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: 2008 2009
ACTIVITIES UNCHANGED FROM FY 2008
Pharmaceutical interventions are critical for the overall success of the PEPFAR program. However, along
with their life-saving and disease preventing properties, use and misuse of these medicines can also result
in adverse patient reactions or trigger resistance diminishing their therapeutic benefits. Many of the
antiretroviral and anti-infective drugs utilized by the PEPFAR program can have adverse effects that are not
well recognized in select certain clinical settings.
Primary activities for FY 2009 will include the establishment of an adverse drug reaction (ADR) notification
system and an accredited National Center for Pharmacovigilance (NCPV) located within the Pharmacy Task
Force (PTF) in compliance with World Health Organization (WHO) requirements. Additionally, it will be
important to develop standard operating procedures (SOP) to facilitate quality ADR reporting, and to
monitor and supervise the ADR system in selected sites. Furthermore, it will be necessary to develop
protocols for prevention and prompt identification of ADR, toxicities and drug interactions for chronic
patients. Finally, prophylaxis for OIs and TB treatment must also be administered appropriately.
PEPFAR funding will not only assist the PTF in establishing a pharmacovigilance system at the central
level, but also within the districts as well. This will be achieved through trainings for health providers,
implementation of data collection systems, and reporting on ADR notification. In addition to working with
the PTF, CIDC, and the National University of Rwanda, SPS works working with 12 district hospitals, 8
district pharmacies in the public sector, and 10 district pharmacies in the private sector.
To enhance capacity in this area, SPS will work with PTF pharmacists in order to help them finalize the
National Pharmacy Policy; update the Essential Medicines List and Standard Treatment Guidelines; and
establish a National Medicines Committee (NMC). Other capacity building measures will include a seminar
for members of the NMC and other partners to provide guidance on containing antimicrobial resistance and
the development of pharmaceutical management pre-service training modules for University of Rwanda
pharmacy students emphasizing rational drug use and pharmacovigilance. SPS will also identify three
national level staff to participate in PV courses organized by the National Drug Authority of Morocco (two
individuals were trained in this manner using FY 2007 funds).
In FY 2009, SPS will expand the ADR notification system to all district hospitals by training clinical and
pharmacy staff in pharmacovigilance (PV) while emphasizing the need to prepare for the challenges of
implementing the new ART treatment regimen. SPS will also assist with the implementation of recently
developed SOPs. Expansion of the PV program will also include the following quality assurance activities:
following-up with trained staff to ensure routine monitoring of the quality of the ADR system; conducting
targeted supervision for improvement and participation in evaluation of activities; monitoring drug cohorts
first in sentinel sites and eventually in all sites; and building PTF capacity in analyzing and validating PV
data.
An important goal of this activity continues to be providing a small-scale passive and active surveillance
programs for adverse events experienced by Rwandan patients who receive PEPFAR distributed
pharmaceuticals. Preliminary work with the PTF has occurred and the need to conduct this activity through
regional collaboration based on experience in other African countries has been identified. The funds
necessary to further develop the surveillance program were reprogrammed to SPS (formerly RPM Plus) in
collaboration with the President's Malaria Initiative (PMI) and CIDC. To date, such funding has been used
to provide TA to establish a small-scale passive surveillance program for adverse events as part of a drug
safety program. SPS provided training to caregivers in select hospitals in the utilization of user-friendly
reporting forms as well. They also trained a GOR analyst in forms interpretation. In addition, SPS has
provided periodic QA and supervision to health care providers to ensure proper completion of reports,
quality of data, and reporting to the PTF. SPS will continue its involvement with all of these activities in FY
2009.
These activities will continue to complement PMI investments to ensure that pharmacovigilance system
strengthening is well-integrated into both HIV/AIDS and malaria medication distribution networks. This
approach is also in keeping with the goals of the Rwanda PEPFAR five-year strategy and the National
Prevention Plan by continuing to provide assurance and strengthening of quality treatment commodities and
ARV services.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16880
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16880 16880.08 U.S. Agency for Management 7584 7584.08 SPS $200,000
International Sciences for
Development Health
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $70,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.15:
ACTIVITY HAS BEEN CHANGED IN THE FOLLOWING WAYS:
In FY 2008, PEPFAR continues scaling up its technical and management support to the MOH and the
Pharmacy Task Force (PTF), a committee of stakeholders based within the MOH. Strengthening
Pharmaceutical Systems (SPS), receiving a five-year award with a mandate to build pharmaceutical
capacity in developing countries.
During FY 2009, SPS will be building institutional and individual capacity on RDU and pharmacovigilence as
well as policy level support to MOH. Institutional capacity building will be directed towards transferring
technical capacity to the institutions that impact the pharmaceutical system in planning, development and
implementing processes (Pharmacy Task Force, PTF, TRACPLUS-Center for Infectious Disease Control
(CICD), University of Rwanda, Rwandan Association of Pharmacies, ARPHA). ARPHA is in accord with
this mission. In FY 2008, SPS focused its technical assistance on pharmacovigilance and rational use of
medicines at both the national and peripheral levels. In the area of rational drug use, SPS in collaboration
with PTF, has undertaken activities to improve dispensing practices at public and private pharmacies. In
FY 2009, these activities will be continued and scaled-up to an additional ten districts. SPS will also support
ten private pharmacies in pharmacy care and counseling. Other SPS institutional capacity building RDU
activities will include: producing targeted materials and job aids for the dispensers in hospitals and health
centers; training and mentorship for one district pharmacist in each district; implementation of developed
tools in selected private pharmacies; messages to raise public awareness about RDU; establish Drug
Therapeutic Committees to an additional 12 hospitals, strengthen ability for management of HIV drugs
including rational use of first and second line therapies.
Individual capacity building will be directed towards those with chronic conditions, mainly HIV infected and
TB infected patients. The TA will focus on: managing appointments; identification of side effects/toxicity;
referral to clinical services as needed; counseling on taking medications properly; motivating patients to
adhere to treatment regimens; counseling patients going to the pharmacy without first having seen a
clinician; providing accurate dosages of drugs to children, including ART; identifying the most important
drug and food interactions, as well as contraindications for the 25 - 35 most commonly used medications
used for treatment of OIs. SPS will also promote hygienic practices with medications. Given the GOR's
priority and focus on decentralization and community involvement, SPS will provide training on good
dispensing practices and RDU for community health workers (CHWs) who will assist with case
management by visiting and encouraging patients to keep appointments, fill prescriptions, and take
medicines as prescribed.
Policy and procedure development support is directed towards the MOH. In FY 2008, SPS is creating a
process for national quality assurance (QA) in drug testing, inspection, and monitoring. SPS is also
providing support for developing policies and procedures for drug regulation. PEPFAR built capacity of
pharmacists by providing materials, training pharmacists, and supporting the University of Butare's School
of Pharmacy to integrate HIV/AIDS pharmaceutical management into its curriculum. Additionally, SPS is
developing a fee structure for commercial registration of drugs, including pricing policy and plans for
financial audits.
In FY 2009, SPS support will continue in the areas of drug registration, testing QA, inspection and
monitoring, and policy development for drug regulation. SPS will also continue to provide support in
developing pricing policies and procedures for health providers. While waiting for National Drug Authority
(NDA) approval and implementation, SPS will assist the PTF of the MOH to develop an implementation plan
that clearly defines roles and responsibilities, in addition to supporting a strategic plan to include a drug
registration system.
In FY 2008, SPS is providing district level support. More specifically, SPS is providing managerial and
technical assistance to the PTF and ensuring that PTF meets requirements to decentralize pharmaceutical
management at the district level, and providing TA to establish and make the national drug registration
system operational. SPS will continue these activities in FY 2009, and assist PTF in the development and
implementation of the National Pharmaceutical Pricing Policy. To ensure effective decentralization and
integration of pharmaceutical functions and activities, PEPFAR will continue to support the strengthening of
PTF systems and institutional capacity in FY 2009.
Under FY 2008, PEPFAR continues developing systems and building capacity at the PTF / ARPHA to
enhance implementation of the national pharmaceutical policy, in part through private sector RDU forums.
SPS is providing capacity development of RAMA in pharmaceutical management, rational drug use and
implementation of national pharmaceutical policy. Through working with the National University of Rwanda,
SPS will facilitate integration of pharmaceutical management modules in the academic curriculum and
assist NUR in operational RDU research. These activities will continue in FY09. In FY 2009, SPS will
provide full time TA to the PTF to assist with the implementation of National Medicines Committee activities
as well as with the establishment of DTCs as part of hospital structures. SPS will develop and implement a
plan to monitor the compliance of the Standard STD Treatment Guidelines.
These activities are in keeping with PEPFAR's five-year strategy and supports the GOR's national human
resources and organizational capacity building strategy.
Continuing Activity: 16883
16883 16883.08 U.S. Agency for Management 7584 7584.08 SPS $500,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $250,000
Estimated amount of funding that is planned for Education $200,000
Table 3.3.18:
