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.
SUMMARY:
This is a University of Pretoria prevention of mother-to-child transmission (PMTCT) monitoring project aimed at improving the quality of PMTCT service delivery. During FY 2005 and FY 2006, the foundations for the Child Healthcare Problem Identification Program (ChIP) were laid using PEPFAR funding. FY 2007 funding will be used to continue monitoring the impact of: 1) properly managing HIV-infected pregnant women and their children; 2) the impact of the intervention on perinatal and infant mortality; and 3) the impact of cotrimoxazole prophylaxis and antiretroviral therapy on HIV-infected children. The premise of ChIP is that through ongoing monitoring and analysis of data on child deaths, key indicators can be identified, which will allow both healthcare providers and policy makers to advocate for improved quality of care strategies to be implemented. In the long-term, this will result in fewer child deaths from HIV and other causes. The major emphasis of the work falls in Health Management Information Systems, with a lesser emphasis on monitoring, evaluation and reporting, as well as other strategic information (SI) activities. Target populations for the activity include infants and children, HIV-infected pregnant women, HIV-infected infants and children, policy makers, and public and private healthcare workers.
BACKGROUND:
HIV infection has a major impact on fetal, infant and child mortality. The impact on fetuses is mostly indirect, resulting in pre-term delivery, growth restriction or infection; whereas, infants younger than age 5 tend to die from the direct results of the HIV infection. Perinatal mortality in South Africa is currently monitored by the Perinatal Problem Identification Programme (PPIP). Prior to FY 2005, information on the causes of death in children was not routinely collected, and there was no methodology to determine the impact of PMTCT. However, with FY 2005 and FY 2006 PEPFAR funding, and in collaboration with the National Department of Health (NDOH), the PPIP system was updated to include fields for antiretroviral (ARV) therapy during pregnancy and neonatal nevirapine administration.
FY 2005 and FY 2006 PEPFAR funding was also used to implement ChIP, the new hospital-based audit system on the causes of death in children, in 21 sites across South Africa. During FY 2006, in collaboration with NDOH, the ChIP system was updated to include fields for cotrimoxazole prophylaxis, ARV therapy for mothers and children, administration of nevirapine to infants and infant feeding information. These updates will allow NDOH to determine the uptake of ARV therapy in children and the number of children dying from HIV-related infections, as well as provide an indirect proxy for the impact of PMTCT.
Healthcare workers were trained to use the PPIP and ChIP monitoring systems. Analysis of the 2005 data from 21 sites indicated that only 51% of children who died had an HIV test and of these, 92% were exposed or infected. In addition, of the children who died, 34% did not receive appropriate cotrimoxazole prophylaxis, and only 6% of those children qualifying for ARV received it. Although the purpose of ChIP is to monitor the causes of death in children, particularly as they relate to HIV, it also enables hospitals to identify preventable causes of death and identify strategies to address them. Health professionals from these sites were trained to use ChIP, and to understand how the data obtained from the program can feedback into the program. As a result of this quality improvement feedback mechanism, ChIP has become a valuable tool that not only impacts morbidity and mortality, but also service delivery as a whole.
ACTIVITIES AND EXPECTED RESULTS:
Three activities will be carried out in this program area.
ACTIVITY 1: The Rollout and Training on ChIP
FY 2007 funding will be used to continue promoting, supporting and expanding ChIP implementation across South Africa. This will include national and provincial training workshops and the development of training packages for 22 sites (12 established and 10 in-training sites). A minimum of two health professionals from each site will be trained,
ensuring sustainability. Sites will be monitored and evaluated annually to assess quality and sustainability, as well as to ensure that ChIP is being used as a quality improvement mechanism. The project has established linkages with the national and provincial departments of health, and will continue to liaise with the NDOH.
ACTIVITY 2: Saving Children Report
With FY 2005 and FY 2006 funding, ChIP used data from the existing sites to develop annual versions of the Saving Children Report. In FY 2007, data from 30 established sites will be used to compile the third annual Saving Children Report. The target audience for the report is healthcare workers and policy makers. It is anticipated that the third report will be used to highlight gaps and challenges within child health service delivery, giving special attention to HIV, as well as to advocate for the implementation of recommendations aimed at improving quality of care for HIV-exposed and -infected infants and children. At the national and provincial level, the reports will be disseminated to ensure continued communication with the NDOH and to ensure further expansion of the project in FY 2008.
ACTIVITY 3: Strengthening Linkages
This activity focuses on strengthening the linkages between ChIP and PPIP sites to provide information on improving the quality of PMTCT service delivery. Data from the updated PPIP which focuses on PMTCT compliance will be analyzed and the impact of PMTCT at these sites will be assessed by ChIP data. Improved PMTCT service delivery will be achieved through feedback of this information to the department of health at facility, provincial and national levels.
ChIP contributes to the PEPFAR goals by strengthening PMTCT information and monitoring systems, and ensuring a quality of care feedback mechanism aimed at improving quality of care for HIV-infected children. In addition, this project contributes to PEPFAR's 2-7-10 objectives by early identification of children born to HIV-infected mothers and linking them to appropriate treatment and care programs.
