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: 2010 2011 2012 2013 2014
COP 2010 Overview Narrative
HIVQUAL/US Health Resources and Services Administration is a continuing mechanism from COP 09
HIVQUAL/US Health Resources and Services Administration has one comprehensive goal and four objectives across the HTXS, HBHC, PDCS and PDTX technical areas. The main goal is to provide technical assistance to the MOHSS to establish a quality improvement program that allows public health facilities to continuously assess the quality of care they deliver to HIV/AIDS patients. Information from this quality improvement program is used by clinic staff to guide efforts to improve HIV care delivery.
To achieve this goal HIVQUAL has the following objectives:
1. Build capacity for MOHSS program officers and health care providers to become more proficient in using quality improvement tools and methodologies to improve HIV care.
2. Establish a quality of care performance measurement system that monitors to what extent treatment and care provided to patients infected with HIV complies with Namibian National Guidelines for HIV/AIDS care.
3. Establish a system to evaluate the results of efforts to improve the quality of HIV/AIDS treatment and care at all public health facilities.
4. Provide technical assistance (TA) on strategies to develop local, regional, and national consumer involvement processes in HIV/AIDS health care programs.
Links to the Partnership Framework goals and benchmarks over the life of its agreement/award.
This activity closely supports the commitments of the USG in the partnership framework which is currently under development.
As part of the USG contribution to the goal of "enhancing the quality of care" within the partnership framework implementation plan (PFIP), the USG commits through year five to provide TA to enhance quality management and quality improvement of HIV service delivery. In COP10, the USG will support the roll out of structured quality improvement program to all public HIV treatment and care facilities.
The Implementing Mechanism's geographic coverage and target population(s).
In collaboration with USG agencies in Namibia, HIVQUAL will work within the MOHSS to reach out to all public health facilities including those with faith-based affiliations. The target population for the quality improvement program will be all HIV infected children, adolescents and adults receiving HIV care and treatment within all the public health facilities, as well as the health care workers (HCW) staff providing that care.
Key contributions to health systems strengthening
Consistent with the new PEPFAR vision of improving sustainability of national programs, HIVQUAL will support efforts to decentralize program management and build program management capacity at regional, district and other sub-national levels. The HIVQUAL approach emphasizes the development of quality improvement systems and processes involving clinic staff and consumers within the MOHSS and other organizational leadership. These structural features are designed to be sustainable even when staff turnover is high or organizational affiliations support change. Through building capacity at the national and local levels for quality improvement and use of strategic information by providers for program improvement, HIVQUAL will strongly contribute to overall health systems strengthening.
Implementing Mechanism's cross-cutting programs and key issues
In terms of cross-cutting attributions funding for HIVQUAL contributes towards the Human Resources for Health (HRH) component of Performance Assessment/Quality Improvement.
The Implementing Mechanism's strategy to become more cost efficient over time
HIVQUAL values cost efficiency and from the beginning has been working through the structures of the MOHSS, by providing technical assistance through the targeted use of New York-based consultants and the extensive use of USG Namibia technical staff within the program framework. This strategy is consistent with the new PEPFAR vision to ensure cost efficiencies. The MOHSS coordinates the program with other partners in the public sector through its Case Management Unit, and thus is able to expand coverage of the program with low costs. The use of Case Managers also builds human capacity within the MOHSS system. In 2009, the MOHSS took over management of these positions from a private contract firm. This was a first step toward full absorption into the MOHSS human resource system.
Monitoring and evaluation plans for included activities.
The activity itself is primarily focused on the utilization of clinical data for improving quality of care. As such, monitoring and evaluation of clinical services is continual. HIVQUAL is required to submit bi-annual progress reports detailing achievements in terms of PEPFAR indicators and other measures specific to the activities. An independent external evaluation was conducted in 2008.
Quality Improvement (QI) training; assessment of quality management programs at participating clinics; performance measurement (at six-month intervals) on selected core indicators; ongoing QI coaching and mentoring at participating sites, and; promotion of patient engagement in HIV care. Funding for HIVQUAL is split 85%:15% between HTXS/HBHC and PDTX/PDCS because the program focuses on quality improvement of clinical services in all four program areas.
Continuing Activity
Estimated Budget = $18,750
ADDITIONAL DETAIL:
This activity is conducted under the leadership of the MOHSS Directorate of Special Programs (DSP) in close collaboration with CDC Namibia and the US-based HIVQUAL team for technical support. The program has been rolled out to all 34 health districts of Namibia, and at least five health centers offering HIV care through the Integrated Management of Adolescent and Adult Illness (IMAI) strategy. Activities in COP11 will focus on quality program implementation in these sites, and expansion to additional health centers.
1) Quality Improvement (QI) training. The USG-MOHSS HIVQUAL team will continue to build capacity for QI in public healthcare facilities and among MOHSS technical staff and healthcare providers. Advanced in-service trainings will be provided to staff who has received training in prior years. Basic training in QI will be provided to all relevant new staff. Training activities will be done in collaboration with I-TECH. Specifically activities will include Training of Trainers workshops to promote decentralization of QI trainings throughout Namibia, and to support the expanded national quality program.
2) Assessment of quality management programs at the participating clinics. An assessment tool to measure the capacity of the quality management program at each facility will be used to measure the growth of quality management activities as well as the quality of staff members' skills. The findings from these assessments will guide coaching interventions. Aggregated facility-specific data will provide population-level performance data to indicate priorities for national quality improvement activities and campaigns. Similarly, local performance data will be used to identify facility-specific gaps in the delivery packages of care and then devise customized interventions to improve services at local facilities.
3) Performance measurement (at six-month intervals) on selected core indicators. HIVQUAL will continue to develop providers' skills for collecting and using performance data within their own organizations to improve their HIV treatment and care. Indicators will track the provision of the basic treatment and care package. Selected national core indicators will monitor proportions of pediatric patients receiving HAART, ART adherence, Cotrimoxazole prophylaxis, pediatric nutrition, immunizations, growth monitoring and TB screening. Facility-level data derived from the national health information system will be used to improve quality.
4) Ongoing QI coaching and mentoring at participating sites. The program will continue to invest in transferring knowledge and skills to local technical advisors in the MOHSS. The transfer of QI skills will be accomplished through coaching and mentoring for MOHSS staff and health care providers. These QI skills will include performance data interpretation skills, quality program planning and design of quality improvement projects and implementation through improvement project cycles.
5) Promotion of consumer engagement in HIV care. HIVQUAL will provide technical assistance to the MOHSS on strategies to develop local, regional, and national strategies and programs to increase consumer (patient) involvement in HIV/AIDS programs. Increased participation by patients, pediatric patients' parents and guardians, and other "consumers" will improve HIV care and treatment services by enhancing the feed-back loop between patients, providers and the MOHSS. Specifically this activity, which was started in two sites in late 2009, will include working with the MOHSS to devise a written national plan for consumer involvement. The plan will outline structures to ensure active participation of people living with HIV/AIDS in the development and improvement of HIV/AIDS programs. This will also include a needs assessment to determine local, regional, and national priorities. Regional civil society groups will be engaged at local facility level to identify and solicit diverse community opinions.
Quality Improvement (QI) training; assessment of quality management programs at participating clinics; performance measurement (at six-month intervals) on selected core indicators; ongoing QI coaching and mentoring at participating sites, and; promotion of patient engagement in HIV care. Funding for HIVQUAL is split 85%----:15% between HTXS/HBHC and PDTX/PDCS because the program focuses on quality improvement of clinical services in all four program areas.
Estimated Budget = $74,089
Quality Improvement (QI) training; assessment of quality management programs at participating clinics and among health care workers trained in pediatric HIV care; performance measurement (at six-month intervals) on selected pediatric indicators; ongoing QI coaching and mentoring at participating sites, and; promotion of patient (and family) engagement in HIV care. Funding for HIVQUAL is split 85%:15% between HTXS/HBHC and PDTX/PDCS because the program focuses on quality improvement of clinical services in all four program areas.
Estimated Budget = $36,250
5) Promotion of consumer engagement in HIV care. HIVQUAL will provide technical assistance to the MOHSS on strategies to develop local, regional, and national strategies and programs to increase consumer (patient) involvement in HIV/AIDS programs. Increased participation by patients, pediatric patients' parents and guardians, and other "consumers" will improve HIV care and treatment services by enhancing the feed-back loop between patients, providers and the MOHSS. Specifically this activity which was started in two sites in late 2009, will include working with the MOHSS to devise a written national plan for consumer involvement. The plan will outline structures to ensure active participation of people living with HIV/AIDS in the development and improvement of HIV/AIDS programs. This will also include a needs assessment to determine local, regional, and national priorities. Regional civil society groups will be engaged at local facility level to identify and solicit diverse community opinions.
Estimated Budget = $44,174
1) Quality Improvement (QI) training. The USG-MOHSS HIVQUAL team will continue to build capacity for QI in public healthcare facilities and among MOHSS technical staff and healthcare providers. Advanced in-service trainings will be provided to staff who have received training in prior years. Basic training in QI will be provided to all relevant new staff. Training activities will be done in collaboration with I-TECH. Specifically activities will include Training of Trainers workshops to promote decentralization of QI trainings throughout Namibia, and to support the expanded national quality program.
