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/mechanism in FY 2009.
The identification and follow up of HIV positive infants has been a priority of the PEPFAR program since its
inception in Rwanda. There are number specific challenges to ensuring the health of infants of HIV positive
mothers, including loss to follow up, poor nutrition, and the early identification and referral of HIV positive
infants to appropriate care and treatment. The PEPFAR program has addressed these challenges with
technical support to the MOH and provider trainings at the district level
However, certain challenges persist.
The 2005 RDHS-III results indicate 45% of children under five are stunted due to chronic malnutrition.
According to the Rwanda National Nutrition Plan 2005-2010, chronic malnutrition in under-fives is
significantly associated with poor infant feeding practices. Although the 2005 RDHS-III indicates high rates
of exclusive breastfeeding for infants less than six months, a UNICEF study indicates only 17.4% exclusive
breastfeeding for infants of the same age. Both studies demonstrate insufficient introduction of
complementary food for infants between 6 and 24 months. Since 2005, UNICEF, in collaboration with the
Treatment Research AIDS Center,TRAC, has led the adaptation of the WHO/UNICEF Infant and young
child feeding (IYCF) guidelines and development of training materials and tools in Rwanda for the
strengthening of IYCF counseling and support in the context of PMTCT. In FY 2006, PEPFAR collaborated
with UNICEF to support training at PMTCT sites in IYCF. However, UNICEF does not have the in-country
capacity to ensure ongoing support, monitoring, and refresher training of sites in the country.
Consequently, since FY 2007, PEPFAR funds have supported an advisor through BASICS to provide TA to
the MOH and TRAC for ongoing monitoring of IYCF, particularly in the following: rapid assessment of
current provider knowledge and skills in IYCF; use of and adherence to AFASS guidelines and criteria
during infant feeding counseling for pregnant HIV-positive women; and pre- and post-partum IYCF
counseling and support; adapt monitoring tools, checklists and job aids for providers; conduct with TRAC
and MOH an integrated TOT for IYCF and training of district supervisors in follow-up supervision of
providers in IYCF counseling; adherence to AFASS protocols; lactation management specifically among
symptomatic HIV-positive mothers; and support to HIV-positive mothers in adhering to their infant feeding
choice.
BASICS activities are in accordance with national guidelines and support the integration of IMCI into HIV
activities through technical assistance to the MOH. However, BASICS is coming to an end in FY 2008.
However, the follow-on TBD mechanism will build on BASICS' work with the MOH over the last two years.
More specifically, in FY 2009, the follow on mechanism will: provide TA to the MOH to better follow up
exposed infants until their serostatus has been established at 18 months; strengthen referrals within
PMTCT to care and treatment and appropriate vaccinations; strengthen MOH's systems for routine infant
screening and testing to monitor changes in serostatus over 18 months; and monitor growth and nutritional
status in accordance with national guidelines.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTVITY UNCHANGED FROM FY 2008:
inception in Rwanda. There are a number of issues that are specific challenges to ensuring the health of
infants of HIV positive mothers, including loss to follow up, poor nutrition, and the early identification and
referral of HIV positive infants to appropriate care and treatment. The PEPFAR program has addressed
these challenges with technical support to the MOH and provider trainings at decentralized health facilities.
There continues to be many missed opportunities to reach infants and children with HIV at multiple entry
points to care, including at MCH services, PMTCT programs, pediatric inpatient wards; through home based
care programs, and others. To reduce missed opportunities, in FY 2007 and FY 2008, BASICS
strengthened functional referral networks, and active communication and collaboration between units within
facilities, between different levels of facilities and between the facilities and surrounding communities
through community health workers, NGOs and CBOs. However, there needs to be renewed emphasis on
this issue with the GOR's adoption of CHWs as the point of entry to the health system.
BASICS also provided technical support to other PEPFAR and USG partners to integrate post partum care
packages for newborns and mothers, family planning and safe motherhood activities into their current
PMTCT work. Their work also included the development of job aids and training tools, and conducting
training of health workers at the facility and community levels of care to increase early identification, referral
to care and treatment services, tracking, follow up and continued care for infants and children exposed to
HIV. BASICS drafted and pre-tested a pediatric HIV orientation module for CHWs and PLWHA groups who
do not need training at the level addressed in pediatric ART courses for prescribers and who might not be
an appropriate audience for IMCI-HIV training. This type of information and training allowed this audience to
increase their index of suspicion for infants and children with HIV, and to appreciate the importance of
diagnosing HIV, and the benefits of OI prophylaxis and ART and the follow up needs of children and
families once children start on ART.
BASICS' technical support to improve earlier and expanded identification of infants exposed to HIV will
increased the number of infants and children accessing care and treatment services. Since FY 2007,
PEPFAR funding for BASICS has been augmented and complemented by CSH funds with the goal of
comprehensively addressing IMCI and other MCH challenges. Funding for BASICS will come to an end in
FY 2008. However, there will be a follow on TBD mechanism that will build on BASICS' work over the last
two years.
More specifically, in FY 2009, the follow on mechanism will provide TA to the MOH to better support infants
who are diagnosed as HIV+ through the following: ensuring routine testing to monitor CD4 counts;
supporting the MOH to strengthen protocols for pediatric ARVs and OIs including CTX are followed at
decentralized levels in the district hospitals and health centers. In FY 2009, the TBD mechanism will also
strengthen referrals for HIV+ children to nutritional support and counseling, LLINs, safe water, and
psychosocial support. Also, in accordance with GOR's national guidelines on pediatric care and treatment,
the TBD BASICS follow-on mechanism will develop protocols to routinely monitor and support infants and
children until they can be counseled on their serostatus and understand the concomitant health implications.
Table 3.3.10:
