The SCIP project is comprised of two results-oriented projects in Nampula, directed by Pathfinder International, and Zambézia, directed by World Vision, that aim to integrate health, HIV, water/sanitation, and rural enterprise program components to contribute to an overall objective of strengthening communities. The SCIP Project aims to bring together, in conjunction with funds from other sectors, income growth, increased use of child survival and reproductive health services, community based safe- motherhood programs, and programs to reduce the transmission of HIV. The goals under this program are to implement new methodologies for collaboration with existing programs, avoiding duplication of efforts and ensuring maximum impact. The SCIP program aims to strengthen capacity of the public health system, NGOs, and CBOs to support facility-based services through improved service delivery and management and supervision systems.

Pathfinder will carry out activities at the provincial, district, and community levels in 14 districts of Nampula in a coordinated, complementary manner with other USG funded development activities. USG resources will support strategic health behavior change targeting the main drivers of the epidemic including multiple concurrent partnerships (MCP), trans-generational and transactional sex and low condom use among the general population and youth. Prevention strategies will also be targeted to reach mobile populations and commercial sex workers (MARP's), OVC, PLHIV, and underserved populations. HIV preventions will be promoted through multiple behavioral approaches that are complementary and reinforcing, including community outreach, peer group education and other media outlets like radio. The SCIP program provides excellent opportunities to wraparound other behavior change and prevention activities, including hygiene education, safe water use, and other healthy behaviors to create a strong health promotion program and better informed communities that are motivated to improve their health status. Additional programming will address child survival and safe motherhood with other development funding. Furthermore, Pathfinder will provide training and support for integrated programs including malaria and TB. Additional activities will be geared towards sustained community social infrastructure through a range of allies and networks of support they can draw upon to solve community health problems.

SCIP Pathfinder programs will address several key gender issues. Pathfinder works with the MMAS to promote gender equality and HIV prevention among women aged 10-24, especially focused on gender- based violence. HIV prevention activities will mainstream gender by explicitly addressing power in relationships, strengthening women's self-efficacy in negotiating healthy partnerships, and addressing male and female behavioral norms that contribute to widespread concurrent partnerships and cross- generational sexual relationships. Community behavior change communication (BCC) (including public theatre) and facility counseling services will call on men to be responsible husbands and fathers who practice safe sex, and will engage couples in condom use for mutual protection. Also, SCIP will provide technical assistance (TA) to NGOs/CBOs to design messages and activities that attract boys and men to address male involvement in prevention activities. Water-related programming is designed for women to gain access to water resources in the community. Finally, SCIP will reach mobile populations and other high-risk populations such as commercial sex workers with specially tailored programming to address their higher risk lifestyle and related HIV prevention needs.

The SCIP program will support achievement of goals outlined in the Partnership Framework by strengthening both the clinical and community-based capacity of health care workers; strengthening linkages between services working towards comprehensive health care; and decentralization and strengthening of health systems. The Project Team will work closely with Nampula Provincial Government officials including the Health Directorate and the DPS to improve the quality of services and to implement an integrated community-based approach. These packages are designed to horizontally and synergistically integrate project activities across geographic regions and technical sectors, providing coordinated, efficient implementation, complete with stakeholder engagement.

Pathfinder will bring proven models, tested materials, and appropriate products and technologies, or 'Best Buys', to the project, thereby saving development costs and offering the best use of scarce resources. SCIP will support local, district, and provincial stakeholders to transfer knowledge, improve skills, and establish linkages for positive change and sustainability. Furthermore, Pathfinder aims to reduce

constraints to the development and growth of the value chains for focus commodities.

The project will develop a performance management plan and data collection and analysis system based on project needs which will include a) developing a computerized management information system (MIS) to facilitate data analysis and use to project stakeholders at community, district, and province levels and ensure quality reporting to multiple funding streams; b) conducting regular data audits to ensure quality, including non-duplication of reporting; and c) disseminating monitoring & evaluation information to all partners and funders, including required reports.

To promote collaboration with other USG and GOM supported activities, SCIP will aim to strengthen community-facility linkages and increase referrals and follow-up of patients for improved continuum of care, specifically through training on linkages with community services, home based care (HBC), antenatal care (ANC), antiretroviral therapy (ART), and child-at-risk testing and consultations. Pathfinder will work in close collaboration with organizations providing HBC services for PLHIV. Program beneficiaries who are sick will be referred to ART services and if needed, referred to a HBC program to ensure continuum of care. Pathfinder will collaborate with the MOH HBC focal person, as well as with both focal PEPFAR clinical service partners in Nampula province, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and the International Center for AIDS Care and Treatment Programs (ICAP), both focal PEPFAR clinical services partners in Nampula province, to facilitate referrals and improve health outcomes of patients. SCIP will facilitate increased access to CT and provide counseling and referrals to facilities or HBC services for those who test positive.

The project will work with community/home-based interventions to improve nutrition; vaccinations; healthy spacing & timing of pregnancy; exclusive breastfeeding; complementary feeding/breastfeeding counseling; micronutrient supplementation; long lasting insecticide treated nets.

Pathfinder, through the SCIP project, will establish linkages to OVC programming. Economic opportunity strengthening will be addressed through support to the development of youth farmers clubs linked to schools and Community Youth Centers from Geração Biz, OVC and other youth programs. The SCIP agricultural staff will learn from Multi Year Assistance Program (MYAP) agricultural extension agents and OVC will operate and make use of MYAP demonstration conservation farming plots. SCIP partners will identify OVC and their caregivers to participate in the MYAP farmer associations.

In addition to strengthening MOH and MMAS-linked Community Leadership Councils (CLCs) and Community Health Workers (CHWs) that will support community mobilization for health, SCIP will begin the preparation to organize one Inter-faith Network (IFN) per district, specifically for community support of PLHIV and OVC. Activities will include the identification of OVC and foster families and linking them with junior farmer's associations, advocating on behalf of OVC during property right issues, and assisting them to obtain school and health documentation. They will also organize activities targeting project related health and livelihood support. IFN members will collectively engage community groups to promote acceptance of OVC and PLHIV. Pathfinder will provide direct TA and assistance to IFN, and encourage them to obtain legal FBO status, in order to be eligible for sub-grants for implementation of community

HIV/OVC activities. Meanwhile care group animators when visiting households will initiate the identification of OVC and foster families, linking them with junior farmer's associations, advocating on behalf of the OVC during property right issues, and assisting to get OVC school and health documentation.

Activities will actively promote CT and advocate for the increased use of CT facilities and ensure

appropriate treatment linkages. Peer educators/activist/volunteers will be trained in skills-based

interpersonal communication (IPC) implementation for HIV prevention and promotion of CT. At the

district, health facility and community levels, Pathfinder will support the promotion of all methods of family

planning and the importance of counseling and testing, including at adolescent health clinics. Finally,

Pathfinder will promote inter-personal communication and HIV counseling and testing activities aimed at

couples.

Focusing on both health facilities and community partners as key points of entry, SCIP will promote

healthy behavior change through local media, IPC, and IEC materials, to be monitored through sub-

partner Population Services International (PSI)'s TRaC methodology. Specific behaviors promoted will

include delay of sexual debut, abstinence, fidelity, and reduction in concurrent partnerships, based on

formative research and appropriately tailored to each population segment. SCIP interventions will adopt

The Choose Life curriculum for youth aged 10-25 which includes a Be Faithful manual for married youth,

and addresses multiple concurrent sexual partners, sexual networks, cross generational and

transactional sex, gender, alcohol, and drugs. SCIP will also use these curricula with faith-based groups,

and will also use materials developed for youth HIV prevention under the Geração Biz project for school

and community activities.

The project seeks to reduce HIV transmission by encouraging the adoption or continuation of lower risk sexual behaviors and on changing societal level norms to support risk reduction. Behaviors promoted

include correct and consistent condom use and partner reduction. Target groups will include men and women engaged in MCP and/or cross-generational relationships, populations living or working in districts along major transport corridors including PLHIV. Combination prevention campaigns implemented under SCIP will be aligned with national level campaigns using a behavior change approach that relies on best practices from Mozambique and neighboring countries in Southern Africa, and that combines various media outlets and interpersonal and community outreach and events tailored to each population group, to ensure optimal exposure and reach throughout 14 districts in Nampula.

Prevention of Mother to Child Transmission interventions are integrated with USAID funded child survival (CS) and reproductive health (RH) programs, including family planning (FP), and within primary health care services. This approach will help to increase the uptake of services for HIV+ pregnant women and provide them with comprehensive care. These complementary services are therefore key areas of importance to increase the quality and availability of goods, services, and information, increasing demand for goods and services, and increasing the social infrastructure to support communities. Activities will include emphasis on primary prevention of HIV among women of childbearing age and access to quality FP services as a major strategy to reduce vertical transmission. Pathfinder will enhance the role of lay counselors in Nampula to strengthen linkages with and enhance capacity of civil society groups involved in primary prevention. A strategy for male involvement in HIV+ women's RH/Maternal Child Health (MCH) needs will be promoted including couples' counseling and testing, promotion of male involvement in reproductive health decision and childcare, and the promotion of condom use during pregnancy. Furthermore, Pathfinder will enhance capacity of health workers to identify and counsel on RH needs of HIV-infected pregnant women and couples, including the implementation of provider initiated testing and counseling (PITC) within FP.

Wraparound activities include improved maternal and child nutrition practices, especially for HIV-exposed infants, as major strategy to improve maternal survival (MS) and CS and reduce vertical transmission. Pathfinder will integrate the maternal & child nutrition module in PMTCT training and will provide nutrition counseling training to health staff. Finally, the Pathfinder program will implement a framework for psychosocial support for HIV+ pregnant women and their families, including education about stigma reduction and the prevention of gender based violence.