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.
The proposed activity would provide funding for the Ministry of Labor, Invalids and Social Affairs (MOLISA)
to institutionalize drug addiction and HIV curricula into its staff training universities, and to identify and pilot a
best-practice drug treatment service model in Vietnam. In collaboration with FHI, which is already
developing and implementing HIV and drug addiction treatment curricula, MOLISA will work to
institutionalize this curricula into its training universities. These activities will provide the first direct PEPFAR
support to MOLISA with the goal of reaching a host-country owned, sustainable, rights-based and evidence-
based solution to drug treatment in Vietnam. This will also create a public health environment that better
coordinates and links HIV and addictions prevention.
Vietnam's primary response to injecting drug use (mainly heroin) has been the development of mandatory
treatment in custodial, government-run rehabilitation centers (‘06 centers'), in which detoxification is
followed by one to four years of rehabilitation through labor and vocational training. These centers primarily
serve drug-dependent males, and HIV prevalence among residents has been estimated as high as 50
percent. Managed by MOLISA, 06 centers have been politically popular, but subscribe to a punitive
approach to drug addiction that is not based on international best practice.
Additionally, there are significant human resource gaps in the field of addictions treatment. It is difficult to
staff the government-run 06 system and private drug treatment with qualified health care professionals due
to low prestige, poor pay and limited career advancement opportunities. Furthermore, addiction counseling
is a new concept in Vietnam, a country in which the mental health field is underdeveloped and an unpopular
career choice.
The centers have limited medical and other psycho-social support services and after long periods of time in
custody, returnees find it difficult to reintegrate into communities. It has been estimated that over 70 percent
of returnees relapse into regular injecting drug use. The 06 system has failed to effectively treat drug
addiction in Vietnam, and there are few drug rehabilitation, HIV/AIDS or other psycho-social support
services available. The small number of private treatment clinics that currently exist are unable to provide
sufficient level or quality of services for injecting drug users (IDU). These clinics must adhere to MOLISA
guidelines, though anecdotal reporting suggests that service quality is equal to or lower than that provided
in 06 centers. The lack of strong models for addictions care and treatment have stymied MOLISA's ability
to provide technical oversight of private treatments services, and limited the Ministry's ability to advocate for
private sector regulation or policy reform.
In addition to service delivery, there continue to be concerns around human rights within the 06 system.
There is no judicial process for remanding individuals to the centers, and few mechanisms to ensure
continuity of care and treatment for HIV-infected IDU in the centers and in the community after release.
There are also concerns about the cost and sustainability of maintaining the 06 center system in the future.
In order to begin to address gaps in drug treatment through the public and private sector, the proposed
activities will support MOLISA in the initial development of a stronger, sustainable, evidence-based
approach to IDU needs in Vietnam.
INSTITUTIONALIZE ADDICTIONS COUNSELING AND CASE MANAGEMENT TRAINING PROGRAMS IN
MOLISA UNIVERSITIES ($40,000):
Addictions-training has been part of the FHI prevention portfolio since 2006. However, continuation in
COP09 will involve scaling up a long-term, sustainable educational model by beginning to house these
trainings in MOLISA universities.
Supporting MOLISA to institutionalize drug addiction and HIV curricula into its staff training universities will
lead to a more sustainable PEPFAR intervention and the establishment of more effective drug treatment
modalities in Vietnam. MOLISA would be seen as taking the lead in identifying and developing a quality
alternative to both the 06 system and the currently limited private drug treatment system. FHI, with USAID
support, is already developing and implementing HIV & drug addiction treatment curricula which focus on
(1) pre-service medical, (2) in-service general concepts, (3) professional addiction counseling and (4)
professional case management. Items 3 and 4 should be long-term training programs in order to generate
effective and sustainable professional development and service provision. FHI will work with MOLISA to
institutionalize drug addiction and HIV curricula, and develop a longer-term timeline for permanent handover
of addictions training to MOLISA.
ALTERNATIVE DRUG TREATMENT PILOT ($210,000):
COP 09 funding will be used to support MOLISA to identify and develop alternative drug treatment
approaches and models, based on international best practice. This would include provision of an
international consultant, who will work with the SAMSHA Technical Advisor, to assist MOLISA in identifying
proper treatment models. The consultant would provide TA to MOLISA in generating recommendations for
the most appropriate alternative drug treatment services to be piloted in Vietnam. MOLISA staff would also
generate recommendations and guidance on potential international organizations that could assist Vietnam
establishing sustainable and best-practice drug treatment.
Upon identification of an appropriate model, PEPFAR will support MOLISA to pilot an alternative drug
treatment center. The PEPFAR Prevention team, including CDC, SAMSHA and USAID, will coordinate this
process carefully to ensure that MOLISA and FHI activities are harmonized.
A private, evidence-based drug treatment pilot would:
- Provide best practice drug treatment services to clients
- Provide in-service training and mentoring to professional addiction counselors and case managers
- Link to MOLISA training universities and become a center of excellence for best-practice methods &
approaches
- Provide free-of-charge treatment to a percentage of poorer clients
- Build a cohort of mental health and drug treatment professionals, infrastructure and services
Activity Narrative: - Raise the level of professional prestige around drug treatment
- Serve as an entry point for an international private drug treatment partner to invest in and establish
services on a for-profit basis
This small scale pilot would provide an opportunity for MOLISA to build on existing evidence-based models
and international best practices to strengthen policy advocacy efforts with national policy-makers. MOLISA
staff would work with existing FHI TA to train staff (including addiction counselors and case managers) and
pilot a voluntary drug treatment center (location TBD). This center could serve in the future as a ‘center of
excellence' by providing best practice models, training and mentoring of drug treatment staff throughout
Vietnam, and by providing short-to-medium term staff exchanges between the pilot and other centers.
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
prevention of drug use: 300
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 30
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $90,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.06:
This is a new activity in FY09.
The Department of Social Evils within the Ministry of Labor, Invalids and Social Affairs (MOLISA) regulates
prostitution and illicit drug use in Vietnam and will become a PEPFAR HIV/AIDS prevention partner in FY09.
The PEPFAR strategic information team will engage the department in improving information systems to
monitor prevention activities and applying valuable MOLISA data on IDUs and CSWs, such as population
size estimates, to help focus intervention efforts.
Human capacity development (HCD) - Strengthening pool of SI Technical Assistance Resources:
Funds will be used to contract one Vietnamese national full time to provide direct strategic information
technical assistance to MOLISA activities. This position will become an active member of the National M&E
technical working group and an extension of the national PEPFAR supported SI Team. Since MOLISA is
the GVN agency responsible for the management of programs targeting IDUs and CSWs, PEPFAR has
prioritized HCD activities for the MOLISA SI team. This person will work directly to provide direct assistance
to improving strategic information available on those programs. Being an IDU-driven epidemic, a focus on
services and programs targeting IDUs is the cornerstone of the SI strategy. By providing direct HCD support
to partners engaged in PEPFAR supported programs, PEPFAR Vietnam will continue to build a culture of
data use where partners and their associated programs continue to be evidence-based, focused and
sustainable.
Health Management Information Systems (HMIS) - Information Systems Development for IDU and CSW
Programs:
Basic paper and electronic information systems for service delivery and program management will be
prioritized by program area. These funds will help to support the assessment and improvement of paper
systems associated with MOLISA programs and to identify a core set of information for computerization for
better program planning and implementation. Information system requirements documented through this
process will be supported through TBD funds for software development and deployment.
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.17:
