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
Hospice Africa Uganda commenced its activities in 1993 with three major objectives. (i)To provide an
appropriate Palliative Care service to patients with cancer and/or HIV/AIDS and their families with defined
operational areas, (ii) To enable the provision of Palliative Care services in Uganda, through Advocacy,
Education and training and (iii)To facilitate the initiation and expansion of Palliative Care in Africa by
providing an affordable African model. Since October 2005, Hospice Africa Uganda (HAU) has been in
partnership with USAID/Uganda to expand access to and scope of quality palliative care to PHA and their
immediate families. HAU has adopted three approaches, namely, (i) direct service delivery and (ii) indirect
expansion through training and supporting AIDS care and support organisations, including public and
private agencies to integrate pain management, symptom control and end of life care into their services and
(iii) advocacy in palliative care, to scale up access to palliative care. Over the last two years of partnership
with USAID/Uganda, HAU has grown as an accredited leader and the only institution in Uganda with
technical expertise to provide and build capacity for pain and symptom management services. HAU has
grown into a beacon service modeling affordable and culturally acceptable palliative care and a ‘centre of
education' to enable increased access to comprehensive palliative care and education in Uganda. (HAU
provides and supports palliative care interventions in accordance with WHO definition, 2002).
The Hospice Cooperative Agreement with USAID ends in September 2008. Although access to ART
continues to improve with increased resources, the need for palliative care services remains real. Under the
current HAU program, the symptom burden of PHAs is significant, with a high incidence of pain and multiple
symptoms experienced throughout the course of the disease, from the point of diagnosis to end of life care
and bereavement support. The HAU experience demonstrates palliative care can improve the quality of life
throughout the continuum of illness. In addition to managing the symptom burden, HAU also undertakes
preventive care focusing on condom education and distribution especially targeting discordant couples and
delivery of family planning information. Other elements of preventive care delivered by HAU include
prevention of malaria by improving access to insecticide treated bed nets, counseling for disclosure of
status, and HIV testing of family members whose status is unknown. To strengthen its quality of care
delivery, HAU participated in the development of a tool to measure the effectiveness and quality of palliative
care in Africa, the African Palliative Outcome Scale (APOS). The APOS quality of care audit revealed that
palliative care is highly effective in pain and symptom control. The HAU experience establishes the
importance of providing palliation from the point of diagnosis, and moves away from the traditional view of
palliative care as a specialist area introduced at the end of the patient's life.
Since 2005 HAU has seen over 2,700 patients with HIV/AIDS or HIV/Cancer, of whom 1,500 were admitted
onto program as they required specialist palliative care for pain and symptom management or end of life
care. The care provided has been a mix of home visits, out-patient care, outreach and hospital
consultations. In an effort to ensure comprehensive care, HAU has strengthened linkages with other AIDS
care and support organizations, to provide shared and complementary care and avoid duplication of
services. For instance HAU refers PHAs to HIV support organizations for social support interventions such
as income generating activities while the same providers also refer to HAU the PHA that need pain and
symptom control. HAU has developed a training program in collaboration with some HIV in reach centers
where the staff of the in reach centers are trained by Hospice, carry out placements in Hospice and practice
under the guidance of Hospice staff at their sites. There's also a new initiative of community day cares
which are organized by the communities where Hospice staff provide clinical services. The service aims to
support the patient and their families by providing patients with social activities and making clinical care
available nearer to their homes. The activities appear to be successful with the communities organizing and
managing the activities and hospice clinical staff providing the clinical care and support as needed.
Currently two in three HIV patients receive shared care. In addition Hospice has established a relationship
with Makerere University and Mbarara teaching University. Medical students in their fourth year have
placements with Hospice for training in Palliative Care. This is in addition to the many other organizations
and institutions that send their students for placements. These initiatives need to be sustained beyond the
current HAU program.
One of the main factors inhibiting palliative care service development and expansion in Uganda is not only
the lack of trained palliative care personnel, in both basic and specialist palliative care, but also lack of
career progression for health workers considering specialization in palliative care. Since 2005, HAU training
units has successfully carried out palliative care education program. In sum 865 health and allied health
professionals and 391 community members were trained, totaling 1256. The capacity of 23 training
institutions was strengthened to teach modules on palliative care, and palliative care was also incorporated
into 5 national health professional curricula and four training institutions. In addition HAU has developed
some IEC materials to educate the public about Palliative Care and to dispel the myths about the use of
morphine for pain relief. Other than the short courses that are conducted on site HAU has been able to
conduct Palliative Care training in 5 districts upcountry. These are Gulu, Rakai, Mukono, Arua and
Bushenyi. However rigorous follow up of trainees is yet to be done for all trainees. In the follow up of
trainees in clinical tutors schools Hospice has been able to identify some of the challenges in the field and
support the tutors to carry out Palliative Care training.
In FY 2009, HAU will support the direct provision of specialist palliative care/consultations using modern
methods of pain and symptom control and end of life care to an estimated 2,200 PHAs, at times and places
convenient for the PHA and their carers', in a culturally and socially sensitive way. Home based care and
community care will form the backbone of these direct care services during the critical stages of illness.
HAU through networks and formal collaborations with other public and private service providers such as
Mulago Hospital, TASO, and Meeting Point will co-manage patients so as to maximize synergies, reduce
duplication of care, and enable PHA's to access broad spectrum of services.
Hospice will continue to provide direct clinical services to patients and also act as a centre for Palliative
Care excellence, where trainees from various organizations can have placements after training. Hospice will
also continue to deliver preventive care which include but is not limited to: prevention for PHAs, delivery of
the basic care package and support disclosure and testing of family members.
Activity Narrative: Hospice will build capacity of at least 1000 multi-disciplinary care providers and community workers through
training/education to incorporate pain and symptom control, spiritual care, and end of life care and
bereavement into their existing programs. Hospice will strengthen the institutionalization of PC through the
establishment of departments for palliative medicine at Makerere and Mbarara Medical Schools. Hospice
will modify its district training program to cover regions and carry out more than one comprehensive 6
months training within a region to create a critical mass of palliative care practitioners.
Hospice will continue to advocate for the inclusion of pain management and symptom control as integral
elements of essential care in Ugandan palliative care policies. This will be through engaging policy makers.
Hospice will continue to advocate for the implementation of palliative care policies at the national and local
levels, and the establishment of palliative care services through the already established institutions. HAU
will work closely with MOH/PCAU/APCA and other palliative care providers for joint advocacy and in the
setting of standards, technical assistance and development of appropriate resources such as referral
guidance and IEC for palliative care.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14197
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14197 3990.08 U.S. Agency for HOSPICE 6737 1124.08 HOSPICE $811,000
International AFRICA, Uganda
Development
8419 3990.07 U.S. Agency for HOSPICE 4834 1124.07 HOSPICE $811,000
3990 3990.06 U.S. Agency for HOSPICE 3161 1124.06 $600,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $900,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
