SCIP World Visions overall goal is to improve health & livelihood of children,women & families, targeting 658,125 beneficiaries in FY12 in 16 districts of Zambézia Province.SCIP will strengthen & increase access to health,nutrition & HIV&AIDS care systems for its target groups that will forge stronger linkages with government entities,local NGO & INGOs;Promote and finance demand-driven community investments for health improvement, potable water, & sanitation;Build & reinforce existing institutional capacity of government at provincial/district levels & community groups/councils in decisions directly related to improving the living conditions of rural population.SCIP will support achievement of goals outlined in the PF & GHI strategies by strengthening clinical and community-based capacity of health care workers to deliver services;strengthen linkages between services to working towards comprehensive health care for PLHIV & OVC;strengthen organizational and technical capacity of CSOs. SCIP & FGH will formally collaborate in active case finding of ART patients;Bi-directional referral system for HIV+;Harmonize training schedules with DPS;Coordinate HIV&AIDS prevention messages;Harmonize placement of waiting huts with PMTCT expansion sites;Accreditation plan of counselors in HIV Rapid Test;Nutrition Rehabilitation Program. USG costing exercise of community interventions is under way & will influence budget allocations & ensure cost efficiencies overtime.FY12 funds request was lower due to pipeline. Data collection tools & systems will be redesigned as needed to accommodate needs for data integration with local government. Vehicles : COP11=23; COP12=1;Total=24(15 for community outreach;4 for WASH;3 to supervise;1 truck to transport equip/supplies;1 for admin.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? No

World Vision will receive $ 2,176,000 HBHC funds for its activities. Zambézia is a GHI focus province which will receive increased funds for counseling and testing and also benefit from an increase in the numbers of people on ARV. This will mean that there imply an increase of people in need of care and support. In FY12, there will be a need to strengthen World visions HBC activities. HBC activists provide services to PLHIV that include: 1) palliative care, 2) referrals to treatment and care services, 3) promoting adherence to treatment for HIV/TB and OIs such as CTX, and 4) follow-up care. They also provide psychosocial and spiritual support, appropriate nutritional advice, emotional counseling, and referral for food assistance. The MoH has requested partners implementing HBC to place greater emphasis in the areas of adherence to treatment, nutrition (Food Support and Nutritional education) and palliative care. Advocacy for CT, PMTCT, and referrals to TB/HIV treatment, and FP services are integral messages for all Community Health Councils (CHCs)/CHVs visits.World Vision networks with community based organizations, non-governmental organizations, and other USG partners to leverage access to prevention and treatment services and facilitate treatment adherence through groups, follow-up by Home Visitors (HVs), and other community members. World Vision will collaborate with PEPFAR clinical partners in Zambézia Province to strengthen referral services for PLHIV. World Vision will support the dissemination of the GAAC (Grupo de Apoio a Adesão Comunitária) strategy at community level. This is a recently launched MoH retention strategy which aims to mobilize stable HIV patients on ART to organize themselves in groups, whose members take turns to collect their ARVs at the health facility. World Vision will also support the distribution of the Basic Care Kit (condoms, certeza, soap, IEC materials) promoted through community settings.In addition, the project is strengthening the community-based and complementary health service support structure to improve access and quality of maternal, newborn, and child health (MNCH) and family planning services for PLHIV, while improving behavior and care seeking practices. Household level support utilizes an integrated approach, occurring in the context of multiple activities:1) Timed and Targeted Counseling using the life cycle approach and registration;2) Using Mother/Father Groups to reach groups of people in familiar circumstances, with peer support;3) BCC activities to enhance uptake of services, prevent spread of diseases such as malaria, diarrhea, STI, HIV and increase use of long lasting insecticide treated nets (LLIN);4) Home visits for HBC, OVC care, and combination HIV prevention activities;5) Community mobilized adolescent support groups to improve knowledge and practice on reproductive health (RH), family planning (FP), and prevention of STIs and HIV.During household interactions, Community Health Volunteers (CHVs) foster antenatal care (ANC) visits, including PMTCT, for HIV+ pregnant women, encourage skilled delivery, support CT participation, and educate families in the recognition of signs of illness and complications including when and how to access skilled health care.

The lead partner and sub-partners are all International NGOs.

The goal of this project is to improve the health and livelihoods of children, women, and families in the Province of Zambézia through Community Strengthening approach.

The main model for OVC support is through Community Health Committees (CHC) in 16 districts of Zambézia Province. The CHC network is a model for mobilizing and strengthening community-led care for OVC. It is a multi-sectorial approach that incorporates health, social welfare, education and justice. The CHC network is embedded in the community and actively involves beneficiaries (PLHIV, OVC, and women). CHCs are the primary mechanism for providing care and support to OVC, PLHIV, and vulnerable households, as well as for referring people to reproductive health/family planning (FP), CT, PMTCT, ART, and malaria and TB testing and treatment, where available. The project provides a comprehensive, and quality essential services for OVC and their families based on the initial family needs assessment. CHC-led interventions focus on HIV care and support but are not exclusively addressing only HIV issues in the community.

The Youth Farmer Clubs (YFC) component improve the livelihoods of the OVCs. OVCs are identified by Home Visitors, who are members of the Community Health Councils, and refer them to the YFC. These YFC are linked to the Farmer Associations supported through the P.L. 480, Title II Multi-year Assistance Programs (MYAPS). YFCs are assisted by an agricultural extension worker that provides training in life skills, building on knowledge gained in school but presented in a way to make the activities both fun and educational. The products of the farming activity are primarily for consumption and the surplus for selling. The profits may be used to buy school materials and/or other priority needs of the OVC participating in the Club. The Club is also a venue to learn other activities such as nutritional education, sessions on Child Protection Laws, Childrens rights, issues around Gender-based violence (GBV) and Prevention messaging.

The project will establish loan guarantee mechanisms generating income to support health related activities. Projects may target specific groups of OVC who will be assisted to register as formal, legally binding associations with the intention of beginning income-generating activities (IGAs). Training and assistance in business planning, management, market linkage, and technical knowledge will transform these initiatives into successful business activities. IGAs will be tailored to the context of each target community and include agriculture production or processing within the framework of the value chain analysis to be performed by the project. The income and some of the produce will be used to support the educational, financial, and nutritional needs of OVCs. This project will build on previous successful experiences of the seven implementing partners in the consortium.

SCIp World Vision is one of the projects chosen by the Ministry of Women and Social Action (MMAS) to pilot the recently approved OVC Standards of Care, to gather evidence for sharing at the national vetting meeting prior to approval by the Council of Ministers.This amount was reduced due to OVC pipeline and allocations of fund to ARV drugs in FY11.

These funds will be used to strengthen local leadership councils at community and district level. These councils are composed of community leaders and civil society members, and in theory (though not always in practice) they are the civil society counterpart to local government as part of Mozambiques decentralization strategy. SCIP has been helping these councils assess local problems and solutions, although more work is needed to make these councils representative of their communities and to link them to government. There are other possible civil society-local government coordination fora that may also be relevant to support, such as Provincial Development Observatories and local health steering committees.

SCIP will assess the best way to provide support to local councils (or other civil society-government fora) and the most relevant districts to focus on. SCIP will assess priority capacity-building needs (such as advocacy, planning, access to information, and community organizing) and facilitate training and mentoring to address them.

This activity contributes directly to the Global Health Initiative Governance area, by improving planning and budgeting at local levels, and by strengthening the capacity of civil society to advocate for its concerns and hold government to account.This amount was 0 due to pipeline and allocations of fund to ARV drugs in FY11.

SCIP World Vision will receive $300,000 of COP 12 HVAB funds for its youth-focused HIV prevention activities for individuals age 10-14. In addition to promoting healthier behavior change and norms, this years utilization of STP funds will have a stronger focus on promotion of HIV and health service uptake.This funding will primarily support all youth-focused activities, including those aimed at students, out-of-school-youth, OVC head of households, and adolescents, especially adolescent girls. Specifically, $200,000 will support community and clinic level communications to increase service utilization by creating more enabling environments and $100,000 will support community enforcement and awareness of existing legislation or creation of new legislation to focus on linkages between alcohol consumption, GBV and safe behavior.

This activity will continue to utilize the Go Girls (Avante Raparigas) curriculum, developed from research by JHU in Zambezia province, in small group interpersonal communications with girls, boys, teachers, families and communities. There are 15 sessions that around themes that include the following: puberty, reproductive health, pregnancy, family planning, HIV and STIs, trans-generational sex, self-assessment of risk, multiple partnerships, reasons for girls vulnerability to HIV, etc.SCIP will continue to ensure quality assurance through monitoring and supervisory visits, will continue to emphasize cross-fertilization of youth programs with its activities in HIV CT, family planning, care and condom programming activities.

SCIP World vision will continue to provide community-based counseling and testing for general population ($161,000) and for MARPs ($20,000). General population CT will have a stronger focus on reaching men in the workplace by targeting men participating in USAID Agriculture, Trade and Business projects in Zambézia province; pre-service teachers linked to the USAID Education portfolio; partners of PLHIV; and adolescent girls. MARP CT will continue its focus on commercial sex workers and truckers. Zambézias HIV prevalence is 12.6%; 15.3% prevalence among women . It is the province with the highest estimated number of HIV positive adults age 15-49 years who do not know their sero-status (162,000). SCIP will continue its door to door home-based CT for general populations and outreach CT for MARPs using the national testing algorithm. As the lead community-based CT partner for Zambézia, this activity will also receive $100,000 to help NPCS and DPS coordinate non-communication aspects of future provincial CT campaigns.As Zambézia is a COP 12 GHI focus Province, this activity will receive new additional funding to promote CT service uptake, especially among partners of PLHIV. This includes:$50,000 for identification, tracking and case management of partners of PLHIV; $26,600 for strengthened linkages via peer navigators that will escort HIV+ individuals from service to service in the facility setting and to maintain facility to community linkages;$83,500 for innovative ideas, such as conditional cash transfers, to encourage partners of PLHIV to seek CT.All CT partners will benefit from QA/QI support to INS at the central level. The lead clinical partner in Zambézia will receive funds to support EQA logistics for all CT partners, including SCIP World Vision. All of SCIP World Visions HVCT funds are used to carry out community-based counseling and testing with the majority targeting the general population and 4.5% ($20,000) targeting MARPs. Other activities targeting PLHIV and their partners are stated above and represent approximately 36% of this activitys total HVCT budget. No HVCT funds are directly allocated to MC. The project will mobilize communities and District Health Associations (DHAs) to increase the demand and use of CT services and coordinate with care, support and treatment providers to establish a two-way referral system of clients. Clients who test positive (including pregnant women) will be counseled to seek PMTCT services, pre-ART, ART and family planning (FP) counseling, care, and support, referred to existing community volunteers, and made aware of existing support groups for PLHIV. Planned HVCT trainings include quality assurance and control, supply planning and forecasting, campaign coordination, linkages/continuum of care, treatment as prevention.

The COP 12 ATS-C target of 23,579 individuals reached with counseling, testing and results is lower than last years. An additional 2,500 individuals will be reached through SCIP World Visions ATS-C MARPs activities. SCIP World Visions past year results (SAPR 11 + Q3) is 23,400 individuals counseled, tested and received results (41.2% achievement).SCIP World Vision will continue to ensure quality assurance through monitoring and supervisory visits, will continue to emphasize cross-fertilization of gen pop and MARP programs with its activities in HIV CT, family planning, care and condom programming activities.

SCIP Ogumaniha will receive $429,025 of COP 12 HVOP funds for HIV prevention activities for general population individuals age 15-49, MARPs (CSWs and Truckers), men in the work place, and PLH and their partners. In addition to promoting healthier behavior change and norms, this years utilization of STP funds will have a stronger focus on promotion of HIV and health service uptake. Ogumaniha will continue to use a mix of interventions that include community radio, interactive drama, small group interpersonal communication activities, and street outreach.$139,500 will support continued implementation of male and female condom programming for key populations, including MARPs, men, discordant couples and PLH; $150,025 will support continued and intensified delivery of HIV prevention and risk reduction messages and condoms to MARPs and another $139,500 will strategically scale up community based positive prevention activities.Ogumanihas MARP outreach activists have grown to include peer activists to reach CSWs and truckers along the transport corridors and Zambezia/Malawi border. Activists seek beneficiaries during evening hours along the highway and focus on promotion and distribution of condoms, promotion of CT and STI services, and risk reduction messages. There are no firm size estimation data for MARPs in Zambezia province.

This year, Ogumaniha will partner with a USAID Agriculture activity to reach men working in cashew factories with HIV prevention messages and CT services on a quarterly basis. Mainly relying on interactive theatre, messages will focus on importance of knowing ones HIV status, risks associated with multiple partnerships which include age-disparate relations, and gender.This activity will continue to promote CT services, including community based CT offered by Ogumaniha. Individuals identified to be HIV positive will be referred to Ogumanihas care and support program, but will also benefit from the positive prevention messaging and community based positive prevention funded under HVOP. There will be intensified focus on supporting PLH and their partners, with special emphasis on discordant couples, and their families.Ogumaniha will continue to ensure quality assurance through monitoring and supervisory visits, will continue to emphasize cross-fertilization of gen pop and MARP programs with its activities in HIV CT, family planning, care and condom programming activities.

Under this activity and using pipeline from 2011, the partner will address PMTCT activities aiming to promote the demand creation, and those that support the integration of exposed children to access OVC basic services. SCIP will strengthen communities for effective linkages needed with ANC where PMTCT services are being provided to improve the continuum of care for HIV-exposed and infected children, their mothers and/or fathers, including infant-feeding counseling or risk assessments.

Two mechanisms for encountering pre or post-partum women to refer to PMTCT services through the ANC clinics will be used. One is through the HBC activistas coming across them among their HBC client base, the other is through community mobilization activities intended to publicize the MNCH clinics/PMTCT services and encourage uptake of those services through referrals. In communities where Mother to Mother (M2M) groups already exist, SCIP will help to strengthen them.

Key interventions include community activities designed to increase demand for maternity services, including development of psychosocial support groups and collaborative work with traditional birth attendants (TBAS), advocacy with Health authorities to introduce special services for couples (i.e evening or weekend hours, incentives). In addition, due to transport constraints partners will support maternity waiting houses.

To increase retention, specific support will be provided to intensify busca activa (active follow up) with demonstration of innovative models. Community involvement will be directly linked to retention. Community platforms will be strengthened to increase demand for utilization of PMTCT and maternal and newborn services.

Community engagement and mobilization will be critical for utilization and retention in PMTCT services, as discussed above. In addition to strengthening facility-community linkages and focusing on the role of civil society, psychosocial support will be provided in all PMTCT settings. Male involvement will be supported through community-based interventions. The program will implement a strategy of community mobilization for demand creation in close collaboration with community leaders. Work with traditional birth attendants will be continued to support uptake of and adherence to facility-based services, and linkages to community-based services (including home-based care and community testing and counseling for HIV) will be strengthened. Community partners are expected to strengthen prevention efforts including partner/couples HTC, bringing couples together for mutual disclosure, in order to reduce transmission risk during pregnancy and prevent seroconversion. Activities will be implemented for prevention and reduction of gender-based violence. Opportunities to coordinate with non-PEPFAR USG activities (e.g. Food for Peace breast feeding support groups) will also be explored.