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: 2007 2008 2009
SUMMARY:
Xstrata received funding in FY 2007 for a public-private partnership with the Mpumalanga Department of
Health (MPDOH). The implementing partner for this is Re-Action! Consulting (RAC). RAC will facilitate a co-
investment partnership with Xstrata to provide support for strengthening targeted government clinic sites,
continuing to improve access to basic preventive, clinical care and psychosocial support services in one
district of Mpumalanga, extending into a second district during FY 2008. The project will build on a public-
private mix (PPM) model for strengthening HIV and TB service delivery that Xstrata and RAC has already
begun to implement in the province with funding from Xstrata (dollar for dollar match with PEPFAR).
Xstrata and RAC will work through established partnerships with local government, MPDOH, community
groups and private providers. Project deliverables have been defined in response to specific requests for
assistance from the MPDOH. Major emphasis will be given to development of health workforce capacity,
with minor focus on community mobilization/participation, building linkages with other sectors, local
organization capacity development and strategic information. The target populations are underserved
communities of men, women and children, and people living with HIV and AIDS in Nkangala District,
extending to a second district during FY 2008, where Xstrata Alloys has its operations.
BACKGROUND:
Xstrata Coal employs 4,000 people at 11 mines (collieries) located within the socio-economically deprived
Coal Powerbelt region of Mpumalanga, and has more than 10,000 employees with operations in three
provinces of South Africa (Mpumalanga, Limpopo, and North West) and Swaziland. This funding
partnership enables scaling up the community extension component of Xstrata's comprehensive workplace
HIV and AIDS program that is managed by RAC. The project is based on implementing a PPM service-
strengthening model of capacitating government providers within primary care clinic sites to deliver HIV-
related preventive, clinical and psychosocial care services. FY 2008 funding will allow continued support to
sites established in FY 2007and to expand the number of sites within two target districts. The scope of
assistance is defined within a MOU between Xstrata and the MPDOH, and responds to specific requests for
support by the provincial department's HIV and AIDS Unit, as well as the district management teams. This
fits within a broader range of interlinked corporate social investments being made by Xstrata to support
sustainable local development in these communities.
The project will provide technical assistance, health workforce capacity development, clinic infrastructure
improvements, strengthening of pharmaceutical supply management systems and service monitoring for
public sector primary care clinics to deliver quality HIV-related preventive and clinical care services. This will
contribute to strengthening district-level primary health care service networks and district service
management, with a strong focus on improving human resource capacity, including through training and
deploying community outreach workers to deliver household-level services. The project works in partnership
with other PEPFAR partners in the province to achieve synergies and avoid duplicating activities.
ACTIVITIES AND EXPECTED RESULTS:
Three activity areas will be implemented to strengthen delivery of palliative and psychosocial care, HIV
prevention, and TB services at government primary health care sites within two districts of Mpumalanga and
to create strong linkages with community outreach services and home-based care. Service improvement
plans will be implemented at each site based on specific service strengthening needs that are identified and
agreed with District Management Teams and facility managers. This will result in more effective delivery of
the essential package of HIV-related primary care interventions (including cotrimoxazole provision and
integrated preventions services, including prevention with positives )integrated with Sexual and
Reproductive Health services (including STI care, family planning, maternal health); Maternal, neonatal and
child health services; and TB services to implement TB-HIV collaborative activities. Re-Action will also
collaborate with the Foundation for Professional Development (FPD) in implementing services at Witbank
Hospital.
ACTIVITY 1: Strengthening primary health care and district hospital delivery of HIV-related palliative and
other clinical care services
A multi-skilled RAC Service Strengthening Team will undertake a detailed situation analyses (together with
the district management team) within each target sub-district to identify specific service strengthening needs
and prioritize sites for accreditation/down-referral. Service improvement plans will be developed to
systematically address these needs. All available service providers at this level will be identified and
supported to participate in delivering service tasks aligned with the national programs and coordinated
through a 'public-private mix' delivery approach.
Services will be improved overall to both ensure that HIV-infected adults and children attending these sites
have access to the essential package of HIV-related care and support interventions (including
cotrimoxazole provision and integrated preventions services, including prevention with positives) integrated
with Sexual and Reproductive Health services (including STI care, family planning, maternal health);
Maternal, neonatal, child health services, and basic hygiene and sanitation. Prevention with positives and
treatment services will be appropriately integrated into routine primary care services, so that service
capacity is strengthened overall. Access to TB diagnosis and treatment will be improved at supported sites
by implementing TB/HIV collaborative activities. Health worker training will be addressed through in-service
training delivered in collaboration with other PEPFAR partners, based on National Program standards and
integrated management approaches.
Technical assistance will be provided to improve public sector human resource management capacity so
that health workers can be more effectively recruited to fill vacant positions at these sites. Where necessary,
critical staff positions will be filled on a temporary basis (on agreement that these posts will be filled as soon
as possible by permanent public sector employees). Site management capacity will be strengthened,
including through leadership development activities. Strong linkages will be created between these first-
level sites and second-level facilities for appropriate referral of patients and 'down-referral' of treatment,
where necessary. Appropriate 'task-shifting' will be encouraged. Physical upgrades to clinic infrastructure
will be undertaken through Xstrata co-investment and essential equipment will be procured. Health
Activity Narrative: information management systems and patient monitoring systems will be strengthened through in-service
training, technical assistance and procurement of equipment where necessary.
ACTIVITY 2: Community mapping, mobilization, health promotion, treatment preparedness and support,
referral to appropriate health and social services
Community outreach workers will be trained to provide basic household health risk assessments and health
promotion under supportive supervision. A full time project coordinator will be dedicated to coordinating
community initiatives. They will mobilize the community to access care services, including HIV testing and
counseling (through the 'I know!' campaign developed by RAC) and will direct community nurses to deliver
provider-initiated HIV testing and counseling within households. Individuals with social and health risks will
be referred for appropriate services and follow-up will be arranged. This will result in risk mapping of all
households within targeted communities and systematic follow-up, linking patients to facility-based HIV and
related palliative services.
ACTIVITY 3: Community Support and Psychosocial Care
Linkages with community-based service organizations (including faith-based organizations and non-
governmental organizations) will be strengthened and all providers will be encouraged to participate in
delivering their service tasks in more coordinated ways through the 'public-private mix' approach (which
RAC will support district management teams to oversee). Peer support groups for HIV-infected and affected
individual and family members will be established at all sites and linkages to the community will be
strengthened through Community Outreach Services to provide social and psychological support.
Traditional healers will be engaged and trained in partnership with the MPDOH and supported to provide
appropriate referrals to the clinic sites, to provide chronic care support and health promotion. Attention will
be given to gender equity, increasing male involvement in the program, addressing stigma and
discrimination.
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.
With FY 2008 reprogramming funds, the community care program will be strengthened; PPM models
initiated in 3 more provinces (Limpopo, North West and Northern Cape); and the up and down-referral of
patients supported through technical assistance in a third district in Mpumalanga (Gert Sibanda).
Sustainability of this program is assured through the public-private partnership between Xstrata and the
MPDOH. By providing support for palliative care in underserved communities, Xstrata is contributing to the
2-7-10 PEPFAR goals of providing care to 10 million people infected and affected by HIV.
Health (MPDOH). The implementing partner for this activity is Re-Action! Consulting (RAC). RAC will
facilitate a co-investment partnership with Xstrata to provide support for strengthening targeted government
clinic sites, continuing to improve access to basic preventive, clinical care and psychosocial support
services in one district of Mpumalanga, extending into a second district during FY 2008. The project will
build on a public-private mix model for strengthening HIV and TB service delivery that Xstrata and RAC has
already begun to implement in the province with funding from Xstrata (dollar for dollar match with PEPFAR).
communities of men, women and children and people living with HIV and AIDS in Nkangala District,
Xstrata Coal is a subsidiary of a multi-national mining group committed to practical ways of achieving
sustainable development and contributing to the health and social welfare of employees and their
communities. The company employs 4,000 people at 11 mines (collieries) located within the socio-
economically deprived Coal Powerbelt region of Mpumalanga. Xstrata Alloys has more than 10,000
employees with operations in 3 provinces (Mpumalanga, Limpopo, and North West) and Swaziland. This
funding partnership enables scaling up the community extension component of Xstrata's comprehensive
workplace HIV and AIDS program managed by RAC. The project is focused on implementing a public-
private mix service-strengthening model of capacitating government providers within primary care clinic
sites to deliver HIV-related preventive, clinical and psychosocial care services. FY 2008 funding will allow
continued support to sites established in FY 2007 (working towards full site accreditation) and to expand the
number of sites within two target districts. The scope of assistance is defined within a Memorandum of
Understanding between Xstrata and the Mpumalanga Department of Health and Social Services, and
responds to specific requests for support by the provincial department's HIV and AIDS Unit, as well as the
district management teams. This fits within a broader range of interlinked corporate social investments
being made by the Xstrata Group to support sustainable local development in these communities.
with other PEPFAR contractors in the province to achieve synergies and avoid duplicating activities.
Three activities will be implemented to strengthen the provider-initiated testing and counseling ( PITC)
services in two districts in Mpumalanga, in collaboration with the Mpumalanga Department of Health.
ACTIVITY 1: Strengthen Primary Health Care sites to deliver Counseling and Testing Services
Technical assistance and training will be provided to improve public sector human resource management
capacity so that critical staff positions will be filled to strengthen counseling and testing services. Physical
upgrades to clinic infrastructure (undertaken by Xstrata) will accommodate additional counseling space and
essential equipment will be procured. Health information management systems and patient monitoring
systems will be strengthened through in-service training, technical assistance and procurement of
equipment where necessary. Service delivery will be improved overall to ensure that HIV-infected adults
and children testing positive are referred to the essential package of HIV-related, treatment, care and
support interventions at designated clinic sites.
ACTIVITY 2: Public Health Sector Workplace HIV Response at the Identified Sites
Retention of health workforce capacity and health worker performance through strengthening public health
sector workplace HIV response at the identified sites will be undertaken. A workplace HIV intervention for
health and allied workers will be implemented to build 'AIDS competence' in the health workforce at the
selected sites, to encourage uptake of HIV testing and counseling and to promote appropriate health action
(including care-seeking) and improved attitudes towards patients.
ACTIVITY 3: Community Mapping, Mobilization, Health Promotion, Treatment Preparedness and Support,
Referral to Appropriate Health and Social Services
promotion under supportive supervision. They will mobilize the community for HIV testing and counseling
(through the 'I know!' campaign developed by RAC) and will direct community nurses to deliver provider-
initiated HIV testing and counseling within households (door-to-door campaign). Individuals with social and
health risks will be referred for appropriate services and appropriate follow-up arranged. This will result in
risk mapping of all households within targeted communities and systematic follow-up, linked to facility-based
services. The community program will be monitored and improved using normative standards and tools
developed by WHO (IMAI). Community Health Workers will receive close supportive supervision by
professional nurses. A regular learning review will be undertaken, based on an established improvement
methodology and ongoing in-service training will be provided from both 'in-house' and external sources.
Periodic review of strategic information and performance indicators will support monitoring the quality of
service delivery. Each community health worker will undergo routine performance appraisal based on Re-
Action's established Human Resource management procedures.
Activity Narrative:
With FY 2008 reprogramming funds, RAC will expand the door-to-door VCT campaign in two communities
in Mpumalanga - Ermelo and Breyten.
ACTIVITY 4: Community Support and Psychosocial Care
RAC will support district management teams to oversee). Peer support groups will be established at all sites
and linkages to the community will be strengthened through Community Outreach Services. Traditional
healers will be engaged and trained in partnership with the MPDOH and supported to provide appropriate
referrals to the clinic sites, to provide chronic care support and health promotion. Attention will be given to
gender equity, increasing male involvement in the program, addressing stigma and discrimination
MPDOH. By providing support for counseling and testing in underserved communities, Xstrata is
contributing to the 2-7-10 PEPFAR goals.
Xstrata is a new PEPFAR partner, which received funding in FY 2007 for a public-private partnership with
the Mpumalanga Department of Health (MPDOH). The implementing partner for this is Re-Action!
Consulting (RAC). RAC will facilitate a co-investment partnership with Xstrata to provide support for
strengthening targeted government clinic sites, continuing to improve access to basic preventive, clinical
care and psychosocial support services in one district of Mpumalanga, extending into a second district
during FY 2008. The project will build on a public-private mix model for strengthening HIV and TB service
delivery that Xstrata and RAC has already begun to implement in the province with funding from Xstrata
(dollar for dollar match with PEPFAR).
assistance from the MPDOH. Major emphasis will be given to development of human capacity
development, local organization capacity building and strategic information. The target populations are
underserved communities of men, women and children and people living with HIV and AIDS in Nkangala
District, extending to a second district during FY 2008, where Xstrata Alloys has its operations.
workplace HIV and AIDS program that is managed by RAC. The project is based on implementing a public-
continued support to sites established in FY2007 (working towards full site accreditation) and to expand the
Understanding between Xstrata and the Mpumalanga Department of Health and Social Services (MPDOH),
and responds to specific requests for support by the provincial department's HIV and AIDS Unit, as well as
the district management teams. This fits within a broader range of interlinked corporate social investments
Four activity areas will be implemented to strengthen and scale up antiretroviral treatment provision at
government health care sites within two districts of Mpumalanga. Service improvement plans will be
implemented at each site based on specific service strengthening needs that are identified and agreed with
District Management Teams and facility managers. This will result in these clinics being accredited by the
Department of Health as antiretroviral treatment sites (for 'down-referral' and/or treatment initiation) with
stronger links to referral-level facilities. Referral linkages with antenatal clinic services will be improved to
ensure continuing care of infected mothers and their children. Activities at Witbank Hospital will be
coordinated with the Foundation for Professional Development (a PEPFAR partner).
Discussions are also underway with private companies to commence activities in the Northern Cape.
ACTIVITY 1: Strengthening primary health care and district hospital delivery of HIV-related treatment and
related clinical care services
systematically address these needs. Strong linkages will be created between these first-level sites and
second-level facilities for appropriate referral of patients and 'down-referral' of treatment, where necessary.
Services will be improved overall to ensure that HIV-infected adults and children attending these sites have
access HIV-related treatment, care and support interventions and that these services are appropriately
integrated into routine primary care services, so that service capacity is strengthened overall.
Physical upgrades to clinic infrastructure will be undertaken through Xstrata co-investment and essential
equipment will be procured. Health information management systems and patient monitoring systems will
be strengthened through in-service training, technical assistance and procurement of equipment where
necessary.
Trained and supervised community outreach workers will be deployed to undertake household-level health
risk assessments (with particularly emphasis on reaching women and children) and provide referrals for HIV
treatment, treatment literacy, follow-up and adherence support within households and to recover treatment
defaulters.
Health worker training needs will be addressed through suitable in-service training delivered in collaboration
with other PEPFAR partners, based on national standards and integrated management approaches.
capacity so that health workers can be more effectively recruited to fill vacant positions at these sites.
Critical staff positions will be filled to ensure that HIV treatment services are not compromised. Appropriate
Activity Narrative: task-shifting will be encouraged.
ACTIVITY 2: Direct HIV care and antiretroviral treatment provision
A multi-disciplinary care team will continue scaling up delivery of chronic HIV care and treatment at the
selected clinics in the province. MPDOH sites will be assisted with human resource capacity to deliver HIV
services for patients initiated and already on antiretroviral treatment. Antiretroviral drugs to eligible
community members at these sites will be provided by the MPDOH through a down-referral mechanism.
Access to TB diagnosis and treatment will be improved at supported sites by implementing TB/HIV
collaborative activities such as active HIV screening of TB patients for early ART initiation.
ACTIVITY 3: Community Support
and linkages to the community will be strengthened through community outreach services.
Community outreach workers will assist with patient retention in treatment programs by conducting home
visits to assess why patients are defaulting on clinic visits and make appropriate referrals.
Sustainability of this activity area for ongoing support to deliver antiretroviral treatment is assured through
the public-private partnership (PPP) between Xstrata and the Mpumalanga Department of Health.
By providing support for HIV treatment in underserved communities, Xstrata is contributing to the 2-7-10
PEPFAR goals.
With FY 2008 reprogramming funds, RAC will expand support for comprehensive HIV care and treatment
services in an additional district in Mpumalanga (Gert Sibanda), and also expand the public-private mix
model in 3 new provinces (Limpopo, North West and Northern Cape).
