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
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Activities
Two Regional Officers for Care and Treatment positions were created and filled at Rukwa and Ruvuma
Regions. The two program officers and clinical medical Director are Tanzanian citizens.
These positions are necessary to improve monitoring and coordination of HIV/AIDS care and treatment
scaling-up activities at the Region and district level. It is anticipated that more than 50% of primary health
care facilities will expand their services to include HIV/AIDS care and treatment during FY08 and FY09.
The Clinical Medical Director works as a member of the Mbeya Referral Hospital, fully accredited
to practice medicine in Tanzania. He works with the Department of Internal Medicine at this facility to
help run 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 Mbeya, Ruvuma and Rukwa regional
medical offices 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. The Region programme coordinator works with the RMO and Region AIDS
coordinator to plan, coordinate, supervise, monitor and evaluate the scaling-up of HIV/AIDS care and
treatment services. Also, supervise and participate in HIV/AIDS care and treatment in-service-trainings.
*END MODIFICATION*
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
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:
Activity Narrative: 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.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13667
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13667 9233.08 Department of US Department of 6569 1143.08 M&S $423,330
Defense Defense
9233 9233.07 Department of US Department of 4604 1143.07 $487,500
Table 3.3.09:
THIS IS A NEW ACTIVITY.
DoD will collaborate with the National AIDS Control Program (NACP)/Ministry of Health and Social Welfare
Table 3.3.11:
ACTIVITY UNCHANGED FROM FY 2008 COP.
This narrative for FY 2008 has no modifications, but much emphasis will be put on scaling up electronic
sites.
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.
Continuing Activity: 13670
13670 8683.08 Department of US Department of 6569 1143.08 M&S $30,000
8683 8683.07 Department of US Department of 4604 1143.07 $61,720
Table 3.3.17:
TITLE: IMPROVING DATA QUALITY IN THE SOUTHERN HIGHLANDS
NEED and COMPARATIVE ADVANTAGE
Walter Reed HIV Care Program in the Southern Highlands covers three regions of Mbeya, Rukwa and
Ruvuma; the program supports prevention care and treatment.
Inadequate human capacity, poor infrastructure and weakness of health information system are the major
challenges facing DoD partners in Southern Highlands, including both treatment partners and
Community/Outreach partners as well. The program intends to strengthen capacity of the partners in data
management and use for decision making in this fiscal year 2009. Technical support will be provided in the
entire spectrum related to strategic information to all the partners
ACCOMPLISHMENTS
The past period Walter Reed program together with partners in the Southern Highlands have accomplished
a significant assignment and recognizes the achievement that include, implementation of its own database
which is capable to accommodate both PEPFAR and NACP needs, conducting regular training and
refresher trainings on PEPFAR requirements as part of strengthening reporting system, providing regular
supervision as well as Monitoring of Program activities, 8 electronic Sites have been established - however
we still have some that are manual. All the Community /outreach partners have data collection tools and are
able to report on PEPFAR requirements. An M&E Manager has been hired to complement the SI team.
DoD SI team work hand-on- hand with both treatment and community outreach partners to process and
compile monthly, quarterly, semi-annual and annual progress reports.
All sites in the southern highlands have staff trained on data collection and computers have been supplied;
while in the other regions, only one site per region has had people trained and computer supplied in the
past years.
DoD SI team has already completed revising and amending local data collection tools which will help on
upgrading the database.
1. In FY 2009, DoD will harmonize and strengthen data collection tools
2. To introduce Web base application for CTC sites
2a) Installation of the system at each site.
2b) Training data entry staff Web base soft ware
2c) Web program maintenance
2. Link of all CTC sites using V sat in areas where no local internet (network) provider.
2a) Installation of V-sat dishes (4 sites)
2b) Supply of computers
2c) Supply of backup generators
3. Strengthening M&E capacity by hiring a competent data Manager who will be providing technical
assistance to implementing partners on reporting and performance requirements.
4. To conduct workshops/ trainings for Implementing Partners on data quality and use.
4a) Orient health care workers on updated data collection tools
4b) To train all partners on data analysis
5. Document, share and disseminate lessons learned and best practices
5a) Identification of promising and evidence based practices
5b) Dissemination and sharing of best practices.
LINKAGES: These program activities will be linked to other reporting system that works in the same areas
and sites taking the opportunity to strengthen the existing rather than establishing parallel structures.
Management of Monitoring and Evaluation information will be done by the same existing structures in the
program areas. Collaboration will occur with treatment, and outreach partners, NACP, other USG ART
team, Web Masters (Net work Providers) and DoD M&E Unit.
TARGET POPULATION: The target populations for these activities are DoD implementing partners and
specifically CHACs, DACCs, RACCs including treatment and outreach M&E persons.
CHECK BOXES: More emphasis will be put to Data Quality activities.
M&E: DoD SI will ensure they provide technical assistance on implementing of SOPs, data quality entry, link
of information from sites to main saver, conducting of regular internal data audit and activities monitoring.
SUSTAINABILTY: This is very crucial in any program and we hope to ensure the same through adoption of
innovative ideas on data quality and use. Emphasis and focus will be on involvement of strategic institutions
and organizations where appropriate. Adherence to reporting requirements and data management that will
be achieved through capacity building and regular technical support to implementing partners.
New/Continuing Activity: New Activity
Continuing Activity:
ACTIVITY HAS BEEN SIGNIFICANTLY REVISED.
$631,050
TITLE: Management and Staffing:Tanzania - Cost of Doing Business for DOD
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
expanded 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.
The cost of doing business will include support for two direct hires; one of the direct hires is the Country
Director 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. The second direct
hire will provide administrative and financial support at the implementation site in Mbeya and PEPFAR will
support 50% of this position. This submission will support ICASS costs associated with these two positions.
The DOD team works in conjunction with the USG at a national level to ensure that programs reflect the
priorities of the GoT.
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.
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.
MAJOR ACTIVITIES:
The cost of doing business will include support for two direct hires 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 these
positions.
Continuing Activity: 13671
13671 8918.08 Department of US Department of 6569 1143.08 M&S $631,050
8918 8918.07 Department of US Department of 4604 1143.07 $267,000
Table 3.3.19:
M&S 760,854
Activity 3505.08
More than 30 community based groups in the Southern Highlands support extension of clinical services by
Currently, ten staff (including one US Direct Hire) provide technical assistance to treatment, palliative care,
and OVC support services. Thirteen Tanzanian staff provide administrative support including accounting,
and other program support services. One more US Direct Hire will be recruited to provide oversight for
operations in Mbeya. This position will be 50% supported by PEPFAR.
The US Contract laboratory Director 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 three 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.
Funding under this submission will support salary and benefits for 14 technical, managerial, and support
staff.
Continuing Activity: 13672
13672 3505.08 Department of US Department of 6569 1143.08 M&S $790,854
7842 3505.07 Department of US Department of 4604 1143.07 $878,518
3505 3505.06 Department of US Department of 2895 1143.06 $675,000
Lugalo, to all 7 hospitals now supporting services and a total of 2,466 on ART. Through its direct
of over 10,000 on ART and 26,000 on care. By September 2008, the number of facilities expanded
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.
The Clinical Care Medical Director directly supporting the DOD Walter Reed HIV/AIDS Care Program in the
Southern Highlands is providing ART technical assistance partner institutions. 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 six FSN equivalent technical advisors, hired by the DOD (two
physicians, two clinical officers and two nurse), and Mbeya Referral Hospital personnel, the Walter Reed
Program undertakes supportive supervision throughout the Southern Highlands for all CTCs.
FY2009 funds will be used to continue to support some DOD SI personnel. These management and
staffing costs for Strategic Information will support eight data management officers, and one
information/data analyst. These SI officers will provide technical assistance to Referral, Regional, District
hospitals in the Southern Highlands of Tanzania. This support is centrally housed at the MRH. These SI
officers assist the M&E officer to achieve the following:
1) Revise existing M&E forms and database to accommodate national modification of systems.
2) Provide support in implementing electronic records to facility staff at ART sites through out the Southern
Highlands
3) Provide regular supportive supervision to all the sites providing ART and have proper electronic system
in place for data management.
4) Provide financial management software training and equipment support to partners.
FY 2009 will also be used to continue to support DoD lab personnel. These management and staffing costs
for lab will support six laboratory technicians and engineer. These laboratory officers will provide technical
assistance to Referral, Regional, District hospitals in the Southern Highlands of Tanzania. This support is
centrally housed at the Mbeya Referral Hospital (MRH) and covers the Mbeya, Rukwa and Ruvuma
regions. FY 2009 funding will continue to support lab technicians at MRH and also support and monitor
performance of HIV/AIDS related laboratory testing services through the development of supportive
supervision teams from the MRH. To date we have been able to establish a well functioning laboratory team
that provides technical assistance to all three regions (Mbeya, Rukwa and Ruvuma) in maintaining and
implementing standard operating procedures and Quality Assurance/Quality Control programs and assuring
that all district and regional laboratories contribute to our treatment goals in the Southern Highlands of
Tanzania.
In addition to in country personnel, the DoD offers US based 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 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 personnel including two physicians, two clinical officers and two nurses.
Activity Narrative: DoD will collaborate with the NACP/MOHSW to implement the national M&E system for care and treatment
Funding under this submission will support salary and benefits for the Clinical Care Medical Director, six
Tanzania medical personnel including two physicians, two clinical officers and two nurses.
