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 narrative is for three months only.
The most limiting factor in scaling up of anti-retroviral therapy (ART) services is lack of trained providers -
physicians, nurses, clinical officers, laboratory personnel, and others. The priorities of the National Human
Resources Strategic Plan include recruitment, deployment, and retention of health workers. The Health
Services and Systems Program's (HSSP) role in the ART program is to support the Ministry of Health
(MOH) to retain critical staff in areas of greatest need and provide support in performance improvement and
quality assurance. In FY 2005, HSSP recruited and placed nine Provincial Clinical Care Specialists (CCSs)
to enhance ART coordination and quality assurance; initiated the recruitment of doctors under the rural
retention scheme and development of guidelines and systems for the accreditation of ART sites.
In FY 2006, HSSP's focus was on continued support to CCSs, placement of medical doctors to serve in
remote areas and recruitment of non-physician health care workers for the retention scheme. In FY 2007,
HSSP continued to support the nine CCSs and the retention scheme for doctors, non- physician health
providers and nurse tutors. HSSP paid the salaries and provided maintenance and fuel expenses for
supervision trips of the CCSs in the nine Provincial Health Offices (PHOs). The CCSs continued to provide
technical backstopping and supervision to junior doctors implementing HIV/AIDS activities in the districts as
part of human resource capacity development. They also worked with the PHOs to coordinate ART scale-
up in hospitals and health centers, served as provincial ART trainers, and monitored and supervised the
private sector ART provision. CCSs assisted other USG programs in the provinces, including Zambia
Prevention, Care and Treatment Partnership (ZPCT), Health Communication Partnership, and Centre for
Infectious Disease Research in Zambia (CIDRZ). CCSs served as a conduit for provincial coordination and
quality assurance.
In FY 2008 HSSP will continue to support the nine CCSs through payment of salaries and provision of fuel
expenses for supervision and coordination of ART scale up in hospitals and health centers. The Rural
Retention Scheme for medical doctors, nurse tutors and other health workers will be supported using
funding already received from FY2005, FY 2006 and FY 2007.
In FY2009 (October to December), CCSs will orient new provincial and district staff in HIV program
management and document successful practices and lessons learned through the CCS program.
Regarding the area of health worker retention in FY2009, HSSP will continue to support MOH to manage
the 119 staff on the retention scheme and arrange for their transition to pool funding support and assist the
MOH to develop strategies to sustain the currently deployed health workers on the retention scheme
beyond the life of the project. HSSP will continue to provide TA to MOH in preparation of the semi-annual
management and financial reports of the ZHWRS; and document the development, implementation and
evaluation of the ZHWRS.
In FY 2006, HSSP supported MOH and Medical Council of Zambia (MCZ) to develop an ART accreditation
plan, consensus-building on ART standards and initiated accreditation of private ART sites. In FY 2007,
HSSP/MCZ continued to roll out the accreditation system to more districts. So far 125 sites have been
assessed of which 41 have been accredited. Eight of these are private sites. In FY 2008, HSSP will
support MCZ to monitor, document and improve the overall functioning of the accreditation system.
In 2009, HSSP will continue to monitor and provide feedback to accredited ART sites and document and
disseminate lessons learnt in developing and implementing an ART accreditation system. HSSP will
continue to work closely with the CDC, ZPCT and the WHO to support the MOH in improving services for
HIV/AIDS patients in health facilities.
In FY 2007, HSSP and other partners supported the integration of HIV/AIDS services into MOH
Performance Assessment tools and developed minimum quality assurance standards for HIV/AIDS
services. The tools and minimum standards were approved by MOH and are in use in all districts. In FY
2008, HSSP will focus on monitoring of implementation of the Performance Assessment tools and
standards and strengthening supervisory services that focus on case management and quality
improvement.
In FY 2009, HSSP will continue to support the MOH to monitor performance assessments and targeted
technical support supervision to further consolidate HIV/AIDS systems and services; and ensure that these
activities are integrated in the district action plans.
To ensure sustainability, HSSP will ensure that all guidelines, protocols, plans, and budgets developed
during the life of the project are disseminated to relevant stakeholders. This enables the MOH to plan and
implement activities independently. All project activities are integrated into the existing programs and
structures to ensure continuity of services after HSSP concludes.
All FY 2009 targets will be reached by December 31, 2009. The project will end in December 2009.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14367
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14367 3531.08 U.S. Agency for Abt Associates 6803 1022.08 Health Services $1,000,000
International and Systems
Development Program
8794 3531.07 U.S. Agency for Abt Associates 4942 1022.07 Health Services $2,570,000
3531 3531.06 U.S. Agency for Abt Associates 2910 1022.06 Health Services $2,250,000
Table 3.3.09:
This activity will last for three months and links to Catholic Relief Services/AIDS Relief, and Center for
Infectious Disease Research Zambia (CIDRZ). This activity also links with HSSP's human resource
development component under the Other/Policy Analysis and System Strengthening program area.
The Health Services and Systems Program (HSSP) has successfully worked with the Ministry of Health
(MOH), and in collaboration with other partners to develop and disseminate standard data elements, data
collection, and reporting tools, and to train health facility staff. In FY 2008, HSSP will continue to support
and supervise districts and hospitals to improve data quality and enhance utilization of data for informed
decision making by strengthening the provincial structures and competencies in supervision and technical
backstopping for ARTIS/HMIS. Nine provincial health staff and three MOH headquarters staff will be trained
for this purpose. HSSP will also work with CDC to aggregate facility data (SMARTCARE CARD) and
facilitate overall integration into the HMIS. It is expected that there will be improvement in the quality of
action plans, implementation, and services in general. Reviewing district action plans has revealed that
planning is not sufficiently based on evidence or sound epidemiological data, hence the need to focus on
improving data utilization at service delivery level.
In 2009 (October to December), HSSP will continue to support and supervise districts and hospitals to
improve data quality. HSSP will support provinces in technical support supervision activities building on the
skills developed during the project life.
To ensure sustainability, all systems developed with support from HSSP have been part of the on-going
overall Health Management Information System (HMIS) review. As implementation of the revised HMIS
becomes an established part of the daily activities of the MOH, so will HSSP's contributions to the process.
HSSP will continue to work closely with the MoH, Provincial Data Management Specialists, District Health
Information Officers and other partners to develop, disseminate, and maintain the HIV/AIDS reporting
systems which are integrated into the overall HMIS. HSSP's mandate is to ensure integration of ART,
PMTCT, CTC, and TB indicators into the HMIS and ensure usage and maintenance of the developed
information system.
All FY 2009 activities will be implemented using FY 2008 funds and hence no budget has been developed.
Continuing Activity: 14368
14368 3532.08 U.S. Agency for Abt Associates 6803 1022.08 Health Services $200,000
8795 3532.07 U.S. Agency for Abt Associates 4942 1022.07 Health Services $320,000
3532 3532.06 U.S. Agency for Abt Associates 2910 1022.06 Health Services $320,000
Table 3.3.17:
This activity is for three months.
Building on FY 2005, FY 2006, and FY 2007 activities of strengthening policy and systems that support
HIV/AIDS services, the overall focus for Health Services and Systems Program (HSSP) in FY 2009 will be
to work with the Ministry of Health (MOH) to provide targeted technical support; and finalise and
disseminate lessons learnt, in the following areas: 1) planning; 2) human resource planning and
management (HRPM); 3) pre- and in-service training; and 4) HIV/AIDS coordination and Sector Wide
Approach (SWAp).
In the area of planning, in FY 2009, HSSP will support the provincial health offices to review and finalise
district action plans, ensuring that HIV/AIDS services are planned for, based on priorities and objectives of
the National Health Strategic Plan; and document experiences and challenges in planning for HIV/AIDS
services.
In FY 2007, HSSP worked with the MOH to disseminate HIV/AIDS human resource (HR) planning and
projection guidelines and plan for HR requirements to deliver a minimum package of HIV/AIDS services.
HSSP supported Provincial Health Offices (PHOs) to assess their district HR needs and developed 72
district HR staffing plans. In FY 2008, HSSP will support MOH and PHOs to strengthen the role of
Technical Supportive Supervision (TSS) in HR planning and management. In FY2009, HSSP will provide
technical support supervision to strengthen district compliance to HR guidelines.
In the area of pre and in service training in FY 2009, HSSP will monitor the use of the National In-service
Training Coordination System developed in FY2005 to ensure that skills enhancement is linked to provision
of HIV services. In the area of pre-service training, HSSP will monitor the use of the revised curriculum and
provide technical support supervision to faculty to ensure that graduates from nurse and other clinical
training institutions are adequately trained to provide HIV services. HSSP will also document and
disseminate its valuable experiences in curriculum review in order to share knowledge and garner support
for strengthening health worker skills in providing HIV services.
In FY 2009 HSSP will also continue to support HIV/AIDS coordination and SWAp activities and specifically
provide technical assistance to the SWAp program to assist MOH to meet milestones under the Sector
Program Assistance (SPA); and document best practices in the HIV/AIDS service provision such as the
referral mechanism at national and district levels, and disseminate for use in improving quality of care for
people living with HIV and AIDS (PLWHA).
HSSP will work in collaboration with USG partners and other stakeholders in finalizing its activities and
disseminating lessons learnt to ensure continuity. The Provincial Health Office and respective directorates
will be encouraged to work independent of the project to review, and monitor and evaluate planned
activities.
FY2009 activities will be implemented using carryover funds from FY 2008
Continuing Activity: 14560
14560 3529.08 U.S. Agency for Abt Associates 6803 1022.08 Health Services $850,000
8793 3529.07 U.S. Agency for Abt Associates 4942 1022.07 Health Services $1,194,000
3529 3529.06 U.S. Agency for Abt Associates 2910 1022.06 Health Services $1,194,000
Table 3.3.18:
