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
April09 Reprogramming: Reduced $195,000.
This activity has been receiving funds from Adult Treatment Program Area and for 2009 will receive funds
from Sexual Prevention Program Area as well.
Activity unchanged from FY08. AIHA through its technical partner UCSF, will continue to implement
Positive Prevention (PP) programs in the Maputo, Sofala and Zambezia Provinces in Mozambique. In
2006, AIHA developed and initiated a partnership between the University of California, San Francisco
(UCSF) and two HIV/AIDS service sites in the Maputo Province: Namaacha Health Center and Esperanca-
Beluluane VCT Center. Since 2006, partners have joined efforts to conduct and develop programs and
interventions, specifically targeting the clientele at each site. Working under the assumption that the patient-
provider relationship contains vast opportunities to carry-out HIV transmission interventions, partners
developed provider and patient specific goals and objectives to track behavior changes in both populations.
The goals of the intervention are the same: both the health care providers from Namaacha Health Center,
and community based workers and PLWHA support group members from
Beluluane-Esperanca VCT Center develop skills to address the prevention needs of HIV-infected individuals
accessing their services or participating in PLWHA support group activities. This includes discussions
about:
HIV risk behavior (risk reduction techniques)
Encourage partner testing
Counseling and support
How to disclose HIV to partners and family members
How to produce or maintain healthy families
Individualized prevention plans and risk reduction techniques
Currently this program is in the scale up phase to provide healthcare workers at the facility-based sites and
PLWHA and counselors at the community-based sites with competencies, comfort, and skills to discuss risk
behavior, risk reduction techniques and prevention needs, thereby decreasing HIV transmission, and
encourage HIV testing (including partner testing). During FY07, in collaboration with MOH, Provincial Health
Directorate, and other stakeholders, CDC and UCSF staff identified additional sites to expand the
intervention to two provinces with high prevalence, Sofala and Zambezia.
In FY08, the partnership focused on the completion (including piloting) of training materials and developing
an intervention package (including a toolkit) designed and developed through the work at the above sites, to
make these materials available for other sites and partners in Mozambique to develop Positive Prevention
(PP) programs.
During FY08 the technical partner organized a pilot training using PP curriculum developed to be used by
the partners to train various providers and counselors to develop their own individual PP programs and
prevention messages tailored to the specific site. The PP curriculum was piloted to obtain input from health
care workers, including counselors and the materials were revised to include the feedback from the pilot.
The materials are used by partners to train other organizations in Mozambique.
With FY09 funds the project will expand the Positive Prevention activities, by conducting a TOT training for
trainers, counselors, program managers and staff for 22 community-based prevention staff (2
staff/province); dissemination of materials to organizations participating (i.e. training materials, PP toolkit,
job aids, flip charts, IEC materials etc.), and disseminate the materials to organizations participating (i.e.
training materials, PP toolkit, job aids, flip charts, IEC materials etc.)
In addition, FY09 funds will be used for expansion of FY08 Twinning Partnership and capacity building for
Mozambican PLWHA and Women's Rights Organizations (Starting with one organization in FY08, adding 1-
2 in COP09)-Previously under treatment, but moved to prevention with broader scope, in line with team
discussions - Southern Prevention Initiative to strengthen the partnership with the International organization,
Women Organized to Respond to Life-Threatening Diseases (WORLD) and the identified Mozambican
Women Association/women support group, to assist prevention projects targeting women and women
empowerment opportunities (through either small subgrants and/or procurement of items needed and
identified by the group seeds, T-shirts, transport funds to the ARV Treatment Centers).
Measurable project outcomes consist in tracking behavior changes in WLWHA and direct service providers
and
implementing and managing M&E systems and tools to monitor outcomes. It is anticipated that 75
individuals (both service providers and women) will receive PP training and support.
Goals
Although continued specific partnership objectives will be jointly developed by implementing partners, AIHA,
UCSF and CDC-Mozambique during workplan development, initial focus areas, based on AIHA's
experience thus far,
include the following: (a)To increase the knowledge and skills of WLWHA, counselors and
peer educators/activists to address prevention counseling, adherence counseling, disclosure of HIV status,
partner notification and risk reduction techniques; and (b)To increase the capacity of support group
participants to organize group discussion, meetings, facilitate groups, address specific issues such as
stigma and discrimination, positive living, encourage partner testing.
Project Management
Twinning Center staff in Washington DC will continue to support this partnership by assisting partners to
develop a workplan including goals and objectives, partnership communication plan, and monitoring and
evaluation plan.. Both partners have identified partnership coordinators who work with Twinning Center staff
to monitor the partnerships' progress and to help identify areas where technical assistance might be
Activity Narrative: required. The Twinning Center will also be responsible for day-to-day project administration including
budget monitoring, logistical support and reporting. The Twinning Center can also provide training to the
individual organizations on financial administration and subgrant management.
Monitoring and Evaluation
AIHA Twinning Center staff and UCSF technical PP experts have assisted partners to develop a
monitoring and evaluation system for the partnership. AIHA and UCSF will continue to assist the partners in
implementing this system and developing training-specific monitoring tools. In collaboration with USG
stakeholders, AIHA and partners will continue to select the appropriate PEPFAR indicators and other
relevant indicators based on planned activities in the workplan. AIHA and UCSF continue to assist partners
to develop the appropriate tools and systems necessary to collect and report relevant data and provide
technical assistance when necessary. AIHA reports these data to USG teams quarterly and will further
evaluate the partnership's effectiveness in meeting its goals and objectives upon completion of the workplan
period.
Twinning Partnership Philosophy
In keeping with its mission to advance global health through partnerships that mobilize professionals,
institutions, and communities to better address delivery and quality of health care, the American
International Health Alliance established the Twinning Centre to help integrate and improve HIV/AIDS
prevention, care and treatment in the countries most affected by the global AIDS pandemic. Operating
under a cooperative agreement with the Health Resources and Services Administration (HRSA), and in
collaboration with the various USG agencies coordinating the President's Emergency Plan for AIDS Relief
(PEPFAR), the Twinning Centre establishes and manages both north- south and south-south partnerships
which focus on strengthening institutional capacity to create a sustainable response to the HIV pandemic.
The partnerships focus on a peer-peer methodology and leverage resources through volunteerism and in-
kind
contributions. Most twinning partnerships are able to leverage substantial resources to greatly
increase the value of the partnership.
Deliverables and Products:
Number of Twinning Partnership and capacity building with Mozambican PLWHA and Women's Rights
Organizations buided
Number of PP Facility Based Program Managers, Trainers, Counselors and Staff trained, including
provision of a kit of PP toolkit for the community-based prevention staff
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.03:
April09 Reprogramming: Decreased $757,520.
ACTIVITY UNCHANGED FROM FY2008:
AIHA through its technical partner UCSF, will continue to implement Positive Prevention (PP) programs in
the Maputo, Sofala and Zambezia Provinces in Mozambique. In 2006, AIHA developed and initiated a
partnership between the University of California, San Francisco and two HIV/AIDS service sites in the
Maputo Province: Namaacha Health Center and Esperanca-Beluluane VCT Center. Since 2006, partners
have joined efforts to conduct and develop programs and interventions, specifically targeting the clientele at
each site. Working under the assumption that the patient-provider relationship contains vast opportunities to
carry-out HIV transmission interventions, partners developed provider and patient specific goals and
objectives to track behavior changes in both populations. The goals of the intervention are the same: both
the health care providers from Namaacha Health Center, and community based workers and PLWHA
support group members from
Currently this program is in the scale up phase to provide healthcare workers at the facilty-based sites and
make these materials available for other sites and partners in Mozambique to develop PP programs.
prevention messages tailored to the specific site. In addition, project implementers developed partner
opportunities with the International organization, "Women Organized to Respond to Life-Threatening
Diseases" (WORLD) and a TBD Mozambican Women Association to create prevention projects targeting
women and women empowerment opportunities. Partners explored the collaboration opportunities with a
nascent Mozambican treatment literacy organization (MATRAM) to incorporate PP messages into their
activities. This initial exploration is expected to lead to strengthening of partnership in the subsequent year
(FY09).
In FY09, as a continuation of activities, additional PP activities will include disseminations of the PP
curriculum, train master trainers, conduct ToTs for facility based care and treatment program managers and
staff including the provision of PP toolkits to staff and participating organizations; a PP ToT for community
based care and treatment program managers and staff targeting national NGOs and CBOs -1 Training for
18 staff from Clinical Care & Treatment partners (3 staff/agency) and 1 Training for 18 staff from
HBC/community care partners (10 ANEMO trainers, 3 Ministry trainers, 5 staff from bigger international
Home Based Care Partners); and an exchange study tour for PP implementers in-country to visit other PP
sites to establish close collaboration among all sites. Partners will continue to support existing PLWHA
groups through either small sub-grants and/or procurement of items needed by the group (e.g. seeds, T-
shirts, transport funds for treatment follow up, etc).
Partners will continue the collaboration and supporting opportunities with the Mozambican treatment literacy
organization (MATRAM) to incorporate PP messages into their activities at the community level.
Measurable project outcomes consist in tracking behavior changes in PLWHA and direct service providers
implementing and managing M&E systems and tools to monitor outcomes. It is anticipated that 195
individuals (both service providers and individuals) will receive prevention with positives training.
Although continued specific partnership objectives are jointly developed by both partners with input from
MOH, and CDC Mozambique initial focus areas, based on the technical partner (UCSF) experience so far,
will include the following: (a)To increase the knowledge and skills of healthcare workers, counselors and
PLWHA peer educators to address prevention counseling, adherence counseling, disclosure of HIV status,
partner notification and risk reduction techniques among PLWHA; (b)To increase the capacity of staff and
PLWHA peer educators at the PP program sites to monitor and evaluate PP activities; and (c) To increase
the level of PLWHA patient monitoring/surveillance in conjunction with PP activities.
evaluation plan. Both partners have identified partnership coordinators who work with Twinning Center staff
required. The Twinning Center will also be responsible for day-to-day project administration including
Activity Narrative: budget monitoring and logistical support. The Twinning Center can also provide training to the individual
organizations on financial administration and subgrant management.
AIHA Twinning Center staff and UCSF technical and PP experts have assisted partners to develop a
In FY09, continuation of support and activities for the selected sites in Maputo, Sofala and Zambezia
Provinces including support for the PLWHA support groups, through either small subgrants and/or
procurement of items needed and identified by the groups (seeds, T-shirts, transport funds to the ARV
Treatment Centers). In FY09 continuation and scale up of PP ToT trainings for the clinical care partners
staff, home based care and community care partners, Mozambican PLWHA organizations or groups;
and implementing and managing M&E systems and tools to monitor outcomes. It is anticipated that 130
individuals (both service providers and individuals) will receive PP training.
Deliverables and Products
Number of sites supported and activities developed in the demonstration sites (Maputo, Zambézia and
Sofala Provinces) and number of existing PLWHA groups supported
Number of staff trained from Clinical Care & Treatment partners
Number of staff from HBC/community Care partners ( ANEMO trainers, MOH trainers, staff from bigger
international HBC partners)
Number of staff from Mozambican PLWHA Organizations or groups trained and received some mentorship
on PP with these organizations
M&E for scale -up of PP activities: (1) Routine monitoring of basic process indicators (e.g. # partners
involved, # sites, # staff trained); (2) Program evaluations (TBD, possibly annually)
Collaboration with MATRAM, by integrating PP messages in the treatment education/literacy activities
Number of exchange visits between PP sites in Mozambique
New/Continuing Activity: Continuing Activity
Continuing Activity: 13203
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13203 8799.08 HHS/Health American 6411 3720.08 Twinning $1,028,200
Resources International
Services Health Alliance
Administration
8799 8799.07 HHS/Health American 4940 3720.07 Twinning $400,000
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $939,237
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In Mozambique, there are an estimated 1.6 million people living with HIV/AIDS; of these, about 141,800 are children under 15
years and 44,700 of these were estimated to meet the criteria for ART eligibility in 2008. ARV treatment given to HIV-infected
children improves the quality of life and reduces morbidity and mortality. Recent studies have shown improved survival when
treatment is initiated early during infancy, preferably during the first six months of age.
Pediatric HIV care and treatment was mentioned, but not fully addressed, in the 2004-2008 national strategic plan of the health
sector (PEN Saúde). At the time pediatric HIV needs were viewed as "not urgent" and no targets were defined. It became a
program area under the Ministry of Health (MOH) in 2005, however, when it was included in the HIV/AIDS Program and in the
2006-2009 Poverty Reduction Strategy (PARPA II) of Mozambique. In 2006, the MOH developed a detailed plan to scale-up
pediatric HIV care and treatment services.
Scale up of treatment: ARV treatment became available for children starting in 2003 in a few selected sites. The number of sites
providing pediatric ART has expanded from 22 sites in 2005 to 70 sites in 2006 and 148 sites in September 2007. This
represented 71% of all ART sites in the country. There are currently three high volume pediatric HIV Day Hospitals in the three
major referral hospitals in Mozambique: the Maputo Central Hospital clinic in the south, has been providing services to HIV-
exposed and infected children since 1994; the Beira Central Hospital located in the central region of the country, initiated pediatric
HIV services in 2006; and the Nampula Central Hospital initiated pediatric HIV clinical services in 2007. These centers specialize
in pediatric HIV care and serve as training, demonstration and referral sites with the staff providing supervisory support to other
ART treatment sites in their respective regions. Overall, the MOH provides oversight and supervision for pediatric HIV treatment at
a national level.
The USG has been a major contributor to national pediatric ARV treatment services in Mozambique and supports delivery of
these services at all referral hospitals. As reported in the SAPR 2008, the USG supports 119 out of 216 sites providing ARV
treatment services; 177 of all ART sites in Mozambique provide ART for children, and of these (49%) are supported with PEPFAR
funds. Of the 119 USG ART sites, 87% (103) provide ART for children. PMTCT services are provided at all USG sites where
adult and pediatric treatment services are co-located.
Based on data from the Ministry of Health, the number of children currently benefiting from ARV treatment has been increasing
yearly, from 677 in 2004 to 7,845 in July 2008. However, the proportion of children on ART continues to be low compared to the
estimates of those in need of ARV treatment (estimated to be 44,700) in the country and also in relation to the total number of
persons on ART. Of the 112,256 persons on ARV treatment, only 6.9% are children under 15 years of age. Based on 2008
SAPR data, the USG was providing treatment services to 63% (4,436) of all children receiving treatment in Mozambique at that
time (MOH estimate of 7,049). Approximately 8% of all patients (54,838) receiving treatment at USG funded sites were children
under 15 years of age (SAPR08).
The current MOH reporting system does not include cohort information on retention in care and treatment for adults and children.
Additionally, pediatric treatment data at present is not disaggregated by age group such that information regarding children below
two years of age is not routinely available. Consequently it has not been possible to report on these indicators for Mozambique.
The USG will support MOH in the establishment of a national patient monitoring system which will help to improve collection of
this information.
Plans for FY09: The MOH plans to appoint a National Pediatric HIV Coordinator to manage the program by working closely with
the two regional coordinators based in the central and northern regions of the country. The 2005 HIV/AIDS treatment manual for
children is currently being updated to incorporate changes in recommendations for treatment initiation for infants based on recent
WHO guidelines. In addition, HIV-infected infants who were exposed to Nevirapine for PMTCT prophylaxis or maternal treatment
will be offered a first line combination regimen that includes a protease inhibitor (ritonavir/lopinavir) in accordance with WHO
recommendations. Furthermore, specific training modules on pediatric ART for clinical officers (técnicos de medicina) and psycho
-social training tools to support children and adolescents living with HIV/AIDS are also being developed.
The MOH, supported by USG agencies and partners, will continue to scale-up quality pediatric HIV treatment services. One of the
main objectives for FY09 is the implementation of early infant diagnosis and treatment of all children under one year of age
regardless of clinical and immunological conditions, as recommended by WHO. The key interventions will focus on:
a) Training of health workers on pediatric ARV treatment service provision. This will be accomplished via different education
modalities such as reproduction and dissemination of updated Pediatric HIV guidelines and job aids; mentoring, on-the-job
training, and supervision to update providers on new ARV treatment guidelines for children to ensure quality of ARV treatment
provided. Through USG support, the MOH has planned training of clinical officers starting in early in the calendar year 2009 in
order to enable scale-up of ART treatment in remote areas.
b) Strengthening the linkages between PMTCT and other child health services to reduce drop outs and missed opportunities. The
new flow chart and algorithm being developed by the National PMTCT and Child Health technical working groups will play an
important role in linking the HIV exposed and infected infant into care and treatment through referral from PMTCT, immunizations
and Well Child clinic.
c) Counseling and testing materials for children and adolescents are being developed. Provider initiated counseling and testing
(PICT) will be promoted for all at-risk children to improve access for HIV infected children into ARV treatment. Psychosocial
support for children and their families along with support for retention and adherence on ART will be provided by psychologists,
when available, lay counselors or trained health workers. Psychosocial materials are also being developed to support this activity.
For monitoring and evaluation, the MOH, through USG support, will implement a national pediatric HIV program evaluation that
will contribute to improving the quality of pediatric ART services provided, as well as identify key indicators for routine care and
treatment assessment. The USG has been working on the protocol for this program evaluation along with MOH counterparts
since 2007. Local administrative issues that delayed start up have been resolved and the activity will start early in the calendar
year 2009.
In FY08 the USG funded six clinical services partners implementing HIV treatment programs in Mozambique. USG implementing
partners were charged with the responsibility to provide comprehensive care and treatment services, as well as technical
assistance, training support, program monitoring, supportive supervision, quality assurance and local system strengthening. USG
partners currently support treatment services in all the provinces in the country.
In FY09, USG partners will increase service delivery in seven new districts and increase the number of sites providing care and
treatment services from 119 to 182. All USG partners will be funded to provide pediatric ART services at all existing USG
supported sites currently providing adult treatment services. The USG will focus on improving and evaluating the quality of
treatment services being provided, following MOH goals.
Partners will continue to emphasize patient monitoring to assure adequate follow-up and retention of children on ART. They will
continue program monitoring, supervision visits, mentoring, on-the-job training and maximizing the electronic tracking system of
patients, ensuring data quality in reproduction and dissemination of ARV treatment reports. In addition, partners will coordinate
activities with local organizations to provide psychosocial support, nutritional support, and assessment and linkage with care
services when needed.
The Supply Chain Management System, through USG support, has been strengthening the national logistics system to better
ensure timely procurement and distribution of necessary commodities, including ARV and drugs to treat opportunistic infections.
This has been described in more detail in the ARV drugs program narrative and relevant activity sheets. In FY09, the USG will
provide support for ARV treatment to 11,874 children at 182 sites and training for 1,524 health workers in pediatric and adult HIV
care and treatment.
Pediatric HIV care and support: Care services for HIV-infected children are provided at the national level, including the health
facilities not yet providing ARV treatment. According to SAPR08 data, 230,828 individuals, including children less than 15 years,
are receiving care services. The quality of data collected needs to be improved in order to more accurately document what
proportion of children are on care, what proportion of children on care are receiving cotrimoxazole prophylaxis and what
proportion of children in the care program are being lost to follow up. HIV exposed infants are followed up with at the Child at Risk
Consultation Clinics (CCR). The CCRs provide care services for all high risk children (very low weight, twins, in treatment for TB,
etc) including HIV exposed children. The care services include provision of PlumpyNut for HIV infected children who have weight
for height ratio < 80% of the median and provision of cotrimoxazole for all HIV exposed and infected children following the national
guidelines.
In FY09, partners will continue to support provision of the preventive care package at all USG sites. The package includes: clinical
monitoring; access to early infant diagnosis (EID); cotrimoxazole prophylaxis; prevention, diagnosis and treatment of opportunistic
infections (OIs); infant feeding counseling and support; pain management at facility level through on the job training and
supportive supervisions; safe water kits; nutritional support by linking community based organizations and OVC programs; and
coordination with the President's Malaria Initiative (PMI) for the distribution of treated bed nets distribution. Ongoing activities to
improve pediatric care and support services include:
a) Universal use of the updated childhood growth and immunization card that now includes information on PMTCT (mother's HIV
status, ARV prophylaxis or ART) and b) Finalization and implementation of flow charts and algorithms linking HIV programs with
PMTCT, immunizations and Well Child clinics in order to improve identification of HIV exposed children and link them with care
services.
In FY08, efforts were made to scale up early infant diagnosis of HIV. This service became available in Maputo City and more
recently in Nampula central hospital lab. Through USG and other donor support, the MOH is working to strengthen the laboratory
services needed to support EID. Efforts are now underway to establish a third laboratory in the central region with capacity to
perform DNA PCR testing using dried blood spots (DBS) for EID. Training of nurses and other heath workers on EID is needed to
ensure expansion of this service in the more remote areas. A focal person will be identified at each province to coordinate this
activity with the USG partners. This is expected to improve the turn-around time of test results to the mothers, currently taking
more than three or four months. In order to improve the DNA PCR DBS logistics, the USG agencies and partners will work with
the MOH to advocate for the increased involvement of provincial and district health personnel in the collection, processing, and
transportation of samples and the reporting of results.
Program Evaluation: The MOH and USG will conduct a program assessment of the current practices of selected CCRs providing
pediatric care services for HIV exposed infants. The assessment will analyze how pediatric care services are provided at the CCR
with respect to provision of cotrimoxazole prophylaxis, the cycle involved in DNA PCR DBS testing, referral processes and
retention in care of exposed and infected children, and assess how linkages of HIV services with PMTCT and other child health
programs (immunization clinics, regular child follow-up clinics) are working.
Linkages: The USG will improve linkages of OVC programs and clinical care services by improving referral systems to assure
continuation of care at the community level.
Through technical assistance in planning, coordinating and monitoring, the national Maternal and Child Health program will
establish adequate linkages between HIV care and treatment services and pediatric HIV care, treatment and follow-up.
Challenges: Currently, HIV exposed infants are referred from PMTCT services. Referral mechanisms are still weak and there is
no well documented data on how pediatric care services are provided at CCR and how these services are linked with ARV
services. There is no standardized system for identifying HIV-exposure or infection status of children coming for immunization or
curative outpatient services.
Obstacles for assuring quality services with adequate follow up include: lack of trained and skilled staff to provide quality pediatric
care services; weak linkages with PMTCT and other programs that provide services to children; non-standardized entry points for
care and treatment; a weak system of identification and follow-up of HIV exposed and infected children; lack of national coverage
of early infant diagnosis using dry-blood spot/DNA PCR testing; inadequate health staff supervision; a need to revise and update
the national strategy for pediatric care and treatment services.
Table 3.3.10:
The AIHA Twinning Center proposes to create, manage, evaluate, and provide technical assistance to a
partnership between a TBD partner from Brazil and one or more Mozambican organizations to increase TB
literacy at the community level.
Currently in Mozambique, there is a lack of information on tuberculosis at all levels of the healthcare
system. Healthcare workers are beginning to receive information and training from the Ministry of Health,
but little effort has been done to educate community and home- based care providers. Brazilian
organizations have considerable experience in community education on tuberculosis, including educating
those infected with HIV and or TB to provide outreach to others.
Through support from COP 08, The Twinning Center is working with key US government supported
organizations in Mozambique and Brazil to identify the appropriate partners from each country. The
Brazilian partner will likely be a local or international organization currently supported by the US
government, whereas the Mozambican partner will likely be a local organization. This partnership will focus
on the development and dissemination of materials to educate the community about TB/HIV co-infection
and educate community care providers on recognition of signs and symptoms of TB in PLWHAs.
In COP 09, AIHA is requesting continued funding to support the Brazilian/Mozambican TB/HIV partnership.
In year two, partners will work together to implement activities to scale-up current TB/HIV prevention and
treatment by increasing TB literacy at the community level. Activities will include:
• Develop materials to educate the community on the importance of accessing TB screening services and
identifying potential symptoms of TB
• Identify and utilize local media and other forms of communication to disseminate messages
• Increase the capacity of integrated TB and HIV management and referral systems to provide educational
materials to the community
• Train a cadre of healthcare professionals as trainers in TB/HIV awareness
Continuing Activity: 15809
15809 15809.08 HHS/Health American 6411 3720.08 Twinning $100,000
Emphasis Areas
Health-related Wraparound Programs
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $100,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.12:
This is a continued activity between lay counselors in Mozambique and the Kenya Association of
Professional Counselors in Nairobi, Kenya.
With FY08 funds an assessment was conducted to evaluate existing trainings in integrated counseling for
HIV prevention and positive living. This assessment included extensive evaluation of the existing trainings
programs currently preparing lay counselors in Mozambique and assessed the impact of training on
counseling service delivery and on the uptake of VCT, PMTCT, and HIV Care services.
CDC/Mozambique and the MOH Mozambique conducted an assessment in Kenya, visiting the Kenyan
Association of Professional Counselors, visit facilitated by AIHA Twinning Center.
Currently there is a cadre of lay counselors in Mozambique who are providing basic Counseling and Testing
(CT) services in the Counseling and Testing in Health Units (CTH - ATS). There is a need to strengthen the
capacity of the existing lay counselors to provide integrated counseling services and referrals and also to
increase the number of lay counselors. In an effort to create a cadre of multitask counselors who can
provide counseling and testing for HIV in CT sites and clinical settings, appropriate referrals for HIV positive
and negative clients, counseling for treatment and treatment education among many other duties, technical
assistance will be provided to the Ministry of Health to define the role of multitask counselor and outline
competencies for this professional cadre.
This activity will bring together the Kenyan Association of Professional Counselors and counselors
throughout Mozambique to strengthen their access to resources in training, sharing information, and
communication. The goal is to create an association of counselors in Mozambique which can work together
to create a sustainable environment to build on training and exchange of resources.
Discussions are underway with the MOH Human Resources Department to establish competencies for new
cadre of lay counselors able to provide counseling in all aspects of HIV/AIDS prevention (including positive
prevention), treatment and care, testing, discordant results, mother-to-child-transmission, treatment
adherence, palliative care etc, and develop a support system to address issues such as counselor burn-out.
Activities for FY09 will include close collaboration with stakeholders, particularly the National Department of
Medical Assistance (DNAM), Counseling and Testing Program and supporting Human Resources and
Training Department within the Ministry of Health to develop competencies for the lay counseling
profession, develop a standardized curriculum to train lay counselors - who will be able to take on lower-
level nursing responsibilities and contribute to task-shifting efforts - and develop check lists to address
supervisory issues. Further, suggestions will be made on the implementation of this new cadre of
professionals.
Continuing Activity: 15808
15808 15808.08 HHS/Health American 6411 3720.08 Twinning $250,000
Table 3.3.14:
ACTIVITY UNCHANGED FROM FY2008: (No new funds for FY09)
This is a continuing activity of Activity # 8941.08 (these could not be formally linked). The description of this
activity is below.
This activity is also linked to Activities 8639 and 8632.
The USG's SI team's primary challenge in collaborating with the Ministry of Health (MoH) on key public
health evaluations and routine data analysis is the limited number of trained staff working at a technical
level high enough to support these monitoring and evaluation (M&E) activities. Of specific concern is the
entire lack of staff with the capacity to support the SI Team's principal strategy: to address issues around
the quality of service delivery for HIV care and treatment programs. Additionally, there are no accredited
PhD programs in M&E or public health in Mozambique that can help to build this capacity in the future.
Accordingly, we will support long-term M&E training for one candidate with an M.D. currently working in the
MoH's National Institue of Health (INH). The selected candidate, who has been in the MoH for 10 years, will
attend an accredited PhD program at a foreign university in health policy, planning and financing. This area
of study is directly related to program monitoring and evaluation for quality service delivery improvement.
As previously mentioned, there are no in-country opportunities to receive this training at a local university.
To ensure that the MoH and the USG receive maximum benefit from this long-term training, the candidate
has agreed that his dissertation will focus on the Cost Effectiveness M&E PHE evaluation described in
Activity 8639 and related to Activity 8632. In addition, he will sign a return commitment letter as described in
PEPFAR's long term training guidance. We anticipate that the outcomes of the PHE will be more robust
with the involvement of this MoH in this capacity.
This will be funded with carryover funds; there have been administrative delays in entering the candidate
into the program. No new funds are needed.
Table 3.3.17:
ANEMO/St. Luke's Hospital School of Nursing
This is a continuation of current activities. AIHA will continue to strengthen ANEMO's capacity to function
as a well-structured, sustainable national association through a partnership with a St. Luke's School of
Nursing
The African Palliative Care Association (APCA) and The National Association of Mozambican Nurses
(ANEMO) partnered for a period of two years to strengthen the organizational capacity of ANEMO. During
this time, partners accomplished the following objectives:
1. ANEMO hired a new national coordinator and a financial assistant
2. Partners jointly developed a strategic plan for ANEMO and the regional branches
3. APCA and ANEMO developed a new governance structure for ANEMO
4. APCA assisted in the development of a website for ANEMO to establish regular communication between
AMENO staff in Maputo and the provinces,
5. ANEMO national coordinator created a Mozambique Palliative Care Association (MOPCA)
6. Partners created and circulated a newsletter to assist with income-generating activities for ANEMO
The APCA/ANEMO partnership officially ended this past May, 2008 and ANEMO shortly thereafter initiated
partnership activities with St. Luke's Hospital School of Nursing.
During the first year (COP 08) of the St. Luke's Hospital School of Nursing partnership, St. Luke's
representatives traveled to Mozambique to meet with ANEMO representatives. During this exchange visit,
St. Luke's partners toured the ANEMO facilities, both in Maputo and in the provinces, and became familiar
with the current HIV/AIDS situation in Mozambique. Soon thereafter, ANEMO partners traveled to the US to
assess the current HIV/AIDS situation in the US and to meet with additional St. Luke's partners. While on
this partner exchange visit, partners developed their year one partnership workplan, which outlined
partnership activities for the next twelve months.
In COP 09, AIHA is requesting additional funding ($190,000) to continue the St. Luke's Hospital School of
Nursing /ANEMO partnership. In year two, partners will work together to implement activities to strengthen
membership, association building and sustainability of ANEMO. Activities will include:
• Developing and implementing a comprehensive communication strategy to reach and include all
members, provinces, and external stakeholders,
• Implementing a strategy to enhance and improve organizational capacity,
• Expanding ANEMO's services from Maputo to additional provinces; and
• Conducting income generation activities to achieve financial stability for ANEMO
Catholic University of Mozambique/University of Pittsburgh
This is a continuation of current activities. AIHA will continue to increase the availability of quality HIV/AIDS
services in the Sofala Province of Mozambique through a partnership with the University of Pittsburgh
The University of Pittsburgh (U Pitt) and Catholic University of Mozambique (UCM) have partnered for a
period of three years. During this time, partners' significant accomplishments have included the following:
• Partners have defined clinical competencies and designed practical hands-on training sessions for UCM
faculty and staff
• Partners have established formal relationships with local HIV treatment clinics to serve as sites for the
practical component of the training; developed M&E capacity at UCM for measuring quality and
effectiveness of trainings
• Partners trained ICSB instructors; trained in-service healthcare workers based on MOH priorities; and
trained orderlies in universal precautions/infection control.
• The University of Pittsburgh School of Medicine, Division of Infectious Diseases, recruited a well-qualified
family practitioner with experience delivering health care in resource limited settings to serve as the Medical
Director for the Training Center
• Partners leveraged large-scale donations for the Training Center at UCM
In COP 09, AIHA is requesting additional funding ($370,000) to continue the University of Pittsburgh /
Catholic University of Mozambique. Partners will undertake the following activities:
• Fully establish cohort of HIV-positive patients for training purposes
• Identify priorities for healthcare worker training with MoH
• Continue to develop curriculum for various levels of healthcare workers with MoH and other training
partners in MZB
• Develop methods to evaluate efficacy of training for various levels of health care workers
• Work with MoH to integrate HIV care with primary medical care per MoH timelines
Individual Scholarships
The American International Health Alliance's Twinning Center proposes to continue a partnership focusing
on the long-term training of a Mozambican healthcare professional. Based on the current needs in
Mozambique and input from USG stakeholders in country, an individual will be identified and placed in a
healthcare setting or university. The first year activity will begin with the placement of a healthcare
professional at a partner institution with the expectation that institutional relationships will be strengthened
during this first year. It is also expected that the Mozambican health professional will be able to draw on
experiences and resources obtained while overseas to strengthen and reinforce his or her own institution.
FY09 funds (96,000) will continually support scholarships for individuals.
Goal
The partnership's overall goal is to increase the knowledge of a Mozambican health professional by
participating in a long-term training in a university and to strengthen the institutional link between the two
universities.
Activity Narrative: Deliverables/Products
ANEMO/St Luke's Hospital School of Nursing
1. A comprehensive communication strategy to reach and include all members in order to strengthen
ANEMO's membership
2. A strategy to enhance and improve organizational capacity
3. ANEMO's services expanded to additional provinces
3. Income generation activities that will lead ANEMO to achieve financial stability
1. A Cohort study of HIV positive patients
2. Training priorities for health care workers in the MoH
3. Training curriculum for different levels of health care workers in the MoH
4. Tools for training evaluation of different levels of health care workers in the MoH
Individual's scholarship
5 individuals recieving long term training
Continuing Activity: 13205
13205 5442.08 HHS/Health American 6411 3720.08 Twinning $675,000
8800 5442.07 HHS/Health American 4940 3720.07 Twinning $620,000
5442 5442.06 HHS/Health American 3720 3720.06 Twinning $455,600
Estimated amount of funding that is planned for Human Capacity Development $150,000
Estimated amount of funding that is planned for Education $96,000
Table 3.3.18:
