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
TITLE: Management and Staffing for DOD
NEED and COMPARATIVE ADVANTAGE:
The US Department of Defense (DOD) will provide technical and managerial support to two primary
programs: the Walter Reed HIV/AIDS Care Program in the Southern Highlands and activities with
PhamAccess International and the Tanzanian Peoples Defense Forces (TPDF). In the Southern Highlands,
the DOD, has been working directly with the Mbeya Referral Hospital (MRH) since June 2004 and the
Regional Medical Offices (RMO) of Mbeya, Rukwa and Ruvuma since June 2005 in rolling out treatment
throughout the Southern Highlands.
ACCOMPLISHMENTS:
Activities with the TPDF have expanded quickly in the past year from the one primary referral hospital,
Lugalo, to all seven hospitals now supporting services and a total of 2,466 on ART. Through its direct
relationship and technical support of the MRH and RMOs in Mbeya, Rukwa and Ruvuma, the Southern
Highlands now has 16 facilities (2007 SAPR) supporting ART services and boasts a combined patient-load
of over 10,000 on ART and 26,000 on care. By September 2008, the number of facilities will expand
significantly to 47, ensuring 50% of all facilities in all three regions are executing some level of ART related
services from identification, initiation, follow-up, and monthly dispensing. In support of roll out in the
Southern Highlands and to ensure quality services, the DOD has worked with the MRH in developing
supervisory teams, consisting of a medical officer, clinical office and nurse, which attend clinic days at lower
level facilities once or twice per month. DOD is currently working on strengthening similar teams as the
regional level to decentralize supervision in a tiered manner effectively ramping up expansion of coverage.
ACTIVITIES:
The Clinical Care Medical Director, directly supporting the DOD Walter Reed HIV/AIDS Care Program in the
Southern Highlands, is a US physician, retired Army, with over 20 years of experience in providing ART to
HIV positive individuals. This individual works as a member of the Mbeya Referral Hospital, fully accredited
to practice medicine in Tanzania. He has worked with the Department of Internal Medicine at this facility to
help establish its HIV Care and Treatment Center (CTC) as well as help maintain its day-to-day operations.
Along with MOH employees at the facility, he also works directly with the three regional medical offices
listed above to adapt CTC standard operating procedures to their particular needs. With the assistance of
one foreign service national (FSN) equivalent technical advisor, hired by the DOD, and Mbeya Referral
Hospital personnel, the Walter Reed Program undertakes supportive supervision throughout the Southern
Highlands for all CTCs.
In addition to in-country personnel, the DoD offers US-based technical assistance (TA) in this area.
Clinicians and laboratory personnel for support of treatment efforts make routine visits to Tanzania to
include support of military-to-military efforts with the People's Defense Forces (TPDF). This technical
assistance includes, but is not limited to, development of quality assurance/quality control measures for
care and monitoring, standard operating procedures in both clinic and supporting lab services, and patient
record management. This TA will require on average quarterly visits by two personnel for approximately one
week each trip. The cost estimate of each TA visit will include airfare, per diem and lodging. Funding under
this submission will support salary and benefits for the Clinical Care Medical Director, one Tanzania medical
officer.
LINKAGES:
The clinical medical director and the DOD team works in conjunction with Department of Internal Medicine
at the Mbeya Referral hospital to manage the HIV Care and Treatment Center (CTC). The DOD medical
team also works directly with the Regional Medical Offices in the three regions of Mbeya, Rukwa, and
Ruvuma to ensure that CTC standard operating procedures are maintained down to the health center level.
CHECK BOXES:
Though funding under this submission focuses on DOD staff support, the areas of emphasis of activities will
include local organization capacity building, pre-service and in service training, and QA/QC and QI to
support care and treatment in the Southern Highlands of Tanzania and the TPDF.
M&E:
DoD will collaborate with the National AIDS Control Program (NACP)/Ministry of Health and Social Welfare
(MOHSW) to implement the national M&E system for care and treatment to collect and report patient care
and treatment data based on the national protocol.
SUSTAINABILITY:
In all activities, 99% of personnel involved at the referral hospital are direct hired by the MOHSW. These
arrangements are aimed at providing sustainable human resources to the MRH initiative being the mentor
of zonal requirements. MRH will continue to use hospital staff to provide supportive supervision to hospitals
in the three regions of Mbeya, Ruvuma and Rukwa.
TITLE: SI Management and Staffing for DoD
NEED and COMPARATIVE ADVANTAGE: The DOD manages several large treatment and community
based partners in the Southern Highlands of Tanzania as part of its civilian-based PEPFAR activities. Its
main treatment partner is the Mbeya Referral Hospital (MRH). The MRH is one of five zonal hospitals in
Tanzania. Its function in the Southern Highlands is to provide training, to coordinate and oversee the quality
of treatment and to establish health service referral systems among four regions (Mbeya, Iringa, Rukwa and
Ruvuma) serving a catchment population of over six million people. Initiated in late 2004, the DOD
developed a partnership with the MRH to assist in providing direct technical assistance in strengthening
paper-based patient records and developing and rolling out an electronic medical records system (EMRS)
to support facilities throughout the Southern Highlands. In addition, the DOD serves to provide direct
monitoring of fiscal management of all direct partners under their funding.
ACCOMPLISHMENTS: To date, DOD has been able to establish a well-functioning SI team that works
closely with the MRH providing technical assistance to all three regions (Mbeya, Rukwa and Ruvuma) in the
areas of patient and data management. DOD staff provide training, supportive supervision, electronic data
upload, and generation of NACP reports. In FY 2007, DOD staff trained 20 additional persons, provided
nine computers to new sites, and upgraded the previously-supported six sites so they can now store,
retrieve, and analyze data more easily. In addition, the DOD has assisted 16 members from nine NGOs with
financial management systems and training to improve recording and reporting.
ACTIVITIES: In FY 2008, a Monitoring and Evaluation (M&E) officer will be hired to further strengthen DOD
capacity to monitor and evaluate the progress of partners in meeting PEPFAR targets. This position was
included and approved as part of the USG "Staffing for Results" exercise in FY 2007. This M&E officer will
provide technical assistance to Referral, Regional, District hospitals in the Southern Highlands of Tanzania.
Specific activities to be undertaken by DOD staff include: 1) Revise existing M&E forms and database to
accommodate national modification of systems. 1a) Initiate meeting with USG SI team, partners, NACP,
and UCC to review M&E areas where changes are needed. 1b) Make necessary changes to local forms at
CTC clinics, revising M&E systems for modifications with University Computing Centre. 1c) Modify
electronic record forms. 1d) Update systems at MRH and all sites in the zone.
2) Provide support in implementing electronic records to facility staff at ART sites throughout the Southern
Highlands. 2a) Conduct needs assessment on the sites already being supported as well as new sites to be
brought on-line in FY 2008. 2b) Develop and conduct refresher-training for staff at existing sites and initial
training for new sites. 2c) Purchase and provide computer equipment for new sites, providing technical
support for equipment.
3) Provide regular supportive supervision to all the sites providing ART and ensure proper electronic
systems are in place for data management. 3a) Implement standard operating procedures (SOP) for data
entry, record keeping, proper storage and utilization of medical records. Conduct quarterly visits to sites and
collect data for analysis at the program office. 3b) Monitor implementation and quality of data entry,
implementing corrective measures as required. Provide feedback to sites for program management.
4) Provide financial management software training and equipment support to partners. 4a) Procure financial
software package from vendor.
4b) Install and train sites on use of software package. 4c) Implement use of the system across sub partners.
LINKAGES: This activity is linked to NACP, UCC and USG ART and SI entries, as well as all DOD ART
partner entries.
CHECK BOXES: This is an SI activity.
M&E: Through supportive supervision, the M&E officer will provide technical support to ensure
implementation of SOP and quality data entry. The electronic medical record system is linked to the
National CTC2 and CTC3 databases and is capable of producing national reports and identifier-stripped
data for national analyses. DOD staff enter patient records from clinic visits into the CTC upon completion of
the patient visit. Data are transferred electronically to the data centre where they are synthesized and fed
back to the CTC team for use in patient management.
SUSTAINABILITY: Investing in local human capacity for M&E ensures sustainable management of
information for overall program management. MRH will continue to provide local staff to work along side
DOD to implement training and supportive supervision to all sites in the three regions of Rukwa Ruvuma
and Mbeya.
TITLE: Management and Staffing:Tanzania - Cost of Doing Business for DOD
NEED and COMPARATIVE ADVANTAGE: The US Department of Defense (DOD) will provide technical
and managerial support to two primary programs: the Walter Reed HIV/AIDS Care Program in the Southern
Highlands and activities with PhamAccess International and the Tanzanian Peoples Defense Forces
(TPDF). In the Southern Highlands, the DOD, has been working directly with the Mbeya Referral Hospital
(MRH) since June 2004 and the Regional Medical Offices (RMO) of Mbeya, Rukwa and Ruvuma since June
2005 in rolling out treatment throughout the Southern Highlands.
ACCOMPLISHMENTS: Activities with the TPDF have expanded quickly in the past year from the one
primary referral hospital, Lugalo, to all 7 hospitals now supporting services and a total of 2,466 on ART.
Through its direct relationship and technical support of the MRH and RMOs in Mbeya, Rukwa and Ruvuma,
the Southern Highlands now has 16 facilities (2007 SAPR) supporting ART services and boasts a combined
patient-load of over 10,000 on ART and 26,000 on care. By September 2008, the number of facilities will
expand significantly to 47, ensuring 50% of all facilities in all three regions are executing some level of ART
related services from identification, initiation, follow up and monthly dispensing.
More than 25 community based groups in the Southern Highlands support extension of clinical services by
providing home-based care, counseling and testing Orphan care, and prevention programs.
ACTIVITIES: The cost of doing business will include support for one direct hire to oversee both the TPDF
and Walter Reed HIV/AIDS Care Programs and the provision of technical assistance required to implement
and manage the Emergency Plan activities. This submission will support ICASS costs associated with this
position.
LINKAGES: The DOD team works in conjunction with the USG at a national level to ensure that programs
reflect the priorities of the GoT.
CHECK BOXES: Though funding under this submission focuses on DOD staff support, the areas of
emphasis of activities will include local organization capacity building, pre-service and in service training,
and QA/QC and QI to support care and treatment in the Southern Highlands of Tanzania and the TPDF.
M&E: DoD will collaborate with the NACP/MOHSW to implement the national M&E system for care and
treatment to collect and report patient care and treatment data based on the national protocol.
SUSTAINABILITY: As much as possible, local staff is hired to fill needed administrative and technical
positions. This not only provides partners with added resources but the expansion of the technical skills and
expertise among the DoD local staff as part of program implementation adds to the development of the
human capacity in addressing HIV/AIDS issues in Tanzania.
ACTIVITIES: Currently, six (two Tanzanian/LES, three USPSC/Contractors and one USG Direct Hire) staff
provide technical assistance to treatment, palliative care, and OVC support services. Eight Tanzanian staff
provide administrative support including accounting, and other program support services.
The US Contract laboratory manager for the DoD under technical advisors/non-M&S is leveraged from
research/operating expenses and is not included under Emergency Plan funds. One of the US Contractors
and one Tanzanian technical advisor specifically support clinical care and treatment and are supported
under a line item submission in the treatment program area. The USG direct hire, located in Dar es Salaam,
is responsible for administering the program and represents the DoD field effort and TPDF programs with
the USG Team, other bilateral donors and GOT. All but four of the staff supporting the combined DoD
efforts in Tanzania are in country nationals who work closely with our implementing partners. As much as
possible, local staff is hired to fill needed administrative and technical positions. This not only provides
partners with added resources but the expansion of the technical skills and expertise among the DoD local
staff as part of program implementation adds to the development of the human capacity in addressing
HIV/AIDS issues in Tanzania.
Administrative costs will support both the TPDF and Walter Reed HIV/AIDS Care Programs and include the
provision of technical assistance required to implement and manage the Emergency Plan activities. DoD
personnel, ICASS, local travel, management, and logistics support in country will be included in these costs.
