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
The funding level for this activity in FY 2009 will remain the same as in FY 2008. Only minor narrative
updates have been made to highlight progress and achievement.
This activity relates to Boston University (BU) PMTCT activities.
In support of the Zambia National HIV and AIDS Strategic Framework 2006-2010 (ZASF) as well as
strengthening the capacity of the national health system to provide sustainable HIV/AIDS services, the
United States Government (USG) through CDC directly supports the Southern Provincial Health Office
(SPHO) in its plan to better coordinate and oversee prevention of mother-to-child transmission of HIV
(PMTCT) services; to provide training; and expand PMTCT services to health centers currently not
covered by Boston University Center for International Health and Development-Zambia (BUCIHDZ) formerly
the Zambia Exclusive Breastfeeding Study (ZEBS). BUCIHDZ will continue to provide PMTCT services in
the 8 districts where they currently work. This will be achieved through the coordination and leadership of
the SPHO to ensure uniformity and standardization of the PMTCT services in line with the minimum
package of maternal, neonatal and child services. In order to create a sustainable PMTCT program, the
SPHO will play a key role in ensuring that technical supportive supervision is provided to these districts and
will coordinate all PMTCT services and implementing partner (BUCIHDZ) to ensure optimal resource
utilization.
The Southern Province has 11 districts; all districts have scaled-up PMTCT. Out of 234 maternal and child
health centers in the province, the USG in FY 2007 supported a total of 165 PMTCT sites through Boston
University while the SPHO directly supported 21 sites with training of health workers. In joint partnership
with Boston University (BU), the PHO ensured that all the 186 sites provided PMTCT services in these
underserved districts. A total of 309 health workers and community health cadres have been trained in the
provision of the services. Of the sites that provide PMTCT services, 25 also provide antiretroviral treatment
(ART) services, whilst 173 provide tuberculosis (TB) treatment, counseling and testing, and other palliative
care services to which the pregnant women are also referred through an established referral system. In FY
2008, this system was further strengthened to ensure that all HIV+ pregnant women had their CD4 count
done, were given an efficacious regimen for ARV prophylaxis, screened for TB and further linked to ART
services for initiation of comprehensive HIV care, and to orphans and vulnerable children (OVC) and
palliative services.
In FY 2008, this activity continued to supplement PMTCT training in the three districts not supported by BU
(Namwala, Sinazongwe and Itezhi-tezhi) with training of providers and scaling up the number of PMTCT
sites in order to roll-out the services to the rural most populations. With SPHO support, these districts rolled
-up PMTCT services in all their health facilities. The services provided at these sites are in line with the
core PMTCT interventions as stipulated in the protocol guidance. The SPHO trained 50 health workers
through this activity to cater for attrition and for newly graduated /engaged staff who may not be previously
trained. The SPHO working in partnership with BU ensured that an additional 25 new PMTCT sites were
established across the province to bring the coverage of PMTCT services to 90% of health facilities in the
province.
In FY 2009, the SPHO will continue providing PMTCT services to the three districts it is directly supporting,
will strengthen the component of technical and supportive supervision to the 11 districts, and will ensure
that all PMTCT services are standardized and in line with the Ministry of Health (MOH) protocols.
In addition to the scale-up of PMTCT sites, the SPHO will collaborate with the BUCIHDZ in order to
strengthen the existing PMTCT services. In this regard, apart from continued support for monitoring of
services, the SPHO will work with the MOH PMTCT Technical Working Group (TWG) and Johns Hopkins
Program for International Education in Gynecology and Obstetrics (JHPIEGO) in developing PMTCT
mentorship tools. The current team of provincial mentors will be oriented to the use of these tools, and a
further team of 60 mentors consisting mainly of MNCH Coordinators will also be trained and supported to
under-take monthly mentorship to PMTCT sites. The mentors will conduct onsite fresher skills development
for 75 previously trained health workers in the three focus districts to provide technical updates. The SPHO
will further train 50 health workers in integrated PMTCT package to cater for new recruited health workers
and cushion the old ones.
One factor that hinders the PMTCT program is the lack of active male involvement. The SPHO in
partnership with Men Take Action will train 250 male community based PMTCT agents/mentors as a key
activity in strengthening male participation in the roll-out of this activity. Participants to this training will
include men selected from work-places in the urban and peri-urban settings, apart from the typical
community agents as modeled in Zimba. SPHO in collaboration with CDC will pilot a male involvement
facility-based intervention that seeks to provide couple counseling and encourage men to attend ANC with
their partners. The SPHO ‘s involvement in the coordination of the program will ensure 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 Government of the Republic of Zambia
plays a key role in the continued delivery and sustainability of PMTCT services.
Support will continue to be provided to strengthen PMTCT services in the Southern province 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. This activity is linked to a
wrap-around with Integrated Management of Childhood Illnesses (IMCI) and community based village
registers and records (RED-C strategy for EPI), as well as Pediatric ART services. Having being
successfully implemented in Sinazongwe, Namwala and Itezhi-Tezhi, SPHO will collaborate with BUCIHDZ
to roll-out the concept to the remaining eight districts. The follow-up concept was initially piloted in
Sinazongwe district and resulted in an increase in the follow through rate from 39% to 84% over a period of
six months. Based on these results, the concept was adopted and integrated into the national training
curriculum for community health worker training under MOH. Using this new curriculum, the SPHO will
training 100 community health workers per district in Namwala, Itezhi-tezhi and Namwala to further
strengthen the community component and infant-mother tracking system. Support will be provided for
Activity Narrative: community mobilization and leadership meetings with Village headmen, councilors and chiefs in these
districts. Further support will be provided for Income Generation Activities (IGAs) for sustainability in terms
of capital funds and support for three income generating activities coordinators at each district to build
capacity and keep volunteers engaged in the PMTCT program.
Support for strengthening of contraception services within ART services, antenatal clinic (ANC) services,
and other service areas for the prevention of pregnancies in HIV positive women and women with a high
risk of being HIV positive will be scaled-up as part of wrap around with family planning services.
Strengthening of linkages with Adolescent Friendly Health Services will also be an important area of focus
so as to collectively begin reducing the rate of HIV positive pregnancies in general across the province.
In FY 2009, the SPHO will spearhead and provide leadership with an enhanced coordination of PMTCT
supply chain management to ensure that no supply stock-outs disrupt PMTCT services; improve the
monitoring and reporting system to ensure that all PMTCT sites and districts in the province are reporting
and lastly, strengthen the referral systems namely for infant-mother pair follow-up, ART for HIV positive
women especially for CD4 testing and link HIV positive women and their exposed infants to appropriate
HIV/AIDS programs supported by the USG partners for orphans and vulnerable children and home based-
care in the Southern Province.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15550
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15550 9739.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $350,000
Disease Control & Office - Southern U62/CCU02514
Prevention Province 9
9739 9739.07 HHS/Centers for Provincial Health 5015 2973.07 SPHO - $350,000
Emphasis Areas
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $100,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Activity Narrative: This is a continuing activity from FY 2008 and funding will significantly increase in order to
address a wider scope of HIV prevention services
The activity is linked to activities supported by the USG for the SPHO including
counseling and testing (CT), tuberculosis (TB) and HIV, and HIV treatment services.
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Provide training to community and religious leaders to incorporate prevention messages and activities at
their functions.
Actively work with health centers to integrate prevention in other aspects of care such as counseling and
testing, prevention of mother to child (PMTCT), tuberculosis treatment, and antiretroviral (ART).
Youths will be recruited to ensure their longevity with the programs.
Increase education on and treatment of sexually transmitted infections (STIs) at all districts and health
centers
A radio program will be implemented to increase community awareness around prevention.
In the FY 2007, the Zambia Demographic Health Survey report, indicated a reduction in the HIV prevalence
in Southern Province from 16.2% in 2004 to 14.5% in 2007. Despite this reduction in prevalence, there is
no room for complacency and the SPHO is working towards continuing to impact prevention activities to
further reduce the rates of HIV infection
Since FY 2007, the SPHO provided support for establishment and strengthening of adolescent friendly
corner services in the 11 districts in 55 health facilities out of the provincial total of 234 and supported the
training of 80 health workers including district focal persons and partners in complete package of adolescent
reproductive health services. Support was also provided for the provision of supplies such as information
Education and Communication (IEC) materials, audio visual equipment (TV and VCR), support for
community sensitization and strengthening health facility implementation including orientation of staff and
peer HIV, and counseling. By the end of FY 2008, over 15,000 adolescent youths were reached with
integrated information on STI, HIV, ANC, condom use, family planning and other prevention strategies.
This support will continue and it is expected that by the end of FY2009, 90% (210) of health facilities in the
province shall offer complete package of Adolescent friendly health services.
The program shall continue to target the adolescents aged 10-24yrs and reach 20,000 young people with
integrated information on Adolescent Sexual Health including STI/TB/HIV/AIDS and ART services by the
end of FY 2009.
The adolescent friendly services function under the existing health care services and are part of the
government run facility and provide a point for access to health services, condom collection, and social
activities; however the attrition rate among the youths running the centers is high due to limited incentives
and the need for them to move on in life. This is why training involves both health care workers who are
more permanent and the fluid population of youths. To avoid continuous training of youth who move on,
funds will be used to hire two youths at each center on a permanent basis to ensure continuity and stability.
For the rest of the youth who will move on with their lives and careers, it is hoped that they will carry with
them the knowledge and life skills about HIV/AIDS and related services and act as peers for the
communities that they move to train/study in and work with.
To accomplish this, direct support was provided to all the 11 Districts in FY 2008 to establish and strengthen
the Youth Friendly HIV/STI prevention and treatment services. In addition, the SPHO trained 100 health
providers from 100 sites to work with young people in various HIV/AIDS interventions and thus increased
the number of sites offering youth friendly health services from 55 to 155. One hundred HIV peer
counselors were also trained from the old 55 sites. As a result of this intervention, about 20,000 young
people aged 10-24 were reached with integrated information on STI, TB, and HIV. In order to address the
problem of inadequate facilities and services to attract the patronage of youths which in time hinders the
control of HIV and STIs, the SPHO supported the refurbishments of at least six youth friendly corners in
each of the 11 districts and further provided IEC materials in form of Television, VRC, radios, netball, and
football kits. An initial 50 bicycles were procured to strengthen outreach activities in the communities.
In FY 2009, the SPHO will continue to strengthen and scale-up HIV prevention services to all the districts
and continue to expand STI services. In 2009, districts will work with community health workers and youth
peer educators to take STI and HIV prevention education into the community. Community leaders will be
trained work with their communities to increase the number of both youth and adults seeking STI treatment
early and to promote less risky sexual behaviors. The existing 135 adolescent friendly sites will be
strengthened through quarterly district technical supportive supervision while an additional 55 sites will be
provided with direct support to strengthen the delivery of youth friendly services.
Support will continue to be provided to establish health centre based youth groups who will be provided with
a full range of HIV/STI preventive massages and strategies. For the youths who are not sexually active,
emphasis will be placed on building self esteem and skills to enhance abstinence and/or delay of sexual
debut. The youths will be provided with the information on the dangers of early sexual activities. On the
other hand, peer educators will be trained to identify sexually active youths in order to provide them with a
complete package of HIV prevention strategies include access to condom supplies and referral to services
for STI/HIV counseling and testing .In addition , the community will be mobilized and encouraged to directly
open dialogue with youth people to address factors that fuel HIV transmission such as multiple and
concurrent partnership, harmful cultural practices, cross generational and transactional sex.
In FY 2009, the SPHO will conduct a small survey in Livingstone and Gwembe districts in order to
investigate the needs of the youths particularly the out of school youths to facilitate effective program design
and appropriate intervention for HIV amongst this population.
The data collection tools, which will be adapted from WHO, will continue to be used for monitoring the
Activity Narrative: quality of the services provided. The strengthening of YFHS will also improve young people's health
seeking behavior and thus facilitate early diagnosis and management of tuberculosis (TB) and STIs
including HIV. Linkages to TB/ART services will also be strengthened.
In 2008, SPHO implemented a prevention for positive component to working
with both youths and adults. SHPO will work with School of Medicine who are funded to build provincial
health facilities' capacity to deliver prevention for positives and negatives program and integrate prevention
to CT, PMTCT, tuberculosis (TB) and antiretroviral therapy (ART) that refer those who are positive and
negative to the prevention workshops. Funds for 2008, were used to build the Provincial Health Office's
and District Health Management Teams capacity to implement a prevention for positive program; hiring a
prevention for positives coordinator, train the coordinator, develop materials and implement the program in
at least two districts in the province.
In FY 2009, SHPO will work with Intrahealth and school of medicine who are funded to build provincial
health facilities' capacity to deliver prevention for positives and negatives program to additional six districts
in the province as well as integrate prevention into other aspects of health care. Intrahealth with continue to
provide supportive supervision. A monitoring component will be initiated to track program outcome. Part of
2009 funding will be used to scale up prevention for positives component to additional five districts in the
province including training community leaders. About 2,400 adults will be reached through these
workshops in 2009.
Also, in 2009, activities to reach the out of school youths and adults 12 sensitization and preventive radio
programs for youths on TB/HIV/AIDS/STIs will be aired. The media will provide a forum to education the
community on STIs and HIV/TB and where to find relevant health services. Topics to be covered will
include, Importance of CT, Couples CT, PMTCT, Youths and CT and prevention, Prevention for positives
and negatives, Adherence including nutrition, alcohol and HIV, STIs, HIV and TB, domestic violence, male
circumcision, and child sexual abuse. These topics will be addressed in relation to risk behavior and
behavior change. The SPHO in collaboration with the provincial prevention technical working group will
identify experts in the areas above to lead the discussions.
Targets set for this activity cover a period ending September 30, 2009.
Continuing Activity: 17064
17064 17064.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $115,000
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Child Survival Activities
* TB
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.03:
THIS IS A NEW ACTIVITY:
•Increased access to Male Circumcision (MC) services
This activity will be linked to the former JHPIEGO and University of Zambia (UNZA) School of Medicine (MC
training center activity) CDC activity.
From fiscal year (FY) 2007 to FY 2009, JHPIEGO have trained provincial health offices to build their
capacity to provide safe, quality, and effective MC services. MC is an evidence based prevention
intervention which so far has only been implemented at one site in the province, namely Livingstone
General Hospital. The intervention is known to reduce the risk of acquiring HIV infection. The expectation
is that after the training the provincial health offices will take the lead in scaling-up MC services at their
district health facilities. The service will be targeted to reach a total of 500 clients during the first year.
This funding is for the SPHO to expand provision of MC services in at least five of the district health
facilities. The funds will be used for capacity building and establishment of MC team at each of the seven
selected district facilities to deliver MC services. The SPHO will target to develop teams of eight health
workers per site. Collectively, 60 health personnel will be trained. Renovation of space for MC,
procurement of necessary equipment, and translation of MC information, education and communication
(IEC) materials will also be funded. We will work with JHPIEGO and the UNZA School of Medicine in site
selection and supportive supervision. Training in some of the five districts will be conducted in conjunction
with JHPIEGO who have been funded to do training and provide supportive supervision until the province is
confident to take over such role.
Based on the experience from Livingstone General Hospital, the SPHO will implement comprehensive MC
services in another five hospitals (Choma, Mazabuka, Siavonga, Maamba, and Monze). This activity will
also include community mobilization and sensitization. The approach to achieving these objectives in 2009
will be to provide direct funding to the districts based on the detailed plans developed by the districts for
scaling-up of MC. The SPHO in partnership with JHPIEGO and the Ministry of Health (MOH) central level
provide implementation TSS and will mentor district supervisors in ensuring that the quality of service is
maintained high.
In order to ensure sustainability of the program and to promote lasting behavior change, MC services will be
integrated as part of regular health service provided by the district health offices. Community leaders will be
engaged and educated to conduct community mobilization for the MC services. Community health workers
currently covering counseling and testing, prevention of mother to child, tuberculosis (TB) and Malarial
message in each districts selected will be further trained to include MC message in their packed of
community health education.
The key with MC interventions will be to integrate strong prevention message and couple this with vigilant
HIV counseling and testing services. The expected outcome of prevention will be clearly made to ensure
each person circumcised understands their role in prevention and the need to not see MC as a magic bullet
but a step that must be accompanied with strong consistent use of condoms, being faithful, and abstaining
from high-risk sexual interactions.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.07:
This activity is linked to EGPAF (CIDRZ) and CRS.
The Southern Province Health Office (SPHO) proposes to expand antiretroviral (ART)
services in the province in FY 2009 and continue to work closely with partners such as the Center for
Infectious Disease Research in Zambia (CIDRZ) and Catholic Relief Services (CRS) in expanding and
consolidating the services. There will be close communication, exchange of ideas, and experiences
between the providers in the province through clinical symposia in order to continue providing improved and
quality ARV treatment services.
Population of the province stands at 1,396,906, with growth rate of 2.3% and Sero-prevalence rates
standing at 14.5%. Despite this decline in the HIV prevalence, improved HIV diagnostic capacities in the
province (leading to an increasing burden of HIV infected individuals), and the government's policy on
provision of free ART, the demand for ART services continues to increase. Of the provinces total
population, 85% is living in rural areas and 15% in urban areas. The province now has the fourth highest
HIV prevalence rates after Lusaka (20%), Central/Copperbelt (17.5/17%), and Western Province (15.2%).
This means there are approximately 200,000 persons living with HIV/AIDS, with 40,000(20%) in need of
ART.
In FY 2008, the SPHO ART subcommittee was further strengthened and expanded to incorporate partner
working in these areas such as CIDRZ, CRS, and, Boston University (BU) to continue to provide guidance
and leadership in the implementation and expansion of the HIV/AIDS treatment and care services. As a
result of this coordinated effort in providing quality and province wide HIV treatment and care services, the
province enrolled 22,000 individuals on ART, i.e. approximately 8,000 above the target of 14,460 and
managed to increase the number of active HIV/AIDS treatment sites to 34 from 25.
In FY 2008, the SPHO prioritized improving the quality of HIV/AIDS treatment and care service as opposed
to rapid scale-up to new sites with compromised quality, and thus maintained the 34 sites in the province.
In order to further improve the quality of service in the province, 16 ART sites were accessed for
accreditation using the standards set by the Medical Council of Zambia.
In FY 2009, the SPHO will continue to provide support for the scale up of the innovative and comprehensive
clinical mentorship program aimed at improving quality of TB/HIV/AIDS/STI and general clinical case
management. This strategy is in recognition of the weak clinical case management in general across the
province and will thus serve as a quality assurance system for case management along side the continued
scale up of HIV and TB services including ART to the primary level of health care. Between FY 2007 and
FY 2008, a total of 42 clinical mentors were trained in mentoring skills and performed field based
mentorship activities at five major hospitals: Livingstone General Hospital, Choma General Hospital, Monze
Mission Hospital, Mazabuka Hospital, and Siavonga Hospital with high HIV and TB patient loads. This
strategy has further proved to be effective in realigning clinical skills in addressing challenges in HIV/TB
treatment.
In FY 2009, the SPHO will continue to strengthen the clinical mentorship program and provide regular
technical support to the mentors in partnership with CIDRZ and CRS. Support provided will include
transportation , supplies and up-keep for mentors when out of station, support to provincial and zonal
planning and review meetings, and that an additional 25 clinical mentors will be trained in mentoring skills to
reduce the burden on the few existing mentors and maintain high standards of case management in the
In FY 2009, the SPHO will support the implementation of strategies to ensure HIV prevention is reinforced
in ART treatment settings. To accomplish this, an initial 66 peer educators will be trained to work in the 33
ART sites to provide support to HIV patients to promote non risk behaviors amongst positive patients and
encourage treatment buddies to seek early counseling and testing for HIV/AIDS.
In order to strengthen HIV prevention with treatment services, the SPHO will collaborate with ART treatment
department to integrate behavior change through prevention with positives. Three approaches will be used
1) asking clients if their partners have tested and if not, they will be encouraged to bring them to test. The
emphasis will be on the importance of couples knowing their status together 2) couples will be enrolled and
engaged in discussions for at least two hours once a week for four weeks exploring HIV/STI/TB prevention
and to come up with ways to limit new infections and re-infections 3) after the four sessions,
couples/individuals will be referred to community discussion groups formed and trained to promote HIV/STI
prevention. Community groups will be led by community leaders trained in prevention and behavior
change using participatory learning approaches.
As this is a new strategy in the ART program, the SPHO will dedicate $130,000 to ensure effective HIV
prevention activities including prevention for positives. The funds will be used to hire prevention for
positives coordinator, additional counseling staff to engage patients into longer counseling sessions that
address prevention, alcohol use and adherence, staff to run the discussion groups and train community
leaders in prevention. Funds will also be used to provide transportation for follow up with community
discussion groups. Funds will also be used to develop behavior change and communication materials and
implement the program in the six districts (Livingstone, Mazabuka, Choma, Monze, Siavonga and Kalomo)
with highest HIV prevalence in the Southern Province.
SPHO will work with Intrahealth and School of Medicine (SOM) who are funded to build provincial health
facilities' capacity to deliver prevention for positives and negatives program to the six districts in the
province as well as integrate prevention into other aspects of health care. Intrahealth will continue to
provide supportive supervision. A monitoring and evaluation (M&E) component will be initiated and
integrated into the overall SPHO M & E to tract program performance and outcomes.
The Southern Province is a large province with several remote health facilities making it difficult for clients to
access ART services. The infrastructure in these health centers is inadequate and generally not conducive
for friendly ART services. In FY 2008, the SPHO directed part of the USG support towards infrastructure
improvements for at least three ART sites in each of the 11 districts in the province. In FY 2009, this activity
will be continued and support will be provided to infrastructure improvement in 16 ART sites which are
planned to be opened during this year as a scale up strategy to implement ART at primary level of health
Activity Narrative: care.
The Ministry of Health still faces and enormous human resources crisis. The need for trained health
workers to offer ART/OI services is still a critical requirement for effective and quality ART services.
In FY 2009, in each of the 16 new primary health care sites, six (6) health workers will be trained on ART/OI
management totaling 96. Further training gaps will be identified from the existing facilities especially the 19
major hospitals and at least three (3) health workers will be trained per hospital (total of 57). The provincial
database of ART training needs for all districts (names and cadres) will continue to be revised and updates
on a regular basis to include changes in staffing levels.
In FY2009, the Provincial ART Sub-committee will continue to coordinate the ART program in the province
in collaboration with partners like CIDRZ, CRS and BU. The SPHO will work with district health offices
(DHO) to conduct site assessment for the targeted 16 new ART sites, using the existing assessment tools.
However, considering that HIV/AIDS management concepts are rapidly evolving, and that the clinical
problem encountered with ART treated individuals continue to evolve with increasing duration on therapy, a
lot more attention will be paid to the updating of knowledge and skills for these health workers. Such
continuing professional development (CPD) will be achieved through increased on site technical supportive
supervision (TSS) and technical assistance (TA) by specialists and the holding of quarterly clinical symposia
for 40 previously trained health workers each quarter.
Further, with increased counseling and testing capacity, more TSS will be required to strengthen linkages
between community counseling and other services to Tuberculosis (TB), PMTCT and ART services.
In FY 2009 considerations will continue to be made for accelerating the expansion and decentralization
process which was started in FY 2007 to the district level in line with the current National ART scale up plan
to ensure that ART delivery becomes an integrated service in the basic health care package. This will
ensure sustainability and ownership of ART services. In this case, the Provincial ART Sub-committee will
focus on monitoring and evaluation. Aspects such as the identification of potential ART centers, the
structured assessments of the identified sites and the supervision of the service will continue to be
implemented by the DHO.
District health teams will continue to be supported to strengthen district ART sub-committees for effective
coordination. The provincial health office will support the holding of quarterly review meetings at provincial
level involving key district program officers. The meetings will both serve as a monitoring and evaluation
coordinating forum as well as to provide a forum for the district managers to review performance of the
services and share best practices across districts in the continued scale-up of ART services.
Support will be provided to health center staff to work with community leaders, neighborhood health
committee, trained birth attendants, treatment supporters and community health workers in increasing
awareness on the availability and benefits of ART services. To strengthen this community component, 300
community members will be trained in home based care and supported to follow up and care for patients at
community level. This, cumulatively, is expected to result in 26,000 HIV patients with province-wide
coverage being enrolled on ART by the end of FY 2009.
Support will also be provided to ensure sustainability of community participation in the delivery of
comprehensive care services by introducing income generating projects for community care givers. This
strategy will be supported initially in Livingstone district, Kazungula district and Kalomo district as it requires
close monitoring and supervision.
Targets set for this activity cover a period ending September 30, 2010.
Continuing Activity: 15553
15553 9760.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $250,000
9760 9760.07 HHS/Centers for Provincial Health 5015 2973.07 SPHO - $250,000
Table 3.3.09:
THIS IS AN EXTENSION ACTIVITY OF THE OBJECTIVES ON PEDIATRIC ART UNDER THE ACTIVITY
ART/OI IN FY 2005-FY 2008 AND IS PRESENTED AS A SEPARATE SECTION FOR FY 2009.
This activity is linked to all the Southern Provincial Health Office (SPHO)funded activities in counseling and
testing (CT), (# 3669.08), prevention of mother-to-child transmission (PMTCT), (#9739.08), adult treatment
(#9760.08), prevention programs (#17064.08 and NEW SPHO) as well as laboratory services (# 16979.08).
Funding is also linked to other United States Government (USG) partners in pediatric care and support
(ICAP PDCS # NEW and PCOE #NEW) and treatment (#ICAP PDTX and Pediatric Center of Excellence
(PCOE) #NEW, EGPAF PDTX # NEW and CRS AIDSRelief PDTX #NEW and PDCS # NEW.
The SPHO proposes to implement activities aimed at scaling-up comprehensive pediatric HIV/AIDS
services in the province in FY 2009 and will work closely with partners such as the Center for Infectious
Disease Research in Zambia (CIDRZ), Catholic Relief Services (CRS), UTH and Livingstone Pediatric
Centre's of Excellence and Columbia University and Boston University PMTCT program in expanding and
rolling out the services.
The prevalence of HIV in Southern Province is estimated at 14.5 % (ZDHS, 2007), representing a 1.5 %
reduction from 2004. Despite this positive decline in the HIV prevalence, improved HIV diagnostic capacities
in the province (leading to an increasing burden of HIV-positive diagnosed individuals) especially infants
and children, and government's policy on provider initiated counseling and testing provision of free ART to
all PCR/ Positive/confirmed infants has led to a continued increased in the demand for ART services in
children.
In FY 2008 the Southern Provincial Health Office (SPHO) ART subcommittee was further strengthened and
expanded to incorporate partners working in this area such as CIDRZ, CRS, BU-PMTCT and continued to
provide guidance and leadership in the expansion of HIV treatment and care services.
As a result of this coordinated effort in providing quality and province wide HIV treatment and care services,
the province enrolled 22,000 individuals on ART, i.e. approximately 8,000 above the target of 14,460, and
managed to increase the number of active HIV Treatment sites at the end of 2007 to 33.
Despite these tremendous achievements on the general ART program, the SPHO has noted poor
performance in Paediatric HIV enrollment and scale up of the services which currently stands at 7% of adult
enrollments which is below the WHO recommendation of pediatric ART clients constituting10 % of total ART
enrollments.
Using the experience and expertise from the Livingstone General Hospital Paediatric Centre of Excellence,
the SPHO will provide leadership and coordination in rolling out Paediatric HIV services to all 33 ART sites
in the province. Quarterly review and planning meetings will facilitate, on one hand, communication,
exchange of ideas, and experiences between service providers at district /facility level and cooperating
partners and SPHO on the other hand. Amongst other quality assurance activities, clinical symposia will be
held in order to ensure quality comprehensive HIV/AIDS services for children.
In collaboration with CIDRZ and CRS, the SPHO will open and support six Satellite Centres of Excellence at
Choma General Hospital, Monze Hospital, Kalomo Hospital, Namwala Hospital, Maamba Hospital, and
Itezhi-tezhi District Hospital. This will greatly assist in increasing Paediatric HIV uptake in the province from
the current 7% to at least 11% of adults on ART and target to enroll at least 80% of eligible infants and
children by the end of 2009. Six (6) data associates will be hired for data management at each of the sites.
The Southern Province is vast with several remote health facilities making it difficult for clients to access
ART services. The infrastructure in these health centers is inadequate and generally not conducive for
friendly ART services. In FY 2009, the SPHO will direct part of the USG support towards infrastructure
improvements for at least seven sites providing Paediatric HIV treatment services
In order to address the significant weakness in the pediatric ART component, the PHO will allocate
substantial resources for capacity development in Comprehensive Pediatric HIV Care and Treatment,
increase linkages with PMTCT. The Ministry of Health still faces enormous human resources crisis. The
need for well trained health workers to offer Comprehensive Paediatric HIV treatment and care services is
still a critical requirement for effective and quality ART services. In each of the 33 ART sites, three health
workers will be trained, giving a total target of 99 health workers.
problems encountered by pediatric ART treated individuals continue to evolve a lot more attention will be
paid to the up-dating of knowledge and skills for these health workers. Such continuing professional
development (CPD) will be achieved through increased on-site technical supportive supervision (TSS) and
technical assistance (TA) by specialists and the holding of quarterly clinical mentorship training updates for
50 previously trained clinical mentors. This activity will also be linked to the UTH Paediatric three month's
clinical attachment program to improve performance on general Paediatric which has so much convergence
with Paediatric HIV/ART.
In order to further enhance quality, the SPHO will orient the existing team of provincial mentors in the use of
the recently developed Paediatric ART mentorship materials. This will increase capacity for pediatric ART
mentorship of then existing ART mentorship program currently in existence with strong collaboration and
technical assistance from HSSP, CDC - GAP and CIDRZ.
To strengthen this activity financial support will be provided for quarterly mentorship field activities.
Further training gaps will be identified especially from the proposed five Satellites of PCOE and appropriate
training will be conducted in provider initiated routine CT for all children to facilitate early diagnosis.
Activity Narrative: In order to strengthen the early diagnosis of children mainly challenged by the centralization of the
DNA/PCR equipment 500 Kilometers away, the province will work with partners to ensure that DBS courier
system is well coordinated for early transportation of specimens and feedback from Lusaka. The SPHO will
thus work with DHOs to strengthen the intra-district courier system capacity by strengthening systems and
boosting the transport capacity in the form of one extra motor cycle for each district. The district focal
persons will be mentored in DBS TA/TSS to ensure quality. Focus will be mainly on Itezhi-tezhi, Namwala,
and Sinazongwe which receive direct SPHO/CDC funding.
Parallel to the scale-up of comprehensive pediatric HIV care, the SPHO will continue to roll-out the Family
Support Units which provide routine counseling and testing for children and their family members , a
concept that has proved vital for the provision of psychosocial support to the HIV infected children and their
families. During FY 2006/07, and based on the success of the FSU at Livingstone General Hospital, the
SPHO rolled-out this concept to Maramba UHC, Choma General Hospital, Monze Mission Hospital, and
Itezhi-Tezhi Hospital with support from CDC and UNICEF. The SPHO will continue to roll-out the FSU's to
Namwala, Kalomo, Zimba and Maamba Hospitals during 2009
In FY 2009, there will be acceleration in the expansion and decentralization process which was started in
FY 2007 to the district level in line with the current National ART scale up plan to ensure that ART delivery
becomes an integrated service in the basic health care package. This will ensure sustainability and
ownership of ART services. In this case, the Provincial ART Sub-committee will focus on monitoring and
evaluation. District health teams will be encouraged to incorporate Paediatric ART as a key component of
the District ART sub-committees for effective coordination. The SPHO will support the holding of an
orientation training for Paediatric ART for district managers and support quarterly review meetings at
provincial level involving key district program officers. The meetings will both serve as a monitoring and
evaluation coordinating forum as well as to provide a forum for the district managers to review performance
of the services and share best practices across districts in the continued scale-up of Paediatric ART
services.
Additional support will be provided to health center staff to work with community leaders, neighborhood
health committee, trained birth attendants, treatment supporters and community health workers in
increasing awareness on the availability and benefits of early HIV diagnosis among children and availability
of these. The community health leaders and workers also assist in enhancing adherence to treatment and
follow up of patients.
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $60,000
Table 3.3.11:
updates have been made to highlight progress and achievements.
This activity relates to activities in counseling and testing, laboratory infrastructure, palliative care, and basic
health support activities.
In Southern Province the HIV prevalence had reduced from (16.8% to 14.5 and the Tuberculosis (TB)
incidence rate has increased from 415/100,000 in 2006 to 421/100,000 at the end of 2007. Livingstone
district, which is the provincial capital of Southern province, continues to report extremely high HIV
prevalence (31.2%). The number of TB cases notified in the province reduced from 6,103 in 2006 to 6,074
at the end of 2007. The smear positive rate also reduced from 25.8% in 2006 to 24.6% in 2008 and the cure
rate increased from 82.2% in 2006 to 84% at the end of the first half of 2007 reported in 2008.The cure rate
for the 2nd quarter 2007 patients was 86.6%. The provincial data confirms that 70% of TB patients are also
co-infected with HIV. The province has implemented Provider Initiated Counseling and Testing (PICT) of TB
patients for HIV in order to ensure early detection of HIV in TB patients since 2005.As a result of the scaling
up of PICT, significant progress has been made in testing TB patients for HIV, increasing from 36% of TB
patients tested in 2006 to 72% by mid 2008. Based on the performance assessment standards of 80%,
SPHO in 2009 targets to raise the acceptance rate of TB patients testing for HIV to 90% using lessons
learnt from LGH where over 95% of TB patients are tested for HIV.
Although it is part of the national guidelines to implement TB/HIV activities that ensures that all HIV infected
individuals in Anti retroviral treatment (ART) and other service areas such as prevention of mother-to-child
transmission (PMTCT) and sexual transmission infections (STI) clinics are screened for TB, the province
has identified weakness in this area. In order to address this, the TB/HIV activity has been strongly linked to
the ART clinical mentorship program, which ensures comprehensive screening and correct case
management of all HIV and TB patients. With this strategy, SPHO targets to ensure that at least 80% of all
HIV positive individuals will be screened for TB at the end of 2009.
Although World Health Organization (WHO) recommends Isoniazid prevention treatment (IPT) for HIV
positive individuals, it does not currently form part of the national guidelines for TB/HIV activities and hence
will not be implemented in the province.
In FY 2007, SPHO provided training in TB/HIV integration to 130 health care workers in all the 11 districts in
the province to enhance the implementation of these activities in 19 TB diagnostic/ART sites. In 2008,
SPHO further expanded the implementation of TB/HIV activities from 19 sites in 2008 to 33 sites. In order to
increase case finding of TB, SPHO expanded TB diagnostic centers from 32 sites in 2006 to 43 sites in
2008.
The SPHO further trained 152 health workers in PICT and 170 health care workers in TB/HIV integration by
end of 2007. In order to increase community participation in this program area, the SPHO trained 200
community members as lay counselors and provided funds directly to the districts for the implementation of
these training activities. In FY 2007, the number of health centers providing integrated TB/HIV activities
increased to a total of 173, representing 78% of the total number of possible sites (234). Staff has been
trained in PICT in 93 sites, whilst psychosocial counselors have been trained to provide TB/HIV services in
an additional 87 sites. By the end of FY 2007, direct district support resulted in training an additional 300
health workers in TB/HIV collaborative activities based on the training of trainers' model utilizing the core
group of trainers resulting from the USG supported activities of JHPIEGO in FY 2006, FY 2007, and FY
2008 (activity 9032) .Other activities supported with the funding have been the strengthening of referral links
between the TB and HIV treatment programs to ensure that all HIV-infected TB patients are referred for
ART and all HIV-infected patients are screened for TB. The SPHO technical implementation team provided
continued technical support which resulted in 72% of the 6000 expected TB patients received counseling
and testing services by mid 2008.
In FY 2009, in order to maintain high standard of quality, the SPHO will conduct quarterly technical support
supervision on TB/HIV services at provincial and district levels. To maximize program impact with the
available resources and avoid duplication between the partners, in FY 2009, SPHO TB/HIV support shall
focus mainly on Sinazongwe, Namwala, Monze, Itezhi-tezhi, Livingstone, and Kazungula and directly
support 118 sites. The Centers for Infectious Disease Research in Zambia (CIDRZ) strengthened TB HIV
services in the province in FY2008. In FY 2009 TBD will focus on Mazabuka, Choma, Gwembe and
Kalomo, while CRS will provide support for activities in Siavonga district. Linkages between the TB/HIV
program and existing home based care programs funded through the USG/SUCCESS and RAPIDS) and
other donors will be strengthened. In FY 2008 six hundred (600) community based treatment supporters
that are currently used to supervise directly observed treatment for TB patients received additional training
in TB/HIV integration and adherence counseling with the potential to provide support for adherence to ART
by the end of 2008.
In order to ensure accuracy of data and quality of care, the provincial and district health offices in
partnership with CIDRZ, CRS and Boston University conducted regular technical support supervision (TSS)
visits to the health centers and provided technical assistance to address identified areas of weakness. As a
result of this activity, an estimated 6,000 HIV infected individuals would have received TB treatment
according to national guidelines at the end of 2008.
Twelve (12) new TB diagnostic centers were opened in the five highest TB/HIV districts in the province
(Livingstone, Monze, Mazabuka, Siavonga and Choma) by the end of 2007 using resources from the USG.
These sites were supported with infrastructure improvements to create a conducive environment for TB/HIV
activities by March 2008. In FY 2009, an additional 10 new TB diagnostic sites will be opened and the
existing 43 sites will be further strengthened. Owing to the staff limitation in laboratories, 20 TB
microscopists will be trained in TB slide examinations and in order to intensify case finding, 20 microscopes
will be procured for the same sites with trained microscopists.
Activity Narrative: The Provincial TB/HIV coordinating committee that is tasked with the strategic direction, planning and
supervision of the TB/HIV integration activities throughout the province will receive continued support.
Membership on this committee is drawn from the TB/HIV program's partners. This committee meets on a
quarterly basis. Similar structures were established and supported in all the 11 districts. In FY 2009, this
activity will continue and support will be provided to expand to health centre levels to strengthen community
coordination of TB/HIV activities.
Quarterly review meeting, linked to TB Directly Observed Treatment Short course (DOTS) review meetings
and symposia which are co-funded by the Global Fund will continue to be held. The provincial TB/HIV
Monitoring and Evaluation/ review meetings will be attended by district TB/HIV Coordinators, laboratory
staff, Clinicians and pharmacy staff. The SPHO will fund quarterly district specific review meetings with
health centre staff in the seven districts.
In FY 2008, the SPHO continued to strengthen the community component of integrated TB/HIV
management through the training of 600 community treatment supporters bringing the total 1,200 in the
province. In FY 2009, 300 community treatment supporters will be trained in TB/HIV integration in
Kazungula, Livingstone, Sinazongwe, Namwala, Itezhi-tezhi, and Monze districts.
In FY 2008, the SPHO provided support towards training of 300 HW in PICT, in order to provide integrated
TB/HIV services in 200 (90%) of the 234 facilities in the province. In FY 2009, 120 HW will be trained from
the six districts listed above to ensure that all health workers are competent to provide PICT. In addition,
300 health workers will be training in TB WHO revised modules to strengthen the management of TB in
relation to HIV/AIDS.
The Provincial and district TB/HIV coordinating committees will continue to be strengthened and provided
with support for quarterly district technical review meetings as a way of strengthening supervisory
capacities at district level. In order to enhance the capacity for monitoring and evaluation of TB/HIV
program, the TSS 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.
In FY 2009, the SPHO will direct at least 35% of the total funding to infrastructure improvement in order to
reduce the risk of transmission of TB in 18 sites with a focus on clinical areas where patients may have
undiagnosed TB. The sites to benefit from this activity include Livingstone district (Libuyu clinic, Linda clinic,
and Musi-o-tunya clinic), Monze (Manungu clinic, St Mary's clinic and ZCA clinic), Kazungula (Nyawa,
Kauwe, and Simaango clinics), Sinazongwe (Sinazongwe HC, Sinamalima, and Sinazeze) Itezhi-tezhi
(Itezhi-tezhi hospital, Kaanzwa, and Lubanda HCs), Namwala (Namwala hospital, Moobola and Muchila
Health Centers).
The SPHO will provide support to renovate additional 10 ART sites in the above districts in the province,
focusing on the sites with the largest number of ART patients in order to strengthen infection control. In
addition, the SPHO will disseminate and conduct training for 50 HW in infection control using the guidelines
produced by Jhpiego in the six districts.
As a result of this support to the SPHO, 85% of an estimated 8,000 patients will access TB diagnostic
services, and receive HIV counseling and testing over 12 months. In addition it is estimated that 70% of the
clients testing HIV positive in other service areas will be screened for TB and referred for appropriate care.
SPHO will care for 4,000 HIV infected clients receiving TB treatment and 6,400 clients to receive counseling
and testing for HIV with results.
There are no gender disparities in the provision and access to TB/HIV diagnosis and treatment in Zambia.
To ensure sustainability, the activities are enshrined in the Ministry of Health provincial and district health
strategic plans.
Targets set for this activity cover a period ending September 30, 2010
Continuing Activity: 15551
15551 3649.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $400,000
9017 3649.07 HHS/Centers for Provincial Health 5015 2973.07 SPHO - $210,000
3649 3649.06 HHS/Centers for Provincial Health 2973 2973.06 Southern $150,000
Disease Control & Office - Southern Provincial
Prevention Province Health Office
Estimated amount of funding that is planned for Human Capacity Development $160,000
Table 3.3.12:
This activity is linked to SPHO funded activities under prevention,# 1706.08 laboratory, #9739.08, adult
treatment #9760.08, pediatric treatment # PDTX NEW as well as other partner activities under tuberculosis
and HIV, HVTB JHPIEGO (#3644.08) and CHAZ HVTB (#9734.08), counselling and testing, HVCT DAPP
(#3678.08), JHPIEGO (#4527.08), Intra Health (15503.08) and, CRS (#9713.08).
The HIV prevalence rate in Southern Province has dropped from 16.2% to 14.5% among adults aged 15-49
years (Zambia Demographic Health Survey (DHS), 2007). According to the DHS 2002, Syphilis prevalence
rate among adults aged 15-49 in 2002 was 4.1%.
In FY 2005 and FY 2006, USG directly funded the Southern Province Health Office (SPHO) to expand
counseling and testing (CT) services in the 19 TB diagnostic and antiretroviral therapy (ART) centers in
Southern Province. In 2006, the SPHO focused on the five highest HIV/TB burden districts; Choma,
Livingstone, Mazabuka, Monze and Siavonga where 20 health workers were trained in psychosocial CT and
200 community members were trained as lay counselors. Funds also supported the Mosi-o-Tunya Family
Support Unit (FSU) at Livingstone General Hospital (LGH) with logistics for running the FSU and support for
counselors.
In FY 2007, the SPHO trained 34 health workers in psychosocial counseling and 20 lay HIV counsellor
supervisors along with 270 community members trained as lay counsellors. The SPHO also offered
additional training to health workers previously trained in ART and opportunistic infections (OI) management
in the following areas;
- ARV drug adherence counseling,
- Prevention of HIV transmission in those who test positive (positive prevention),
- Issues around discordance disclosure, and
- An update on current protocols in HIV testing and HIV management.
In addition, 69% of HIV positive individuals were screened for TB and referred for appropriate management.
All these areas were covered in new training in FY 2008.
An additional focus of this activity was on strengthening HIV/STI prevention services and STI treatment
services for youth in FY 2007. In FY 2008, this activity was strengthened and directly supported under
condoms and other prevention to streamline reporting and have targeted focus on the prevention of STIs
including HIV.
In 2008, an additional 300 community lay counsellors and community adherence supporters were trained.
The SPHO further expanded the community component of counseling and testing by training 600
community HIV counselors, strengthened linkages with partners like Kara Counseling and Testing Trust,
Provincial and District AIDS Task Forces, New Start Centre and other organizations involved in counseling
and testing, through quarterly consultative planning and review meetings.
In order to expand the services offered and provide adequate space for counseling, resources were
allocated to minor renovations at 3 CT sites in each district of the Southern Province. Direct support
continued to be provided to the Mosi-o-tunya Family Support Unit (MFSU) HIV counseling and testing
initiative at Livingstone General Hospital. In addition to the MFSU, support was extended to six new Family
Support Units at ; Livingstone District, Monze Mission Hospital, Monze District, Choma General Hospital,
and Itezhi-tezhi District. It is anticipated that by the end of FY 2008, an estimated 15,000 clients would have
been reached.
Expansion of CT services for HIV remains a key activity that helps achieve the goals of the President's
Emergency Plan for AIDS Relief (PEPFAR) by strengthening the identification of individuals at high-risk of
being infected and linking them to care and support service (SPHO HTXS and SPHO HLAB #9739.08). In
FY 2007, USG has continued to support the SPHO to provide couples CT for sexually transmitted infections
(STIs) and strengthen linkages with the ART services in 33 sites within the 11 districts in the Southern
Province. Quarterly supportive supervision in the districts were conducted by the SPHO technical committee
members with a view of mentoring local district supervisors and thereby building supervisory capacity and
ensuring quality counseling and testing services.
In addition, two health workers were trained on HIV adherence counseling and rapid testing using
standardized guidelines and protocols at the Ministry of Health in each of the 33 ART sites, giving a
cumulative total of 108 trained HW. It is hoped that this training of health workers will result in improved
adherence by TB patients on ART and improve the cure rate from 77.4% in 2005 to 95% in 2009. The
training will continue to strengthen the linkages between the CT services and the STI, TB and ART
programs to ensure that HIV positive patients are routinely screened for TB and STIs. It is expected that
80% of all individuals testing HIV positive will receive screening for TB. With the expanded CT services in
the province, it is expected that 40,000 individuals will receive counseling and testing for HIV by the end of
FY2009
In FY 2009, the SPHO will continue to strengthen and expand CT services as a key HIV intervention by
scaling up and support for the implementation of the provider initiated counseling and testing. This initiative
has been successful at LGH where all patients have been routinely provided with CT services. This initiative
will be scaled up to all the 18 remaining major hospitals in the province. To accomplish this, the SPHO will
strengthen the existing diagnostic counseling and testing strategy to include routine counseling and testing
of all patients rather than only TB and pregnant mothers. Initial training will be provided to 76 health workers
from the 19 major hospitals.
The SPHO will further facilitate the implementation of programs to increase demand for CT services in FY
2009. Although the HIV/AIDS pandemic has been in Zambia for over 20 years, the current uptake of HIV
testing services in the province is still as low as 16%.This therefore compels the SPHO to lead and
coordinate initiatives to increase the demand for counseling and testing services. To achieve this, the SPHO
will work with partners such as Zambia Emory Research Project, Intra Health, Development Aids People to
Activity Narrative: People (DAPP), and the District Health Management Teams to support community based counseling and
testing in the province. This will include support to two mobile drama groups in each district, and support
community based door to door counseling and testing using the new HIV rapid testing algorithm. In addition,
20 community counselors will be trained per district in HIV testing including members of the mobile drama
groups giving a total of 220 for all the 11 districts. The SPHO will support the districts to ensure availability
of counselors in all counseling and testing sites at all times including task shifting. To cater for the urban
and peri-urban communities, training in community counseling and testing will also include participants from
selected work-places within the province.
The SPHO will also continue to address the poor infrastructure in most health facilities by supporting
infrastructure improvement in counseling and testing in at least 5 sites in each of the 11 districts.
The SPHO will continue to strengthen the Family Support concept for adults in order to increase the number
of individuals accessing counseling and testing services. In this regard, support will continue to be provided
at LGH were this module has been successful for Livingstone District, Monze Mission Hospital, Monze
District, Choma General, and Itezhi-tezhi district hospitals. Specific focus will be given to developing
capacity for couple counseling within the FSU's so as to address the high rate of new HIV in couples as
reported by the Ugandan study aimed at developing new strategies for HIV intervention to avert new
infections (Lancet infectious diseases, 2008) and the 2007 ZDHS preliminary report. Expertise and training
support will be drawn from the ZERHP couples counseling program.
This activity, in addition to the work that JHPIEGO is doing in CT (#4527.08), will collaborate with the
mobile CT services targeting mobile population and agribusiness, and the program to provide mobile/boat
VCT in Namwala and Itezhi-Tezhi(HVCT #15503.08) through Intra Health.
To sustain this program, the districts will include the activities in the Government of the Republic of Zambia
annual district health plans. Emphasis on training and incorporation of CT in all service delivery points
empowers staff and ensures long term sustainability.
Continuing Activity: 15552
15552 3667.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $200,000
9018 3667.07 HHS/Centers for Provincial Health 5015 2973.07 SPHO - $200,000
3667 3667.06 HHS/Centers for Provincial Health 2973 2973.06 Southern $150,000
Estimated amount of funding that is planned for Human Capacity Development $80,000
Table 3.3.14:
ACTIVITY UNCHANGED FROM FY2008
This activity is linked to the TB/HIV (#0724) , PMTCT, ART in Southern Provincial Health Office (SPHO),
and the Centers for Disease Control and Prevention - Technical Assistance (CDC-TA #9022), Comforce
(#8996), Chest Diseases Laboratory (CDL #5510), University Teaching Hospital Virology (UTH #9042),
EGPAF-CIDRZ (#16956) and Supply Chain Management Systems (SCMS #9524) within the Laboratory
section.
The Southern Provincial capital, Livingstone district, is 500 km from Lusaka. At the end of FY 2007, HIV
prevalence in this province was 16.2% with a tuberculosis (TB) incidence rate of 421/100,000. The
Province ranks fourth behind Lusaka, Central, and the Copperbelt provinces in terms of the HIV and TB
burden in Zambia. Livingstone district continues to report extremely high HIV prevalence (31.2%) and the
TB notified cases for the province reduced from 6,103 in 2006 to 6,074 at the end of 2007. The smear
positive rate also reduced from 25.8% in 2006 to 24.6% in 2008 and the cure rate has increased from
82.2% in 2006 to 88% in 2008
Availability of laboratory services in most of the more rural districts continues to be limited, due to several
factors including shortage of man power and lack of suitable infrastructure, and a continual source of power.
However, there is still an increasing demand for specialized laboratory investigations to initiate and monitor
antiretroviral therapy.
In FY 2008, The United States Government (USG) provided support to Southern Province for the
improvement and implementation of quality assurance/quality control (QA/QC) programs in prevention of
mother to child transmission of HIV (PMTCT), counseling and testing (CT), diagnostic counseling and
testing (DCT), TB HIV, and antiretroviral therapy (ART) laboratory services. The goal of the activity was to
build capacity and sustainability at the local level by transferring skills for equipment procurement and
maintenance, sample transport, and establish laboratory quality systems within the province by supporting
orientation of quality improvement training at all sites. In collaboration with CDC, UTH, and CDL in FY
2008, 19 laboratories were targeted in Southern Province.
In FY 2009, SPHO will work with MOH, CDC, and other partners to conduct the following activities: 1)
ensure smooth functioning of the courier system for dried blood spots (DBS) for early infant diagnosis and
sputum samples to the reference laboratories; 2) renovate rooms at the new centre of excellence building to
set up a polymerase chain reaction (PCR) laboratory unit where early infant diagnosis will be performed
using DBS; 4) procure equipment and materials needed for the district hospital laboratories, procure
equipment service maintenance contracts and procure equipment and materials to set up the PCR
laboratory in Livingstone; 5) hire one biomedical scientist and one laboratory technologist to perform PCR
work in the new PCR lab. SPHO will also hire an additional laboratory deputy coordinator (biomedical
scientist) and a laboratory technologist to assist the provincial laboratory manager coordinate with the CDC
Zambia provincial contact for improving the quality of laboratory services, training, and all other lab program
activities within the southern province.
In FY 2009 SPHO will support the roll-out of Laboratory QA programs for rapid HIV testing currently
performed in the CT, DCT, and PMTCT in the Southern province by working closely with the National HIV
Reference Laboratory (UTH), CDC laboratory staff, and provincial laboratory coordinating committee. Plans
will be drafted to identify training sites, participants, dates, and time. The funds will be used to support and
cover the cost of the training; to monitor and evaluate the performance of staff at testing sites, to liaise with
the Zambian National Blood Transfusion Service (ZNBTS) for testing panels; to support participant
transportation to training sites and training materials to ensure smooth, effective and efficient subsequent
roll out in all districts at all sites in Southern Province. In addition, an integrated program to include,
laboratory data management, onsite quality assurance that assists in improving and standardizing
antiretroviral therapy laboratory services will continue. SPHO will procure equipment and supplies and
support key laboratory staff to attend training, conferences, and/or workshops for professional development
purposes.
Furthermore, in FY 2009, SPHO will also assist the MOH, UTH, and CDC with its national QA activities in
other Laboratory testing including CD4. SPHO will strengthen TB diagnostic capabilities within laboratory
network in the Southern province by support staff for trainings in HIV/TB, external quality assurance (EQA)
for acid fast bacilli (AFB) smear Microscopy, and improving sensitivity of TB smear diagnosis by using LED
microscopy and participating in the national QA for TB microscopy. The province will also work with the
supply chain management (SCMS) to ensure un-interrupted supply of Laboratory commodities
In order to strengthen coordination, planning, monitoring and evaluation of laboratory infrastructure and
services, the SPHO will improve information flow by communicating with partners involved in the laboratory
program, co-ordinate and support regular meetings with CDC and other partners such as SCMS, CIDRZ,
and MOH, to allow dissemination of activity and improve collaboration to avoid duplication of activities and
encourage feedback. In addition SPHO will continue to support a provincial biomedical scientist and four
laboratory technologists at major hospitals; Livingstone, Choma, Monze, Mazabuka by providing needed
training and overtime allowances. This cadre of lab personnel will assist the SPHO in coordinating and
strengthening laboratory services including technical support to lab facilities in the province. Apart from
routine laboratory investigations, they will assist the districts and institutions in ensuring timely reporting of
laboratory supplies and information and troubleshooting.
The activities will compliment and support the MOH National Lab QA program, to continue to build local
capacity and sustainability
Continuing Activity: 15554
15554 9797.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $200,000
9797 9797.07 HHS/Centers for Provincial Health 5015 2973.07 SPHO - $400,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.16:
This activity relates to Ministry of Health (MOH) (#3713.08) and Technical Assistance/Centers for Disease
Control and Prevention (CDC) (#3714.08).
In FY 2008, the United States Government (USG) with President's Emergency Plan for HIV/AIDS Relief
funding provided initial support to Very Small Aperture Terminal (VSAT) internet connection for the province
through the Southern Provincial Health Office (SPHO) in Livingstone to improve strategic information
activities.
This support for improving internet service and email communication will reduce the isolation through
increased access to information. Communication flow between central level and the province was
enhanced with this service and helped link the SPHO and the District Health Offices (DHO). 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 distant learning programs and conduct research projects. Such investment
in technology is a sustainable contribution to essential communications infrastructure for many years ahead
and a great contribution of the USG to the MOH technological improvements.
In addition, the FY 2008 funding helped support other activities involved in the implementation and roll-out
of the SmartCare system within the province. At the provincial level, support was provided in terms of
training of 44 district health managers who included the District Directors of Health(DDH), district manager
of planning(MPD), maternal child health coordinators (MCH) and district health information officers(DHIO) in
SmartCare software. This was followed by opening of 22 SmartCare sites representing two sites per
district. In addition to training of 44 district managers, 44 health facility staff were trained in the use of
SmartCare software.
In FY 2008, an additional 58 sites were opened for the SmartCare program bringing the total of SPHO sites
to 80.
In FY 2009, the Southern Provincial Health Office (SPHO) will continue to strengthen and provide support to
80 SmartCare sites by training 120 health workers in the use and maintenance of the SmartCare program
from both the new and old sites. Support will also be provided in terms of SmartCare supplies such as
tonners and other stationery to ensure smooth implementation of the SmartCare program.
The SPHO will further scale-up and open 22 more sites and provide training to 44 facility staff. Support will
also be provided to ensure that there is systematic and consistent flow of data from SmartCare facilities to
the Southern Provincial Health Office to the Central level of the Ministry of Health for planning and health
decision making. The province will further provide support, disseminate and supervise upgrades and other
enhancements to SmartCare periodically when changes are made to the system.
In FY 2009, the SPHO will provide support for Internet wireless connections for 19 major hospitals in the
province for enhanced information management system. This information technology network connectivity
will strengthen the on-going clinical mentorship program which is key in improving the quality of care for TB
and HIV/AIDS patients in the province. The availability of internet services will provide an opportunity to the
clinical mentors to access latest information and updates in the clinical management of TB and HIV/AIDS.
The SPHO will also provide support for maintenance and monthly subscriptions for the network services.
The SPHO will maintain a mailing list for provincial mentors for sharing of experiences and lessons learnt
from everyday work. An e-discussion forum will therefore be established. The SPHO will also provide
subscription for key medical journals (Lancet, AIDS) for access by the clinical mentors.
In FY 2009, the SPHO will continue to strengthen the district and health centre coordination through
quarterly planning and performance review meetings with district health managers (DDH, MCH, TB FP,
MPD, DHIO, and DA). Strategic information will continue to be collected, aggregated, and analyzed for
monitoring and evaluation purposes. It is the responsibility of each DHO to submit strategic information to
the PHO through the data management office. In order to strengthen monitoring and evaluation (M&E) and
general data management, the PHO will continue to support an M&E officer recruited in 2008 and support
10 Data Associates, one based at each district health office, two at LGH, one at Choma GH, one at Monze
Hospital, one Maamba, one Siavonga, one Kalomo, one at Mazabuka and one at the provincial health office
respectively. Supplies will be provided for M&E and information management.
Continuing Activity: 16979
16979 16979.08 HHS/Centers for Provincial Health 7180 2973.08 SPHO - $120,000
Table 3.3.17:
