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:
ACTIVITY 1: PROVISION OF PALLIATIVE CARE:
Areas identified for the modification and enhancement of the provision of Palliative Care are: nutritional
support; strategic alliances; and the implementation of a Hospice Data Management System.
Nutritional Support: Many patients cared for by Hospice Palliative Care Association (HPCA) are hungry, an
urgent need which often overshadows other serious holistic needs. There are numerous reports from
caregivers who go to homes where there is nothing to eat, causing distress not only to the patients and
families, but to the caregivers themselves. The provision of palliative care would be strengthened by a co-
ordinated, comprehensive approach to nutritional support.
Strategic Alliances: Given the wide range of clinical and social services required by HIV and AIDS patients
and their families, coupled with the need for a comprehensive and coordinated approach towards Palliative
Care, it is imperative that HPCA and its member hospices establish strategic alliances with a wide range of
partner organizations. One of the outputs of these alliances will be a Palliative Care strategic plan for every
province, health district and health sub-district to be implemented jointly by these partner organizations.
Hospice Data Management System (HDMS): During FY 2009 HPCA will be implementing a comprehensive
HDMS in all member hospices.
ACTIVITY 2: DEVELOPMENT OF NEW DEVELOPMENT SITES:
The focus of this activity is to expand the reach of palliative care. The major modification and enhancement
of this activity will be the adoption of a country-wide strategic approach to the identification and
development of new palliative care service sites. HPCA's Vision is 'Quality Palliative Care for All'. Currently
HPCA's existing 141 palliative care service sites extend to all nine provinces reaching 87% (46 of 53) of the
health districts in South Africa. Since many of the health districts cover a large geographic area with a high
HIV and AIDS prevalence, HPCA intends to expand palliative care services to every health sub-district in
South Africa. The strategy for doing so will be based on a correlation between HIV and AIDS prevalence
and existing palliative care service sites in every health sub-district. Sub-districts with a poor correlation
between HIV and AIDS prevalence and existing palliative care services will be targeted as palliative care
development zones prioritised for the development of new palliative care service sites. It is recognised that
HPCA and its member hospices will never have, nor desire to have, the capacity to provide care for all
persons in need of palliative care. Consequently, HPCA will forge strong collaborative partnerships with a
wide range of partners including government clinics, non-governmental organizations; existing home-based
care organizations and faith-based organizations. HPCA's main role will be to build the capacity of these
partners to provide quality palliative care for all within their health sub-district. Within this strategic
framework the notion of what constitutes a palliative care development site may broaden to include a wider
range of partner organizations.
Reflecting on the success of a recent HPCA pilot project in the Eastern Cape, one of the approaches used
to expand the reach of Palliative Care will be for member hospices to support community-based home care
organizations within their health sub-district to include Palliative Care within their range of services. This
implies that organizations that have a variety of services (e.g. support groups, peer education, OVC etc) will
incorporate a palliative care 'stream' focusing on the specific needs of people needing pain and symptom
management and families who need to be trained to care for such patients. Currently at least ten hospices
are keen to implement this model.
ACTIVITY 3: ACCREDITATION AND QUALITY IMPROVEMENT:
The modifications and enhancements of the HPCA accreditation and quality improvement system will be to
explore the development of a more flexible and differentiated quality monitoring and improvement system
which can be applied to a wide range of partner organizations. During FY 2007 HPCA staff participated in
an extensive review of the existing Standards for Palliative Care developed in collaboration with the Council
for Health Service Accreditation of South Africa (COHASA). While these Standards are appropriate to
member hospices that will become exemplar sites for quality Palliative Care they may not, in their entirety or
current form, be appropriate to the large number and wide range of partner organizations that HPCA is
capacitating to provide quality palliative care. Consequently the need to explore a more flexible and
differentiated accreditation and quality improvement system has become apparent.
ACTIVITY 4: HUMAN CAPACITY DEVELOPMENT:
HPCA provides support to local organizations to integrate palliative care into their services while building
capacity for good governance and management of these organizations. Long-term sustainability is a key
objective of HPCA Human Capacity Development.
The modifications and enhancement envisaged for this activity is a rapid expansion of the provision of
palliative care training tailored to the expressed needs of hospices and partner (including PEPFAR
Partners) organizations within each province, health district, and sub-district. The increased demand for
palliative care training from the public health sector, member hospices, and partner organizations will
necessitate a more comprehensive, strategic and focussed approach towards human capacity development
for palliative care.
One of the bottlenecks to the comprehensive roll-out of palliative care training has been the absence of an
overarching implementation plan tailored to expressed needs of partner organizations.
---------------------------
Activity Narrative: SUMMARY:
The Hospice and Palliative Care Association of South Africa (HPCA) currently has 75 member hospices and
73 development sites throughout South Africa (SA), each an independent legal entity. The Mission of HPCA
is to provide and enhance the provision of sustainable, accessible, quality palliative care. PEPFAR funds
will strengthen the capacity of member hospices and other governmental and non-governmental
organizations to provide quality services to HIV-infected persons.
BACKGROUND:
HPCA strengthens existing services and develops new services through direct funding to member hospices
to promote accessibility and availability of palliative care in SA, including work with religious leaders and
member hospices that are faith-based organizations. HPCA personnel at national, provincial and district
levels continue to provide the infrastructure and coordination to develop and strengthen palliative care
programs within member hospices, the formal health care sector and NGOs. Improved collaboration
between HPCA and the National Department of Health (NDOH) is a key objective, aimed at optimum
utilization of scarce palliative care resources. FY 2006 funding has allowed the training of 7,108 trainees
from October 2006 to July 2007. The major focus of FY 2008 funding will be to provide direct palliative care
to patients and their families, to assess quality of palliative care, assist in the development of new services,
provide support to the care providers and provide training in palliative care. An HPCA member hospice will
also focus on increasing male patients' participation in the fight against HIV and AIDS. The Bana Pele
Project, in partnership with St Nicholas Hospice, will be using PEPFAR funding in FY 2008 to focus on the
expansion of palliative care in their area. HPCA will provide capacity building support to St Nicholas, who
will be administering the Bana Pele Project. Additional funding has been granted for Soweto Hospice in
Gauteng for FY 2008 which was managed by Hope Worldwide previously. HPCA intends to liaise with
Prison Services and the SA Defense Force (military populations) to share palliative care expertise and
support to these organizations.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Provision of palliative care
HPCA is funding member hospices to provide care to patients with HIV and their families. Sites providing
palliative care include home-based care (HBC), day care centers, and in-patient units. Services include
elements of the preventive care package, management of opportunistic infections including provision of
cotrimoxazole, pain and symptom management, clinical prophylaxis, prevention with positives, treatment for
TB, psychosocial and spiritual care, and bereavement support for families and friends. Addressing
prevention with HIV-infected individuals is an important part of a comprehensive care strategy. Through
healthy living and reduction of risk behaviors, these prevention with positives interventions can substantially
improve quality of life and reduce rates of HIV transmission. The goal of these interventions is to prevent the
spread of HIV to sex partners and infants born to HIV-infected mothers and protect the health of infected
individuals. Family care includes training in all aspects of patient care, infection control, prevention, nutrition,
individual and family counseling and reduction of stigma. Increased participation by male patients will be
encouraged by an after-hours clinic at a member hospice. Bereavement care is integral to the provision of
palliative care and will be offered throughout the course of the illness as well as after the death of the
patient. A key aspect of both individual counseling and hospice support group services is reduction of
stigma and discrimination and reconciliation within families. Nutritional support will also be arranged (with
non-PEPFAR funding). ART referrals, as additional access sites are made available, will be a component,
including pediatric cases of advanced HIV. If the need for OVC services is identified but not provided by the
hospice, an established referral system is used to refer the patient to an outside service provider.
ACTIVITY 2: Development of new palliative care sites
This activity entails enhancing existing and establishing new palliative care services. HPCA Provincial
Palliative Care Development Coordinators (PPCDCs) lead development teams (PPCDT) in the regions,
comprising technical expertise from local hospices. The PPCDT assists in identifying new development
sites and providing financial and non-financial resources and mentorship to help build capacity in these
sites. The main criteria for development are community need and available resources. In addition to
development the PPCDCs also develop public-private partnerships between HPCA and government
departments to support these development sites. PEPFAR-funded Regional Centers of Palliative Learning
(CPLs) in 10 regions and mentor hospices will continue to develop new service delivery sites. The CPLs are
attended by health professionals in the public and private sectors including doctors, nurses, pharmacists,
and home-based care (HBC) workers. A mentor hospice is a fully accredited hospice, and receives funding
to provide technical expertise and meet mentorship needs in its region. Through these development
activities, the total number of HPCA palliative care sites will be expanded and palliative care will be more
accessible to currently under-resourced and under-served areas, increasing the availability of quality
palliative care to many more HIV and AIDS patients and families. Sustainability of existing and new sites is
addressed through ongoing fundraising workshops, through increased quality of services, through increased
human resources capacity building and through increased collaboration with the formal health care sector.
The integration of palliative care into existing non-hospice health services e.g. district hospitals, home-
based care organizations and clinics, has become an important aspect of the expansion of palliative care.
ACTIVITY 3: Accreditation and Quality Improvement
PEPFAR funding has facilitated the development of comprehensive HPCA and Cohsasa (Council for Health
Services Accreditation of SA) Standards of Palliative Care, which include standards of management and
governance, and clinical, psychosocial, spiritual care and quality improvement to ensure quality palliative
care in service delivery. A mentorship and accreditation program is based on these standards. FY 2008
funding will continue to support the accreditation and quality improvement of existing member hospices
based on compliance with these standards. Trained mentors and surveyors visit the hospices and an audit
Activity Narrative: of the hospice standards is carried out. To date, eleven hospices have received full accreditation, and many
are in preparation. The hospices that receive full accreditation are used as mentor hospices in Activity 2
above and to assist new member hospices to comply with the standards. The accreditation process is
aimed at raising the standard of palliative care services throughout the country.
ACTIVITY 4: Human Capacity Development
The objective of this training is to increase skills in delivery of quality palliative care services including
elements of the preventive care package. A CPL is an established hospice which has either achieved, or is
close to achieving, full accreditation and which has been selected because it has the best resources and
expertise to provide training and promote awareness of palliative care. A multi-disciplinary approach is used
in ongoing training programs to ensure human capacity development. In partnership with higher education
institutions, professional associations and the National and provincial Departments of Health, Social
Development and Education, a wide range of accredited palliative care training programs are offered for
volunteers, community health workers, nurses and doctors. HPCA strives to have all training curricula
accredited.
PLHIV will receive at least one clinical and one other category of palliative care service. Palliative care to
family members of PLHIV or OVC will be provided in at least two or the five categories of palliative care
services.
HPCA supports the USG South Africa Five-Year Strategy to expand access to quality palliative care
services and improve quality of palliative care and HBC services, and thereby contributes to the 2-7-10 goal
of providing care to 10 million people affected by HIV.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13798
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13798 3019.08 U.S. Agency for Hospice and 6613 478.08 $7,667,500
International Palliative Care
Development Assn. Of South
Africa
7615 3019.07 U.S. Agency for Hospice and 4487 478.07 $4,720,000
3019 3019.06 U.S. Agency for Hospice and 2672 478.06 $2,800,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $400,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
FY 2008 COP activities will be expanded to include:
-The establishment of the Pediatric Palliative Care Training and Resource Center in collaboration with all
project partners and the Department of Pediatrics of the University of the Free State.
SUMMARY:
The Hospice Palliative Care Association of South Africa (HPCA), founded in 1988, currently has 70 member
hospices throughout South Africa (SA), each member being an independent entity. The HPCA Mission is to
provide and enhance the provision of sustainable, accessible, quality palliative care. The target population
is orphans and vulnerable children (OVC). The emphasis areas are human capacity development (training)
and local organizational capacity building. PEPFAR funding will be used to strengthen the capacity of HPCA
member hospices to provide pediatric palliative care to vulnerable children through identifying hospices that
provide care for OVC. The St Nicholas Bana Pele Children's Network (SNBPCN) project, in partnership with
St Nicholas Children's Hospice in Bloemfontein, a sub-partner, will improve the quality of life of OVC by
providing quality Pediatric Palliative Care in the Motheo and Xhariep Districts of the Free State, and
increase identification of HIV-infected children and improve access to antiretroviral therapy for them.
Pediatric Care is provided to HIV-infected children and those exposed to malnutrition, low birth weight, HIV-
related disabilities, and infectious diarrhea. These children are admitted to the in-patient units. Many
children move between the Pediatric and OVC programs as their condition changes.
to promote accessibility and availability of palliative care in SA. HPCA personnel at national, provincial and
district levels continue to provide the infrastructure and coordination to develop and strengthen palliative
care programs within member hospices, and government and non-government organizations. PEPFAR
funding has allowed the training of 329 trainees in Pediatric Palliative Care
from October 2007 to July 2008. These trainees include Doctors, Social Workers, Trainers, Professional
Nurses, Enrolled Nurses, Home-based Caregivers and Managers. The major focus of PEPFAR funding in
FY 2009 is to provide direct palliative care to patients and their families, to assess quality of palliative care,
assist in the development of new services, provide support to the care providers, and provide training in
palliative care. In FY 2008 an OVC funding component has been added to the HPCA program, to ensure
that children infected and affected by HIV and any other life-limiting conditions will be identified, supported,
receive pediatric palliative care and antiretroviral therapy and, where necessary, referred for further support.
ACTIVITY 1: St. Nicholas Bana Pele Children's Network (SNBPCN) project
In FY 2009 HPCA will be managing the SNBPCN grant with advice and support from AED. HPCA will
provide mentorship to St Nicholas to build capacity within that hospice. Capacity Building for the SNBPCN
project will also include the appointment of new staff in the Free State to coordinate the project. Capacity
building in the communities will take place to identify and care for HIV-infected children through education
and training from the hospice wellness centers. The wellness centers are health drop-in facilities to promote
and monitor health. Holistic services are provided, including weighing of babies, nutritional advice, and
immunization. Education in the homes and in community groups will also be provided in order that
communities can develop the capacity to provide care for these vulnerable children and use community
resources including local primary health care clinics. PEPFAR funding for the SNBPCN project, will be used
to improve the quality of life of OVC who require Pediatric Palliative Care in the Motheo and Xhariep
Districts of the Free State, increase identification of HIV-infected children and improve access to
antiretroviral therapy through a strengthened referral system and the establishment of a cooperative
network consisting of relevant government departments, the antiretroviral program, faith-based
organizations and other non-profit organizations. OVC palliative care patients will receive direct support and
family members will receive psychosocial, emotional and spiritual care into the bereavement period.
Training for the SNBPCN project: A Pediatric Palliative Care Training and Resource Center will be
established in collaboration with all project partners and the Department of Pediatrics of the University of the
Free State. The objective is to promote palliative care for children and provide a resource for the Free State
Province for expert advice and support. Materials on palliative care for children will be developed and used
for training. Community capacity will be improved through training and services from eight community
Wellness Centers in impoverished areas linked to the development of a Pediatric Palliative Care Training
and Resource Centre, together with the Department of Pediatrics and Family Medicine. Prevention
education will be provided with the faith-based organizations to reach young people and training in palliative
care for children will be given to individuals. This activity will be supported by an array of monitoring and
evaluation activities to assist in monitoring the progress and measuring the results. Monitoring and
Evaluation expertise will be provided for Pediatric Palliative Care by HPCA.
ACTIVITY 2: Capacity Building
HPCA will provide capacity building expertise to the member hospices which provide Pediatric Palliative
Care. The HPCA curricula for Pediatric Palliative Care has been reviewed and updated. This specialized
training will be provided by the 10 HPCA Centers of Palliative Learning (CPLs) and HPCA Regional
Education Forums.
ACTIVITY 3: Pediatric Palliative Care Services
The pediatric care services will be provided as follows: identification of OVC infected by HIV, accessing
grants, assistance with foster care placements, assisting with access to education, HIV prevention
information, education and counseling, health care including pain and symptom management, Anti
Activity Narrative: Retroviral Therapy (ARV) and TB Medication supervision, day care, support to Child and Youth-Headed
Households, bereavement support, resilience and memory training, spiritual, emotional and psychosocial
care, and support for elderly caregivers, home-based care, in-patient care and early childhood development
programs. HPCA member hospices will provide the following Pediatric services: psychosocial, emotional
and spiritual support will be provided to family members with identification of very vulnerable households
such as those headed by children and young people, or the elderly.
This activity will be supported by appropriate Monitoring, Evaluation and Reporting (M&E) activities
and tools to measure progress. Other support activities are improving access to ARVs, monitoring and
adherence of ARVs, nutritional interventions and facilitating access to social grants. Funds will be used for
direct funding for nurses, social workers, and social auxiliary workers and for transport and administration
costs of these human resources. Focus will be on the girl-child and the role of the female caregiver,
including the role of the grandmothers in support of OVC. This program will be for five specific pediatric
services and seven integrated pediatric services, with at least one per province.
This program will also focus on strengthening of existing comprehensive and or extensive pediatric
programs through direct funding. Linkages to other services such as TB treatment, ARV treatment and
support will be integrated into the OVC services.
ACTIVITY 4: Advocacy and Liaison
HPCA will liaise with corporate social investment programs and Government to strengthen and increase
funding for the care and protection of OVC infected by HIV. Where OVC support services are required
which are outside the scope of hospice expertise, e.g. child protection and nutrition, HPCA will identify
suitable partners with the technical expertise and resources to provide these services and to strengthen
HPCA OVC programs. The SNBPCN project will promote Pediatric palliative care for children and raise
public awareness. Links through existing Child Care Forums will be strengthened through liaison with the
Department of Social Development.
ACTIVITY 5: Pediatric Palliative Care Training;
The Pediatric Palliative Care training will be strengthened to include the South Africa PEPFAR OVC
indicators, gender issues etc. Existing Pediatric Training curricula will be revised and expanded. Pediatric
palliative care training courses will include the following: Definitions of pediatric palliative care, Conditions
requiring pediatric palliative care, Models of pediatric palliative care,
The Rights of the Child, Palliative care within the context of childhood development, Pain management
in children, Symptom management, Nutrition, young person's understanding of death, Communication with
children, Emotions of the child and family members, Spiritual care and support of the child, young
person and family, Bereavement support including resilience and memory approaches, Social and legal
issues relating to children and young people. Ethical issues Core competencies and practical experience,
and the mapping of family members (similar to a family tree), to determine the support structure which each
child has in their home environment.
With the increased funding to HPCA for pediatric palliative care for children, forty (40) sites will be identified
for support and development of pediatric care programs. These sites will be in all 9 provinces and will be
spread among urban and rural sites. Preference will be given to areas where there are no children's
palliative care programs with the long-term aim to have a children's palliative care program in all health
districts and sub-districts in South Africa.
A Pediatric Palliative Care Officer will be employed to support hospices in the development of their
programs and collaborate on the development of materials and a training curriculum.
The St Nicholas Bana Pele Children's Network will be established in the Motheo and Xhariep Districts
of the Free State with a strong referral system between programs caring for children for effective
supervision and follow-up of all HIV-infected and affected children, working together with the Departments
of Social Development and Health, as well as Faith-based and community-based organizations, in the
province. Eight community centers with early childhood development services, and services for the children
and families, will be developed.
Two grandmother support groups will be established and developed.
Through these activities, HPCA supports the vision outlined in USG's South African Five Year Strategy to
expand access to quality pediatric palliative care services thereby contributing to the 2-10-7 goal of
providing care to 10 million people affected by HIV.
New/Continuing Activity: New Activity
Continuing Activity:
* Safe Motherhood
Estimated amount of funding that is planned for Human Capacity Development $100,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $100,000
Table 3.3.10:
Tuberculosis (TB) Task Team
The Hospice Palliative Care Association of South Africa (HPCA) will organize an interdisciplinary TB task
team comprising seven members, which will report to HPCA Management Committee (MANCO) via the
Patient Care Committee. This committee will include three patient care representatives, one person from
the monitoring and evaluation (M&E) committee and one each from the Organisation Development,
Pediatric, and Education and Training committees. The professional team members will compile the terms
of reference for this committee, and the team's mandate will be to:
1. Assess the current level of integration of HIV and TB services in member hospice programs;
2. Identify best practices among member hospices;
3. Facilitate the implementation of recommendations that emanated from the HPCA conference workshop
on how to incorporate a TB focus into palliative care programs;
4. Review and adapt current HPCA TB Guidelines in a palliative care context;
5. Facilitate the collection of relevant data;
6. Monitor the implementation of the HPCA TB Guidelines in hospices receiving TB funding;
7. Evaluate the effectiveness of the TB Task Team and submit a report to the patient care committee on
completion of the first year;
8. Explore the potential for regional TB task teams; and
9. Liaise with the HPCA Education Committee regarding the identification and meeting of TB training needs.
TB Task Team meetings will be linked to Patient Care Committee meetings to save costs. It is anticipated
that during 2009 there will be a series of regional TB workshops to address:
1. Increasing case finding;
2. Implementing infection control;
3. Conducting risk Assessment;
4. Integrating services with examples of best practice; and
5. Accessing, documenting and using information.
-----------------------
The Hospice Palliative Care Association of South Africa (HPCA) currently has 75 member hospices
throughout South Africa (SA), each an independent legal entity. The Mission of HPCA is to provide and
enhance the provision of sustainable, accessible, quality palliative care. PEPFAR funds will strengthen the
capacity of member hospices and other governmental and non-governmental organizations to provide
quality services to HIV-infected persons.
between HPCA and National Department of Health (NDOH) is a key objective, aimed at optimum utilization
of scarce palliative care resources. FY 2006 funding has allowed the training of 7,108 individuals from
October 2006 to July 2007. The major focus of FY 2008 funding will be to provide direct palliative care to
patients and their families, to assess quality of palliative care, assist in the development of new services,
provide support to the care providers and provide training in palliative care. The services provided by HPCA
members for TB care are included in Palliative Care where the HIV patient is also diagnosed with TB.
ACTIVITY 1: Patient Care
Patients' adherence to uninterrupted treatment is encouraged and monitored. It is the practice of HPCA
member hospices and development sites to integrate TB care of the patient with HIV care, and the HPCA
training courses include DOTS training for home-based carers. HIV patients receiving HIV-related care are
routinely referred for TB screening. They are also referred to the local clinic or district hospitals for TB
medication and followed up through the home-based care network. Many hospices use the DOTS-based
national TB control strategy, in collaboration with the provincial Department of Health. HPCA also supports
efforts to prevent and manage drug-resistant TB among HIV-infected TB patients. TB infection controls are
implemented at hospice sites, such as maximized ventilation as an environmental control measure.
Exposure to TB is an occupational hazard in the course of caring for patients. HPCA has developed
guidelines for the Prevention of Transmission of Tuberculosis for staff in member hospices. The HPCA
guidelines recommend that all HIV-infected patients be tested for TB before admission to a hospice
program and that those with TB should be on TB treatment for 2 weeks before being considered for
admission to a hospice in-patient unit, for the protection of staff and other patients. HPCA and its members
will also focus on strengthening the relationships with public TB clinics to ensure appropriate referral and
follow-up mechanisms are in place for TB patients. In FY 2008 PEPFAR funding will be used to build on
existing TB services provided by member hospices by enhancing and expanding them. Joint TB/HIV
activities will be implemented at member sites. All patients receiving HIV care and treatment support will be
routinely referred for TB screening and followed up as appropriate.
ACTIVITY 2: TB Training
This activity will entail additional training of hospice staff and home-based care worker in TB screening, TB
Activity Narrative: testing, treatment and infection prevention. No additional staff will need to be employed for the TB program.
HPCA's existing training structures of Centers of Palliative Learning and the Regional Education Forums will
be utilized and the TB aspects will be incorporated in the palliative care curriculum. Training will be given in
accordance with national standards and will include TB screening, TB testing and treatment, prevention of
infection, and environmental controls. Because of multidrug-resistant (MDR) and Extensively Drug Resistant
(XDR) strains of TB, intensive training and Guidelines for HPCA members will be provided. Workshops will
be held regionally presenting optimum environmental controls. Funding will be used for this additional
training and possibly also to assist member hospices with ventilation equipment, irradiation lighting and
respirator masks as appropriate. Both of the above TB activities will be monitored and evaluated on an
ongoing basis. The target populations for this activity are people living with HIV and AIDS and the emphasis
area is human capacity development as both pre-service and in-service training will be provided to all HPCA
staff members and their affiliate organizations.
Continuing Activity: 13800
13800 13800.08 U.S. Agency for Hospice and 6613 478.08 $481,000
Estimated amount of funding that is planned for Human Capacity Development $106,700
Table 3.3.12:
After the success of the pilot project, with increased funding the program will be expanded to forty sites,
within all provinces, with a long term view to having a children's hospice program within each health district
and sub-district which make up the district.
A National OVC Officer will be appointed to assist in the support of the forty sites and other development
sites, as well as with training.
For the St. Nicholas Bana Pele Children's Network, specific staff will be appointed to develop and manage
the network and provide training and mentorship to other network partners and to ensure effective liaison
with government departments regarding children.
-------------------------
The Hospice Palliative Care Association of South Africa (HPCA), founded in 1988, currently has 75 member
hospices throughout South Africa (SA), each an independent legal entity. The HPCA Mission is to provide
and enhance the provision of sustainable, accessible, quality palliative care. The target population is
orphans and vulnerable children (OVC). The emphasis areas are human capacity development (training)
and local organizational capacity building. PEPFAR funding used to strengthen the capacity of HPCA
provide care for OVC. The Bana Pele project, in partnership with St Nicholas Children's Hospice (St
Nicolas) in Bloemfontein, a sub-partner will improve the quality of life of OVC in the Motheo and Xhariep
Districts of the Free State, and increase identification of HIV positive children and improve access to
antiretroviral therapy for them.
care programs within member hospices, and government and non-government organizations. FY 2006
PEPFAR funding has allowed the Palliative Care training of 7,108 trainees from October 2006 to July 2007.
These trainees include Doctors, Social Workers, Trainers, Professional Nurses, Enrolled Nurses, Home-
based Caregivers and Managers. The major focus of PEPFAR funding in FY 2008 is to provide direct
palliative care to patients and their families, to assess quality of palliative care, assist in the development of
new services, provide support to the care providers, and provide training in palliative care. In FY 2008 an
OVC funding component has been added to the HPCA program, to ensure that children infected and
affected by HIV and any other life-limiting conditions will be identified, supported, receive pediatric palliative
care and antiretroviral therapy and, where necessary, referred for further support.
ACTIVITY 1: Bana Pele Project
In FY 2008 HPCA will be managing the Bana Pele Partnership grant. HPCA will provide mentorship to St
Nicholas to build capacity within that hospice. Capacity Building for the Bana Pele project will also include
the appointment of new staff in the Free State to coordinate the project and expand services to new regions
and into more rural areas. Capacity building in the communities will take place to identify and care for HIV-
infected and affected children through education and training from the wellness centers. The wellness
centers are health drop-in facilities to promote and monitor health. Holistic services are provided, including
weighing of babies, nutritional advice, and immunization. Education in the homes and in community groups
will also be provided in order that communities can develop the capacity to provide care for these vulnerable
children and use community resources including local primary health care clinics. PEPFAR funding for the
Bana Pele Project, will be used to improve the quality of life of OVC in the Motheo and Xhariep Districts of
the Free State, increase identification of HIV positive children and improve access to antiretroviral therapy
through a strengthened referral system and the establishment of a cooperative network consisting of
relevant government departments, the antiretroviral program, faith-based organizations and other non-profit
organizations. OVC will receive direct support and family members will receive psychosocial, emotional and
spiritual care into the bereavement period.
Training for the Bana Pele Project: A Pediatric Palliative Care Training and Resource Center will be
and Resource Center, together with the Department of Pediatrics and Family Medicine. Prevention
evaluation activities to assist in monitoring the progress and measuring the results.
HPCA will provide capacity building expertise to the member hospices selected to participate in the OVC
program. The selection of participating hospices is based on the following criteria: 1.Those hospices which
currently have an established children's program included in the palliative care services they offer were
considered.2.The numbers of OVC patients reported in their statistics.3.A representative spread of the
difference models of OVC service provision e.g. day care, home-based care and in patient units.4.The
community need in the region and availability of OVC services within each region. PEPFAR support will be
provided to these hospice sites to enable them to equip the hospice for this role. This funding will also be
used for the salary of an OVC coordinator at each OVC site, plus partial funded posts. In FY 2007 20
Activity Narrative: hospices were supported by this project and in FY 2008 this will increase to 29.
ACTIVITY 3: OVC Care Services
The pediatric care services will be provided as follows: identification of OVC, accessing grants, assistance
with foster care placements, assisting with access to education, HIV prevention information, education and
counseling, health care including pain and symptom management, Anti Retroviral Therapy (ARV) and TB
Medication supervision, day care, support to Child and Youth-Headed Households, bereavement support,
resilience and memory training, spiritual, emotional and psychosocial care, and support for elderly
caregivers, home-based care, in-patient care and early childhood development programs. HPCA will
provide the following OVC services: psychosocial, emotional and spiritual support will be provided to family
members with identification of very vulnerable households such as those-headed by children and young
people, or the elderly. This activity will be supported by appropriate Monitoring, Evaluation and Reporting
(M&E) activities and tools to measure progress. Other support activities are improving access to ARVs,
monitoring and adherence of ARVs, nutritional interventions and facilitating access to social grants. Funds
will be used for direct funding for nurses, social workers, and social auxiliary workers and for transport and
admin costs of these human resources. Focus will be on the girl-child and the role of the female caregiver,
services and seven integrated pediatric services, with at least one per province. This program will also focus
on strengthening of existing comprehensive and or extensive pediatric programs through direct funding.
Linkages to other services such as TB treatment, ARV treatment and support will be integrated into the
OVC services.
funding for the care and protection of OVC. Where OVC support services are required which are outside the
scope of hospice expertise, e.g. child protection and nutrition, HPCA will identify suitable partners with the
technical expertise and resources to provide these services and to strengthen HPCA OVC programs. The
Bana Pele project will promote palliative care for children and raise public awareness. Links through existing
Child Care Forums will be strengthened through liaison with the Department of Social Development.
ACTIVITY 5: OVC and Pediatric Palliative Care Training
requiring pediatric palliative care, Models of pediatric palliative care, The Rights of the Child, Palliative care
within the context of childhood development, Pain management in children, Symptom management,
Nutrition, young person's understanding of death, Communication with children, Emotions of the child and
family members, Spiritual care and support of the child, young person and family, Bereavement support
including resilience and memory approaches, Social and legal issues relating to children and young people.
Ethical issues Core competencies and practical experience, and the mapping of family members (similar to
a family tree), to determine the support structure which each child has in their home environment.
Continuing Activity: 13799
13799 12479.08 U.S. Agency for Hospice and 6613 478.08 $1,250,000
12479 12479.07 U.S. Agency for Hospice and 4487 478.07 $350,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $50,000
Table 3.3.13:
The activities described in the FY 2008 narrative are about to commence. The Hospice Palliative Care
Association (HPCA) will monitor the standards of service delivery at the counseling and testing (CT) sites
and implement a quality assurance policy and procedure for hospice CT activities.
The Hospice and Palliative Care Association of South Africa (HPCA) currently has 75 member hospices
quality services to HIV-infected persons. BACKGROUND: HPCA strengthens existing services and
develops new services through direct funding to member hospices to promote accessibility and availability
of palliative care in SA, including work with religious leaders and member hospices that are faith-based
organizations. HPCA personnel at national, provincial and district levels continue to provide the
infrastructure and coordination to develop and strengthen palliative care programs within member hospices,
the formal healthcare sector, and NGOs. Improved collaboration between HPCA and National Department
of Health (NDOH) is a key objective, aimed at optimum utilization of scarce palliative care resources. FY
2006 funding has allowed the training of 7,108 trainees from October 2006 to July 2007. The major focus of
FY 2008 funding will be to train and support staff from identified hospices to integrate counseling and testing
(CT) into their services as a pilot program. The program will focus on training and supporting hospice staff
to provide CT services to patients and their families.
ACTIVITY 1:
Pilot Site ProjectPEPFAR funding in FY 2008 will enable HPCA to select four pilot sites in four provinces to
integrate CT into their patient services. The funds will be used to employ a professional nurse at each of
these four sites, to pay related overheads and to provide the necessary equipment and rapid test kits.
Information brochures will be produced for distribution at these four hospice sites and wherever else
appropriate. After completing the pilot project, HPCA will extend these CT services to all member hospices
and sites. Within these four hospice sites, CT will also be provided to families in homes as part of the home-
based care program.
ACTIVITY 2:
CT TrainingSpecific counseling and rapid testing training will be provided to these four, and other hospice
professional nurses, who will be certified after having received the required training. If necessary, lay
counselors will also receive specialized training to alleviate the burden on the clinical staff. Additional
training will be provided on couple counseling and testing. Home-based caregivers (HBCs) will be trained to
identify potential HIV patients in the community or family members and neighbors of patients. Those
identified will be encouraged and referred to the hospice for CT. The HBCs will also receive training on
antiretroviral treatment support and the importance of treatment adherence. The four professional nurses
will also be trained in supervision skills, as they will be supervising the HBCs involved in supporting this pilot
project.
ACTIVITY 3:
Client ServicesThe target population for CT will be patients, their families, and neighbors. The objective is to
identify those in most need of HIV treatment at the earliest opportunity. Confidentiality will be maintained
through a professional approach. The pilot hospices will have stocks of high quality CT rapid test kits and
external quality control measures around rapid testing will be implemented. Free tests will be offered, in a
medical setting at these sites, by trained and certified staff to all patients and their families or neighbors who
present with conditions that might suggest underlying HIV disease. Specially trained personnel will provide
appropriate pre- and post-test counseling in all cases. HIV-infected patients will be routinely referred for TB
testing, and to antiretroviral (ARV) clinics for CD4 counts and ARV treatment. Ongoing counseling and
referrals for medical care will be available to those who test HIV-infected. HPCA personnel will facilitate
ARV treatment support for enhanced adherence to antiretroviral drugs. Trained home-based caregivers will
provide enhanced treatment support and patients will be referred to support groups. Those who test HIV
negative will be encouraged to maintain their negative status though educating them about prevention, and
how to protect themselves and their partners. It has been shown that CT reduces the transmission of HIV
from infected individuals to their partners. Hospice site staff will be trained in the importance of targeting
men, and on couple counseling and testing. Disclosure remains voluntary, but HIV-infected patients will be
encouraged to disclose their HIV status to their partners and families when they feel safe to do so. Couple
counseling will help to address this issue. The four professional nurses at each site will supervise home-
based caregivers who will be providing information and support on CT in the communities.
ACTIVITY 4:
Liaison with ARV Clinics and the Department of Health The four pilot sites will improve liaison with local
ARV clinics and the Department of Health to optimize CT in that region. Patients will be referred to HIV
support and advocacy groups.
Continuing Activity: 16864
16864 16864.08 U.S. Agency for Hospice and 6613 478.08 $97,000
Estimated amount of funding that is planned for Human Capacity Development $21,000
Table 3.3.14:
