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.
United States Agency for International Development Zambia issued a new bilateral Nutrition RFA by
December 2008 to establish a bilateral Nutrition activity. Following current Office of the Global AIDS
Coordinator (OGAC) Food & Nutrition guidance, the bilateral mechanism funded by the RFA will provide
food and nutrition support to PMTCT Clients (HIV positive pregnant and lactating women, and their
children), with a special focus on moderately to severely malnourished clients who are on antiretroviral
treatment (ART) or eligible to begin ART. The new activity funded by the RFA will link these new PMTCT
services with other PEPFAR program areas in Zambia, including ART, Care and Support, counseling and
testing (CT), and orphans and vulnerable children (OVC). The new activity will also liaise closely with the
PATH IYCN activity in COP FY 2008 to ensure coordination, collaboration, and a smooth transition without
gaps in services when PATH IYCN funding ends.
Emphases of this new activity in 2009 will include increased efforts to link PMTCT activities especially
Nutrition support for HIV positive pregnant and lactating women, and their Infants and Young ART, OVC,
home-based care (HBC), and CT services, in order to minimize HIV transmission and maximize survival
time for HIV positive women and children. AWARDEE TBD will take the USG lead in Zambia on promotion
of improved nutrition for HIV positive (or exposed) women and infants, including community-based
promotion of exclusive breast-feeding up to six months, as well as timely introduction of appropriate
weaning and complementary foods.
In addition, United States Agency for International Development has underscored that AWARDEE TBD will
collaborate actively and openly with the Government of the Republic of Zambia (GRZ) and with other United
States Government (USG) partners. The aim of collaboration will be to ensure optimal provision of
Technical Assistance (TA) and training to USG partners and GRZ. In order to expand sites and services
with the new reprogramming funds, AWARDEE TBD will embrace a partner-friendly and client-oriented
approach. AWARDEE TBD will consciously minimize the demands on overstretched clinical staff and
community caregivers, while empowering them with skills and materials for clinical and community
nutritional care and support. AWARDEE TBD will help design and support services and referrals to simplify
and facilitate client continuity of care in clinic and community settings, and in-between.
Lastly, AWARDEE TBD will work on sustainability and capacity building in the last year of PEPFAR. The
most lasting gains will be in terms of organizational sustainability (organizations will continue operations
after PEPFAR) and sustainability of services (organizations will continue services as resources permit).
The most difficult to achieve will be financial sustainability (maintaining the same level of funding).
The objectives of this activity are to integrate nutritional assessments, counseling, and appropriate, cost-
effective, targeted nutritional supplementation, into PMTCT services to reduce post-partum HIV
transmission and mortality among exposed infants. This activity will provide strong community outreach to:
promote six months of exclusive breastfeeding for HIV-exposed newborns (mixed feeding increases the risk
of HIV transmission); integrate nutritional screening and targeted nutritional supplements into PMTCT
services for HIV+ pregnant and lactating women, especially those with low CD 4 counts; and support
appropriate weaning of HIV exposed and HIV+ infants through nutritional counseling, as well as timely and
targeted provision of appropriate weaning and complementary foods.
This activity focuses primarily on the post-partum period and has a strong clinic-community linkage
component. The community linkage will come through directly linking PMTCT clients to existing cadres of
thousands of home-based care and OVC volunteer caregivers, who will be trained to support exclusive
breast feeding until six months and appropriate weaning and complementary feeding practices thereafter.
This activity will build on existing and planned PMTCT services. By providing support for safer feeding
practices and preventing/treating malnutrition, it will help ensure that women and children are protected
against post-partum transmission. In addition, this activity will help increase PMTCT uptake by offering a
more comprehensive PMTCT package to HIV positive pregnant and lactating women and their infants,
including nutritional assessment, counseling, and, where needed, nutritional supplements. This, combined
with expanded ART access, will constitute a very attractive PMTCT package for many eligible women.
AWARDEE TBD will work jointly with USG Zambia funded partner(s) and the GRZ, to provide technical
assistance, offer training technical advice and materials and other inputs to support nutritional assessment,
counseling, and supplements at various clinical locations. This will ensure that approaches recommended
at the clinic level are supported thereafter by community-based caregivers. Antenatal clinics and PMTCT
sites will first identify high-risk women (low CD4 counts and/or malnourished) and "prescribe" and
"dispense" appropriate, cost-effective maternal nutritional supplements to support the health of the mother
and reduce the risk of low birth weight infants. These same women and their infants would then benefit
from the standard PMTCT services, reducing the risk of transmission.
After the birth of the child, AWARDEE TBD-supported training and TA will ensure ongoing clinical
assessment and nutritional counseling at clinical sites, such as well-child/maternal-childhood health (MCH)
clinics, which will advise on exclusive breastfeeding (EBF) and Acceptable, feasible, affordable, sustainable
and safe (AFASS) practices up to six months and on how to introduce appropriate weaning and
complementary foods thereafter. Selected clinic sites will also "prescribe" and "dispense" nutritious weaning
and complimentary foods for infants who are deemed to need them, and to mothers who present with low
CD4 counts and/or signs of serious malnutrition.
AWARDEE TBD will work with United States Agency for International Development and CDC PMTCT
projects to select and establish as many "demonstration sites" as COP FY2008 funding will allow, based on
such criteria as HIV prevalence, client load, malnutrition rates, facility-perceived need, capacity, and
willingness each in the Northern and Southern half of Zambia. The catchment areas for each site will
include ART and PMTCT clinical services, and community support services (HBC and/or OVC caregivers),
as well as well-child/MCH/under-five clinical care. The combination of these services will allow a complete,
integrated PMTCT-HBC-ART network to function.
Activity Narrative: Recent research has confirmed the value of exclusive breast-feeding for PMTCT clients and their infants.
This approach will afford PMTCT partners (Zambia Prevention, Care and Treatment Partnership (ZPCT)
and Zambia Exclusive Breastfeeding Services (ZEBS)) an option to improve maternal and infant survival
and mortality, through strengthened nutritional assessment, counseling, and support, beyond the first six
months of life. It would also help determine the value of community-based promotion of EBF and
appropriate weaning and feeding practices linked to a network of clinical PMTCT and ART services.
AWARDEE TBD will assist United States Agency for Inernational Development Zambia to adapt or adopt
the United States Agency for International Development Kenya "Food by Prescription" model, as well as
other experience with nutrition assessment and supplementation in Zambia (e.g., CIDRZ, SUCCESS). The
models offer opportunities for replication and expansion. Based on a detailed assessment of local private
sector food processing capacity, AWARDEE TBD will assist United States Agency for International
Development to make best use of existing private producers to cost-effectively produce (and/or procure)
and distribute appropriate food and nutrition support products. AWARDEE TBD will incorporate a private
sector orientation fully into the activity from the outset, and will provide ample private sector skills and
capacity for success in this area via a combination of direct staffing and/or consultancy services.
It is anticipated that through technical and training assistance, and design of materials and products,
AWARDEE TBD will be able to support a full range of services including nutritional assessment and
counseling and, as required, nutritional supplements to approximately 10,000 HIV positive women and
infants at ten carefully selected sites. AWARDEE TBD will begin with those sites selected and supported by
PATH IYCN, and expand to others as resources permit. This number of sites assumes that the women and
children will benefit from food supplements on average for three-six months.
This activity has a strong capacity building aspect for both clinical sites (PMTCT, ART, and well-child/MCH
clinics) and the OVC and HBC community caregivers, who will acquire and make use of valuable nutritional
assessment and counseling skills.
The initial investment in production and distribution of appropriate food supplements for mothers and
weaning foods for infants will stimulate the private sector investment in appropriate food supplements, as
well as attract wrap-around funding, such as income-generation, other appropriate forms of food aid for
malnourished people living with HIV/AIDS (PLWHA) and their infants, or support to increase agricultural
yields.
If successful, the model can be replicated/expanded to serve more sites and all under-five children of HIV
positive mothers through better nutrition guidelines and training in nutritional assessment and counseling for
clinical and community based caregivers. This will depend on funding availability. Demonstration of the
effectiveness of this approach may facilitate future access to further funding from a variety of sources.
All FY 2008 targets will be reached by September 30, 2010.
New/Continuing Activity: Continuing Activity
Continuing Activity: 20732
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
20732 20732.08 U.S. Agency for To Be Determined 11947 11947.08 Nutrition RFA
International
Development
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
USAID Zambia issued a new bilateral Nutrition RFA by December 2008 to establish a bilateral Nutrition
activity. Following current OGAC Food & Nutrition guidance, the bilateral mechanism funded by the RFA
will provide food and nutrition services to People Living With HIV/AIDS (PLWHA), primarily, moderately to
severely malnourished clients who are on ART or eligible to begin ART. The new activity funded by the
RFA will link to ART service delivery providers (CIDRZ, AIDS-Relief, and ZPCT), Palliative Care services
(RAPIDS, SUCCESS, PCI/ZDF, ZPCT, and others) as well as to PMTCT clients who receive either a full
course of prophylaxis or a full course of ART, and to OVC providers
Emphases of the RFA will include: increased efforts to link to ART OVC, HBC, and PMTCT activities, and
to provide nutritional support and counseling to benefit malnourished PLWHA, OVC and HIV positive
infants, especially those on ART. Goals are to optimize treatment outcomes and survival time, minimize
HIV transmission, and help reduce malnutrition in PLWHA through targeted, time-limited nutritional support.
The goal of this new activity will be to improve ART patient outcomes by introducing nutritional assessment,
nutritional counseling, and therapeutic feeding for severely malnourished ART clients. Severely
malnourished palliative care clients who have not yet initiated ART will also be eligible for therapeutic foods.
This approach is in line with OGAC Food & Nutrition Guidance issues in September 2006. This activity will
address clinical malnutrition, a medical condition common in individuals with HIV/AIDS, and will not be used
to address food security -a broader, non-clinical problem.
This activity will be modeled at least partially on the successful USAID Kenya "Food by Prescription"
program. It will carefully target nutrition interventions to improve clinical outcomes in malnourished
PLWHA. The program will screen and target malnourished clinically malnourished adults and children with
HIV, following Zambian guidelines on treatment of malnutrition and will have strict client "entry and exit"
criteria as recommended by OGAC. The "Food by Prescription" initiative will follow WHO recommendations
and will be evidence-based.
The awardee TBD will work with USG partners and the GRZ to continue to develop and finalize guidelines
to integrate nutrition and therapeutic feeding into ART and palliative care services. An initial regimen of
therapeutic feeding, with a timely transition to supplementary food and then to a regular diet, corresponds to
the need for clients who have experienced the "wasting" effect associated with the onset of ARC, to: rebuild
lost body mass; enabling them to resume a normal, active life as they respond to ART, rebuild their immune
systems; and go back to work.
AWARDEE TBD will build capacity to provide nutritional assessment, nutritional counseling, and nutritional
support (therapeutic and then supplementary foods) for 7,500 or more severely malnourished PLWHA who
are either ART clients, or eligible HBC clients waiting for ART.
To meet this target, AWARDEE TBD will provide training and technical assistance to clinical staff and
community-based health workers (volunteer home based caregivers as well as their registered nurse
supervisors, etc) at a number of selected sites which have a constellation of existing ART, HBC, and other
HIV/AIDS related services. AWARDEE TBD will also provide funding to support the cost of producing,
distributing, monitoring and reporting on therapeutic and supplementary foods.
The AWARDEE TBD will address private sector, market orientation, as well sustainability concerns by
working with one or more private sector partners, such as local food processing plants, to produce the
RUTF and HEPS products, as well as by using a training of trainers (TOT) model. By using existing local
food processing with the requisite quality control, the USG will not have to pay for plant or equipment. Local
food processors will have to demonstrate that they can produce a consistent, quality product while adhering
to strict cost control as well. This may allow the processors to market therapeutic and supplementary foods
of high quality through the private sector, positioning them for sale in pharmacies and doctors' practices. In
cases where clients cannot afford to buy them at retail prices, the USG could use "social marketing" price
schemes to reduce the cost, or could provide them at no cost to truly destitute clients.
The AWARDEE TBD will build local capacity and strengthen local institutions. There are possibilities for
Public-Private Partnerships (PPP), leveraging and wrap-arounds, such as the Land O'Lakes PPP funding
for a food processor to produce fortified food products for malnourished PLWHA. The AWARDEE TBD will
explore leveraging opportunities to mobilize corporate donations to reduce the cost of production, or provide
free constituents for food products.
Continuing Activity: 20731
20731 20731.08 U.S. Agency for To Be Determined 11947 11947.08 Nutrition RFA
Table 3.3.09: