The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity relates to activities in MTCT: EGPAF/CIDRZ, Care International, and CHAZ.

Eastern Province is divided into eight districts and currently all eight are receiving support for the prevention

of mother to child transmission of HIV (PMTCT) services by the United States government (USG)-funded

partners, Center for Infectious Disease Research Zambia (CIDRZ), Churches Health Association of Zambia

(CHAZ) and CARE International. The sites that provide PMTCT also refer/provide antiretroviral therapy

(ART), tuberculosis (TB), and palliative care services to which the women are also referred. As of March

2006, CIDRZ and CARE International had trained 40 health care providers in the minimum package of

PMTCT services and instituted 30 PMTCT sites.

In FY 2008, in joint collaboration with CDC/EPHO, CIDRZ and CARE International, Eastern Provincial

Health Office (EPHO) will spearhead the scale-up of PMTCT services in the province in-line with the

national PMTCT expansion plan. This support will enable key technical staff from EPHO to coordinate,

plan, and integrate services with CDC/EPHO, CIDRZ, CARE International, and the Churches Health

Association of Zambia. In addition activities will include expanding and linking PMTCT services with other

HIV services in all districts of the province through mapping of services during the performance audits

conducted by the Provincial Health Office (PHO) every quarter.

In FY 2008, this activity will continue to supplement PMTCT training in the all districts by partnering with

CIDRZ, CARE International and CHAZ with training of providers and scaling up the number of PMTCT sites

in order to roll-out the services to the rural most populations. The services provided at these sites will be in

line with the core PMTCT interventions as stipulated in the protocol guidance. The EPHO will train 175

health workers through this activity. The EPHO working in collaboration partnership with its partners, will

ensure that additional PMTCT sites will be established in the districts that are implementing PMTCT across

the province. As this is a joint effort with the other partners, it has been agreed that to avoid double

counting of targets, the EPHO will only report on the number of health workers trained and the partners in

each respective district will report on the other 3 PMTCT OGAC indicators to the USG. The EPHO will

ensure through TA that services are established and sites are reporting. Other activities to be implemented

will include monitoring visits, training of 50 program managers in the implementation and monitoring of the

PMTCT services including Focused Ante Natal Care (FANC), dissemination of national policy and

guidelines on PMTCT, strengthening of MCH services, and standardization of PMTCT services.

In FY 2008, in joint collaboration with CIDRZ, CARE International and CHAZ, the EPHO will spearhead the

scale-up of PMTCT services in the Province in-line with the national expansion plan. This support will

enable key technical staff from EPHO to coordinate, plan, and integrate services with the partners. This

activity will include expanding and linking PMTCT services with other HIV services in the province including

Pediatric ART services, through mapping of services during the performance audits spearheaded by the

EPHO every quarter, as well as the creation of a referral system for HIV/AIDS services.

Support will continue to be provided to strengthen PMTCT services in the Eastern province through

improving coverage of counseling and testing amongst pregnant women, improving uptake of prophylaxis

among HIV+ pregnant women identified, and through strengthening of tracking and follow-up care services

for HIV exposed infants and their families by adequately trained and mentored health workers and

community health workers.

IN FY 2007, In an effort to support the Zambia national framework and build capacity of the national system

to provide sustainable HIV/AIDS services, the United States Government through CDC provided direct

support to the EPHO to build its capacity to coordinate and oversee PMTCT services in the province,

provide training, and expand PMTCT trainings to health centers currently not covered by CIDRZ, CHAZ,

and CARE International. CIDRZ, CHAZ, and CARE International will continue to provide PMTCT services

in districts where they currently work but with the coordination and leadership of the EPHO to ensure

uniformity and standardization to the PMTCT services. In order to create a sustainable PMTCT program,

the PHO will continue to play a key role in ensuring that supportive supervision is provided to these districts

and will coordinate all PMTCT services and implementing partners to ensure optimal resource utilization.

In FY 2008, this activity will supplement the PMTCT training in Chama and Mambwe districts that have not

yet initiated PMTCT on large scale, and will supplement training in the other districts with few trained

providers in PMTCT service delivery. A total of 175 health providers will be trained through this funding.

The EPHO working in collaboration with CIDRZ, CHAZ, and CARE International will ensure through the

provision of technical assistance that more sites in the province establish the PMTCT services.

The PHO's involvement in the coordination of the program will ensure geographical coverage and

coordinated planning among districts for the integration of PMTCT services into routine maternal and child

health units which will lead to the development of a sustainable model where the Government of the

Republic of Zambia plays an active role in the continued delivery of PMTCT services.

In FY 2007 the EPHO received plus-up funds to strengthen PMTCT services in the Eastern province

through the improvement of coverage of counseling and testing amongst pregnant women, uptake of

prophylaxis among HIV+ pregnant women identified through adequately training and mentoring of health

workers and community health workers. The EPHO also coordinated training and supervision of PMTCT

services through the planning of PMTCT services at district level, the integration and strengthening of

PMTCT into maternal and child health. These funds were used to establish support systems that ensure

sustainability of the PMTCT scale-up such as improved PMTCT supply chain management, improve the

monitoring and reporting system and strengthen the linkage to ART.

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity is linked with the other activities for the Eastern Province Health Office (EPHO) including

counseling and testing and the CDC new activity for EPHO in ARV services.

Chipata District in Eastern Province has a very high HIV prevalence of 25.9% and syphilis prevalence of

8.8% (Antenatal Clinic sentinel surveillance, 2004) among pregnant women aged 15-44 years. Adolescents

contribute considerably to the high prevalence of HIV with16.2% of women in Chipata aged 15-19 testing

HIV-positive during the 2004 ANC sentinel surveillance. Special reproductive health services focusing on

youth is a key activity to reduce STI and HIV transmission among adolescents. Chipata district has started

prevention and counseling and testing programs for this age group and the District Health Management

Team (DHMT) has begun to establish 30 Youth Friendly Corners in urban and peri-urban health centers. In

FY 2007, Chipata DHMT will strengthen the Youth Friendly Corner services as well as expand the concept

to include all of the 39 health centers in the district in order to reach youth with HIV prevention messages

and link them to the services available in their communities. These Youth Friendly Corner services are

needed to address gaps in the current services in reaching all youth and especially at-risk youth.

The Youth Friendly Corners are critically needed to address existing gaps in current services; youth are not

able to be reached, especially at-risk youth. These corners are rooms reserved specifically and

conveniently for adolescent peer educators and trained health providers in which youth friendly services are

provided to adolescents. It has been observed in some studies by non-governmental organizations and the

district health management teams that: 1) youth found it difficult to access health services from health

institutions because of age differences with health providers and that the health services were not

satisfying the needs of young people, and 2) Youth Friendly Corners act as the entry and exit points for all

youth clients presenting with STIs, HIV,TB infections and for those seeking safe reproductive health options.

Cases requiring further attention of health workers are referred to the appropriate services for follow-up.

Other activities carried out in these corners are peer counseling, community mobilization through drama,

focus group discussions, door-to-door campaigns, health education talks, and recreational activities

(sporting activities and educational modeling). The Corners also provide an opportunity for dissemination of

condoms to sexually active mature youth when appropriate. Youth who express interest in being tested for

HIV are referred to the nearest clinic where they can receive counseling and testing for HIV.

To ensure quality services for the youth, a trained health worker at each Youth Friendly Corner who has a

sincere desire to work with youth provides knowledge and skills to them. The program relies heavily on

youth volunteers and the turn-over rate is high as the youth access further training or become employed.

To ensure adequate numbers of peer counselors and peer educators, ongoing training of new peer

counselors and educators is required. In FY 2007, 40 new staff will be trained to provide HIV/AIDS

prevention programs that are not exclusively focused on abstinence and/or being faithful. An important

component of the Youth Friendly Corner approach is to conduct sensitization sessions within certain high-

risk communities. In FY 2007, 1,000 individuals will be reached through community outreach HIV/AIDS

prevention programs that are not exclusively focused on abstinence and/or being faithful.

This activity will support the Youth Friendly Corner program of Chipata district through the Provincial Health

Office by strengthening the 30 sites that have already been established and expanding to open nine more

sites where youth friendly services will be offered. In addition, all sites will strengthen their sensitization

activities in the community and behavior change sessions in high-risk areas and events. Increased

awareness on the issue of integrated reproductive health among the youths will be created through

reorientation of all health care staff.

In future years, the EPHO plans to scale up the Youth Friendly Corner approach to the seven other districts

within Eastern Province. Activities to strengthen the Youth Friendly Services will be included in the annual

district and health centre health plans in order to ensure sustainability of the programs.

The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

Eastern Province includes eight districts, which are predominately rural with an overall HIV prevalence of

13.2% and a reported incidence rate for tuberculosis (TB) of 259/100,000 in 2004. Outside of Chipata, the

provincial head quarters (which has an HIV prevalence of 26.3% and TB notification rate in 2004 of

380/100,000), access to health-care facilities and services are limited. TB/HIV integration activities were

initiated by CARE International using USG funds in FY 2005 and 93 health-care workers, from the 3 highest

population districts (Chipata, Katete, and Petauke) were provided with some level of TB/HIV integration

training. The largest barriers to implementing and maintaining TB/HIV integration were due to limited human

resources, coupled with an expected increase in patient-load.

In FY 2006, the USG provided funds to the Eastern Provincial Health Office to support four disadvantaged

districts namely, Mambwe, Chama, Chandiza and Nyimba. This support enabled the province to train 19

health staff from TB diagnostic centers in TB/HIV integration.

To address the staffing issues, by the end of budget period 2006, the USG supported the Provincial Health

Office (PHO) to employ a TB/HIV coordinating officer who is based in the provincial health office and is

responsible for coordinating TB/HIV activities, supervision, trainings, surveillance, and program monitoring

and evaluation. The TB/HIV coordinator has been working closely with the Provincial TB/HIV committee

and Provincial TB officer in coordinating activities in the province and providing joint supportive supervision.

Other than the USG support, the districts have been receiving support from the Global Fund to scale-up TB

control by strengthening directly observed treatment strategy (DOTS). Another key partner is CARE

International (#8819), which also previously supported TB control activities in the area for the past three

years. Due to the limited access to health care facilities and acute shortage of facility-based healthcare

staff in Eastern Province, special emphasis was placed on the development and support of community

volunteers to provide TB/HIV integrated care.

In FY 2007, Chama, Mambwe, Chadiza, and Nyimba districts 88 health staff were trained in TB/HIV

integration with support from the USG with an additional 124 health staff from the four districts trained in

diagnostic counseling and testing. A total of 120 lay counselors from the community will have been trained

by the end of FY 2007 in TB/HIV collaborative activities to strengthen community support and awareness.

Monthly community sensitization meetings with the Neighborhood Health Committee, church, and other

community leaders would be held. Monthly supportive technical supervision from the province and the

districts to the service outlets will be implemented. In order to enhance the capacity for monitoring and

evaluation of TB/HIV program, technical supervision visits will include a component of training in the use of

information for management decisions at district level, including ensuring that health workers are competent

in the use of data collection and recording tools. Monthly district and quarterly provincial meetings were

held to monitor the program activities at district, health center, and community levels. To increase on

TB/HIV collaborative activities, all four districts participated in the World TB day commemorations. Linkages

between the TB programs and other USG funded home-based care programs would be strengthened to

ensure continuum of care for the HIV infected TB patients by the end of FY 2007.

By the end of FY 2007 an assessment of infrastructure would be carried out to identify sites that require

minor renovations and refurbishment in order to ensure the availability of appropriate infrastructure to

provide the counseling and testing for TB patients and to reduce transmission of TB in clinic settings. It is

estimated that one site per district will benefit from these renovations.

An estimated 678 TB patients will have been diagnosed by the end of FY 2007 and 65% of these (441) will

receive counseling and testing for HIV. It was also estimated that 880 HIV positive clients will be diagnosed

and 30% (264) to be screened for TB disease.

To enhance equity in coverage and ensure standardization of TB/HIV services CIDRZ worked with the PHO

to provide technical assistance and build its capacity in the integration of TB/HIV care in provincial and

district hospitals. Additional technical capacity was provided by the Clinical Care Specialist assigned by

HSSP who is resident at the PHO and a CDC Field Office Manager who would be placed in the PHO in FY

2007.

By mid 2007 out of 52 health facilities providing treatment for TB in the 4 districts, 45 reported HIV testing

for TB patients though very few of the staff have been trained in diagnostic counseling and testing. Of the

estimated number of 678 TB patients, 70% (475) will receive counseling and testing for HIV and be referred

for HIV care and treatment including ART. It is also estimated that 900 HIV positive clients will be diagnosed

and 40% (360) will be screened for TB disease. It is estimated that 75% of TB patients referred for ART

services will receive HIV care and support. The TB patients found eligible for ART will be commenced on

treatment according to the national guidelines. A system to track the referrals and the TB patients

commenced on ART treatment will be developed. Isoniazid preventive treatment (IPT) for HIV positive

clients does not currently form part of the national program guidelines for TB/HIV activities and hence will

not be implemented. How ever, should the ministry of health adopt this intervention, the PHO will implement

IPT.

In FY 2008, 300 health care providers will receive training in TB/HIV integration activities both at health

facility and community levels. Among these are 100 health trained staff and 200 community volunteers. The

training for the health staff will focus on the Diagnostic counseling and testing (DCT). The community

volunteers will be trained in lay counseling and adherence support for both TB and ART treatment. Quality

of care will be assured by supportive supervision to the staff and community volunteers after the training.

The Provincial project management team and the District Health Management Team (DHMT) will conduct

quarterly supervision to the trained staff and the community volunteers will be provided with technical

support monthly by the health center staff.. The DHMTs will conduct quarterly TB/HIV technical review

meetings for the health centre staff where data will be analyzed and validated before submission to the

province. Quarterly meetings will also be organized for the community TB/ART lay counselors and

adherence treatment supporters to share experiences and submit reports to the health centers. There will

be quarterly TB/HIV technical review meetings organized by the provincial health office to analyze and

validate the data from the four districts.

Activity Narrative:

The provincial health office will strengthen the Provincial TB/HIV Coordinating committee and quarterly

meetings will be held to focus on the integration of the program in the districts. The District TB/HIV

Coordinating committees will be established in the four districts and quarterly meetings will be held

Renovations to infrastructure to create space for TB/HIV/laboratory services and to prevent the spread of

infection will be done. Each district will identify one site for these renovations.

With an additional $75,000 plus-up funds for TB/HIV, the EPHO will renovate an additional one to two sites

per district based on results of the assessment and will focus on clinics with the highest number of ART

patients. In addition training will be conducted for staff in the provincial hospital and the district hospitals in

the guidelines on prevention of TB in health care settings under development by JHPIEGO .

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

Related activities: This activity is linked to EPHO HVTB, EPHO HTXS, CARE HVCT, and CRS HVCT.

In Eastern Province, the estimated HIV prevalence rate among adults aged 15-49 years is 13.2%. In 2004,

the HIV prevalence rates among adults aged 15-49 years in Chipata, Katete, and Petauke were 26.3%,

18.1% and 9.3% respectively. The provincial tuberculosis (TB) notification rate in 2004 was 263/100,000

population. The syphilis prevalence rate among adults aged 15-59 years is estimated to be 9.3%.

In fiscal year (FY) 2006, the United States Government (USG) is supporting a number of counseling and

testing activities, at the Eastern Provincial Health Office (EPHO), including: rehabilitation and renovation of

counseling and testing rooms in the four selected health facilities (Nyimba, Mambwe, Chama, and Chadiza);

training 100 community lay counselors and 40 health care workers in adherence counseling; setting up

appropriate referrals to health centers. In addition the district recording and reporting system will be used to

document counseling activities as well as fulfill the reporting targets under President's Emergency Plan for

AIDS Relief. FY 2006 funding is expected to be available in mid-September 2006 and these activities will

start immediately when funding is available.

In FY 2007, USG will continue to support the EPHO to expand counseling and testing activities to four

additional sites within these districts for a total of eight. The recent national policy of providing routine

counseling and testing in health facilities that can provide antiretroviral therapy (ART) services supports the

plan to train 80 health care providers in HIV/AIDS counseling and rapid HIV testing. These trainings will

also include: appropriate referral of HIV positive clients to PMTCT and ART services and emphasis on

prevention of transmission of HIV among those who test positive (positive prevention) as well as issues

surrounding disclosure and discordance. This training program will complement the training to be provided

under activity EPHO HTXS (new) and EPHO HVTB (#9006) in HIV and ARV's and OI's; TB/HIV and

STI/HIV correlation and integration. The training will include TB screening using a screening questionnaire

for all persons testing HIV positive and appropriate referrals to the TB service. It is expected that at least

50% of all individuals testing positive for HIV` will receive TB screening. Due to the current human resource

crises in Zambia, an additional 100 lay counselors will be trained in counseling to increase HIV awareness,

care, and referral of cases that need further counseling and care to health facilities. These counselors will

help improve adherence among patients on ART. Training costs increase substantially when conducted in a

rural setting where the districts are far apart as compared to standard costs for services provided in urban

areas.

Service outlets for CT will also increase from one in each district to a minimum of two. The EPHO and the

District Health Management Teams will provide technical supervision to service remote sites monthly. There

will be monthly meetings for monitoring and sharing of experiences in each of the four districts. Linkages

with other USG-funded programs in the area of prevention care and treatment and the Global Fund

activities will be strengthened through quarterly partner meetings to share experiences and avoid overlap.

Logistics such as HIV test kits are being supported by the USG through the Central Medical Stores. The

districts currently hold monthly meetings with organizations and community-based groups implementing CT

activities to report on findings, share experiences, and to identify weaknesses.

The expected outcome of this activity is to provide HIVtesting services to 400 STI patients and 200

HIV/AIDS patients and approximately 1,322 clients will receive CT services from the CT outlets.

These activities will be coordinated by the EPHO and linked to the activities to be implemented by CARE

(new activity HVCT) and will result in a substantial increase in access to CT in the province in all districts.

Additional support for CT will be provided in faith based institutions in two districts through Catholic Relief

Services HVCT (#9713).

There are established structures in terms of human resource, infrastructure, and resource mobilization

through the Government of the Republic of Zambia and other donors support to ensure sustainability of the

program. The activities will also be included in future national health plans, which will secure national

funding for the activities. Emphasis on training and incorporation of CT in all service delivery points

empowers staff and ensures long-term sustainability. It is hoped that Global Fund money will also be able

to support these activities in future years.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

Related activities: This activity links to EGPAF, CRS, counseling and testing, Other prevention, laboratory

services, SI, PMTCT, and TB/HIV.

The Eastern Province, with a population of 1.6 million people, has an HIV sero-prevalence of 13.2% among

the general population between 15 - 49 years (DHS 2002). The province has eight districts and is primarily

rural. Currently there are 11 sites offering antiretroviral therapy (ART) in the province, which are based

primarily at the district and mission hospitals. The scale-up of ART services in the province has been

acheived in close collaboration with the assistance of the Catholic Relief Services (CRS) and the Center for

Infectious Disease Research in Zambia (CIDRZ). As of June 30, 2007 a total of 12,588 clients in the

Eastern Province were receiving ART through the government program.

Due to the vast distances and poor road networks and transportation system in the province, the cost of

providing care is high and access to ART is limited to mainly those with means of transportation. In order to

increase access to ART for a larger portion of the population, the Eastern Provincial Health Office (EPHO)

would like to expand the number of service delivery points in five of the districts by adding an additional two

sites per district. The EPHO plans to expand ART services to the hard-to-reach areas of the province by

developing mobile ART clinics to provide care to some of these areas. The EPHO will liaise with CIDRZ

and CRS in the selection of sites to avoid duplication and to increase geographical coverage of the province

with ART services. The EPHO has the advantage of having a presence and basic infrastructure in almost all

corners of the province through which ART services will be provided, however rehabilitation of the existing

infrastructure may be required in some areas of the province.

In FY 2007, the United States Government (USG), through Health and Human Services (HHS)/Centers for

Disease Control and Prevention (CDC) provided direct support to EPHO for supportive supervision by

provincial teams of ART service delivery in districts and to enable improved linkages with the national ART

program. Activities included: monitoring visits, training, policy and guideline dissemination, participation in

national quality improvement efforts, and integration and scale-up of the national ART information system.

Fifty members of staff were trained in the national ART training modules including Pediatric ART and by the

end of FY 2007 an estimated 2,000 additional people will be receiving ART.

In FY 2008, EPHO will work with the Churches Health Institute of Zambia (CHAZ), CIDRZ, and CRS to

scale-up support in ART services in Eastern Province. This support will enable key technical staff from

EPHO to plan and integrate services with partners to expand and link ART services in target and harder to

reach districts throughout the province. In FY 2008, emphasis will be placed on strengthening current sites,

including comprehensive pediatric ART services and mobile ART services.

Funding form the USG will be used to train an additional 50 health care workers in ART provision, including

pediatric ART with an estimated 3,000 new clients accessing antiretroviral services in Eastern Province.

Ten percent of those on ART will be children and early infant diagnosis of HIV by polymerase chain reaction

will be strengthened. Other activities will include strengthening of partner linkages through technical support

(recoding, reporting, monitoring and evaluation), strengthening of linkages between programs (PMTCT, CT,

TB/HIV), and intensifying community involvement through training of adherence treatment supporters and

having therapeutic meetings at community level.

Direct funding for ART service delivery and technical assistance will complement other support to the

province in areas such as TB/HIV and counseling and testing which will ensure sustainability of ART

services within the province.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity is linked to the UTH Virology activity.

This activity will provide local support to Eastern Province for implementation of the University Teaching

Hospital (UTH) national PMTCT and VCT quality assurance program and infrastructure development within

the districts and rural health centers of this province. Some major limiting factors for implementation,

support and sustainability of laboratory programs outside of the capital city are due to: 1) travel distances; 2)

lack of transport for onsite supervision and feedback; and 3) lack of funds for equipment and maintenance

support at the provincial and district levels. Eastern Province is seven hours by road from Lusaka where

the UTH, Centers for Disease Control and Prevention (CDC) and Ministry of Health (MOH) laboratory

experts are located. Supervisory travel visits to Eastern and other provinces must be divided by the time

and number of technical experts. The goal of this activity is to provide more opportunities for active

participation of CDC technical staff with the local laboratory team in transferring skills for procurement,

laboratory management and improving quality health care delivery to the patients. It is also a goal to build

capacity and sustainability at the local level by training and providing support for activities to be conducted

by local staff within the province for PMTCT and VCT as well as care and treatment support. During FY

2008 the goal is to continue improving capacity in both staffing and infrastructure in ten laboratories within

Eastern Province.

Eastern Province is a predominately-rural province with an HIV prevalence of 13.1%. Access to health

care facilities and services are limited, with an estimated 40% of the population living more than 12

kilometers from the nearest health facility. These distances are walked when health care is required.

Availability of laboratory services in most of the districts is limited due to several factors, which include lack

of technical human resources, lack of suitable infrastructure and services such as a source of power,

geography, and increasing numbers of persons participating in PMTCT and VCT programs at local levels.

Antiretroviral (ARV) laboratory care and treatment services are limited. Sample preparation and transport

support can alleviate the lack of services due to laboratory infrastructure and technical limitations. In FY

2008 onsite training and technical support for existing personnel in basic laboratory testing and transport will

continue being provided. Laboratory quality assurance (QA) programs for rapid HIV testing currently

performed for VCT and PMTCT will be supervised and supported by the national HIV reference laboratory

(UTH). An integrated program to include laboratory data management and onsite QA will assist in

improving and equalizing ARV laboratory services to PLWHA in these areas. Support will be provided for

basic infrastructure improvements and the provision of alternate sources of power such as solar panels and

automated backup generator specifically for the provincial and other laboratories currently lacking this

infrastructure because of erratic electrical power source with the province.

This activity will allow the EPHO to build its capacity to take the leadership supporting its laboratory

functions within the districts. It will also allow the district to draw and train the necessary laboratory

personnel to provide supportive supervision within the districts and rural health centers.

The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

This activity relates to Ministry of Health (MOH), and Technical Assistance/Centers for Disease Control and

Prevention (CDC).

Eastern Province, with eight districts, is a predominately rural province with an overall HIV prevalence of

13.2% and a reported 2004 tuberculosis (TB) incidence rate of 259/100,000. Outside of the provincial

capital of Chipata (which has an HIV prevalence of 26.3% and TB notification rate in 2004 of 380/100,000),

access to health-care facilities and services are limited.

FY 2007 funding supported Very Small Terminal (VSAT) internet connection for the province through the

Provincial Health Office (PHO) in Chipata to improve strategic information activities. Improving internet

service and email communication will reduce the isolation through increased access to information.

Communication flow between central level and the province will be enhanced with this service and help link

the PHO and the District Health Offices (DHOs). It is assumed that the availability of good internet access

will also be an important motivator to retain staff as it offers them an opportunity to participate in distance

learning programs and conduct research projects. Such investment in technology is a sustainable

contribution to essential communications infrastructure for many years ahead. The Government of the

Republic of Zambia's (GRZ) National Develop Plan (NDP) places improved information services as a top

priority, contributing non-United States Government efforts for sustainable use of technology of this kind in

to the future.

In addition to continuing ongoing support for the communications initiatives of FY 2007, FY 2008 funding will

help support other activities involved in the implementation and roll-out of the SmartCare system within the

province. At the provincial level, support will be required for the provision of supervisory visits to the

districts, further training for staff in new facilities, and also maintenance and support for deployed sites

through the continuous supply of printing and other consumables required to keep the systems running and

also to ensure that there is seamless flow of data from SmartCare at facility level to the provincial level. The

province, in addition to providing this support, will disseminate and supervise upgrades and other

enhancements to SmartCare periodically when changes are made to the system

Targets set for this activity cover a period ending September 30, 2009.