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
This is a continuing activity from FY 2008. No narrative required.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12876
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12876 2743.08 HHS/Centers for Treatment and 6323 97.08 TRAC $300,000
Disease Control & Research AIDS Cooperative
Prevention Center Agreement
7244 2743.07 HHS/Centers for Treatment and 4351 97.07 TRAC $450,000
2743 2743.06 HHS/Centers for Treatment and 2551 97.06 TRAC $60,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $300,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
1. Activities have been elaborated
2. This activity has been moved from HVOP in FY 2009 to CIRC
The overall goal of this activity is to decrease new HIV infections through male circumcision (MC) in the
general population with emphasis that MC be offered as a part of an expanded approach to reduce HIV
infections in conjunction with other prevention programs, including HIV testing and counseling, treatment for
other sexually transmitted infections, promotion of safer-sex practices and condom distribution.
The World Health Organization and UNAIDS recommended that MC be made available in countries highly
affected by HIV/AIDS to help reduce transmission of the virus through heterosexual sex. In FY 2008, the
Government of Rwanda (GOR) and PEPFAR are supporting the expansion of MC interventions in the
military and will start training for providers on safe MC program activities.
In FY 2009, PEPFAR will support the GOR and the TRACPlus - Center for Infectious Disease Control/MOH
(CIDC) in developing a policy for MC as an effective HIV prevention method alongside the ABC strategy.
PEPFAR will also support CIDC/TRACPlus to work with a prevention partner to develop appropriate
messaging to the general population on MC.
These new activities will complement current PEPFAR-supported MC activities in the military, the
development of a strategy for roll-out of MC in the general population beginning with students, and
formative work on MC roll out to the general population.
These activities support PEPFAR and GOR prevention priorities as outlined in the Rwanda PEPFAR Five-
Year Strategy.
New/Continuing Activity: New Activity
Continuing Activity:
* Addressing male norms and behaviors
Table 3.3.07:
ACTIVITY UNCHANGED FROM FY 2008:
In FY 2008, PEPFAR supported CIDC in central activities to ensure quality of HIV basic care and support
(BCS) services. CIDC created a forum for information exchange between facility-based BCS service
providers to identify weaknesses and constraints as well as methods for program improvement (including
quarterly workshops for health center staff, district supervisors, CIDC and DSS). CIDC defines the roles of
different types of health facilities in OI and STI service delivery in accordance with the network model (i.e.
health center versus hospital) and monitors OI and STI service delivery sites to determine the sustainability
of activities. In addition, in order to integrate palliative care at both facility and community levels to ensure a
continuum of care, PEPFAR-supported national policy and guidelines adaptation on palliative care. CIDC is
also revising and integrating into the national HIV training curriculum modules on psychosocial support,
nutritional assessment, counseling and management of malnutrition and screening diagnosis and
management of STI.
By the end of FY 2008, CIDC will have designed BCS-related tools (including PLHIV case management
tools, patient assessment and follow-up forms, and referrals) and counter-referral forms from facility to
community and vice versa. In addition CIDC will have finalized the list of OI drugs, including use of opioids
at clinic and community level for pain management. In FY 2008 CIDC will conduct training of trainers'
sessions on BCS for 200 doctors; and 100 nurses, social workers, HIV case managers, and nutritionists. In
addition, PEPFAR will continue to support CIDC through a national nutrition advisor position to oversee all
nutrition programming activities at the national level; and providing supervision of training and nutrition
activities implementation at site and community levels.
In FY 2009, CIDC will also implement prevention with positive activities and integrate them into care and
treatment. The activities will reinforce and follow up programs started in 08, by assuring training of
physicians and community counselors who will be providing prevention counseling for HIV positives. The
activities will also reinforce the Five Prevention Steps for HIV Infected individuals. In addition, they will
assure training and incorporate Prevention with Positives activities as a Standard of Care in ART site. This
will help ensure that People Living with HIV/AIDS will benefit from the tailored interventions to reduce
transmission rates to HIV uninfected populations. Clinical and Lay Community Counselors will promote
Couples Counseling and Testing and provide prevention for positive messages to all their clients, but
particularly PLHIV, to reduce their high risk behaviors through abstinence, being faithful to one partner or
promoting "secondary abstinence" and counseling and discussing condom use for those discordant
couples. Trained Lay Community Counselors will benefit from training HIV positive individuals on aspects
of health, including prevention interventions to all their HIV positive clients.
PEPFAR will also support CIDC for a new staff specialist on STIs. This staff will work with STI specialists at
CDC and clinical partners to coordinate training, data analysis and use to better understand the
epidemiology of STI in Rwanda in order to inform HIV prevention partners on special groups at higher risks.
The CIDC specialist on STIs will ensure that site staff are well trained and the tools are available to screen
diagnose treat clients with STIs and their partners and that sociodemographic data are available on those
clients to indicate appropriate prevention strategies.
CIDC will supervise decentralized training on palliative care both for facility-based providers and community
-based providers. CIDC will also design, in collaboration with PBF and the MOH Community Health Unit,
key HIV program-related indicators to monitor for PBF at community level. Lastly, CIDC in collaboration with
SCMS will provide timely and accurate data on OI and STI drug and diagnostics consumption, and OI and
STI-related morbidity and mortality to the CPDS for drugs and reagent quantification. These activities
support the PEPFAR five-year strategic goals of promotion of a continuum of HIV care and Rwandan
national plan for palliative care and integration prevention and HIV care interventions.
CIDC will also supervise decentralized training on Prevention with Positives both for facility-based providers
and community-based providers. CIDC will also design, in collaboration with Health QUAL and the MOH
Community Health Unit, key HIV program-related indicators to monitor for prevention with positives at
community level and facility levels.
These activities support the PEPFAR five-year strategic goals of promotion of a continuum of HIV care and
Rwandan national plan for BCS and integration of prevention and HIV care interventions.
Continuing Activity: 12877
12877 2744.08 HHS/Centers for Treatment and 6323 97.08 TRAC $200,000
7245 2744.07 HHS/Centers for Treatment and 4351 97.07 TRAC $100,000
2744 2744.06 HHS/Centers for Treatment and 2551 97.06 TRAC $0
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.08:
THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED
Continuing Activity: 12880
12880 2745.08 HHS/Centers for Treatment and 6323 97.08 TRAC $350,000
7246 2745.07 HHS/Centers for Treatment and 4351 97.07 TRAC $650,000
2745 2745.06 HHS/Centers for Treatment and 2551 97.06 TRAC $344,135
Table 3.3.09:
The USG works closely with relevant units of the MoH to develop and implement plans to extend HIV-
services for adults and children in Rwanda. Since the initiation of PEPFAR, the USG has provided funding
and TA support to the CIDC (MoH). In the past year the scope of areas under CIDC (formerly
TRAC/TRACPlus) were redefined to include not only HIV but also malaria, TB and other infectious
diseases, to reflect these increased functions the unit was renamed as CIDC. In FY 2008, the USG
provided funding to CIDC to strengthen central, district and site-level capacity to increase access and
quality of pediatric HIV care and treatment services in Rwanda. CIDC provides supervisory and technical
support to districts and health care facilities in the provision of services for HIV, malaria, TB and other
infectious diseases following a network model. CIDC also conducts training of trainers in pediatric HIV care
and treatment and provides leadership in the development of work plans and agendas, guidelines and
training materials and general coordination to support pediatric HIV scale-up in Rwanda.
In FY 2009, PEPFAR will fund CIDC to ensure continuation and strengthening of activities started in FY
2008. With TA from PEPFAR implementing partners, CIDC will develop and revise pediatric HIV care and
treatment guidelines, training materials, job aids and other tools as needed. In addition CIDC will revise the
pediatric HIV care and treatment training curriculum to include emerging issues such as adolescent health,
treatment failure, adherence and prevention with positives. Training of trainers will be conducted on the
revised tools and guidelines. For FY 2008, newly updated pediatric treatment guidelines reflecting recently
disseminated recommendations from the World Health Organization (WHO) will be available and refresher
training of health care providers will begin in early 2009.
To ensure quality of pediatric training at decentralized level, CIDC will supervise training on pediatric HIV
care and treatment for facility-based and community-based providers at decentralized levels. In
collaboration with the UPDC unit within the MoH, CIDC will assist district health teams to establish pediatric
clubs at 100 ART sites as a component of psychosocial support for HIV-infected children and adolescents.
These clubs will be used to provide on-going support for children in care and on treatment or affected by
HIV and assist with addressing issues around disclosure and adherence support. One child counselor per
ART site will be trained to organize children support groups.
In FY 2009, CIDC will emphasize quality improvement in pediatric care and treatment at ART sites and
improving pediatric enrollment and retention into care. In collaboration with Columbia University and the
Institute of Human Virology (IHV) of AIDSRelief, CIDC will implement a harmonized mentorship program to
improve the quality of pediatric HIV care, treatment and support.
In order to improve HIV diagnostic services for infants and children, CIDC will train (300) health care
workers at PMTCT, MCH and other pediatric venues on follow-up, tracking and service delivery for HIV-
exposed infants and diagnosis of HIV in infants and children.
PEPFAR will continue to assist CIDC to improve national M&E capacity for pediatric care and support and
link with the national HMIS (TRACnet) system. The revised pediatric HIV indicators and harmonized data
collection tools developed in FY08 will be implemented nationally. In addition, in collaboration with the
Performance-Based Financing (PBF) working group and the Community Health Unit of the MoH, CIDC will
design pediatric HIV program-related indicators to monitor PBF activities at the community level. In
collaboration with SCMS, CIDC will provide timely data on OI and diagnostics consumption, as well as data
on OI related morbidity and mortality for more accurate drug and reagent quantification and forecasting.
the Rwandan National Plan for integration of HIV prevention and care interventions at national, district and
site-levels.
Estimated amount of funding that is planned for Human Capacity Development $62,500
Table 3.3.10:
Estimated amount of funding that is planned for Human Capacity Development $82,500
Table 3.3.11:
ACTIVITY UNCHANGED FROM FY 2008.
The overall goal of this activity is to build capacity at central level for TB/HIV guidelines, tools, supervision,
and monitoring and evaluation.
In FY 2008, TRACplus has been supporting TB/HIV collaborative activities at the central level through
continuation of an existing TB/HIV advisors at to oversee collaborative activities, which support guidelines,
curricula, and tool revision, networking with clinical partners, and supervision of all PEPFAR and non -
PEPFAR sites for quality TB and HIV services to co-infected patients.
In FY 2009, PEPFRAR funding will continue to support the positions of the national advisors at TRACplus.
The advisors will lead national activities on TB/HIV as related to guidelines, norms and tools review. They
are part of the national team of TB/HIV supervisors in addition to those located at AIDSRelief, FHI, CDC,
PNILT, and WHO. They will plan and coordinate TB/HIV training at the central and decentralized level. The
team will participate in monthly joint supervision of TB/HIV activities at the district level and report issues
and gives feedback to the national technical working group. The TB/HIV advisors at TRACplus will continue
to support the drafting and implementation of a TB infection control plan at selected hospitals. They will
continue to participate in the national supervision team for quality of health services including TB
PEPFAR will continue supporting the TB unit within TRACplus in training, monitoring, supervision, and add
on MDR and X-DR TB surveillance. TB/HIV program will recruit one medical doctor to oversee one stop
TB/HIV service, MDR and X-DR related activities, work with facilities to find all TB patients who failed first
line and second line therapies, and ensure that MDR cases adhere to their treatment regimens. This MD will
work with the National Reference Laboratory for identification and diagnosis of second-line drug resistance
among MDR patients who fail treatment or die during treatment.
TB unit at TRACplus will train 259 providers on TB infection control and support them to implement the TB
infection control activities based on available funds from PEPFAR implementing partners and global fund
support at the site level. In collaboration with PEPFAR clinical partners and Global Fund, TRACplus will
implement one stop TB/HIV service in 26 hospitals and 120 health centers.
In FY 2009 TRACplus will strengthen the TB/HIV monitoring and evaluation system by revising M&E tools
based on the WHO recommendation and by improving the data analysis and its utilization for decision
making. With PEPFAR support TRACplus will carry out astudy on prevalence of TB/HIV co- infection and
MDR-TB in three prisons.
In order to improve the adherence of TB patients TRACplus will supervise community DOTS approach by
supervising the community health workers(CHW), developing tools related to community DOTS as well as
by facilitating transportation of CHWs.
Continuing Activity: 12878
12878 12595.08 HHS/Centers for Treatment and 6323 97.08 TRAC $120,000
12595 12595.07 HHS/Centers for Treatment and 4351 97.07 TRAC $0
Estimated amount of funding that is planned for Human Capacity Development $310,000
Table 3.3.12:
Continuing Activity: 12879
12879 2741.08 HHS/Centers for Treatment and 6323 97.08 TRAC $150,000
7242 2741.07 HHS/Centers for Treatment and 4351 97.07 TRAC $120,000
2741 2741.06 HHS/Centers for Treatment and 2551 97.06 TRAC $120,000
Table 3.3.14:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
In FY 2009, the evaluation of the electronic medical record system will be added as a new activity.
PEPFAR has made significant investments in surveillance in Rwanda since 2004. The capacity of CIDC to
carry out surveillance activities has markedly improved over the years. In FY 2008, CIDC is undertaking
multiple surveillance activities aimed at better understanding the state of the HIV epidemic in Rwanda.
These include HIV sentinel surveillance at antenatal care facilities, a behavioral surveillance survey (BSS+)
among high risk groups (sex workers, truck drivers, youth), and ARV drug resistance surveillance.
Building on activities implemented in previous years, PEPFAR will continue to support sentinel surveillance
activities in 30 antenatal care facilities. In order to determine the sub-groups among the youth population
that are at highest risk of HIV infection, CIDC will carry out a rapid assessment of HIV prevalence among
specific youth groups such as youth who are living or working on the streets full-time or part-time, and
orphans. Moreover, CIDC will conduct a rapid assessment of the behavior of the clients of commercial sex
workers. In FY 2009, CIDC will also strengthen ARV resistance surveillance. This will be carried out in
collaboration with CDC, WHO and the National Reference Laboratory.
A triangulation of HIV/AIDS program coverage data with behavioral, environmental and health status data
from surveys and studies was performed in 2008 with technical assistance from the University of California
San Francisco (UCSF) and CDC/Atlanta. A second triangulation exercise is planned for FY 2009, and will
again utilize technical support from UCSF and CDC/Atlanta. CIDC will assume greater responsibility for this
activity as the objective is to build local capacity for triangulation activities in Rwanda.,
The focus of M&E activities in FY 2009 under the TRAC cooperative agreement will be on enhanced data
quality, planning, reporting, and utilization of data for program improvement. CIDC will support data analysis
and use as it relates to clinical care, treatment, and PMTCT to monitor the quality of services provided. The
M&E Unit of CIDC will continue to train district level supervisors and conduct periodic supervision visits to
health facilities in collaboration with the MOH. The M&E unit will also continue to maintain the postings and
digital library.
In FY 2008, CIDC is evaluating the performance of TRACnet (Rwanda's phone and web-based reporting
system for HIV/AIDS) with technical assistance from PEPFAR. In FY 2009, PEPFAR will continue to
support CIDC in rolling-out of new TRACnet functionalities and modules for malaria, TB and the integrated
disease surveillance reporting system (IDSR). In addition, the SBI (Surveillance, Bioinformatics & IT) Unit
will enhance the TRACnet data quality and improve feedback to sites. CIDC's SBI unit staff will continue to
provide on-site IT training to all ART sites, including the use of TRACnet for reporting of ARV drug, disease
surveillance and program indicators.
An electronic medical record system has been implemented at seven sites. Support will be provided to
CIDC for the evaluation of the system, and also to estimate the costs of the extension of the system to
include other clinical specialties and the gradual expansion to achieve national coverage.
Limited funding will be available for the procurement of IT equipment and to support internet connectivity.
All the above activities reflect the ideas presented in the PEPFAR Five-Year HIV/AIDS Strategy in Rwanda
and the GOR National Multi-sectoral Strategic Plan for HIV/AIDS Control by directly supporting the
development of a sustainable strategic information system for the national HIV/AIDS program.
Continuing Activity: 12881
12881 2739.08 HHS/Centers for Treatment and 6323 97.08 TRAC $834,040
7240 2739.07 HHS/Centers for Treatment and 4351 97.07 TRAC $262,700
2739 2739.06 HHS/Centers for Treatment and 2551 97.06 TRAC $333,822
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $6,735,154
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Health Systems provide the foundation for service delivery. Long-term sustainability of programs and activities supported by
PEPFAR is dependent on well established and functioning systems.
Rwanda is a dynamic country, characterized by the rapid adoption of new approaches, strategies and programs. At the same
time, Rwanda is experiencing a critical deficit in human resource capacity, resulting in movement of senior staff within and outside
the Health Sector. An approach simultaneously supporting key individuals (through training and mentorship) and strengthening
processes (through development of systems, tools and user- friendly guidelines) is required for sustainability of the Health Care
system and HIV program in Rwanda. Ultimately, building capacity in Rwanda requires the strengthening of systems by
empowering key individuals with skills and knowledge and developing sustainable processes and tools based on best practices.
PEPFAR health systems strengthening efforts cut across a broad range of issues that directly impact service delivery. These
include strengthening national health sector financing, increasing availability of skilled human resources, capacity building for local
NGOs, policy development, TA and staff secondment to key Government of Rwanda (GOR) institutions, improving management
systems for critical health systems, such as logistics and information management, and strengthening basic national health
functions such as epidemiology, infant and maternal health etc. Other key issues include addressing legal issues surrounding
gender based violence (GBV), inheritance and property rights, and orphans and vulnerable children (OVC), through collaborative
ventures with other government sectors in Rwanda such as Ministries of Education and Infrastructure, and the Minister within the
Prime Minister's office on Gender and Family Promotion.
Since its inception in FY 2004, PEPFAR has invested significantly in at least four distinct strata of capacity building: 1)
organizational capacity building for NGOs and governance for central and decentralized GOR structures; 2) development and
improvement of overarching health systems; 3) national human resource management; and 4) individual level training, mentoring
and capacity building. In coordination with the World Bank, Global Fund for AIDS, Tuberculosis and Malaria (GFATM) and other
donors, investment in each of these levels of capacity building has strengthened the GOR's ability to provide quality HIV national
prevention, care and treatment services. Given that these four levels of capacity building are interlinked and collectively contribute
to a strong health system, PEPFAR has prioritized capacity building as a cross-cutting issue. Many activities listed in other
sections of this FY 2009 COP also contribute to the dual objectives of both building the MOH and GOR's capacity of providing
HIV services and advancing the sustainability of the PEPFAR program.
PEPFAR is committed to adherence to the ‘three ones' One National Framework, one National Coordinating Agency and one
National M&E System. FY 2009 provides for technical assistance (TA) for development and implementation of the National
Strategic HIV/AIDS plan. In FY 2009 a Health Systems Strengthening Advisor will liaise between PEPFAR and the GOR and
Development Partners to continue to promote harmonization of activities within the National Framework. In FY 2008, PEPFAR is
actively strengthening the National AIDS Control Commission (CNLS) through TA, co-chaired Technical Working Groups (TWG)
and supporting strategic planning. These activities will continue to be supported in FY 2009. In other sections of the COP 2009,
activities working towards integrated systems for information collection and analysis are described.
Organizational capacity building for NGOs and governance for central and decentralized GOR structures:
In line with the PEPFAR Gender focus, the Health System Strengthening Portfolio (OHSS) will support capacity building in drafting
legislation, including designing and implementing a process for gender-targeted legislation to correct the current legislation
regarding land distribution and inheritance for women through the Rural Development Institute (RDI). Avocat sans Frontiers
("Lawyers Without Borders") is providing TA to the Kigali Bar Association in FY 2008, strengthening the capacity of this
organization to draft legislation that protects other vulnerable groups (OVCs, prisoners and PLWA ).
At the health system level, PEPFAR provides long-term TA to the National AIDS Control Commission (CNLS), TRACPlus- Center
for Infections Disease Control (CIDC), and the National Tuberculosis and Leprosy Program (PNILT) for the development of
national policies for HIV prevention, care and treatment and to strengthen GOR HIV coordination mechanisms and linkages
between programs. The IntraHealth Capacity Project continues to support a Human Resource Advisor at the MOH Human
Resources Department, to assist in the implement the national Human Resources for Health (HRH) policy, database and strategic
plan, as well as MOH reorganization. In FY 2008 the Community HIV/AIDS Mobilization Program (CHAMP) continues to develop
the financial and managerial capacity of locally-based NGOs and provides staff support to the Minister within the Prime Minister's
office on Gender and Family Promotion to integrate policies that will advance gender equity in HIV services. In FY 2009 the follow-
on award will further emphasize capacity building of these NGOs resulting in future self sufficiency for local Rwandan partner
organizations based on measurable goals.
Development and improvement of overarching health systems:
At the organizational level, PEPFAR has similarly supported capacity building for GOR and other Rwandan NGOs since FY 2004.
The strategies used include financial and management assistance, skills-building in specific areas of technical expertise, M&E,
and commodities and logistics management. PEPFAR thus worked with the GOR and other funders to strengthen National
laboratory capacity in Rwanda. At the central level funding to the National Reference Laboratory (NRL) has built capacity to
provide quality HIV testing for Voluntary Counseling and Testing (VCT), Prevention-of-Mother-To-Child Transmission (PMTCT),
and Pediatric and adult care and treatment programs. Over the past three years the NRL has also developed capacity for Early
Infant Diagnosis (EID) and with PEPFAR support, is expanding capacity for EID in 2008. USG partners have worked in
collaboration with the NRL, District Health Teams (DHT) and site level personnel to expand basic laboratory capacity for HIV
management and OI treatment at District and Health Center levels. At the request of the MOH, logistics providers, RPM+ and the
Supply Chain Management System (SCMS) supported the National Central Medical Stores (CAMERWA) at the central level and
helped to establish a system of district pharmacies to ensure and monitor drug availability, and actively distribute commodities to
the district and Health Center levels. This expansion of capacity building from the national to the district level parallels the GOR's
decentralization process. In FY 2009, the efforts to continue improvement of the active distribution system and the Logistics
Management Information System (LMIS) will be linked with building CAMERWA's ability to directly procure anti-retroviral drugs
(ARVs) and other commodities for the national program.
Rwanda is committed to the decentralization of health service provision by building management capacity at the District Level.
Sustainable Management Development Program (SMDP, a CDC training program) will provide training and support to District
teams to address a gap in capacity at this level, recognized by the MOH. A network of epidemiologists, operating from District
level and disseminating skills to front line health workers, and information to MOH and International colleagues will be provided
through the Field Epidemiology and Laboratory Training Program (FELTP). In FY 2009 the scale-up of Quality Improvement
through the proven HealthQual methodology, involving patients and health providers in the process through use of health facility,
data will be included.
In line with PEPFAR priorities for FY 2009 a package for male circumcision services will be developed. The package, based on
lessons learned from neighboring countries, will contain at minimum, messages on sexual behavior and condom use, infection
control measures and safe circumcision practices. Implementation will begin in FY 2009 within the Rwandan military, an FY 2009
target population.
National human resource management:
At the human resource level, PEPFAR supports pre-service, in-service, and refresher training of health professionals. The
emphasis for FY 2009 will be the initiation of all relevant modules used in in-service training, to be provided for all cadres
concerned on leaving pre-service training, with the ultimate goal of incorporating these into the pre-service curricula. Since FY
2005, PEPFAR has actively supported pre-service nursing training and the Rwanda HIV/AIDS Public Interest Fellowship to
develop a cadre of program managers. In FY 2008, the IntraHealth Capacity Project and Columbia University supports the
implementation of the pre-service nursing and medical school curricula developed with PEPFAR support in FY 2007. In FY 2009,
ongoing support for students in MPH programs will be augmented by training in field epidemiology and sustainable management
through short courses in Applied Epidemiology at the School of Public Health. In FY 2008, many existing implementers continue
their capacity building efforts: CAPACITY will expand the national curricula to medical schools in collaboration with the GOR.
Specialized training in TB/HIV care and treatment will be expanded - an area in which PEPFAR system strengthening investments
have resulted in better diagnosis of TB among PLHIV, and lower mortality rates for adults with TB. Training in infection control
and injection safety, PMTCT and Pediatric HIV will also be expanded and incorporated into the pre-service curriculum.
In FY 2009 PEPFAR will also continue to support at least five pre- and in-service training initiatives, given the acute shortage of
health care providers and HIV program managers. PEPFAR will support the implementation of the revised nursing curriculum,
expand the number of participants in the Public Interest Fellowship program, continue support to a social work certificate program
to strengthen the continuum of care for PLHIV. In addition, PEPFAR will expand and promote the initiative to use nurses to
oversee ART service delivery, which will target PMTCT to provide an increase in access or anti-retroviral therapy (ART) to
pregnant women.
Individual level training, mentoring and capacity building:
In FY 2008 TA is being used to provide one-on-one mentorship from Central to District levels directly through short and long term
advisers. This support will continue in FY 2009. At the community level, the Regional Outreach Addressing AIDS through
Development Strategies follow-on (ROADS II) and the follow-on Community-based project will strengthen locally-based non-
governmental organizations (NGOs) and civil society associations towards the ultimate goal of becoming prime partners.
Measurable goals and objectives, evidenced-based models, taking into account best practices in the field, will be the guiding
principals in design of the follow-on model. Linkages to clinical partners will be strengthened. FY 2009 includes an initiative to
empower police officers to attend to cases of gender-based violence (GBV), strengthening linkages with health services for
necessary referrals for protection against HIV and Sexually Transmitted Infections (STIs).
Program evaluation, to provide the PEPFAR program with an understanding of the progress towards its goals, will include a
baseline assessment of knowledge and practices at the peripheral level in the recognition and action during outbreaks. This
assessment will provide a benchmark with which to evaluate the wider impact of the FELTP activity. The impact of the MPH
training on systems and processes at different levels of the health sector will also be evaluated.
Table 3.3.18:
