PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
The National Department of Health's ACTIVITY 3 is no longer being funded under this program area but has
been moved to the CARE Umbrella Grants Mechanism. This will be replaced with an activity aimed at the
district levels to strengthen monitoring and evaluation of the entire prevention of mother-to-child
transmission (PMTCT) program. A consultant will be employed to monitor the worst reporting districts in
terms of PMTCT data submission. The consultant will travel to the districts, conduct a data audit, and
identify problems with data collection. Based on the findings of the assessment, interventions to improve the
data quality and the data collection will be implemented. Activities will be implemented in the worst
performing PMTCT districts first. By the end of the financial year, it is anticipated that approximately half of
the health districts will be covered, hence strengthening reporting in the national PMTCT program.
-----------------------------
In close collaboration with the National Department of Health (NDOH), CDC will provide overall HIV and
AIDS programmatic support to the national and provincial prevention of mother-to-child transmission
(PMTCT) program. In addition, NDOH relies on CDC to implement activities that address NDOH's emerging
priorities, provide financial and technical support quicker than the NDOH systems allow. PEPFAR PMTCT-
specific activities are represented on the NDOH operational plan, and contribute to the overall
implementation of the national PMTCT program.
SUMMARY:
The aim of the "In Support of the NDOH PMTCT" project is to provide technical assistance to the NDOH
and provincial health departments to ensure expansion and strengthening of PMTCT services in all nine
provinces. The major emphasis area is training. Minor emphasis areas include development of
network/linkages/referral systems, policy development, local organization capacity development, quality
assurance, and strategic information. Target populations for these activities include policy makers, National
AIDS Control Program staff, other NDOH staff, other healthcare workers, women, family planning clients,
pregnant women, people living with HIV, HIV-infected pregnant women and their infants.
BACKGROUND:
The goal of the National PMTCT program is to reduce mother-to-child transmission of HIV by improving
access to HIV counseling and testing in antenatal clinics, improving family planning services to HIV-infected
women, and implementing clinical guidelines to reduce transmission during childbirth and labor. In addition,
the National program is responsible for ensuring follow-up of infants born to HIV-infected mothers and
ensuring that these infants are identified early and referred to treatment if necessary. The purpose of this
project is to provide technical assistance to NDOH by funding two program assistants to work within the
NDOH on all aspects of the program. The technical assistance focuses particularly on capacity building of
healthcare workers and community healthcare workers, development and implementation of provincial
PMTCT-specific operational plans, strengthening national and provincial reporting systems, coordinating the
national PMTCT steering committee meeting, developing a monitoring and evaluation system for early
infant diagnosis and strengthening service delivery by implementing systems strengthening activities.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Capacity Building
In FY 2005, PEPFAR and the NDOH finalized the PMTCT and Infant Feeding Curricula and PEPFAR
funding produced a trainers' guide, participants' guide and course directors' guide. In FY 2006, course
directors and trainers were updated on the finalized curriculum and provincial training coordinators were
assisted in developing provincial training plans to implement the curriculum at the provincial level. FY 2007
funding was used to ensure expansion of the PMTCT training throughout the country. Particular support
was given to expand training on PCR implementation and monitoring and evaluation of the PMTCT
program. FY 2007 Plus up funding will be used to align the existing PMTCT and Infant Feeding Curricula
with the important policy shift in the area of PMTCT ARV prophylaxis. As of FY 2008 the national PMTCT
policy will no longer be single dose nevirapine, but the provision of dual therapy to all HIV-infected pregnant
women. It is anticipated that the regimen will be AZT from 24-28 weeks and nevirapine at the onset of labor.
FY 2008 PEPFAR funds will be used to assist the NDOH and provincial DOHs to develop strategies for the
implementation of the new PMTCT policy, the development and printing of the new PMTCT guidelines,
training and updating of all health care workers. Funds will be used to ensure that all healthcare workers
offering antenatal care, postnatal and child health services receive training. These activities will contribute to
the PEPFAR goal of averting seven million new infections, as healthcare workers will be trained to integrate
PMTCT into routine service, and more pregnant women will receive PMTCT services.
ACTIVITY 2: Technical Assistance
In FY 2004 CDC placed a technical advisor at the NDOH to support the PMTCT program. For the last three
years, this advisor has worked closely with the national PMTCT program and the national PMTCT steering
committee to identify gaps and challenges to PMTCT implementation and develop strategies to strengthen
PMTCT implementation. As the PMTCT policy will shift in FY 2008, it is necessary to bring an additional
PMTCT advisor on board to assist the NDOH in the roll-out of the dual therapy PMTCT policy. This will
mean that in FY 2008, CDC will support two PMTCT advisors at the NDOH. The one advisor will focus on
the maternal aspects of the PMTCT program and integration of PMTCT into antenatal care services. This
advisor will be tasked with assisting the NDOH increase PMTCT uptake, develop strategies and provincial
operational plans for the roll-out of dual therapy, providing technical assistance to the provinces to address
health systems challenges in PMTCT implementation. A second advisor will focus on ensuring rollout of
early infant diagnosis, ensuring stronger linkages between PMTCT and treatment, care and support,
addressing infant feeding issues and creating systems to improve follow-up of PMTCT enrolled mothers and
Activity Narrative: their infants. These advisors will offer technical assistance for the implementation of policy, monitoring and
evaluation and day-to-day programmatic support to the NDOH. The technical advisor will conduct provincial
site visits to assess quality of PMTCT service delivery and will work directly with the provinces to strengthen
and improve existing services.
ACTIVITY 3: Monitoring Early Infant Diagnosis
Using FY 2007 and FY 2008 funding a monitoring and evaluation system for early infant diagnosis is
currently being developed and piloted at the coronation hospital complex in Gauteng province. FY 2008
funding will be used specifically to support the scale-up and rollout of early infant diagnosis services to other
clinics and hospitals in Gauteng province. The monitoring and evaluation system is currently being
developed as no national system to monitor early infant diagnosis exists. The district health information
system (DHIS) which is responsible for the national data set only captures the number of infants tested at
12 months of age. The new system includes monitoring and evaluation training on the national early infant
diagnosis testing protocol implementation, implementation itself and client adherence and follow-up. The
activity is a logical follow-on from the formative/descriptive work conducted in FY 2006, and the results
obtained from the formative work served as the basis for formulating monitoring and evaluation tools (both
quantitative and qualitative, exploring both quality of care and service provision and client adherence and
psychosocial impact) that can be used for early infant testing rollout. Expected results include development
of a draft monitoring and evaluation package to be tested in a number of facilities as the early infant testing
training and protocol are progressively rolled out. The draft package will also include an assessment of the
feasibility of implementing the package in different types of health facilities and how it can be adapted to
facilities already offering the service. In addition, while the monitoring and evaluation package will be
thorough and comprehensive, certain components may not be realistic for certain clinical settings.
Therefore, part of the package will explore different levels of monitoring and evaluation (gold, silver, bronze
standard) depending on the clinical environment. This will ensure exploration of quality of care issues in
greater depth. This activity will contribute to PEPFAR goals by facilitating a process where HIV-infected
infants can be identified early and referred to antiretroviral therapy facilities for monitoring and ensuring that
they receive treatment at the appropriate time. In addition, the focus on quality of care will ensure
sustainable implementation of early infant diagnosis.
ACTIVITY 4: Collaboration with Other Donors and Stakeholders
At the request of the NDOH, a stakeholders analysis of PMTCT activities is currently underway. This
analysis will identify and map all existing PMTCT activities taking place around the country. It will facilitate
the identification of gaps in PMTCT service delivery and highlight the different levels of support being given
by various donors and stakeholder to the NDOH PMTCT program. FY 2008 funding will be used to hold a
National PMTCT stakeholders workshop, where the results of this analysis will be presented. The NDOH,
the donors and stakeholders will then decide how to scale up and strengthen PMTCT activities. The
premise behind the stakeholders workshop is to ensure that there is no overlap in activities, all areas of the
country are being provided with support and assistance and that stakeholders and donors are collaborating
in the rollout of PMTCT services. The expected result of this activity will be the development of one national
annual PMTCT operational plan for South Africa. The NDOH, with support from CDC, will take the lead on
this activity.
The "In support of NDOH" activity plays a pivotal role in the implementation of the national PMTCT program
as all activities assist the NDOH and provincial departments of health in the rollout of the New Strategic
Plan (NSP) for HIV and AIDS, and the accelerated prevention strategy. Funding will ensure that the new
PMTCT policy is disseminated throughout the country and that health care workers are trained in
accordance with the NSP. This program will contribute to 2-7-10 goals by ensuring implementation of quality
PMTCT services and by preventing vertical transmission.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14057
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14057 3564.08 HHS/Centers for National 6698 500.08 CDC Support - $1,475,813
Disease Control & Department of with CARE UGM
Prevention Health, South
Africa
7369 3564.07 HHS/Centers for National 4393 500.07 CDC Support $2,351,665
Disease Control & Department of
3564 3564.06 HHS/Centers for National 2680 500.06 CDC Support $150,000
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
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
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM FY 2008
PEPFAR funds will be used to continue to support the National Department of Health (NDOH) Youth and
HIV directorate. Since FY 2005, PEPFAR funds have been used to place a Youth HIV advisor at the NDOH.
This advisor has provided programmatic support to the NDOH in terms of growing the youth program and
ensuring support for non-governmental organizations (NGOs), faith-based organizations (FBOs), and other
organizations working in the area of youth and HIV. The emphasis will be on human and local organization
capacity development, and training. The target populations will include host country government workers,
implementing organizations and youth between the ages of 10 -18. Activities will also focus on young
adults, between the ages of 18 and 24, especially women. The focus for this group, particularly those
women that are sexually active, will be on the B component of the AB program
Four NGOs will be supported to carry out AB prevention activities for youth through the NDOH cooperative
agreement. The funds requested under this COP entry "In-Support of the NDOH" will continue to support a
youth specialist that provides technical assistance to the NDOH on youth activities including the provision of
technical oversight to the four NGOs. The "In-support of the NDOH" funds are also allotted to small-scale
activities at the request of the NDOH for AB prevention activities.
Three activities will be carried out in this Program Area.
ACTIVITY 1: Technical Assistance
FY 2008 funding will ensure continued support for a locally employed staff to provide technical and
programmatic assistance to the NDOH in the area of youth and HIV. The youth advisor will continue to work
closely with NDOH in the design and delivery of their youth interventions. In addition, the youth advisor will
ensure collaboration between youth-based NGOs funded through the CDC-NDOH cooperative agreement.
ACTIVITY 2: Expansion of the Peer Educator Program
Providing coordination and oversight for Rutanang peer education trainings (particularly addressing
abstinence and be faithful, youth-friendly services, HIV prevention initiatives and strategies, male norms and
behavior and violence, cohesion, stigma and discrimination) offered for the NDOH, the South African
Department of Education (DOE), and other South African Government partners in collaboration with
Harvard University.
ACTIVITY 3: Capacity Building
FY 2008 funding will be used to build the capacity of local organizations that are working with Youth.
Capacity building will be achieved through the provision of training on HIV and on the promotion of AB
messages. This will be done in collaboration with the NDOH and DOE and in line with their priorities.
ACTIVITY 4: Families Matter!
FY 2008 funds will be used to begin to adapt and implement the Families Matter! Program (FMP). FMP is
an evidence-based, parent focused intervention designed to promote positive parenting and effective parent
-child communication about sexuality and sexual risk reduction for parents of 9-12 year olds, with the
prospect of expanding to parents of teenagers at a later stage. FMP recognizes that many parents and
guardians may need support to effectively convey values and expectations about sexual behavior and
communicate important HIV, sexually transmitted infection, and pregnancy prevention messages to their
children. The ultimate goal of FMP is to reduce sexual risk behaviors among adolescents, including delayed
onset of sexual debut, by giving parents tools to deliver primary prevention to their children. Families Matter!
is delivered over five consecutive sessions where each lasts for three hours. Each session builds upon the
foundation laid in the previous session. Activities will be implemented in accordance with the NDOH
These activities support the PEPFAR 2-7-10 goals and the USG five-year strategy by ensuring close
collaboration with the NDOH in the area of AB and youth HIV-related activities. This support strengthens
NGO and FBO activities and contributes to seven million new infections averted.
Continuing Activity: 14058
14058 7966.08 HHS/Centers for National 6698 500.08 CDC Support - $1,032,425
7966 7966.07 HHS/Centers for National 4393 500.07 CDC Support $620,000
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Table 3.3.02:
These FY 2008 activities have not yet been implemented:
Families Matter! will be implemented beginning in September 2008. Many of the Centers for Disease
Control (CDC) funded youth partners will be involved in the adaptation and piloting of the curriculum of
Families Matter!. Families Matter! is an HIV/AIDS prevention initiative that targets parents that will ensure
that youth are getting the same HIV prevention messages at schools, at home and through non-
governmental organizations (NGOs) that are implementing life-skills and peer education programs in their
communities. FY 2009 activities will ensure scale-up of the Families Matter! curriculum.
Once the funding of Health Sciences Research Council's (HSRC's) healthy relationships initiative becomes
available in December 2008; the prevention specialist will develop a strategy for implementation of a
prevention with positives strategy across CDC funded treatment and care partners.
----------------------
AIDS programmatic support to the national and provincial Departments of Health. In addition, NDOH relies
on CDC to implement activities that address NDOH's emerging priorities, providing financial and technical
support more quickly than the systems of NDOH allow. PEPFAR other prevention-specific activities are
represented on the NDOH operational plan, and contribute to the overall implementation of the national HIV
and AIDS program. During FY 2007, CDC participated in the development of the Accelerated HIV and AIDS
Prevention Strategy. During this process, a number of activities where identified and prioritized by the
NDOH. These include activities focusing on prevention with positives (PwP); activities targeting parents,
and activities focused around young women between the ages of 20 and 30. The PwP activities will
complement the PwP activities within the CARE portfolio.
The aim of the "In Support of the NDOH other prevention" project is to provide technical assistance to the
NDOH and provincial health departments to ensure expansion of existing prevention efforts in all nine
provinces of South Africa. In addition this project provides ensures technical assistance and implementation
of new and innovative projects in the prevention arena. Two new prevention initiatives will be piloted in
South Africa using FY 2008 PEPFAR funding. These include "Families Matter!!" and a clinic-based
prevention with positives initiative. The major emphasis area is training with a particular focus on in-service
training. Other emphasis areas include development of network/linkages/referral systems and local
organization capacity development. Target populations for these activities include healthcare workers,
community-based and non-governmental organization, the general population, including children aged 10-
18 years, youth, parents, people living with HIV (PLHIV) and discordant couples. A particular focus of this
activity is prevention with positives. Addressing prevention with HIV-infected patients is an important part of
a comprehensive prevention strategy. Through healthy living and reduction of risk behaviors, these
prevention interventions can substantially improve quality of life and reduce rates of HIV transmission. The
goal of these interventions is to prevent the spread of HIV to sex partners and infants born to HIV-infected
mothers and protect the health of infected individuals. The rapid scale-up of HIV care and treatment has
created an opportunity to reach many HIV-infected individuals with prevention interventions on a regular
basis.
FY 2008 funding will be used to building the capacity of local organizations supported by the NDOH that are
working with in the area of other prevention. Capacity building will be achieved through the provision of
training on HIV and on the promotion of prevention messages. This will be done in collaboration with the
NDOH and in line with their priorities. Prevention messages and activities will target the general population
and will focus on reducing concurrent partners, correct and consistent condom use, and behavior change
messaging.
ACTIVITY 2: Families Matter!!
FY 2008 PEPFAR funding will be used to begin to adapt and implement the Families Matter!! Program
(FMP). FMP is an evidence-based, parent-focused intervention designed to promote positive parenting and
effective parent-child communication about sexuality and sexual risk reduction for parents of 9-12 year olds.
FMP recognizes that many parents and guardians may need support to effectively convey values and
expectations about sexual behavior and communicate important HIV, STD, and pregnancy prevention
messages to their children. The ultimate goal of FMP is to reduce sexual risk behaviors among adolescents,
including delayed onset of sexual debut, by giving parents tools to deliver primary prevention to their
children. Families Matter!! is delivered over five consecutive sessions where each lasts for three hours.
Each session builds upon the foundation laid in the previous session. Activities will be implemented in
accordance with the NDOH.
ACTIVITY 3: Prevention with Positives
HIV clinics and hospitals will be supported to adapt and implement a comprehensive package of prevention
interventions for HIV-infected individuals in care and treatment settings. Two provinces will be selected to
pilot the intervention, namely Free State and Mpumalanga. The prevention interventions include provider-
and counselor-delivered prevention messages, family planning counseling and services to HIV-infected
Activity Narrative: women and their partners, STI management and treatment, and testing of partners and children.
Specifically, health care providers will be trained to deliver targeted behavioral messages to patients on
disclosure, partner testing, and sexual risk reduction (abstaining or being faithful and using condoms
consistently) during all routine clinic visits. Providers will be trained to deliver family planning counseling and
services (funded through wrap around funds) to HIV-infected women and their partners in the HIV clinic
settings and these services will be integrated into the HIV clinic. In addition, providers will be trained to
manage and treat STIs in the HIV care and treatment setting. Lay counselors will be placed in these
settings for more in-depth prevention counseling beyond what health care providers have the time to
address. They will counsel persons living with HIV on several key prevention issues, including sexual risk
reduction, disclosure, adherence, reduction of alcohol consumption, and testing of sex partners and children
in the HIV clinic setting. These interventions will be implemented using the CDC's HIV Prevention in Care
and Treatment Settings Prevention Package, which includes several training packages and job aids. Other
prevention is addressed by all providers in all components of the intervention. Medical providers will
promote consistent condom use with all patients during each clinic visit. Mid-level providers and lay
counselors will routinely recommend consistent condom use through tailored prevention messages. In
addition, condom use is promoted in the Family Planning intervention as a method of dual protection.
Condom use is also promoted as part of STI management as a method for reducing STI transmission and
acquisition. In addition to recommending condoms and providing educational materials on condoms, clinics
will stock an adequate supply of male condoms to distribute to each HIV-infected patient at every clinic visit.
ACTIVITY 4: Women 20-30
FY 2008 funding will be used to work with the NDOH to refine its prevention strategy targeting young
women between the ages of 20-30. Funding will be used to assist the NDOH in integrating HIV prevention
activities within the family planning setting. Activities will be aimed at the Provincial Maternal Child and
Women's Health Coordinators. These provincial coordinators meet quarterly to discuss pertinent issues
affecting women and children in their provinces and develop strategies to address these challenges. FY
2008 funding will be used to facilitate two quarterly meetings that address integration of HIV prevention into
family planning services. At the first quarterly meeting, the facilitator will ensure that an implemental
integration strategy specific to each province is developed. Thereafter, at the subsequent meeting,
provincial coordinators will be required to report on progress, and challenges relating to the integration of
HIV prevention and family planning services.
Continuing Activity: 14063
14063 14063.08 HHS/Centers for National 6698 500.08 CDC Support - $200,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.03:
The project will increase access to care and support services by implementing a community wellness
program through support groups. This program will aim at empowering people living with HIV (PLHIV) to be
more involved in managing their illness. The projects will also seek to strengthen home-based care
programs by providing funding to community-based organizations, building their capacity through training of
carers on care and support programs and a family-centered approach to care and support activities.
Activity 1: Establishing wellness programs in support groups
The projects will recruit PLHIV from counseling and testing sites to join support groups where they will
receive information, counseling, coaching and support and HIV and AIDS related issues. PLHIV will be
assisted in the following: (acceptance of status, disclosure, prevention with positives, HIV and AIDS and
TB/HIV, alcohol and substance abuse and HIV and AIDS, treatment literacy, nutrition assessment and
counseling and treatment adherence. PLHIV will be encouraged to bring their family members and other
members of the community for care and support services related to HIV and AIDS.
Activity 2: Family centered Approach to Care and Support services
The projects will strengthen home-based care services and train carers on family counseling and testing,
prevention messages for the family, prevention with positives, water and sanitation within the home
environment, and infant follow-up including growth monitoring. CBOs will be contracted to provide home-
based care services to PLHIV and their families.
---------------------------
The aim of this project is to provide technical assistance to the National Department of Health (NDOH) and
provincial health departments to ensure expansion and integration of palliative care services within all
palliative care programs, including PEPFAR, in all provinces. Target populations for these activities include
host country government, healthcare workers and community healthcare workers. PEPFAR funds will be
used to employ one full time palliative care technical advisors to be placed at CDC and one full time
palliative care technical advisor in each of the nine provinces to assist with the coordination of palliative care
activities at provincial and district level, enhance capacity of provincial and district staff by providing support
and technical assistance for the implementation of the Basic Care Package at district level in all nine
provinces. The funds will also be used as part of a joint (inter-agency) APS to attract new partners to
implement the Basic Care Package for PLHIV who do not qualify for ARV treatment.
The goal of the National palliative care program is to ensure the universal access to palliative to all PLHIV
and family members especially those who do not qualify for ARV therapy thus establishing a continuum of
care from testing HIV positive to end of life care.
ACTIVITY 1:
The technical advisors at provincial level will be responsible for coordinating the implementation of the Basic
Care Package and the integration of pain assessment and management into HIV care services at district
level. This will ensure consistency and quality across all palliative care services and will build capacity within
the provincial DOH to monitor and support palliative care services. It is expected that these advisors will be
able to support and advocate for supportive palliative care policies at the national level and within the
provinces respectively and ensure that these policies are in line with the South Africa National Strategic
Plan for HIV and AIDS. These coordinators will liaise with provinces and work across all PEPFAR partners
within the provinces to ensure quality palliative care services are rendered according to national and
PEPFAR guidelines. They will also provide technical assistance at provincial level in monitoring and
evaluation of Care programs at district level.
ACTIVITY 2:
Funds will be utilized in the joint agency APS to attract new partners to implement the Basic Care Package
in all nine provinces. USG is seeking partners to implement services in: acceptance of status, disclosure,
screening and treatment of opportunistic infection (cotrimoxazole and INH prophylaxis), nutrition
assessment and counseling, pain and symptom screening and management, knowledge of HIV infection
and disease progression, ART and treatment adherence, TB treatment and adherence and basic hygiene
and safe water. Addressing prevention with HIV-infected individuals is an important part of a comprehensive
care strategy. Through healthy living and reduction of risk behaviors, these prevention with positives
interventions can substantially improve quality of life and reduce rates of HIV transmission. The goal of
these interventions is to prevent the spread of HIV to sex partners and infants born to HIV-infected mothers
and protect the health of infected individuals. The rapid scale-up of HIV care and treatment has created an
opportunity to reach many HIV-infected individuals with prevention with positives interventions on a regular
basis. Emphasis will also be placed on accessing gender equity in care programs. USG is seeking partners
to implement these services in hard to reach rural areas.
The main beneficiaries for this program will be PLHIV who will be encouraged to compete. This program will
contribute to 2-7-10 goals by ensuring the implementation of quality palliative care and increasing access to
palliative care services.
Continuing Activity: 14071
14071 14071.08 HHS/Centers for National 6698 500.08 CDC Support - $1,285,000
Table 3.3.08:
With the appointment of a new Deputy Director-General responsible for oversight of the HIV & AIDS, TB,
and Maternal and Child Health Program, it is expected that support to the Department of Health will
increase in FY 2009, as it has already been seen in FY 2008, with increased support to the Free State and
Eastern Cape Health Departments, and financial support set to expand to other provinces, including the
North West province.
As per the expanded vision in PEPFAR II, and the need to provide comprehensive support, funding to
support all the components of the Comprehensive Plan for HIV and AIDS Care, Management and
Treatment (CCMT), including integrating prevention with positives, maternal and child health, pediatric care,
support and treatment, and TB-HIV integration.
Activities commenced in FY 2008 and expected to continue in FY 2009 include:
a) Implementing the community IMCI module through the capacity building of community health workers
currently involved in supporting ART adherence at home and community level;
b) Printing of revised guidelines on HIV care and treatment, including management of people living with
HIV;
c) Support for additional staff and related travel costs; and
d) Community mapping of HIV care and treatment services.
---------------------------------
PEPFAR funding is set aside to support the National Department of Health (NDOH) in the implementation of
the Comprehensive Plan for HIV and AIDS Care, Management and Treatment, by providing financial and
technical assistance to ensure greater access to antiretroviral treatment (ART).
This is an ongoing activity in support of the National Department of Health, and has received PEPFAR
funding since FY 2005. The activities are implemented by CDC staff supporting the National Department of
Health, and will, when necessary, involve contracting out services.
ACTIVITY 1: CDC Staff Member Costs
Staff and travel costs for a locally hired CDC staff member to provide support to the National Department of
Health (including the nine provincial health departments) when required in the implementation of the
Comprehensive Plan. This includes site visits to PEPFAR-supported treatment sites, and regular provincial
consultations with PEPFAR partners working within a specific province to ensure coordination and
integration with the South African Government (SAG).
ACTIVITY 2: Meetings with Stakeholders
At least six meetings will be held with external stakeholders, including those organizations supported by
PEPFAR. These meetings are held to discuss new developments in ART, program progress,
implementation challenges, and creating new partnerships. Provincial coordinators for ART programs are
involved in these meetings (national meetings). In addition meetings are held at provincial level to
strengthen coordination at local level by mapping service provision at district level, determine gaps, and
direct support.
ACTIVITY 3: Communication Materials
FY 2008 funds will be used to develop and distribute communication and marketing materials to the nine
provincial management teams and PEPFAR partners relating to ART. This will focus specifically on job aids
to ensure patients are properly managed once they test HIV positive. It also includes the distribution of
technical materials to strengthen the five priority areas: human capacity development; pediatric HIV care
and treatment; scaling up HIV counseling and testing; TB/HIV integration; and initiating ART at primary
health care level.
ACTIVITY 4: Training
FY 2008 PEPFAR funds will be used for training meetings as requested by the National Department of
Health, including training in the integrated management of childhood illnesses (IMCI) with a focus on
pediatric ART.
ACTIVITY 5: Longitudinal Surveillance
FY 2008 funding will be used to support the National Department of Health effort to implement longitudinal
surveillance (in previous COPs referred to as LSTEP). This activity will supplement Department of Health
funding for surveillance. The sample will include both PEPFAR and non-PEPFAR supported sites to ensure
representivity. This will include a retrospective sample cohort of persons on treatment with 6- and 12-month
outcome data, and the ongoing monitoring of those still on therapy (at 6-month intervals), and a prospective
Activity Narrative: cohort, which will collect information on a sample of people newly initiating ART and tracking the individuals
over a period of time at 6-month intervals.
ACTIVITY 6: Monitoring and Evaluation
PEPFAR funds will be used to provide support to the Department of Health in the design and
implementation of standardized pre-ART and ART registers. This activity will also include the training of
data capturers to strengthen the collection of ART data at facility level.
These activities contribute to the implementation of the 2-7-10 PEPFAR goals by strengthening the capacity
of the National Department of Health and the nine provincial health departments to implement the
Comprehensive Plan, and ensure improved access to treatment.
Continuing Activity: 14061
14061 3282.08 HHS/Centers for National 6698 500.08 CDC Support - $873,000
7368 3282.07 HHS/Centers for National 4393 500.07 CDC Support $1,342,728
3282 3282.06 HHS/Centers for National 2680 500.06 CDC Support $357,272
Table 3.3.09:
The National Department of Health (NDOH) Activities 9-13 will be completed and will not be funded with FY
2009 funds.
FY 2009 activities will seek to enhance TB/HIV support for the NDOH and provincial Departments of Health.
An example of such an activity is currently being undertaken in one district in the Eastern Cape where
PEPFAR partners are working collaboratively to implement an integrated TB/HIV program. This activity will
be expanded to other provinces in FY 2009. Other proposed activities are to collaborate with stakeholders
to expand provision of training focused on HIV counseling and testing, and quality management systems,
TB infection control, TB specimen collection, isoniazid preventive therapy, TB screening, and TB/HIV
recording and reporting. Where feasible, training will be delivered through the existing Regional Training
Centers. United States government staff will work with provincial departments of health on advocacy,
counseling, social mobilization and improving TB/HIV referral systems. Technical assistance will also be
provided to primary schools that have been selected by the South African government as Health Promoting
Schools for TB/HIV training and other support as requested.
Finally, geographic information systems (GIS) mapping activities for PEPFAR partners will be scaled up to
guide partners' expansion of TB/HIV activities strategically.
---------------------
Tuberculosis (TB) is the leading cause of death among people living with HIV/AIDS, and addressing TB/HIV
is an important part of meeting the Emergency Plan 2-7-10 goals. CDC/PEPFAR carries out additional
activities to strengthen and enhance TB/HIV activities in support of the South Africa National Department of
Health (NDOH). Activities supported with these funds focus on TB/HIV program and laboratory support.
ACTIVITES AND EXPECTED RESULTS:
Technical AssistanceCDC staff will provide technical assistance to the NDOH and related organizations
regarding TB/HIV program and laboratory activities. Staff needs consist of one CDC direct-hire, 2 locally-
employed staff (TB/HIV clinical coordinator and TB/HIV monitoring and evaluation advisor), 2 contractors
(TBHIV laboratory officer and TB/HIV laboratory training advisor).
TB/HIV SurveillanceThe ETR.Net is the software application conceived and managed by the NDOH
National TB Control Program (NTCP) and reflects program-defined needs and inputs. This has been
developed by WamTechnology CC, a South African private information technology firm. WamTechnology
works with CDC South Africa and the NTCP to develop software and provide support for the ETR.Net. This
software has been modified to track HIV testing and care services among TB patients. The TB/HIV module
will be fully implemented during FY 2008. Expected results include strengthening of TB/HIV recording and
reporting system to include patient-level data collection on TB/HIV (TB patients counseled and tested for
HIV, started on cotrimoxazole (CTX), referred for HIV care and starting antiretroviral treatment (ART). This
will in turn be used to bolster referral systems between services leading to more comprehensive care for
TB/HIV patients.
ACTIVITY 3:
MDR/XDR reportingFunds will be used to improve reporting and surveillance systems for drug-resistant TB
cases. In collaboration with the NDOH, funds will be used to expand the number of users using a web-
based system to improve the management and reporting of MDR and XDR-TB cases, data mining activities,
and surveillance analysis of drug-resistant TB cases. Data linkages with the laboratory information
management systems within the National Health Laboratory Services will be expanded.
ACTIVITY 4:
Infection ControlIn collaboration with the NDOH, funds will support the implementation of a national TB
infection control plan including a national training agenda, standardized training materials, involvement of
other partners (universities, research centers) to accelerate provision of trainings within South Africa.
Expansion of activities will also support expansion of an infection control warmline and/or technical
assistance unit for ongoing technical assistance requests from provinces and partners.
ACTIVITY 5:
TB/HIV Pediatric clinical managementIn collaboration and with support from the NDOH, funds will be used
to develop a standardized pediatric TB/HIV clinical management training course materials reflecting SA
NDOH and WHO guidelines, initiate efforts to provide access to training via online services, and to
implement a warmline consultation service to provide pediatric TBHIV clinical management guidance to
providers.
ACTIVITY 6:
TB/HIV integrationIn collaboration with the NDOH, expand implementation of field-based DOT program in 4
districts with high default rates. Efforts would include treatment monitoring in addition to patient tracking and
management using Community health care workers. Project would be evaluated and compared to other
Activity Narrative: DOT models.
ACTIVITY 7:
MDR/TB/HIV clinical managementIn collaboration and with support from the NDOH, funds will be used to
expand efforts to provide access to MDR/TB/HIV clinical management training, and continued support for a
warmline consultation service to provide MDR/XDR/TB/HIV clinical management guidance to providers.
ACTIVITY 8:
TB/HIV Strategic PlanFunds will be used to support the implementation and monitoring of the TB/HIV
strategic plan for South Africa PEPFAR partners.
ACTIVITY 9:
TB/HIV Laboratory Quality AssuranceIn collaboration with the National Health Laboratory System (NHLS)
and the National Institute of Communicable Diseases (NICD), funds will be used to strengthening quality
assurance measures among laboratories and to strengthening existing and initiating new External Quality
Assurance (EQA) programs related to HIV and TB diagnostics. Activities will support measures to
strengthen reviews, measuring clinical performance, reporting indicators, and disseminating performance
reviews for action.
ACTIVITY 10:
TB/HIV Regional Laboratory Training Center (RLTC)With the availability of significant HIV and TB technical
and scientific resources within South Africa, NICD and NHLS are both well placed to continue to provide
regional laboratory support within Sub-Saharan Africa in these areas. Funds will be used, in collaboration
with NICD and NHLS to expand and strengthen existing TB and HIV regional support mechanisms and
enhance further collaboration with other PEPFAR-funded countries through the established RLTC. Regional
support will include TB and HIV related laboratory services and training initiatives.
ACTIVITY 11:
TB/HIV Laboratory capacityIn collaboration and with support from the NDOH, PDOH, NHLS, and NICD,
funds will be used to increase the national coverage of HIV and TB diagnostics and treatment monitoring
capabilities. Efforts will also include strengthening laboratory reporting systems and specimen transport
needs in support of rural clinics and laboratories. Efforts will focus to address existing gaps in laboratory
testing outreach and penetration.
ACTIVITY 12:
Laboratory Policy StandardsIn collaboration and with support from the NDOH, PDOH, NHLS, NICD,
National Institute of Occupational Health (NIOH), South African National Accreditation System (SANAS),
and the Medical Research Council (MRC), funds will be used to encourage and support the development
and implementation of a South African National Laboratory Strategy Plan. The plan will provide the vehicle
for establishing minimum standards and/or requirements for any laboratory (public/private) that performs
tests on human specimens and certify through issuance of a certificate those laboratories that meet the
certificate requirements. Efforts will also attempt to synchronize infection control standards and policies
across all TB/HIV laboratories.
ACTIVITY 13:
New TB/HIV Automation and TechnologiesIn collaboration and with support from the NHLS and NICD
through co-funding, funds will be used to assess existing, validate, and implement new automated
laboratory diagnostic equipment and high capacity instrumentation for TB and HIV. Activities will be carried
out to increase laboratory through-put for infant PCR, viral load, and TB diagnostics to meet increased
demand, as well as strengthening NHLS's ability to improve diagnostic, reporting and surveillance activities
in relation to TB and HIV.
Continuing Activity: 14059
14059 3045.08 HHS/Centers for National 6698 500.08 CDC Support - $3,654,550
7365 3045.07 HHS/Centers for National 4393 500.07 CDC Support $2,040,000
3045 3045.06 HHS/Centers for National 2680 500.06 CDC Support $600,000
Table 3.3.12:
In FY 2008, the South African Parliament enacted the some sections on the new Children's Act. This
included bringing down the age of consent to an HIV test to 12 years. The challenge is that most health
providers in public health facilities are not trained in discussing HIV issues with children as young as 12
years and so although the Act stipulates that children should be allowed to consent for an HIV test on their
own without parental consent, in reality they are not offered the service due to lack of training on the side of
health workers. The Centers for Disease Control and Prevention (CDC) will work closely with National
Department of Health and the provincial departments of health to train health workers in HIV counseling and
testing services for children and adolescents.
------------------------
provincial health departments to ensure expansion and strengthening of CT services in all nine provinces.
Target populations for these activities include host country government, healthcare workers, and community
healthcare workers. PEPFAR funds will be used to employ two full-time CT technical advisors to be placed
at NDOH. The technical advisors will assist with the coordination of CT activities, enhance capacity of
NDOH CT staff by providing support for the NDOH annual CT technical meeting, and to support the
implementation of provider-initiated testing and counseling (PITC) in five public facilities sites per province.
The goal of the National CT program is to ensure the universal access to HIV counseling and testing. The
purpose of this project is to provide technical assistance to NDOH by funding two CT technical advisors to
work within the NDOH on all aspects of the program. Responsibilities of the technical advisors include
focusing particularly on development of national guidelines on PITC and the training of healthcare providers.
The technical advisors will also monitor the implementation of PITC in all provinces. They will also assist in
the development and implementation of quality assurance guidelines around HIV testing.
The project will also support capacity building of healthcare workers and community healthcare workers,
development and implementation of provincial CT specific operational plans, strengthening of national and
provincial reporting systems, coordination of the national CT steering committee meeting, development of a
monitoring and evaluation system for early infant diagnosis and strengthening service delivery through the
implementation of systems strengthening activities.
ACTIVITY 1: Technical Assistance to NDOH
Technical assistance to NDOH will be conducted by two technical advisors. Although both will engage with
NDOH regularly, one of the advisors, who will be a locally employed staff person, will work at the National
program. Specific technical assistance to the national CT program will be around capacity building for all
cadres of healthcare workers, monitoring and evaluation, the development of protocols and guidelines, and
the implementation of PITC in all nine provinces.
The responsibility of the technical advisors will include support for the provision of quality HIV testing which
will require (a) the development and implementation of quality assurance guidelines on HIV testing; (b)
standardization of national quality assurance guidelines; and (c) supervision of quality training for all CT
coordinators, laboratory technicians and nurses who conduct HIV testing.
Support will also be provided for the accreditation of non-medical CT facilities according to the NDOH
requirements as well as the revision of all current training materials relating to CT.
In addition, PEPFAR funds will support skills enhancement of current NDOH and provincial staff by
providing support for the national CT technical meeting and attendance of NDOH CT staff at the
International HIV and AIDS meeting.
This program will contribute to 2-7-10 goals by ensuring the implementation of quality CT services and
increasing access to CT services.
Continuing Activity: 14060
14060 3046.08 HHS/Centers for National 6698 500.08 CDC Support - $1,847,540
7366 3046.07 HHS/Centers for National 4393 500.07 CDC Support $1,275,000
3046 3046.06 HHS/Centers for National 2680 500.06 CDC Support $2,000,000
Table 3.3.14:
In close collaboration with the National Department of Health (NDOH) and the National Health Laboratory
System (NHLS), the CDC Laboratory Branch will provide HIV and TB laboratory programmatic support to
the national and provincial departments of health. The aim of the "In Support of the NDOH Laboratory
Infrastructure" project is to provide technical assistance to the NDOH and provincial health departments to
ensure expansion and strengthening of existing laboratory services in all nine provinces. Activities will be
carried out to address laboratory-specific unmet needs that impede full implementation of national
laboratory programs, ensure uniform quality assurance measures and effective monitoring and evaluation
among laboratories; strengthening of laboratory reporting systems; and promote efforts to synchronize
infection control activities in collaboration with the National Institute of Occupation Health (NIOH); The major
emphasis area is policy driven, with additional support in training, accreditation, establishing Public Private
Partnerships (PPPs), Quality Assurance and Quality Control (QA/QC), strategic planning, technology
development and establishing possible collaborations and coordination of training and other possible
support networks for laboratories in South Africa.
With the establishment of a Laboratory Branch within the South Africa CDC, Global AIDS Program in FY
2008, current funds will be used to support the implementation and to provide support to the National
Department of Health (NDOH) through collaboration with the NHLS, National Institute of Communicable
Diseases (NICD), and NIOH. The NHLS is accountable to the NDOH through its Executive Board and is
responsible for public sector laboratory services. The NHLS also governs activities and provides funding to
the NICD to provide surveillance, research and programmatic operations, as well as funding to the NIOH for
policy development activities related to occupational health.
ACTIVITY 1: National Policy
Collaborate and support the development and implementation of effective NDOH laboratory monitoring
indicators and assessment mechanisms to assist in the monitoring of national laboratory quality, HIV rapid
testing, and to assess overall laboratory coverage; Establish a working group with Public/Private
laboratories to strategize further collaborative partnerships, and to establish a national lab advisory
committee
ACTIVITY 2: Training
Promote and strengthen quality of HIV testing in public Counseling and Testing (CT) sites within SA and
with PEPFAR partners; Strengthen specimen collection techniques and result management activities in
public and PEPFAR TB and HIV sites; Strengthen laboratory safety and infection control practices within
laboratories in TB and HIV sites; Continue to provide regional and local laboratory support through the
established African Center for Integrated Laboratory Training (ACILT).
ACTIVITY 3: Services
Support Public/Private laboratories in acquiring International Standards Organization (ISO) and the South
African National Accreditation System (SANAS) accreditation as requested that are involved in TB & HIV
activities.
ACTIVITY 4: Capacity Development
This activity is broadly focused on capacity development and improvement of laboratory activities within
public primary health facilities.
ACTIVITY 5: QA/QC
Support activities to improve quality of HIV testing in public CT sites and NHLS laboratories and with
PEPFAR Partners
ACTIVITY 6: Geographical Information Systems (GIS) Mapping
Identify specific laboratory service coverage issues within SA and with PEPFAR partners; Integrate existing
PEPFAR partner GIS data with laboratory GIS data for further strategic planning.
ACTIVITY 7: Technology
Continue to support technology development to decrease lab burden and increase laboratory throughput
and turn around time; Continue to support the development of an integrated laboratory patient management
system with NHLS (biometrics) to increase the ability of clinics to track patients and to incorporate real-time
laboratory test results.
ACTIVITY 8: Conferences/Workshops
Establish a Public/Private Laboratory Conference to discuss possible collaborations and possible
coordination of training and other possible support networks.
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $16,992,903
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
For FY 2009, South Africa (SA) Strategic Information (SI), as part of the larger PEPFAR program, is oriented toward further
aligning health management information systems (HMIS) and monitoring and evaluation (M&E) systems to South African
government (SAG) standards. SASI will enhance the use of SI with an emphasis on strengthening surveys and surveillance,
understanding data quality and using geographic information systems (GIS), and moving toward comprehensive SI capacity
building activities. SASI accomplishments include: 1) developing and using an electronic, web-based partner reporting system, the
Data Warehouse (DW); 2) incorporating systematic data quality assessments into partner performance cycles; 3) developing a
South Africa SI Manual (the South Africa-specific indicator guide) for use by implementing partners; 4) hosting M&E capacity
building workshops held several times per year; and 5) conducting innovative evaluations of partner performances, which are
embedded into the FY 2009 COP process, and include key members of the SAG and USG HQ technical staff.
Despite these accomplishments, the SI team faces significant challenges in FY 2009 including: 1) the disparate nature of HMIS
among PEPFAR-supported implementing partners, the SAG systems supported by the Departments of Health and Social
Development, and partners' systems supported by other donors; 2) the tendency for abundant collection and reporting of results-
oriented data among all stakeholders without due attention paid to data quality or an understanding or appreciation of their
broader use; and 3) a lack of human capacity in the country team, resulting in SI team members spending much time on COP
issues and partner management rather than core SI functions. Addressing these challenges is an essential goal for FY 2009;
implementation plans are outlined below.
Functioning of Strategic Information Team within the Country Team
The SI team comprises one M&E Advisor each from CDC and USAID who both serve as the SI liaisons to OGAC. An additional
M&E Advisor is seconded to the National Department of Health (NDOH). The team has expanded to include two M&E assistants,
one each at CDC and USAID, an HMIS specialist, and an epidemiologist/surveillance officer based at CDC. In FY 2009, a USG SI
Knowledge Management specialist based at USAID will take the lead on developing the USG GIS strategy, in addition to serving
as full-time manager of the USG DW. Like other PEPFAR focus countries, the SI team also relies upon key in-country partners to
help implement the USG SI vision. In SA, John Snow International was recently awarded a contract to assist the SI team to
implement activities such as training, provision of technical assistance to implementing partners and the SAG, GIS data use, etc.
The SI team plans and implements activities as one USG team and receives final inter-agency vetting and approval. In previous
years, the team deliberated within the context of an SI Technical Working Group (TWG) consisting of members from the other
USG agencies and program areas. The "Staffing for Results" exercise conducted in 2008 led to a decision to disband the SI TWG.
With the added strength of the new hires mentioned above, the SASI team plans to develop a more broadly based Technical
Team that will greatly enhance its ability to plan and lead SI activities that benefit the program.
The SASI team developed the DW to which PEPFAR partners submit their plans and reports. All USG partners currently use the
same templates and reporting guidelines. Results for OGAC reports are jointly drafted by all USG agencies. In FY 2009, a high
priority is set on the transition of the DW from an in-bound reporting platform to an interactive database that will allow users to
customize queries on indicator results by program area, by site, and by geographical unit across reporting periods. The new USG
DW manager will develop a scoring system per quarter to track the transition; all changes will be vetted and approved by DW user
groups. The SI team views the DW as a hub for a broad set of data use activities; hence, the long-term goal is to expand the DW
beyond its narrow PEPFAR reporting functionality to a role that can be widely used and appreciated by SAG stakeholders.
The SI team leads the formulation and review of country targets. Direct targets are a sum of partner targets. The USG Activity
Managers and SI Advisor review partners' targets to ensure that they are reasonable and achievable. All partners report treatment
activities on a quarterly basis by site. A customized version of the Track 1 treatment form is used. All other partners report on a
semi-annual and annual basis.
The total targets for prevention of mother-to-child transmission and TB/HIV are based on national estimates to which PEPFAR
contributes. For FY 2009, the SI team will provide substantial leadership and technical assistance toward finalization of a national
orphans and vulnerable children (OVC) management information system, which will be linked to the OVC results reporting
templates of PEPFAR-funded partners, and to other non-PEPFAR OVC organizations. This activity will be implemented in
response to requests from the National Department of Social Development (DOSD) and is an important example of how SI
contributes to the third of the Three Ones. Upon completion of this national harmonized database, the SI team expects to have
acquired the necessary OVC data to estimate the number of OVC benefiting from USG indirect support.
The antiretroviral treatment and counseling and testing targets are based on current uptake and projections and reflect
modifications in national policy. The total HIV care and support target is difficult to measure since it is not collected at the national
level as defined by OGAC. The SI team has a wealth of experience in formulating targets and in developing data systems to assist
with the supporting of results reporting against such targets. During FY 2009, the SI team will further enhance the underlying
reporting and data systems and will continue to provide technical assistance to USG and to the OGAC SI Division in how results
and targets are formulated, interpreted, and reported in the field.
Overarching SI System
M&E is a priority in the South Africa HIV & AIDS and STI National Strategic Plan, 2007-2011 (NSP) and the USG will continue to
respond to these needs by providing direct funding and targeted technical assistance to various SAG departments. In
collaboration with the National Department of Health (NDOH) and other key stakeholders, the USG has contributed to the
development of the NSP's M&E framework. During FY 2009, the USG aims to increase collaboration and harmonization of M&E
systems. Currently, a District Health Information System (DHIS) exists, but it is not implemented in all provinces, and the quality
of the HIV data is variable. The SI team plans to align the PEPFAR results reporting systems with the DHIS. Additionally, the SI
team continues to emphasize data quality of reported results via targeted capacity development workshops involving SAG M&E
personnel that affects DHIS reporting as well as PEPFAR required results. Finally, data are included in the UNGASS report but
timeliness and reliability of data reporting remain a concern.
Several SAG departments work independently of the NDOH on HIV issues. While the USG embraces the goal of supporting one
M&E system, it is often necessary to assist in building M&E systems within the different departments, taking care to assure
integration whenever possible (see above example with DOSD and the national OVC database).
The SI team emphasizes rapid and comprehensive responses to SAG requests for technical assistance in SI. For FY 2009, the
response strategy involves forming close partnerships with relevant SAG stakeholders so that assistance is more sustainable (i.e.,
all SI tools are shared and adapted for the particular context). The team's long-term goal is to turn over SI functions and activities
to SAG counterparts and local partners. The strategy is based on rigorous M&E capacity development at increasingly lower levels
and harmonization of measurement and data collection objectives.
The SI team has worked with several provincial departments of health to provide technical assistance in M&E in the past year; this
support will be continued in FY 2009. Coordination with the NDOH had been strained, but collaboration is expected to accelerate
during FY 2009. This is partially because of the groundwork laid during FY 2008 and partially because of the new enthusiasm for
public health and HIV activities engendered by the new direction and leadership within the NDOH.
Surveys and Surveillance
Seroprevalence and behavioral surveillance activities in the general population are primarily supported through the National
Institute for Communicable Diseases, the Medical Research Council (MRC), and the Human Sciences Research Council (HSRC).
These organizations and the SAG drive the process; PEPFAR provides partial support for these surveys, and the SI team
provides technical assistance with survey design and implementation. Johns Hopkins University in collaboration with USG
PEPFAR partners will implement the next national communication survey during FY 2009 to monitor trends in behavior in relation
to media exposure. The SI Team plans to incorporate these surveillance activities and survey findings into its capacity
development activities to enhance data use among partners and stakeholders. Thus, the analysis and further use of these survey
results will be an important set of activities for FY 2009.
The USG continues to provide technical assistance for these activities, including direct personnel support at the national and
provincial health departments, development of surveillance systems, and training to specific NDOH programmatic units.
Health Management Information Systems (HMIS)
To date there is not a comprehensive SAG HMIS strategy. As a result, the SI team looks for key opportunities to leverage
PEPFAR resources toward the use of systems that complement existing SAG systems and help pave the way toward
harmonization. For FY 2009, the USG HMIS strategy addresses the challenge of harmonizing systems toward national standards.
PEPFAR supports HMIS at the partner level, but the USG has not been prescriptive about design and implementation. Many
treatment partners have developed systems in the absence of a national or provincial MIS. An HMIS assessment of treatment
partners was conducted in FY 2008. Results indicated the importance of harmonization of such systems to ensure communication
with facility level systems and interoperability with the DHIS, which will be the focus of data quality improvement activities.
Monitoring and Evaluation
A local PEPFAR contractor routinely conducts Data Quality Assessment (DQA) to build partner M&E capacity, and to ensure
results reported to OGAC are valid and reliable. Through FY 2008, the rapid increases in PEPFAR funding and number of
partners in SA limited the time and resources that could be expended on evaluating partner performance and using data
effectively for program planning. The SA Team awarded a contract to a SA organization to enhance the ability of USG Activity
Managers to measure partner performance and to assess data quality. The SI team has made considerable progress in improving
data quality among implementing partners; however, data quality within the SAG M&E system remains a concern. Priority for
strengthening data quality with the SAG systems is a priority for FY 2009.
The USG conducted a substantial partner evaluation in FY 2008 as part of COP preparation. The evaluation critically reviewed
partners' performance, current and future plans, and budgets. Results of the evaluation directly affected FY 2009 COP budgets
awarded to implementing partners and provided useful feedback to partners on current and future implementation strategies. SAG
members were fully involved in this partner evaluation process. A further refined methodology will be used during the FY 2010
COP preparations.
The USG supports a comprehensive and systematic approach to partner M&E capacity building that will continue during FY 2009.
These activities include: 1) M&E workshops that assist partners in developing M&E plans; 2) DW enhancement to assist USG and
partners with the collection, reporting, and analysis of data; 3) DQA initiative mentioned above; and 4) the establishment of a
fellowship program to place recent South African master's degree graduates with partners in need of more intensive M&E training.
The success of these four initiatives is substantial and has been documented in previous COP narratives. The plan for FY 2009 is
to go beyond the standard five-day M&E training workshops and offer a series of trainings that reflect a broader range of SI topics
to a wider set of participants. The SASI team intends to test various methodologies and metrics to evaluate training effectiveness.
The vision for capacity building involves a comprehensive program in SI training, akin to a graduate program in an applied field
with an emphasis on developing cadres and networks of skilled SA practitioners.
Finally, in January 2009, the SI team has requested that a team of people with SI expertise from USG HQ agencies visit South
Africa to conduct an external evaluation of the SI portfolio. The primary objective of this visit will be to guide a long- and short-term
vision of the SI strategy in South Africa.
Table 3.3.17:
PEPFAR funds will support the National Department of Health (NDOH) to implement Epidemiology and
Strategic Information (ESI) activities in the HIV and AIDS programs. Emphasis areas include the
development of Health Management Information Systems (HMIS) strategies and their implementation
monitoring and evaluation (M&E) support, epidemiologic use of data, expansion of survey and surveillance
activities and additional staff for ESI. Target populations include South African policy makers, members of
the National AIDS Control Program, and other staff in the NDOH. Activities described in this COP entry
have been requested by the national or provincial Departments of Health.
The NDOH lacks trained M&E personnel for specialized information gathering and management tasks. Data
on disease surveillance and HIV and AIDS service uptake are often not up to standard or not transmitted in
a timely manner, negatively affecting the NDOH's ability to analyze epidemiological trends effectively. CDC
has provided technical support for M&E since 2003, including developing standard indicators, policies and
guidelines, and training tools. Funds will be used to expand the NDOH's M&E activities, especially its
human capacity development at the national and provincial levels.
ACTIVITY 1: Training
This activity is ongoing and in the past year has primarily focused on improving data in the CT, PMTCT and
Care and Support programs.
Funds will be used to supplement the cooperative agreement funds with the NDOH and will be used to
conduct M&E trainings for HIV and AIDS program staff at the national, provincial and district levels. The
M&E trainings will include both program and information officers and will cover the importance of M&E and
epidemiologic use of data in measuring the effects of the HIV epidemic. In addition, focus will be given to
the new PMTCT indicators created by NDOH and currently being rolled out to provinces. Staff will be
trained to use the District Health Information System (DHIS), health indicators, and more sophisticated M&E
techniques for program planning. HIV and AIDS program staff will also be trained in data management
techniques.
ACTIVITY 2: Staff
There are seven ESI positions included in this COP entry.
(1) An M&E Advisor, who is seconded to the NDOH HIV and AIDS Directorate, will continue to provide
technical assistance to the NDOH and provincial health departments to support data use and analysis
efforts at the NDOH.
(2) An M&E Advisor based at the CDC office will continue to work closely with the NDOH and with other
PEPFAR implementing partners on data issues, reporting and other program monitoring and evaluation
(3) A Health Management Information Systems (HMIS) Specialist will continue to work closely with the
NDOH and with other PEPFAR implementing partners to develop and implement HMIS strategies and
ensure alignment at the national level.
(4) An M&E Assistant will continue to work closely with the M&E Advisor based at the CDC office to provide
feedback to NDOH and other PEPFAR implementing partners with regard to data quality and analysis of
data from the data warehouse.
(5) A Surveillance Program Specialist/Epidemiologist will be hired to expand epidemiologic technical
assistance to the NDOH and other PEPFAR implementing partners involved in surveys and surveillance.
(6) A HMIS assistant/GIS Mapping Specialist will be hired to provide technical expertise to the NDOH and
other PEPFAR implementing partners to utilize mapping techniques and to inform our strategy.
(7) A Statistician will be hired to provide technical assistance to the NDOH and other PEPFAR
implementing partners for study design and sampling determinations and various analyses.
Additional funds will be used to support SI staff as per recommendations from the Staffing for Results
exercise or NDOH requests.
ACTIVITY 3: Support to the South African government (SAG)
Relations between the United States and South African governments are steadily improving. In an effort to
continue to strengthen this relationship, funds have been budgeted for technical assistance that both the
national and provincial Departments of Health frequently request on an ad hoc basis. These requests are
increasing on daily basis. Recent examples include technical assistance to the KwaZulu-Natal Premier's
Office for improving data quality and data use in the province, to the NDOH for conducting a Data Quality
Assessment of the TB/HIV data management system in the NDOH, to the North West province providing
M&E related activities and to the Northern Cape Department of Health providing data management and
capacity building.
ACTIVITY 4: Strengthening Management Information Systems
PEPFAR South Africa has prioritized the harmonization and coordination of MIS within PEPFAR-supported
partners and with the SAG M&E systems. The USG recognizes that as PEPFAR programs are scaling up
and a need exists for a more strategic plan for developing and implementing systems that focus on patient
care, community-based care, and managing aggregated data. The USG HMIS staff person will provide
Activity Narrative: support to partners, especially those working in the public sector, and will provide technical assistance to
the NDOH for harmonization of health systems and to the Department of Social Development on an MIS for
orphans and vulnerable children. In order to provide guidance to PEPFAR partners on the use of new
technologies when designing added functionalities to existing HMIS, FY 2009 will be expanded to allow for
new technologies to be trialed and tested using structured evaluation and assessment methodologies.
These technologies will include (but are not limited to) digital pens, quick forms, smart cards and cell
phones.
Improving the NDOH's ability to collect, process and utilize SI will directly contribute to improvements in HIV
and AIDS service delivery by having the information available for decision-making purposes. These
improvements, in turn, will have a positive impact on South Africa's ability to prevent new infections, care for
patients living with HIV, and to provide treatment for those with AIDS, in support of PEPFAR's goals. These
efforts also support the USG Five-Year Strategy for South Africa by building capacity within the South
African government.
ACTIVITY 5: GIS/Mapping
FY 2009 will be expanded to include mapping activities for PEPFAR related sites and services, geospatial
analysis and to acquire geospatial data sets and related consulting services. Internal GIS and mapping
capacity will also be built by staff attending selective training, acquiring the necessary software and
hardware tools and appointing the necessary skills.
ACTIVITY 6: Surveys and Surveillance
FY 2009 COP will be expanded to include survey and surveillance activities that involve sentinel
surveillance, TB/HIV co-surveillance, facility surveys and epidemic modeling. Triangulation and/or cross-
validation studies may also be developed and conducted to strengthen the information that has already
been collected.
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PEPFAR funds will support the National Department of Health (NDOH) to implement M&E activities in HIV
and AIDS programs. The major emphasis area for this program is the development of health management
information systems, with minor emphasis on improving information technology and communication
infrastructure, M&E and reporting, and proposed staff for Strategic Information (SI). Target populations
include South African policy makers, members of the National AIDS Control Programme, and other staff in
the NDOH. Activities described in this COP entry have been requested by the national or provincial
Departments of Health.
Funds will be used to conduct orientation sessions on M&E for HIV and AIDS program staff. The sessions
will focus on new and existing M&E officers, and will inform staff of the importance of M&E in measuring the
effects of the HIV epidemic. Staff will be trained to use the District Health Information System (DHIS), an
electronic database that tracks disease and health indicators, and trained to use relatively more
sophisticated M&E techniques for program planning. HIV and AIDS program staff will be trained in data
management techniques. This activity is ongoing and in the past year has primarily focused on improving
data in the PMTCT program.
There are four SI positions included in this COP entry.
(2) An M&E Advisor based at the CDC office will continue to work closely with the NDOH and with PEPFAR
partners, on management information systems, data issues, and activities with the Western Cape
Department of Health.
(3) A Management Information Systems (MIS) specialist, who has recently been hired, will conduct an
assessment of USG-supported MIS.
(4) An M&E Assistant will soon be hired to improve the data analysis of PEPFAR data and assist in
providing feedback to partners and the South African Government (SAG) about PEPFAR activities. The
USG is currently engaging with the provincial departments of health to improve collaboration and
communication about PEPFAR-funded activities. This position will assist in facilitating these activities in the
future.
Activity Narrative: exercise.
ACTIVITY 3: Support to the SAG
Relations between the United States and South Africa are steadily improving. In an effort to continue to
strengthen this relationship, funds have been budgeted for technical assistance that the national and
provincial Departments of Health frequently request on an ad hoc basis. Examples include technical
assistance to the KwaZulu-Natal Premier's Office for improving data quality and data use in the province
and assistance with conducting a Data Quality Assessment of the TB/HIV data management system in the
NDOH.
The South Africa PEPFAR Task Force is prioritizing the harmonization and coordination of MIS within
PEPFAR-supported partners and with the South African Government M&E systems. The USG recognizes
that as PEPFAR programs are scaling up, there is a need for a a more strategic plan for developing and
implementing systems that focus on patient care, community-based care, and managing aggregated data.
The new USG HMIS staff person will develop an investment strategy in MIS and work towards aligning or
improving communication between systems. He will provide support to partners, especially those working in
the public sector, and will provide technical assistance to the NDOH for harmonization of health systems
and to the Department of Social Development on an MIS for orphans and vulnerable children.
Continuing Activity: 14062
14062 3044.08 HHS/Centers for National 6698 500.08 CDC Support - $3,213,058
7364 3044.07 HHS/Centers for National 4393 500.07 CDC Support $500,000
3044 3044.06 HHS/Centers for National 2680 500.06 CDC Support $205,000
Estimated amount of funding that is planned for Human Capacity Development $250,000
