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
SUMMARY and BACKROUND
Since 2004 EGPAF has supported the expansion of integrated PMTCT services within existing maternal
and child health (MCH) services in four provinces. In addition, EGPAF has strengthened the linkage
between PMTCT and care and treatment services to ensure access to ARV treatment (ART) for HIV+
pregnant women and their families. EGPAF has expanded PMTCT support to a total of 42 health facility in a
total of 27 districts. Between October 2007 and June 2008, a total of 65,643 pregnant women received HIV
counseling and testing at EGPAF supported sites, and 9,738 women were identified as HIV+ of whom 6,341
received ARV prophylaxis and 644 ART (7%); 3,738 exposed infants received ARV prophylaxis and 3,807
started CTX. EGPAF will support scale up of PMTCT services to a total of 82 sites in FY09. The percentage
of HIV+ women receiving ARV prophylaxis will increase from 65% to 75% and the proportion of women
starting ART will increase from 7% to 15%. EGPAF targets to increase the percentage of infants receiving
ARV prophylaxis to 75% of exposed infants while increasing the percentage of exposed infants receiving
CTX prophylaxis to 60%.
While PMTCT has expanded and over time important improvements have been made to increase access
and quality of services, several challenges remain. These include: adherence to ARV regimens, enrollment
into long-term care, timely access to ART for eligible women, low levels of institutional deliveries in some
districts, follow up of HIV exposed infants until definitive HIV diagnosis, and effective promotion of and
support for safer infant feeding practices. For interventions to be successful, involvement of the community,
in particular male partners and mothers/mothers-in-law, is necessary.
In FY09 EGPAF activities will focus on:
-Providing technical support to MOH for the development or revision of policies, guidelines, training
documents, IEC materials and job aids through active participation in relevant working groups;
-Providing technical support and managerial and technical capacity building at provincial (DPS) and district
(DDS) MOH levels;
-Supporting districts to expand PMTCT services into peripheral sites;
-Fostering family-focused approaches in the supported health centers;
-Supporting the implementation of a quality improvement program;
-Ensuring linkages between health services and community that will improve adherence to services,
including access to psychosocial support services.
To enhance the capacity of DPS and DDS to oversee, manage and monitor HIV services including
MCH/PMTCT, and improve integration of EGPAF-supported activities into DPS and DDS HIV and health
plans, EGPAF will move to a district-wide approach which establishes a partnership between EGPAF and
the districts and includes a subgrant to the district for the delivery, expansion and quality improvement of
services.
ACTIVITIES
(1) Improve capacity of DPS and DDS to expand and manage PMTCT programs. ($2,132,000)
To enhance the capacity of DPS and DDS to manage and monitor HIV services including MCH/PMTCT,
and achieve better integration of EGPAF supported activities into DPS and DDS HIV and health plans,
EGPAF plans to move to a district-wide approach. This will includes support for quarterly task force and
coordination meetings, joint supervision; recruitment of additional MCH nurses and lay counselors to reduce
the human resources gap impairing quality service delivery; and funds for medical equipment and small
renovations needed to ensure confidentiality within MCH services.
(2) Training and mentoring. ($1,109,000)
In FY08 EGPAF initiated a PMTCT clinical mentoring program. In FY09, EGPAF will continue to implement
this mentoring program. District level chief MCH nurses will be trained as mentors so they can support the
scaling up of quality PMTCT programs within their district and ensure expansion into all health facilities with
ANC services. Funds will support formal training in mentoring and PMTCT and counseling and testing,
supervision and the mentoring of health staff on site.
(3) Quality Improvement of MCH/PMTCT services ($ 465,000)
To ensure quality of services during the scale up of PMTCT services, EGPAF will support the
implementation of a Quality Assurance (QA) program. This will utilize tools developed by MOH. The
modules of this program support the development and strengthening of clinical skills, patient friendly service
delivery, management skills, and monitoring and evaluation for performance improvement.
The mentoring program and quality assurance programs will contribute significantly to building capacity of
health staff at provincial, district and health facility level and thus contribute to the sustainability of the
MCH/PMTCT program.
(4) Primary Prevention ($279,000)
Primary prevention is included in services for women starting ANC through group education and counseling.
EGPAF will continue to support integrated routine screening for STI's, including rapid syphilis testing in
ANC. Supported prevention education activities include theatre, group discussions, working with community
leaders.
(5) Linkages with Communities and Psychosocial Support ($515,000)
Through the partnership with local CBOs and the employment of peer educators and lay counselors,
EGPAF supports psychosocial services for pregnant women and mothers living with HIV. In addition to
support group activities, they have implemented infant feeding counseling and food preparation
demonstrations. They further provide active tracing of defaulting patients including pregnant women and
HIV exposed infants lost to follow up. EGPAF will continue to support the implementation of support group
activities at the health facility level through training of peer educators and health staff. EGPAF recognizes
that enhancing the organizational and programmatic capacity of community based partners would improve
the overall program quality and provide the organization with the tools to grow, expand coverage and
Activity Narrative: become independent. By providing financial/managerial and programmatic oversight of these subgrantees,
EGPAF will build capacity of local CBOs in these areas.
To strengthen linkages between health facility-based services and community-based support services,
EGPAF will provide basic PMTCT-related training of community leaders, traditional birth attendants with
focus on encouraging facility-based delivery and follow up, and CBO volunteers. EGPAF will also support
district level meetings that include DDS, health facility staff, community leaders, and CBO representatives.
In context of primary prevention and linkages, EGPAF will continue to make efforts to ensure that male
partners are invited for HIV counseling and testing, and issues around gender-based violence will also be
addressed in the context of psychosocial support.
(6) Support to MOH ($150,000)
The Foundation has supported MOH at central level in several technical working groups. In FY09 EGPAF
will continue to be actively involved in these working groups. Areas that need to be addressed are:
integration of ART in ANC/MCH services, improving male involvement and psychosocial support guidelines
for HIV+ pregnant women. EGPAF has used its past experience in running support groups and materials
developed to contribute to the development of national guidelines and training curriculum, lead by I-TECH to
be finalized. For FY09 EGPAF plans to support roll out of the PMTCT support groups using national
guidelines and training curriculum. The Foundation will continue to support MOH for the operationalization
of the Infant Feeding Policy and the Strategy for Communication and Social Mobilization for the Promotion,
Protection and Support for Breastfeeding which is being drafted in the last quarter of 2008. This
operationalization includes the development and reproduction of job aids and IEC materials and support for
IEC activities, and the training of relevant staff of MOH, community workers and CBO workers in the use of
these materials. EGPAF will work with DPS to document and share lessons learned and best practices
regarding the mentoring and QA programs and PMTCT service delivery and expansion in general.
In addition, the supported package of PMTCT services will include continued promotion of dual protection
and integration of provider initiated testing and counseling (PITC) within Family Planning services, support
for medical equipment, and distribution of insecticide treated bednets for malaria prevention will be
integrated into services in coordination with PMI.
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
* Malaria (PMI)
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $1,200,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $75,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Summary and Background:
Activities are carried out to ensure care and support for HIV-infected patients and families throughout the
continuum of illness. EGPAF has been supporting the implementation of a comprehensive package of HIV
care and treatment services to HIV infected patients in a total of 25 districts in four provinces. This will be
expanded into an additional 7 districts. Care and support services have been crucial components of the
program. EGPAF has supported clinic-based care and support services as well as community-based care
and support services by providing small subgrants to local, community-based organizations.
Providing a comprehensive care package of care and support includes the prevention, diagnosis and
treatment of opportunistic infections, assessing and addressing nutritional needs as they interact with health
status and treatment success, and pain management. In addition, addressing psychosocial needs of adults
in care is crucial and includes continuous counseling, including secondary HIV prevention or Positive
Prevention, adherence support as well as ensuring linkages with home-based care and community support
services where available.
EGPAFs activities to ensure palliative care for identified HIV infected adults focus on:
- building capacity within the health facility setting to provide comprehensive and quality patient and family
centered HIV care and support services through training, formative supervision jointly with SDSMAS and
DPS, clinical mentoring, and quality assurance; training and formative supervision will include district health
staff in management and supervisory roles to enhance their skills in supervising and improving the quality of
clinic-based care and support services;
- building capacity within community-based organizations to provide quality patient and family centered HIV
care and support services, through training and technical assistance, including the provision of job aids;
- facilitate district-level coordination and effective linkages between health facilities, community-based
organizations and other existing support services.
EGPAF will support HIV care and support services in a total of 59 health facilities in 31 districts.
EGPAF plans to provide care and support services to 66,434 patients and provide Cotrimoxazole
prophylaxis to 33,217 patients. 80 health staff will receive training to provide HIV-related care and support
for HIV infected individuals.
Activities and Expected Results:
OI Management:
Health staff will receive (refresher) training in OI management for adults. This training will also include the
assessment and management of pain. During OTJ training and mentoring by EGPAF's clinical advisors,
attention will be paid to the management of opportunistic infections. Eighty health staff will be trained in OI
management.
In Gaza province, EGPAF has supported the provision of bednets and safe water supplies (Certeza) to
PLHA on ART and pregnant women through a collaborative effort with PSI. EGPAF will seek continued
collaboration with PSI for this purpose in Gaza and other provinces depending on the resources available to
PSI.
As existing data indicate a high prevalence of syphilis in Cabo Delgado of syphilis, EGPAF will work with the
DPS in Cabo Delgado to assess the reason behind this high prevalence in conjunction with assessing
prevalence of congenital syphilis. Based on findings, EGPAF will support DPS Cabo Delgado to improve the
diagnosis and management of syphilis, providing OTJ training to health staff, ensuring availability of rapid
syphilis tests and adequate treatment of diagnosed cases.
Nutrition assessment and support:
EGPAF will continue to support the implementation of activities related to HIV and nutrition. To ensure that
the assessment of nutritional status is routinely done in all PLWH, OI training of staff includes the
assessment of nutritional status (including for the pre-TARV period) and management of malnutrition in
adults (assessment, treatment and supplementation). In addition, staff will be trained in nutrition counseling
and monitoring of nutrition interventions, specifically the provision of Plumpy'Nut for outpatient treatment.
Malnourished adults will be referred to nutritional supplementation interventions where this is available.
Positive Prevention (PP):
Two of EGPAF's Care and Support Officers participated in the TOT on PP. EGPAF will train 80 health staff
and lay counselors on Prevention with Positives, using the recently developed training. Additional health
staff will be trained on-the-job. Also volunteers of the community-based organizations can be trained in PwP
during the regular OTJ training/workshops for the subgrantees.
Community linkages and Psychosocial Support:
EGPAF will continue to build capacity within local, community-based organizations to provide psychosocial
support services for PLHA, patients on ART and their families. This includes training of community
volunteers and leaders in technical areas (e.g. HIV, PMTCT, pediatric HIV, nutrition and HIV, PwP,
etcetera), organizational capacity building of these CBOs, as well as the provision of small subgrants for the
implementation of psychosocial support and health and nutrition education activities. These include: general
HIV education in the community, active tracing of defaulting patients, nutrition counseling and adherence
support, facilitation of support groups, linkages with food support initiatives and small income generating
activities in some instances. Once trained, volunteers will be able to support PwP activities. EGPAF will
provide subgrants for the implementation of these activities to 15 CBOs.
In districts without viable community-based organizations, EGPAF will recruit and provide training and
supervision to a total of 60 volunteers/peer educators to support counseling and education within clinical
services as well as conduct active tracing of defaulting patients.
EGPAF will work with the SDSMAS to enhance the role of Acção Social in providing psychosocial support
for HIV-infected persons and their families, especially for particularly vulnerable families. To ensure
coordination of activities and effective linkages between clinic-based services and community-based
Activity Narrative: services, EGPAF will support and facilitate quarterly district level coordination meetings that include
SDSMAS leadership, CBO leadership, community-leaders as well as district level staff from other
organizations, including those supporting home-based care and other HIV support.
Clinic-based counseling and psychosocial support:
EGPAF will continue to support districts to recruit additional staff to strengthen the teams providing care and
treatment services. These include lay counselors, to ensure counseling of patients in care and on ART and
referral to community-based support services. Lay counselors together with peer educators facilitate
support groups for patients in care and on ART.
Monitoring and evaluation:
The computer based patient tracking system (PTS) will be expanded to 17 districts. This PTS facilitates the
monitoring of quality of care provided to patients in care and provides important information regarding the
monitoring and retention of patients in care, treatment adherence, and occurrences of OIs.
In the EGPAF supported QA program specific attention will be paid to indicators related to quality of care,
including TB-screening of HIV-infected patients and the provision of OI prophylaxis. EGPAF staff will work
with health staff to identify and address barriers to providing quality care services and reduce the number of
patients not on ART who are lost to follow up before they are eligible to initiate ART.
Systems strengthening
To enhance the capacity of DPS and DDS to oversee, manage and monitor HIV services and achieve
better integration of EGPAF supported activities into DPS and DDS HIV and health plans, EGPAF plans to
move toward a district-wide approach which establishes a partnership between EGPAF and the district and
includes a subgrant to the district for the delivery, expansion and quality improvement of services.
Reinforcement of the institutional capacity will include support to quarterly task force meetings, joint
supervision at provincial and district level; recruitment of additional health staff to strengthen teams and lay
counselors to reduce the human resources gap in the districts and ensure staff to implement psychosocial
and adherence support activities. It also includes funds for medical equipment and small renovations that
will facilitate patient flow and ensure confidentiality during consultation and counseling sessions.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12964
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12964 8595.08 HHS/Centers for Elizabeth Glaser 6352 3574.08 Track 1 ARV $350,000
Disease Control & Pediatric AIDS Moz
Prevention Foundation Supplement
8595 8595.07 HHS/Centers for Elizabeth Glaser 4869 3574.07 Track 1 ARV $1,004,591
Estimated amount of funding that is planned for Human Capacity Development $128,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $18,241
Table 3.3.08:
April09 Reprogramming: Increased $466,173.
Project HEART is in its third year of implementation in Mozambique. Through Project HEART,
EGPAF/Mozambique is supporting the Mozambique Ministry of Health (MOH) to implement HIV care and
treatment programs in four provinces (Gaza, Maputo, Nampula and Cabo Delgado), using an integrated and
holistic approach, EGPAF/Mozambique is improving quality of services through formal, in service training
and mentoring; capacity building; family-centered approaches to comprehensive care; community
education, sensitization and mobilization; and support for the development of guidelines and creation of an
enabling policy environment at the national level.
By the end of Project HEART Year Five (PY5), EGPAF will support the care and treatment services in 25
districts (24 plus pediatric care and treatment in Machava) within four provinces. By the end of June 2008,
Project HEART/Mozambique had ever enrolled a total of 32,391 patients in care, with 10,408 ever receiving
ART. Overall, since the program's inception, 358 patients on ART (3.4 percent) have died, 623 patients on
ART (5.9 percent) were lost to follow-up, and 220 patients (2.1 percent) were transferred out to other health
units. SAPR data reported from 3 sites for FY08 showed that 88% of patients were alive and on treatment at
12 months of treatment initiation. Efforts are being made to improve the quality of data regarding retention
of patients in care and treatment.
During its 4th year of implementation, EGPAFs care and treatment program will focus on implementing
comprehensive, family-focused care and treatment programs in a total of 59 sites (38 ART sites and 21
satellite sites) in 34 districts in 4 provinces and initiating ARV treatment in 8,475 patients with a total of
18,780 adults on ART by September 2009 and 28,209 by September 2010. During FY09 EGPAF will
expand support to eight new, remote districts. New districts are: Chicuacuala, Massangena and Chigubo in
Gaza Province, Memba in Nampula Province, Magude in Maputo Province and Balama, Macomia and
Namuno in Cabo Delgado Province. In addition, by the end of FY09 Care and Treatment services in Nacala
Porto as well as the Clinical HIV services in the Police Health Facility in Matola will have transitioned from
ICAP support to EGPAF.
EGPAF is the Lead PEPFAR clinical partner in three provinces (Maputo, Gaza and Cabo Delgado). In
these provinces, EGPAF will work particularly closely with the DPS to strengthen the provincial system
primarily by hiring three Clinical Advisors to provide technical support to the Provincial Health Directorates.
The advisors will assist the DPS office in planning, implementation, coordination and monitoring of clinical
care and mentoring activities related to HIV/AIDS and Tuberculosis within the province they are assigned to
work. As lead partner, EGPAF will also support the DPS to coordinate HIV/AIDS activities at provincial level
including organizing and convening monthly/quarterly provincial partners' meetings, taking the lead in
supporting expansion of treatment services where there is no partner coverage and if resources permit.
EGPAF plans to move towards partnerships between EGPAF and the DPS and District Social and Health
Directorates (DDSMAS) that will include a subgrant for the delivery, expansion and quality improvement of
services. This will help to enhance organizations and human resource capacity of DPS and (DDSMAS),
achieve better integration of EGPAF supported activities into DPS and DDSMAS HIV and health plans, and
work toward sustainable programs and services.
Treatment Expansion
EGPAFs approach is to support the MOH in the implementation of the national HIV/AIDS strategic plan and
initiate and strengthen HIV care and treatment services integrated into existing health services. Care and
treatment services follow national guidelines and for formal training MOH training curricula are used.
To ensure that HIV is more systematically diagnosed in health care facilities in order to facilitate patient
access to HIV prevention, treatment, care and support services, EGPAF has worked with the health
facilities to ensure the provider initiated counselling and testing (PICT) is implemented at the main entry
points into care, in particular in the inpatient department and TB clinics, pediatric outpatient consultation,
family planning services, and STI clinics. HIV- testing is routinely offered in ANC and maternity service,
including postpartum to those women not previously tested. HIV-positive patients are immediately enrolled
into care and screening and staging is taking place as soon as possible and ART initiated if patient is
eligible and ready to initiate ART. In some sites ART for pregnant women is initiated in ANC, while in others
HIV+ pregnant women are referred to ART services when eligible. All HIV-positive patients are screened
for TB and referred for TB prophylaxis or treatment as needed.
EGPAF will support DPS to provide training to health staff in HIV-related services; for province level, formal
MOH curricula are used for the training. In addition to in service training, EGPAF staff will provide formative
supportive supervision, on the job training based on identified gaps and quality issues, and clinical
mentoring on site.
EGPAF will reinforce and standardize its district approach, using its technical expertise to assure effective
implementation of existing Care and Treatment clinical care tools and strengthening tools where needed.
EGPAF will have cross-functional geographic teams to provide medical, clinical, psycho-social and
community technical assistance to sites and districts. EGPAF will initiate subgrant financing with provinces
and districts to support needed inputs, such as staff, equipment and supplies. Quarterly payments will be
tied to steady progress in quality and efficiency of care and treatment as identified in regular supervision
visits. EGPAF will support capacity development of Mozambican providers to provide integrated clinical
services with consistent and effective use of job aids, algorithms, medical record flow charts, supervision
check lists and other clinical systems. In addition to site support, EGPAF will support districts and provinces
to identify best practices and lessons learned for broader implementation and support specialized technical
assistance for provinces. When implemented, EGPAF will support the roll out of the MOH clinical-
mentoring, started in FY08 on a pilot basis (Cabo Delgado).
Community linkages and adherence support
Activities aimed at improving adherence to therapy will continue and reinforced during COP09. Activities will
include provincial trainings on adherence and psychosocial support, training of peer educators and
initiatives with PLWHA including positive prevention using materials already developed through CDC
Activity Narrative: support.
Within the health facility lay counselors are employed to support pre-ART and adherence counseling.
EGPAF has been actively involved in the development of the adherence counseling training curriculum for
health staff and lay counselors and will continue to train health and lay staff in adherence assessment (pill
count), counseling and support. EGPAF will work with facilities to improve the identification of defaulting
patients by improving filing system and monitoring of planned consultations taking place, to ensure that
defaulting patients care rapidly be tracked and recuperated.
In addition, EGPAF has established partnerships with local community based organisations (CBOs) and
recruited peer educators and lay counselors to provide psychosocial services for patients in care and on
ART.
The CBOs implement support group activities and through their volunteers conduct active tracing of
defaulting patients. In some districts home-based care including adherence counseling and defaulter tracing
is supported by other USG and non-USG partners and collaborative relationships are established.
To strengthen linkages between health facility based services and community-based support services,
EGPAF will support DDMAS to conduct district level coordination meetings that include DDMAS, health
facility staff, community leaders, and CBO representatives. Where needed, job aids will be developed for
this group.
Finally, nutritional support for severely malnourished patients (following MoH criteria) with Fortified Blended
Foods (FBF) as approved by the MoH, for an estimated 10% of HIV+ patients costing approximately $1.00
per day per patient or $120.00 per patient for a 4 month period, for 4-6 months as needed.
Monitoring and Evaluation/Quality Assurance
EGPAF/Mozambique continues to collaborate with the HIV Quality Improvement program-HIVQUAL and
John Snow Incorporated (JSI) on implementing a capacity building model for quality improvement, designed
to improve care and treatment for people living with HIV. Quality of care in clinical settings is measured by
defining core indicators based on national guidelines; abstracting charts from a randomized sample of
patients; and using performance data to identify with health staff quality improvement interventions and to
identify priorities and strategies followed by monitoring progress over time. This specific program will be
expanded into eight new sites. However, in any other sites not specifically targeted with the HIVQual QA
program, random chart reviews will be conducted during routine supervision and provide the basis for the
identification of quality of care issues, discussions with staff on challenges and recommendations for the
site as a continuous process of quality improvement.
Continued support from JSI will ensure that the HIVQUAL tool and methodology are integrated into
EGPAF's overall quality management plan and are part of a wider quality improvement process in EGPAF-
supported sites. The purpose of this collaboration is to build capacity within EGPAF staff as well as within
MOH staff at the district and site levels. EGPAF has provided districts with an electronic patient tracking
system (PTS) and finances data entry clerks at these sites. This will be expanded to an additional 8
districts. EGPAF will also work with district and their data entry staff to improve their skills in analysis,
interpretation and use of available data for performance assessment and improving capacity for monitoring
and evaluation at the district level. At global program level, data will be used for basic program evaluation.
Sustainability
As a first step in the transition to local ownership and ensure the long-term sustainability of the program,
EGPAF will move toward a partnership with DPS and DDSMAS that includes sub grants. EGPAF will
provide sub grants that will allow province and district to fill resource gaps that are a barrier to quality
service delivery, such as additional health and lay staff, equipment and supplies, resources of regular
supervision, transportation of samples, provision of water and electricity, minor infrastructure improvements.
The training and support necessary to ensure management and accountability for these funds contribute to
the institutional/managerial capacity building necessary for the DDSMAS/DPS as a local organization to
receive and manage funds directly in the future and contribute to strengthening the health system at district
and provincial level.
Continuing Activity: 12966
12966 5182.08 HHS/Centers for Elizabeth Glaser 6352 3574.08 Track 1 ARV $7,250,000
8593 5182.07 HHS/Centers for Elizabeth Glaser 4869 3574.07 Track 1 ARV $5,934,660
5182 5182.06 HHS/Centers for Elizabeth Glaser 3574 3574.06 Track 1 ARV $2,905,600
Estimated amount of funding that is planned for Human Capacity Development $213,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $12,161
Table 3.3.09:
Since 2006, a total of 2,011 children were enrolled in in care and treatment services in 22 districts with 25
service outlets supported by EGPAF. Of those children, 629 had initiated ART. EGPAF will continue to
support pediatric care and support services in 59 sites in 34 districts in 4 provinces. EGPAF expects to
enroll a total of 4,834 children into HIV care and train 80 health staff.
With PEPFAR funds, EGPAF will change its implementation approach from direct technical and financial
support based on specific requests to providing funding to the national health system at the provincial and
district levels through subagreements. EGPAF believes provincial and district level health authorities are
equal partners in the planning, implementation, and evaluation of service delivery. To strengthen overall
functioning of the health system, it is imperative that MOH counterparts are fully engaged and empowered
to identify needs and resources to improve quality of care and health outcomes. In an effort to improve the
management of service delivery and improve efficiency and sustainability, EGPAF will work closely with the
provincial and district level health authorities to develop workplans and budgets based on identified gaps
and needs and provide adeqaute resources and technical assistance to achieve results, particularly
preventing new pediatric HIV infections and increasing enrollment of pediatric patients in treatment.
Therefore,the majority of pediatric care activities will be implemented through subagreements with the DPS
and/or DDSMAS.
Increasing access to care for HIV exposed and infected infants is inextricably tied to the optimal functioning
of PMTCT, CCR and basic child health services. Pregnant women are routinely counseled and tested for
HIV in ANC and labor and delivery and HIV exposed children receive follow up care in post natal care and
are referred to CCR. Efforts are being made to implement provider-initiated counseling and testing (PITC)
in pediatric wards and at other points of entry into the health facility which has resulted in an increased
number of HIV-positive children identified. Once identified, these children are enrolled in care. Efforts are
then made to ensure the children are screened and staged, and that eligible children are promptly initiated
on ART, following national guidelines.
According to the new pediatric treatment guidelines, each child below 1 year of age with confirmed HIV
infection will initiate ART regardless of CD4 count. This provides an opportunity for MCH nurses to provide
pre-ART counseling and communicate PCR results during post-natal care and CCR. Given that treatment
will be initiated early, through support to both PMTCT and ART programs, EGPAF will strengthen linkages
between services to ensure children receive adequate follow up care. Specifically, EGPAF will designate
one lay counselor per site to provide counseling of children/caregivers and to reinforce linkages along the
continuum of care from point of entry to treatment. Currently, the average turnaround time for PCR results
is 8-10 weeks. EGPAF will continue to actively participate in the PCR working group which is tasked with
revising the PCR manual to improve the logistic component of PCR sample/results and to adapt the
counseling for caregivers accordingly. In addition, EGPAF will continue to provide transport support for the
collection and return of DBS-PCR and CD4 count samples.
Management of opportunistic infections, counseling and psychosocial support are integral components of a
comprehensive approach to caring for HIV-infected children. To ensure that health staff is well-equipped to
provide quality palliative care to children, EGPAF will support formal refresher trainings in OI prevention,
diagnosis and treatment for health staff and ensure that children promptly initiate ART. Further training on
IMCI/HIV/AIDS, early infant diagnosis and DNA-PCR will be provided. Classroom trainings will be reinforced
through regular on the job training, supervision and mentoring. At the provincial, district and facility level,
EGPAF will place strong emphasis on building capacity of health staff in the treatment of malnutrition in
children and TB screening in pediatric patients at each entry point. While pediatric ART services are only
available at the district level, EGPAF will support the decentralization of certain aspects of care, including
management of severe malnutrition, prevention and diagnosis of OIs and IMCI to peripheral sites through
training of health facility staff, strengthening of referral networks and ongoing supervision.
Enhancing the family's coping strategies in dealing with the child's illness including, increasing knowledge of
HIV and adherence and disclosure of the child's status to other family members, are important aspects of
pediatric care and support. However, often children and families do not have access to support that is
tailored to their developmental needs. In an effort to create the physical and emotional space conducive to
providing adequate care for children, EGPAF will provide support to districts to establish child friendly
corners in health facilities where children can engage with their families and other children. To address the
specific psychosocial needs of children, EGPAF will facilitate the creation of child support groups at each
health facility and organize ARIEL camps for HIV infected children and their caregivers. Through the camps
and support groups children receive HIV, adherence and positive living education tailored to their
developmental stage, individual and groups counseling and participate in recreational activities designed to
foster communication, self-expression and sharing of strategies for living with a chronic illness .
Loss to follow-up, particularly of HIV exposed children continues to be a major challenge to ensuring
children living with HIV are enrolled in and retained in care. To address this, EGPAF will identify and train
at least one lay counselor and peer educator based at each health facility to focus exclusively on the
counseling and active tracing of children and their caregivers who have abandoned care and/or treatment.
EGPAF will strengthen linkages between existing OVC care and support programs and clinical care,
particularly in Gaza Province. Working through community-based organizations and other partners with
programs targeting OVC and their families, EGPAF will ensure that OVC have access not only to HIV care
and treatment as needed, but are also referred to psychosocial support and food and economic assistance,
where possible.
At the national level, in collaboration with the MOH and other partners, EGPAF will support the pediatric
psycho-social support workshop to share lessons learned and provide updates on achievements and
challenges in the implementation of the national curriculum on pediatric counseling and adherence. EGPAF
will also continue to participate in different MOH level working groups focus on pediatric HIV care and
treatment. Specifically staff will contribute to the working group and roll out of EID, the working group on
pediatric TB.
Activity Narrative: In PY4, EGPAF collaborated with PSI to ensure access to LLIN and Certeza for children enrolled in HIV
care and treatment. EGPAF will seek continued collaboration with this PEPFAR partner to be able to
continue to provide these measures to prevent malaria and diarrhea in HIV infected children and expand
access into other provinces if possible.
monitoring of quality of care provided to patients, including children, in care and on ART, and provides
important information regarding the monitoring and retention of children in care, treatment adherence, and
occurrences of OIs.
In the EGPAF supported QA program indicators related to quality of pediatric care, including TB-screening
of HIV-infected children and the provision of OI prophylaxis, will be included. EGPAF staff will work with
health staff to identify and address barriers to providing quality care services and reduce the number of HIV
exposed and infected children in care lost to follow up.
* Child Survival Activities
* TB
Estimated amount of funding that is planned for Human Capacity Development $73,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,641
Table 3.3.10:
April09 Reprogramming: Increased $37,752.
This is a continuing activity.
Since 2006, a total of 2,011 children were enrolled in care and treatment services in 22 districts with 25
service outlets supported by EGPAF. Of those children, 629 had initiated ART of which 86.5% were
retained in care. During the 4th year of Project HEART (Help Expand Anti-Retroviral Therapy for Children
and Families) implementation in Mozambique, EGPAF will continue to support pediatric treatment services
in 59 sites in 34 districts in 4 provinces. EGPAF plans to enroll a total of 1,150 children in ART and train 138
health staff in pediatric ART in FY09.
With PEPFAR funds, EGPAF will change its approach from direct technical and financial support based on
specific requests to providing funding to the national health system at the provincial and district level
through subagreements. EGPAF believes provincial and district level health authorities are equal partners
in the planning, implementation, and evaluation of service delivery. To strengthen overall functioning of the
health system, it is imperative that MOH counterparts are fully engaged and empowered to identify needs
and resources to improve quality of care and health outcomes. In an effort to improve the management of
service delivery and improves efficiency and sustainability, EGPAF will work closely with the provincial and
district level health authorities to develop workplans and budgets to identify gaps and needs and provide
adeqaute resources and tehcnical assistance to acheive results, particularly preventing new HIV infections
and increasing enrollment of patients in treatment. Therefore, some pediatric treatment activities will be
implemented through subagreements with the DPS and/or DPS.
To increase access to pediatric treatment EGPAF will support similar activities for adult treatment with a
strong focus on improving early identification of HIV infection in children, building the capacity of health staff
to provide pediatric treatment, ensuring provider initiated counseling and testing at each entry point to
enhance the identification of infants and children in need of ART and improving linkages between PMTCT
and Care & Treatment services. Specifically, EGPAF will support formal trainings in various areas
including, EID, PITC, pediatric ART, pediatric counseling and adherence support, counseling on nutrition
and HIV and screening and treatment of malnutrition, including the use of ready to use therapeutic food
(RUTF). Roll-out of IMCI with HIV/AIDS component including training of health staff at the provincial and
district level is planned as well as the training of tecnicos de medicina in pediatric ART followed by
mentoring at EGPAF supported sites.
To complement these basic trainings, EGPAF technical staff will provide on the job training, supervision and
mentoring at the provincial and district level which will include follow up and support in the implementation
of revised pediatric care and treatment guidelines as needed. To facilitate sharing of experiences and
continuous training on pediatric HIV management, EGPAF will organize 2-week rotations for clinicians
based in the districts to perform clinical rounds and receive on the job training at Hospital do Dia in the
Central Hospital of Maputo or at Chamanculo.
Through continued support to pediatric HIV care and treatment services at General Hospital of Machava
EGPAF will launch a training program/learning center for health staff (i.e. tecnicos de medicina, agents de
medicina, MCH nurses) initially from selected districts supported by EGPAF to gain hands-on experience in
pediatric care and treatment and upgrade their skills and increase confidence in treating HIV-infected
children. To lead this initiative and provide support for pediatric treatment at Machava EGPAF has
seconded a pediatrician from the Baylor Center of Excellence.
EGPAF has provided districts with an electronic patient tracking system (PTS) and supports data entry
clerks. This will be expanded to an additional 8 districts. EGPAF will also work with district and their data
entry staff to improve their skills in analysis, interpretation and use of available data for performance
assessment and improving capacity for monitoring and evaluation at the district level. The PTS facilitates
the monitoring of quality of care provided to patients, including children, in care and on ART. At global
program level, data will be used for basic evaluation of pediatric care and treatmen programs.
EGPAF/Mozambique continues to collaborate with HIVQUAL and JSI on implementing a capacity building
model for quality improvement, designed to improve care and treatment for people living with HIV. Quality
of care in clinical settings is measured by defining core indicators based on national guidelines; abstracting
charts from a randomized sample of patients; and using performance data to identify with health staff quality
improvement interventions and to identify priorities and strategies followed by monitoring progress over
time. This program will be expanded to include pediatric HIV quality of care indicators. this QA program wil
be expanaed into 8 additional sites. in any other sites not specifically targeted with the HIVQual QA
program, chart reviews will be conducted during routine supervision and provide the basis for the
In the 3rd year of project HEART EGPAF will continue to implement a study, funded with FY08 PHE
monies, of the barriers to pediatric HIV care and treatment for HIV exposed and infected infants and
children. EGPAF will work with the supported provinces and districts to define strategies addressing the
barriers identified in this study. The results of this study will be shared with the MOH and other partners to
inform policy changes on access to pediatric care and treatment.
Faced with limited resources, health facilities in rural areas often do not have the appropriate equipment
and supplies required to treat children. Therefore, EGPAF will assist with the procurement of outpatient/
inpatient medical equipment suitable for children, including pill boxes, scales, examination tables, etc. -
provincial pediatric care meetings.
EGPAF has established partnerships with local CBOs and recruited peer educators and lay counselors to
provide psychosocial services for patients in care and on ART, including active tracing of defaulting
patients. EGPAF will work with facilities to improve the identification of defaulting patients by improving filing
Activity Narrative: system and monitoring of planned consultations taking place, to ensure that defaulting patients care rapidly
be tracked and recuperated through the collaboration with local CBOs. Lay counselors will be trained
specifically in adherence counseling and psychosocial support for children and their caregivers.
EGPAF will continue to partner with local community-based organizations in the four provinces to increase
the community´s ability to prevent HIV transmission, increase the use of health services with a particular
focus on prevention and treatment of pediatric infection and to provide psychosocial and nutrition support to
HIV+ children and their families in EGPAF supported districts. With regards to pediatric treatment, CBO
activities focus on the the creation of supports groups for HIV-infected and affected children and their
caregivers with the intent to support and improve treatment adherence and conduct active tracing of
defaulters.
With regards to nutrition, CBOs will be supported and trained to identify malnourished children in
communities and refer them to health services for treatment or supplementation (according to the
diagnosis). In line with the roll out of community based treatment for severely malnourished children without
complications, which is currently undertaken by the Ministry of Health, CBOs will also be capacitated to be
involved in the follow-up of children receiving this community based treatment in between their regular
consultations in the health facility, and active tracing where needed.
Estimated amount of funding that is planned for Human Capacity Development $300,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $150,000
Estimated amount of funding that is planned for Water $50,000
Table 3.3.11:
REPLACEMENT NARRATIVE:
All PEPFAR clinical partners will support core TB/HIV collaborative activities in accordance with the WHO
Interim Policy (2004) in all districts and facilities that are supported for other clinical activities. This includes
(1) active participation in TB/HIV coordinating mechanisms at national, provincial, and local level, supporting
MOH TB/HIV planning and supervisory activities, and assisting with TB/HIV monitoring and evaluation
activities. In addition, clinical partners assist national TB programs with activities to reduce the burden of
TB in HIV-infected persons under their care through comprehensive and routine TB screening, isoniazid
preventive therapy (IPT) for those without symptoms or contraindications, and facility-level infection control
measures. Finally, all clinical partners support activities by the TB program to reduce the burden of HIV
through provider-initiated counseling and testing (PICT) for all TB patients (including children),
cotrimoxazole preventive therapy (CPT) (provided in TB clinics) for all TB patients, and referrals or on-site
provision of ART to coinfected patients. In accordance with new WHO guidance and with experience in
Mozambique that some activities (e.g. HIV-testing, CPT and ART) have advanced faster than others, all
partners will be encouraged to strengthen activities related to the 3 I's: intensified TB case finding, IPT, and
infection control. This includes support for routine (and WHO and NTP-recommended) contact tracing.
Partner-specific activities are described below.
This activity is related to EGPAF activities funded in adult and pediatric treatment, systems strenghthening,
Strategic information, systems strengthening and lab and infrastructure;
Through Project HEART, EGPAF/Mozambique is supporting the Mozambique Ministry of Health (MOH) to
implement HIV care and treatment programs in four provinces (Gaza, Maputo, Nampula and Cabo
Delgado). By the end of FY08, EGPAF will support the care and treatment services in 24 districts within
four provinces and within the program a total of 32,391 patients were enrolled in care, with 10,408 ever
receiving ART of which 629 children.
As of June 2008, 3,866 TB patients were counseled and tested. Of the 1,968 TB patients identified as HIV-
positive (51%), 468 initiated ART (23.8%). While EGPAF has strengthened the linkages between TB and
HIV, additional improvement is needed.
Care & Treatment: TB/HIV
During project year 4 (PY4) and PY5 EGPAF Mozambique has reinforced linkages between the TB and HIV
services. Activities to this end included systematic counseling and testing of TB patients, systematic
screening of HIV patients for TB and progressive implementation of INH prophylaxis and increasing the
enrollment of co-infected patients in HIV care and treatment services.
To strengthen counseling and testing of TB patients, EGPAF/Moz has supported training of TB staff in HIV
counseling and testing in the 24 districts currently supported. This resulted in an impressive 91% of TB
patients getting counseled, tested and receiving their results. As a result over 90% of adult TB patients are
counseled and tested and receive their test results. However, staging and screening for ART eligibility and
initiation of ART remains low, between 18 and 28 percent of the total TB/HIV co-infected patients.
Currently, 24% of the TB/HIV co-infected patients initiate ART, while 75% of co-infected patients receive
CTX prophylaxis.
Regarding pediatric TB/HIV, the pediatric counseling curriculum and guidelines from MOH are nearly
finalized and then will be implemented. Counseling and testing of pediatric TB patients will be improved
over the coming year.
EGPAF has also worked with sites to ensure integration of TB staff into the ART committees and on-job
training, thus reinforcing the link between TB and HIV services. .
EGPAF has supported the implementation of systematic ICF by orienting MOH staff tin the use of the
screening tool and regular review of implementation in supported sites during direct supervision and
mentoring. The current MOH/HIVQUAL exercise will help evaluate the results of systematic screening of TB
among HIV + patients and improving access to ART for co-infected patients.
Through Quality Improvement activities, EGPAF has demonstrated increased referral efficacy from TB to
HIV services of HIV + patients from nearly non-existent to rates varying from 40% to 100% depending of the
Province and the reporting period. Challenges remain to identify more ART eligible patients; however, active
monitoring of the efficacy of referral will identify weaknesses to be addressed. EGPAF intends to increase
the percentage of TB-HIV co infected patients benefiting of ART from 24 % to 35% in FY09.
Regarding Isoniazide Preventive Therapy(IPT) and contact tracing, EGPAF will similarly monitor the
systematical implementation of these policies in its supported sites, districts and Provinces during the
second half of PY5. No data are currently available to assess how widely these policies have been
implemented at field level.
ACTIVITIES AND EXPECTED RESULTS
During PY6, EGPAF will continue quality improvement reviews to reinforce the links between TB and HIV
services in existing and new sites. EGPAF will ensure that MOH staff systematically counsel and offer HIV
tests to all TB patients. The proportion of TB patients offered HIV CT will increase to 95% with a target of
3,866 TB patients.
EGPAF will reinforce MOH/TB staff capacity to manage HIV co infected patients.
EGPAF technical staff will train MOH staff on identification of complications related to TB, HIV and ART. A
minimum of 66 staff members will follow formal training on TB and HIV co- management. EGPAF will
provide direct site support to reinforce proper referrals from TB to HIV services. Additionallly will suport the
the development of infection control plans in the sites (administrative and adequate environmental
Activity Narrative: measures). Education sessions and sensitization of patients and health staff will be provided to reinforce the
importance of preventive measures and to avoid nosocommial TB infection.
Screening for ART eligibility and initiation of ART will be a priority. EGPAF aims to enroll 35% of TB-HIV co
infected patients on ART.
EGPAF will strengthen contact tracing and implementation of INH prophylaxis, particularly targeting
children. A target of 15% of adult contacts should be reached by end of COP 09. EGPAF plans to reach
25% of children below 5 years, known contacts of TB patients. This will be estimated through reviews of TB
registers.
EGPAF will also ensure that MOH staff does implement systematic TB screening (using the ICF
questionnaire) of HIV+ patients within the HIV services, and reinforce initiation and adherence to CTX
prophylaxis for all eligible TB patients. EGPAF has set benchmarks for 50% of HIV patients registered
within C&T services and 75% of patients on ART to be systematically screened for TB by end of COP09. A
minimum of 1,673 HIV-TB co infected patients will be enrolled into care of which 586 will initiate ART.
- TB Laboratory capacity
Through laboratory mentoring in collaboration with FURJ/FUJB, three Provinces and 6 districts shall benefit
from this mentoring program. Standard operating procedures and quality of TB investigations and protocols
will be established and reinforced. This laboratory mentoring program will strengthen both Provincial and
district levels in Maputo, Gaza and Cabo Delgado Provinces.
Continuing Activity: 12965
12965 8594.08 HHS/Centers for Elizabeth Glaser 6352 3574.08 Track 1 ARV $450,000
8594 8594.07 HHS/Centers for Elizabeth Glaser 4869 3574.07 Track 1 ARV $145,000
Estimated amount of funding that is planned for Human Capacity Development $55,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $2,534
Table 3.3.12:
This is a new activity.
For FY09 PEPFAR Mozambique team has undergone a clinical partner rationalization exercise in order to
streamline support to cover all clinical services in a whole district by one clinical care partner. EGPAF will
have FY09 budget allocations to cover facility based counseling and testing interventions - Provider
Initiated Counseling and Testing and CT in Health.
In COP09, former GATV that are co-located with health facilities will be integrated with PICT programs
under the supervision of health facilities and clinical partners, while community-based outreach testing will
be managed by community partners. EGPAF will train health facility staff and support lay counselors to
provide HIV testing at 100% of EGPAF-supported facilities. EGPAF currently supports testing within health
facilities as part of PMTCT and PITC. At 16 former PSI-supported GATV services, these services will
continue to provide voluntary testing to patients at high risk, partners and family members who come to the
health facility. EGPAF will work closely with PSI to assure service continuity while maximizing the efficiency
of the model of testing. EGPAF will continue to work closely with community-based counseling and testing
to maximize population access to testing. When patients test positive, they will be enrolled into or effectively
referred to follow-up for enrollment in care and treatment.
Primary target population: Partners of pregnant women will be actively encouraged to come in for testing.
Family members of HIV+ patients will be encouraged to come in for testing. Provider-initiated testing will be
systematically implemented at all facilities, focusing on high risk groups, including all malnourished children,
hospitalized children, TB patients and family members.
Organizations implementing project: EGPAF will subgrant to DPS and DDS to provide comprehensive, high
quality HIV clinical services, including CT. EGPAF will support districts and health facilities to manage
previously autonomous GATV services.
PEPFAR funding will include in a subgrant to the DDS and DPS which will include staff and other direct
operating costs to support the service.
PSI has been supporting CT at 16 sites in EGPAF supported districts. As part of partner rationalization,
responsibility to support CT will be transferred to EGPAF. EGPAF will support these new CT services at a
level consistent with funding and with support at other district sites.
Over 50% of these funds will go to service expansion, as sites that previously did not support out-patient
testing of high risk patients, family planning and PITC services will be initiated.
Table 3.3.14:
THIS IS A NEW ACTIVITY
In FY06 EGPAF started support to MOH in Mozambique for the expansion of HIV Care and Treatment
services. In FY06, EGPAF implemented care and treatment services in two Provinces (Nampula and Gaza)
and eight districts where EGPAF was already supporting PMTCT services, helping MOH to increase access
to quality HIV care and treatment (C&T) services for HIV positive patients. In FY07, EGPAF increased its
support to four Provinces and 17 districts while in FY08, the expansion considered the same 4 Provinces
but 24 districts. As of June 2008, EGPAF has assisted the MOH to provide access to C&T services to
32,391 patients, including 2,011 children. From these, 10,408 initiated ART including 629 children.
Laboratory services are an integral service component to support optimal care and treatment to HIV
patients. As other USG partners supported laboratory services for HIV care and treatment, EGPAFs main
activity has been to assess adequacy of laboratory sites and adjusting working environment to optimize
laboratory services and practices in some key districts within available resources. This has included
laboratory renovations in some districts to ensure that laboratory infrastructure was such that new
equipment, provided by APHL, could be placed.
There are important challenges in providing quality laboratory services that are essential to proividing
quality HIV care. Biochemistry and hematology equipment is not avilable in all districts and CD4 equipment
so far has only been availabe in the provincial capital. Therefore, EGPAF has supported districts in
transporting of specimens when necessary. This shall be reduced once districts have been provided with
hematology and biochemistry analyzers and also CD4 equipment is placed in additional sites within the
province.
EGPAF has supported MOH in its efforts to roll- out DBS PCR program for Early Infant Diagnosis (EID) by
facilitating initial trainings, providing supervision at site level and contributing to the EID working group.
During the second half of FY08, to reinforce capacities and practices of laboratory staff and improve the
laboratory environment, EGPAF in partnership with Federal University of Rio de Janeiro (FURJ) will be
supporting a mentorship program initially in Cabo Delgado Province. This laboratory mentoring program will
cover first the provincial laboratory then include two key districts over an initial period of nine months.
EGPAF will recruit a Technical Advisor for Laboratory Services to be placed at the DPS in the EGPAF lead
provinces. This Laboratory Technical Advisor will build capacities at Provincial and district levels, identifying
logistic and organizational challenges, analyzing existing systems and procedures, defining priorities and
proposing sustainable solutions and improvements, in collaboration with EGPAF teams or other
implementing partners in the Province. The laboratory advisor will support training at site level, on the job
training of laboratory staff, as well as formal classroom training, including pre-service training as relevant.
The laboratory advisor will build the capacity of the Provincial laboratory counterpart, contribute to his
professional development, and improve coordination with different partners, donors and authorities. His
work shall be integrated with on-going laboratory activities within the province, specifically regarding the
EGPAF-FURJ laboratory mentoring program in the EGPAF lead provinces. The provincial Laboratory
Technical Advisor will make significant contributions to improve the quality of laboratory services in the
province where he will be posted.
Table 3.3.16:
patients. EGPAF has standardized laboratory services in different sites throughout the four Provinces. The
main activity has been to assess adequacy of laboratory sites and adjusting working environment to
optimize laboratory services and practices in some key districts within available resources. This has
included laboratory renovations in some districts to ensure that laboratory infrastructure was such that new
As CD4 machines are only available in the provincial reference laboratories, EGPAF has supported districts
in transporting of specimens when necessary. In some districts the transportation of samples for
biochemistry and hematology is supported as equipment is not available in all districts. This shall be
reduced once districts have been provided with hematology and biochemistry analyzers and also CD4
equipment is placed in additional sites within the province.
The laboratory Technical Advisor based at the EGPAF National Office level will be responsible for
overseeing the laboratory component of the PMTCT and Care and Treatment Program within the EGPAF
supported district and supporting EGPAF staff in providing supervision of laboratory services within the
program. In addition, (s)he will function as a counterpart for the three Laboratory Technical Advisor based in
DPS of EGPAF lead provinces.
The Laboratory Advisor will liaise and coordinate activities related to laboratory services with NGO's and
partners assisting the MOH in laboratory issues such as Clinton Foundation, SCMS, and APHL. The
Laboratory Advisor will identify weaknesses in laboratory processes, procedures, and logistics, propose
adequate strategies for improvement, and contribute to a plan towards building capacities at national,
provincial and district levels. He will give specific attention to realities and problems emanating from field
level, communicate needs and priorities identified and channel solutions to adequate forum and authorities.
The work of the laboratory advisor shall be integrated with on-going or new MOH national and provincial
laboratory activities and policies. He shall also respond to priorities identified by EGPAF teams or other
direct implementers in the Province in the lead Provinces., specifically regarding the EGPAF-FURJ
laboratory mentoring program in the Province. Overall, the EGPAF Laboratory Technical Advisor will
improve laboratory services as a crucial component of quality care in the provinces supported by EGPAF.
Estimated amount of funding that is planned for Human Capacity Development $85,000
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a new activity in that it is organized as its own separate activity, but is a continuation of the
subactivity listed as Activity 8639.08 in COP 08 (Provincial M&E Officers).
This is related to the following activities in COP 09:
Ministry of Health has placed increasing focus on strengthening human and technical resources at the
provincial level to improve the coordination and delivery of services in the province. In FY08, Ministry of
Health developed a standard set of technical advisor positions to be placed at the Provincial level; these
four positions included advisors in Clinical Care, Laboratory, Pharmacy, and Monitoring and Evaluation.
USG was asked to assist with the funding and recruitment of these positions at the provincial level. The
primary partner responsible for providing technical assistance in the area of clinical services in a province
will also be responsible for the recruitment and support of the four technical advisor positions, including this
Monitoring and Evaluation Technical Advisor position.
The M&E Provincial Advisor will provide support in the cooridnation of routine activities related to monitoring
and evaluation at the Provincial Directorate of Health, giving priority to endemic diseases, including HIV.
This advisor will help to reinforce adn support the implementation of the decentralization of HIV services
including related data collection systems. S/he will provide leadership in the supervision and management
of data to ensure the quality of data at the district and site level, help to strengthen the flow of data to the
district, provincial, and central levels. Additionally this person will support the Provincial Directorate of
Health in the analysis and dissemination of data (for example, to the site level, Ministry of Health, and
partners.) This person will sit within the Provincial Department of Planning and Cooperation at the
Provincial Directorate of Health.
EGPAF has been asked to place 3 M&E Advisor in Maputo Province, Gaza, and Cabo DelGado as part of
their overall support to clinical services in these Provinces.
Table 3.3.17:
April09 Reprogramming: Increased $401,941.
This activity will contribute to building a strengthened health system at the provincial level within a more
sustainable national system.
The Ministry of Health is vitally interested in developing a cadre of technical advisors, preferably
Mozambicans, where possible. The USG shares this goal and will be working with all treatment partners to
develop ways of preparing Mozambicans for these positions such as on-the-job mentoring and education. 1
Pharmacy and 2 Lab advisors placed at DPS will support Provincial and District Health Directorates to
ensure provincial HIV clinical health care quality, addressing supervision to clinicians and laboratory staff
and drug supply at the health facilities. Additionally, EGPAF clinical supervisors in provinces will be
increasingly directed to invest in province and district-level clinical capacity by supporting formal quality
improvement, training trainers, supervisors, development and use of clinical tools.
Given the urgent need for increasing the number health care workers at all levels, PEPFAR funds will be
used to pay for course fees associated with attending a pre-service institution. The goal of this activity is to
both increase the production of health care workers and lessen the numbers who drop out due to financial
constraints. $300,000 will support one class (20 students per class) for 20 clinical officers (Tecnicos de
Medicina) at the Institute of Health Science in Pemba after 3 years will increase the health workforce in
Cabo Delgado province ($200,000).
In addition, these funds will support one class (20 student per class) of MCH nurses ($100,000).
EGPAF will build further provincial health capacity by providing training and on-site clinical and financial
supervision of subgranted funds provided directly to provinces and districts for HIV clinical services
management. Provinces and Districts will receive needed funding for them to scale up PMTCT, CT and
Care/Treatment services. Subgrants funds will be used for the most critical bottlenecks or rate limiting steps
for HIV scale-up. EGPAF will provide managerial, financial and clinical training and on-going TA.
Developing financial and managerial capacity and the ability to meet compliance standards will increase the
province's ability to receive external funding from multiple donors. EGPAF will work collaboratively with
provinces and districts to develop proposals and budgets, support implementation and build capacity.
Districts will receive funds via subgrants to coordinate district wide services.
Gap year funding is a means for assuring employment for newly graduated health staff at Ministry of Health
facilities. New graduates will be hired using PEPFAR funds at Ministry of Health salaries and placed at
govenment health facilities while their recruitment process into the National Health Service is processed.
This typically takes anywhere from 6-12 months. PEPFAR funds for salary support will cease once the
graduate becomes an employee of the National Health Service. $40,000 are available to support the
provincial health directorate to pay salary for the period of time up to 12 months of approximately 25
graduates from training institutions assigned to different health facilities in the Gaza, Cabo Delgado and
Maputo provinces. It is expected that this gap year funding will retain graduates at their work while the
national health services and other ministeries finalize their recruitment process to become those new health
workers as public servants integrated in the national health services. In calendar year 2009, it is anticipated
that the MOH will institute salary reform and therefore raise salaries so the number of staff supported may
change.
As the Ministry of Health moves toward an integrated health care model, there is increasing need for better
coordination lead by treatment partners within health districts. PEPFAR funds will support coordination
activities to 31 districts.
In COP09 will for the first time treat infrastructure development as a discrete rather than embedded program
area, with appropriate budgetary provision, and a program structure designed to improve the speed, quality,
and cost effectiveness of implementation. Two mechanisms will be employed to deal with large- and
medium-scale construction. Treatment partners will be relieved of the burden of having to manage activities
that are somewhat removed from their primary fields of excellence. However there will still be cases where
it is more efficient and appropriate for these partners to organize minor building repairs and improvements
locally rather than through a central mechanism. Many health facilities are in need of small renovations and
treatment partners are well poised to respond to those needs as a result of their ongoing interaction with the
facilities. Repairs and rehabilitations of 9 health units to improve services and of up to 5 drug storage rooms
within EGPAF-supported provinces.
Products/Deliverables:
Number of technical advisors by cadre: one pharmacy advisor, 2 laboratory advisors
Technico de Medicina: 20 TdM trained and graduated
Maternal Child Health Nurse: 20 MCH nurses trained and graduated
Number of new graduates receiving gap year funding by cadre: 25 health staff
District coordination-develop a coordination plan: 31 districts
Number of Health facilities supported with repairs to infrastructure - 9
Dollar amount spent on infrastructure - $360,000
Estimated amount of funding that is planned for Human Capacity Development $660,000
Estimated amount of funding that is planned for Education $300,000
Table 3.3.18:
