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:
Due to Population Council's (PC) strategic planning and consideration of the PEPFAR South Africa
technical considerations, counseling and testing (CT) activities, which focuses on integrating HIV prevention
and CT into family planning (FP) services, have been moved to the PMTCT program area.
ACTIVITY 1: Development and Implementation of Integrated Antenatal and Postnatal Care Policy and
Guidelines for KwaZulu-Natal
This activity from COP FY 2008 has been modified to include support to services and to assess the
effectiveness of implementation of the comprehensive PMTCT policy and guidelines. This modification was
made because the National Department of Health (NDOH) has drafted national PMTCT guidelines and has
requested PC to conduct a service-driven assessment of the implementation. Due to the release of the new
national PMTCT guidelines, the final review of the antenatal and postnatal care (ANC/PNC) policy and
guidelines was extended to ensure that the documents are harmonized. There was also a change in the
KwaZulu-Natal Department of Health (DOH KZN) Maternal Child and Women's Health's (MCWH)
management team, resulting in changes in the implementation of policy and guidelines. Instead of initial
plans, the DOH KZN decided to pilot the integrated policy and guidelines in eight facilities in the
uMgungundlovu district prior to provincial rollout. The launch of the integrated ANCC/PNC policy and
guidelines was delayed and will be supported in FY 2009.
PC will continue to provide technical assistance (TA) to the KZN DOH at their request in ensuring that the
integrated ANC/PNC policy and guidelines that were developed and finalized in FY2007 using PEPFAR
funding are implemented within the province. These guidelines integrate PMTCT into antenatal and post-
natal care and are harmonized with the new national PMTCT guidelines. In order to scale up the
implementation of the ANC/PNC policy and guidelines to all 11 districts within KwaZulu-Natal, training
manuals and job aids will be adapted to close any gaps and address weaknesses that may be identified
based on the integration experiences of the uMgungundlovu pilot district implementation. PEPFAR funds
will be used to print the training manuals and job aids and to fund a consultant who will adapt the training
manuals and job aids.
Program assessment and monitoring will be conducted in collaboration with the KZN DOH. The ANC/PNC
policy and guidelines include indicators that should be collected to ensure that the implementation of
integrated HIV and maternal health services is effective. PC will assist the province in the adaptation of
monitoring and evaluation (M&E) tools to include indicators in the policy. PC will conduct quarterly provincial
and site visits to collect the information from the district reports and District Health Information Systems
(DHIS), and will monitor and support the implementation of the policy and guidelines. Site visits will be
conducted with the provincial and district managers/coordinators. The KZN DOH will be encouraged to
include the policy and guideline indicators in the routine DHIS and clinic supervision tools for district
managers.
In order to ensure that the integrated ANC/PNC policy and guidelines are extended to other provinces, a
feedback session will be held by the PC in collaboration with the KZN DOH to ensure that the integrated
ANC/PNC policy and guidelines, training materials and job aids as well as the experiences of implementing
the integrated package are presented to the NDOH and representatives of the other provinces. PEPFAR
funds will be used to host the session. Situational analysis (i.e., review of current ANC/PNC policy) will be
conducted in one district each in Limpopo and Gauteng (Gauteng has already shown interest in having an
integrated policy) to ensure that these provinces are also implementing the ANC/PNC policy and guidelines
that integrate PMTCT into maternal health.
ACTIVITY 2 : Integration of Counseling and Testing into Family Planning Services
In the past years, PC has developed expertise in developing strategies and interventions focused on
preventing HIV transmission, through activities like the promotion of counseling and testing. This activity,
which is co-funded by the NDOH, seeks to implement the South African government policy and the national
contraceptive guidelines by increasing CT uptake by FP clients. These models have been implemented in
three South African districts in 30 clinics in the North West province and will be introduced to all seven
regions in the North West, Gauteng and the Eastern Cape provinces. This program had focused on training
FP health providers in HIV and FP integration, development of network/linkages /referral systems, creating
conditions for scale-up and capacity building and continued partnership with the national and provincial
government.
In FY 2009, PC will continue to provide technical assistance to the North West province, and will scale up
support to Gauteng, Eastern Cape and another district in North West province.
ACTIVITY 3: Integration of FP into ART Services
technical considerations, integration of antiretroviral treatment (ART) services, have been moved from the
Adult Treatment to the PMTCT program area. The integration of CT into FP services undertaken in North
West province, resulted in the realization that it is necessary to integrate FP into ART services in order to
address unwanted pregnancies, fertility intentions and reproductive needs of people living with HIV . This
activity focus on providing access to FP and ART servicesby training providers on integrated services and
strengthening referral systems within the two services. In FY 2009 information, education and
communication (IEC) materials on integrated reproductive health and HIV services will be developed for
clients as booklets and posters. These will be distributed to facilities within the district and provinces. Key
messages will be communicated on dual protection, reproductive intentions and options for people infected
with HIV, routine counseling and testing, male involvement in RH, and use of hormonal contraceptives and
ART. Messages for the IEC materials will be developed in collaboration with the health providers, and
clients' community representative group discussions will be conducted with clients and providers to assess
Activity Narrative: needs and develop key themes and issues to be addressed in the IEC. These materials will be translated
into isiZulu, the local language used in KwaZulu-Natal, and then printed and shared with facilities and
districts.
--------------------------------------
SUMMARY:
Population Council (PC) is using PEPFAR funding to provide technical assistance (TA) to the KwaZulu-
Natal Department of Health (KZN DOH) in the development of a provincial antenatal (ANC) and postnatal
(PNC) policy and evidence-based comprehensive guidelines. These will incorporate aspects of HIV
prevention, counseling and testing (CT), prevention of mother-to-child transmission (PMTCT), antiretroviral
(ARV) and male involvement, which are aimed at providing pregnant women, their partners and infants with
quality comprehensive care during the ANC and PNC period. The target populations for this activity are
people living with HIV and AIDS, HIV-infected pregnant women, and program managers. The emphasis
areas for this activities are local organization capacity development (major), strategic information, and
human capacity development (training and task shifting).
BACKGROUND:
PC currently provides TA using a participatory methodology aimed at ensuring that local, national and
international evidence, and relevant guidance from the vertical HIV related programs (CT, PMTCT, and
ARV) feed into the development of comprehensive and integrated provincial ANC and PNC policies and
guidelines. This ongoing project, which commenced in 2004 with PEPFAR funding, is carried out in
collaboration with the Reproductive Health and HIV Research Unit (PEPFAR funded) and two KwaZulu-
Natal DOH directorates (Maternal Child and Women Health [MCWH]/PMTCT, Sexually Transmitted
Infections [STI]). The KZN MCWH is the lead for the provincial "Core Team". The overall function of the
Core Team is to steer the development of policy and guidelines. To date, multiple stakeholders and the
Core Team have developed drafts of both the policy and guidelines. As part of the process to inform the
development of the policy and guidelines, the Core Team conducted focus group discussions with pregnant
women to identify their maternal health needs. Further resources, including monitoring and evaluation tools,
a set of job aides and training materials had been developed to support the implementation of the policy and
guidelines.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Continued technical assistance to the KZN DOH in support of the implementation of the policy
and guidelines
PC will provide ongoing TA to the KwaZulu-Natal DOH as key drivers of the comprehensive and evidence-
based policy and guideline development. The development of the policy and guidelines has been a
provincial process which has mainly been driven by the MCWH/PMTCT program. As a way of strengthening
integration at district and facility levels and for sustainability of the implementation of the guidelines,
technical assistance will be expanded to other programs which are STI, HIV and AIDS, ART, VCT, TB and
gender. Task teams representing these programs will be formed to assist in driving the implementation of
the policy and guidelines. Specific support will include assistance with the development of district work
plans for implementation, development of health delivery systems as well as continued training on M&E.
Ongoing support will be provided to the relevant programs to identify any implementation issues and further
training will be organized where necessary. PEPFAR funds will be utilized for conducting
feedback/debriefing sessions, facilitating the development of health delivery systems, coordination of the
development of district work plans and training. The target population for this activity involves program
managers and health providers of the six programs listed above.
ACTIVITY 2: Supporting and evaluating the effectiveness of the implementation of the comprehensive
policy and guidelines in improving maternity care at provincial level
In order to improve the implementation of the policy and guidelines, the evaluation will take several forms
(testing the effectiveness of job aides and training materials, M&E tools, training of trainers, assessment of
provider attitudes, as well as ANC and PNC client satisfaction assessment). Based on the outcome of this
evaluation, identified gaps will be addressed and relevant adaptations will be made. PEPFAR funds will be
used for the design of data collection methodology and tools, training of data collectors, collection of data,
data entry, analysis and interpretation of the evaluation data at facility level.
This activity will contribute to the overall PEPFAR goals of preventing 7 million new infections by
strengthening PMTCT programs with policy and guidelines and an implementation plan in the province most
affected by the HIV and AIDS crisis.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14269
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14269 2971.08 U.S. Agency for Population Council 6759 268.08 $291,000
International SA
Development
7613 2971.07 U.S. Agency for Population Council 4486 268.07 Frontiers $0
International
2971 2971.06 U.S. Agency for Population Council 2651 268.06 Frontiers $100,000
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $83,162
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY 1: Abstinence and Being Faithful Life Skills
Population Council (PC) will continue to provide activities described in FY 2008, but the role of PC will
change. In FY 2009, PC will work with the Mpumalanga Department of Education and help them take over
the implementation of the program. As an exit strategy, and to ensure sustainability, PC will ensure that a
model has been adapted, and that this program is completely integrated to the existing Life Skills Program;
and that the recipients have developed a sense of ownership. The Council will provide assistance with
training, work plan development, and program monitoring and management, and other technical issues as
needed.
ACTIVITY 2: Faith-Based Organizations and Mutual Monogamy
The program will remain the same in FY 2009; however, the role of PC will change. In FY 2009, PC will
work with the South African Council of Churches and Eastern Cape Provincial Council of Churches
(ECPCC) to take over the implementation of the program. As an exit strategy and to ensure sustainability,
PC will ensure that a model has been adapted, and that this program is completely integrated in the existing
faith-based organization (FBO) and church activities, and that the recipients have developed a great sense
of ownership.The Council will provide technical assistance with training, work plan development, and
program monitoring and management, and other technical issues as needed.
ACTIVITY 3:
Due to the Population Council's strategic planning and the PEPFAR South Africa's technical considerations
the activities and budget for this project have been moved from APS to AB Prevention.
This activity is linked to Activities 1 and 2. The main objective is to sustain, strengthen and work beyond the
existing interventions aimed at reaching school learners with AB life skills messages, and building the
capacity of FBOs to carry out HIV prevention messages to church members. This program will reach out-of-
school youth, which the existing two projects miss, with a structured and balanced ABC strategy that
addresses three key behaviors recommended to prevent the likelihood of sexual transmission of HIV, (i.e.,
abstinence from sexual intercourse; being faithful to one sexual partner; and correct and consistent use of
condoms). The proposed program will be implemented in two provinces (i.e., Eastern Cape and
Mpumalanga) in collaboration with the ECPCC and Mpumalanga Provincial Council of Churches [MPC].
These two provincial FBOs have strong linkages with PC.
In FY 2008, this program will be piloted in two communities, one district in Eastern Cape [Amathole District]
and one in Mpumalanga [Nelspruit]. During FY 2009, PC will scale up this program by identifying two
additional districts in each of the two provinces. This strategy is meant to provide an opportunity for a phase
-out scale-up approach, which will also give the partners their own opportunity to develop and test relevant
interventions, apply lessons learnt and program the results in the new sites, while strengthening activities in
the pilot sites with technical assistance from Population Council.
During FY 2009, this program will focus on consolidating relevant, effective interventions in the communities
reached in FY 2008, developing and facilitating sustainability plans for these sites. Secondly, the program
will rapidly expand into two additional districts in each of the two provinces, drawing on lessons from year
one. During this scale-up phase, the following activities will be reinforced: 1) building synergy among the
three activities; 2) mobilizing youth and different stakeholders; 3) building service delivery capacity, and
fostering linkages and networks in new sites; 4) facilitating and fostering sustainability interventions,
including community leadership/ownership, and developing management and resource mobilization skills;
5) monitoring key indicators and outcomes and documenting results and program lessons; and 6)
disseminating results widely and facilitating utilization by different stakeholders engaged in prevention
programs for youth.
---------------
SUMMARY: Prevention efforts are key to reducing sexual transmission of HIV. In South Africa, the
Population Council (PC) has implemented several prevention programs targeting young people, learners, as
well as men and couples to delay sexual debut, promote faithfulness and mutual monogamy, and to reduce
risk behaviors. With PEPFAR FY 2008 funds, PC intends to strengthen and expand these activities. The
proposed activities are in response to requests from various government departments (provincial and
national), and will draw upon exiting partnerships with South African institutions and organizations such as
the Departments of Health and Education and the South African Council of Churches. BACKGROUND:
Over the past few years, the PC has developed an expertise in developing strategies and interventions that
more specifically focus on the role of men in HIV prevention. The first activity has been to work with the
Department of Education, South African Council of Churches and local FBO piloting interventions on AB in
primary schools and mutual monogamy in churches in Mpumalanga Province and the Eastern Cape
Province, respectively. These community interventions have reached couples, church members, youths,
teachers, learners, parents/guardians and other stakeholders. However, reaching an adequate number of
men through churches is a major challenge because fewer men than women participate in church activities.
This year's activities will continue to increase male involvement through specific strategies such as
strengthening couples interventions and educating learners. The emphasis area include: human capacity
development public health evaluations / targeted evaluations. Interventions will target program managers,
program implementers, NGOs and other stakeholders. ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: AB Life Skills AB Life Skills: Adapting a comprehensive school-based AB Life Skills Curriculum
for 8th and 9th grade learners. The AB Life Skills curriculum, Dare to be Different (D2BD) is a Horizons
developed comprehensive ABC prevention curriculum specifically designed for South African schools.
D2BD is unique to the life skills curricula currently being implemented in South African schools as it is an
outcomes-based curriculum that utilizes a learner-centered approach that promotes a balanced ABC
prevention strategy by emphasizing abstinence (A) and faithfulness (B) and building upon the existing
condom knowledge of in school learners. D2BD has been designed to meet all the learning outcomes and
assessment standards set forth by the South African DOE and the National Curriculum Statement for the
Activity Narrative: national Life Orientation/life skills program in schools. D2BD promotes a balanced ABC strategy through a
comprehensive curriculum that addresses/promotes goal setting, character building, messages and
activities that promote the advantages of abstinence and the consequences of sexual engagements,
activities around risk assessment, and skills building, including: decision making, critical thinking, problem
solving, resisting peer pressure and communication skills. D2BD features two additional components: (1)
Hometalk: homework activities fostering parent/child communication, and (2) Peer Support: supplemental
activities to be implemented by trained learners. The current Life Orientation curricula being implemented in
South African schools do not address any of the above mentioned messaging or skills building and this is
what makes the D2BD curriculum unique.D2BD has been piloted in nine primary schools in Mpumalanga
District among 1,562 learners and 25 teachers. Data from the pilot suggests that the curriculum differs from
what is currently being implemented, provides more comprehensive information on HIV prevention,
encourages parent-child communication around HIV prevention and pregnancy and is well received by
learners and teachers. In FY 2008, Population Council will build on the findings of the pilot and
implementation of the curriculum in 6th and 7th grades in 2006 and 2007 and adapt the AB life skills
curriculum D2BD for use in 8th and 9th grade (13-14 year old learners) classrooms in South African schools
in Mpumalanga Province. The D2BD curriculum that has been developed for the 6th and 7th grades, and as
the Life Orientation learning outcomes and assessment standards vary by grade, D2BD will need to be
adapted to reflect the requirements for the 8th and 9th grade DOE Life Orientation Program. Population
Council will monitor and evaluate the implementation of the adapted curriculum in the 8th and 9th grade
classrooms. Some formative research, and a pre-test and pilot will need to be conducted to be sure that the
material is age appropriate, that it meets the DOE Learning Outcomes and Assessment Standards and that
teacher's are comfortable with the curriculum. For this evaluation Population Council is interested in
following the same cohort of students who participated in the program in 2007. As this study will be a cohort
study Population Council will also need to continue monitoring and evaluating the implementation of the AB
life skills curriculum in the 7th grade classrooms. The 2008 cohort study will follow the 1,562 learners who
received the AB curriculum as part of their schools Life Orientation Program in the 6th and 7th grades in
2007. The cohort study evaluation will focus on sexual behavior outcomes but will also examine knowledge
and attitudinal outcomes around abstinence and faithfulness. ACTIVITY 2: Strengthening FBO Prevention
Activities Kindly note that the program area for the FBO Mutual Monogamy Study has been changed to
Counseling and Testing. For FY 2008, this program focuses on promoting Couple's HIV Testing and
Counseling through faith-based organizations The program will continue to focus on couples in churches
with the goal of mutual monogamy among these couples. Couples will continue to receive messages and
skills to enable them to establish and/or maintain mutual monogamy in their partnerships. Indeed, mutual
monogamy messages are still important for this population as baseline data collected April 2007 among
church members in Butterworth and Alice indicated that approximately one-third of church-goers in stable
relationships suspected their primary partner to be having sex with someone else, and 17 percent of those
in stable relationships indicated they had sex with someone else outside of their primary relationship. Given
the potential for exposure to HIV through non-monogamous relationships, HIV testing among couples
becomes crucial, particularly in light of the high level of HIV serodiscordance among couples that have been
reported in Sub-Saharan Africa.An integral part of the FBO program on mutual monogamy has been the
promotion of HIV counseling and testing, particularly as a couple, so that they can know their HIV status
and plan accordingly as a couple. In the current program, individuals and couples have been referred for
HIV counseling and testing, however, the quality of the service of couple counseling and testing is likely to
be poor. Therefore, by adding on the couple counseling and testing component to this program, the
program becomes more comprehensive. This activity contributes to the PEPFAR goal of averting seven
million infections.
New/Continuing Activity: New Activity
Continuing Activity:
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $85,800
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
and Service Delivery
Table 3.3.02:
NO FY 2009 FUNDING IS REQUESTED FOR THIS ACTIVITY:
This activity was approved in the FY 2008 COP, is funded with FY 2008 PEPFAR funds, and is included
here to provide complete information for reviewers. No FY 2009 funding is requested for this activity. In FY
2009, Population Council APS program areas were incorporated into their "Population Council" COP entry
(previously a separate entry). This program area will continue as an FY 2009 program area under the
partner heading entitled "Population Council". Therefore there is no need to continue funding this activity
with FY 2009 COP funds.
Continuing Activity: 14271
29684 29684.07 HHS/Centers for Africare 12183 12183.07 New CDC TA $25,000
Disease Control & Mech Africare
Prevention
29683 29683.07 HHS/Centers for Columbia 12180 12180.07 New CDC TA $25,000
Disease Control & University Mech Columbia
29682 29682.07 HHS/Centers for Tulane University 12184 12184.07 New CDC TA $25,000
Disease Control & Mech Tulane
29681 29681.07 HHS/Centers for JHPIEGO 12182 12182.07 New CDC TA $150,000
Disease Control & Mech JHPIEGO
29680 29680.07 HHS/Centers for Family Health 12181 12181.07 New CDC TA $25,000
Disease Control & International Mech FHI
14271 2968.08 U.S. Agency for Population Council 6759 268.08 $582,000
7611 2968.07 U.S. Agency for Population Council 4486 268.07 Frontiers $0
2968 2968.06 U.S. Agency for Population Council 2651 268.06 Frontiers $250,000
Table 3.3.03:
In FY 2009, technical assistance (TA) will be provided to three provinces to raise awareness on the
importance of sustainable inter-sectoral collaboration for sexual and gender-based violence. TA will be
provided for debriefing sessions of sexual assault, antiretroviral therapy (ART) and voluntary testing and
counseling (VCT) providers from Department of Health (DOH), Department of Justice (DOJ), the South
African Police Services (SAPS) and the Social Development (SD) in Gauteng, Free State and the Eastern
Cape to address staff retention, stress and burn out.
The PHE from FY 2008 (below) has ended. The results from the desktop reviews on screening for domestic
violence and round table were conducted. The finalization of the male involvement strategy will result in the
presentation of the draft policy framework and male involvement strategy to the National Department of
Health (NDOH), and the dissemination of the draft to provinces under the guidance of the NDOH.
Recommendations from community discussions to inform information, education and communication (IEC)
targeted at male involvement in reproductive health (RH) will be implemented in FY 2008.
ACTIVITY 1: Scale-up of a comprehensive post-rape care and HIV post exposure prophylaxis (PEP)
In FY 2009 the Population Council (PC) will continue to provide technical assistance on the implementation
and scale-up of a comprehensive post-rape care and HIV post exposure prophylaxis (PEP) strategy (which
includes male involvement in reproductive health). The strategy also includes strengthened legal and
mental health components and is being implemented at Tintswalo Hospital and 25 facilities (including two
hospitals and two community health centres) in Mpumalanga, Limpopo, KwaZulu Natal and Eastern Cape,
and two Primary Health Care (PHCs) in North West, KwaZulu Natal, Mpumalanga and Free State province
to ensure sustainability of the program. The monitoring and referral systems developed in FY 2008 will be
adapted to all 25 intervention sites. Champions will be identified during a two day training that PC will
conduct in the provinces to support and monitor the intervention onsite and give monthly feedback to the
facility managers on implementation progress and challenges. The overall management and data collection
systems developed in FY 2008, which will include the retrospective data collection to assess the number of
survivors who sero convert after the assault (with or without PEP) at Tintswalo hospital, will inform DOH and
PC's activities to address the gaps/best practice. One of the envisaged activities could include TA to the
DOH to include and monitor this indicator to be able to assess the impact of the program. PC will conduct
quarterly support site visits with the provincial, district and facility managers and champions, and will also
provide TA for regional exchange site visits on a bi-annual basis to allow providers to share best practices.
These visits will be supported through separate funding from PEPFAR allocated to strengthening the
response to sexual assault at the regional level. Reports from all visits will be generated and reported to PC
on a quarterly and on an ad hoc basis to address challenges and inform the action plan. Data quality will be
monitored and strengthened in collaboration with the district health information systems team and PC
trained data capturers. The multi-sectoral project advisory committee established in FY 2007 will continue
playing a role in bringing key stakeholders together to share information and experiences, identify gaps in
the implementation of the comprehensive models, and assess on-going opportunities for strengthening
linkages between the health and criminal justice systems. PC will provide TA for the establishment of similar
committees in the other two provinces, and encourage active involvement and participation at the service
provider level. PC will undertake all activities with the DOH at all levels, including cost sharing on activities
like training, material development, sharing of tools, policies and protocols, campaign activities and selected
workshops.
ACTIVITY 2: Scale up to other facilities in Mpumalanga and three provinces (Limpopo, Eastern Cape and
KwaZulu-Natal)
A situational analysis on the implementation of the comprehensive post-rape care and HIV post exposure
prophylaxis (PEP) strategy, a screening for domestic violence (DV) and the Thohoyandou Victim
Empowerment Program (TVEP) which aims to increase and improve service access for victims of sexual
and gender-based violence (SGBV) will be conducted, documented and presented at two hospitals and two
community health centres (CHCs) in Mpumalanga, KwaZulu Natal, Limpopo and Eastern Cape for scale-up.
Focus group discussions will also be conducted with men (two per province) to determine the role of men in
sexual assault care. Buy-in and planning meetings will be held at provincial and district levels to ensure that
there is increased accessibility and availability of comprehensive sexual assault care including PEP and
psychosocial support (HIV & AIDS and STI Strategic Plan for South Africa Key Priority Area 1:2). Provinces
will be supported to encourage other government departments including the South African Police Services
(SAPS), Department of Justice (DOJ), and Department of Social Development (SD) to the buy-in.
Coordination and planning meetings will be held to ensure a collaborative effort in addressing sexual
assault care and domestic violence. Monitoring, intervention, referral tools and training materials will be
shared with new provinces. PC will provide TA to strengthen linkages between service providers in the
public sector and Thuthuzela Centres (TTC) to develop a mechanism that ensures good client flow, sharing
of best practice, coordination and collaboration. Population Council (PC) will provide TA to provinces on
sexual assault and DV awareness campaigns and intersectoral collaboration events nationally (one
campaign/event per province and one national event).
ACTIVITY 3: Psychosocial support for government service providers
PC will provide TA in four provinces for debriefing sessions of sexual assault providers from the
Department of Health (DOH), DOJ, SAPS and SD. A psychologist will be contracted to conduct eight
debriefing sessions (two per province), and PC will support provinces to strengthen provincial debriefing
Activity Narrative: sessions with the available resources in various departments, and the debriefing material developed and
provided by the psychologist. A debriefing package for use in other facilities will be developed and shared.
ACTIVITY 4: Information Dissemination
PC will provide TA to the four provinces to share lessons learned from the implementation of the
intervention at various forums at the district, provincial and national levels. PC will also present findings and
reports to the National Department of Health (NDOH) and the international community. Lessons learned
from PC work on sexual assault in the region and internationally will be shared with South African
stakeholders.
---------------------
TYPE OF STUDY: Continuing.
PROJECT TITLE: Expanding Access to Comprehensive Post-Rape Services.
NAME OF LOCAL CO-INVESTIGATOR: The Tshwaranang Legal Advocacy Centre (TLAC) of Limpopo and
Mpumalanga provinces.
PROJECT DESCRIPTION: Population Council (PC) and Rural Aids and Development Action Research
(RADAR) implemented and evaluated a rural, multi-sectoral model for post-rape care in Limpopo during FY
2007. Obstacles in providing comprehensive post-rape care were identified, including uptake of service by
community, institutional and provider capacity, quality of service delivery, and inter-sectoral linkages. An
intervention strategy was developed to address these obstacles. During FY 2008 the intervention strategy
will be implemented in rural areas of Limpopo and Mpumalanga in collaboration with the Tshwaranang
Legal Advocacy Centre (TLAC).
EVALUATION QUESTION: The aim of this public health evaluation (PHE) is to add a strengthened legal
and mental health component to the existing model for post-rape care and HIV post-exposure prophylaxis
(PEP) in two areas of rural South Africa. The evaluation question involves examining whether the more
comprehensive post-rape care and HIV post-exposure prophylaxis programs (i.e., with the strengthened
legal and mental health components) effectively address the obstacles identified in the FY 2007 study.
PROGRAMATIC IMPORTANCE: There has been growing alarm regarding the high levels of rape reported
in South Africa. Sexual violence and violence against women have become one of considerable political
importance and the Department of Justice (DOJ) has launched a major initiative to address the needs of
rape victims in a comprehensive manner. Meeting the immediate healthcare needs of rape survivors
(including sexually transmitted infections, treatment of injuries, and counseling) is a priority. Guidelines exist
for the provision of PEP, along with these other key services. However, evidence shows that these are not
often followed. In addition, study findings reveal an often poor link between medical post-rape services and
the necessary legal and police procedures.
The PHE undertaken by PC and TLAC will seek to explore the effect of incorporating a legal services
component into a health services model and the relationship between the health and criminal justice
systems. There are currently no examples of such an approach in South Africa, with the exception of
Thuthuzela Centres, which do provide access to the criminal justice system by working with the South Africa
Police Services. These centers, however, do not provide legal advice and assistance to clients. The model
will provide the opportunity to explore whether a justice model can usefully be included in a health services
model.
Although interventions have strengthened the health sector response to violence, they have also revealed
weaknesses in addressing the legal needs of rape survivors. Nurses and doctors have been trained in
collecting forensic evidence, but few cases are actually brought to court, and even less successfully
prosecuted. Lack of confidence in legal proceedings appears to discourage survivors from seeking medical
care or reporting to police. This PHE will contribute to the knowledge base needed to inform the design of
interventions that address the lack of comprehensive physical and mental healthcare for rape victims, as
well as the lack of legal recourse. The emphasis areas of this activity will be on increasing women's legal
rights, reducing violence and coercion, human capacity development (training), local organization capacity
building, and strategic Information.
TIMELINE AND FUNDING: The total project timeframe is two years. This entry describes activities during
Year 2 of project, which involves implementing and evaluating the intervention strategy developed in Year 1;
analysis of evaluation data; and dissemination of findings. Budget request for the second year is $350,000.
METHODS: Prior to the commencement of the intervention, Population Council and TLAC will collect data
from the South African Police Services occurrence books, a review of applications for protection orders and
court records detailing outcomes of rape cases. A random sample of these baseline data will be drawn from
the previous year, describing (1) who accesses and the criminal justice system; (2) the services that they
use; (3) case outcomes; (4) current problems around networking and referrals between the health and
criminal justice systems; and (5) what impedes women's access to justice? From these observations the
short, unobtrusive methods of interview to be used later in the study will be informed. This later portion of
the PHE involves the continuous monitoring of the HIV/PEP register kept at the Tintswalo Hospital. (This
register is a restricted site study in which Tintswalo Hospital serves as the hub for the surrounding rural
areas.) The register will yield monthly data on the number of individuals who received the comprehensive
HIV post-exposure prophylaxis model. This monitoring activity will form the sampling frame for women who
will be contacted to participate in the (probably rapid) qualitative and quantitative assessments of the
intervention and its intended outcomes of improved satisfaction with post-exposure services and improved
knowledge and attitudes about such services. Taken as a whole, the key problems that need to be
addressed will be based on the analyses of the baseline data, with additional observations being gleaned
from the purposive sampling of women to be interviewed (methodologies of which are to be determined
during the initial phase of the PHE). These two sets of data will then inform the overall case management
and data collection systems to be designed and disseminated as the final deliverables.
Activity Narrative: POPULATION OF INTEREST/GEOGRAPHIC AREA: This PHE addresses women in rural South Africa who
are either rape victims themselves or vulnerable to rape and its series of adverse outcomes. The
geographical area of focus is rural areas of Limpopo and Mpumalanga provinces.
INFORMATION DISSEMINATION PLAN: The results of this PHE will be disseminated at provincial and
national levels in South Africa to policymakers and advocates who are in demand of valid data that could
inform improved programs addressing PEP in general and post-rape health care in particular. Results will
be presented to local, provincial, and national government officials and made available online through the
Population Council and other websites. Findings will also be presented at USAID/South Africa at the
appropriate time, as well as at national and international conferences as applicable.
BUDGET JUSTIFICATION FOR YEAR 2 (USD): The majority of funds (just under 80% of the total) will be
used for salaries and benefits for study staff, including the principal investigators/lead behavioral scientists,
field directors, data managers, statistical analyst, trainers, and data collectors. Approximately five laptop
computers and related support (IT) equipment will be purchased for field data entry and analysis
(equipment, approximately 3%). Supplies will include general office supplies, computer supplies, and
photocopying of data collection instruments (1.5%). Travel (approximately 6% of the total) will include local
transport for the study team and limited international travel for Population Council New York/Washington-
based technical expertise visits to South Africa. Finally, communications, office space, and other expenses
will account for approximately 10% of the total.
Estimated amount of funding that is planned for Human Capacity Development $196,857
here to provide complete information for reviewers. No FY 2009 funding is requested for this activity. During
the PEPFAR South African Interagency Partner Evaluation, it was decided that Population Council should
reconfigure its program areas to focus its strategy as an organization, as well as to optimize its areas of
expertise. A decision was made to cease Adult Treatment services and focus on Pediatric Treatment
services. Therefore there is no need to continue funding this activity with FY 2009 COP funds.
Continuing Activity: 14273
14273 7861.08 U.S. Agency for Population Council 6759 268.08 $970,000
7861 7861.07 U.S. Agency for Population Council 4486 268.07 Frontiers $0
Table 3.3.09:
ARV services are being rolled out in a phased approach in South Africa; however, barriers to accessing
treatment remain at the community and health facility level, particularly for children and OVC. Data from
public sector sites also reveal that counseling and testing (CT) is not acting as an effective entry point for
treatment, care and support services due to poor linkages and referral systems. The Population Council
(PC) will address issues concerning accessing treatment through three key activities with an emphasis on
linkage and referral networks. The emphasis areas are human capacity development, local organization
capacity building and wraparound (health).
Access to HIV and AIDS treatment for children (0-14 years) is lagging far behind that of adults in South
Africa. An estimated 240,000 children suffer from HIV and AIDS and only 8% receive ART treatment.
Reasons for this lack of access include: 1) Limited programs aimed at improving access to pediatric HIV
services, including HIV voluntary counseling and testing (VCT) for children; 2) Caregivers who are not
aware of pediatric HIV and AIDS services; 3) HIV-infected children receiving services after becoming
symptomatic of HIV infection; and 4) Limited and underutilized PMTCT/Plus programs that only provide
services for infant HIV infection. The Population Council will address both the quality of service delivery and
client utilization issues that limit access to pediatric HIV services for children aged 0-14 years. PC will focus
on evaluating and scaling-up interventions aimed at strengthening referral systems to HIV services for
infants, children, and OVC in a variety of service delivery settings. In addition, we will build human capacity
to improve the integration of pediatric HIV services into existing HIV services. Further, we will address
challenges faced by caregivers in accessing HIV care for children and OVC.
Due to Population Council Strategic Planning and PEPFAR SA technical considerations, activities and
budget for activity 1 and 2 have been moved from Adult Treatment to Pediatric Treatment. PC will modify,
and consolidate two existing pilot projects, the Family Centered Approach (FCA) and the Caregiver project,
to improve access to pediatric counseling and testing and ultimately link children found to be positive to HIV
care and treatment services. Through these projects, we will address three key areas with an emphasis on:
strengthening and building referral networks; human capacity development (intervention at health facilities);
local organization capacity building; and wraparounds (health).
The FCA project aims to actively involve HIV-infected adults in the referral of family members, spouses, and
children to VCT and other HIV services. This approach addresses the family's critical role in the early
identification and continued treatment of HIV-infected children. The FCA intervention will be conducted at
several clinical service delivery points, focusing on HIV-infected caregivers who are new or currently
enrolled in ART programs. Providers trained in this approach will encourage HIV-infected caregivers to
seek counseling and testing services for their spouses and children of unknown status. Through training
service providers, this project will also build capacity and structure within selected clinics for improved
linkages to pediatric HIV services.
The Caregiver project will maximize the use of existing FCA and linked clinic infrastructure to increase HIV
testing of high-risk children age 0-14 by referring their caregivers from South African Social Security Agency
(SASSA) pay points. Currently the Caregiver project uses SASSA grant pay points to explore the feasibility
of caregiver referrals to linked FCA pediatric HIV services. The Caregiver project aims to build these types
of referral networks for caregivers in a variety of non-clinical and community-based service delivery settings
including additional SASSA sites, improving access to linked pediatric HIV services, particularly for OVC
and children who are more likely to be HIV-infected.
Currently both pilot projects are underway in the North West and the Eastern Cape provinces. The FCA
project is implemented in 5 sites: Cecilia Makiwane Hospital, Potsdam Clinic, Nu1 and Nu12 clinics and
Tapologo clinics. The Caregiver project is being implemented at the SASSA grant pay points in Native units
1, 10, 12, 15, Potsdam, Tsitsing, Mogajana and Boitekong paypoints.
With FY 2009 funding, the proposed projects will be expanded to new regions of the Eastern Cape. In
these regions, PC will focus on three major municipalities: Ndlambe, Makana & Nelson Mandela. This will
be done in collaboration with the Department of Health and the SASSA.
Overall, these projects will contribute to increasing the number of children, including OVC, who receive VCT
and HIV care and treatment. In addition, they will strengthen the family and caregiver role in seeking and
utilizing pediatric HIV services. In FY 2009, PC will provide FCA training to service providers in pediatric
settings in selected health facilities that are providing ART services. This training will improve linkages to
pediatric services and aid in the integration of family services within a clinical setting. Additionally, through
the linked Caregiver activities, we will build and strengthen referral systems at government agencies and
other community-based organizations to increase HIV counseling and testing for infants, OVC, and children
of unknown HIV status in non-clinical settings.
ACTIVITY 1:
The Caregiver/FCA project will improve access to pediatric counseling, testing, and treatment through a
Family Centered Approach and referral of caregivers from SASSA sites.
In COP FY 2009, PC will focus on refining the FCA intervention, improving linkages to pediatric HIV
services from various clinical service delivery points, strengthening pediatric tools and services offered to
maximize access, and modifying provider trainings to better address the necessity of testing immediate
family members, such as spouses and children of unknown HIV status. The linked Caregiver Project will
focus on strengthening referral systems from SASSA sites to linked FCA clinics, incorporating SASSA
employee training to streamline referrals, exploring new non-clinical venues appropriate for pediatric HIV
service referral, and modifying referral card systems used to monitor the success of the intervention, to
maximize HIV service access for infants, OVC, and children through engaging their caregivers.
Activity Narrative: ACTIVITY 2:
In order to ensure that quality pediatric services are available at selected FCA clinics, PC will ensure
protocols are followed, and use existing pediatric site assessment tools, standard operating procedures,
forms, and referral tools to determine the quality of services and capacity of the facility for delivering
pediatric HIV services. PC will also modify the provider FCA training manual based on findings from COP
FY 2008 activities. This revised manual will act as a resource for all providers and will be provided to sites
beyond the sites of introduction, incorporating issues related to stigma and status disclosure, pediatric ART
literacy, care, pediatric nutrition, and psychosocial support.
The FCA will build human capacity by conducting trainings with providers. These curricula will include
trainings on how to enable their patients to understand the necessity of bringing other family members in for
VCT and/or treatment and care. The FCA program will additionally improve referral linkages for children
age 0-14 at key clinical based entry points including PMTCT, ART, and VCT (post-test counseling) through
increasing the number of staff trained in the FCA approach. The program will also strengthen the capacity
of families to care for infants, children, and OVC by prolonging the lives of parents and caregivers and by
providing economic, psychosocial, and other risk reduction support to OVC and their families and
caregivers.
ACTIVITY 4:
Providers will continue to strengthen and implement the patient referral card system for encouraging family
members and spouses of unknown HIV status to access linked VCT services. While this activity previously
increased the number of new patients seen at FCA clinics by 10%, PC will further modify recruitment tools
(i.e., referral cards) and provider training based on COP FY 2008 pilot findings to maximize utilization.
ACTIVITY 5:
4) The Caregiver project will continue to build, strengthen, and modify the referral card system at SASSA
sites, encouraging caregivers to access linked HIV counseling and testing services. With a continued
presence at SASSA sites, it is expected that caregivers will be more likely to access these services and
refers other caregivers. In addition, the caregiver project will explore other community-based venues or
government agencies where access to caregivers caring for children at higher risk for HIV might be found.
ACTIVITY 6:
The PC Caregiver staff will continue to encourage and advise caregivers of children aged 0-14 at SASSA
pay points, and other government and community organizations, to access HIV testing services for children
aged 0-14 of unknown status in their care. In addition, PC will conduct referral trainings with SASSA
employees. SASSA employees will be trained to refer appropriate caregiver grant recipients to pediatric
HIV services. This will increase the capacity of SASSA employees to integrate caregiver referrals into their
routine distribution of grants and decrease the necessity of hiring additional staff to perform these functions
at SASSA sites.
ACTIVITY 7:
With FY 2009 funding, PC will continue to collect demographic information and describe characteristics of
caregivers of children and OVC accessing SASSA services and other government or community-based
organizations. PC will use this information to continually improve our ability to predict the likely users of the
referral card system and to improve the approach.
Estimated amount of funding that is planned for Human Capacity Development $37,700
Table 3.3.11:
the PEPFAR South Africa Interagency Partner Evaluation, it was decided that Population Council should
expertise. A decision was made to streamline its activities, removing counseling and testing activities and
expanding Other Prevention services. Therefore there is no need to continue funding this activity with FY
2009 COP funds.
Continuing Activity: 14272
14272 2970.08 U.S. Agency for Population Council 6759 268.08 $339,500
7612 2970.07 U.S. Agency for Population Council 4486 268.07 Frontiers $0
2970 2970.06 U.S. Agency for Population Council 2651 268.06 Frontiers $250,000
Table 3.3.14:
