SUMMARY:

CARE serves as an umbrella grant making mechanism for the Centers of Disease Control. CARE has been

an umbrella grants mechanism since FY 2006. CARE's primary responsibility is for the financial oversight of

the grant which includes review of the financial reports and on-site assessment of the supporting

documentation. CARE does not provide programmatic level technical assistance to the sub-grantees.

Technical assistance and programmatic over-site is provided by CDC activity managers. The specific

activities that CARE is responsible are listed below. The target area for PMTCT umbrella grants mechanism

is local organization capacity building. The target population is pregnant women and children under the age

of five. Currently CARE support three indigenous organizations who are implementing PMTCT activities,

these include Wits Health Consortium - National Health Laboratory Services; Nozizwe Consulting; and

Leonie Selvan Communications.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Contractual Responsibilities

CARE is responsible for the contractual arrangements of the sub-grants with CDC South Africa. These

arrangements include application for funding for implementation of activities by the sub-grantees that have

been approved by CDC South Africa to meet the PEPFAR goals. CARE will prepare all supplemental and

continuation application, and ensure that progress reports are received by the sub-grantees. CDC activity

managers will be responsible for the technical review of the sub-grantees; thus targets met by the sub-

grantees for the PMTCT program will not be assigned to CARE.

ACTIVITY 2: Financial Oversight

CARE is responsible for the financial oversight of the sub-grants. This activity includes the review of

financial reports submitted by the grantees on quarterly/6-monthly basis; and on-site assessment of the

supporting documents to ensure compliance with the contract. These on-site assessments will be

conducted on a 6-monthly basis. CARE will also ensure progress reports are received from the sub-

grantees and approved by the activity managers of CDC South Africa on a quarterly/6-monthly basis prior to

the disbursement of continuation funding.

Although these activities do not directly contribute to the overall PEPFAR goals and objectives, the

Umbrella Grants Mechanism ensure that PEPFAR support can be given to small and medium-sized

organizations, enabling them to facilitate the achievement of the PEPFAR 2-7-10 goals.

SUMMARY:

CARE serves as an umbrella grant-making mechanism for the Centers of Disease Control and Prevention

(CDC). Specific responsibilities of include the financial oversight of the grant which includes review the

financial reports and on-site assessment of the supporting documentation.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Contractual Arrangements

CARE is responsible for the contractual arrangements of the sub-grants with CDC Atlanta. These

arrangements include application for funding for implementation of activities by the sub-grantees that have

been approved by CDC South Africa to meet the PEPFAR goals. Care will prepare all supplemental and

continuation application, and ensure progress reports are received by the sub grantees. CDC activity

managers will be responsible for the technical review of the sub-grantees, thus targets met by the sub

grantees for the HVAB program will not be assigned to CARE.

ACTIVITY 2: Financial Oversight

CARE is responsible for the financial oversight of the sub grants. This activity entails the review of financial

reports submitted by the grantees on quarterly/6 month basis; and on-site assessment of the supporting

documents to ensure compliance to contract. These on-site assessments will be conducted on a six month

basis. CARE will also ensure progress reports are received from the sub grantees and approved by the

activity managers of CDC South Africa on a quarterly/6 month basis prior to the disbursement of

continuation funding.

CARE is contributing to the 2-7-10 PEPFAR goals through support to indigenous and international FBOs

and NGOs providing AB and Youth focused services to communities in all nine provinces.

SUMMARY:

CARE will continue its work in building HIV and AIDS competence of civil society organizations (CSOs) who

deliver HIV-related care services in South Africa. CARE aims to scale up palliative care by administering

and managing 26 small grants and targeted technical assistance to identified grantees to scale up HIV-

related palliative care services in organizations that are unable to receive direct funding due to limited

capacity. Minor emphasis activities include community mobilization, training and development of networks.

BACKGROUND:

The CARE Letsema project is part of a five-year project, which started in October 2005. CARE in FY 2008

will geographically expand implementation further into the Free State (along Lesotho border) and Limpopo

border along the Great Limpopo Tranfrontier Park. In FY 2008 other changes will occur, namely, expansion

into Mpumalanga, and southerly along the Great Limpopo Transfrontier Park along the borders shared with

Mozambique and Swaziland. Technical program areas are supported by small grants and technical

assistance for that program area, directly through CARE, as well as through identified Sectoral Education

and Training Authority (SETA) accredited partners with specialized expertise in HIV-related palliative care

and support. Since FY 2006, Letsema has been working primarily in the eastern Free State near the

Lesotho border and will continue to work in this area.

ACTIVITY 1: Strengthen Delivery of Quality HIV-Related Palliative Care Services

Targeted training and mentoring support will be provided to selected organizations to address the clinical,

physical and psychological care of HIV-infected individuals, and the psychological, spiritual and social care

of affected family members. Technical emphasis will be supporting CSOs to appropriately message, provide

and/or refer for elements of the basic preventive care package including prevention with positives. The aim

of this activity is to build a more integrated HIV response that responds to the family as a whole and

promotes increased coordination of services within the community, facilitating greater uptake and utilization

of health and social government services such as HIV counseling and testing, treatment and social

assistance. CARE aims to strengthen the referral network within each of the organizations it supports. This

is an integrated response that promotes community mobilization, awareness and implementation of HIV

prevention, care and treatment support activities as a continuum. Service delivery will be strengthened, and

quality and success rates in accessing government services will be improved by:

(1) placing salaried professional staff (nursing supervisors and social workers) together with sub-partners

and contracted specialists to train and mentor staff and volunteers to improve the clinical component of

home-based care within the government's specified guidelines and curriculum;

(2) technical support to CSOs emphasizing the messaging, delivery and/or referral for evidence-based

preventive care interventions which include the following: OI screening and prophylaxis (including

cotrimoxazole, TB screening), counseling and testing for clients and family members, malaria prevention

with ITNs (where appropriate), safe water and personal hygiene strategies to reduce diarrheal disease,

nutrition counseling and supplementary feeding (where clinically indicated) or referral for nutritional and food

support, HIV prevention counseling, provision of condoms, referral for family planning services for HIV-

infected women, and appropriate child survival interventions for HIV-infected children. The package of

services also includes basic pain and symptom management, psychosocial support, treatment support for

OIs (including cotrimoxazole prophylaxis and TB treatment) and antiretroviral therapy (ART) and

psychological, spiritual and social support of affected family members; and,

(3) strengthening collaboration among government departments at district and provincial levels to ensure

access to basic healthcare, ART, legal documentation, state income grants, support for staying in school,

and volunteer stipends and improved service coordination; and develop workplace support and supervision

for volunteers.

CARE as part of the social service category will expand its savings and lending model, as well as income

generation training to households of HIV-infected people to generate an income to deal with the shocks and

stressors of HIV and AIDS, consumption and asset building (which includes productive income). Both

economic products serve social support functions to deal with issues like that of stigma, discrimination, child

rearing, death and hardship that HIV-infected people and their families encounter. A gender analysis of the

savings and lending groups through Local Links has revealed that 98% of the beneficiaries are women.

Once these women have met their families' basic needs for food, school fees, transport to clinic and

medication etc. the savings and the interest earned is put to productive use through income generation

activities. This activity addresses gender issues through ensuring equitable access to HIV-related care

services for both men and women and encouraging male involvement and mobilization of community

leaders throughout the program.

ACTIVITY 2: Capacity Building

The activity combines organizational development training and mentoring to enhance institutional

strengthening identified of CSOs to improve organizational functioning and service quality. The program will

achieve this through an innovative combination of capacity building approaches including training

workshops, mentoring, cross-visits, and organizational technical assistance. The proposed intervention will

minimize one-time training and workshops and will develop longer term activities to strengthen CSOs and

networks, ensuring sustained capacity building and joint learning. Organizational capacity will be

strengthened to improve institutional functioning by (1) undertaking organizational assessments (human

resources, policy development, project management, finance and governance) of each of the participating

CSOs; (2) developing clear organizational/human development training and mentoring plans to address

gaps emerging from the assessment; and (3) providing training in project management, basic book-keeping,

narrative and financial reporting, monitoring and evaluation. These activities are key to increase

sustainability by building local organization capacity.

ACTIVITY 3: Management of Sub-Grants

The activity provides and manages sub-grants to 26 CSOs, to sustain operations through improved

fundraising and coordination. The activity aims to increase access to resources for small CSOs that do not

meet the criteria of government and/or international donors, but that provide valuable care and support

Activity Narrative: services at the community level in a culturally appropriate manner.

ACTIVITY 4: Improved Networking and Coordination Among CSOs and Related Stakeholders

The activity supports sharing, cross learning and co-ordination of services among partners and related

stakeholders at district level. CARE and partners will continue to interact with government departments and

structures for improved access to services for HIV-infected people, their families as well access to

resources for CSOs.

ACTIVITY 5: Implement Basic Package of Care

CARE will support the implementation of the Basic Package of Care for individuals infected with HIV but not

yet eligible for ARV treatment, as well as individuals who are ready and eligible for ARV treatment but for

whom there is no immediate access to services. Services includes spiritual, social, psychological, clinical

and prevention for HIV-infected persons and their families. CARE will do this by providing small grants to

CSO to form support groups for PLHIV where they will receive a structured program of HIV-related palliative

care as approved by PEPFAR and the National Department of Health South Africa. This structured program

comprises the Basic Package of Care. CARE will work closely with the Department of Health in

Mpumalanga to identify these CSO for funding.

In all of the above activities, 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.

This activity will increase civil society organizational capacity to deliver quality basic healthcare and to

expand access to quality palliative care services, thereby addressing the priorities set forth in the USG Five-

Year Strategy for South Africa. In addition, the people receiving care and support will contribute to the care

portion of the 2-7-10 goals.

SUMMARY:

CARE serves as an umbrella grant making mechanism for the Centers of Disease Control. CARE has been

an umbrella grants mechanism since FY 2006. CARE's primary responsibility is for the financial oversight of

the grant which includes review of the financial reports and on-site assessment of the supporting

documentation. CARE does not provide programmatic level technical assistance to the sub-grantees.

Technical assistance and programmatic over-site is provided by CDC activity managers. The specific

activities that CARE is responsible are listed below. CARE will oversee the sub-grant to UKZN CAPRISA.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Contractual Responsibilities

CARE is responsible for the contractual arrangements of the sub-grants with CDC South Africa. These

arrangements include application for funding for implementation of activities by the sub-grantees that have

been approved by CDC South Africa to meet the PEPFAR goals. CARE will prepare all supplemental and

continuation application, and ensure that progress reports are received by the sub-grantees. CDC activity

managers will be responsible for the technical review of the sub-grantees; thus targets met by the sub-

grantees for the PMTCT program will not be assigned to CARE.

ACTIVITY 2: Financial Oversight

CARE is responsible for the financial oversight of the sub-grants. This activity includes the review of

financial reports submitted by the grantees on quarterly/6-monthly basis; and on-site assessment of the

supporting documents to ensure compliance with the contract. These on-site assessments will be

conducted on a 6-monthly basis. CARE will also ensure progress reports are received from the sub-

grantees and approved by the activity managers of CDC South Africa on a quarterly/6-monthly basis prior to

the disbursement of continuation funding.

Although these activities do not directly contribute to the overall PEPFAR goals and objectives, the

Umbrella Grants Mechanism ensure that PEPFAR support can be given to small and medium-sized

organizations, enabling them to facilitate the achievement of the PEPFAR 2-7-10 goals.

This activity was approved in the FY 2007 COP, is funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. No FY 2008 funding is requested for this activity.

PEPFAR funds $400,000 were allocated to CARE International to provide services to OVC within their

palliative care program. The number of OVC identified by CARE International warrants a program on its

own. CARE International is funded by USAID to provide services to OVC in South Africa. In FY08 all OVC

identified by CARE International will be transferred to the USAID funded project. Both projects are

implemented by CARE International therefore a smooth transition with uninterrupted services at the same

level is anticipated.

SUMMARY:

CARE serves as an umbrella grant making mechanism for the Centers for Disease Control and Prevention

(CDC). CARE's responsibility is the financial oversight of the grant, including review of the financial reports

and on-site assessment of the supporting documentation.

ACTIVITY 1:

CARE is responsible for the contractual arrangements of the sub-grants with CDC/Atlanta. These

arrangements include application for funding for implementation of activities by the sub-grantees that have

been approved by CDC South Africa, in support of PEPFAR goals. CARE will prepare all supplemental and

continuation applications, and ensures that progress reports are received by the sub-grantees. CDC activity

managers will be responsible for the technical review of the sub-grantees, and thus their targets for the CT

program.

ACTIVITY 2:

CARE is responsible for financial oversight of the sub-grants. This activity entails the review of financial

reports submitted by the grantees on quarterly or semi-annual basis. CARE will also conduct on-site

assessments of supporting documents to ensure compliance to contract. These assessments will be

conducted on every six months. CARE will also ensure that progress reports are received from sub-

grantees, and are approved by the activity managers of CDC South Africa on a quarterly/semi-annual basis,

prior to the disbursement of continuation funding.

SUMMARY:

CARE serves as an umbrella grant making mechanism for the Centers of Disease Control. CARE has been

an umbrella grants mechanism since FY 2006. CARE's primary responsibility is for the financial oversight of

the grant which includes review of the financial reports and on-site assessment of the supporting

documentation. CARE does not provide programmatic level technical assistance to the sub-grantees.

Technical assistance and programmatic over-site is provided by CDC activity managers. The specific

activities that CARE is responsible are listed below. CARE will oversee the sub-grant to UKZN CAPRISA.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Contractual Responsibilities

CARE is responsible for the contractual arrangements of the sub-grants with CDC South Africa. These

arrangements include application for funding for implementation of activities by the sub-grantees that have

been approved by CDC South Africa to meet the PEPFAR goals. CARE will prepare all supplemental and

continuation application, and ensure that progress reports are received by the sub-grantees. CDC activity

managers will be responsible for the technical review of the sub-grantees; thus targets met by the sub-

grantees for the PMTCT program will not be assigned to CARE.

ACTIVITY 2: Financial Oversight

CARE is responsible for the financial oversight of the sub-grants. This activity includes the review of

financial reports submitted by the grantees on quarterly/6-monthly basis; and on-site assessment of the

supporting documents to ensure compliance with the contract. These on-site assessments will be

conducted on a 6-monthly basis. CARE will also ensure progress reports are received from the sub-

grantees and approved by the activity managers of CDC South Africa on a quarterly/6-monthly basis prior to

the disbursement of continuation funding.

Although these activities do not directly contribute to the overall PEPFAR goals and objectives, the

Umbrella Grants Mechanism ensure that PEPFAR support can be given to small and medium-sized

organizations, enabling them to facilitate the achievement of the PEPFAR 2-7-10 goals.

SUMMARY:

CARE serves as an umbrella grant making mechanism for the Centers of Disease Control. CARE has been

an umbrella grants mechanism since FY 2006. CARE's primary responsibility is for the financial oversight of

the grant which includes review of the financial reports and on-site assessment of the supporting

documentation. CARE does not provide programmatic level technical assistance to the sub-grantees.

Technical assistance and programmatic over-site is provided by CDC activity managers. The specific

activities that CARE is responsible are listed below. CARE will oversee the sub-grant to UKZN CAPRISA.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Contractual Responsibilities

CARE is responsible for the contractual arrangements of the sub-grants with CDC South Africa. These

arrangements include application for funding for implementation of activities by the sub-grantees that have

been approved by CDC South Africa to meet the PEPFAR goals. CARE will prepare all supplemental and

continuation application, and ensure that progress reports are received by the sub-grantees. CDC activity

managers will be responsible for the technical review of the sub-grantees; thus targets met by the sub-

grantees for the PMTCT program will not be assigned to CARE.

ACTIVITY 2: Financial Oversight

CARE is responsible for the financial oversight of the sub-grants. This activity includes the review of

financial reports submitted by the grantees on quarterly/6-monthly basis; and on-site assessment of the

supporting documents to ensure compliance with the contract. These on-site assessments will be

conducted on a 6-monthly basis. CARE will also ensure progress reports are received from the sub-

grantees and approved by the activity managers of CDC South Africa on a quarterly/6-monthly basis prior to

the disbursement of continuation funding.

Although these activities do not directly contribute to the overall PEPFAR goals and objectives, the

Umbrella Grants Mechanism ensure that PEPFAR support can be given to small and medium-sized

organizations, enabling them to facilitate the achievement of the PEPFAR 2-7-10 goals.