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:
The University of the Western Cape (UWC) program is part of the University Technical Assistance Program
aimed at strengthening human capacity development and ensuring sustainability in multiple program areas.
The PMTCT focus is on improving the outcomes of HIV-infected women and their infants through multiple
approaches, which address system strengthening and human resource development at the district and
primary health-care levels. These activities center on monitoring and evaluation (M&E) and the integration
of PMTCT services into routine maternal and child health (MCH) service delivery. The project focuses on
improving the quality of Community Health Worker (CHW) programs, and increasing the capacity of nurse-
midwives to implement integrated PMTCT and MCH in one district in the Western Cape. In addition, the
program focuses on the development and implementation of a facility-based M&E system for integrated
PMTCT/TB/HIV services in KwaZulu-Natal.
BACKGROUND:
In FY 2009, UWC will build on expertise obtained as a PEPFAR sub-partner to the Medical Research
Council. Activities started in FY 2008 will be continued and expanded to KwaZulu-Natal.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1:Improving Quality of CHW Programs for Delivery of HIV and AIDS Services
The use of CHWs such as home-based caregivers, lay counselors, and adherence counselors, to support
the delivery of HIV and AIDS care in communities, is becoming increasingly common in South Africa. CHWs
are a key cadre of personnel in PMTCT activities as they can identify and refer women in the community for
appropriate treatment and care, as well as provide a direct point of support. The National Department of
Health (NDOH) introduced a National Community Health Worker Policy Framework in 2003 that regulates
initiatives. Work conducted by UWC in 2007 indicated, however, that implementation of the Community
Health Worker Policy Framework is not being monitored or evaluated; that standards for training and
supervision are either not available or not being adhered to; that training materials are not available in local
languages; and district and sub-district managers have not received sufficient training and guidance in the
implementation of these programs. Working in close collaboration with the national and relevant provincial
Departments of Health, emphasis will be placed on rolling out the M&E tools developed in FY 2008 to the
entire Western Cape province. A training course will be developed for implementers of the framework. The
course will be accredited with UWC and the Health Professions Council of South Africa and will train be
used to train middle-level managers. Some of the data elements developed in the course of this evaluation
will be inserted into the Human Resource Information System being developed in the activity described
under the Health Systems Strengthening Component. It is anticipated that following the limited rollout of the
evaluation tool in FY 2009 the tool will be revised again and a national audit conducted in FY 2010. The
following sub-activities will be implemented to support this activity.
ACTIVITY 1A: Roll Out of the Audit Tool
The audit tool will be rolled out in the Western Cape. The rollout of the audit tool will be conducted in close
collaboration with the national and provincial Departments of Health, with the aim of setting up a monitoring
system for CHW programs. Fieldworkers and fieldwork coordinators will be appointed and trained in the
Western Cape. The results of the audit will be written up and made available to national, provincial and
district policy makers and managers.
ACTIVITY 1B: Training District and Sub-district Managers in the Implementation of CHW Programs
This project will develop a 5-day short course for 20 implementers of the CHW policy. The training course
and materials will be developed in consultation with colleagues from UWC, and National Department of
Health, and will then be offered to implementers as part of the School of Public Health's Winter School
program and subsequently evaluated and revised.
ACTIVITY 2: Training Nurse-Midwives In Community-Based PMTCT, HIV Prevention And Management
Skills And Competencies
The South African government is currently faced with a challenge of implementing a new national policy on
PMTCT. The policy is based on the premise that health-care providers, specifically, nurses and midwives
will be the key players in implementation, especially in areas where there are no medical doctors and in
rural areas. The Western Cape developed a provincial PMTCT protocol in June 2008, thus indicating the
need for specific competencies for those who will be providing services, especially in relation to integrating
PMTCT and MCH services. This project seeks to develop the capacity of nurses and midwives, a crucial
cadre of health care workers, as providers of integrated services as well as mentors for students in in-
service training. UWC has a relationship with the Overberg Health District, Teewaterskloof (TWK) sub-
district/municipality where students from the Community and Health Science faculty are exposed to rural
health; thus providing a valuable relationship and opportunity to train midwives in a rural area. The six
clinics in the TKW sub-district serve an impoverished population, including women on farms who have no
access to health education.
The project will build capacity through training nurses and midwives in the prevention and management of
HIV and AIDS, including integrating the PMTCT program into MCH services in the TWK district. The nurse-
midwives will need skills and competencies including provision of PMTCT prophylaxis, AZT and nevirapine
to pregnant women, prompt referral for HAART, and PCR for children. While the project, in this phase,
focuses on improving the capacity of nurse-midwives to deliver effective services, in the long-term it builds
them as mentors for students who will be placed in these facilities. Core competencies for nurse-midwives
to implement integrated PMTCT and MCH services will be developed in consultation with the Western Cape
Department of Health, and in alignment with the provincial protocol and the directorates of HIV and AIDS
and Maternal & Child Health. A training package for rural clinic based midwives will then be developed,
focusing on these core competencies as well as on mentoring undergraduate nurse-midwife trainees. The
Activity Narrative: training package will be in line with the national curriculum, but will be adapted for nurses and midwives in
rural, minimally resourced settings, and will include components of how to train and mentor students who
are placed with them. The development of the training package and training will be done concurrently
through participatory reflective action approach, which uses the following steps: drawing experience from
the participants and trainers, reflection, action and review. This method takes a form of a spiral where
learning materials and content are developed together with participants and there is constant feedback until
completion of a final product (training package). At least two nurse-midwives per health facility will be
trained (12 in total). Monthly mentoring will also be provided by the UWC coordinators. Feedback on the
training will also be provided to the district and provincial managers. The effectiveness of the training will be
evaluated by participants, and the outcomes of the training by monitoring the indicators of targets reached
in relation to the provincial PMTCT protocol, for example, the number of pregnant women undertaking HIV
testing.
Activity 3: Building Capacity to Monitor and Evaluate HIV Care in KwaZulu-Natal
KwaZulu-Natal has a population of 10 million people (20.9% of South Africa's population). The antenatal
HIV seroprevalence in 2006 was 39.1%, the highest of any province. KwaZulu-Natal also had the greatest
number of reported TB cases (34,928 cases registered in 2006) and the lowest cure rate (45.2% for cases
registered in 2005). The majority of TB cases in the province are co-infected with HIV (64.4%). The province
is divided into three administrative areas and 11 districts. The School of Public Health at UWC has been
implementing and evaluating interventions to reduce MTCT of HIV through a project call Good Start in 2
sites in KwaZulu-Natal (Umzimkulu and Umlazi). The PEPFAR-funded Good Start facility-based project
developed and piloted an HIV/PMTCT/TB M&E system that has now been finalized and accepted for
implementation throughout the province. UWC has been requested to assist the province in implementing
the new system. The project will help KwaZulu-Natal implement an M&E system for integrated
PMTCT/HIV/TB care at facility and community level.
The project will employ three HIV M&E trainers who would report to the provincial HIV M&E officer. Each
trainer will be responsible for one area of the province and the districts that fall within that area. The trainers
will train district information officers and district HAST coordinators on the new HIV M&E system, including
the patient-held card, clinical chart, pre-ART register and ART register. They will also train on the existing
M&E systems for voluntary counseling and testing, PMTCT and TB. The trainers will assist the districts in
training staff in all primary care health facilities and all ART sites on the new and existing systems. There
will be at least 2 training workshops in each of the 11 districts (22 in total). The first workshop will focus on
data collection tools and the second workshop will focus on monthly and quarterly reporting. The trainers
will maintain close contact with the district coordinators and assist them with facility-level support visits.
They will collect and collate monthly and quarterly reports and provide feedback to the districts. They will
encourage and support regular district meetings at which indicators for integrated HIV/TB/PMTCT will be
presented, discussed and used to assess program performance and address deficiencies. There are
currently long delays in printing and distribution of some stationery used by the Department of Health. The
project will assist the province to establish systems to ensure an uninterrupted supply of stationery for
integrated HIV/TB/PMTCT care, including printing and distribution when required. The large numbers of
people in HIV care in KwaZulu-Natal make the long-term follow up of patients in HIV care difficult using a
paper-based system. There is therefore a need to develop and train relevant staff on an electronic HIV M&E
system. The program will be assessed in several ways, including a review of the completeness and
accuracy of recording and reporting for the new HIV M&E system 6 months and 12 months after
implementation in the 11 districts. Subsequent training will be provided to address problems found during
the reviews.
---------------------------
Summary
The University of Western Cape is implementing multiple activities aimed at improving human capacity
development to address HIV and AIDS in South Africa.
BACKGROUND
The 2004 report of the Joint Learning Initiative on health human resources states that "after a century of
most spectacular health advances in human history, Human survival gains are being lost because of feeble
national health systems. The HIV and AIDS emergency has undoubtedly contributed to this problem,
particularly in South Africa. The pressure on health care workers is immense and with the crisis of attrition
and out-migration of personnel, systems in South Africa are challenged as never before. This has been
placed in stark relief by the urgent need to respond to HIV and AIDS epidemic, and especially the current
imperative to deliver antiretroviral therapy (ART) to large numbers of sick people who are often living in
areas where health systems have been poorly developed. This project focuses on strengthening and
expanding the development and implementation of comprehensive HIV and AIDS prevention in South Africa
in order to mitigate the impact of the HIV and AIDS epidemic. The emphasis area for these activities is
human capacity development, training, including pre-service and in-service training for nurse midwives.
The primary target groups for these activities include nurse midwives and community healthcare workers in
the public sector. Secondary target groups include HIV positive pregnant women and their infants.
ACTIVITY 1: Improving the quality of community health worker programs for the delivery
The use of community health workers, such as lay counselors to support the delivery of HIV and AIDS care
in communities is becoming increasingly common in South Africa. The National Department of Health
(NDOH) has introduced a national community health workers policy framework in 2003 which unifies and
regulates initiatives in this regard. This project aims to develop an audit tool to assess the implementation
of CHW programs in the country using PMTCT as an example. The tool will be piloted in one urban and
one rural sub-district and feedback will be disseminated via a workshop to the NDOH and corresponding
PDOHs where the piloting occurred. The project will begin with a series of workshops with policy makers
and program implementers in two provinces, and national experts to define the scope and key components
of the tool. This will be followed by the development of the tool, during which time further consultation with
Activity Narrative: stakeholders will take place.
ACTIVITY 2: Training nurse mid-wives in community-based PMTCT
Nurses and midwives are a backbone to the health system and are major role players in the delivery of
quality health services, especially in the context of maternal and child health services. With HIV and AIDS
the most common primary cause of maternal ad child deaths in the country, this puts a challenge onto the
already depleting MCH health services and to heath care providers, the midwives. The overall aim of this
project is to build capacity through the training of midwives in the prevention, management and integration
of PMTCT into maternal and child health services in a rural district in the Western Cape. The school of
nursing, UWC, will develop a training program targeting midwives managers/supervisors at health facilities,
qualified midwives at primary health care/community health centers and midwives trainees (within
undergraduate and postgraduate studies). Midwives implementing PMTCT at primary health care will
mentor the midwifery trainees. The midwives managers/supervisors will be responsible for conducting
training and implementing the train-the-trainer skills education program for the MCH facility manager on
integration of PMTCT into MCH services.
New/Continuing Activity: Continuing Activity
Continuing Activity: 22313
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
22313 22313.08 HHS/Centers for University of the 9625 9625.08 $470,000
Disease Control & Western Cape
Prevention
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $311,151
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
SUMMARY:
The University of the Western Cape (UWC) program forms part of University Technical Assistance Program
(UTAP) aimed at strengthening human capacity development and ensuring sustainability of efforts in
multiple program areas.
UWC's activities focus on increasing the prevention of HIV through multiple approaches aimed at key
sectors that increase the reach of prevention messages, and ensuring that preventive messages are
received in different areas of life - in school, at community sport activities and within the community. The
program prioritizes prevention messages aimed at youth both in and out of schools and the general adult
population. It addresses key issues around social norms that mitigate the impact of prevention. The project
focuses on improving the capacity of sports coaches and managers involved in community sport programs
to integrate HIV prevention messages into their activities. Another focus of the project is to increase the
capacity of traditional healers and medical professionals to more effectively integrate their HIV/AIDS
services and develop effective prevention messages and services. These activities increase the expertise in
prevention programming within the academic, health worker, education, and community sectors by
incorporating quality assurance processes into the development of materials, as well as monitoring the
impact of activities.
UWC will carry out two separate activities in this program area.
ACTIVITY 1: HIV/AIDS Prevention Through Sports Participation
This activity is led by the UWC's Department of Psychology, which has a long-standing project exploring the
benefits of sports in lifestyle change and disease prevention, with support from the UWC Department of
Sports and Recreation. The United Nations Sports for Development Inter-Agency Task Force and UNICEF's
sports for development division have recognized and endorsed the critical role sports has in development
through Sports Plus Programming, where health messages are incorporated into sports activities. Within
such programming, life skills, health behavior skills and HIV prevention skills are added to sports activities.
This is known as Sports Plus Programming. Sport is potentially a powerful component in the fight against
HIV/AIDS. In Africa, there are examples of several prominent non-governmental organizations (NGOs)
using sports as leverage for HIV information. The most prominent are 'SCORE' and 'Kicking AIDS Out'.
These are primarily directed at children sports participants. The 'Preventing Aids through Sports
Participation,' developed and piloted in FY 2008 on the West Coast Winelands, will be rolled out to an inner-
city township.
The project trains sports teachers, sports coaches and administrators in HIV prevention such that it can be
incorporated into their roles and actions as coaches. In this way children affiliated with, and engaged in
sports in schools and communities will receive the HIV prevention messaging as part of their coaching in
their sports. Both males and females can be reached through the sports against HIV/AIDS messages.
Whereas males tend to avoid HIV/AIDS prevention messaging, they can be readily reached through their
involvement in sports and where anti-HIV/AIDS messages will be delivered in a medium acceptable to both
male and female sports participants.
Using FY 2009 funding, sports coaches, mentors, administrators and organizers within designated regions
in Western Cape Province will be trained in the manual through workshops. Sports coaches and
administrators will be identified from the West Coast/Winelands region (primarily rural) and Langa (an urban
township) of the Western Cape Province. Both sports coaches in community clubs and school-based sports
teachers are targets of the activity. The training manual will be adapted to address needs of the urban
township coaches, and opportunities for sharing of experiences and lessons between the two regions. Sixty
coaches, sports teachers and administrators will be trained. There will be two training workshops in each
region, with three months of spacing between the two workshops. The training will be staggered to enable
'digestion' of the material and for ensuring that the information is incorporated into local coaching practices.
Monitoring and evaluation of the training will be included in the activities through measuring the impact of
training as well as measuring the effectiveness of the training materials and methodologies. This will be
documented by one of the facilitators. Materials and methodology will be reviewed as needed.
This activity is part of a broader strategy to engage with higher education institutions and sports coaches
accrediting bodies to introduce HIV through sports participation into their mainstream sports and sports
coaching curricula. During FY 2009 initial discussions will be held with representatives of these institutions.
Their input into the development of the final manual and training methodology will also be canvassed.
The project will actively engage the coaches who are also involved in female-dominated sports. In the
project area meetings numerous female coaches of female teams attended. In particular netball and
basketball (to a lesser extent) are popular female sports at club and school level. Therefore netball and
basketball coaches will be actively recruited as participants. The workshop curriculum and manual content
will address the HIV messaging from a gender-specific and gender-sensitive perspective.
ACTIVITY 2: Training Health Care Providers and Traditional Health Care Practitioners on Collaboration for
HIV/Aids Prevention and Care
This activity is led by the Department of Anthropology and Sociology at UWC and builds on its experience of
engaging traditional healers in understanding the cultural meanings of illness and facilitating the building of
relationships between traditional healers and bio-medical health care professionals.
Evidence from the initial training in FY 2008 suggests that traditional healers will need to be further
Activity Narrative: educated on HIV/AIDS. Using FY 2009 funds, a refresher training will be conducted. Feedback from a 100-
hour training program will be finalized, and accredited through UWC and the South African Qualifications
Authority (SAQA). The process of accreditation is one of the key tasks in FY 2009. Six workshops will be
held with traditional healers and formal health care professionals in the Western, Eastern and Northern
Cape. A policy brief will be developed and presented to the Department of Health on the interaction
between the formal health care sector and the Traditional Healers Council concerning HIV/AIDS prevention
and care in the Western and Eastern Cape (where work was begun in FY 2008). Ninety formal health care
workers, herbalists and traditional healers will receive the training in the integrated module package
To further the reach and understanding of the relationship between traditional and formal health care
approaches a short course aimed at general health and traditional practitioners will be developed. During
FY 2009, priority will be given to course development, and accreditation with the Health and Welfare Sector
Education and Training Authority (HWSETA) and Health Professions Council, with the implementation of
the course happening in FY 2010. The use of multi-media (print, powerpoint, video) will be prioritized in the
training curriculum in order to further enhance closer understanding and co-operation between formal health
care practitioners and traditional healers in relation to issues concerning HIV/AIDS from the different cultural
perspectives of biomedicine, traditional healing and the use of medical plants. The integrated program will
be translated into isiXhosa. The training programs will be evaluated through participant evaluations, as well
as outcome evaluations to understand to what extent participants have integrated the learning. Ten
representatives of the National and provincial Departments of Health and representatives of the Interim
Traditional healers Council at provisional levels will participate in a collaborative workshop in which policy
recommendations are discussed.
Continuing Activity: 22497
22497 22497.08 HHS/Centers for University of the 9625 9625.08 $180,000
* Reducing violence and coercion
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $103,593
Table 3.3.03:
The University of the Western Cape (UWC) program is part of University Technical Assistance Program
aimed at strengthening human capacity development and ensuring sustainability of efforts in multiple
program areas.
The activities under this program focus on health system and education system strengthening to support
THE TB/HIV program. A key emphasis is on improving access to information for district-based clinicians to
diagnose and treat TB and HIV more rapidly and effectively. The project will also improve access to
information and build the capacity of clinicians in understanding drug resistant HIV strains. The education
sector is highlighted as a key focus for information, education and communication activities, through an
intervention that builds capacity through training teachers, learners, and parents (as members of school
governing boards) to become health promoters and providers of care and support by providing multi-media
and interactive information.
ACTIVITY 1: A Web-Assisted Consultation Service to Support TB/HIV Clinicians in Southern Africa
TB is the most common opportunistic infection and most important cause of death in people infected with
HIV in Southern Africa. Information for the clinical management of multi- and extensively drug-resistant TB
(MDR/XDR-TB) is changing very quickly and it is difficult for clinicians to access this information. This
project will develop and pilot a remote web-assisted consultation service for TB/HIV diagnosis and
treatment. This service will build the capacity of clinicians in Southern Africa to provide optimized TB/HIV
care. Using FY 2009 funds, the web system will be modified and enhanced based on the use of the system,
and the information from the training and utilization workshops. Eighteen clinicians and clinical nurse
practitioners (one doctor and one clinical nurse practitioner from each of the nine provinces) will be trained
to review the system.
ACTIVITY 2: Molecular Surveillance by Accurate Detection of HIV-1 Drug Resistance Mutations in Patients
on Antiretroviral Treatment in Southern Africa: An Informatics Approach
Scaling up access to antiretroviral therapy (ART) in Southern Africa to extend survival among the HIV-
infected is a significant challenge, requiring considerable increases in expertise and skilled implementation.
Major challenges to success include monitoring and evaluation (M&E) of patient adherence and the
prevalence of drug resistance in treated cohorts. Bioinformatics methods are widely used in developed
countries to identify drug resistance mutations in HIV patients on ART. These methods are the basis upon
which policy guidelines are set in order to inform the clinician when to switch antiretroviral (ARV) drug
regiments affected by the appearance of resistance mutations. The identification of the levels of ARV drug
resistance in an epidemic is used to define the first and second line ART regimens that are most effective to
treatment.
In FY 2008, the system will have been designed and software developed, data will have been gathered and
the initial database populated. Twenty clinicians from public and private ART sites around South Africa will
have participated in a training workshop. In FY 2009, the system will be adapted and finalized and the web-
assisted interface for HIV drug resistance analysis will be made available at http://hivweb.sanbi.ac.za.
This project will establish web-based tools to provide accurate detection and monitoring of the spread of
drug resistance mutations in patients on ART in Southern Africa. The project will transfer developed drug
resistance databases technology developed by UWC's partners at Stanford University and at REGA
Institute (Leuven, Belgium) to the South African National Bioinformatics Institute (SANBI)/UWC. The system
under development will provide an accessible web portal for decision support for ART regimen switching in
resource-constrained environments where laboratory/molecular markers such as CD4 count, viral load and
resistance mutation data are not available. Core components of the Stanford HIV database will be
transferred to SANBI/UWC. These components include SQL databases and a number of software
applications. The SANBI/UWC server will contain a read-only copy of the public version of the Stanford
database and a password-protected local server that will be used to store and analyze Southern African HIV
-1 sequences. A number of software applications and scripts will be transferred to the SANBI server,
including the Drug Interpretation Interface and the ART-AiDE (http://hivdb.stanford.edu/). These two
software applications are commonly used to identify drug resistance mutations and to manage clinical and
treatment data. The REGA database will be used as the local South African database to manage both
treatment and sequence data (http://www.kuleuven.be/rega/). The participants of the Southern African
Treatment Network (http://www.saturn4hiv.org) in South Africa will deposit and share their sequences and
clinical data on treatment cohorts. SANBI/UWC will apply bioinformatics techniques to determine the
prevalence of drug resistance mutations in treated individuals in Southern Africa. The interfaces to the
Stanford and REGA databases and analysis tools will be available for secure medical and controlled public
usage at the SANBI/UWC website. The SANBI/UWC website will also give access to HIV sequences and
treatment information from public databases.
SANBI/UWC, REGA and Stanford personnel will train a minimum of thirty clinicians in the country to use the
web interface tools to manage patients on ART. The clinicians will be trained through distance learning and
a hands-on workshop on how to use the web portal for management of patients on ART.
The project will also monitor and evaluate the prevalence and spread of drug resistance mutation in
Southern African population, and use this data to inform public health policy decisions.
The system will be continuously optimized based on feedback from users and workshop participants.
Monthly data will be collected to identify where requests for assistance are logged (thus evaluating whether
the target audience is being reached), and to monitor the types of queries being submitted and the
response time to queries. Consultations with the Department of Health and Department of Science and
Technology will be undertaken to secure resources to maintain the system beyond 2010.
Activity Narrative: ACTIVITY 3: A Web-Based HIV/TB Educational Program for South African School Learners
There is a very high proportion of young South Africans at risk of HIV and TB. South Africa is ranked eighth
in the world for the number of TB cases and the Western Cape has the highest number of cases in South
Africa. Of the total population, 49% of the at-risk populations are children and youth under 18 years of age.
Currently there is insufficient information on TB and HIV in schools.
A web-based interactive TB/HIV educational program for schoolchildren at secondary school level will be
developed, and the Health Promoting Schools that are part of the overall UWC program will be used to test
the educational program.
This activity will include three pre-selected pilot schools, all part of the Health Promoting Schools program
(see COP 2008). The schools include St Andrews Secondary School, Elswood Secondary School and
Ravensmead Secondary School, all located in Cape Town and all operating under the auspices of the
Western Cape Department of Education. An interactive web-based educational program will be developed
to educate learners on the causes of HIV and TB, including topics of prevention, risk factors, testing, and
treatment. The three schools are equipped with computer laboratories that have access to the internet, and
are therefore able to pilot and develop the program. Educational content will be presented in an engaging
format that encourages incorporation into school lessons, particularly into the Life Orientation curriculum
that is already taught at these schools. Thirty teachers in the pilot schools will receive training on the use of
the web-based educational software. Thirty learners from the pilot schools will test the web-based software
to assess comprehensiveness of content and user friendliness of the software. Bug-fixing and modifications
to the web-based software will be based on teacher and learner feedback. The grades 8-9 educational
material will presented in English, and subsequently translated and presented in isiXhosa and Afrikaans.
The interactive material will be presented to the Department of Education for assessment and validation.
This project will collaborate with the national and provincial Departments of Health and Education;
consultations will be held with both Departments regarding dissemination and continued utilization of the
tool beyond 2010.
The project contributes to PEPFAR's targets by increasing the quality of service delivery in the diagnosis,
treatment and palliative care of TB/HIV patients. It provides a web-based support system that will benefit
clinicians working in remote service districts and will increase the knowledge of those within the education
system. This system will aim to prevent TB and HIV infection, promote effective referral mechanisms for
treatment and care for those affected by HIV and TB and those who are within the school system.
-------------------------------
The University of Western Cape (UWC) is implementing multiple activities aimed at improving human
capacity development to address HIV and AIDS in South Africa.
human capacity development, training, including pre-service and in-service training. The minor emphasis
area is local organization capacity building. Target populations include public and private sector health care
workers and youth attending secondary schools.
HIV and AIDS require a comprehensive approach with a view beyond the health system. Consistent with
this approach, the activities in this program area demonstrate a multi sectoral approach to targeting a
variety of health professionals. There are two separate activities in the program area.
Activity 1: A web resource to support TB/HIV Clinicians in South Africa
HIV in South Africa. Information for clinical management of multiple drug resistant TB (MDR), and
extensively drug resistant TB (XDR) is changing very quickly and it is difficult for clinicians to access this
information. This project will develop and pilot a remote web-assisted consultation service for TB/HIV will
diagnosis and treatment. This service will build the capacity of clinicians in Southern Africa to provide
optimal TB/HIV care. A specialist consultative service and information of relevance to clinicians necessary
to support accurate TB/HIV diagnosis, treatment and palliative care will be provided as a single web-
accessible system. The system will offer a web-based consultation service to which clinicians can send in
questions on how to manage problem cases and receive responses from recognized experts. The site will
provide links to existing clinical guidelines, a photo library with images of clinical presentations and relevant
data-mined information of the most recent updates from scientific literature. 20 Clinicians from various
service outlets dealing with TB/HIV will be trained in efficient use of the system and will participate in the
pilot. The system will be modified after the pilot and 90 clinicians will be trained in the use of the final
system.
Activity 2: Addressing TB/HIV through the development of health promoting schools
A holistic approach is needed to address TB/HIV effectively. The World Health Organization has noted that
Activity Narrative: "the school is an extraordinary setting through which to improve the health of student, school personnel,
families and members of the community." The UWC Health Promoting Schools Forum is a partnership
between academics at UWC, the Western Cape Reference Group for Health Promoting Schools, the
Western Cape Department of education (WCED) and the Western Cape Department of Health. This forum
has been active in supporting the development of health promoting schools in the Western Cape. There are
currently 130 health promoting schools in the Western Cape. WCED has identified 21 communities as
being in particular need of multi-sectoral interventions through Western Cape Social Transformation
program. The broad goal of this activity is to reduce the spread of TB/HIV in the school community. The
specific aim of the activity is to build and strengthen human capacity among all in the school community.
The purpose of this activity is to ensure the establishment of health promoting secondary schools, to
facilitate the development of TB/HIV policies in the schools and to facilitate a process of developing healthy
psychosocial and physical environment in the school community, and to improve knowledge in the school
community related to TB/HIV.
Continuing Activity: 22492
22492 22492.08 HHS/Centers for University of the 9625 9625.08 $300,000
Estimated amount of funding that is planned for Human Capacity Development $166,353
Table 3.3.12:
The University of the Western Cape (UWC) program forms part of the University Technical Assistance
Program (UTAP), which is aimed at strengthening human capacity development and ensuring sustainability
of efforts in multiple program areas. The activities in this program area focus on improving human resource
information systems (HRIS) that enable managers at the district and sub-district levels to more effectively
use the information collected for human resource planning and management. Another key emphasis is on
strengthening the management capacity of health and human resource managers within health
departments. The project also focuses on expanding health-related resources and promoting effective
partnerships between the education and health sectors, through the establishment of health promoting
schools at the secondary school level.
During FY 2008, this project identified and started working with three secondary schools in a low resource
community in Elsies River, Cape Town. Teachers, learners and parents of learners have participated in
workshops at individual schools. Using FY 2009 funds, the project will continue to work with the learners,
teachers and parents in the three identified secondary schools. There will be workshops with the learners,
teachers and parents. There will be mentoring of teachers. There will be leadership camps for the learners.
Links will also be made between the schools and community groups. Joint initiatives will be developed
between the three schools. Also, the English language version of the training manual will be completed.
The training involves a series of workshops for parents, teachers and learners that will be held over a period
of 10 months. Empowerment activities will be used to build self-esteem and support healthy school-
community and family values. Forty-six individuals (15 teachers, 15 learners, 15 parents, and 1 school
nurse) will be trained. Twenty learners will participate in a leadership camp which will focus on empowering
activities while learning about addressing HIV and TB. Local community groups, such as the theatre group
Sound Track 4 Life and Children's Resource Centre will be involved in this training.
UWC will carry out three separate activities in this programmatic area.
ACTIVITY 1: Management and Leadership Training for HIV/AIDS Program Managers and Human Resource
Managers at the Provincial and District Levels
This activity aims to strengthen the overall capacity of both human resource managers and HIV project
managers to deal with the ever-increasing challenges faced in their workplace through the provision of a
leadership and management training program. The program is designed to improve the management and
leadership skills of these health personnel.
The goal of the project is to improve the skills, knowledge and competencies of new HIV project managers
and emerging human resource managers, so that they may be better equipped to deal with the challenges
of their work at local and provincial government levels. The assumption is made that most HR managers
have already received some management and leadership education/training. The training program within
this activity is more relevant to people who have either newly entered the field of management or are
aspiring to become managers in the near future.
Using FY 2009 funds, local and provincial government officials will be consulted to review the five-day
training program developed in FY 2008. The training will continue to be rolled out in FY 2009, with 30 new
HIV project managers. Additionally, 30 emerging or up-coming human resources managers at provincial
and district levels will be trained in public service leadership and management. The training program will be
evaluated by participants and outcomes will be measured through assessment processes. In addition the
effectiveness of the training will be measured by the increase in demand for the training program. The
course will be accredited through UWC and the Health Professions Council.
ACTIVITY 2: Human Resource Information Systems for District Level Planning and Management
Background: Planning and managing programs are often hampered by the unavailability of reliable human
resources information. Developing good health program information systems is a labor intensive and time
consuming process and the staff that operates them must be trained and supported. Over the past 10 years
and still currently, the School of Public Health at UWC has been at the forefront of developing and
supporting the implementation of routine district and program health information systems (specifically
human resource information systems) and enabling health workers and managers to systematically and
routinely, collect, collate, analyze, interpret and utilize information. This project contributes to the
strengthening of capacity for the collection of data and use of human resource information to manage
programs like the HIV/AIDS program. The aim of the project is to improve the quality of health care provided
through developing a sustainable, decentralized capability to operate and maintain integrated district-based
HRIS, as well as increasing the use of information by health care providers. A participatory approach will be
used with the established task team to develop the tools and collect the data required for decision making.
Training will be targeted at both the producers (task teams) and the users (managers) of the information.
The project strategy includes both a bottom-up and top-down approach. The approach requires the
participation of the district and the National Department of Health. A task team was established in FY 2008
at the district level and regular communication specifically aimed at participation in the development of the
system with the national and provincial Department of Health. In addition, regular formal feedback sessions
are provided to the National Department of Health to ensure that the development of the human resource
information system is in line with the current and new national policies.
Activity Narrative: Using FY 2009 funds, the framework for a district-based HRIS developed in FY 2008 will be piloted in one
district in the Western Cape. A training and mentoring program will be developed in consultation with a five-
member task team, reaching at least 20 managers. The training will focus on the use and monitoring of
human resource information; as well as training of the tool developed. The HRIS tool will be piloted in one
district in the Western Cape (West Coast), with the on-going training of district and sub-district managers.
Monthly mentoring visits will be conducted to provide support mentoring on the collection and use of human
resource information. The managers will be supported in compiling a district human resource management
report based on the data collected.
ACTIVITY 3: Addressing TB and HIV Through the Development of Health Promoting Schools
Background: Multiple factors lead to the spread of TB and HIV in the school community. While poverty is the
underlying social determinant, in many of the communities in the Western Cape substance abuse, including
alcohol and drug abuse, and violence are also factors that lead to risky sexual behavior. Consequently a
holistic approach is needed to address TB and HIV effectively.
The World Health Organization has identified schools as effective settings for the promotion of health. This
project focuses on training to strengthen human capacity using the holistic health promoting schools
framework to address the problems of TB and HIV. The National Department of Health, Health Promotion
Unit has identified the development of health promoting schools as a priority. It is in the process of
reviewing its Draft Guidelines on Health Promoting Schools. The outcome of this project will feed into this
process.
The UWC Health Promoting Schools Forum is a partnership between academics at UWC, the Western
Cape Reference Group for Health Promoting Schools, the Western Cape Education Department (WCED)
and the Western Cape Department of Health (Health Promotion). The forum has been active in supporting
the development of health promoting schools in the Western Cape. There are currently approximately 130
health promoting schools in the Western Cape. Until this project began development had only taken place in
primary schools. This project aims to develop secondary schools as health promoting schools.
The broad goal of this project is to reduce the spread of TB/HIV in the school-community in South Africa.
The specific aim of this project is to build and strengthen human capacity among all in the school
community. This includes, firstly, to promote sexual abstinence and delay sexual debut and, secondly,
among older adolescents, teachers, and parents, to develop and strengthen the ability to make healthy
choices related to sexual behavior in order to reduce risky sexual behavior. The project also seeks to
enhance the care of young people who are HIV affected within the education system and improve referrals
for treatment and care.
This project contributes to the Policy Analysis and Systems Strengthening target, specifically the
development of a district-based human resource information system. This project is directly linked to the
provision of management and leadership training for new HIV program managers and HR managers at the
provincial and district levels.
------------------
national health systems." The HIV and AIDS emergency has undoubtedly contributed to this problem,
workers including human resource managers and HIV program managers.
Activity 1: Provide management and leadership training for new HIV program managers and human
resources managers at the provincial and district level:
leadership and management training program. The goal of the project is to improve the skills, knowledge
and competencies of new HIV project managers and human resource managers so that they may be better
equipped to deal with the challenges in their work. The objectives of the project are to provide a training
program that would aim to introduce participants to the concept of "self-management"; provide participants
Activity Narrative: with an understanding and overview of the management functions of planning, organizing, and leading;
familiarize managers with the concept of innovation and allow them to apply creativity techniques so that
managers may be able to lead projects to meet new innovative ideas and introduce problem solving and
decision making processes and techniques applicable to their work environment. In this activity a training
curriculum approved for continuing education credit through the UWC Division of Lifelong Learning will be
implemented. Twenty new HIV project managers will be trained in public service leadership and
management and ten human resource managers at the provincial and district level will be trained in public
service leadership and management.
Activity 2: Human Resources Information System
UWC's current work with the NDOH has initiated a process of conducting a human resource information
audit in South Africa and developing a framework of national indicators for human resource management,
development and planning. This activity will take this process to the next level by developing a district
based human resource information system (HRIS) for general human resources information, with a specific
focus on HRIS requirements for HIV and AIDS program delivery. Planning and managing programs is often
hampered by the unavailability of reliable human resource information. Yet, developing good health
program information system is a labor intensive and time consuming process and the staff that operates
them must be trained and supported. The aim of the project is to improve the quality of health care provided
through developing a sustainable, decentralized capacity to operate and maintain integrated district based
HRIS, as well as increasing the use of information by health care providers. This activity will develop a
framework for district-based HRIS for the management and planning of human resources and will also
develop a training program fro the data collectors and information users on the development and use of
human resource information. In addition, a group of data collectors and information users will be trained on
the district based HRIS for piloting.
These activities contribute to the PEPFAR goals by training HIV program manager and developing a district
based HRIS. This will lead to improved human capacity development for the implementation of HIV and
AIDS services.
Continuing Activity: 22330
22330 22330.08 HHS/Centers for University of the 9625 9625.08 $300,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $196,345
Table 3.3.18:
