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 project has recently embarked upon activities aimed at strengthening its occupational health and safety
aspect. Focusing mainly on phlebotomy, such activities have been conducted in partnership with the South
African National Blood Services (SANBS). In FY 2009, the Making Medical Injections Safer (MMIS) project
is planning to coordinate the development of a National Training Curriculum and adopt with SANBS and
other partners a set of National Guidelines to be used for phlebotomy. These will go a long way in relieving
pressure on the nursing staff as well as providing much needed norms and standards in the context of a
generalized HIV epidemic.
In addition, MMIS has embarked on a number of partnerships to support waste management in the context
of HIV/AIDS treatment. These have included skills and knowledge transfer to the nine provincial
coordinators of the country's Comprehensive Care, Management and Treatment Plan, training sessions in
preparation for the down-referral of treatment related services, as well as input to the overall training
curriculum related to HIV/AIDS treatment.
FY 2009 should also see the execution of the follow-up injection safety survey. This endeavor comes at a
time when a set of policies, strategies and guidelines have been developed and implemented by MMIS and
its main partner, the National Department of Health (NDOH). It will provide insight into the extent to which
the scale and scope of such operations need to be sustained. A presentation to the NDOH's management
committee including findings from the 2006 survey, interventions initiated since, as well as the approach to
be used for the planned 2009 survey has been approved by the Director-General of Health and is
scheduled for October 7, 2008.
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SUMMARY:
The Making Medical Injections Safer (MMIS) project conducted by John Snow Research and Training, Inc.
(JSI) aims to bring about an environment where patients, healthcare workers and the community are better
protected from the transmission of HIV and other blood-borne pathogens through medical practices. The
project targets healthcare workers and the population at large. Emphasis areas include training and human
resources, development of policy and guidelines as well as commodity procurement.
BACKGROUND:
The project's initial stages have moved from a pilot to a full geographical scale implementation by its mid-
term. The review conducted in 2007 and its findings will guide implementation of priority interventions
towards the second half of the funding cycle building up to September 2009. To this effect the fiscal year FY
2008 will focus on ensuring that the remaining resources allocated to this project are used to maximize the
opportunities to lower risks of transmission. To this end a particular focus will be placed on linking current
injection safety activities to phlebotomy. Discussions to this effect have been embarked upon with the
NDOH unit responsible for the coordination and implementation of the country's Comprehensive Plan for
HIV and AIDS Care, Management and Treatment as well as the South African National Blood Services
(SANBS), a South African organization partially funded by PEPFAR. Such a focus will also strengthen the
MMIS project's ability to support the effective implementation of the newly launched HIV & AIDS and STI
National Strategic Plan, 2007-2011 in its chapter on Accelerated Prevention.
MMIS in collaboration with the National Department of Health (NDOH) completed the first national injection
safety and infection control survey in public facilities in South Africa in 2007. The results indicated that there
were gaps in training in the areas of waste management and injection safety. During 2007 MMIS addressed
recommendations emanating from this survey through training and ongoing behavior change
communication (BCC) activities. The BBC activities address issues such as safe phlebotomy procedures,
the appropriate use of multi-dose vials, reducing the current rate of recapping of needles after injections, the
overflowing of sharps containers and other survey findings requiring attention and action. The NDOH and
the KwaZulu-Natal Department of Health have retractable syringes available on the national and provincial
tenders, adopting them for use and making sustainable financial allocations from the fiscus to cover related
costs in their Mid-Term Expenditure Framework spanning 2007-2009.
A similar approach remains an option for the other provinces as far as the national tender is concerned and
MMIS will continue to play an advocacy role towards such policy decisions to be considered in the interest
of self-sustainability.
ACTIVITES AND EXPECTED RESULTS:
ACTIVITY 1: Healthcare Workers' Training
More healthcare workers will be trained in FY 2008 to reach the target of 3,975 set for the said fiscal year.
Senior and middle managers, clinical staff as well as waste handlers will be trained to increase the public
health sector's capacity in injection safety and infection control. This will continue to be done in partnership
with organizations such as MINDSET Health, BroadReach Health Care and the Democratic Nurses'
Organisation of South Africa. Following discussions initiated in FY 2007, MMIS will together with other
PEPFAR funded projects continue to work towards the improvement of monitoring tools aimed at measuring
the use and effectiveness of its tele-education through the MINDSET Health Channel. The project is not
intending to provide additional support towards the expansion of the said channel but will benefit from such
expansion (as made possible by the South African Government as well as other PEPFAR partners) as
these will increase the reach and accessibility of MMIS Injection Safety content to additional health facilities
in the country. The current reach of the Mindset Health Channel covers 300 facilities, 79 of which were
connected by JSI through its MMIS project. The rest of the facilities networked with PEPFAR partners as
well with individual provincial departments of health. In addition, the project will continue to work closely with
the NDOH's Quality Assurance and Environmental Health Directorates to have trainers trained during past
Activity Narrative: fiscal years cascade the training in their districts and facilities. Training of trainers will also take place
together with an increased focus on phlebotomy. MMIS trained more than 2,000 healthcare workers in FY
2007.
ACTIVITY 2: Behavior Change Communication
FY 2008 funds will be used to continue to disseminate educational materials to healthcare workers and the
communities they serve. The community outreach program will form part of the South African government's
Khomanani campaign whereby community outreach workers visit 100,000 persons each month to
disseminate health information. From FY 2008, MMIS content will officially become part and parcel of this
campaign, at no additional cost from JSI. The visits will not only serve to educate and inform community
members, but safety boxes for disposing of used medical injections at home will also be distributed where
necessary.
ACTIVITY 3: Logistics and Procurement
MMIS finalized a national Logistics and Procurement strategy in 2007. The key focus of the strategy is to
increase sustainability in provinces and local government efforts to acquire commodities such as safety
syringes that are now available on national and provincial tenders. Where needed, JSI will use PEPFAR
funds as bridging funds to ensure transition to this effect. In Ethekwini such funding will be provided until
March 2008 while the municipality goes on tender for sustained procurement beyond this period. In the Free
State information from a 2007 analysis will be used to procure protective equipment for healthcare workers
in FY 2008 to ensure an uninterrupted supply. In addition, special courses for logisticians and senior
managers will be run to address weaknesses related to ensuring the uninterrupted supply of commodities
such as sharps containers. Such courses will aim to increase skills and competencies for effective and
efficient stock management for the first target group. They will also be aimed at improving contract
management skills for the latter.
ACTIVITY 4: Norms and Standards
MMIS will work with the NDOH and the Council for Health Service Accreditation of South Africa to
implement norms and standards on injection safety policy and waste management. A supervision check list
will be developed to allow the structuring of mentoring and supervision of activities related to injection safety
and infection control in healthcare facilities.
The Making Medical Injections Safer activity contributes to meeting the vision outlined in the USG Five-Year
Strategy for South Africa by strengthening the health sector's capacity to provide safe medical injections
and thereby represents an important prevention activity. It is a sustainable program that it is building human
capacity and working closely with the South African government to implement long-lasting policies for
injection safety. It also supports PEPFAR's goals of preventing seven million new infections.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13951
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
29459 29459.05 Department of Kenya AIDS NGO 323 323.05 $291
Health & Human Consortium
Services
29458 29458.06 U.S. Agency for CARE 12060 12060.06 CARE $151,999
International International
Development
29457 29457.06 U.S. Agency for Family Health 12059 12059.06 FHI $410,211
29456 29456.06 U.S. Agency for Population 12058 12058.06 PSI $105,000
International Services
Development International
29455 29455.06 U.S. Agency for Population 12058 12058.06 PSI $700,030
29454 29454.06 U.S. Agency for World Relief 12057 12057.06 WR $53,992
International Corporation
29453 29453.06 U.S. Agency for Tuberculosis 12056 12056.06 TBCAP $205,744
International Control Assistance
Development Project
29452 29452.06 U.S. Agency for US Centers for 12055 12055.06 HHS/CDC $200,000
International Disease Control
Development and Prevention
29451 29451.06 HHS/Centers for National Institute 2842 1153.06 $301,550
Disease Control & for Medical
Prevention Research
29450 29450.06 HHS/Centers for University of 12078 12078.06 FXB-GAP $38,000
Disease Control & Medicine and
Prevention Dentistry, New
Jersey - Francois-
Xavier Bagnoud
Center
13951 2945.08 HHS/Centers for John Snow, Inc. 6667 249.08 Safe Medical $2,223,732
Disease Control & Practices
Prevention
7317 2945.07 HHS/Centers for John Snow, Inc. 4376 249.07 Safe Medical $0
2945 2945.06 HHS/Centers for John Snow, Inc. 2641 249.06 Safe Medical $2,115,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $28,550
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $3,208,216
Table 3.3.07:
