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.
This is a new activity to carry out an assessment on performance-based financing (PBF). The MOH has shown interest in the PBF model to improve the quality of health services. This initial assessment will gauge the readiness of the Mozambican health system to adopt such a model and provide recommendations on how it could be implemented.
In Mozambique health worker salaries are not tied to performance, one of the factors leading to low productivity, poor quality, and lack of innovation. The working definition of PBF is the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. PBF aligns resource use with the motivational factors that promote hard work, innovation and results. By making payments when results are verified, PBF aims to align health worker actions with goals for increasing the volume and quality of services. Substantial improvements in key health indicators have been achieved using the PBF approach in Afghanistan, Haiti, and Rwanda. PBF also results in managers and health workers becoming more proactive, innovative and focused on being accountable for results. Other results are an increased use of data for decision-making, improved management, and increased cost-effectiveness.
As any PBF program must be tailored to the local context, and the first step of this activity will consist of an assessment to lay out the framework. This activity will assess the pre-requisites for PBF in Mozambique and lay out the next steps needed, such as policy changes or a functional Human Resource information system (HRIS), for a PBF approach to be piloted in FY 2011 or beyond. Stakeholder engagement is critical to PBF success and the assessment will involve a broad range of stakeholders to ensure sufficient buy-in. Other essential components could be included in the assessment, e.g. how performance contracts will be designed and managed, performance indicators and targets, how payments will be tied to results and processed, and mechanisms to manage and validate performance, with recommendations. Lessons learned from other countries where PBF has been successful will be used.
The assessment will lay the groundwork for various elements of the Partnership Framework, although the benefits will not be felt until a functioning PBF model is in place. The relevant Partnership Framework objectives are Objective 2.2, as PBF will improve the GOM's capacity to use available resources to improve service delivery; Objective 3.2, as it will improve the motivation and retention of health workers; and the objectives under Goal 4, as it will improve the quality of HIV treatment. Human resources for health (HRH) is a cross-cutting focus because of the focus on health worker motivation, performance and retention.
The geographic coverage of the assessment is expected to be at central, provincial, district and facility level. Target population will include employees in the MOH and health facilities, and stakeholders such as users of health care facilities and other donors.
The contribution to health systems strengthening is by improving service delivery, motivation of the health workforce, health finance through effective use of available resources, and leadership/governance by assessing the feasibility of a national approach to strengthen the health system. Improved health outcomes will not be limited to HIV.
The activity will recommend the most cost-effective options for PBF that will allow effective use of available resources.
The partner will develop a work plan with indicators to measure progress during the assessment. USG Mozambique staff will be closely involved in the assessment. The assessment will propose a monitoring and evaluation system for a PBF approach in Mozambique.
The system barriers addressed are weak incentives for health workers (low salaries, lack of incentives, no links to performance), leading to low productivity and quality of care. This activity will address these barriers by assessing the feasibility and proposing recommendations for a PBF approach, which would encourage health workers to achieve results, thereby increasing the use of health services and improving quality.
There are linkages across the functional areas of service delivery, human resources, health finance, and leadership/governance, as explained in the implementing mechanism narrative above. There is an intentional spillover effect as the assessment aims to improve overall health outcomes, health worker motivation and supervision.
