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
Rwanda has scaled up HIV treatment services in recent years with the support of PEPFAR, the Global
Fund, World Bank MAP project and other partners. The quality of HIV services has become a priority
during this period of growth. Concurrently, MOH and TRACPlus-Center for Infectious Disease Control
(CIDC) have strived towards integration of previously vertical programmes, such as HIV/AIDS, into general
health service provision. MOH has established desks for Quality and monitoring & evaluation (M&E) . In an
effort to include Quality Improvement (QI) in this process, TRACPlus-CIDC and CDC Rwanda invited
HIVQual International to Rwanda to conduct an initial assessment in December 2007 to recommend how
this framework can provide benefits to the overall health system, including HIV/AIDS care and services.
During the past year, Quality Improvement stakeholders representing the MOH, TRACPLUS-CIDC,
Management Sciences for Health, Performance-Based Financing (MSH/PBF), UNICEF, the National AIDS
Control Program (CNLS), clinical implementing partners and the USG, have engaged in discussions on the
implementation of a national quality improvement program in line with the National Quality Improvement
Policy and Strategy and HSSP II.
In line with the MOH focus, stakeholders recommended that an integrated health sector wide Quality
Improvement approach (HealthQual) should be implemented.
The HealthQual Model is based on the concept that quality management programs should reflect a balance
between quality improvement and performance measurement. The model should also be built upon a
foundation of programmatic support and management infrastructure. This organizational approach to
quality management emphasizes the development of systems and processes to support quality
improvement activities involving clinic staff and consumers with support from program leadership.
More specifically, the HealthQual Model builds capacity in data collection and analysis at the clinic level,
linking these activities to building systems that improve processes and outcomes of care. Through this
process, HealthQual facilitates the strengthening of systems for documentation, permitting monitoring of
appropriateness of care, and development of capability for self-assessment.
The model will be integrated into the existing programs of the MOH so that it is part of the national
guidelines and other national quality improvement activities. Staff from the Ministry of Health will lead the
project with guidance and support provided by the HealthQual Team in-country and the CDC-Rwanda
office. Introduction of HealthQual into the Rwandan Health System provides the unique opportunity of
integrating this QI approach with the Performance Based Financing strategy the Rwandan Government has
scaled up nationally.
A list of quality indicators that correlate with the infectious/communicable diseases has been drafted by
TRACPlus-CIDC with support from PEPFAR. HealthQual is included in the National policy on Quality of
Care. As policy and framework evolve adaptions will be made to ensure harmonization and synchronization
of work. HealthQual will be using infectious diseases as a starting point, eventually broadening its scope to
health sector wide QI performance measurements. With the involvement of both the MOH and MSH/PBF,
HealthQual Phase I will be ready for implementation in FY09.
HealthQual Rwanda will build capacity in data collection and analysis at the clinic level, linking these
activities to building systems that improve processes and outcomes of care. Through this process,
HealthQual will facilitate the strengthening of systems for documentation, which will permit monitoring of
appropriateness of care and development of capacity for self-assessment.
Performance Measurement
The primary benefit of the HealthQual approach is to produce data that are immediately available to
providers to use for improvement. Existing database systems such as those used for PBF, TRAC-Net, and
Global Fund reporting will be used for this process. Feasibility of this harmonization will depend on whether
the current methods permit calculation of rates of appropriateness of care, specifically, sorting out the
various denominators for whether appropriate care has occurred.
A data manager at the district hospital and health clinic level will facilitate report generation and the
interpretation of results for self-assessment. Each participating clinic should identify a point person, who is
responsible for managing quality improvement in the clinic and communicating with the country lead.
For Phase 1, a representative mix of clinics will be selected across the country. Selection of a diverse
group will reinforce the national nature of this initiative and facilitate scale up after the first phase of program
implementation.
Quality Improvement and Management
Improving care is the ultimate goal of the HealthQual project. Quality improvement methods and tools must
therefore be adapted and implemented in each hospital and health center.
HIVQual International will organize a training of trainers (TOT), together with local partners, which will
ensure that all district supervisors have a working knowledge of basic QI concepts and tools. QI activities
will then be implemented at the health clinic level, in partnership with the community. HealthQual will be
responsible for initiating QI trainings at the community level, and engaging PAQs in quality management.
Furthermore, HealthQual Rwanda will coordinate the work of all PEPFAR-funded partners and other
organizations, especially Twubakane, MSH, and UNICEF. Currently, numerous QI trainings have been
conducted by these different groups. HealthQual will ensure that a systematic approach to training will be
implemented across the country.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.18:
