PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Summary: Re-Action! Consulting (RAC) will continue to facilitate a co-investment partnership with Xstrata
and other private companies to provide support for strengthening targeted government clinic sites,
continuing to improve access to basic preventive, clinical care and psychosocial support services. The
program will continue build on a public-private mix model for strengthening HIV and TB service.
Background:
Xstrata and RAC will work through established partnerships with local government, the Mpumalanga
provincial Department of Health (MPDOH), community groups and private providers. Project deliverables
have been defined in response to specific requests for assistance from the MPDOH. Major emphasis will be
given to development of health workforce capacity, and community mobilization/participation, building
linkages with other sectors, local organization capacity development and strategic information.
Activities: RAC will work in partnership with the District Management Teams (DMTs) in the provinces of
Mpumalanga, Limpopo, North West and Northern Cape to develop and establish a task mix for Adult Care
and Support service delivery.
In partnership with the DMTs, RAC will support the DOH with the sourcing, recruitment, training and
supervision of critical health care professionals to deliver sustainable care and support programs.
RAC will establish community partnerships with the aim of strengthening existing HIV care and support
programs in these communities, training of and providing supportive supervision to health care
professionals and facilitating behavior change interventions focused on individual households in the
community.
RAC will facilitate the building or renovation of three wellness clinics in the Nkangala District. This will be
financed by Xstrata Coal South Africa as part of their contribution of the co-investment partnership model.
The Outreach Workers (OWs) program will be expanded to allow for intensified provision of care and
support services through the early identification of and referral to HIV related care, support and treatment
services. RAC will scale up care and support activities by recruiting and training 40 OWs and 20 traditional
Healers focused on providing palliative care and quality of care and support services
---------------------------
SUMMARY:
Xstrata received funding in FY 2007 for a public-private partnership with the Mpumalanga Department of
Health (MPDOH). The implementing partner for this is Re-Action! Consulting (RAC). RAC will facilitate a co-
investment partnership with Xstrata to provide support for strengthening targeted government clinic sites,
continuing to improve access to basic preventive, clinical care and psychosocial support services in one
district of Mpumalanga, extending into a second district during FY 2008. The project will build on a public-
private mix (PPM) model for strengthening HIV and TB service delivery that Xstrata and RAC has already
begun to implement in the province with funding from Xstrata (dollar for dollar match with PEPFAR).
Xstrata and RAC will work through established partnerships with local government, MPDOH, community
groups and private providers. Project deliverables have been defined in response to specific requests for
assistance from the MPDOH. Major emphasis will be given to development of health workforce capacity,
with minor focus on community mobilization/participation, building linkages with other sectors, local
organization capacity development and strategic information. The target populations are underserved
communities of men, women and children, and people living with HIV and AIDS in Nkangala District,
extending to a second district during FY 2008, where Xstrata Alloys has its operations.
BACKGROUND:
Xstrata Coal employs 4,000 people at 11 mines (collieries) located within the socio-economically deprived
Coal Powerbelt region of Mpumalanga, and has more than 10,000 employees with operations in three
provinces of South Africa (Mpumalanga, Limpopo, and North West) and Swaziland. This funding
partnership enables scaling up the community extension component of Xstrata's comprehensive workplace
HIV and AIDS program that is managed by RAC. The project is based on implementing a PPM service-
strengthening model of capacitating government providers within primary care clinic sites to deliver HIV-
related preventive, clinical and psychosocial care services. FY 2008 funding will allow continued support to
sites established in FY 2007and to expand the number of sites within two target districts. The scope of
assistance is defined within a MOU between Xstrata and the MPDOH, and responds to specific requests for
support by the provincial department's HIV and AIDS Unit, as well as the district management teams. This
fits within a broader range of interlinked corporate social investments being made by Xstrata to support
sustainable local development in these communities.
The project will provide technical assistance, health workforce capacity development, clinic infrastructure
improvements, strengthening of pharmaceutical supply management systems and service monitoring for
public sector primary care clinics to deliver quality HIV-related preventive and clinical care services. This will
contribute to strengthening district-level primary health care service networks and district service
management, with a strong focus on improving human resource capacity, including through training and
deploying community outreach workers to deliver household-level services. The project works in partnership
with other PEPFAR partners in the province to achieve synergies and avoid duplicating activities.
ACTIVITIES AND EXPECTED RESULTS:
Activity Narrative: Three activity areas will be implemented to strengthen delivery of palliative and psychosocial care, HIV
prevention, and TB services at government primary health care sites within two districts of Mpumalanga and
to create strong linkages with community outreach services and home-based care. Service improvement
plans will be implemented at each site based on specific service strengthening needs that are identified and
agreed with District Management Teams and facility managers. This will result in more effective delivery of
the essential package of HIV-related primary care interventions (including cotrimoxazole provision and
integrated preventions services, including prevention with positives )integrated with Sexual and
Reproductive Health services (including STI care, family planning, maternal health); Maternal, neonatal and
child health services; and TB services to implement TB-HIV collaborative activities. Re-Action will also
collaborate with the Foundation for Professional Development (FPD) in implementing services at Witbank
Hospital.
ACTIVITY 1: Strengthening primary health care and district hospital delivery of HIV-related palliative and
other clinical care services
A multi-skilled RAC Service Strengthening Team will undertake a detailed situation analyses (together with
the district management team) within each target sub-district to identify specific service strengthening needs
and prioritize sites for accreditation/down-referral. Service improvement plans will be developed to
systematically address these needs. All available service providers at this level will be identified and
supported to participate in delivering service tasks aligned with the national programs and coordinated
through a 'public-private mix' delivery approach.
Services will be improved overall to both ensure that HIV-infected adults and children attending these sites
have access to the essential package of HIV-related care and support interventions (including
cotrimoxazole provision and integrated preventions services, including prevention with positives) integrated
with Sexual and Reproductive Health services (including STI care, family planning, maternal health);
Maternal, neonatal, child health services, and basic hygiene and sanitation. Prevention with positives and
treatment services will be appropriately integrated into routine primary care services, so that service
capacity is strengthened overall. Access to TB diagnosis and treatment will be improved at supported sites
by implementing TB/HIV collaborative activities. Health worker training will be addressed through in-service
training delivered in collaboration with other PEPFAR partners, based on National Program standards and
integrated management approaches.
Technical assistance will be provided to improve public sector human resource management capacity so
that health workers can be more effectively recruited to fill vacant positions at these sites. Where necessary,
critical staff positions will be filled on a temporary basis (on agreement that these posts will be filled as soon
as possible by permanent public sector employees). Site management capacity will be strengthened,
including through leadership development activities. Strong linkages will be created between these first-
level sites and second-level facilities for appropriate referral of patients and 'down-referral' of treatment,
where necessary. Appropriate 'task-shifting' will be encouraged. Physical upgrades to clinic infrastructure
will be undertaken through Xstrata co-investment and essential equipment will be procured. Health
information management systems and patient monitoring systems will be strengthened through in-service
training, technical assistance and procurement of equipment where necessary.
ACTIVITY 2: Community mapping, mobilization, health promotion, treatment preparedness and support,
referral to appropriate health and social services
Community outreach workers will be trained to provide basic household health risk assessments and health
promotion under supportive supervision. A full time project coordinator will be dedicated to coordinating
community initiatives. They will mobilize the community to access care services, including HIV testing and
counseling (through the 'I know!' campaign developed by RAC) and will direct community nurses to deliver
provider-initiated HIV testing and counseling within households. Individuals with social and health risks will
be referred for appropriate services and follow-up will be arranged. This will result in risk mapping of all
households within targeted communities and systematic follow-up, linking patients to facility-based HIV and
related palliative services.
ACTIVITY 3: Community Support and Psychosocial Care
Linkages with community-based service organizations (including faith-based organizations and non-
governmental organizations) will be strengthened and all providers will be encouraged to participate in
delivering their service tasks in more coordinated ways through the 'public-private mix' approach (which
RAC will support district management teams to oversee). Peer support groups for HIV-infected and affected
individual and family members will be established at all sites and linkages to the community will be
strengthened through Community Outreach Services to provide social and psychological support.
Traditional healers will be engaged and trained in partnership with the MPDOH and supported to provide
appropriate referrals to the clinic sites, to provide chronic care support and health promotion. Attention will
be given to gender equity, increasing male involvement in the program, addressing stigma and
discrimination.
PLHIV will receive at least one clinical and one other category of palliative care service. Palliative care to
family members of PLHIV or OVC will be provided in at least two or the five categories of palliative care
services.
With FY 2008 reprogramming funds, the community care program will be strengthened; PPM models
initiated in 3 more provinces (Limpopo, North West and Northern Cape); and the up and down-referral of
patients supported through technical assistance in a third district in Mpumalanga (Gert Sibanda).
Sustainability of this program is assured through the public-private partnership between Xstrata and the
MPDOH. By providing support for palliative care in underserved communities, Xstrata is contributing to the
2-7-10 PEPFAR goals of providing care to 10 million people infected and affected by HIV.
Activity Narrative:
New/Continuing Activity: Continuing Activity
Continuing Activity: 13909
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13909 8257.08 HHS/Centers for Xstrata Coal SA & 6648 4763.08 $1,348,000
Disease Control & Re-Action!
Prevention
8257 8257.07 HHS/Centers for Xstrata Coal SA & 4763 4763.07 New APS 2006 $100,000
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Safe Motherhood
* TB
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $500,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $200,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $200,000
Education
Water
Estimated amount of funding that is planned for Water $100,000
Table 3.3.08:
The ongoing training and mentoring of Outreach Workers (OWs) will be expanded, and on-the-job training
will be provided to ensure the incorporation of practical skills in the work situation. Xstrata will strengthen
and implement the integration of drugs and lab costs into the department of health systems in three districts
in Mpumalanga - Ngakala, Gert Sibande, Ehlanzeni (focusing in Breyten especially).
Antiretroviral therapy (ART) adherence training will be included as well as integrated to fit into skills
applicable in the work situation.
FY 2009 funding will contribute to the additional evaluation and development of systems and program
frameworks.
Focus will be shifted to include not only infrastructure development (space), but also the need to establish
co-invested partnerships with local government to support health systems strengthening.
Xstrata will enhance the OW project through the identification and partnering of service providers already
working in the communities providing community-based services such as home-based care, adherence
counseling, referral for counseling and testing, support groups, nutrition counseling, and tracking and
tracing of defaulters to enhance Adult Treatment services.
The OW program not only identifies other stakeholders, but builds relationships and creates a resource list
of services offered in the community. This modification will allow for the development of a feedback and
review mechanism to facilitate information sharing at a community and district level.
------------------------------
SUMMARY:Xstrata is a new PEPFAR partner, which received funding in FY 2007 for a public-private
partnership with the Mpumalanga Department of Health (MPDOH). The implementing partner for this is Re-
Action! Consulting (RAC). RAC will facilitate a co-investment partnership with Xstrata to provide support for
strengthening targeted government clinic sites, continuing to improve access to basic preventive, clinical
care and psychosocial support services in one district of Mpumalanga, extending into a second district
during FY 2008. The project will build on a public-private mix model for strengthening HIV and TB service
delivery that Xstrata and RAC has already begun to implement in the province with funding from Xstrata
(dollar for dollar match with PEPFAR).Xstrata and RAC will work through established partnerships with local
government, MPDOH, community groups and private providers. Project deliverables have been defined in
response to specific requests for assistance from the MPDOH. Major emphasis will be given to
development of human capacity development, local organization capacity building and strategic information.
The target populations are underserved communities of men, women and children and people living with
HIV and AIDS in Nkangala district, extending to a second district during FY 2008, where Xstrata Alloys has
its operations.BACKGROUND:Xstrata Coal is a subsidiary of a multi-national mining group committed to
practical ways of achieving sustainable development and contributing to the health and social welfare of
employees and their communities. The company employs 4,000 people at 11 mines (collieries) located
within the socio-economically deprived Coal Powerbelt region of Mpumalanga. Xstrata Alloys has more than
10,000 employees with operations in 3 provinces (Mpumalanga, Limpopo, and North West) and Swaziland.
This funding partnership enables scaling up the community extension component of Xstrata's
comprehensive workplace HIV and AIDS program that is managed by RAC. The project is based on
implementing a public-private mix service-strengthening model of capacitating government providers within
primary care clinic sites to deliver HIV-related preventive, clinical and psychosocial care services. FY 2008
funding will allow continued support to sites established in FY 2007 (working towards full site accreditation)
and to expand the number of sites within two target districts. The scope of assistance is defined within a
Memorandum of Understanding between Xstrata and the Mpumalanga Department of Health and Social
Services (MPDOH), and responds to specific requests for support by the provincial department's HIV and
AIDS Unit, as well as the district management teams. This fits within a broader range of interlinked
corporate social investments being made by the Xstrata Group to support sustainable local development in
these communities.The project will provide technical assistance, health workforce capacity development,
clinic infrastructure improvements, strengthening of pharmaceutical supply management systems and
service monitoring for public sector primary care clinics to deliver quality HIV-related preventive and clinical
care services. This will contribute to strengthening district-level primary health care service networks and
district service management, with a strong focus on improving human resource capacity, including through
training and deploying community outreach workers to deliver household-level services. The project works
in partnership with other PEPFAR partners in the province to achieve synergies and avoid duplicating
activities.ACTIVITIES AND EXPECTED RESULTS:Four activity areas will be implemented to strengthen
and scale up antiretroviral treatment provision at government health care sites within two districts of
Mpumalanga. Service improvement plans will be implemented at each site based on specific service
strengthening needs that are identified and agreed with District Management Teams and facility managers.
This will result in these clinics being accredited by the Department of Health as antiretroviral treatment sites
(for 'down referral' and/or treatment initiation) with stronger links to referral-level facilities. Referral linkages
with antenatal clinic services will be improved to ensure continuing care of infected mothers and their
children. Activities at Witbank Hospital will be coordinated with the Foundation for Professional
Development (a PEPFAR partner). Discussions are also underway with private companies to commence
activities in the Northern Cape. ACTIVITY 1: Strengthening primary health care and district hospital delivery
of HIV-related treatment and related clinical care servicesA multi-skilled RAC Service Strengthening Team
will undertake a detailed situation analyses (together with the district management team) within each target
sub-district to identify specific service strengthening needs and prioritize sites for accreditation/down
referral. Service improvement plans will be developed to systematically address these needs. Strong
linkages will be created between these first-level sites and second-level facilities for appropriate referral of
patients and 'down referral' of treatment, where necessary. Services will be improved overall to ensure that
HIV-infected adults and children attending these sites have access HIV-related treatment, care and support
interventions and that these services are appropriately integrated into routine primary care services, so that
service capacity is strengthened overall. Physical upgrades to clinic infrastructure will be undertaken
Activity Narrative: through Xstrata co-investment and essential equipment will be procured. Health information management
systems and patient monitoring systems will be strengthened through in-service training, technical
assistance and procurement of equipment where necessary.Trained and supervised community outreach
workers will be deployed to undertake household-level health risk assessments (with particularly emphasis
on reaching women and children) and provide referrals for HIV treatment, treatment literacy, follow-up and
adherence support within households and to recover treatment defaulters.Health worker training needs will
be addressed through suitable in-service training delivered in collaboration with other PEPFAR partners,
based on national standards and integrated management approaches. Technical assistance and training
will be provided to improve public sector human resource management capacity so that health workers can
be more effectively recruited to fill vacant positions at these sites. Critical staff positions will be filled to
ensure that HIV treatment services are not compromised. Appropriate task-shifting will be
encouraged.ACTIVITY 2: Direct HIV care and antiretroviral treatment provisionA multi-disciplinary care
team will continue scaling up delivery of chronic HIV care and treatment at the selected clinics in the
province. MPDOH sites will be assisted with human resource capacity to deliver HIV services for patients
initiated and already on antiretroviral treatment. Antiretroviral drugs to eligible community members at these
sites will be provided by the MPDOH through a down referral mechanism. Access to TB diagnosis and
treatment will be improved at supported sites by implementing TB/HIV collaborative activities such as active
HIV screening of TB patients for early ART initiation. ACTIVITY 3: Community SupportLinkages with
community-based service organizations (including faith-based organizations and non-governmental
organizations) will be strengthened and all providers will be encouraged to participate in delivering their
service tasks in more coordinated ways through the 'public-private mix' approach (which RAC will support
district management teams to oversee). Peer support groups will be established at all sites and linkages to
the community will be strengthened through community outreach services. Community outreach workers
will assist with patient retention in treatment programs by conducting home visits to assess why patients are
defaulting on clinic visits and make appropriate referrals. Sustainability of this activity area for ongoing
support to deliver antiretroviral treatment is assured through the public-private partnership (PPP) between
Xstrata and the Mpumalanga Department of Health.By providing support for HIV treatment in underserved
communities, Xstrata is contributing to the 2-7-10 PEPFAR goals.
With FY 2008 reprogramming funds, RAC will expand support for comprehensive HIV care and treatment
services in an additional district in Mpumalanga (Gert Sibanda), and also expand the public-private mix
model in 3 new provinces (Limpopo, North West and Northern Cape).
Continuing Activity: 13911
13911 8260.08 HHS/Centers for Xstrata Coal SA & 6648 4763.08 $1,320,000
8260 8260.07 HHS/Centers for Xstrata Coal SA & 4763 4763.07 New APS 2006 $827,284
Estimated amount of funding that is planned for Human Capacity Development $58,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
Estimated amount of funding that is planned for Economic Strengthening $50,000
Estimated amount of funding that is planned for Water $32,500
Table 3.3.09:
FY 2008 COP activities will be expanded to include:
-Recruitment and training of an additional 40 Outreach Workers to assist HIV-infected children access home
-based care and support services; and
-Link the existing community outreach program to treatment and prevention programs.
Re-Action! will support the Mpumalanga Department of Health (DOH) with the scaling-up and expansion of
pediatric care and support services. Services offered at local clinics will be linked to the first level of
interaction within households through Community Outreach Workers.
The Outreach Worker (OW) program is a direct entry point for HIV-infected children to access home-based
care, referral, treatment and support groups. This is initiated by the "I know the way to live" campaign
whereby individuals have the opportunity to test for HIV at home. In addition, the OWs conduct follow-up
visits identifying potential health risks in the households, as well as the tracking and tracing of defaulters. Re
-Action is already through its Public, Private Mix Methodology collaborating with the Department of Social
Services, Churches and NGOs in Mpumalanga.
Re-Action! will: 1) source, recruit and train an additional 40 OWs, as they are regarded as an important link
between the community and district health facilities and are directly involved in developing the community
intervention strategies; 2) link the existing community outreach program to treatment and prevention
programs at a clinical level ensuring effective cross-referral and patient follow-up; and 3) build the capacity
and skills of health care professionals and Outreach Workers (OWs) in the management and treatment of
pediatrics; 4) skills upgrading will take place through training, mentoring and technical assistance (the
duration, process and methodology will be finalized once an assessment has taken place as well as around
the ongoing needs of the health care professionals and outreach Workers); 5) increase the number of OWs
that deliver community-based and household targeted pediatric care and support services; 6) conduct
household needs assessments identifying potential health risks; and 7) increasing TB case finding for
families by increasing the number of household visits conducted in the community.
The quality and psychosocial management of HIV-infected individuals underscores the Re-Action! program
and the OWs are thereby supervised by a professional nurse, thus ensuring the quality and clinical
accuracy of palliative care services rendered at household level. The expansion of the program into 3
additional sites in Mpumalanga will require the recruitment of 2 professional nurses and 1 social worker as
shared program resources.
Nutritional assessments and counseling support is key to the day-to-day management of HIV-infected
children and Re-Action! will recruit a dietician as a shared program resource across all program areas, with
specific focus on the identification of pediatrics with nutritional deficiencies. OWs in the community will work
in close collaboration with the clinical staff and will follow-up on an individual level.
The activities have been modified in the following ways:
-The ongoing and expanded training and mentoring of OWs to ensure the incorporation of pediatric care,
support and treatment skills in day-to-day counseling at a household level.
-Enhancing the OW project through the identification and partnering of service providers already working in
the communities providing pediatric and child support community-based services such as home-based care,
adherence counseling, referral for counseling and testing, support groups for care givers, nutrition
counseling, and tracking and tracing of defaulters to enhance overall treatment services.
Expected Results: Re-Action through its activities expects that 120 children with HIV/AIDS at a grassroots
level will be identified earlier and therefore access care and treatment regarding HIV/AIDS and TB.
New/Continuing Activity: New Activity
Continuing Activity:
* Increasing women's access to income and productive resources
Table 3.3.10:
Xstrata is a new PEPFAR partner which has received funding since FY 2007 for a public-private partnership
with the Mpumalanga Department of Health (MPDOH). The implementing partner for this is Re-Action!
Consulting (RAC). RAC will facilitate a co-investment partnership with Xstrata to provide support for
care and psychosocial support services in Mpumalanga The project will build on a public-private mix model
for strengthening HIV and TB service delivery that Xstrata and RAC has already begun to implement in the
province with funding from Xstrata (dollar for dollar match with PEPFAR).
organization capacity development and strategic information. In FY 2009 expansion into other provinces is
planned.
Xstrata Coal is a subsidiary of a multi-national mining group committed to practical ways of achieving
sustainable development and contributing to the health and social welfare of employees and their
communities. The company employs 4,000 people at 11 mines (collieries) located within the socio-
economically deprived Coal Powerbelt region of Mpumalanga. Xstrata Alloys has more than 10,000
employees with operations in three provinces of South Africa (Mpumalanga, Limpopo, and North West) and
Swaziland. This funding partnership enables scaling up the community extension component of Xstrata's
primary care clinic sites to deliver HIV-related preventive, clinical and psychosocial care services. The
scope of assistance is defined within a Memorandum of Understanding between Xstrata and the
Mpumalanga Department of Health and Social Services, and responds to specific requests for support by
the provincial department's HIV and AIDS Unit, as well as the district management teams. This fits within a
broader range of interlinked corporate social investments being made by the Xstrata Group to support
public sector primary care clinics to deliver quality HIV-related preventive and clinical care services, with an
increased focus in FY 2009 on children. This will contribute to strengthening district-level primary health
care service networks and district service management, with a strong focus on improving human resource
capacity, including through training and deploying community outreach workers to deliver household-level
services. The project works in partnership with other PEPFAR contractors in the province to achieve
synergies and avoid duplicating activities.
There are currently very few children initiated on treatment in Mpumalanga, and this is thus an important are
of focus in FY 2009. Re-Action! Consulting (RAC) will work in partnership with the District Management
Teams (DMTs) in the provinces of Mpumalanga, Limpopo, North West and Northern Cape to develop and
establish a task mix for pediatric treatment service delivery.
ACTIVITY 1: Human Capacity Development
In partnership with the DMTs, RAC will support the Department of Health (DOH) with the sourcing,
recruitment, training and supervision of critical health care professionals. RAC will also focus on the re-
training of existing personnel, not only in pediatric HIV care and treatment, but also on-the-job training such
as the collection of treatment data and reporting, advanced counseling and program management skills.
ACTIVITY 2: Site Assessments
At a strategic level the RAC program team will undertake a joint assessment for each service provider
site/group of competencies development needs (behavioral, skills, systems). RAC will establish these
partnerships with the aim of strengthening existing pediatric HIV treatment programs in the specific
provinces, training of and providing supportive supervision to health care professionals, and facilitating
behavior change interventions focused on individual households and OVC households in the community.
ACTIVITY 3: Community Identification
Based on the district based health service/ response improvements plans and RAC's experience in five
existing sites, the model of door-to-door voluntary counseling and testing, OVC and pediatric identification
and referral will be rolled out into three additional sites. This community-based approach focuses on the
family and the early identification of and enrollment of children into treatment programs. RAC aims to
increase the number of children identified and enrolled on treatment. At all of the eight clinics, emphasis will
be placed on the integration of TB/HIV services and RAC will ensure that all services are implemented as
per the relevant guidelines.
ACTIVITY 4: Accreditation
In partnership with the provincial health departments, the RAC program team will identify and engage
available service sites and providers (public sector and non-government, including private general
practitioners (GPs), community-based organizations (CBOs), and traditional healers). RAC facilitated the
accreditation of the Bernice Samuel Hospital as a antiretroviral therapy (ART) initiation site and another
three sites have been established as down referral sites from the Witbank Hospital Wellness Clinic. As part
of health systems strengthening activities relating to treatment, RAC will facilitate the accreditation of the
existing down referral sites to initiation sites for HIV treatment, as well as facilitate the process of three new
Activity Narrative: sites being developed as either down referral or initiation sites for HIV treatment, as per the national
accreditation guidelines and the National Strategic Plan (NSP).
ACTIVITY 5: Outreach Workers
The OW project is a direct entry point for HIV-infected children to access home-based care, referral,
treatment and support groups. This is initiated by the "I know! the way to live" campaign whereby individuals
have the opportunity to test for HIV at home. In addition, the OWs conduct follow-up visits identifying
potential health risks in the households, as well as the tracking and tracing of defaulters. The quality and
clinical management of HIV-infected children underscores the RAC program and the outreach workers
(OWs) are supervised by a professional nurse, thus ensuring the quality and clinical accuracy of palliative
care services rendered at household level. The expansion of the program into three additional sites in
Mpumalanga will require the recruitment of two professional nurses and one social worker as shared
program resources.
ACTIVITY 5: Nutrition
Nutritional assessments are key to the clinical management of HIV-infected adults and children and RAC
will recruit a dietician as a shared program resource across all program areas. The activities have been
modified in the following ways: the ongoing and expanded training and mentoring of OWs to ensure the
incorporation of pediatric care, support and treatment skills in day-to-day counseling at a household level.
RAC will enhance the OW project through the identification and partnering of service providers already
working in the communities, providing pediatric and child support community-based services such as home-
based care, adherence counseling, referral for counseling and testing, support groups for caregivers,
nutrition counseling, and tracking and tracing of defaulters to enhance overall treatment services.
Some elements of pediatric treatment are also addressed in more details in other linked areas of the COP,
including Pediatric Care and Support, Counseling and Testing, ARV Drugs, and Adult Treatment.
Estimated amount of funding that is planned for Human Capacity Development $75,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
Estimated amount of funding that is planned for Economic Strengthening $10,000
Estimated amount of funding that is planned for Water $5,000
Table 3.3.11:
Re-Action! will support the District Management Team in the Mpumalanga province in three districts
(Ngakala, Gert Sibande and Ehlanzeni) with the development and integration of adherence support for
individuals co-infected with TB and HIV at a household level through building capacity in the Outreach
Worker project to deliver household driven services. Re-Action! will further support the district management
system by improving the capacity of health-care professionals to collect quality of data that relates to TB
diagnosis and treatment of patients receiving HIV services.
Re-Action! will assist the Department of Health to integrate TB/HIV service delivery through a public-private
mix (PPM) within the Mpumalanga province and into three additional provinces (Limpopo, North-West and
Northern Cape) in eight health districts. This will focus on district-level integration of HIV and TB
interventions and the improvement of existing services in public health care facilities.
Through the PPM Health Systems Strengthening approach, Re-Action! will integrate public and private
sector contributors to address identified systems constraints to scaling up HIV and TB services within the
target districts. This is conducted in partnership with District Health Management Teams and local
government. It includes strengthening facility and community-based health services in both the public and
non-state sector, to increase points of access to care, support and treatment services, improve service
linkages and align basic service planning and delivery with government plans and programs.
Expansion of these partnerships into the additional provinces will be a developmental activity leading to
signing of partnership and co-investment agreements with companies and memoranda of understanding
(MOU) with the provincial Departments of Health.
ACTIVITIES AND EXPECTED RESULTS
Health systems strengthening activities will include:
1. Promote understanding of the PPM approach to TB/HIV control, as recommended in the HIV & AIDS and
STI Strategic Plan for South Africa, 2007-2011, through technical assistance.
2. Train health workers in eight facilities on TB/HIV service delivery.
3. Strengthen supply of isoniazid for isoniazid preventive therapy (IPT) at service sites.
4. Implement PPM for TB/HIV service activities (TB screening, referral and DOTS) at seven private sector
sites (i.e., five GPs, two Company Occupational Health Clinics) with supportive supervision.
5. Implement the appropriate TB/HIV task mix (screening, referral and DOTS) among community outreach
workers and through household-level care and support.
6. Strengthen TB reporting and surveillance at all provider sites in the district.
7. Document progress and establish good practices through service quality improvement activities. This
requires appointing a Health Advisor and procuring specific additional external technical assistance, as
required. Reaction! will promote increased awareness and capacity of the HIV & AIDS, STI and TB team
within target health districts for strengthening implementation of TB/HIV collaborative activities, including
IPT and preventing occupational TB exposure.
Re-Action!, as the implementing agency for co-invested PPM, aimed to scale up the efforts of co-invested
partners, and to mainstream health and sustainability activities through the providing upstream support for
strengthening local government Primary Health Care Clinics (PHCC); expanding access to HIV and TB
prevention, diagnosis, treatment, care, support and education; increasing human resource capacity to
deliver primary health care services and to raise the quality of standards of HIV and AIDS and TB
prevention, diagnosis, treatment, care, support and education; partnering with other PEPFAR partners, to
facilitate synergies in implementing project activities sustainably; expanding existing community outreach
activities to individual households; increasing access and opportunity for HIV voluntary counseling and
testing; partnering with TB/HIV collaborative service activities such as the DOTS project led by the
Department of Health; renovating existing government PHCC and facilities; preparing PHCC for
accreditation; building local capacity; promoting and strengthening country strategic objectives; and
developing new PPM networks and brokering co-invested funding.
Estimated amount of funding that is planned for Human Capacity Development $522,500
Table 3.3.12:
SUMMARY AND BACKGROUND:
Re-Action! Consulting will work in partnership with the District Management Teams (DMTs) in the provinces
of Mpumalanga, Limpopo, North West and Northern Cape to develop and establish a task mix for Pediatric
Treatment service delivery.
In partnership with the DMTs Re-Action! will support the DoH with the sourcing, recruitment, training and
supervision of critical health care professionals. Re-Action! will also focus on the re-training of existing
personnel, not only in HIV concerns, but also on-the-job training such as the collection of treatment data
and reporting, advanced counseling and program management skills.
At a strategic level the Re-Action! program team will undertake a joint assessment for each service provider
site/group of competencies development needs (behavioral, skills, systems). Re-Action! will establish these
partnerships with the aim of strengthening existing HIV treatment programs in these provinces, training of
and providing supportive supervision to health care professionals and facilitating behavior change
interventions focused on individual households and OVC households in the community.
In partnership with the DoH the Re-Action! program team will identify and engage available service sites
and providers (public sector and non-state, including private GPs, CBOs, Traditional Healers). Re-Action!
facilitated the accreditation of the Bernice Sameul site as a ART initiation site and another 3 sites have been
established as down-referral sites from the Witbank Hospital Wellness Clinic. As part of Health Systems
Strengthening (HSS) relating to Adult Treatment Re-Action! will facilitate the accreditation of the existing
down-referral sites to initiation sites for HIV treatment, as well as facilitate the process of three new sites
being developed as either down-referral or initiation sites for HIV treatment, as per the national accreditation
guidelines and the National Strategic Plan (NSP).
Based on the district-based health service/ response improvements plans and Re-Action!'s experience in
five existing sites, the model of door-to-door VCT, OVC and pediatric identification and referral will be rolled
out into three additional sites. This community-based approach focuses on the family and the early
identification of and enrollment of children into treatment programmes. Re-Action! aims to increase the
number of children identified and enrolled on treatment. At all of the eight clinics, emphasis will be placed on
the integration of TB/HIV services and Re-Action! will ensure that all services are implemented as per the
relevant guidelines.
The OVC program is a direct entry point for HIV-infected children to access home-based care, referral,
have the opportunity to test for HIV at home. In addition, the Outreach Workers (OWs) conduct follow-up
visits identifying potential health risks in the households, as well as the tracking and tracing of defaulters.
Re-Action! will source, recruit and train an additional 40 OWs, as they are regarded as an important link
between the community and district health facilities and are directly involved in developing OVC intervention
strategies.
The quality and clinical management of OVC underscores the Re-Action! program and the OWs are thereby
supervised by a professional nurse, thus ensuring the quality and clinical accuracy of palliative care
services rendered at household level. The expansion of the program into three additional sites in
Nutritional assessments are key to the clinical management of HIV-infected individuals and especially OVC.
Re-Action! will recruit a dietician as a shared program resource across all program areas.
* Child Survival Activities
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $130,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,000
Estimated amount of funding that is planned for Economic Strengthening $40,000
Table 3.3.13:
ACTIVITY UNCHANGED FROM FY 2008
Xstrata is a new PEPFAR partner, which received funding in FY 2007 for a public-private partnership with
the Mpumalanga Department of Health (MPDOH). The implementing partner for this activity is Re-Action!
(dollar for dollar match with PEPFAR).
communities of men, women and children and people living with HIV and AIDS in Nkangala District,
employees with operations in 3 provinces (Mpumalanga, Limpopo, and North West) and Swaziland. This
funding partnership enables scaling up the community extension component of Xstrata's comprehensive
workplace HIV and AIDS program managed by RAC. The project is focused on implementing a public-
private mix service-strengthening model of capacitating government providers within primary care clinic
sites to deliver HIV-related preventive, clinical and psychosocial care services. FY 2008 funding will allow
continued support to sites established in FY 2007 (working towards full site accreditation) and to expand the
number of sites within two target districts. The scope of assistance is defined within a Memorandum of
Understanding between Xstrata and the Mpumalanga Department of Health and Social Services, and
responds to specific requests for support by the provincial department's HIV and AIDS Unit, as well as the
district management teams. This fits within a broader range of interlinked corporate social investments
being made by the Xstrata Group to support sustainable local development in these communities.
with other PEPFAR contractors in the province to achieve synergies and avoid duplicating activities.
Three activities will be implemented to strengthen the provider-initiated testing and counseling ( PITC)
services in two districts in Mpumalanga, in collaboration with the Mpumalanga Department of Health.
ACTIVITY 1: Strengthen Primary Health Care sites to deliver Counseling and Testing Services
Technical assistance and training will be provided to improve public sector human resource management
capacity so that critical staff positions will be filled to strengthen counseling and testing services. Physical
upgrades to clinic infrastructure (undertaken by Xstrata) will accommodate additional counseling space and
essential equipment will be procured. Health information management systems and patient monitoring
systems will be strengthened through in-service training, technical assistance and procurement of
equipment where necessary. Service delivery will be improved overall to ensure that HIV-infected adults
and children testing positive are referred to the essential package of HIV-related, treatment, care and
support interventions at designated clinic sites.
ACTIVITY 2: Public Health Sector Workplace HIV Response at the Identified Sites
Retention of health workforce capacity and health worker performance through strengthening public health
sector workplace HIV response at the identified sites will be undertaken. A workplace HIV intervention for
health and allied workers will be implemented to build 'AIDS competence' in the health workforce at the
selected sites, to encourage uptake of HIV testing and counseling and to promote appropriate health action
(including care-seeking) and improved attitudes towards patients.
ACTIVITY 3: Community Mapping, Mobilization, Health Promotion, Treatment Preparedness and Support,
Referral to Appropriate Health and Social Services
promotion under supportive supervision. They will mobilize the community for HIV testing and counseling
(through the 'I know!' campaign developed by RAC) and will direct community nurses to deliver provider-
initiated HIV testing and counseling within households (door-to-door campaign). Individuals with social and
health risks will be referred for appropriate services and appropriate follow-up arranged. This will result in
risk mapping of all households within targeted communities and systematic follow-up, linked to facility-based
Activity Narrative: services. The community program will be monitored and improved using normative standards and tools
developed by WHO (IMAI). Community Health Workers will receive close supportive supervision by
professional nurses. A regular learning review will be undertaken, based on an established improvement
methodology and ongoing in-service training will be provided from both 'in-house' and external sources.
Periodic review of strategic information and performance indicators will support monitoring the quality of
service delivery. Each community health worker will undergo routine performance appraisal based on Re-
Action's established Human Resource management procedures.
ACTIVITY 4: Community Support and Psychosocial Care
RAC will support district management teams to oversee). Peer support groups will be established at all sites
and linkages to the community will be strengthened through Community Outreach Services. Traditional
healers will be engaged and trained in partnership with the MPDOH and supported to provide appropriate
referrals to the clinic sites, to provide chronic care support and health promotion. Attention will be given to
gender equity, increasing male involvement in the program, addressing stigma and discrimination
MPDOH. By providing support for counseling and testing in underserved communities, Xstrata is
contributing to the 2-7-10 PEPFAR goals.
Continuing Activity: 13910
13910 8258.08 HHS/Centers for Xstrata Coal SA & 6648 4763.08 $832,000
8258 8258.07 HHS/Centers for Xstrata Coal SA & 4763 4763.07 New APS 2006 $400,000
Estimated amount of funding that is planned for Human Capacity Development $425,000
Table 3.3.14:
Re-Action! will assist the Department of Health (DOH) to strengthen health service delivery through public-
private partnerships within three additional provinces (Limpopo, North West and Northern Cape) in eight
health districts. This will focus on district-level improvement and support activities that build on existing
public-private mix (PPM) projects that Re-Action! has been implementing with Xstrata Coal in Mpumalanga
province. These activities will strengthen service delivery networks within these districts, prepare facilities to
meet provincial and national healthcare standards (NHS) towards accreditation and increase the points of
access to services.
The PPM health systems strengthening approach identifies all public and private sector contributors to
address identified systems constraints to scaling up HIV and TB services within the target districts. This is
conducted in partnership with district health management teams and local government.
signing a partnership and co-investment agreements with companies and Memorandums of Understanding
with the provincial Departments of Health.
Re-Action! will carry out nine separate activities in this program area.
ACTIVITY 1: Developing the Competencies of DOH District Management Teams
ReAction! will develop the competencies of DOH district management teams for effective stewardship,
planning and management of district-level services through training (including human resource
management and leadership training), mentorship and responding to specific technical assistance needs.
An organizational and leadership development practitioner will be appointed for this. A technical support
network will be established for identifying and procuring short-term technical assistance from external
contractors.
ACTIVITY 2: Strengthening Referral Networks and Service Linkages
ReAction! will strengthen referral networks and service linkages by engaging all health service providers at
a further three public sector hospital and primary care clinic sites (to a total of eight); at least five additional
private general practitioners; two company occupational health clinics; and community-based service
organizations. This requires appointing an additional 3 PPM Project Coordinators (one per province) to
identify providers, establish service networks and facilitate training, with supportive supervision.
ACTIVITY 3: Improving Clinic Infrastructure
The aim of this activity is to increase service delivery capacity by refurbishing and equipping a further three
health facilities, and continuing to upgrade a total of seven facilities.
ACTIVITY 4: Strengthening Public Sector Pharmaceutical Supply Management
This will contribute to improvements in antiretroviral therapy (ART) management, procurement, storage,
distribution and use to increase access to quality HIV treatment at seven down-referral sites, whilst
contributing overall to improving the capacity of district health services.
ACTIVITY 5: Improving Health Management Information Systems (HMIS)
This activity will focus on HMIS improvement through strengthening patient monitoring within health
facilitates; conducting service availability mapping; collecting household-level heath risk assessment data;
and building the technical capacity of public service managers for using strategic information in planning
and service improvement.
ACTIVITY 6: Healthcare Worker Recruitment
Assisting the DOH to recruit health workers for approximately 40 vacant staffing positions, that will be
contracted out to Human-Scale Resources. This includes temporarily placing not more than five additional
health workers in critical service posts whilst these are being filled through public sector recruitment.
ACTIVITY 7: Providing Clinical Mentorship and Training
Clinical mentorship and in-service training will be provided to 50 health workers through clinical outreach
teams visiting service sites on a periodic basis. An additional two full-time equivalent professional nurses,
two counselors; part-time nutritionists and social workers will be appointed for this.
ACTIVITY 8: Community Health Worker Capacity Building
An additional 20 community health workers will be recruited and trained based on the national 59 day
training curriculum, up-skill of 40 existing community health workers, and providing supportive supervision
to household-level health service outreach, covering communities of approximately three million people.
ACTIVITY 9: Monitoring and Setting Standards
This activity will focus on documenting progress and establishing good practices through service quality
Activity Narrative: improvement activities. This requires appointing a health advisor and procuring specific additional external
technical assistance, as required.
Overall, these activities will strengthen facility and community-based health services in both the public and
non-state sectors, to increase points of access, improve service linkages and align basic service planning
and delivery with government plans and programs.
Estimated amount of funding that is planned for Human Capacity Development $240,000
Estimated amount of funding that is planned for Economic Strengthening $60,000
Table 3.3.18:
