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:
Project Phidisa (Phidisa) is a clinical research project focused on the management and treatment of HIV
infection in the uniformed members of the South African National Defence Force (SANDF) and their
dependents. Phidisa no longer caters for pediatric cases, creating a huge need for specific pediatric training
for clinicians and other health-care workers in all roll-out sites. This will include training health care workers
on prevention of mother-to-child transmission (PMTCT) according to the revised South African national
PMTCT guidelines, that includes provision of dual therapy and that must be implemented in all South
African Military Health Service facilities.
Health-care professionals will be trained to implement the new policy in antenatal care, including provider-
initiated testing and counseling, dual therapy to all HIV-infected pregnant mothers, partner testing, and
antiretroviral therapy to newborns and other siblings. The PMTCT Policy guidelines also include polymerase
chain reaction testing of all HIV-exposed babies at 6 weeks and 3 months later. According to the new WHO
guidelines, early infant diagnosis is critical and the South African Department of Defence (SA DOD) will
adopt a policy of placing all HIV-infected infants under 12 months on highly active antiretroviral therapy.
HIV-infected mothers who had, previously opted to exclusively bottle feed were responsible for the
purchase of infant formula feed. The SA DOD, in line with National Department of Health Guidelines, has
changed this policy to provide infant formula feed to mothers who choose to exclusively bottle feed. Both
cotrimoxazole and INH prophylaxis is given where indicated and babies/children are referred to the pediatric
department for further management. HIV-infected mothers are then referred to adult antiretroviral treatment
clinics for further treatment and follow-up.
Information, education and communication material relevant to PMTCT is developed and distributed as part
of the Corporate Communication Plan for the Masibambisane DOD prevention program.
------------------------------
SUMMARY:
The South African Department of Defense (SA DOD) Prevention of Mother-to-Child Transmission (PMTCT)
program is an integral component of the SA Department of Defense Comprehensive Management,
Prevention, Care and Treatment Program. It focuses on training military healthcare workers with
standardized educational materials based on World Health Organization (WHO) and South African National
PMTCT guidelines to ensure appropriate and uniform PMTCT services for HIV-infected mothers and their
babies. Healthcare workers in all military hospital and clinic settings throughout all nine provinces will be
trained. The program will include counseling and testing of mothers as part of antenatal care, the provision
of antiretroviral treatment for PMTCT, in line with national policy, appropriate management of infant
deliveries, follow-up support for infant feeding practices, and linkages with treatment, care and support for
HIV-infected women. It is envisioned that PMTCT will serve as an entry point for male partners and other
family members to access counseling, testing, care and treatment services. The major emphasis area is
training, with minor emphasis on information, education, and communication, and policy and guidelines.
Target populations include adults, pregnant women, HIV-infected pregnant women, people living with HIV,
HIV-infected infants, doctors, nurses, laboratory workers, pharmacists, and other healthcare workers within
the military.
BACKGROUND:
Since 2000, the SA DOD has provided a comprehensive care, management and treatment plan for HIV and
AIDS to members of the military and their families that includes PMTCT as a mode of intervention. This
PMTCT intervention has served as an entry point to treatment and care, thereby ensuring access to
treatment for women. Although this intervention has already been integrated into the HIV and AIDS
program, it has never received PEPFAR funding and is not standardized across all military units in all nine
provinces. It is envisaged that future management of the SA DOD PMTCT project will include more vigorous
PMTCT training for military healthcare workers and ensuring that healthcare workers are able to link
PMTCT and antiretroviral treatment programs. In addition, healthcare workers will also be trained to see
PMTCT as a HIV and AIDS service delivery entry point for the whole family, including mothers, fathers,
infants and other children. This expansion requires standardization of protocols, more vigorous
implementation of a comprehensive package of PMTCT services according to WHO and national
guidelines, and monitoring and evaluation of the PMTCT program.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Training
SA DOD will modify PMTCT clinical practice guidelines to be implemented in PMTCT programs. Existing
guidelines will be reviewed annually during a PMTCT workshop attended by SA DOD doctors and nurses.
The goal of this workshop will be to ensure that current WHO PMTCT guidelines and NDOH PMTCT
guidelines are being incorporated into all SA DOD communication tools and educational aids for
practitioners and patients and that PMTCT services available for whole families (including mothers, fathers,
and babies) are standardized across all military health units in all nine provinces. SA DOD will provide
standardized PMTCT training to healthcare providers using these evidence-based clinical practice
guidelines as part of a comprehensive package of PMTCT services. Dependent upon human resource
capacity within SANDF, the Director of the SA DOD HIV and AIDS Program will decide whether the training
will be centralized within SA DOD or will need to be outsourced to an accredited training institution. The
PMTCT training program was included for FY 2007 into the ARV training program, which is outsourced to
the University of Pretoria. One hundred eighty six healthcare workers have been trained since April 2005. It
is expected that another 56 healthcare workers will attend this training in August 2007. Due to human
resource shortage and capacity within the SAMHS, the FY 2007 PMTCT funding has not been utilized, yet
this is still an unmet need.
Activity Narrative: ACTIVITY 2: Service Delivery
SA DOD will provide a comprehensive package of PMTCT services to every pregnant woman. A large
component of this PMTCT package is counseling and testing. All pregnant women will be counseled and
offered HIV testing using the opt-out testing approach. Women who test positive will be post-test counseled
and antiretroviral treatment for PMTCT will be provided. An important component of the comprehensive
package of PMTCT services includes the referral of HIV-infected women to treatment, care and support
services. SA DOD will ensure that all women are fully supported once the HIV status has been established.
This includes support on appropriate infant feeding practices The SA DOD PMTCT program will ensure
that PMTCT does not stop at delivery and an infant follow-up system will be implemented to ensure that the
HIV status of the HIV-exposed infant can be determined and the infant can be referred to treatment, care
and support services. This follow-up system will also ensure that HIV-exposed infants are monitored for
signs and symptoms of HIV infection and that cotrimoxazole prophylaxis is provided appropriately. The SA
DOD program will support HIV-infected pregnant women such that they are in a position to disclose their
HIV status to their families and can encourage their families to participate in the program. This will be done
by providing ongoing counseling and support to these women. SA DOD will also offer counseling and
testing to other family members, and family members who test positive will be referred to treatment facilities
as well. Presently, procurement of antiretroviral drugs for this purpose will be funded by PEPFAR as
managed by USAID.
The PMTCT package also includes micronutrient supplements (multivitamins, iron therapy, folic acid) and
recommendations for a well-balanced nutritious diet for pregnant and lactating women. Nutritional
supplements will be procured through the SA DOD budget. Guidelines will be given to all health units on the
provision of PMTCT and the SA DOD Monitoring and Evaluation team will track women who receive this
PMTCT package of services through the SA DOD health informatics system. It must be noted at this stage it
is not possible to report on the numbers of pregnant women receiving PMTCT services as the SA DOD only
reports on cumulative numbers of adult patients on treatment as agreed. This will be further explored with
the US and SA DOD M&E teams for future reporting in this financial year.
These activities will directly contribute to the PEPFAR 2-7-10 goals by averting HIV infection in children,
increasing access for people living with HIV to counseling, testing, care, treatment and support in the South
African Department of Defense, and increasing the capacity of healthcare providers.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13822
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13822 8049.08 Department of South African 6625 274.08 Masibambisane $50,000
Defense Military Health 1
Service
8049 8049.07 Department of South African 4419 274.07 Masibambisane $50,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Military Populations
Workplace Programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In terms of a knowledge, attitude and practice (KAP) survey (2007), the South African Department of
Defence (SA DOD) has been advised to conduct a more focused program on abstinence and being faithful
(AB) among the Military Skills Development (MSD) youth. The moral, ethical and value-based program
targets the MSD youth by particularly advocating for abstinence, delay of sexual initiation and further,
advocating for secondary abstinence. The SA DOD aims to strengthen these activities to include small
focus group training that will be more effective.
The Combating HIV and AIDS through Spiritual and Ethical Conduct (CHATSEC) program, conducted by
the chaplains, has a huge focus on young recruits. The program concentrates on the individual's moral
values and spiritual beliefs to enforce a culture of abstinence and being faithful. On completion of the
training a pledge ceremony is conducted where participants pledge to live according to their moral values,
to abstain from sex, delay sexual debut and if sexually active, to be faithful. The program also includes
mechanisms such as developing posters reflecting these values, which are used to reinforce awareness.
Approximately 400 Chaplains have been trained in the train the trainer CHATSEC program to date, and
approximately 10,000 troops have received training. The chaplains are also key stakeholders in the
Multidisciplinary Committees that exist at various units, and which they use to continue to promote AB
values.
The Comprehensive Health Assessments that are during recruitment, mobilization preparation and as part
of ongoing health assessments of the soldiers are conducted regularly. During these assessments, there is
a significant component on health education and promotion particularly in the field of HIV, AIDS and
sexually transmitted infections.
The Occupational Health and Safety Programs include aspects of HIV prevention in the workplace.
Other activities include peer education, gender equity training, mass awareness, pre- and post-deployment
training on HIV prevention.
The South African Military Health Services is considering working with other expert implementers to
exchange ideas, and improve program implementation.
----------------------------
The South African Department of Defence's (SADOD) activities are complementary to the other prevention
and care components within the Masibambisane program (the HIV Prevention and Awareness Program of
the SADOD). The focus of this abstinence and being faithful (AB) activity is the training of chaplains as
trainers in the moral, values and ethics-based program, which addresses gender equity, the role of men as
partners, and violence and coercion. This activity will facilitate transferring the value and ethics-based
program to members of the SADOD, training chaplains in pastoral care and counseling, and providing
pastoral care and counseling to HIV-infected and affected members. In addition, workshops are conducted
with unit commanders to ensure buy in and to address stigma and discrimination. Mass awareness and
targeted intervention programs will also address AB components of prevention. The activity has been
expanded to include training of Southern African Development Community (SADC) chaplains. Specific
target populations include HIV-infected pregnant women, people living with HIV (PLHIV), religious leaders
and health workers as well as all other personnel within the military.
The AB component of the Masibambisane program is an integral part of the Chaplaincy HIV program of the
Department of Defence. This ensures more focused prevention messages in terms of abstinence and/or
faithfulness. The program was developed with FY 2004 funding to expose all members of the SADOD to the
training. In order to achieve this objective, all regular Defence Force chaplains as well as a number of
Reserve Force chaplains were trained. The training was reviewed and redesigned in a three-day training
program. This training will continue in order to reach the optimal number of Defence Force members.
Since 2005, all chaplains are trained in the pastoral, care and support program to enable them to render the
appropriate care and support services to HIV-infected and affected individuals and families. This activity will
continue to be implemented by the chaplaincy of the SADOD.
All these activities are monitored through the monitoring and evaluation (M&E) plan for Masibambisane. The
M&E plan includes a focused program evaluation of the training courses. The chaplaincy will also involve
Reserve Force chaplains and liaise with the broader religious community to market the training programs to
civilian communities to mobilize faith-based organizations.
The chaplaincy developed both courses and trained the majority of chaplains within the SADOD. They have
also trained a group of chaplains from Southern African Development Community (SADC) countries and
those chaplains attended the North Atlantic Treaty Organization (NATO) chaplains' conference for the last
three years. Training of Reserve Force Chaplains has resulted in the expansion of the program to civilian
faith-based organizations.
The AB Program will continue with specific focus on highly vulnerable target groups such as the Military
Skills Development (basic training) intake of young recruits between the age of 18 and 25 years.
ACTIVITY 1:
This activity will provide training to chaplains of the SADOD, SADC, and the NATO in the values- and ethics
Activity Narrative: -based intervention program to empower them to facilitate HIV prevention through abstinence and being
faithful. This requires updating and customization of the training curriculum and the printing of training
material.
ACTIVITY 2:
The activity aims to execute the values- and ethics-based program within the SADOD as part of unit
workplace programs to members of the SADOD, focusing on activities that promote abstinence; for
instance, development of skills in unmarried individuals for practicing abstinence and adoption of norms that
supports delaying sex until marriage and that denounce forced sexual activity among unmarried individuals.
This requires the development and printing of facilitation manuals.
ACTIVITY 3:
The SADOD will support the establishment of unit workplace programs through workshops with
commanders on the AB programs to ensure targeted abstinence and faithfulness interventions within units.
The commanders are the chiefs of the units, they have much influence on the military personnel in their
units, therefore their buy in is critical for the success of the program. The workplace program will also
address stigma and discrimination.
ACTIVITY 4:
The SADOD will provide ongoing pastoral care and counseling to HIV-infected and affected individuals and
families within the SADOD with the secondary aim to prevent HIV infection through interventions that focus
on abstinence and faithfulness. This will ensure that the spread of HIV within the SA DOD is contained.
ACTIVITY 5:
SA DOD will conduct community outreach campaigns to address abstinence and faithfulness through media
and awareness activities which includes the development and printing of information and educational
material. Awareness activities are an important component of the SA DOD Abstinence and Be faithful
Prevention Program targeting new recruits who are vulnerable group aged 18 - 25 years.
ACTIVITY 6:
SA DOD will assimilate innovative ways of spreading AB information through attending PEPFAR prevention
partner meetings, publications in military and peer-reviewed magazines and journals and oral and poster
presentations on effective and innovative programs at conferences and seminars.
These activities will contribute to the prevention of HIV infection through increased pastoral care and
counseling in the SA DOD for PLHIV and increased support to healthcare providers thus contributing to the
PEPFAR goal of preventing seven million new infections.
Continuing Activity: 13823
13823 2977.08 Department of South African 6625 274.08 Masibambisane $100,000
7438 2977.07 Department of South African 4419 274.07 Masibambisane $100,000
2977 2977.06 Department of South African 2654 274.06 Masibambisane $100,000
Table 3.3.02:
Activity six, brief motivational interviewing, will not be a focus area for the following financial year.
Having realised that workplace programs (WPP) are critical to HIV prevention and that there has not so far
been optimal implementation of WPP, the South African (SA) Department of Defense (DOD) is going to
make a concerted effort to achieve more than 70% implementation of workplace programs in all DOD units.
More peer educators will be identified and trained. Additionally, more mechanisms for monitoring and
reporting these peer educator activities will be developed. In deployment areas peer education activities will
focus on topics such as alcohol abuse, multiple concurrent partnerships, mutual monogamy and responsible
financial management.
Given that there are examples of successes using role playing as an educational tool, role playing and
drama theatre are areas for further development in the environment of the training units. Another additional
activity will be the purchase and distribution of female condoms. Members will therefore require training on
the use thereof.
With the increasing demand for deployment of SA troops, the WPP will continue being implemented in the
deployment areas both internal and external. There will be a concerted effort to plan for regular site visits to
these deployment areas by the command cadre in order to demonstrate visible leadership support.
----------------------
This prevention activity mainly addresses workplace programs and includes a spectrum of activities such as
mass awareness; peer education on HIV prevention and gender equity through experiential learning and
theories of behavior change in adults; substance abuse prevention; training of South African Department of
Defense (DOD) members to develop and conduct prevention programs; and reducing stigma and
discrimination through guided introspection about participants' sexuality, case studies about people living
with HIV (PLHIV) fact sheets addressing myths, and confronting topics such as fear, stigma, isolation,
discrimination and marginalization. The primary emphasis area for this activity is training, while minor
emphasis will be given to information, education and communication (IEC), strategic information, workplace
programs policy guidance, quality assurance and community mobilization/participation. Due to new
evidence, safe male circumcision practices will be integrated as part of the HIV prevention program. Target
populations include military health workers, doctors, laboratory workers, adults, people living with HIV and
AIDS, and out-of-school youth within the military.
Masibambisane is an integrated prevention, care and treatment program in the SA DOD, addressing the
management of HIV and AIDS within the Department by interventions that target SA DOD personnel and
their dependants. The prevention programs include mass awareness; workplace programs with condom
distribution through condom containers in military units and sickbays (container supplies monitored by
workplace managers); information, education and training; gender equity and substance abuse programs
delivered by social workers, psychologists, occupational therapists, peers and peer educators. The program
uses communication and education through a wide range of media such as pamphlets, posters, industrial
theater (dramatic plays that address coping with stigma and discrimination in the workplace) and videos.
The overall activities are ongoing and in FY 2008. the activities will be continued and expanded upon by
broadening the curriculum and reaching more SA DOD members. The activities are implemented in a
decentralized manner in military units throughout South Africa by various role players and coordinated on a
regional level by Regional HIV and AIDS Coordinators in the Masibambisane Program. A Knowledge,
Attitudes and Practices (KAP) survey (SA DOD, 2006) indicates that there is an overall increase in
knowledge about prevention; however work still remains on preventing risk behavior practices related to HIV
infection. Community awareness and education programs include celebrations of World AIDS Day and
other HIV-related international and national days, exhibitions and displays, sport and recreation activities
that focus on HIV prevention and healthy living and unit competitions with HIV prevention as a focus. All HIV
training packages are centrally-developed by the SA DOD HIV Advisory Committee and the Social Work
Research and Development Department. Training aims are tailored to target groups (i.e. - healthcare
workers, peer educators, or occupational therapists).
Due to the scope of the program area, the SA DOD will carry out nine separate activities.
ACTIVITY 1: Workplace Programs
Workplace programs will be established through the training of unit commanding officers, workplace
program managers and military community development committees. Workplace programs include
discussions of safer sex practices with demonstrations of the correct use of male and female condoms and
the distribution of condoms via workplace-manager monitoring of condom containers placed in each military
unit and military sick bay. Condoms are obtained through the National Department of Health (NDOH) via
their distribution mechanism. This activity will be linked with the values and ethics-based intervention in the
Abstinence and Being Faithful program area and the gender equity training discussed under Activity 4 in
this narrative.
ACTIVITY 2: Peer Education
This activity will focus on peer educator training and training of peers. This includes training during
Activity Narrative: mobilization and preparation for mission readiness as well as training in the operational area. Other
components of this program are: knowledge and attitudes about HIV, skills required to act as peer
educators, and how to run HIV peer group training. This is accomplished through adult learning. Activities
include information about sexuality and occupational exposure to HIV.
ACTIVITY 3: Medical Transmission and Injection Safety
SA DOD will focus on the prevention and management of occupational exposure to HIV infection, including
medical transmission and injection safety through the placement of first aid kits in all workplaces, provision
of personal protective equipment, training of healthcare workers and cleaning staff on occupational health
and safety, and the development and publication of relevant IEC material.
ACTIVITY 4: Gender Equity
This activity will address gender equity and HIV through gender equity training, women empowerment and
men as partner projects, workshops, seminars and awareness campaigns on gender equity as well as the
development and printing of IEC material in this regard. This activity will be linked with the values and ethics
-based intervention in the Abstinence and Being Faithful program area and the peer education and training
discussed earlier in this narrative.
ACTIVITY 5: Substance Abuse Prevention
The development of a model and strategy and implementation of a substance abuse prevention program
will be the focus of this activity. This will consist of training of line commanders on the link between HIV and
substance abuse and a substance abuse summit for services and divisions.
ACTIVITY 6: Brief Motivational Interviewing
Expansion of the pilot study on the use of brief motivational interviewing as a prevention strategy with a
particular focus on the prevention of HIV transmission from HIV-infected individuals.
ACTIVITY 7: Information Sharing
Diffusion of innovation through attendance of PEPFAR prevention partner meetings, publications in military
and peer reviewed magazines and journals and oral and poster presentations on effective and innovative
programs at conferences and seminars.
ACTIVITY 8: Awareness Campaigns
SA DOD will conduct mass awareness activities at the regional level that focus on celebrations of World
AIDS day and other HIV-related international and national days, exhibitions and displays, sport and
recreation activities that focus on HIV prevention and healthy living and unit competitions with HIV
prevention as a focus.
ACTIVITY 9: Male Circumcision
No male circumcision training or service delivery will take place without the express consent of the National
Department of Health. In the absence of such approval and based on discussions with the PEPFAR South
Africa team, funds could fully or partially be reprogrammed. Should the approval for safe clinical male
circumcision activities be given, the following male activities are proposed:
The demand for circumcision must be matched by provision of adequate equipment and training of
personnel to conduct safe, voluntary and affordable male circumcision. Increased provision of accessible
safe adult male circumcision services should increase opportunities to educate men in areas of high HIV
prevalence about a variety of reproductive and sexual health topics, including hygiene, sexuality, gender
relations and the need for ongoing combination prevention strategies to further decrease risk of HIV
acquisition and transmission.
Four main sub-activities will be included in the HIV prevention program:
-Review of policy on male circumcision in the SA DOD;
- Development of clear, consistent and accurate mass awareness messages that promote safe male
circumcision within the context of broader approaches promoting male sexual and reproductive health and
responsible sexual behavior;
- Capacity building of health care professionals to provide safe male circumcision services; and,
- Increasing access for the provision of safe male circumcision service delivery.
Training and messaging would be coordinated with the NDOH and with JHPIEGO, EngenderHealth, and the
NDOH TBD program on male circumcision.
Program implementation will be supported and supervised through staff visits to the regions and monitoring
and evaluation through the HIV and AIDS Monitoring and Evaluation Program of the SA DOD to ensure
performance. Most of the activities and interventions are well established and the challenge in this regard is
to expand interventions to reach an optimal number of members in the SA DOD. The activities will be
scaled-up to reach more dependants; including children of military members.
Continuing Activity: 13824
13824 2978.08 Department of South African 6625 274.08 Masibambisane $275,000
7439 2978.07 Department of South African 4419 274.07 Masibambisane $225,000
2978 2978.06 Department of South African 2654 274.06 Masibambisane $200,000
Table 3.3.03:
The South African National Defence Force (SANDF) is planning a pilot community outreach program for this
FY 2009 in two or three provinces. The aim is to recruit, train, mentor and monitor community-based
workers to do outreach programs in military and the surrounding communities. Members within the military
as well as dependants will be identified to provide care and support to members especially those who are
on extended sick leave and those on treatment.
The expansion of palliative care services and facilities will be undertaken to improve the quality of life of
Department of Defense members. This will largely be comprised of training for both health care workers as
well as dependants/families in palliative care and home-based care.
To improve and better manage adherence, a program on distributing pill boxes and other adherence tools
will be established.
The palliative care program focuses on training of clinic, hospital, and hospice health workers for SANDF,
and HIV-infected and affected individuals and their families. Program activities include training of health
care workers to effectively manage HIV-infected individuals, expanding terminal care facilities, establishing
a home-based care database, and distributing home-based care kits. OI prophylaxis, TB screening, and
identification of individuals who qualify for ART as services are available, will be addressed, following
National guidelines. The care and support is multi-professional and includes psychosocial, nutritional,
spiritual and people living with HIV and AIDS (PLHIV) support. In addition, the program will address the
issue of stigma in the workplace through a targeted program evaluation and contribute to effective and
innovative palliative care programs through attendance of PEPFAR palliative care partner meetings and
conferences. Overall, the program supports the development and implementation of a comprehensive
palliative care plan as part of the South Africa Department of Defense (SA DOD) Plan for the
Comprehensive Care, Management and Treatment of HIV and AIDS.
The SA DOD provides care to the military and their families. Training of health care professionals in the
provision of holistic palliative care has been performed since the inception of PEPFAR, but the development
of a strategy for terminal care to HIV-infected members is fairly new and was established through PEPFAR
funding in FY 2005 following a needs assessment. Some of the main components of the terminal care
strategy are the development of infrastructure, including the upgrading of hospices, of which one was
included in the FY 2005 budget. Further hospices were planned for upgrade in FY 2007 and it is anticipated
that unit-based facilities for the care and support of terminal HIV-infected members will be established
during FY 2008.
ACTIVITY 1: Human Capacity Development
The primary aim of this training is to equip health care workers with the knowledge, skills and attitudes
required to conduct HIV pre and post-test counseling interviews. Training of health care professionals will
be conducted through the Health Care Workers Course developed by the SA DOD. This is a four-day
course, of which two days are dedicated to developing interviewing skills and practicing pre and post test
counseling scenarios. Some time will be spent on issues of sexuality, policy and legislation, and
occupational exposure. This will enhance the ability of health care professionals to manage HIV-infected
individuals. Target health care workers will include physicians, nurses, social workers, and psychologists.
ACTIVITY 2: Provision of care
Expansion of terminal care facilities through the establishment of regional step down care facilities within
military communities Is planned in FY 2008. This may include upgrading or sourcing of hospice services
according to need towards management of individuals with terminal HIV disease. The package of services
also includes basic pain and symptom management and facility-based support for adherence to
opportunistic infections medications (including cotrimoxazole prophylaxis and TB treatment) and
antiretroviral therapy (ART).
Support to individuals providing home-based care through training aimed at optimizing quality of life and
effective management of terminal family and community members living with HIV, sourcing of home-based
care packages (inclusive of items like gloves) and IEC material to ensure appropriate care to terminal HIV-
infected individuals and to prevent transmission of HV to caregivers. The establishment of a home-based
care provider data base will help to ensure quality support to HIV-infected members and their dependants
when home-based care is required.
Patients will be identified for ART and referred, as additional ART services are expanded. Referral to PLHIV
support networks and workshops will help to address stigmatization and discrimination and will be a useful
strategy to ensure healthy living.
ACTIVITY 3: Addressing stigma
As a result of findings of KAP survey (SA DOD, 2006), which suggest continuing stigmatizing attitudes of
individuals surveyed, the SA DOD requested a program evaluation, using qualitative methodology, to
address stigma within the SA DOD associated with HIV-testing and HIV-infected in an effort to modify
Activity Narrative: existing prevention of stigma in the workplace programs and the Health Care Workers Course. The Director
of Nursing will work with the Military Psychological Institute (MPI) in the development of the methodology for
this evaluation.
ACTIVITY 4: Dissemination of innovation
The SA DOD will disseminate innovation through attendance of PEPFAR palliative care partner meetings,
publications in military and peer reviewed magazines and journals and oral and poster presentations on
effective and innovative programs at conferences and seminars.
Program implementation will be supported by supervision and quality assurance through staff visits to the
regions and monitoring and evaluation through the HIV M&E programs to track performance. Technical
assistance will be provided to the SA DOD by the U.S. DOD.
The activities will contribute to the PEPFAR 2-7-10 goals by increasing the number of individuals receiving
palliative care and support.
Continuing Activity: 13825
29792 29792.09 HHS/Centers for To Be Determined 12231 12231.09
Disease Control &
Prevention
29791 29791.09 HHS/Centers for Ministry of Health, 12229 12229.09 $50,000
Disease Control & Rwanda
13825 2979.08 Department of South African 6625 274.08 Masibambisane $100,000
7440 2979.07 Department of South African 4419 274.07 Masibambisane $100,000
2979 2979.06 Department of South African 2654 274.06 Masibambisane $175,000
* Increasing women's access to income and productive resources
* Increasing women's legal rights
Table 3.3.08:
FY 2009 funding will support the two-week antiretroviral (ARV) training and the four-day refresher training of
Health Care Professionals in the South African Military Health Services (SAMHS). A simpler customized
ARV training course for pharmacy assistance will also be funded. Health Care Professionals will also be
trained on TB management, particularly management of multi-drug resistant (MDR) and extremely drug
resistant (XDR) TB, the new TB guidelines and sexually transmitted infection (STI) syndromic management.
There will also be a focus on cervical screening for HIV-infected women.
Adherence counseling facilities will be upgraded at some ARV sites. For improved adherence, members on
treatment will be provided with pill boxes.
The project will also focus on site readiness to ensure accreditation of roll-out sites by the department of
health (DOH).
Another focus area for successful implementation of health care service delivery will be to equip health
centre managers with the necessary management skills. It is necessary that professional clinical training
and guidance is provided to clinicians at sites and units throughout the country.
-------------------------------
The South African Department of Defence (SADOD) has an existing HIV and AIDS program that includes
antiretroviral treatment (ART) services. FY 2008 funds will be used to improve and expand ART and related
services. The main emphasis area is human capacity development. The main target is people living with
HIV (PLHIV) in the military and their families.
This activity commenced in FY 2005 with PEPFAR funding and was mostly focused on the preparation of
pharmacies at the first rollout sites for ART, supplementing SADOD funding for the phased rollout of ART in
the military. Six ART sites have been accredited with the aid of PEPFAR funding, and further funding will
be utilized towards addressing human resource deficiencies that delay implementation of ART at these
sites. FY 2008 activities will focus on the acquisition of commodities in support of ART, laboratory costs
associated with ART, continued human resource support and activities that encourage adherence. Limited
uptake of current ART services may be addressed through a media campaign to educate members and
dependants on ART. To date only two of the six accredited ART sites are operational due to staffing issues,
and thus FY 2008 funding is focused on addressing the needs of the four sites that are accredited, but not
operational.
Training of personnel to strengthen management systems, improve the quality of service through training of
healthcare workers in ARV service provision.
Continued development, modification, and printing of media, including posters and pamphlets, towards the
provision of information and education on ART to members of the SADOD and their dependants.
Interventions aimed at increasing treatment adherence by utilizing, and adapting, where necessary,
available adherence tools.
A needs assessment will be conducted at the four focus ART sites to determine gaps in staffing, and a plan
to address these gaps will be developed and implemented by SADOD, with some support from PEPFAR
funding.
ACTIVITY 5: To ensure quality monitoring and evaluation, the SADOD will implement the HIV and AIDS
database developed in FY 2006 in order to capture all relevant patient data for tracking and reporting
purposes at the four focus ART sites.
These activities will contribute to the number of persons receiving treatment and care in the military, and
support the PEPFAR 2-7-10 goals.
Continuing Activity: 13828
13828 3339.08 Department of South African 6625 274.08 Masibambisane $125,000
7445 3339.07 Department of South African 4419 274.07 Masibambisane $125,000
3339 3339.06 Department of South African 2654 274.06 Masibambisane $75,000
Table 3.3.09:
It is unfortunate that the OVC program was not implemented as planned due to human resource shortage
and other reasons. However the OVC program remains a priority and the new Director of HIV at the South
African Department of Defense (SADOD) has planned to address this with particular focus.
When a Defense Force member is deceased in the SADOD, the Human Resource Office through a process
identifies the Orphans and then hand over these cases to the Chaplains and Social Workers who will
identify needs and provide the necessary support to this identified group. While this is a current practice it is
not as structured and organized as the DoD would like to be. Once these identification mechanisms have
been strengthed it is envisaged that these children will be taken care of for an interim period within the
SADOD before referal to appropriate community structures. The interim care will include support for
schooling, clothing, nutrition and recreation.
In order to ensure that all vulnerable children are efficiently identified, a coordinated approach will be taken
to link all programs where infected parents/guardians are receiving treatment e.g. hospice, roll-out sites,
infectious diseases clinics and the PMTCT sites.
A pilot project on care and support for vulnerable children is being explored. The idea is to adopt a school
which caters for predominantly military children so that programs on substance abuse, sexual health
education and first aid are conducted in the school. Teachers and identified learners will be trained and
supported to conduct these programs. Nutritional support in the form of a soup kitchen will also be explored.
-------------------------
The SA DOD Orphans and Vulnerable Children (OVC) program is a relatively new development in the
Masibambisane program with a focus on establishing a data base and referral system for OVC of military
members. A needs assessment and pilot projects in four sites during FY 2006 will provide the direction for
the future focus and strategy of this program to include support services for HIV-infected infants, children
and caregivers in the military communities and capacity building of these services within the military through
the assistance of NGOs near these communities. The major emphasis area is linkages with other sectors
and initiatives and minor emphasis areas are infrastructure and community mobilization and participation.
The target populations are OVC and their caregivers, HIV-infected infants and children, military personnel,
volunteers and community leaders.
The Masibambisane program initiated the OVC program in FY 2005 with an institutional focus in terms of
establishing a database on military OVC and the initiation of projects at four sites as a pilot to determine the
need and direction in terms of services to OVC. The underlying principle was to establish networks within
communities to address the needs of OVC in general, address stigma and discrimination through access to
comprehensive services and military OVC specifically through collaborative partnerships. Due to the
extensive community involvement and leadership by the communities themselves, the four pilot projects
have had varying levels of success during implementation in FY 2006. This has provided valuable
information that will guide future strategies in this regard. Lessons learned at the pilot sites confirmed that
the approach towards the management of OVC will differ from site to site and need to address activities that
include training caregivers, increasing access to education, economic support, targeted food and nutrition
support, legal aid, as well as psychosocial support and palliative care. Collaboration with local NGOs will be
encouraged in all communities.
The OVC project is coordinated by the Directorate Social Work in the SA DOD as a sub-program of
Masibambisane and has been initiated at the four sites through a local coordinator and collaborative
workgroups from the communities. The projects at the four sites will be expanded to other appropriate
regions and integrated with terminal care activities where appropriate. The program will support the
activities of a military site in Phalaborwa (Limpopo province) while local NGOs will be targeted for funding
through USAID in the other three sites (KwaZulu-Natal, Eastern Cape and North West provinces). This
program will address beliefs and myths about HIV infection, prevention and treatment versus "cures". Self-
help resources that include books about military separation and its affect on families will be provided.
The implementation of activities that were planned for FY 2007 was delayed due to the staff restructuring in
the SA DOD. These activities will therefore be continued in the FY 2008.
ACTIVITY 1: OVC Tracking System
The SA DOD will develop a tracking system to identify and monitor orphans of military members in order to
provide these orphans with the healthcare services and support to which they are entitled.
ACTIVITY 2: OVC Service Site
The SA DOD will renovate a library at the Ba-Phalaborwa military site in Limpopo province to provide a
place for children to learn and foster their education after school. This library will provide an educational
atmosphere that emphasizes learning and a healthy lifestyle for OVC. References will address beliefs and
myths about HIV infection, prevention, and treatment and will include myths about "cures". In addition
information will be provided that deals with family separations and the stress that places on the family
including age-appropriate strategies to address these concerns.
ACTIVITY 3: Sharing Information
Activity Narrative: The SA DOD will sharing information and experiences through attendance of PEPFAR OVC partner
meetings, publications in military and peer reviewed magazines and journals and oral and poster
presentations on effective and innovative programs at conferences and seminars. The SA DOD and other
African countries will benefit from the information presented in peer-reviewed journal and at professional
conferences.
All these activities will be monitored and evaluated with close supervision and support for quality assurance
and the identification of best practices in this program area. Technical assistance will be provided to SA
DOD by the US DOD in order to continue the participatory project begun in 2004, to assist with selection of
additional province to begin OVC military community mobilization and participatory action and to support the
participatory process as it evolves.
Continuing Activity: 17435
29803 29803.09 U.S. Agency for To Be Determined 12236 12236.09
International
Development
29802 29802.09 U.S. Agency for US Agency for 12235 12235.09 $50,000
International International
Development Development
17435 2980.08 Department of South African 6625 274.08 Masibambisane $150,000
7441 2980.07 Department of South African 4419 274.07 Masibambisane $150,000
2980 2980.06 Department of South African 2654 274.06 Masibambisane $100,000
Table 3.3.13:
There will be a new focus on training healthcare providers on routinely offering HIV tests, child testing and
couple counseling and testing. A "know your status" campaign will be launched that encourages members
and their families to test.
Counseling and testing is done on all new recruits, in the CHA's for deployment, promotion,and fitness tests.
VCT is conducted at all rollout sites and sick bays.
Construction and renovation of a counseling and testing center is planned for the Eastern Cape Province
(particularly Mthatha).
---------------------------
Counseling and testing is a critical point of entry to care and treatment services, supports HIV prevention,
and is a pivotal component in the South African Department of Defense (SADOD) plan for the
Comprehensive Care, Management and Treatment of HIV and AIDS. The South African Military Health
Service has a scheduled health-monitoring program that includes HIV testing with pre- and post-test
counseling. Many of the regions have opted for the establishment of a centralized health assessment and
counseling and testing center. Routine counseling and testing (RCT) will be offered as an expansion to
counseling and testing (CT) for individuals as part of sexually transmitted infection (STI) consultations,
pregnant women and couples who plan a family, and CT performed as part of differential and TB diagnoses.
Individuals themselves will make voluntary counseling and testing (VCT) requests.
CT has a positive impact on HIV prevention, and the advantages of early identification and management of
HIV-infected individuals has been shown. This program area is supported through the development and
sourcing of media items, pamphlets and posters to encourage members and dependants to request or
accept an HIV test if they do not know their status or if they have been exposed to an activity with a high
risk of HIV transmission.
One of the major obstacles to requests for and acceptance of CT is stigma and discrimination, and further
support towards this program area is provided through the development and sourcing of media items,
pamphlets, and posters towards the establishment of a non-discriminatory organizational environment. This
includes media products aimed at informing members of the SADOD on the organizational HIV and AIDS
policy and strategy, as well as the management of HIV and AIDS in the SADOD.
The primary emphasis area of this activity is infrastructure development, and minor emphasis is given to
human resources, strategic information and training. Specific target populations include military personnel,
children and youth (non-OVC), men and women of reproductive age, doctors, nurses and healthcare
workers.
The military community is considered a high risk group due to various factors that include foreign
deployments and high mobility. CT provides an opportunity for prevention to both infected and uninfected
individuals. This activity is ongoing. FY 2006 PEPFAR funds were used for renovations and upgrade of
three centralized counseling and testing centers, and for training of healthcare workers. These activities will
continue during FY 2007 and FY 2008. Counseling and testing takes place at all military health care
facilities and therefore it is essential that all healthcare workers are trained in CT.
ACTIVITY 1: Offering of Routine Counseling and Testing/ Provider-initiated Testing and Counseling (PITC)
SADOD will upgrade healthcare facilities that will be used to provide confidential and effective HIV
counseling and testing in highly populated military areas. Healthcare workers will be trained on PITC and
RCT which will be supported by the development and printing of training material. SA DOD will develop
information education and communication materials, which will be used to encourage members to accept an
HIV test if they do not know their status, or, if they have been exposed to an activity with a high risk of HIV
transmission. Best practices will be shared through attending PEPFAR CT partner meetings, publications in
military and peer reviewed magazines and journals, and oral and poster presentations on effective and
innovative programs at conferences and seminars.
Counseling and testing centers will be established using PEPFAR funding. These centers will enable
confidential and effective CT for HIV, and in addition, will provide venues for the training of healthcare
professionals in CT. Training will continue during FY 2007 and FY 2008. Supportive media campaigns will
be established, and these campaigns will encourage voluntary requests for, and uptake of HIV testing.
Uptake of counseling and testing services will be monitored and evaluated through the HIV Monitoring and
Evaluation (M&E) plan of the SADOD HIV and AIDS program. The impact of media on the reduction of
stigma and discrimination is monitored through the annual Knowledge, Attitudes, and Practices (KAP)
survey that is a sub-component of the M&E plan.
Continuing Activity: 13827
13827 2982.08 Department of South African 6625 274.08 Masibambisane $50,000
7443 2982.07 Department of South African 4419 274.07 Masibambisane $50,000
2982 2982.06 Department of South African 2654 274.06 Masibambisane $150,000
Table 3.3.14:
Support similar to that given in FY 2008 is required for FY 2009. There will be a need to purchase
computers, printers and fax machines for the new and existing antiretroviral roll-out sites to maximize
monitoring and evaluation (M&E).
Training of the Nodal HIV and AIDS coordinators on M&E, Project Management and other management
related courses. In addition, it has been identified that a certain percentage of members from the Multi-
skilled development (MSD) program will be trained in basic recording and capturing of data at clinic-level to
improve the reporting system.
There will not be a knowledge, attitude and practice (KAP) Survey in FY 2009, but rather a focus on the
implementation of intervention programs. There will, however, be preparation for the KAP survey which will
be conducted in 2010.
The Monitoring and Evaluation (M&E) plan for the South African National Defence Force (SANDF)
Masibambisane program addresses all components necessary for a comprehensive M&E system for an HIV
and AIDS program. One major component is the health management information system (HMIS), which
was expanded during FY 2007 to encompass HIV and AIDS specific data. During FY 2008 the focus will be
on enhancing the system by developing data collection tools, updating the software package to enable the
efficient tracking of HIV and AIDS data, and training in M&E.
The development of a more comprehensive M&E system for the Masibambisane program has been
supported by PEPFAR since its inception in FY 2004. This plan has continued to develop over the past few
years as the HIV and AIDS program continues to expand. The HMIS used by SANDF is quite robust;
however, it has taken significant work to incorporate all relevant HIV and AIDS data that are required by
PEPFAR, the National Department of Health and the SANDF program managers.
During FY 2007 a total of 25 HIV and AIDS regional program managers were trained on M&E in order to
strengthen reporting at the regional level. During FY 2008 this base of training will be enhanced in terms of
quality as SANDF's Strategic Information (SI) requirements continue to expand.
ACTIVITY 1: Review development of data management system
In FY 2008 the SANDF SI team will review the ongoing development of the HIV program HMIS with the
larger SANDF HMIS. Systems enhancements will be undertaken as per this review.
ACTIVITY 2: M&E and SI training
The focus of this activity is the continued SI training for SANDF staff and ensuring that all have internet and
information technology access to improve reporting capability. It is important to note that internet and
information technology access is extremely important in light of PEPFAR/South Africa's dependence upon a
web-based reporting system for the quarterly, semi-annual, and annual reporting of results. To date SANDF
has had difficulty meeting USG reporting deadlines due to connectivity constraints. Moreover, data quality is
potentially compromised when results that should be reported electronically must first be manually
transposed and then reported in an altered format. This SI activity will also include training of regional and
unit level data collectors in data quality management and reporting. This is important because currently the
extent to which SANDF data management systems are capable of aligning with the reporting requirements
of PEPFAR is not consistent across data collection points, thus affecting reliability of reported results. An
NGO (outside contractor) has conducted an initial consultation and is being considered as the contractor to
implement a systems-wide data quality evaluation with associated training and mentoring.
ACTIVITY 3: Seroprevalence study
The partner will conduct an organizational seroprevalence study to determine an epidemiological baseline
for impact measurement of the SANDF's HIV and AIDS program. The key step toward enabling a useful
evaluation to occur during later years is the establishment of a robust baseline of seroprevalence within SA
DOD populations. This baseline will be the main activity in this area during FY 2008.
ACTIVITY 4: Data Quality and Managerial Audits of M&E Systems
During FY 2008 a series of internal audits and site visits will be conducted in order to verify data, services,
and facilities. These activities will enable the SANDF to report effectively the contribution of the
Masibambisane program elements and targets that contribute to the overall PEPFAR objectives for
prevention, care and treatment. Data obtained through the M&E plan as developed with the support of
PEPFAR funding is utilized to determine successful program components and to identify program gaps to
be addressed. The establishment of the data management system developed in FY 2006 is in the final
testing stage, and gaps identified are being addressed.
Continuing Activity: 13829
13829 2981.08 Department of South African 6625 274.08 Masibambisane $50,000
7442 2981.07 Department of South African 4419 274.07 Masibambisane $50,000
2981 2981.06 Department of South African 2654 274.06 Masibambisane $100,000
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $21,416,356
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The South Africa HIV & AIDS and STI National Strategic Plan, 2007 - 2011 (NSP) emphasizes the strengthening of health
systems as one of the key pillars in mitigating HIV and AIDS and meeting the Millennium Development Goals. During the last two
years, PEPFAR has aligned its programs to strengthen the public health system through programming. Some of the main areas of
focus for health systems strengthening has included: a) developing management and leadership at national, provincial and district
levels; b) developing and implementing policy at national and provincial levels; c) strengthening monitoring and evaluation
capacity of civil society organizations and the National Department of Health (NDOH); d) improving quality of services at district
and facility levels; e) integrating HIV and AIDS programs into other primary health-care services; f) strengthening pharmaceutical
systems within the public sector; g) strengthening the National Health Laboratory System (NHLS) and developing capacity at
district and provincial levels to train health-care providers on HIV and AIDS and TB programs; and h) strengthening the human
resource system.
Strengthening Capacity of Host Government Institutions
PEPFAR South Africa has and will continue in fiscal year (FY) 2009 to strengthen the capacity of the South African government
(SAG) to develop policies that are in line with international guidelines, while taking cognizance of the local context of HIV & AIDS
and TB. PEPFAR South Africa has and continues to support parastatal organizations such as the Human Sciences Research
Council and Medical Research Council to conduct HIV prevalence and behavior change studies that will inform policies at national
and provincial levels.
PEPFAR South Africa will continue to strengthen the national laboratory system by building on existing activities. These include
support for strengthening the national laboratory information management system for multi- and extensively drug-resistant TB;
support for the African Centre for Integrated Laboratory Training, a southern African regional activity; and renovation of 20
national laboratories to allow NHLS to perform line essays on sputum that will allow for two-day turn-around time on TB sputa.
(See Lab Program Area Narrative, and NHLS COP entry.)
The University of Washington I-TECH, a PEPFAR-funded partner, will continue to assist the NDOH to strengthen their Health
Promotion and Quality Assurance Training Centres through direct technical assistance to the Human Resources for Health Unit.
These centers are the hub for knowledge translation and in-service training and quality assurance for the primary healthcare
system in all provinces. The Health Promotion and Quality Assurance Training Centers are mandated to manage the training of
health-care providers at district level within each province. These centers are currently funded through the South Africa national
conditional grant but the provinces lack the capacity to set up these structures and systems to implement the programs. PEPFAR,
through its partners, provides technical assistance to these training centers in development of curricula, assessment of curricula,
integration of HIV and AIDS training into existing PHC training programs, updated training programs to reflect policy changes
(e.g., prevention of mother-to-child transmission (PMTCT) policy), and provision of mentoring to staff at the centers in the
management and implementation of such programs.
Strengthening Leadership and the Policy Environment
The PEPFAR program in South Africa will continue to address strengthening policies and capacity in FY 2009 through support to
the national government, particularly through the placement of CDC activity managers within the national HIV & AIDS and STI
Directorate to assist in policy development.
In FY 2008, PEPFAR South Africa assisted the NDOH in developing the new PMTCT policy that now authorizes dual antiretroviral
treatment for pregnant mothers. In addition, PEPFAR assisted with the development and implementation of the new counseling
and testing policy that recognizes routinely offered counseling and testing. In FY 2009, the focus will be on implementation of
these policies through training of healthcare providers and through PEPFAR partners. Health Policy Initiative will continue to work
with the NDOH's HIV and AIDS Comprehensive Care, Support, and Treatment (CCMT) sub-directorate focusing on capacity
building programs for costing of HIV and AIDS care and treatment interventions at the provincial level. The programs will also
include costing for TB and sexually transmitted infections (STI). This activity will expand in scope by developing a tailor-made
costing model for the CCMT managers. This model will standardize and guide a benchmarked approach within all provinces in
ensuring effective resource needs required for HIV and AIDS care and treatment in their specific province. This will greatly affect
the production of more realistic budgets and will ensure adequate funding.
PEPFAR continues to encourage partners to integrate gender-related issues into all program areas to address gender violence,
male norms, and behaviors within the cultural context, women empowerment, and alcohol and substance abuse in relation to
violence and HIV transmission. Approximately 60% of partners have a gender-related component in their COP.
Strengthening Leadership and Policy Environment for HIV Care and Treatment for Children
In FY 2009, PEPFAR South Africa will continue to provide direct technical assistance to the National Department of Social
Development to set standards for quality of care for orphans and vulnerable children (OVC) and to assist in the development of a
policy framework on the Children's Act (see OVC program area narrative).
Pediatric Care is highlighted this year as a new program area. Although PEPFAR partners have been providing Pediatric Care as
a component of the care and treatment programs in the past, several activities will be highlighted in FY 2009. The focus will be on
a family-centered approach to pediatric care, support, and treatment and on integration of pediatric HIV care and treatment into
routine primary health-care settings. There will also be a special focus on the community component of the Integrated
Management of Childhood Illnesses (IMCI) to integrate pediatric HIV care and treatment into these modules. In addition,
community health workers and home-based caregivers will be trained on IMCI to strengthen infant follow-up and to improve child
health outcomes at the district level. PEPFAR will work closely with counterparts at the NDOH to integrate pediatric HIV care into
existing child health programs (e.g., IMCI and the immunization program). PEPFAR aims to meet some of the Millennium
Development Goals for child survival by strengthening and integrating the PMTCT program into the mother-child and women's
health programs with a special emphasis on the community aspect.
Strengthening Quality of Care
In FY 2009, the United States government will continue to strengthen and expand quality of care at facility and community level in
the following areas: 1) external Quality Assurance (EQA) for laboratory services; 2) CDC/WHO quality management systems
training to ensure quality HIV rapid test kits; 3) laboratory surveillance system to identify and record opportunistic infections (there
are currently 15 sentinel sites country-wide); 4) quality assurance implementation by partners in all program areas with a special
emphasis on therapeutic monitoring of patients on antiviral treatment and pharmacovigilance; and 5) proficiency testing for viral
loads and infant polymerase chain reaction (PCR) tests.
Strengthening Strategic Information
PEPFAR will continue to train local organizations in monitoring and evaluation, recording and reporting on data, and using
information in decision-making. Direct technical assistance will continue to be provided to the national, provincial, and district
health system in the use of information for decision-making.
The United States government will also continue to strengthen the national health system to improve patient care through: 1)
harmonizing health information systems (lab, pharmacy, patient information systems, etc.); 2) strengthening pharmaceutical
management systems (see SPS COP entry); and 3) improving infection control for TB programs at all levels of government.
A significant focus of South Africa's PEPFAR program addresses institutional capacity issues by building the capacity of local non-
governmental, faith-based, and community-based organizations. The goal is to build institutional capacity to increase the
effectiveness and capacity of these partners to achieve expanded and quality services while strengthening the management of
their financial and human resources. Pact, Care, and the Ambassador's Community Grants Program include formal training, on-
site mentoring, improved monitoring and evaluation systems, good governance, and resource mobilization.
Strengthening the GFATM Management Structure and Improving Donor Coordination
The South Africa PEPFAR team works with other donor organizations in coordinating efforts in South Africa through participation
in the donor coordination forum. PEPFAR collaborates with other donors to maximize support to strengthen the South African
health system. PEPFAR is represented on the European Union (EU) Plus Working Group on HIV and AIDS where information
sharing and programmatic issues are discussed. The USG is also represented on the NDOH Donor Coordination Forum. There
are several health system areas where joint funding is coordinated (e.g., the national Human Resource Information System (UK
Department for International Development (DFID) and PEPFAR) and the Clinical Associates Program (DFID, PEPFAR, EU, and
WHO).
PEPFAR continues to support the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) management structure through
representation from our partners on the South Africa National AIDS Council (SANAC) and its Resource Mobilization
Committee,,which serves as the coordinating and management structure for the GFATM.
Table 3.3.18:
More focus will be given to the capacity development of the human resource component in terms of training.
For example, training will be provided in project management, monitoring and evaluation (M&E), good
clinical practice, Diplomas and masters programs in HIV/AIDS and management training.
Training material of the South African Military Health Service (SAMHS) will be evaluated for quality
assurance by external moderators/experts so that all training material may be accredited. Furthermore, a
structured quality assurance process will be implemented for the evaluation of the peer educator program,
starting with the training of the peer educators to the implementation of activities by peer educators at the
unit level. M&E activities will be further enhanced by more organized data capturing, collation and reporting
to the appropriate levels for management reporting.
--------------------
The main components of this program area are planning and coordinating workshops for all the relevant
role players, and building the capacity of those role players to strengthen this program. Most of the training
provided within the South African Department of Defense (SA DOD) HIV and AIDS Training program has
been developed internally by utilizing the knowledge and skills of members in the organization. Training
development workshops are now needed to update training content. The major emphasis areas of these
activities are policy and guidelines and training. The target population is public healthcare workers.
The Masibambisane program was established in 2001, and has received PEPFAR funding from FY 2004. It
is an integrated prevention, care and treatment program in the SADOD, addressing the management of HIV
and AIDS within the Department by interventions that target SADOD personnel and their dependants. The
prevention programs include mass awareness; workplace programs with condom distribution through
condom containers in military units and sickbays (container supplies monitored by workplace managers);
information, education and training; gender equity and substance abuse programs delivered by social
workers, psychologists, occupational therapists, peers and peer educators. The program uses
communication and education through a wide range of media such as pamphlets, posters, industrial theater
(dramatic plays that address coping with stigma and discrimination in the workplace) and videos.
The funding allowed the program to expand and to address program elements that were not possible
before. The program currently consists of seven generic disease processes each with various projects and
sub-projects, namely: prevention, promotion, diagnostics, treatment, rehabilitation, palliative care, research
and development. These are managed by the HIV and AIDS management structure in the office of the
Surgeon General with the Director HIV and AIDS, advisory board, coordinating committee and regional
program managers in each province and each military hospital. The SA DOD HIV and AIDS Management
Structure that facilitate program development, planning, execution, monitoring and evaluation. As the
program expands, various additional role players (new personnel that are coming onto the program, e.g.
doctors, nurses, psychologists, social workers, and nurses) become involved that need to be provided with
induction training, and existing role players need to be provided with strategic guidance towards
comprehensive planning and effective coordination to ensure an integrated approach to HIV an AIDS
management in the SA DOD. This is done through workshops and training.
SA DOD will conduct training for regional and national SA DOD HIV coordinators and sub-program and
project coordinators in the strategic objectives of the program. This training will consist of a workshop that
reviews the results of the Knowledge, Attitude, and Practices (KAP) study and discusses strengths and
weaknesses of the program to help plan for the following year's activities.
SA DOD will conduct strategic and operational planning work sessions to ensure integrated program
development and coordinated execution of program elements (e.g. PEPFAR M&E training which members
of SA DOD attend and then cascade to other regional coordinators). These work sessions will be led by the
Monitoring and Evaluation (M&E) Director at South Africa Military Health Services. Representatives from all
provinces that collect data will be invited to participate. The sessions will address strengths and
weaknesses of the M&E processes and will include training in new M&E activities and guidelines issued by
PEPFAR.
SA DOD will hold training development workshops to assist in the establishment of new HIV-related training
courses and updating of training contents in existing HIV-related training curricula for SA DOD. Training
development will include courses specifically targeted at mid- and upper-level leadership concerning the
prevention of and identification and remediation of stigma and discrimination in the workplace.
A number of training opportunities and workshops have been funded since the inception of PEPFAR and
these opportunities have contributed to the success of the Masibambisane program. The Masibambisane
program is implemented through a cascade of national and regional program coordinators, trainers and sub-
program and project coordinators. These individuals are responsible for the development, planning and
execution of the program to address all the components necessary to ensure a comprehensive HIV and
AIDS Program in the South Africa Department of Defense.
Continuing Activity: 13830
13830 7916.08 Department of South African 6625 274.08 Masibambisane $50,000
