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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In FY 2008, PEPFAR proposed to sign a MOU with Bralirwa, the local Heineken subsidiary and bottler of
beer and soda, to expand the company's provision of HIV prevention services, especially among the
farming community on whom they rely for raw materials. PSI, through the USAID BCSM mechanism was
proposed as the prime technical partner to implement this PPP. However, the deal with Bralirwa has not
been concluded, as the brewery is not prepared to commit to this activity, given that it has a substantial and
complete workplace program that addresses its own staff. The company is also not prepared (financially or
otherwise) to address its suppliers. The FY 2008 funding is therefore not yet obligated.
For FY 2009, PEPFAR Rwanda, recognizing the importance of PPP's and the potential for an activity of this
sort to have significant impact is proposing to identify a new partner to work with, addressing key HIV
prevention strategies as appropriate. PEPFAR intends to direct the FY 2008 funding from this activity to
this new partner and activity. Funding in FY 2009 has therefore been place-marked to ensure that these
new activities continue. PEPFAR proposes that whichever partner is identified, that PSI be the technical
prevention partner. Key messages on abstinence and fidelity will be promoted and this funding is
complemented by funding in the HVOP program area.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Workplace Programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education $20,000
Water
Table 3.3.02:
PEPFAR Rwanda recently awarded a consortium of partners, with Population Services International (PSI)
as the prime, a five year cooperative agreement to implement integrated behavior change and social
marketing (BCSM) activities for HIV. The COAG also covers other significant health issues including
malaria, family planning and maternal & child health with funding from other USAID sources. The main
objectives of the five year agreement are to develop and manage a cost-effective marketing, sales and
distribution network that improves access to branded products related to HIV/AIDS, malaria, reproductive
health and child survival; to develop and implement health communication activities that enhance behavior
and promote health seeking behaviors among Rwandans; to develop and enhance services and referrals,
particularly mobile HIV counseling and testing, to most at risk populations (MARPs); to improve the
management and technical capacity of Rwandan institution(s) to manage and implement similar programs
in the future through a transfer of technical skills and capacity building and to increase the availability of
data and evidence available to inform programming in key health areas.
FY 2007/2008 BCSM activities focused on activities which promote healthy behaviors around abstinence,
partner reduction, correct and consistent condom use, alcohol use, GBV, and counseling and testing
services. Activities also focused on integration of services including family planning and reproductive health
and the social marketing of condoms to most at risk populations. The target groups for these prevention
activities include high risk populations (sex workers and their partners, married couples, PLHIV, discordant
couples, mobile populations, young women in transactional and cross generational relationships, married
men and out of school youth.
Under the AB program area, two key communication campaigns were initiated. One campaign targeted
youth and their parents with messages focused on: improving communication between boys & girls as well
as their parents; skills building to strengthen young people's negotiation, self-affirmation and the ability to
resist peer pressure; and empowerment of young girls. Abstinence and fidelity among youth was highlighted
during this campaign- helping young people increase their personal risk perception and understanding
issues related to sex.
A second campaign targeted young women and their parents, older men and opinion leaders to begin
shifting social norms on transactional and cross-generational sex. Using advocacy and mass media
strategies, the campaign started a dialogue on the issue of cross generational sex, with an aim to change
society's view of the practice and to promote a sense of responsibility among leaders to take a public stance
on cross generational practices that put young women at greater risk.
PSI has also been working in partnership with Rwandan Partner Organizations (RPOs) to strengthen their
capacity to deliver interpersonal communication (IPC) activities at the community level. Important health
messages delivered at the community on abstinence for youth, gender norms and violence have been
complementary to the national mass media campaigns that have been launched.
FY 2009 activities will maintain the AB messages developed for the campaigns, reinforcing them at the
national, community, and interpersonal level. PSI will continue to promote abstinence among out of school
youth through mass media activities and through youth drop in centers in hot spots. Activities addressing
parent child communication will help facilitate dialogue between parents and children and increase the
social support for abstinence. Life skills training will accompany communication campaigns to ensure that
youth have the requisite skills for negotiation, decision making and self-efficacy. Activities with youth will be
age specific and relevant to their context. PSI will also continue to promote activities that increase
awareness about the risk of cross- generational & transactional sex, especially targeting young girls.
In response to emerging data that suggests new infections are occurring primarily among married couples,
PSI will increase communication activities promoting fidelity and partner reduction in marriage, as well as
activities targeted at serodiscordant couples. Findings from research to understand the link between
gender, infidelity and alcohol will be integrated into activities. Related (HVCT) activities will promote couples
counseling and testing to ensure sexual partners know each other's HIV status. To help respond to some of
the data gaps identified in the data triangulation exercise which determined that there were several
‘categories' of youth- some more at risk than others, PSI will work with TRACPlus - Center for Infectious
Disease Control/MOH (CIDC) and others to identify which youth in fact comprise the most-at risk
subpopulations.
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Education $500,000
as the prime, a 5 year cooperative agreement to implement integrated behavior change and social
malaria, FP and maternal & child health. The main objectives of the 5 year agreement are to develop and
manage a cost-effective marketing, sales and distribution network that improves access to branded
products related to HIV/AIDS, malaria, reproductive health and child survival; to develop and implement
health communication activities that enhance behavior and promote health seeking behaviors among
Rwandans; to develop and enhance services and referrals, particularly mobile HIV counseling and testing,
to most at risk populations (MARPs); to improve the management and technical capacity of Rwandan
institution(s) to manage and implement similar programs in the future through a transfer of technical skills
and capacity building and to increase the availability of data and evidence available to inform programming
in key health areas.
Under the HVOP program area, PSI has been implementing activities aimed at increasing condom uptake
and use, addressing distribution and positioning of condoms as dual protection; communication activities to
address the stigma associated with condom purchase and use as well as providing skills to high risk groups
on how to use condoms correctly and consistently. PSI has also been addressing HIV prevention activities
at the workplace, including ‘high-risk' workers such as bar maids, domestic workers and commercial sex
workers. PSI has also been working in partnership with Rwandan Partner Organizations (RPOs) to
strengthen their capacity to deliver interpersonal communication (IPC) activities at the community level.
Important health messages delivered at the community around abstinence for youth, gender norms and
violence have been complementary to the national mass media campaigns that have been launched.
PSI has also gathered evidence on sexual behaviors in prisons- highlighting some of the behaviors that put
prisoners at risk for HIV, as well as an in-depth gender norms qualitative analysis (using the GEM model),
that will provide guidance for improving programming addressing gender and male norms. PSI participated
in the Rwandan Behavior Surveillance Study (2008), focusing on mapping commercial sex workers and
identifying the behaviors that put them at risk.
With support from the Global Fund, PSI launched a new line of studded condoms, targeting a niche market
of the urban man with discretionary income, who is most at risk for high-risk sex. It is expected that the new
studded condom will help improve overall perceptions of condoms to more favorable.
FY 2009 activities will maintain these condom and other prevention activities reinforcing them at the
national, community, and interpersonal level. Activities to increase condom visibility will include the
placement of brand promotional items as well as a new condom communication campaign that seeks to
minimize the stigma that currently surrounds condoms and improve correct and consistent use of condoms.
MARPS including high risk youth will be the focus of these interventions. Activities will take place in the
workplace including places where high risk behavior might occur (hotels and bars), focusing on high- risk
groups like bar maids, truckers, men away from their families.
In response to emerging data that suggest new infections are occurring primarily among married couples,
activities targeted at serodiscordant couples. Related (HVCT) activities will promote couples counseling and
testing to ensure sexual partners know each other's HIV status. Related (HBHC) activities will continue to
actively promote and encourage condom use under prevention with positives activities. PSI will work with
JSI Deliver and SCMS to support CAMERWA (the national warehouse and procurement body) in active
distribution of public sector condoms, to ensure that all health facilities and community based distribution
agents, particularly those offering treatment to PLHIVs have condoms and are distributing them to clients
seeking care.
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.03:
complemented by funding in the HVAB program area.
Estimated amount of funding that is planned for Education $100,000
1. redirection of activities to bilateral mechanism
2. elaboration of activities
Research has shown that 90 % of PLWHA are affected by diarrhea which results in significant morbidity and
mortality. Hand washing, sanitation and water disinfection and safe storage have been proven to
significantly reduce diarrhea rates. According to the 2005 Rwanda Demographic and Health Survey, only
one-third of surveyed households had access to a protected source of drinking water. A significant cause of
exposure to diarrheal disease-causing pathogens is inadequate access to safe water. Only 40% of the
Rwandan rural population and 60% of the urban population have access to safe water. The objectives of the
point of use (POU) activities are to ensure consistent use of POU water treatment products by PLHIV; to
increase access to POU water treatment products by PLHIV; and to improve knowledge of POU and its
effectiveness, hygiene, and safe water storage.
Sur- Eau point of use water treatment product was re-launched in FY 2007, through four main channels
(commercial sector, government health centers, community-based health workers and mutuelle offices in 2
districts in conjunction with the Health System's 20/20 program). PLHIV associations in PEPFAR's 22 focus
districts have been identified as outlets for the sale of Sur Eau. Three major umbrella organizations
(ASOFERWA, SWAA and PROFEMME) partner with PSI to provide outreach, education and program
monitoring to these PLHIv associations. Original starter stock was purchased from PSI, provided to the
associations who sell it and use the funds to obtain additional stock from surrounding health facilities. Mass
media and IPC are an integral part of the activities for safe water and hygiene. PSI has begun and will
continue to integrate safe water and Sur'Eau information into existing VCT and care and support materials
in collaboration with GOR, USG clinical partners and community partners.
Activities in FY 2009 will continue to build on these activities. Additional starter stock will be provided to
associations to expand distribution to PLHIV associations trained by trainers supported by PSI. Water
signage will be produced for placement at water points in the PEPFAR districts, to avoid product stigma and
to target safe water messages to water distribution points where communities gather. Trainings will expand
through Rwandan Partner Organizations targeting PLHIV, as will interpersonal communications outreach
through VCT and ARV sites, to ensure consistent delivery of product and messages to people who present
for testing.
This activity complements PSI's child survival activities around preventing diarrheal disease in children
under 5.
New/Continuing Activity: Continuing Activity
Continuing Activity: 19488
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
19488 19488.08 U.S. Agency for Population 8697 8697.08 $0
International Services
Development International
Table 3.3.08:
ACTIVITY UNCHANGED FROM FY 2008.
No narrative required.
Table 3.3.14:
