessing the potential reach of ART programs
given available financial resources, informing selection of optimal program models, and locating areas
where potential efficiency gains could free-up resources to expand service provision.
Stakeholders (MOH, USG, PEPFAR implementing partners) will participate in the planning and presenting
of the data at meetings and conferences, as well as disseminating information through routine channels
within the USG partners community and MOH organizational structure. Results will be submitted for
publication in an appropriate peer reviewed journal.
The first planning/assessment trip will take place in September 2007. Study protocol is in development and
should be finalized in October 2007. Protocol submission to local IRB and CDC ethical review should occur
in October 2007. The team of investigators should start field data collection in January 2008.
Continuing Activity: 15788
15788 15788.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $0
This is a continuing activity.
CDC in collaboration with the MoH will conduct a program assessment ($30,000) of the current practices of
the high-risk child consultation clinics (CCR) in providing pediatric care services for HIV- exposed infants at
selected sites in Mozambique. The evaluation will determine how pediatric care services are provided at the
CCR's with respect to provision of cotrimoxazole prophylaxis, the cycle involved in DNA PCR DBS testing,
referral processes and retention in care, as well as asses how linkages with of HIV services with PMTCT
and other child heath programs (immunizations, well child clinics.) are working.The results will be used to
identify existing limitations and constartints to optimal functioning of the CCR, identify practices that are
working and aid the MOH in strengthening the CCR. The outcome of the assessment will be to develop
practical interventions and solutions so as to maximize all the entry points for HIV diagnosis, care and
treatment, improve retention of children in care and increase the number of children enrolled into ARV
treatment. The estimated budget, will be used for: Field work, training, supervision visits, printing of data
collection tools, data analysis and reporting.
Salary staff ($47,070) and professional training ($20,000): These funds will be used to support the salary for
a Pediatric Treatment Advisor who is responsible for supervsion, managament of all pediatric care and
treatment activities as well as provide technical support to MOH and implementing partners in this area.
Aditionally, these funds will support short-term training for the Pediatric Treatment Advisor, on pediatric HIV-
related issues and public health evaluations to help her better support MoH personnel and partners in
pediatric HIV/AIDS program.
Continuing Activity: 15790
15790 15790.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $0
Disease Control & Disease Control
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
As part of its plans for FY09 the CDC will provide technical assistance to the National TB Program for both
adult and children in conducting program evaluations, contracting local short term consultants ($ 50,000) to
develop/update national guidelines, printing and distribution of updated guidelines, training of the different
cadres of health ($ 30,000)and ($ 37,000) support monitoring activities including the implementation of the
Electronic TB Register and MDR-TB surveillance system and to support coordination meetings at different
levels including travel.
COP08 Narrative:
This activity will support continuation of technical assistance provided to the Ministry of health during FY07
for implemention of TB and HIV colaborative activities. Funds will be used to update national guidelines
and/or develop new ones in accordance with international standards for TB/HIV, X-MDR-TB management
and infection control. Further, the existing policy documents and guidelines will be printed and distributed
within the country. The new reporting system for drug resistant TB will be implemented to all provinces and
to strengthen coordination between National TB Program and partners, coordination meeting will take place
in all 3 regions and at the national level.
Additionally the requested funds will be used to support partially or in full, 4 CDC staff positions involved in
the TB/HIV program implementation and monitoring as follows:
Clinical Care M&E officer: :Works within the CDC Care team to support palliative care (home based and
clinic based) related program monitoring activities including: evaluating progress in program
implementation, compiling, maintaining and reporting on data records related to partner reports and
proposal submissions; data compilation needed for routine program monitoring, COP preparation and semi-
annual and annual reports
OI Advisor: Works within the CDC care team and serves as the lead technical officer with the overall
responsibility for planning, organizing and monitoring HIV related Opportunistic Infections (OI) projects in
order to scale up and improve the management of OI's. In this capacity provides technical guidance for all
CDC-Mozambique supported OI management activities in the context of MOH and the Emergency Plan
overall strategic programs that aim to expand and improve prevention, follow-up and care services for
PLWHA.
TB/HIV specialist: serves as the lead technical officer for CDC with the overall responsibility for planning,
organizing and monitoring TB/HIV activities. The advisor provides technical guidance to the MOH, CDC-
Mozambique, the Emergency Plan interagency group and implementing partners on TB/HIV collaborative
activities
Medical Epidemiologist: Will provide leadership in activities related to Opportunistic Infections and TB/HIV
program managment, participate in MOH, Inter-Agency, and TB/HIV Task Force meetings, supervise TB/OI
and Home-based care activities (including supervising 3 staff who work closely with MOH on these issues),
supervise cooperative agreement with Mozambique's Ministry of Women and Social Action and lead the
development and implementation of public health evaluation activities related to care and treatment.
Continuing Activity: 12945
12945 8636.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $228,772
8636 8636.07 HHS/Centers for US Centers for 4867 3529.07 GHAI_CDC_PO $572,000
Table 3.3.12:
Since the beginning of Counseling and Testing (CT) service delivery in 2001/2, the USG has supported the
establishment and expansion of CT services. The national CT expansion strategy has undergone some
major changes since early 2005. CDC has been providing Technical Assistance (TA) to scale up Provider
Initiated Counseling and Testing (PICT) in clinical settings, and promote, pilot and expand
the "Counseling and Testing in Health" (CTH) approach.
The proposed funds will contribute to and support the following activities:
(a) Reproduction of CT materials and CT M&E contracts and activities ($57,925) - Printing and
disseminating revised guidelines and training
materials for CT; support the transition from the current CT database to a new system and new procedures
of data collection.
(b) Partially fund the salary and benefits package for the current CT/PMTCT Study Advisor who leads
the implementation of two related areas studies; Partially fund the salary and benefits package for the CT
Youth Advisor who will be responsible for supporting CT activities related to the Youth FOA. ($80,851)
Continuing Activity: 12946
12946 5211.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $395,748
8633 5211.07 HHS/Centers for US Centers for 4867 3529.07 GHAI_CDC_PO $305,000
5211 5211.06 HHS/Centers for US Centers for 3529 3529.06 GHAI_CDC_PO $28,000
Table 3.3.14:
Funding in this activity supports the partial salaries and benefits for the ART site support assistants (2); who
work within the treatment team to Support care and treatment scale-up at site level--this involves frequent
travel and close linkages with staff from partner organizations in the field as well as support activities to
improve quality of treatment scale-up (e.g. HIVQUAL)
Continuing Activity: 15691
15691 15691.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $6,940
Table 3.3.15:
THIS IS A CONTINUING ACTIVITY:
This activity will partially fund the salary and benefits package for the Lab Technical Assistant (50%) and
two approved but yet to be filled positions which are: the ART Site Assistant I (20%), the Art Site Support
Assistant II (20%).
CDC - GHAI-Local-Salary Distribution
This activity will also fund travel of CDC and MoH staff in the Laboratory Section to participate in site visits
and attend scientific conferences.
Continuing Activity: 15692
15692 15692.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $49,143
Table 3.3.16:
This is a continuation of activity 8639.08.
This activity provides funding for the salary, benefits packages, and program-related travel for three
positions - (1)Interagency Reporting Specialist (2) Two M&E Officers
(1) SI Reporting Specialist (existing) The SI Reporting Specialist plays a critical role to review and
disseminate SI related developments and requests. If needed, the specialist provides follow-up or assist in
completion of the SI-related task. Thie position is also responsible for assisting in coordinating, gathering,
inputting, storing, and analysis of PEPFAR COP targets, SAPR and APR results, as well as providing
interpretation of OGAC guidance.
(2) Two M&E Officers (Locally Engaged Staff)
Each Monitoring and Evaluation Officer will serve as a member of the Strategic Information (SI) Team within
the CDC/Mozambique Global AIDS Program office. The officer will report to, and be mentored by, the Sr.
Monitoring and Evaluation (M & E) Specialist and the Sr. SI Coordinator. The M&E officer will assist in the
design, implementation, and strengthening of routine monitoring and evaluation systems as well as program
evaluation in Mozambique. The incumbent will assist the M&E Team in building overall capacity of CDC
partners, including the Ministry of Health (Ministério de Saude, MISAU), by providing technical assistance to
these partners in the monitoring and evaluation of HIV/AIDS programs. The main duties of the position are
to plan, initiate, conduct, evaluate, and coordinate complex HIV/AIDS M & E, and as necessary, applied
evaluation research, to monitor program implementation, document results, and translate data into
meaningful policy and program improvement. The incumbent plays a key consultative role for employees,
contractors, consultants and partners involved in HIV/AIDS program M & E. The incumbent will also be a
key contributor to the strengthening of information systems within CDC partners and MISAU.
The two M&E officers will provide interagency support to two interagency TWGs: the Prevention and
Linkages (CPIP TWG) and Clinical Care and Treatment TWG.
Continuing Activity: 12949
12949 8639.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $510,110
Table 3.3.17:
THIS IS A NEW ACTIVITY
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 4993.08 in COP 08.
Mozambique has not yet implemented a round of Behavioral Surveillance. A pre-formative project was
conducted in FY08 to help the Government of Mozambique and other stakeholders to identify and prioritize
key risk groups (Phase 1). Current groups proposed for inclusion in BSS include female commercial sex
workers, young women involved in transactional sex, miners and their partners, and long distance truck
drivers. This will be followed by the formative phase to develop plans and protocol for BSS+
implementation (Phase 2). Ultimately 3-4 groups will be included in the BSS; final selection of these groups
will be dependent on Phase 2 activities including an assessment of feasibility of inclusion of each group.
Phase 2 will be followed by Phase 3, the survey implementation phase. Currently it is planned that the
survey will include a biomarker to estimate HIV prevalence for these groups. Funds will be used for
technical assistance needed to plan and implement Phase III, required commodities and lab supplies for
BSS implementation, contracting of local field teams for data collection and entry, and technical assistance
for data analysis and dissemination.
Some funds were allocated for BSS with 07 Plus-up monies ($422,000) and COP 08 monies ($578,000).
However, based on the experiences of other countries implementing BSS (including Angola), and that fact
that some characteristics of Mozambique including limited physical infrastructure compounded with the
need to coordinate a complex survey in Portuguese, we anticipate that a minimum of $2.225 million will be
needed to implement a survey that includes four groups.
$25,000 is requested in CDC local funds to support local travel, dissemination activities, and other activities
funded at post. This will complement the additional $1 million being requested in COP 09 through the SI
Program area and the $200,000 being requested in COP 09 through the Other Prevention program area.
THIS IS A NEW ACTIVITY (No new funds for FY09)
As a follow up activity from the FY07 funded Operations Research (OR) workshop, these FY08 funds
($75,000 - part of activity 8639.08) will be used to provide 5 provincial program staff and their mentors the
ability to carry out small operational research projects. Each of these five will have had its draft protocol
produced during the workshop, and the FY08 money will allow them to conduct small scale primary data
collection, perform secondary data analyses using program data and will facilitate contact between the
mentors, most of whom are based in Maputo, and the workshop participants by funding travel to the field.
Note that CDC will ensure that all ethical considerations are included in the proposals and that any ethical
approvals are acquired by local and Atlanta-based IRBs, as appropriate.
Note that some of these funds will be used for a related Good Clinical Practices (GCP) course, targeting a
similar audience as the OR workshop and along the same lines of building capacity to conduct sound and
ethical research from within the National Health System.
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $41,364,801
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In Mozambique, there is wide recognition that the lack of human resources (HR) is the greatest problem facing the public health
system. According to WHO, Mozambique and Malawi have the most dire health personnel statistics per 100,000 (e.g. 3 doctors,
21 nurses for Mozambique) in Africa. There is strong political commitment in Mozambique to increase the quality and quantity of
human resources in the Ministry of Health, as outlined in its recently launched Human Resource Strategy for 2008-2015. This HR
strategy and launch was supported by several donors, including the USG. The strategy describes an ambitious plan that
demonstrates a vision for sustainable strengthening of human resources throughout the public health care system. This high
quality plan has been costed and will require financial support from several health sector donors.
The Minister of Health requested increased USG assistance in human resources and in support of the implementation of the HR
plan. In response, the PEPFAR team prioritized human capacity development in the FY 09 budget. This increased USG support
builds upon the May 2008 DFID (UK Department For International Development) and PEPFAR commitment announced by
President Bush and Prime Minister Brown to strengthening the human resources in four African countries, including Mozambique.
Throughout 2008, there has been significant activity on behalf of this collaboration. Mozambique is the first country to undergo an
assessment of PEPFAR and DFID strengths, comparative advantages and future directions; the assessment has served as a
prototype for the remaining three countries. As a result of this assessment, both donors have been able to capitalize on
comparative advantages.
Further, the USG will support additional technical advisors to work alongside and build the capacity of departments within the
MOH, the National AIDS Council (CNCS), the Ministry of Women and Social Action (MMAS) and the Ministry of Education. These
advisors will provide technical expertise and ensure linkages between other international initiatives (e.g. Global Fund and
PEPFAR/DFID Human Resources for Health (HRH) initiative). The USG team is engaged with other donors in this area and
participates on all Donor Coordination groups, including the Human Resource Technical Working Group.
The outstanding HCD challenges are: lack of public health human resources, weak infrastructure to develop new HRH, a weak
civil society and lack of both capacity and HR policies at the national level. The overarching HCD approach for PEPFAR
Mozambique is the strengthening of the MOH's ability to develop, deploy and retain new health care workers, the strengthening of
civil society by creating greater organizational capacity in local NGOs/CBOs, and collaborating more strategically with other
donors working in HRH activities.
FY09 HCD Priorities: The FY09 priorities for Human Capacity Development are: 1) strengthening pre-service training institutions;
2) operationalizing the MOH's HRH strategy; 3) supporting scholarships/fellowships for health care workers; 4) increasing
technical capacity at the provincial level via salary support; 5) developing public health education; 6) retaining health workers; 7)
increasing non-governmental organization (NGO) and association organizational capacity; 8) revitalizing the community health
care worker cadre; 9) strengthening the financial management and human resources information system (HRIS) systems at the
MOH; 10) expanding South-to-South collaboration; and 11) developing HCD-related infrastructure.
The FY09 increased emphasis on developing the management and leadership capacity of local non-governmental organizations
will be funded through the addition of a Umbrella Grant Mechanism (UGM) component to the existing agreement with the Capable
Partners (CAP) program that has been working to improve the organizational capacity of civil society entities. The UGM will be a
key mechanism to increase the number of indigenous entities (NGOs and associations such as the Medical Council) receiving
PEPFAR funds. PEPFAR Mozambique envisions a continuum of organizational strengthening, starting with US Department of
State supported Quick Impact Projects; graduation of Quick Impact partners into CAP; graduation of CAP partners into the UGM;
and direct PEPFAR granting to local entities, either individually or under consortium-type arrangements. Public-private
partnerships that promote private sector participation in health care provision and care for their own workforce will be
implemented. Also, in FY09, USAID and CDC will fund an interagency annual program statement (APS) gear to attract new
international and local partners to diversify the Mozambique portfolio.
In FY09, increased PEPFAR funds will be used for gap year funding for newly graduated health care workers. Ongoing salary
support of staff working for implementing partners will also be reported on in the Health Workers Salary Report.
Continuing FY08 activities include training systems development (e.g., development of a pre-service information system and
standards for training activities), workplace activities related to HIV, better coordination of in-service training, twinning,
development of clinical mentoring, journalist training, workplace policy and program implementation, and support for the National
AIDS Council.
The Human Resources Information System (HRIS) currently used by the Ministry of Health is inadequate and does not meet the
needs of the Ministry. In FY09, the current HRIS system will be evaluated, and a new system or approach identified. PEPFAR
will support the implementation of the new system or approach through a TBD partner. In addition, the USG will continue to
support the in-service and pre-service training information systems in FY09 via a TBD partner.
Financial management has been identified as a key obstacle to optimal MOH utilization of other donor funding, including the
Global Fund and the Donor Common Fund. A joint MOH, donor assessment of current Ministry financial management systems
will identify problems and develop a detailed plan of action for improving these systems. FY09 funds are requested to work with
the MOH to implement this plan to improve its financial system in order to strengthen the MOH's capacity to plan, use its fiscal
resources, and to accelerate disbursements and flow of available resources. PEPFAR assistance will focus on the existing e-
SISTAF system to ensure adequate financial reporting to donors and strengthen control levels within the MOH itself.
Pre-service training remains a high priority for the MOH. All clinical partners will be supporting scholarships for pre-service
students (nurses, clinical officers, pharmacy technicians) at the provincial level. Other forms of support include faculty
development, curricula revision and infrastructure support. This year, PEPFAR funds will support both a university based MPH
program and a new community public health program (2009 start date) that is located within a current pre-service training
institution. Given the increased number of students attending pre-service institutions, we continue to fund faculty development in
order to improve teaching skills and increase knowledge of topical areas. Investment in renovations, equipment, books and
materials for select pre-service institutions are planned. Long-term training remains a priority given the dearth of health care
workers. The scholarship program for individual medical students has expanded from one medical school, Catholic University of
Mozambique, to an additional medical school, Lurio Medical College. In FY08, selection criteria were developed in order to create
a system of offering scholarships to individuals.
Continuing education (in-service) will continue to be supported in FY09 in the following activities: support for the development of a
cadre of community health care workers; development of a national strategy for in-service training; design of a system for clinical
mentoring; design of a system for fellowships and/or on the job training to develop expertise in M&E, infectious disease and
laboratory; initiation of a Field Epidemiology and Laboratory Training Program (FELTP); and support for new distance learning
activities with the MOH.
Following independence in 1975, the MOH designed a strategy to reach the most remote communities with basic health care
services through the creation of Agentes Polivalents Elemetares de Saude (APES), also known as Community Health Workers
(CHWs). The MOH continued to implement this strategy for a number of years, though the scale of implementation fluctuated for
all levels of CHWs, including in areas such as scope, name of the cadre, training and remuneration. APEs, in particular, ceased
functioning in Mozambique except in a small number of remote locations. In 2007, the Government of Mozambique (GRM)
declared its commitment to the strengthening of primary health care through community health workers and community
involvement to address the most critical health needs. The Minister of Health requested USG support to revitalize the
APES/CHWs. This began in FY08 with the development of a detailed operational plan and a finalized training curriculum. The
USG financing of the GRM's APE program will consists of components which are central to building a national program. These
components include training, institution strengthening interventions and direct financing support for APE salaries in the initial two
years of the program, with the goal that funding be assumed by other donors or MOH; 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.
The MOH, USG and other donors are working to coordinate efforts on this important effort to expand the number of health
workers in Mozambique. Both the World Bank and Round 8 Global Fund Health Systems Cross-cutting Intervention contain
support for revitalizing CHW efforts.
A FY08 evaluation of the quality of the ART training for clinical officers developed by PEPFAR-supported partners highlighted the
need for the development of a formal clinical mentoring system; clinical officers performed poorly on a number of key HIV
treatment tasks including clinical staging, recognition of drug toxicity and adverse drug reactions, and initiation of cotrimoxazole
and antiretroviral therapy. Work on the development of this clinical mentoring system is well underway. Also in FY08, the protocol
and data collection tools for a task analysis of nursing cadres and clinical officers were developed, with implementation planned
for early FY09. The results of this assessment will inform changes in the pre-service curricula for nurses. A third evaluation
funded in FY08 that is underway is the analysis of performance standards for pre-service institutions. As a result of the lengthy
approval process for PHEs in FY08, the proposed PHE to examine the number of students graduating from pre-service education
who are incorporated into the National Health System and factors that promote or inhibit entrance into the system, will only begin
in FY09. In FY09, funds are being requested to conduct an assessment of quality of care in a minimum of six district hospitals in
two provinces. Information from this evaluation will be used to revise pre-service education.
In FY08, some PEPFAR implementing partners provided gap year funding for recent graduates in order to assure that they were
immediately employed at government level salaries while the recruitment process with the National Health Service was underway.
Recent graduates have historically been lost to the public sector due to long administrative delays in initiating their contracts with
MOH. In FY09, lead clinical partners will provide gap year funding in all provinces. Also, funds are programmed to expand the
level of support for building health worker houses to promote health worker retention in rural areas, along with other medium size
infrastructure projects.
Twinning continues to develop the capacity of local organizations. The four ongoing twinning partnerships receiving continuing
support are: Catholic University of Mozambique (UCM) for the development of a clinical training facility; ANEMO, the national
nursing association, for institutional capacity development; Positive Prevention (PP) for development of programs; and a South-
South TB partnership. For the UCM partnership, funds will be used to establish the training facility as a treatment facility so that a
cohort of patients is established for training purposes, to continue curriculum development for various levels of health care
workers, and to work with the MOH to integrate HIV care with primary medical care. A designated staff has been brought to UCM
to work on launching and sustaining this project. In FY08, the twinning partner for ANEMO officially changed to St. Luke's
Hospital School of Nursing. FY09 funds will be used to develop and implement a comprehensive communication plan to reach
members, work on a strategy to improve organizational capacity and work on more sustainable financial stability for ANEMO.
Positive Prevention (PP) programs will continue FY08 activities along with incorporating key PP messages in clinical, home-based
and community care activities and, via a sub-partner, will support prevention projects that target women. Local twinned NGOs will
be reviewed by the new UGM to see what needs to be addressed for sustainability. The TB twining partnership will look at
increasing TB and HIV/TB literacy and to empower patients and affected communities to seek timely diagnosis and treatment.
FY09 funds will be used to increase the number of scholarships for individuals in a variety of topics germane to public health.
Deliverables and products:
Operational plan for MOH HRH strategy; assessment of the HRIS; an improved pre-service curriculum for clinical officers and
nurses; improved teaching skills of facility faculty through training; training information systems for in- and pre-service; quality
standards for pre-service institutions; a larger number of new graduates beginning work immediately; a viable clinical training
facility; a greater number of local NGOs with improved management; increased organizational capacity in associations; initiation
of fellowship programs, including FELTP; implementation and M&E capabilities; refinement of the MOH financial system;
expanded partnerships with the private sector; and an increased number of workplace programs and policies.
Table 3.3.18:
ACTIVITY UNCHANGED FROM FY08.
Salary
The Health Communications Specialist position supports the training and human capacity development
work among with CDC-USG and implementing partners, including technical assistance, coordination and
leadership to universities and training institutions in the Ministry of Health. PEPEFAR funds ($53,970) will
continually support salary and benefits for the Health Communication Specialist.
Training team travel
FY09 funds (45,000) under this activity will support in country and international travels of the training
technical staff (Senior Training Specialist, Training Advisor and Health Communication Specialist) providing
technical assistance to the MoH and working with PEPFAR funded partners.
Health Workers Study Tour
This activity contributes for capacity building of MoH staff from various departments, including Human
Resources, Training, Health Education Departments (RESP) and the HIV/AIDS Program to design the
behavioral intervention for health workers in Mozambique.
FY09 funds ($35,500) will be used to conduct an exchange study tour for MOH and CDC staff to assess
Health Worker and Caring for Caregivers Programs in Tanzania, Zambia, Swaziland and possibly other
countries in the region. This exchange visit will give the opportunity for the MOH staff (stakeholders)
involved to analyze activities currently undertaken in Southern Africa and to assess and inform the best
intervention to be designed and applied to the Mozambican context to support health workers and their
partners, trainees from the MOH Training Institutes with HIV risk reduction, support behavior change and
reduce stigma in the their personal life and at their workplace.
Deliverables/Products to be achieved with FY09 funds:
# of regional exchange study visits for MOH/CDC staff to assess Health Worker and Caring for Caregivers
Programs in Zambia, South Africa, Swaziland and possibly other countries in the region;
Continuing Activity: 12950
12950 8635.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $88,037
Estimated amount of funding that is planned for Human Capacity Development $45,000
Estimated amount of funding that is planned for Education $35,500
This amount will partially fund the Global Fund Liaison position for Mozambique for one year. The position
will facilitate better coordination between the Global Fund and USG efforts including those of the
Partnership Framework.
The CDC office currently has sixty-two (62) approved positions under various mechanisms - including eight
(8) direct hires, forty (40) locally employed staff, including two (2) Eligible Family Member (EFM), and
fourteen (14) contracted staff (COMFORCE, PSC). Thirty-nine (39) positions are currently filled, and twenty
-three (23) positions are currently vacant, but will be filled in the near future. Recruiting and hiring in
Mozambique has proven to be difficult on many fronts due to a lack of available hiring mechanisms
(Comforce is no longer available for overseas hires), DIRE/visa issues with the local government and
severe shortage of local human resources. Even with these tremendous challenges, CDC has been able to
fill many of the vacant positions and is on line to fill the outstanding vacancies during this next fiscal year.
Of the twenty-three (23) CDC vacant positions, selections have been made already for five (5) positions and
are only awaiting final clearances. Of these five (5) positions, two (2) are interagency in nature.
Additionally, three (3) of the 23 positions are in the final stage of the selection process, with placement
expected shortly. The remaining fifteen (15) positions are at various stages of the recruitment process, from
finalizing position descriptions to advertising positions to interviewing of candidates.
Most of the costs included in the M&S budget cover expenses related to supporting the CDC staff and office
expenses. Some technical staff salaries are included in the M&S budget per COP Guidance.
This activity contains funding for the following administrative costs:
- Salary Costs - ($284,742) Admin Assistant PEPFAR Coordinators Office,Contract Specialist I, Contract
Specialist II, HIV Prevention Specialist, Outreach Information Specialist,Prevention M&E Officer.
- Travel (Technical staff Travel) - $150,000
- Office Rents - $356,471
- Residential Electricity - $108,000
- Residential Water - $27,000
- Telecomuting - $10,400
- Local Guard Service - $105,600
- Staff Training - $35,000
- Translation Services for Technical Documents - $75,000
- Office Maintenance- $25,000
- Office Cleaning Services - $8,520
- Virtual Assistance with Programs - $7,500
- Automobile Maintenance - $35,000
- Automobile Fuel - $23,100
- IT Equipment - $93,581
- Housing Upgrades - $250,000
- Comunication - $11,000
- Industrial Shredder - $8,000
- Office Furniture for new Positions - $20,000
- School Fees - $129,816
Continuing Activity: 12951
12951 8634.08 HHS/Centers for US Centers for 6347 3529.08 GHAI_CDC_PO $1,681,877
8634 8634.07 HHS/Centers for US Centers for 4867 3529.07 GHAI_CDC_PO $226,772
Table 3.3.19:
