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 WILL BE DISCONTINUED IN FY 2009.
TITLE: ADDOs' Linkage to Community HIV/AIDS Palliative Care Services
NEED and COMPARATIVE ADVANTAGE: The community-based palliative care services face several
bottlenecks in HBC kits distribution, lack of or poor dissemination of Information Education Communication
for HIV/AIDS materials and prevention products and ineffective referral system to other HIV/AIDS service
for people living with HIV/AIDS (PLWHA).
The Accredited Drug Dispensing Outlets (ADDOs) and the larger systems in which they are embedded
provide a platform for direct delivery of health services that would improve quality of care to people living
with HIV/AIDS. Key advantages of the ADDOs include geographical accessibility, additional human
resources of trained dispensers, available proper storage for medicines and other products, developed
procurement mechanism within the private sector distribution, established record keeping system that
support data collection and reporting and legally allowed to dispense prescription only medicines including
those for treatment of opportunistic infections.
ACCOMPLISHMENTS: To date, Rational Pharmaceutical Management Plus (RPM+) has provided technical
assistance to the Ministry of Health and Social Welfare (MOHSW) and the Tanzanian Food and Drug
Administration (TFDA) to strengthen districts' capacity to address regulatory and inspection barriers in the
private retail sector; incorporated HIV/AIDS and communication skills training modules into the dispenser's
core training; addressed human capacity development needs through training of the ADDOs dispensers;
accredited 584 outlets in Morogoro region; and leveraged resources from other USG investments such as
the President's Malaria Initiative (PMI) to achieve policy changes that support the delivery of subsidized
goods in the private sector.
ACTIVITIES: With FY 2008 funds, ADDOs will: continue linking home-based care (HBC) kit distribution,
improve efficiency of HBC kit distribution, increase coverage of HBC services to rural areas, and contribute
to comprehensive HIV/AIDS care for PLWHA. This includes extending RPM+'s pilot work with Tunajali in
Morogoro for the use of ADDOs to extend HBC services. RPM+ will provide additional training (HIV/AIDS
HBC-related services) to dispensers of participating ADDOs to strengthen their capacity to handle HIV/AIDS
related services. RPM+ will also orient Council Health Management Teams (CHMTs), community-based
organizations and HBC providers on the new roles of ADDOs in support of national HIV/AIDS prevention,
care, and treatment programs.
RPM+ will also strengthen the referrals from ADDOs, where people routinely come with signs and
symptoms suggesting they should be tested for HIV/AIDS, and services for PLWHA. The program will
provide support in tracking the functioning of developed referral system, and conduct feedback meetings
with ADDOs and local health authority to discus successes, challenges, and how to improve the developed
referral system. In addition ADDOs could serve as HIV testing spots piloting the use of lay testers.
An ongoing piece of RPM+'s work is to strengthen ADDOs commodities management and the ADDOs HBC
distribution system through support supervision. In collaboration with other partners' support, RPM+ will
work with CHMTs to conduct ADDOs HIV/AIDS-focused quarterly supportive supervision in participating
ADDOs.
Lastly, RPM+ will work jointly with Family Health International (FHI) and the Health Policy Initiative to
advocate for necessary policy change to support integration of HIV/AIDS activities into ADDOs. This will
include identifying the issues needing policy review/change, holding consultative meetings with MOHSW
and the National AIDS Control Program (NACP) to discuss possible policy changes, and sharing current
intervention results in support of desires policy changes.
LINKAGES: RPM+ has been working with MOHSW, TFDA and other stakeholders at the national level
during the roll out of ADDOs. Management Sciences for Health (MSH) has also closely worked with
regional, district and local stakeholders to mobilize them and seek their support for the ADDOs roll-out.
MSH would engage all these stakeholders for this proposed intervention. At district level, MSH will work
with the CHMTs and the Council Multisectoral AIDS Committees Council Food and Drugs Committee.
In addition, RPM+ will work with Tunajali and its sub-grantees mandated to support implementation of
palliative care services to ensure coordination and technical guidance in the planned activities, as well as
leverage resources from other USG funding such as PMI to integrate the services.
CHECK BOXES: Linking ADDOs to community-based HIV/AIDS palliative care activities will involve building
capacity of private sector grass roots health provider staff to provide basic HIV/AIDS services to
underserved community, with general population as a target. In addition, through this activity local authority
capacity will be strengthened to support implementation of ADDOs HIV/AIDS activities. RPM+ has
wraparounds in malaria and child health portfolios.
M&E: A monitoring plan will be developed to document how ADDOs-HBC linkage works; MSH will closely
work with FHI to develop a detailed monitoring and evaluation plan that document processes and other
relevant indicators. This will entail using tools already in place or developing new ones to capture data
based on NACP M&E framework and PEPFAR indicators.
SUSTAINAIBLITY: Initiative to link ADDOs owners to microfinance institutions for loans is aimed at
improved financing business sustainability. Also, RPM+ has been working with TFDA and MOHSW to
institutionalize the dispensers training and guarantee availability of qualified dispensers. Furthermore, the
owner's contribution to both initial investment and maintenances costs of the ADDOs enterprise has
gradually been increasing. Other ideas such as the community health fund have also been discussed.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13513
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13513 8694.08 U.S. Agency for Management 6534 1441.08 SPS $200,000
International Sciences for
Development Health
8694 8694.07 U.S. Agency for Management 4555 1441.07 RPM+ $200,000
Table 3.3.08:
THE ACTIVITY NARRATIVE REMAINS UNCHANGED FROM FY 2008.
TITLE: Strengthening ART Commodities Management at Facility Level
NEED and COMPARATIVE ADVANTAGE: Although ART sites received technical assistance (TA) to
support comprehensive HIV/AIDS care and treatment, assessments done in various facilities reveals gaps
in HIV/AIDS commodities and pharmaceutical management including management information systems.
The planned expansion of HIV/AIDS treatment care services to lower facilities will require expanding human
resource training to accommodate new staff, whose basic training, skills and knowledge is limited. Follow up
on-the-job support to improve their skills and performance is needed. RPM Plus proposes to jointly address
these gaps in collaboration with the National AIDS Control Programme (NACP) and other USG partners to
provide the training, mentoring and on-the-job training materials needed at facility level.
ACCOMPLISHMENTS: In FY 2006 a rapid assessment of ART pharmaceutical management systems was
done in six faith-based hospitals followed by a dissemination and planning workshop. RPM Plus trained 31
staff from 23 ART sites on HIV/AIDS pharmaceutical management using NACP curriculum, provided TA to
the NACP in development of standard operating procedures (SOPs) for ARV pharmaceutical management
at facility level, and trained staff from 11 ART sites on the ART dispensing tool. RPM Plus also participated
in the ART logistic system training materials review organized by NACP and the SCMS project.
ACTIVITIES:
1. Conduct refresher trainings to pharmaceutical staff working in ART sites to reinforce skills and knowledge
on pharmaceutical management at facility level and provide back up teams to handle the increasing
number of patients enrolling in ART.1a) In collaboration with NACP and SCMS develop a training plan. 1b)
Adapt NACP curriculum to prepare training materials. Hold joint meetings with NACP and SCMS to plan
and harmonize training activities. 1c) Provide TA to Schools of Pharmacy to strengthen their capacity to
support NACP in implementation of HIV/AIDS related trainings.
2. Provide on going mentoring to trained staff in ART sites. This will ensure effective management of ARVs
and other HIV/AIDS related commodities and will increase quality of services. 2a) Adapt NACP supervision
check list. 2b) In collaboration with NACP and other partners under regionalization develop joint supervision
plan for management of ARVs and other HIV related commodities. 2c) Conduct quarterly supportive
supervisory visits.
3. Develop job aids for pharmaceutical management in collaboration with NACP, SCMS which focus
particularly on dispensing practice and inventory management (i.e. receiving, issuing). This will ensure
consistency and high quality in pharmaceutical services provided in ART pharmacies 3a) Design posters on
various aspects of Pharmaceutical Management 3b) Print and distribute posters/job aids to ART sites 3c)
provide on-site training regarding the benefits of and how to use the job aids.
4. Work in collaboration with TFDA/NACP to strengthen Adverse drug reaction (ADR) system for
Antiretroviral to ensure safety of ARVs drug supplied to PLWHA 4a) Conduct orientation of Pharmaceutical
staff on ADR monitoring for ARV 4b) Leveraging resources from PMI, RPM Plus will continue to participate
in ADR working group to address issues related to ADR monitoring and replicate best practice in ART
program c) Provide support to TFDA/NACP in raising public awareness in relation to ADR monitoring for
ARVs.
LINKAGAGE: IN FY 2006 RPM Plus worked in close collaboration with NACP, other partners involved in
regionalization such as Family Health International, and the Elizabeth Glaser Pediatric AIDS Foundation to
strengthen pharmaceutical management systems in selected hospitals. In FY 2008 RPM Plus will work
closely with SCMS, NACP and I-Tech to: identify areas of collaboration regarding common concerns;
harmonize TA; bring in expertise from similar programs in other countries. RPM Plus will also continue the
linkage with partners begun under COP06. RPM Plus will continue to work with TFDA and address issues
related to medicines quality and safety of ARVs.
CHECK BOXES: RPM Plus will continue to support NACP's and other PEPFAR partners initiative to build
capacity of pharmaceutical staff at ART sites through providing in-service, on job mentoring and job aids on
pharmaceutical management. Improved quality of ART services provided by these personnel will benefit the
population of all ages.
M&E: A monitoring plan will be developed to document achievement on TA provided to the site. The data
collection tools would be based National M&E Framework for ART program. RPM Plus will develop
additional indicators to monitor grogram progress. Data quality assurance protocol will be developed and
used to ensure accuracy. Periodical feedback meetings will be held with NACP, SCMS and other partners
and feed the information into national database.
SUSTAINAIBLITY: RPM Plus will use a monitoring, training and planning approach with the aim of
developing local staff capacity to identify problems existing in their facilities, provide skills in developing
interventions to address the identified gaps and on going self performance monitoring. Provision of TA to
the School of Pharmacy and Muhimbili University will build local capacity to support NACP in
implementation of training programs hence ensuring sustainability.
Apr 2009 Reprogramming:
additional $499,999 (from HTXD mechanism ID 4790.09), based on site visits and PMTCT audit USG
determined a need to provide additional TA in strengthening ART pharmaceutical managemetn systems at
facility level. Activity target changes include: Number of organizations provided with technical assistance for
HIV-related institutional capacity building increased from 6 to 7 and number of individuals trained in HIV-
related institutional capacity building increased from 30 to 75.
Continuing Activity: 16996
16996 16996.08 U.S. Agency for Management 6534 1441.08 SPS $213,417
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $150,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.18:
