ACTIVITY WILL BE MODIFIED AS FOLLOWS

This activity links to CRS SUCCESS HBHC (#9180) and all other HBHC activities funded by USG/Zambia.

New emphases will include: stronger promotion of sustainability of palliative care in the final year of the

President's Emergency Plan For AIDS Relief (PEPFAR); increased coordination and linking with both GRZ

and USG funded HIV/AIDS activities; and more capacity building for local HBHC partners. The local partner,

Palliative Care Association of Zambia (PCAZ), will be the lead local palliative care advocate on all palliative

care policy, guidelines and standards, accreditation, coordination, collaboration, training, and evaluation

activities.

Activity Narrative

USAID will continue to manage this twinning support for palliative care activity provided by the American

International Health Alliance (AIHA) Twinning Center through HHS/HRSA. AIHA will provide south-south

twinning support for Palliative Care in Zambia, in partnership with the African Palliative Care Association

(APCA) and its local affiliate/sub-partner, PCAZ.

In FY 2005 and FY 2006, AIHA collaborated with PCAZ through a series of assessment and mentoring

visits with APCA to provide technical assistance to the USG/Zambia Mission. To date, AIHA, APCA, and

PCAZ have reached a number of milestones. PCAZ has a new, stronger management structure, led by a

new National Coordinator with strong management and business development skills as well as palliative

care experience. PCAZ is now a larger, stronger membership organization. PCAZ helped develop a USG

Joint Palliative Care strategy in 2005, and participates in the USG Zambia Palliative Care Forum. PCAZ

has become a leader in taking palliative care for HIV/AIDS forward in the country. In late June 2006, APCA

organized a study tour to Uganda for Ministry of Health (MOH), PCAZ, pharmaceutical board, and drug

enforcement officials to learn about pain management and pain relief drugs (opiates). As a direct result,

upon their return, the Zambian participants formed a National Pain Management Advocacy Team. They are

now moving forward rapidly to advocate for new policy, guidelines, and regulatory change to permit the use

of opiates more widely for pain relief in HIV/AIDS care.

In FY 2006, AIHA and APCA staff conducted trips to Zambia and PCAZ made exchange visits to Uganda to

provide technical assistance for the development/refinement of business plans for PCAZ, to develop and

conduct palliative training courses, and to assess progress in the area of palliative care in Zambia.

In FY 2007, AIHA and APCA continued to strengthen the PCAZ secretariat and executive functions, making

the PCAZ Board a more effective governing body. The partnership focused on strengthening PCAZ's role

as a voluntary coordinating body for Zambian palliative care institutions and care givers. Particularly, the

partnership focused on the development of policy and advocacy skills within PCAZ, and capacity to facilitate

and manage palliative care trainings for all professional levels of HIV/AIDS palliative care givers. Further,

these trainings enabled the PCAZ Secretariat to mobilize resources, including developing grant proposals

and seeking funding from other sources, such as the Global Fund for AIDS, TB, and Malaria. Finally, PCAZ

implemented the membership recruitment plan developed in FY 2006, and advertised it to increase

membership and associated dues. This is a means to develop sustainable revenue streams for the PCAZ,

as part of its long-term business plan.

APCA conducted a supervision visit to PCAZ in December 2007, to review the year's accomplishments and

develop the next year's workplan. The partners met with CRS-SUCCESS to look at how APCA and CRS

can best work with PCAZ to effectively carry out the two workplans and activities. PCAZ appointed new

board members - including a new chairperson - and APCA and PCAZ updated the new members on the

revised work plan and budget for the upcoming year to ensure full support of the partnership. The partners

finalized membership criteria, at a stakeholder meeting. With APCA assistance, PCAZ developed graded

standards for the various palliative care delivery sites. In collaboration with the National HIV/AIDS/STI/TB

Council, PCAZ helped develop national general palliative care standards. In April 2008 PCAZ conducted a

course in morphine use for hospice and district health professionals, covering knowledge of pain control,

pain assessment and measuring tools, pain management in adults, and knowledge of accessory drugs. In

July 2008 APCA and CRS conducted an organizational assessment of PCAZ, measuring its progress in

development as an NGO and as a coordinating body. PCAZ, APCA, and CRS used the results to develop

interventions to address the PCAZ development issues raised in the assessment.

In FY 2009, the APCA/AIHA partnership will continue this south-south twinning partnership to strengthen

the institutional and human capacity of the secretariat and board of the PCAZ. The partnership will also

focus on strengthening PCAZ's role as a coordinating body for palliative care institutions and care givers.

Particularly, the partnership will focus on the development of advocacy skills within PCAZ and capacity to

facilitate and manage palliative care trainings for all professional levels of HIV/AIDS palliative care givers.

The APCA/PCAZ partnership will continue to work together to strengthen the Zambian association by

focusing on four areas of program development and system strengthening.

APCA will assist PCAZ to further develop their institutional capacity by expanding and strengthening the

2006-2009 business plan and work with PCAZ to develop a new multi-year strategic plan . In addition,

APCA and PCAZ will conduct organizational development trainings for the board of directors and PCAZ

staff, develop job descriptions for PCAZ staff, finalize and implement administrative and financial policies,

and develop criteria for membership and fundraising opportunities. In FY 2009, APCA will train 50

individuals on organizational development.

PCAZ, with assistance from APCA, will organize trainings and publish educational materials for diverse

populations including a training and guidelines/training materials for healthcare professionals in the

hospices in pain management and opioid protocols to be implemented as morphine becomes available.

Health professionals to be trained include male caregivers in the surrounding provinces and school

teachers. PCAZ will assist in the organization of World Hospice and Palliative Care Day in Zambia, and

PCAZ will organize a palliative care conference for district and provincial healthcare workers and

Activity Narrative: parliamentarians.

PCAZ will strive to increase palliative care awareness by the use of radio, TV, and seminars and workshops

in addition to conducting advocacy training workshops for diverse populations. With assistance from APCA

and AIHA's Twinning Center, PCAZ will develop a palliative care website to provide healthcare

professionals with opportunities to search the Internet and find the latest evidence-based resources on

palliative care. APCA will assist PCAZ in the development of information, education, and communication

materials which will be made available for dissemination on the new website. APCA, the Twinning Center,

and PCAZ will train 30 individuals on evidence-based medicine.

In FY 2009, PCAZ will coordinate and network with other palliative care service providers for availability of

pain medications. APCA will assist PCAZ in making the public, private, and corporate sector connections

needed to expand and sustain PCAZ efforts in furthering the palliative care agenda in Zambia. In addition,

PCAZ will focus on membership by developing a database and referral system for easily accessible

member and stakeholder information.

To build sustainability, AIHA will continue to support twinning partnerships between US and regional

palliative care organizations and PCAZ to strengthen local human and organizational capacity in palliative

care. AIHA will support regional palliative care premier institutions such as APCA (which includes the

University of Cape Town, Sun Gardens Hospice in Pretoria, Hospice Uganda, and Zimbabwe Home-based

Care programs). AIHA will collaborate with USG partners working on palliative care in Zambia (including

SUCCESS, ZPCT, RAPIDS, PCI, JHPIEGO, and CDC partners) to provide mentoring, train palliative care

health care providers and managers, develop palliative care courses and training programs, and facilitate

technical information sharing.

All FY 2009 targets will be reached by September 30, 2010.

Gender Related Activities:

The HIV/AIDS Twinning Center at the American International Health Alliance (AIHA), takes into account

gender concerns in all policy, program, administrative and financial activities, and in organizational

procedures, thus contributing to organizational transformation. AIHA actively seeks involvement of

beneficiaries and government counterparts in project formulation in order to include their perspective in

gender mainstreaming. Furthermore, attaining a keen sense of the Zambian socio-economic and political

context is of critical importance which will direct programming to address the gender perspective of HIV at

all levels. AIHA likewise strives to consult both women and men, involve both women and men in the

decision making processes, and access the impact of our work on both women and men.

The Twinning Center will work with its institutional partners to ensure that their work addresses gender

considerations where possible. The PCAZ/APCA twinning partnership will develop the institutional capacity

of PCAZ to support palliative care in Zambia, including the special needs of women and girls in the

development of appropriate policies and practice.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $155,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

ACTIVITY UNCHANGED FROM FISCAL YEAR (FY) 2008

This activity relates to UTH (#9043), SPHO (#8993), and Columbia University (#8993).

In cooperation with Health Resources Services Administration (HRSA), the Centers for Disease Control and

Prevention (CDC) will continue to manage this activity in Zambia. In 2006, American International Health

Association focused on the identification and establishment of a partnership with the two pediatric

antiretroviral therapy (ART) centers of excellence. Efforts included communication with relevant

stakeholders, including Columbia University, University Teaching Hospital (UTH) in Lusaka, and CDC.

Based on these discussions and fact finding, AIHA posted an open solicitation to determine the best-suited

partner. The solicitation closed on August 31, and AIHA reviewed applications, selected a partner (the

Center for International Health (CIH) in Milwaukee Wisconsin), and shared the selected partner with

CDC/Zambia for concurrence. Once CDC approved the partner selected, the initial exchange visit to

introduce the partnerships was made in October 2006. During this visit, the partners discussed goals,

objectives, and strategies of the partnership. The Zambian partners from Lusaka and Livingstone then

visited CIH in April 2007 to learn about CIH's organization and resources and develop the partnership work

plan. In keeping with Twinning Center methodology, the partners worked together as equals to develop the

partnership work plan, thereby ensuring buy-in from the partners and increasing the likelihood of

sustainability once funding ends.

In FY 2007, the partnership focused on achieving partnership goals and objectives by completing the year

one workplan and both partners conducted exchange trips. AIHA provided technical assistance,

facilitation, and management to the partnership to scale-up ART services in Zambia by increasing the

pharmaceutical service capacity at the two newly-established pediatric ART centers of excellence.

In FY 2008, AIHA continued to support this partnership which conducted additional pharmacy trainings in

both Lusaka and Livingstone. Through this volunteer-driven partnership, 48 pharmacists received direct on

-site technical assistance in organizing and managing a pharmacy in addition to acquiring necessary skills

to address patient level management, adherence, adverse affects, and medication management trainings.

Additional focus areas included systems development activities, patient booking and tracking, patient flow,

patient records, case management, infection control procedures, and linkages between the clinics and with

other HIV/AIDS resources in Zambia. In FY 2008, the partnership focused on UTH and Livingstone

pharmacists participating in additional trainings on adherence therapy, proper dosage, medication safety,

and pharmacokinetics in a hospital setup.

In FY 2009, the partners will develop a cadre of trained Zambian pharmacists who will serve as trainers to

train additional pharmacists at mission hospitals and hospices targeting primary healthcare for adult patients

as well as children. Through this mechanism, 75 additional pharmacists will be trained on service delivery.

AIHA will continue to assist the facilitation of additional trainings at University Teaching Hospital in Lusaka

and Livingstone General Hospital in Livingstone. The partners will develop UTH faculty and staff to ensure

sustainability of future ongoing pharmacy training.

In FY 2009, AIHA will establish two Learning Resource Centers (LRC), one at UTH and another at

Livingstone General Hospital. LRC utilize information technology to facilitate the exchange of information

and data by providing access to evidence-based research and educational resources. LRC are institution-

or community-based telecenters that consist of one or more computers with Internet access, a scanner that

allows partners to digitize clinical images for use in tele-consultations, resource materials, and a collection

of health and medical databases. The LRC offers healthcare professionals current information on the most

effective practices within their specialization, while helping these professionals build new programs rooted in

evidence-based medicine. The LRC will provide UTH and Livingstone General Hospital faculty and staff

with the latest evidence-based information which they will be able to utilize in their teaching and practice.

In FY 2009, AIHA and the partnership (which includes UTH) will continue to work closely with CDC,

Columbia University, and other relevant stakeholders to ensure that the activities are comprehensive and

coordinated in order to promote sustainability. AIHA has been instrumental in increasing and strengthening

palliative care in Zambia through its partnership with the Palliative Care Association of Zambia; this partner

can be brought in as a resource for the pediatric AIDS treatment centers partnership.

AIHA will continue to increase gender equity in the provision of ART services by imparting knowledge and

skills to equal proportions of males and females in all our programs.

Target set for this activity cover a period ending September 30, 2010.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $180,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

All activities are continuing and relate to activities in Health Systems Strengthening (OHSS).

Activity One: Expand Learning Resource Centers to three additional sites in Zambia

FY 2006-2008 Review

This activity is a continued activity from 2006 and 2007 when the American International Health Alliance

HIV/AIDS (AIHA) Twinning Center established a Learning Resource Center at Maina Soko Military Hospital

and the Defence Force of Health Sciences (DFHS). Initial and subsequent workshops were conducted at

Maina Soko and DFHS to ensure staff were properly trained on evidence-based learning through the use of

the Internet and ongoing support was established through distance learning.

In 2008, AIHA Twinning Center proposed to expand the Learning Resource Center to three additional

military hospitals in Zambia. Due to ZDF restrictions on access to their military bases by non-Zambian

military personnel, AIHA's activities were delayed. AIHA will include this Learning Resource Center (LRC)

roll-out component in 2009 activities, but will slightly alter this activity to reflect the most urgent needs at the

military hospitals. In addition to the LRC component, AIHA will work with LRC staff at Maina Soko and

DFHS to increase access to and scale up facility services, medical records, and libraries within the LRC

itself.

FY 2009 Proposed Activities

In 2009, AIHA will continue to work on the 5 identified LRCs and will focus on two major components. One

component is to roll out the LRC established at the Maina Soko and the Nursing school to 3 additional camp

hospitals managed by the Zambian Defense Force. Funding will support the following activities in 3 camp

hospitals including the establishment of the resource centre, Internet, and resource materials. The staff will

be trained in evidence-based medicine to enable them to use current medical information to treat their

clients. This program will operate in 4 provinces in Zambia and will train 30 staff members in 3 hospitals and

will benefit the staff and patients accessing services in these camp hospitals.

AIHA will engage Zambia LRC staff as appropriate in providing training and mentoring on the roll out of the

Smartcard electronic medical record system. The Maina Soko LRC staff has experience in providing

training on data entry into the Smartcare system and could share their experiences in implementing the

system at Maina Soko. AIHA will coordinate its involvement in the Smartcare rollout closely with CDC,

Jhpiego, and other stakeholders as appropriate.

The second component of this activity is to support the establishment of the telephonic medical consultation

lines in the 3 Camp Hospitals to be connected to Maina Soko Hospital as a tertiary and teaching hospital for

the ZDF. The three Camp Hospitals that will be involved in this pilot will be selected through consultation

with ZDF and DOD. This consultation line is meant to support the junior medical staff during their patient

consultations so that they are able to identify and manage minor illnesses without referring patients to

Maina Soko. The medical staff will be guided on both diagnosis and management of clients. The funds will

support the establishment of this line through a twinning partnership with a US-based institution. The US-

based institution will be identified through consultation with DOD and ZDF. The funds will support exchange

visits between the partners, appropriate equipment and setting up of the sites to initiate and respond to

queries made by the Camp Hospitals. The funds will also support training of the staff in initiating and

responding to the queries. In addition, funds will also be used to buy any additional equipment needed to

ensure that the responses are timely and the necessary documentation is of good quality and can be

received on both ends. This activity will reduce the number of HIV patients referred to Maina Soko and will

increase the confidence, knowledge and skills of medical staff at 2 Camp Hospitals in managing the needs

of their clients. This activity will train 30 staff in 4 Hospitals (Main Soko and 3 Camp Hospitals).

Activity Two: Providing Technical Assistance to Project Concern International (PCI)

FY 2006-2008 Review

AIHA worked with PCI to provide technical assistance to the mobile health units. AIHA Twinning Center

recruited the assistance of a consultant specializing in VCT who worked with PCI to help organize the

mobile unit staff and specifications, job descriptions, needs. The consultant travelled with PCI staff during a

routine visit to Northern provinces in Zambia and during the course of seven days, over 1200 individuals

were tested. When the counselors returned to Lusaka the consultant conducted a follow-up training for 25

PCI staff members.

FY 2009 Proposed Activities

In 2009, AIHA will continue interacting with PCI and the mobile unit to strengthen the operations and AIHA

will provide a consultant to assess and improve monitoring. AIHA will logistically coordinate travel for the

consultant's travel to Zambia to conduct refresher training with the mobile unit core team including technical

assistance for data collection and monitoring systems. As well AIHA will facilitate, coordinate, and manage

the exchange program of 5 VCT counselors to the US where they will have the opportunity to work with

mobile VCT providers in the States

AIHA Twinning Center Methodology

AIHA will work closely with the sub-partners to ensure that the activities of the program objectives and

targets are met. AIHA will ensure partnership objectives are met and within the partnership budget and will

also provide management and technical assistance to the partners. AIHA will manage all funding and will

conduct on-site monitoring to provide technical assistance and ensure that the objectives are implemented.

AIHA's Twinning Center will also leverage private sector in kind contributions including books and other

materials needed to sustain the organizational development of the programs. To establish a sustainable

program, AIHA will work with a sub-partner to ensure that they provide ongoing support and mentoring and

will also identify local stakeholders that will provide ongoing technical assistance to partners. The

contributions of institutional twinning partnerships usually double the value of the initial funding contribution.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15610

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15610 3741.08 HHS/Health American 6799 3043.08 Twinning Center $300,000

Resources International

Services Health Alliance

Administration

8810 3741.07 HHS/Health American 4945 3043.07 Twinning Center $75,000

Resources International

Services Health Alliance

Administration

3741 3741.06 HHS/Health American 3043 3043.06 Twinning Center $150,000

Resources International

Services Health Alliance

Administration

Emphasis Areas

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $300,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 19 - HVMS Management and Staffing

Total Planned Funding for Program Budget Code: $12,423,395

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Achievement of PEPFAR goals in FY 2009 -- and over the next five years is highly dependent on adequate staffing not only within

the host government structures and U.S. partners in Zambia, but also within the five U.S. agencies at Post that administer,

manage, and implement PEPFAR programs. As of October 2008, the U.S. Mission Team has a total of 135 positions working a

minimum of 30% effort on HIV/AIDS; of this number, 134 work full-time on PEPFAR activities and programs. All but 8 of these are

currently filled and recruitment is underway to fill the vacant positions.

Consensus, collaboration, and frank discussion characterize the team Zambia approach. Thus, many important core strengths

are shared across agencies or handled in a cooperative, interagency/section fashion. Examples of these core strength

collaborations include:

- State and USAID promote and support advocacy for and create enabling environments for the formulation and implementation of

policies and legislation that support quality HIV/AIDS services, protect persons made vulnerable by HIV/AIDS, and reduce stigma

and discrimination;

- Peace Corps and State administer PEPFAR-funded and targeted small grant programs;

- DOD builds modern health care facilities, particularly laboratories, to benefit the military and surrounding communities in high

priority areas; CDC provides equipment to the facilities and training for the staff;

- USAID develops and implements innovative, effective programs and community interventions that provide care and support to

orphans and vulnerable children (OVC), their caregivers, and families and that care for people living with HIV/AIDS, particularly

through home-based and hospice care; while DOD, in partnership with USAID, serves OVC in and near military sites;

- Peace Corps broadens the reach of volunteers through linkages with CDC and USAID partners, broadening the reach of the

volunteers; and,

- USAID and CDC provide, manage, and advise on acquisition and assistance mechanisms.

All PEPFAR agencies at post work closely with host government to: quantify projections for HIV/AIDS drugs, commodities and

supplies; procure U.S. contributions; build effective logistic management systems; and collaborate with local and international

partners to support prevention and health service delivery efforts. In close collaboration, all five U.S. agencies develop and use

systems, processes, and tools to ensure the collection and analysis of data to monitor funding and performance while they

improve the quality and availability of human resources (whether government, private, NGO or military) addressing HIV/AIDS.

Consolidating the U.S. reporting into one format using the Zambia Partners Reporting System has enabled the interagency

Strategic Information Subcommittee to streamline reporting.

Specific agencies have unique expertise and abilities that translate into core strengths:

HHS/CDC

- Provides direct technical and financial assistance to multiple national GRZ institutions in support of HIV/AIDS and other public

health programs;

- Undertakes and provides technical assistance in the development and implementation of public health evaluations; and,

- Contributes academically rigorous, peer-reviewed scientific and technical advice drawing on its extensive experience in public

health response, information systems, monitoring and evaluation, surveillance, epidemiology, laboratory strengthening, disease

prevention and control.

USAID

- Builds capacity of public and private sector staff to improve and sustain the delivery of quality HIV/AIDS clinical services at all

levels (national to facility);

- Fosters strong responses to HIV/AIDS through non-governmental, faith-based, community-based, and private sectors and

through wraparound approaches for prevention, care and treatment in the home, community, workplace, and public and private

clinical settings;

- Builds financial, management, and programmatic capacity of government, civil society, faith-based, and the private sector

institutions and organizations involved in HIV/AIDS service delivery; and,

- Cultivates partnerships with the private sector to leverage additional financial and in-kind resources through Global Development

Alliances and public-private partnerships;

Peace Corps

- Resides and works in local communities, implements programs directly to targeted groups;

- Integrates prevention programs into grass roots food security, income generation, health and education projects; and,

- Provides a broader reach to youth through the work of volunteers.

U.S. Department of Defense - DOD

- Provides dynamic prevention, treatment and care programs;

- Serves as sole PEPFAR liaison to the Zambian military and Zambia Defense Forces Medical Services; and,

- Has construction expertise.

U.S. State Department

- Negotiating agreements with ministries, NAC, and other GRZ entities

- Lobbying ministries and parliament for policy change

- Public diplomacy and outreach

- Interagency coordination and management

BEST PRACTICES IN INTERAGENCY COORDINATION

The success of the Zambia PEPFAR team lies in the overlapping and complementary core strengths of the participating agencies.

During our first five years of PEPFAR the team developed several best practices that guide our interagency coordination and

ensure we speak and act as "one USG."

First, interagency coordination is led by the PEPFAR Coordination Office within the Department of State (State). State serves as

overall liaison with the Government of the Republic of Zambia (GRZ) and donors on PEPFAR at the highest level. In addition,

State provides leadership in providing policy, strategic, and budgetary guidance for achieving the goals outlined in the U.S.

strategy on HIV and AIDS in Zambia. Finally, State leads and coordinates public affairs around PEPFAR to better inform the

American people about PEPFAR and to enhance awareness of PEPFAR in Zambia.

The Coordinator chairs weekly meetings of all interagency staff working on PEPFAR. These meetings: coordinate interagency

process; communicate and clarify policy, guidance, and other updates from OGAC; share technical information from the TWGs;

plan and execute strategies to manage near-term issues, and

In 2009, the PEPFAR Coordination Office will be fully staffed to lead these coordination activities. The PEPFAR Coordinator will

lead a staff of five, including the PEPFAR Program Manager, Finance and Operations Officer, Development Outreach

Coordinator, PEPFAR Small Grants Coordinator, and PEPFAR Administrative Assistant. In addition to five staff in the PEPFAR

Coordination Office, the PEPFAR Monitoring, Reporting and Planning Advisor is hired through USAID. Further detail on the

Coordination Office is located within the HVMS activity narrative for the Department of State.

Second among our established best practices are the two high-level groups that oversee PEPFAR: 1) Interagency Country Team,

and 2) PEPFAR Steering Committee. Country Team meets weekly to make programmatic and operational decisions to ensure a

coordinated U.S. MISSION IN ZAMBIA HIV and AIDS program and to strengthen the collaboration between the GRZ and U.S. on

HIV/AIDS. The PEPFAR Steering Committee includes the DCM, USAID Country Director, CDC Country Director, Peace Corps

Country Director, and Defense Attaché. The Committee makes strategic decisions on the direction and potential impact of U.S.

support in HIV/AIDS. These two structures help to set priorities, manage resources, and ensure uniform PEPFAR messaging to

cooperating partners and the GRZ.

Third is our system of interagency Technical Working Groups (TWGs). Standing TWGs include 8 subject matter groups and 7

cross-cutting groups. The subject matter groups include: 1) Prevention of Sexual Transmission; 2) Medical Transmission; 3)

PMTCT and Pediatric ART; 4) Adult ART; 5) Basic Health Care and Support; 6) TB/HIV; 7) OVC; and 8) Counseling and Testing.

The cross-cutting TWGs include: 1) New Partners Initiative; 2) Strategic Information; 3) Management and Staffing; 4) Systems

Strengthening; 5) Food and Nutrition; 6) Laboratory; and 7) Male Circumcision. In addition to the in-country TWGs, several

members of the Zambia team participate in the OGAC TWGs and share information with the broader PEPFAR team in Zambia.

The Zambia PEPFAR Interagency Team also creates ad hoc working groups to respond to important issues as they arise.

In addition, an interagency Management and Staffing Technical Working Group (M&S TWG) was formed to begin the SFR

process, led by the PEPFAR Coordination Office. The M&S TWG mapped existing staffing and operational structures and began

discussions on potential staffing gaps across agencies. Recruitment has been challenging for key positions, resulting in few

qualified applicants. Qualified potential recruits have declined applying for these critical positions, as known work requirements in

PEPFAR focus countries are too demanding. Recruitment will continue to be a challenge.

STAFFING FOR RESULTS

As required as a deliverable for the FY 2009 Country Operational Plan (COP), the U.S. Mission in Zambia PEPFAR team

conducted the Staffing for Results (SFR) exercise to document how the current PEPFAR structure is operating across the five

participating U.S. agencies and how we have worked together successfully over the past four years. SFR in Zambia is being

approached as a flexible tool to inform U.S. Mission in Zambia strategic process on management and staffing. The overall vision

of SFR in Zambia is to document how the PEPFAR team has worked successfully over the past four years, and to help inform

how to better enhance coordination across agencies. The SFR is not intended to establish an immutable staffing structure nor is it

intended as a tool for Washington to determine the appropriate staffing configuration for Zambia. This will be used as an internal

document to help guide decisions as PEPFAR evolves and as key staff transition.

The U.S. Mission in Zambia PEPFAR team views the SFR as a fluid process. Implementation of SFR will be continuous over the

coming years, taking into account the planning necessary for the new embassy compound plans that have already begun. The

construction of the new embassy compound (NEC), which will house four of the five PEPFAR agencies, is scheduled to begin in

2008 with expected completion in 2010. The co-location and management consolidation that will coincide with the move to the

NEC will significantly influence the structure of SFR in Zambia.

MANAGEMENT & STAFFING BUDGET

The total planned spending on management and staffing for FY 2009 is $12,566,908, or 5.3 percent of the total planned budget

for the year.

Table 3.3.19: