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 2015 2016 2017 2018
COP 2010 Overview Narrative
SUBSTANTIALLY CHANGED FROM LAST YEAR Objectives
This is a "to be determined (TBD)" partner. A request for proposals for a five-year cooperative agreement was issued in early 2009. An award is expected within the COP10 approval timeframe.
This program cuts across the HVAB, HVOP, HBHC, PDCS and HVCT technical areas. The main goal is to deliver prevention interventions to individuals in household and community settings. These interventions will include: home-based HIV counseling and testing (HCT), HIV education to promote behavior change, referrals to clinical services, counseling on ART adherence, and referrals to PMTCT services
To achieve this goal the program has five objectives:
1. Train at least 250 field officers (FO).
2. Enhance cross-referrals between facility-and community-based programs.
3. Provide basic "Prevention for Positives" counseling to HIV-positive clients.
4. Collaborate with other organizations to avoid duplication.
5. Mobilize and empower individuals and communities to change HIV risk behaviors.
Links to the Partnership Framework (PF)
As part of the USG contribution to the PF goal of "enhancing prevention," the USG commits to strengthen the GRN capacity to design, implement and finance comprehensive HIV prevention programs.
The PF is aligned with the priority prevention areas described in Namibia's National Strategic Framework for HIV and AIDS 2010-2015 (NSF), and include:
1. Social and Behavior Change
2. HIV Counseling and Testing
3. Prevention of HIV among the Most-At-Risk and Vulnerable Groups
4. HIV Prevention Involving People Living with HIV and AIDS
5. Medical Male Circumcision
6. PMTCT
7. Post-Exposure Prophylaxis (PEP)
8. Condom Social Marketing and Distribution
9. Prevention of Sexually Transmitted Infections
10. Blood Safety
The partner will address all of the above-mentioned prevention priorities with the exception of PEP and blood safety.
Coverage and Target population
This partner will work in the Omusati, Oshana, Oshikoto, Ohangwena, Kavango, Caprivi, and Khomas regions, which have the highest rates of HIV in Namibia. With the exception of the Khomas Region (Windhoek), the remaining regions are in the north, where the majority of the population resides. Emphasis will be placed on reaching remote populations.
Health Systems Strengthening
This program contributes to PEPFAR's broader effort to build human resource capacity by strengthening career pathways within the healthcare sector. The FO cadre could represent an entry-level access point to the GRN civil service, which will be expanded in COP10 to include a new cadre of "Health Extension Workers." With additional training and experience, FO will have the opportunity to advance to extension workers, community counselors, or work in other public health sector positions. FO ensure stronger linkages between health care facilities and communities.
Cross-Cutting Programs and Key Issues
This activity addresses several; cross-cutting programs and key issues including gender, economic strengthening, and wraparounds to other health programs.
Human Resources for Health: This program will build human resource capacity by providing training and stipends to over 250 community-based FO.
Gender: As part of counseling, FO will refer women to local income and productive resources, as well as gender-specific healthcare and social services (e.g., cervical cancer screening, PMTCT, and gender-based violence programs).
Economic Strengthening: The partner will refer HIV-infected individuals to PLWHA support groups, work with existing groups to strengthen them, and help communities to create new groups. Since many PLWHA support groups are involved in microenterprise (e.g., community gardens), program support from the partner will expand these groups' capacity to provide economic support to members.
Wraparound activities will include: Child survival (referrals to health facilities); family planning (counseling and referrals); malaria (education and bed nets); safe motherhood (referrals to PMTCT and ANC care); and TB (screening, and referral).
Cost Efficiencies Over Time
This activity is designed to be cost efficient. Community-based service delivery and outreach utilizes local volunteers who receive a modest monthly stipend. Expanding this model, which has been implemented in Namibia since 2005, can be done at relatively low cost. The partner will collaborate with other partners and MOHSS to ensure efficient delivery of services and to avoid duplication of efforts. Direct technical assistance is provided by CDC technical advisors. HIV test kits will be procured through the existing MOHSS system. Further cost efficiencies are achieved through utilizing the new community-based networks for other public health activities, e.g., distribution of insecticide-treated bed nets and mobilization for events such as National HIV Testing Day and immunization campaigns.
Monitoring and Evaluation Plans
The partner is required to have an extensive monitoring and evaluation (M&E) plan that is linked to PEPFAR and GRN indicators. The partner will submit bi-annual reports on the number of individuals reached, individuals tested, and individuals linked to services. The partner will have a system for adjusting program activities based on M&E information. The evaluation plan will include indicators for each program activity. In addition, an impact evaluation will be included in the TBD partner's scope of work
This activity includes community-based HIV prevention, HIV counseling and testing, and referral to services through door-to-door outreach. Approximately 310 Field Officers (FO) are derived from the communities they serve, work in several regions (Omusati, Oshana, Ohangwena, Oshikoto Kavango, Caprivi, Erongo, Otjozondupa, and Khomas). In addition to outreach activities FOs organize support groups for PLWHIV as well as conduct special outreach to youth, men, etc.
Continuing Activity
Estimated Budget = $20,637
Community prevention with positives (PWP) activities, including implementation of community-based PWP toolkit.
New Activity
Estimated Budget = $150,000
ADDITIONAL DETAIL:
DAPP will train and deploy at least 310 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as household-based HCT and referrals to clinical services. Details on these activities may be found in the HVCT and HBHC narratives. HVOP-related activities will include:
1) Community Outreach. DAPP will provide door-to-door, age-appropriate, education and prevention counseling to households and community members. Based on assessments conducted during the outreach visits, individually tailored packages of advice and services will be prepared. These packages should include:
information on HIV counseling and testing, as well as the ability to perform on site counseling and testing;
information on strategies to reduce sexual risk taking behaviors (e.g., abstinence, multiple concurrent partnerships, correct and consistent condom use, responsible drinking);
information and referrals for male circumcision where appropriate;
tailored prevention information for PLWHA;
referral information and links to appropriate care, and treatment services, including HIV care and treatment services, PMTCT, FP services, as well as TB and STI treatment in close cooperation with government health services;
referral information for social and health services including alcohol, abuse support, gender-based violence, and nutrition support; and
condoms as appropriate.
2) Training. DAPP will provide extensive training for FO on the most up-to-date, evidence-based approaches for effective prevention counseling. The TBD partner will also produce appropriate job aids and tools for the field officers, as well as supporting information, education and communication (IEC) materials for clients.
3) Public Outreach to Special Groups and Public Information Campaigns. DAPP will also be expected to conduct other community-based prevention efforts including education for traditional leaders, youth and other groups. DAPP will also establish tailored referral guides for each region, and will establish community-based resource centers. In addition, FOs will conduct public events to raise public awareness about HIV STI, and TB prevention, care, and treatment.
4) Community PWP. DAPP will implement the PEPFAR-supported community PWP intervention tool kit. This tool kit will include prevention for PLWHIV messaging and referrals, but will also emphasize positive living and social support. DAPP will likely implement these activities through the PLWHIV support groups they organize and support in each region. Test kits and training will be provided from the USAID TBD partner.
This activity includes community-based HIV prevention, HIV counseling and testing, and referral to services through door-to-door outreach. Approximately 310 Field Officers (FO) derived from the communities they serve, work in several regions (Omusati, Oshana, Ohangwena, Oshikoto, Kavango, Caprivi, Erongo, Otjozondupa, and Khomas). In addition to outreach activities FOs organize support groups for PLWHIV as well as conduct special outreach to youth, men, etc. Specific activities under the HVCT program area will include: 1) Mobilizing communities to access mobile HCT services operated by the Ministry of Health and Human Services (MOHSS), and; 2) Delivering HCT services during household outreach visits.
In COP 2011, $150,000 of the total DAPP budget is reserved specifically for community prevention with positives (PWP) activities. Please see the HBHC narrative. Note: home-based testing is a new activity and will take time to get established.
Estimated Budget = $132,242
The partner will train and deploy at least 250 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as referrals, with individual households. Details on these activities may be found in the HVAB, HVOP and HBHC narratives. The 250 FO will perform the following HVCT-related activities:
1) Community mobilization to access MOHSS mobile and facility HCT services. FO will use their unique position in the community to mobilize demand for HCT services offered by the MOHSS. These services are delivered through four MOHSS vans, which will operate across several regions. FO will also work with the MOHSS team, community leaders, and local radio stations to promote each outreach visit. To support this activity, the partner will provide FO with salaries, transportation (e.g., a bicycle or transportation costs), printed materials (e.g., flyers and IEC materials in local languages), and support for public and MOHSS coordination meetings (e.g., tents, office space).
2) Delivery of HCT services during household outreach visits. In 2008, the MOHSS approved the delivery of HCT through non-traditional settings such as mobile/outreach deliver points for the first time. FO will receive training in rapid testing before rapid test kits are deployed with FO as part of their standard household outreach toolkit. The partner will work closely with MOHSS to ensure that all guidelines and procedures are followed in the implementation of household-based testing. All rapid test kits used by FO will be procured and provided by the MOHSS Central Medical Stores. USG technical advisors for HCT will provide technical assistance to the partner, and, where possible, individual mentoring to FOs.
The MOHSS requires retesting of 5% of all rapid HIV testing done as part of external quality monitoring. All HCT facilities including outreach and door to door testing should be enrolled in the EQA scheme and are expected to submit 5% specimens for retesting using ELISA at NIP. Additionally, NIP will provide proficiency panels and Quality Control sets to all rapid test delivery points and compile EQA reports for the program.
This activity includes community-based HIV prevention, HIV counseling and testing, and referral to services through door-to-door outreach. Approximately 310 Field Officers (FO) derived from the communities they serve, work in several regions (Omusati, Oshana, Ohangwena, Oshikoto Kavango, Caprivi, Erongo, Otjozondupa, and Khomas). In addition to outreach activities FOs organize support groups for PLWHIV as well as conduct special outreach to youth, men, etc. In COP 2011, $150,000 of the total DAPP budget is reserved specifically for community prevention with positives (PWP) activities. Please see HBHC narrative. Note: home-based testing is a new activity and will take time to get established.
Estimated Budget = $17,375
Specific activities under the PDCS program area will include:
1) Referral services (to care and treatment for families, especially children;
2) Technical assistance for community support groups for PLWHA; and
3) Support for the coordination and integration of activities with the Ministry of Health and Social Services (MOHSS).
1) Referral services (HIV, STI, and TB care and treatment, as well as preventive care) for families. FO will work with families to promote whole-family health. An emphasis will be placed on ensuring that family members of an HIV positive person (including children) are tested for HIV. In addition, testing or referral for TB will be emphasized when at least one member may have TB disease. In addition to an emphasis on referrals for early identification of HIV and TB exposure, cotrimoxazole prophylaxis and early initiation of ART in those who test HIV-positive will also be emphasized. Adolescents will require special attention; and FO will deliver age-appropriate prevention messages for youth, including information on delaying sexual debut and abstinence. FO will also be vigilant to report suspected child sexual abuse as a cause of pediatric HIV, and make appropriate referrals to government protection units.
2) Technical assistance to community support groups for PLWHA. FOs will provide psycho-social support to community and PLWHA groups, as well as advice on small income-generating projects (e.g. community gardens). Special focus will be placed on building PLWHA's capacity and skills to care for HIV-impacted children. Where older children and adolescents are already HIV-infected, additional support will be provided to facilitate the disclosure of HIV-status to infected children, adherence to OI prophylaxis and or ART, caregivers' concerns and referrals to OVC programs.
3) Coordination and integration. DAPP and FOs will coordinate activities with other community-based groups. A special focus will be placed on coordination with support groups for PLWHA. Such integration will be encouraged to achieve cost savings. In each region, DAPP will coordinate FO activities with the Regional AIDS Coordinating Committees (RACOCs), Constituency AIDS Coordinating Committees (CACOCs), local leaders, and other government and nongovernmental organizations to ensure ownership and support transfer of best practices and lessons learned where appropriate. This coordination will enhance the supervision of FOs and avoid duplication. Links with regional and local coordinating bodies will also allow the FO system to be leveraged to deliver messages about other health events (e.g. National Immunization Days) or to distribute materials such as insecticide-treated bed nets. This leveraging is in line with the "mainstreaming" objectives described in the Partnership Framework (PF) and the National Strategic Framework for HIV/AIDS (NSF).
This activity includes community-based HIV prevention, HIV counseling and testing, and referral to services through door-to-door outreach. Approximately 310 Field Officers (FO) derived from the communities they serve, work in several regions (Omusati, Oshana, Ohangwena, Oshikoto Kavango, Caprivi, Erongo, Otjozondupa, and Khomas). In addition to outreach activities FOs organize support groups for PLWHIV as well as conduct special outreach to youth, men, etc.
Estimated Budget = $846,174
Implementation of CDC's Families Matter! Intervention for youth. The intervention promotes positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction for parents and guardians of 9-12 year olds.
Estimated Budget = $145,082
1) DAPP will train and deploy at least 310 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as household-based HCT and referrals to clinical services. Details on these activities may be found in the HVCT and HBHC narratives. HVOP-related activities will include:
Community Outreach. DAPP will provide door-to-door, age-appropriate, education and prevention counseling to households and community members. Based on assessments conducted during the outreach visits, individually tailored packages of advice and services will be prepared. These packages should include:
Training. DAPP will provide extensive training for FO on the most up-to-date, evidence-based approaches for effective prevention counseling. The TBD partner will also produce appropriate job aids and tools for the field officers, as well as supporting information, education and communication (IEC) materials for clients.
Public Outreach to Special Groups and Public Information Campaigns. DAPP will also be expected to conduct other community-based prevention efforts including education for traditional leaders, youth and other groups. DAPP will also establish tailored referral guides for each region, and will establish community-based resource centers. In addition, FOs will conduct public events to raise public awareness about HIV STI, and TB prevention, care, and treatment.
Community PWP. DAPP will implement the PEPFAR-supported community PWP intervention tool kit. This tool kit will include prevention for PLWHIV messaging and referrals, but will also emphasize positive living and social support. DAPP will likely implement these activities through the PLWHIV support groups they organize and support in each region. In COP 2011, $150,000 of the total DAPP budget is reserved specifically for community prevention with positives (PWP) activities as funded through HBHC. Note: home-based testing is a new activity and will take time to get established.
2) Implementation of CDC Families Matter!
Families Matter! is an intervention to promote positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction for parents and guardians of 9-12 year olds.
The Families Matter! Program (FMP) intervention is an adaptation of the US-based "Parents Matter!" curriculum which CDC has evaluated in the US and Kenya. The ultimate goal of FMP is to reduce sexual risk behaviors among adolescents, including delayed onset of sexual debut, by giving parents tools to deliver primary prevention to their children. Families Matter! is a community-based, group- level intervention that is delivered over five consecutive 3-hour sessions.
Given that this is new activity, and that the needs assessment is not completed, the number of sites and scope of implementation is still to be determined. Costs for the program will include personnel such as an overall manager, facilitators and administration staff. Additional costs will be for project materials, travel, office supplies. With the implementation of this program, materials and trainings will be shared with other organizations such as the Ministry of Gender, Equality and Child Welfare, Lifeline Childline, and others with an interest in Family interventions.
Estimated Budget = $846,173
4) Community PWP. DAPP will implement the PEPFAR-supported community PWP intervention tool kit. This tool kit will include prevention for PLWHIV messaging and referrals, but will also emphasize positive living and social support. DAPP will likely implement these activities through the PLWHIV support groups they organize and support in each region. PWP training and tool kit will be provided by Community TBD training partner
