The overall goal of this activity is to strengthen the community-based response to the HIV epidemic in Mozambique through an integrated approach. Local CSO will be capacitated to effectively respond to the needs of PLHIV, OVC and pre and post-partum women to improve their quality of life. This activity contributes to Goals 1, 3, 4 and 5 of the Partnership Framework. This activity will be implemented in Maputo, Inhambane, Manica, Sofala, Tete, Niassa and Cabo Delgado. CSOs will be supported to design and implement viable economic strengthening interventions targeting households impacted by HIV. Collaboration with INAS and other donors will be emphasized to reduce economic vulnerability of households and improve food security. The nutritional component will be emphasized through referrals to clinical and community services, and nutritional education. As appropriate, beneficiaries will be referred to counseling for RH/FP services. To strengthen bi-directional community - clinical referral systems, SDSMAS will be supported to host regular stakeholders meetings. Gender will address barriers which limit access to services, opportunities and place the burden of care on women and girls. Costing of community interventions is still ongoing, thus no cost data was used.Due to the delays in the award and mobilization phase issues, over $20 million has not been disbursed to FHI 360. Due to this partner large pipeline there has been a substantial reduction of OVC funding, therefore impacting the OVC earmark that will need to be reattributed in FY13. In FY 2011, 8 vehicles were purchased to be used to provide TA and Supervision to local partners; No new vehicle requests in COP 12.

This activity will focus on building the technical and organizational capacity of local organizations to effectively provide family-centered, community-based care and support services to households with PLHIV in Maputo, Inhambane, Manica, Sofala, Tete, Niassa and Cabo Delgado. Home Visitors will ensure that PLHIV are referred to health facilities to have access to the range of care services (cotrimoxazole prophylaxis (CTXp), tuberculosis (TB) treatment, CD4 testing etc) as required. Activities that link with OVC programs to ensure access to basic care and support services are essential to improving quality of life throughout the continuum of HIV infection. ComCHASS will work with ART facilities in catchment area to identify beneficiaries. As the national support group for positives, GAAC (Grupo de Apoio a Adesão Comunitária), strategy is rolled out across the country, ComCHASS CSOs will collaborate by referring PLHIV on treatment to the GAACs in the pilot districts. The philosophy beyond the GAAC strategy is to mobilize stable HIV patients on ART to organize themselves in groups, whose members take turns to collect their ARVs at the health facility. ComCHASS will also look for opportunities to apply the GAAC principles to other community groups, such as Community Care Committees (CCCs), Community Leader Councils (CLCs), the mother-to-mother groups, the VS&L groups, finding efficiencies and savings on labor or travel costs relevant to their activities. In Mozambique a study showed that the most frequent challenges to ART adherence are social and economic in nature (i.e. food and nutrition security, lack of transport). ComCHASS will support implementing organizations/PLHIV associations create village savings and loans, access micro-credit, to reduce the economic vulnerability of the household and barriers to treatment adherence. Positive prevention support groups at community will be established where possible with ART/pre-ART patients who live close to each other. ComCHASS will support the distribution of the Basic Care Kit (condoms, certeza, soap, IEC materials) promoted through community settings.

In an effort to strengthen community referrals systems, ComCHASS has undergone a mapping exercise in implementation districts, which resulted in the creation of a district Services Directory. ComCHASS has also introduced regular stakeholders meetings focused on strengthening referral systems community to clinical services, clinical to community services, intra-community services (referring to other CSOs or NGOs providing services), etc. In provinces with CDC funded partners, ComCHASS is already working with EGPAF in Maputo Province to assure effective referral relationships with non-USAID funded health units. The consortium partner World Relief (WR) is working with I-CAP regarding non-USAID funded health units in the 5 targeted project districts in Inhambane province. WR will follow similar collaboration strategies and meetings with I-CAP that FHI has done with EGPAF.

The prime partner, sub-partners leading implementation in Manica and Inhambane Provinces, as well as the Economic Strengthening Technical Assistance lead, are International NGOs. There are two capacity building partners that are locally owned organizations. The activity will have a major component of Grants Under Contracts that will be made to locally owned organizations that includes CBOs and FBOs, which will be providing the services to the OVC and their families.The overall goal of this activity is to strengthen the community-based response to the HIV epidemic in Mozambique through using an integrated approach that includes: 1) Provision of community-based HIV services (OVC, HBC), including TB detection and effective referrals to facility-based health and social sector services (maternal/child health (MCH), reproductive health (RH), TB and HIV testing and treatment; 2) Improving and expanding access to economic strengthening activities for affected families; and 3) Enhancing the public sectors capacity to provide an integrated continuum of care and support for affected households and individuals. Intensive capacity-building and mentoring of local civil society organizations to effectively respond to the needs of PLHIV and OVC with local solutions and resources to improve their quality of life.Under this activity OVC and PLHIV households will effectively receive family-centered, community-based care and support services in Maputo, Inhambane, Manica, Sofala, Tete, Niassa, and Cabo Delgado. The Home Visitors will ensure that OVC have access to basic services based on family needs assessment. Linkages to National Institute of Social Action and other welfare programs will be strengthened through a two-way referral, using the District Services Directory developed during last fiscal year. Economic Strengthening activities such as Voluntary Savings and Loans will be provided to older OVC and their caregivers to assist OVC families to boost their income. Strengthening communities structures is key, thus Community Committees for Child Protection will be strengthened or established by ComCHASS using the recently approved Ministry of Women and Social Action reference guide.ComCHASS 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. Nutritional support will be emphasized through referrals to clinical Nutrition Rehabilitation Units where they exist. Training on balanced meals and utilization of local nutritional foods will be provided through various opportunities the mother-to-mother groups, the community committees for child protection, household visits, and community mobilization activities. Linkages for OVC continued access to safe water treatment systems, hand-washing soap and hygiene education, will be maintained.During last fiscal year, ComCHASS finalized with success the selection of Civil Society Organizations (CSOs), that will be implementing the direct services in five of the seven provinces, and during this fiscal year they will be doing the same process in Tete, Cabo Delgado and two other districts in Niassa Province. An Organizational Capacity Assessment of the selected CSOs has been done, and a Capacity building of those CSOs has been drafted and will be implemented starting this fiscal year.

Under this activity, the partner will address PMTCT activities aiming to promote demand creation and integration of basic OVC services. The activities will be standardized across the project target districts in Maputo, Inhambane, Manica, Sofala, Tete, Niassa, and Cabo Delgado provinces using pipeline from FY 2011.

ComCHASS 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.

In addition to strengthening facility-community linkages and focusing on the role of civil society, psychosocial support will be provided in all PMTCT settings. There is a recently developed national framework for psychosocial support groups that is currently being rolled out. The community mobilization for demand creation will be 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. Activities will also include prevention and reduction of gender-based violence.

Mozambique is currently piloting community treatment groups of HIV, and a similar model will be explored for PMTCT. GAC will be part of the PMTCT strategy, and ComCHASS is expected to improved referral and service linkages through coordination with implementing clinical partners and other community organizations who are being directed to scale up existing approaches (fast tracking, escorted referrals) and implement innovative approaches.

Infant follow up has been identified as a particular weakness in Mozambique. Implementing daily NVP during breastfeeding will create additional need for an effective follow up system to promote adherence and prevent loss to follow up. Addressing the challenge of providing services for infants is linked to overall efforts to reduce loss to follow up.

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 activist referrals and 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, the sub-partner CSOs will help to strengthen them; where there is no M2M group, the CSOs will help to create them.

Nutritional support will be emphasized through referrals to clinical Nutrition Rehabilitation Units where they exist. Training on balanced meals and utilization of local nutritional foods will be provided through various opportunities: the mother-to-mother groups, the community committees for child protection, household visits, and community mobilization activities.