PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Funding ($250,000) was added to
provide support to the Ministry of Health (MOH) in the areas of mentorship and supportive supervision,
institutionalization of human capacity building, and task shifting through training of lay workers.
This work is closely linked to Johns Hopkins Program for International Education in Gynecology and
Obstetrics (JHPIEGO's) other work with the Zambia Defense Force (ZDF), strengthening integrated HIV
prevention, care, and treatment services and systems. JHPIEGO also works with Project Concern
International (PCI) supporting Counseling and Testing (CT) and Adult Care and Support, as well as
JHPIEGO's work on integrating diagnostic counseling and testing DCT into tuberculosis (TB) and sexually
transmitted infection (STI) services for mobile populations. This program is also closely linked with prior
work conducted by JHPIEGO with Centers for Disease Control and Prevention (CDC) funding, and will
expand in FY 2009 to continue providing support to the (MOH) for harmonization of approaches and
programs and greater sustainability.
For greater clarity, this narrative is separated into two sections to describe activities specific to ZDF and
MOH facilities, while highlighting linkages and opportunities for collaboration between the two systems.
ZDF
JHPIEGO is supporting the ZDF to improve overall clinical prevention, care, and treatment services
throughout the three branches of military service, Zambia Army, Zambia Air Force, and Zambia National
Service around the country. The overall aim of JHPIEGO's support to ZDF is to ensure that the ZDF is
equipped and enabled to provide quality HIV/AIDS services to all its personnel, as well as to the civilian
personnel who access their health system. This includes strengthening the management and planning
systems to support PMTCT and HIV/AIDS care and treatment services, with the appropriate integration,
linkages, referrals, and safeguards to minimize medical transmission of HIV.
Development of PMTCT clinical and training capacity: JHPIEGO has supported quality integrated PMTCT
services at 16 model ZDF sites, and will expand to an additional four model sites in FY 2009 that are yet to
be determined. JHPIEGO will continue to expand facility-based performance improvement systems and
maximize the benefit to ZDF from the model sites by working with ZDF central command and Defense
Force Medical Services (DFMS), as well as base commanders, to develop a system of staff rotation and on-
the-job training. JHPIEGO will continue to select high performing PMTCT providers and develop them as
trainers and mentors to further develop capacity to expand and support PMTCT services.
Through JHPIEGO's support to the ZDF in previous years (FY 2005 - FY 2008), in addition to training
PMTCT service providers and establishing quality PMTCT services at 16 model facilities, the DFMS'
training capacity was strengthened with the training of 16 PMTCT staff as trainers. These trainers worked
with JHPIEGO staff to co-train at least 267 service providers in PMTCT. By the end of FY 2008, JHPIEGO
was working with model sites in all nine provinces.
JHPIEGO will continue to strengthen and expand facility-based performance improvement systems,
providing increasing opportunities for the trained staff from model sites to lead supervision and mentorship
programs, while still mentoring and actively supporting the ZDF sites whenever necessary.
To assist in development of a sustainable quality work force, JHPIEGO worked with the ZDF to identify
capable institutions in order to institutionalize the human capacity building. The Maina Soko Military
Hospital and the Defense School for Health Studies (DSHS) in Lusaka were identified in FY 2008 as the
future center for capacity building within Defense Forces, and will provide continued in-service training on
the number of programs undertaken by JHPIEGO in the ZDF. In FY 2009, JHPIEGO will continue work with
the Maina Soko Hospital and DSHS and will provide them with support and supervision to ensure quality of
services and training.
Integration of PMTCT in comprehensive HIV/AIDS program: Building on the service linkages developed
between PMTCT and antiretroviral treatment (ART), JHPIEGO has integrated TB and Adult Care and
Support services to provide integrated support for facility-based HIV/AIDS prevention, care, and treatment.
As a result of this intervention, the health care workers have a better understanding of the need to address
HIV/AIDS clinical prevention, care, and treatment in a comprehensive way to ensure that clients receive
complete, quality care. To support performance improvement systems, supervision visits have continued to
the eight model sites, as well as the four expansion sites. JHPIEGO has also supported the DFMS to
conduct workshops using the orientation package for lay workers like managers, clergy, community leaders,
and caregivers on HIV/AIDS prevention, care, and treatment. The package covers CT, PMTCT, Care, and
ART as well as linkages to other services such as TB and STIs, to educate the readers on HIV/AIDS and
provide them with accurate and relevant information they can disseminate to more diverse populations.
This has further enhanced advocacy efforts to secure sustained support for these services from
management, community and clients perspective. Furthermore JHPIEGO has helped to build capacity at
institutional level by developing a training package for lay workers/counselors who have been trained and
mentored to add on to the work force both at the facility and community levels in order to address the low
staffing levels.
To ensure sustainability, JHPIEGO has worked closely within the existing ZDF structures and plans.
JHPIEGO facilitates the development and dissemination of appropriate standard guidelines, protocols, and
plans. JHPIEGO also assisted the ZDF with the implementation of a facility-level quality improvement
program. The project's goal is to leave behind quality systems to ensure continuity of services after the
program concludes.
MOH
Large numbers of service providers have been trained in PMTCT and many health facilities nationwide are
providing services, but there is a need to make sure that the knowledge and skills gained in training are
Activity Narrative: being applied correctly and completely on the ground. To do so, facilities and service providers will need
more focused support from supervisors as well as support through task shifting by community counselors.
JHPIEGO has been approached by the MOH to provide support to their PMTCT programs in the following
areas:
Mentorship and Supportive Supervision. In FY 2009, JHPIEGO will consolidate the mentorship and
supervisory tools developed during FY 2006-2008 in collaboration with the MOH and DFMS, and review
them to include the latest evidence on PMTCT-Plus and early infant diagnosis to enhance the provision of
quality PMTCT services and encourage an integrated approach to supervision. JHPIEGO will implement
these tools in the three provinces to be identified, through orientation of district maternal and child health
(MCH) coordinators and development of PMTCT champions and mentorship teams. This will support the
implementation of PMTCT services at sites after service providers have been trained while also addressing
any gaps in knowledge and leading to routine monitoring of the quality and completeness of PMTCT
services. JHPIEGO will work with MOH supervisors to conduct mentoring and supervision visits that will
focus on the provision of high active antiretroviral therapy (HAART) in PMTCT and strengthening of linkages
to ART.
Institutionalization of the human capacity building. To address the sustainability of quality PMTCT service
provision, in FY 2009, JHPIEGO will focus on building capacity at the provincial levels to conduct quality
training by identification of institutions in two provinces that could be developed to provide ongoing capacity
building. Based on the individual assessments of each institution, JHPIEGO will work with the provinces
and districts to holistically improve training capacity and output. Direct assistance to the institutions will be
based on initial assessment, and will include educational equipment and support to establish training
process. The desired result is to improve both pre-service training as well as in-service training based on
national strategies and guidelines. The implementation of these activities will be coordinated at the central
level with MOH.
JHPIEGO will continue to support the MOH and Provincial Health Offices (PHOs) while at the same time
working closely with other implementing partners such as Boston University and Centre for Infectious
Disease Research in Zambia (CIDRZ) to strengthen the district supervision, management and service
provision in keeping with MOH plan for decentralization.
Task shifting: Training of lay workers. To address the critical shortage of service providers in Zambia,
JHPIEGO in collaboration with the MOH, PHOs, District Health Offices (DHOs), and other partners, is
promoting "task-shifting" wherever possible. Task shifting means that tasks that are commonly conducted
by higher-level healthcare workers (e.g., nurses) are shifted to lower-level providers and even lay people.
Lay counselors can provide high quality PMTCT services and collection of Dry Blood Spots (DBS), provided
that they are properly trained and supervised, freeing up health professionals to perform the clinical skills for
which they were trained.
In FY 2007 and FY 2008, JHPIEGO developed and piloted training package on PMTCT for lay workers. In
FY 2009, JHPIEGO will consolidate the training package based on the results of the pilot, and will
implement it in three provinces, to be identified in collaboration with the MOH. At least three lay workers at
each of the PMTCT sites in these provinces will be trained, and JHPIEGO will provide mentoring and
supportive supervision to these workers to ensure quality and safety of services. To support facility
supervisors in their work with the lay workers, JHPIEGO will adapt the mentorship package for health
professionals.
JHPIEGO's work in PMTCT has followed a sustainable model from the start with the development of the
national training package for the MOH in 2003 and has been continued by building a core group of national
PMTCT trainers. These trainers have been provided both with technical knowledge on PMTCT as well as
training knowledge and skills that ensure better, more effective training activities. In addition, JHPIEGO has
worked jointly with the MOH to develop knowledge and skills of not only service providers, but also
supervisors and managers, a group that had not been targeted in the initial national scale-up. Whenever
possible, JHPIEGO will continue to increase gender equity in provision of PMTCT services by training equal
proportions of males and females in all the programs. It is hoped that by training men and women in
provision of PMTCT services, some gender-related constraints to accessing this service may be overcome.
JHPIEGO, as an important partner to the MOH HIV/AIDS programs, supports the ZDF in gaining access to
materials, systems, and commodities funded by the U.S. Government, other donors, and numerous
technical partners who work with the MOH, and to harmonize services and maximize efficiencies between
ZDF and MOH facilities and programs. In FY 2009, JHPIEGO will facilitate further collaboration to ensure
harmonization and standardization of approaches, tools and materials between the two systems.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14621
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14621 3670.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $350,000
Defense
9088 3670.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $262,500
3670 3670.06 Department of JHPIEGO 2987 2987.06 DoD-JHPIEGO $350,000
Emphasis Areas
Health-related Wraparound Programs
* Safe Motherhood
Military Populations
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $103,369
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Reproduce training materials to support training of providers (FY 2008) replaced by training of sexually
transmitted infections (STI)/HIV trainers to increase Zambia Defense Force (ZDF) training capacity (FY
2009).
This program builds on, and links closely, with JHPIEGO's work in tuberculosis (TB)/HIV, Adult Treatment
and Adult Care and Support as well as Centers for Disease Control and Prevention (CDC)-funded work in
TB/HIV and counseling and testing (CT).
throughout the three branches of military service around the country, namely; Zambia Army, Zambia Air
Force and Zambia National Service. The overall aim of the activity is to ensure that the ZDF is equipped
and enabled to provide quality HIV/AIDS services to all its personnel, as well as to the civilian personnel
who access their health system. This includes strengthening the management and planning systems to
support prevention of mother-to-child transmission of HIV/AIDS (PMTCT) and HIV/AIDS care and treatment
services, with the appropriate integration, linkages, referrals, and safeguards to minimize medical
transmission of HIV. JHPIEGO, as an important partner to the Ministry of Health (MOH) HIV/AIDS PMTCT,
antiretroviral therapy (ART), palliative care, HIV-TB, other prevention and injection safety programs,
supports the ZDF in gaining access to materials, systems, and commodities funded by the U.S.
Government, other donors, and numerous technical partners who work with the MOH, harmonizes services
and maximizes efficiencies between ZDF and MOH facilities and programs.
The Defense Force Medical Services (DFMS) supports health facilities at 54 of the 68 ZDF sites with the
remaining sites relying on Medical Assistants and outreach support. These health services are spread out,
many in hard-to-reach areas, around the country, and serve both ZDF and local civilian populations. In
addition, given the mobile nature of the ZDF, it is often the first responder to medical emergencies and
disasters throughout the country. Unfortunately, the ZDF has not benefited from many initiatives that have
been on-going in the MOH public sector mainly because the ZDF has its own heath system running
independently from the national one.
Military personnel are subject to high risk of both STIs and HIV, as a result of the housing and social
situations they find themselves in due to the nature of their work. It is important to take a "no lost
opportunities" approach to prevention of STIs and HIV and service providers must take advantage of each
interaction they have with clients and patients to provide counseling in risk reduction. This is essential in
clients presenting with an STI as they are at higher risk of HIV infection. The ZDF have not benefited from
the same level of investment as the pubic health system under the Ministry of Health (MOH), though they
are now receiving some essential medical commodities directly from the MOH and are being incorporated in
more activities (trainings, assessments, etc.). This is particularly true in the area of STI programs, though it
also extends to HIV/AIDS care and treatment.
Patients need to be counseled on prevention and risk reduction strategies to both provide accurate
information and reinforce prevention methods. STI patients must be effectively counseled and tested for
HIV with those testing negative provided with post test risk reduction counseling and those testing positive
referred to HIV care and treatment services in a timely manner. Based on successful approaches in
integrating CT into antenatal care for PMTCT, JHPIEGO adapted CDC's counseling protocols and training
materials to incorporate diagnostic testing and counseling into TB services more effectively. In consultation
with various partners and the MOH, these materials were adopted as the national diagnostic counseling and
testing (DCT) training package. In FY 2008, JHPIEGO used this package as the basis for integrating
counseling and testing into STI services providing prevention counseling and linking patients with HIV care
and treatment services.
In FY 2009, JHPIEGO will continue strengthening service providers' knowledge and skills in STI and HIV
prevention counseling, working with the ZDF Medical Services to better integrate CT into STI services,
adapting a "no lost opportunities" approach to prevention counseling as well as care for HIV infected clients,
to better STI services. The sustainability of this effort is a major focus of the work and is reinforced through
using and expanding training capacity already developed within the ZDF Medical Services. This activity is
closely integrated with Adult Care and Support activity focused on training of ZDF personnel in syndromic
management of STIs. ZDF trainers previously developed by JHPIEGO will conduct this training, and
JHPIEGO will use FY 2009 funds to support these trainers through co-teaching opportunities and supportive
supervision. In addition, JHPIEGO will train 50 new STI/HIV trainers, and will continue strengthening them
through co-teaching and supportive supervision. In addition, STI information will be incorporated into the
comprehensive HIV/AIDS orientation package for lay workers. This package will be used to provide
prevention education for ZDF personnel. Whenever possible, JHPIEGO will also continue to increase
gender equity in provision of trainings, by providing distance learning opportunities to equal proportions of
males and females in all the programs.
Sustainability is also being addressed through the implementation of standards for various services and a
system for measuring whether or not standards are being met. JHPIEGO will encourage DFMS staff to take
the lead in conducting assessments of services and addressing gaps, while still providing intensive
mentoring and technical support whenever necessary.
Continuing Activity: 14623
14623 12526.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $150,000
12526 12526.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $100,000
Estimated amount of funding that is planned for Human Capacity Development $28,149
Table 3.3.03:
This work is closely linked to JHPIEGO's other work with the Zambia Defense Force (ZDF), strengthening
integrated HIV prevention, care, and treatment services and Systems Strengthening activities in logistics
and planning with the ZDF. It also relates to Project Concern International (PCI)'s support to ZDF in
counseling and testing (CT) and is closely coordinated with the United States Agency for International
Development (USAID) Injection Safety funded program.
throughout the three branches of military service, Zambia Army, Zambia Air Force and Zambia National
Service around the country. The overall aim of the activity is to ensure that the ZDF is equipped and
enabled to provide quality HIV/AIDS services to all its personnel, as well as to the civilian personnel who
access their health system. This includes strengthening the management and planning systems to support
prevention of mother-to-child transmission of HIV (PMTCT) and HIV/AIDS care and treatment services, with
the appropriate integration, linkages, referrals, and safeguards to minimize medical transmission of HIV.
JHPIEGO, as an important partner to the Ministry of Health (MOH) HIV/AIDS PMTCT, antiretroviral therapy
(ART), palliative care, HIV-TB and injection safety programs: supports the ZDF in gaining access to
technical partners who work with the MOH, and harmonizes services and maximizes efficiencies between
ZDF and MOH facilities and programs.
The Defense Force Medical Services (DFMS) supports health facilities at 54 of the 68 ZDF sites, with the
remaining sites relying on medical assistants and outreach support. These health services are spread out,
many in hard-to-reach areas around the country and serve both ZDF and local civilian populations. In
been ongoing in the MOH public sector mainly because the ZDF has its own heath system running parallel
to the national one. While these links are improving, there are continued opportunities to improve
harmonization and maximize the efficiency between the MOH and ZDF health services.
The transmission of HIV through unsafe medical practices, while accounting for a small percentage of
transmission, is largely preventable. The major areas of concern are injection safety (IS) practices,
handling and processing of sharp instruments, and handling and disposal of medical waste. Infection
prevention (IP) practices in Zambia are generally weak, and Zambia continues to face the challenge of lack
of application of standard IP procedures. The availability of Post Exposure Prophylaxis (PEP) for those who
have a potential exposure is also limited. Contributing factors include the severe human resource
constraints in the health sector, limited availability of necessary equipment, commodities and systems, and
weak quality support and supervision systems. The DFMS are no exception. IP/IS have been highlighted
by the management of the DFMS and by other cooperating partners as an area that needs improvement.
Through its role in helping to lead the National Infection Prevention Working Group (NIPWG), JHPIEGO has
ensured that the ZDF becomes an active working group member and that the ZDF benefits from
strengthening of IP/IS and is harmonized with national efforts. This working group includes representatives
from the MOH, National HIV/AIDS/STI/TB Council (NAC), non-governmental organizations, and private
sector, Environmental Council of Zambia, Medical Council of Zambia, and General Nursing Council among
others. One of the priority areas is the management and proper disposal of medical waste, which is an
ongoing issue throughout the country.
From FY 2005 through FY 2008, JHPIEGO's assistance to the ZDF was generating support for sustainable
solutions in IP/IS for the entire DFMS. Response to initial work shows that DFMS personnel have
underestimated the shortcomings in this area, and are enthusiastically moving forward to improve their
services and standards. This has resulted in their identification of needs for whole-site training, which is
essential to change IP/IS standards and practices, and they are working to supplement the training provided
through this program. Between FY 2005 and FY 2008, over 800 service providers and service outlet
managers from over 50 sites were trained and oriented in IP/IS practices and principles including proper
healthcare waste management. Following the training, sites received essential commodities and supplies to
ensure immediate implementation of improved practices in IP/IS. To ensure that IP/IS knowledge and
practices are carried forward, JHPIEGO has helped build the DFMS training capacity by training IP/IS
trainers and co-teaching with them to ensure quality as they conducted follow-on training. JHPIEGO and
DFMS have conducted supportive supervision visits, after training, to address gaps and ensure best
practices are implemented appropriately. . This activity will reduce the rate of HIV transmission since most
of the harmful practices that cause medical transmission will be avoided while utilization of disinfectants and
gloves will enhance personal safety. In addition, post-exposure prophylaxis (PEP) protocols developed
were implemented and tested at key sites and its availability will avert infections among those who are
exposed.
.
In FY 2009, utilizing the IP/IS trainers trained, JHPIEGO will co-teach and train 150 providers from all
different cadres including cleaners, medical assistants, and service providers. These workshops will be led
by the DFMS IP/IS trainers with JHPIEGO staff providing support in clinical and training skills areas to
ensure quality training. It is envisaged that these IP/IS trainers will over time become conversant with the
training materials and will competently handle subsequent trainings on their own. The same trainers will be
utilized by DFMS as supervisory resource persons and mentors in the area of IP/IS. This internal capacity
will enhance sustainability. JHPIEGO will continue with the model of providing seed amounts of essential
commodities while ensuring that future procurements by the ZDF include the necessary IP/IS commodities
including waste receptacles such as bins and bin liners, sharps boxes, personal protective clothing and
disinfectants to all 54 sites (depending on gaps identified. JHPIEGO and ZDF staff will work together to
conduct supportive supervision visits throughout the ZDF to ensure knowledge transfer and to provide "on-
the-spot" training to address any gaps. Opportunities to reinforce the importance of IP/IS practices for staff
from all of the ZDF facilities will be sought out and pursued, ensuring continued advocacy for support at
central and base management levels. Whenever possible, JHPIEGO will also continue to increase gender
equity in IP/IS by training equal proportions of males and females in all the programs.
Activity Narrative: Appropriate IP/IS practices will reduce the volume and potential harmfulness of medical waste, and thus
reduce the risk of needle stick injury for cleaners and communities around the facilities. JHPIEGO will work
with ZDF, the Medical Council of Zambia, and NIPWG to continue to seek and implement sustainable
solutions for improved medical waste management and disposal including the use of incinerators.
JHPIEGO's approach to minimizing the transmission of HIV in the ZDF will ensure greater sustainability of
IP/IS practices by focusing on the development of DFMS training and supervision capacity and the
facilitation of the development, dissemination, and implementation of guidelines and protocols for IP/IS,
PEP, and medical waste disposal systems. These will also raise awareness among all the players and
increase internal demand for IP/IS measures in health care provision. JHPIEGO also seeks sustainability of
the activities by working with all the stakeholders in the ZDF and DFMS including the unit commanders,
service outlet managers, decision makers at the central level as well as the medical service providers,
ensuring that all involved understand the importance and benefits of proper IP/IS practices and protocols.
Continuing Activity: 14622
14622 3676.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $350,000
9091 3676.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $220,080
3676 3676.06 Department of JHPIEGO 2987 2987.06 DoD-JHPIEGO $350,000
Estimated amount of funding that is planned for Human Capacity Development $138,956
Table 3.3.05:
ACTIVITY UNCHANGED FROM FY2008
This program will build upon, and links closely with, JHPIEGO's DOD-funded work in TB/HIV and Adult
Treatment as well as CDC-funded work in TB/HIV and counseling and testing (CT). This activity is closely
integrated with and is part of the Sexual Prevention: Other Sexual Prevention.
JHPIEGO is supporting the Zambia Defense Force (ZDF) to improve overall clinical prevention, care, and
treatment services throughout the three branches of military service, Zambia Army, Zambia Air Force and
Zambia National Service around the country. The overall aim of the activity is to ensure that the ZDF is
systems to support Prevention of Mother To Child Transmission (PMTCT) and HIV/AIDS care and treatment
Adult Treatment, Adult Care and Support, HIV-TB, and Other Sexual Prevention and injection safety
programs, supports the ZDF in gaining access to materials, systems, and commodities funded by the U.S.
situations (clarify how) they find themselves in due to the nature of their work. While the effort to expand
access to and utilization of antiretroviral therapy (ART) services has resulted in a growing number of HIV
infected individuals receiving ART, there has been a lag in emphasizing the care for those same patients
when it comes to diagnosis and treatment of STIs and other opportunistic infections. The ZDF has not
benefited from the same level of investment as the pubic health system under the MOH, though they are
now receiving some essential medical commodities directly from the MOH and are being incorporated in
STI patients must be effectively counseled and tested for HIV, and referred to HIV care and treatment
services in a timely manner. In FY 2008, used the national Diagnostic Counseling and Testing (DCT)
training package as the basis for integrating counseling and testing into STI services linking patient with HIV
care and treatment services, and trained 100 providers.
In FY 2009, JHPIEGO will continue to focus on strengthening service providers' knowledge and skills in STI
diagnosis and care in STI clinics / outpatient services /ART clinics/ TB clinics/ PMTCT clinics, addressing
basic knowledge with more advanced skills and knowledge for STI care in HIV patients. At the same time,
JHPIEGO will work with the ZDF Medical Services to better integrate counseling and testing (CT) into STI
services linking care for HIV infected clients to better STI services. This will be done using different
approaches including group-based training for basic skills and knowledge targeting 50 service providers,
and followed by on-the-job training (OJT) working onsite with service provider teams using a mentoring /
case-based practical approach. Another 50 service providers will be trained using the OJT approach on-
site. These training activities will be conducted by ZDF trainers, JHPIEGO ensuring co-teaching
opportunities and supportive supervision at the service outlets, which will be conducted to ensure that the
skills and knowledge are being correctly applied and to provide on the spot guidance addressing any gaps.
The sustainability of this effort is a major focus of the work and is reinforced through using training capacity
already developed within the ZDF Medical Services, and this activity is closely integrated with the Other
Sexual Prevention activities which will support further development of training capacity for expansion of
training ZDF personnel in syndromic management of STIs. Whenever possible, JHPIEGO will continue to
increase gender equity in provision of basic health care services by training equal proportions of males and
females in all the programs. It is hoped that by training men and women in provision of basic health care
services, some gender-related constraints to accessing these services may be overcome.
system for measuring whether or not standards are being met. JHPIEGO will encourage Defense Force
Medical Services (DFMS) staff to take the lead in conducting assessments of services and addressing
gaps, while still providing intensive mentoring and technical support whenever necessary
Continuing Activity: 14624
14624 12404.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $200,000
12404 12404.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $150,000
Estimated amount of funding that is planned for Human Capacity Development $79,308
Table 3.3.08:
integrated HIV prevention, care, and treatment services and systems, and with the work of Project Concern
International (PCI) supporting counseling and testing (CT) and Adult Care and Support, as well as
JHPIEGO's work on integrating diagnostic CT into TB and STI services for mobile populations. It also
relates to the pre-service training component of the Health Systems and Services Program/USAID as well
as various partners supporting the Ministry of Health (MOH) in the area of HIV care and treatment.
Prevention of Mother To Child Transmission (PMTCT) and HIV/AIDS care and treatment services, with the
appropriate integration, linkages, referrals, and safeguards to minimize medical transmission of HIV. While
focusing on comprehensive strengthening of quality HIV prevention, care and treatment services at selected
model sites, JHPIEGO's support will impact these services throughout the ZDF.
In FY 2009, JHPIEGO will build on previous work to support comprehensive HIV/AIDS prevention, care and
treatment services in the 54 ZDF health facilities. In FY 2005-2008, JHPIEGO initiated and supported
development of 16 model sites, and will continue to develop model facilities with guidance from ZDF,
expanding to four new facilities in FY 2009. JHPIEGO will support the expansion of comprehensive
HIV/AIDS care and treatment services through co-teaching ART, TB/HIV (and other OIs), and PMTCT,
using group-based, on-the-job training and distance learning methodologies already successfully used by
JHPIEGO in other settings.
In FY 2009, JHPIEGO will target at least 80 providers in Adult Treatment, including doctors, nurses, clinical
officers, and other health cadres. The Adult Treatment training is a part of the series of trainings on core
competencies for these cadres and will also include PMTCT management and diagnosis and management
of TB and other OIs, in an effort to strengthen linkages between Adult Treatment and other HIV/AIDS
prevention, care and treatment services to ensure more comprehensive and continuous care for people
leaving with HIV/AIDS. Following the training, supervision visits to the service providers will be jointly
conducted by JHPIEGO and ZDF using SBM-R and other supervisory tools that were developed in the
previous years. To ensure a synergy of the efforts in the process, JHPIEGO will deepen linkages with
MOH, the National HIV/AIDS/STI/TB Council (NAC), and other collaborating partners such as Project
Concern International (PCI) and the Naval Medical Center in San Diego (NMCSD).
Since FY 2005, JHPIEGO trained and retrained 360 service providers in ART and opportunistic infections
management, drawing providers from many service outlets including the model sites. JHPIEGO also
developed ZDF training capacity by training 24 ART and TB staff as trainers. These trainers worked with
JHPIEGO staff to co-train at least 200 service providers in the provision of ART. In addition, the model
sites established between FY 2005 and FY 2008 received support in the procurement of essential
commodities and/or the minor renovation of service outlets to enable the provision of more comprehensive,
quality services. By the end of FY 2008, JHPIEGO was working with model sites in all nine provinces.
To support performance improvement of systems and quality Adult Treatment service delivery, JHPIEGO
will conduct supportive supervision visits to the 16 model facilities initiated in FY 2005-2008. JHPIEGO will
continue supporting the DFMS in conducting workshops using the orientation package for lay workers like
managers, clergy, community leaders, and caregivers on HIV/AIDS prevention, care and treatment., This
package covers CT, PMTCT, Care and Adult Treatment as well as linkages to other services such as TB
and STIs. The purpose is to educate them on HIV/AIDS and provide them with accurate and relevant
information they can disseminate to more diverse populations.
To ensure sustainability, JHPIEGO works within the existing ZDF structures and plans. JHPIEGO facilitates
the development and dissemination of appropriate standard guidelines, protocols, and plans. JHPIEGO
will continue to strengthen and expand facility-based performance improvement systems, providing
increasing opportunities for the trained staff from model sites to lead supervision and mentorship programs,
while still mentoring and actively supporting the ZDF sites whenever necessary. Whenever possible,
JHPIEGO will continue to increase gender equity in provision of Adult Treatment services by training equal
provision of Adult Treatment services, some gender-related constraints to accessing these service may be
overcome.
To assist in development of a sustainable quality work force, JHPIEGO from FY 2005 to FY 2008 worked
with the ZDF to identify capable institutions to be utilized for human capacity building. The Maina Soko
Military Hospital and the Defense School for Health Studies in Lusaka were identified in FY 2008 as the
Maina Soko hospital and will provide support and supervision to ensure quality of services and training.
The ZDF have not benefited from the same level of investment as the pubic health system under the
Ministry of Health (MOH), though they are now receiving some essential medical commodities, including
antiretroviral medications (ARVs) directly from the MOH and are being incorporated in more activities
(trainings, assessments, etc.). JHPIEGO, as an important partner to the Ministry of Health (MOH) HIV/AIDS
PMTCT, Adult Treatment, Adult Care and Support, HIV-TB and Injection Safety programs, supports the
ZDF in gaining access to materials, systems, and commodities funded by the USG, other donors, and
numerous technical partners who work with the MOH, and harmonizes services and maximizes efficiencies
between ZDF and MOH facilities and programs. In FY 2009, JHPIEGO will continue utilizing and building
on the experience and tools developed in the larger public sector Ministry of Health ART expansion
Activity Narrative: programs, which JHPIEGO has extensively supported, and will continue to develop and strengthen linkages
between the ZDF and MOH programs.
Continuing Activity: 14626
14626 3672.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $300,000
9089 3672.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $225,000
3672 3672.06 Department of JHPIEGO 2987 2987.06 DoD-JHPIEGO $300,000
Estimated amount of funding that is planned for Human Capacity Development $157,449
Table 3.3.09:
ACTIVITY UNCHANGED FROM FY 2008
integrated HIV prevention, care, and treatment services and systems and with the work of Project Concern
International (PCI) supporting counseling and testing (CT) and Adult care and support, as well as
relates to the pre-service training component of the Health Systems and Services Program/USAID, as well
as various partners supporting the MOH in the area of HIV care and treatment.
PMTCT and HIV/AIDS care and treatment services, with the appropriate integration, linkages, referrals, and
safeguards to minimize medical transmission of HIV. While focusing on comprehensive strengthening of
quality HIV prevention, care and treatment services at selected model sites, JHPIEGO's support will impact
these services throughout the ZDF.
development of 16 model facilities, and will continue to develop model facilities with guidance from ZDF,
Tuberculosis (TB) and HIV co-infection is estimated to be as high as 70% in Zambia. Military personnel are
subject to high risk of both TB and HIV, as a result of the housing and social situations they find themselves
in due to the nature of their work. While the effort to expand access to and utilization of antiretroviral
therapy (ART) services has resulted in a growing number of HIV infected individuals receiving ART, there
has been a lag in emphasizing the care for those same patients when it comes to diagnosis and treatment
of TB and other opportunistic infections (OIs). Through JHPIEGO's work on integrating HIV diagnostic
counseling and testing into TB services for mobile populations, more TB patients will be able to access HIV
testing and care and treatment services. The focus of this activity, building on our work during FY 2006-
2008, is to ensure that patients enrolled in HIV care are adequately screened for TB, and that caregivers
are able to recognize, diagnose and manage TB and other OIs.
In FY 2009, JHPIEGO will train at least 80 providers, including doctors, nurses, clinical officers, and other
health cadres, in diagnosis and management of TB and other opportunistic infections (OIs). The core
competences in TB screening include referring patients suspected of TB infection for sputum examination
for acid alcohol fast bacilli (AAFB) to the various TB diagnostic centers set up by the Ministry of Health and
supported by CDC. When need for sputum arises, patients or indeed specimens are referred to the CDC
Laboratory at the National Scientific Research Center where such investigations are undertaken. The
training in managing OIs is largely dependent on recognizing clinical signs and symptoms for non life
threatening conditions as well as specific laboratory investigations for life threatening conditions. This
training is a part of the series of trainings on core competencies for these cadres and will also include ART
and PMTCT management, in an effort to strengthen linkages between ART and other HIV/AIDS prevention,
care and treatment services to ensure more comprehensive and continuous care for people leaving with
HIV/AIDS. Following the training, supervision visits to the service providers will be jointly conducted by
JHPIEGO and ZDF using SBM-R and other supervisory tools that were developed in the previous years.
JHPIEGO will continue to expand the local ZDF capacity by training an additional 12 ART and TB staff as
trainers and mentors to support and expand the program. To ensure a synergy of the efforts in the process,
JHPIEGO will deepen linkages with the MOH, the National HIV/AIDS/STI/TB Council (NAC), and other
collaborating partners such as PCI and the Naval Medical Center in San Diego (NMCSD).
JHPIEGO staff to co-train at least 200 service providers in the provision of ART. In addition, the model sites
established between FY 2005 and FY 2008 received support in the procurement of essential commodities
and/or the minor renovation of service outlets to enable the provision of more comprehensive, quality
services. By the end of FY 2008, JHPIEGO was working with model sites in all nine provinces.
To support performance improvement systems and quality ART service delivery, JHPIEGO will conduct
supportive supervision visits to the 16 model sites initiated in FY 2005-2008. JHPIEGO will continue
supporting the DFMS to conduct workshops using the orientation package for lay workers like managers,
clergy, community leaders, and caregivers on HIV/AIDS prevention, care and treatment. This package
covers CT, PMTCT, Care and ART as well as linkages to other services such as TB and STIs. The purpose
is to educate them on HIV/AIDS and provide them with accurate and relevant information they can
disseminate to more diverse populations. Whenever possible, JHPIEGO will continue to increase gender
equity in provision of TB/HIV services by training equal proportions of males and females in all the
programs. It is hoped that by training men and women in provision of TB/HIV services, some gender-related
constraints to accessing this service may be overcome.
the development and dissemination of appropriate standard guidelines, protocols, and plans. JHPIEGO will
continue to strengthen and expand facility-based performance improvement systems, providing increasing
opportunities for the trained staff from model sites to lead supervision and mentorship programs, while still
Activity Narrative: mentoring and actively supporting the ZDF sites whenever necessary.
capable institutions in order to institutionalize the human capacity building. Maina Soko Military Hospital and
the Defense School for Health Studies in Lusaka were identified in FY 2008 as the future centers for
capacity building within Defense Forces, and will provide in-service training on the number of programs
undertaken by JHPIEGO during the past years of work with ZDF. In FY 2009, JHPIEGO will continue work
with Maina Soko hospital and will provide support and supervision to ensure quality of services and training.
PMTCT, ART, palliative care, HIV-TB and injection safety programs, supports the ZDF in gaining access to
materials, systems, and commodities funded by the USG, other donors, and numerous technical partners
who work with the MOH, and harmonizes services and maximizes efficiencies between ZDF and MOH
facilities and programs. In FY 2009, JHPIEGO will continue utilizing and building on the experience and
tools developed in the larger public sector Ministry of Health ART expansion programs, which JHPIEGO has
extensively supported, and will continue to develop and strengthen linkages between the ZDF and MOH
programs.
Continuing Activity: 14625
14625 3673.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $500,000
9090 3673.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $225,000
3673 3673.06 Department of JHPIEGO 2987 2987.06 DoD-JHPIEGO $300,000
Estimated amount of funding that is planned for Human Capacity Development $116,332
Table 3.3.12:
integrated HIV prevention, care, and treatment services and biomedical prevention: injection safety, and
with the work of Project Concern International (PCI) activities with the ZDF in strengthening integrated HIV
prevention, care, and treatment services for the Zambian military. It also relates to the pre-service training
component of the Health Systems and Services Program (HSSP)/USAID.
safeguards to minimize medical transmission of HIV. JHPIEGO, as an important partner to the Ministry of
Health (MOH) HIV/AIDS PMTCT, ART, palliative care, HIV-TB and injection safety programs, supports the
ZDF in gaining access to materials, systems, and commodities funded by the U.S. Government, other
donors, and numerous technical partners who work with the MOH, and to harmonize services and maximize
efficiencies between ZDF and MOH facilities and programs.
The ZDF has a network of 54 health facilities supported by the Defense Force Medical Services (DFMS),
located on bases around the country, that provide health services to personnel in the three branches as well
as to civilian populations in the same areas. Because these facilities are under the Ministry of Defense
(MOD), they do not always benefit from support and resources provided to the MOH, although significant
efforts are ongoing to bring these related services closer together. One area in which the ZDF is challenged
is in the overall management and planning for their health services, particularly when it comes to training
auxiliary health personnel and ensuring the reliable availability of essential commodities to serve the
patients at their various installations. During FY 2009, JHPIEGO will continue to support the ZDF in
strengthening support systems to address these gaps, building on experience and tools developed within
the larger MOH public sector programs and strengthening appropriate linkages with MOH and other
cooperating partners.
ZDF has a program to train a cadre called Medical Assistants, however they have limited, or no training in
HIV-related care and support. Medical Assistants form a very important part of the ZDF health services as
they are often called on, due to inadequate professional health staff, to work in the health centres as Ward
Masters, a position which also includes administrative and medical responsibilities. They are drawn from
defence force branches to participate in three to six months upgrading training, conducted by health
personnel within the ZDF. There are different levels/ranks of medical assistants and progression depends
on the amount of training received. To attain the highest medical assistant level or rank can take two to
three years. Medical Assistant training has not been conducted in a uniform and standardized way,
resulting in inconsistency in training content as they progress from one level to the next, and there has been
very limited preparation of this cadre in the area of HIV/AIDS prevention, care, and treatment. As this cadre
has been used to fill gaps in the medical services that involve a great deal of medical and administrative
responsibility, it is important to ensure they are trained in a standardized and uniform way. Whenever
possible, JHPIEGO will continue to increase gender equity in policy analysis and systems strengthening by
training equal proportions of males and females in all the programs.
To address deficiencies in Medical Assistant training highlighted by the ZDF, during FY 2006 through FY
2008, JHPIEGO worked with the ZDF and other collaborating partners, such as PCI, in FY 2006 and FY
2007 to develop a system to incorporate HIV/AIDS evidence-based information into training for Medical
Assistants and standardize the training as Medical Assistant's progress from one level to the next. This
system was developed to address those already deployed (in-service training) as well as strengthening the
basic Medical Assistants training program (pre-service education). This complemented, and was
coordinated with, ongoing support for strengthening other health worker pre-service training programs. A
set of core competencies in HIV/AIDS prevention, care and treatment has been developed and integrated
into relevant training materials for ZDF Medical Assistants. JHPIEGO supported 20 faculty/trainers, who
received updates based on the revised curriculum, to train 100 deployed Medical Assistants in the core
competencies.
In FY 2006 - FY 2008, JHPIEGO supported the ZDF faculty/trainers to update 200 deployed Medical
Assistants at different levels of Medical Assistant training, and followed them up to ensure that they have
retained knowledge from the training and to address any gaps. This follow-up will continue in FY 2009.
Also, in FY 2009, JHPIEGO will work with the ZDF and Medical Assistants just starting the training to map
out their progression and ensure that it follows the standards developed in FY 2006. Upon completion of
training in the core competencies, Medical Assistants will be prepared to disseminate accurate prevention
information and to support the seeking of care and adherence to treatment by HIV-infected military
personnel. To improve training process and ensure that medical assistants receive latest, evidence-based
information, JHPIEGO will continue standardizing knowledge and clinical skills of the ZDF faculty and
trainers. With the core competencies in place and a methodology for updating them as well as trained
faculty/trainers, the ZDF will be able to sustain the program of training and updating Medical Assistants in
the long term.
The ZDF has experienced difficulties in planning and management of health and HIV clinical prevention,
care, and treatment services as well as gaps in procurement, logistics management and forecasting of
medical supplies and drugs. JHPIEGO will build on experience within the MOH system to support the
development of a better system for planning and managing their health and HIV clinical prevention, care,
and treatment services. JHPIEGO will assist the ZDF in strengthening their planning and management
through extensive support of their planning process and develop strategic planning capacity at the DFMS
central level. To help the ZDF in planning of the health services, JHPIEGO will help to adapt existing tools
Activity Narrative: such as the Smart Care electronic medical record, develop tools (such as Geographic Information Systems
(GIS) mapping of capacities and catchments populations). In addition, JHPIEGO will continue to work with
the ZDF and in-country partners on planning, forecasting, procurement and logistic management to
strengthen the medical procurement and logistics systems throughout the ZDF. JHPIEGO's partner, John
Snow International (JSI) Logistics Services, will assist in the area of logistics support through supportive
supervision of the 260 ZDF staff previously trained by JSI in procurement, logistics management and
forecasting systems. JSI will also monitor the supply chain system for ARVs and HIV test-kits designed with
the ZDF in FY 2007 and FY 2008. In FY 2009, JSI will continue to address supply chain system of
laboratory commodities by supporting the design and implementation of a system for the ZDF. JSI is also
providing similar technical assistance to the MOH, and as such is well positioned to identify areas and
means to strengthen linkages between the ZDF and MOH procurement and logistics systems (JSI/USAID).
As a result, the ZDF will be able to plan and manage services as well as avoid stock outs in ARVs, HIV test-
kits and commodities.
The SmartCare program that employs Electronic Medical Record system enables providers to create and
access updated portable records of the patient's medical history and ongoing treatment plans. The
portability of the medical records device is a key feature, as it can follow patients regardless of where they
are deployed or transferred. This system is especially useful for the mobile personnel of the ZDF, thereby
assisting with continuity of care and treatment. The SmartCare system has been adapted by the MOH and
is the standard EMR system used in Zambia. In FY 2009, JHPIEGO will work with the MOH and
CDC/Zambia to support the rollout of SmartCare and will support the ZDF to adapt this EMR system in 54
ZDF facilities by providing the necessary hardware including computers, capacity building and site
improvement.
These activities are nationwide throughout the ZDF, entailing extensive travel for follow-up supportive
supervision of both the Medical Assistants and the procurement and logistics systems. The core of the
activities will be conducted by ZDF and DFMS staff to ensure buy-in and sustainability of the programs, but
JHPIEGO and JSI will provide support to ensure quality and reliability. These programs will be led by the
DFMS with support from JHPIEGO and JSI. All training and systems management will be done by ZDF
staff supported by JHPIEGO and JSI to ensure that programs belong to the ZDF and are not dependant on
external management.
Continuing Activity: 14627
14627 3668.08 Department of JHPIEGO 6889 2987.08 DoD-JHPIEGO $1,300,000
9087 3668.07 Department of JHPIEGO 5029 2987.07 DoD-JHPIEGO $810,000
3668 3668.06 Department of JHPIEGO 2987 2987.06 DoD-JHPIEGO $500,000
Estimated amount of funding that is planned for Human Capacity Development $185,298
Table 3.3.18:
