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 relates to activities in mother-to-child transmission (MTCT) (#9002).
The activity has been modified in the following: 1) Emphasis on strengthening linkages between prevention
of mother to child transmission of HIV (PMTCT)/ Postnatal services and child health services, 2) Emphasis
on providing comprehensive package of PMTCT services during antenatal, labor and delivery, postnatal
period and child health services, 3) Focus on quality improvement through orientation of health providers in
the Ministry of Health (MOH) Integrated Reproductive Health Services (IRH) Performance Standards, and
4) Focus on maximizing access to early infant diagnosis (EID) through monitoring and strengthening of the
courier system for dried blood spots (DBS), updating and training health providers in DBS specimen
collection.
The population of Western Province is projected at 955,297 with an HIV prevalence of 13.1%. The
expected number of pregnancies is estimated at 40,698 and expected number of deliveries is 39,076.
According to institutional data (2007), 19,371 pregnant women were tested for HIV, out of these 2,280 (11.
8%) tested positive. The provincial terrain is very unfavorable making communication and women's access
to maternal and neonatal health services (antenatal; labor and delivery; postpartum care; and newborn
care) including PMTCT difficult. The province has 11 hospitals and 137 rural health centers (total of 148
health facilities). Further the vastness of the province and low population density makes it difficult to make
services easily accessible to the population, which is compounded by low staffing levels and insufficient
infrastructure.
Despite all the challenges highlighted above, the Western Province Health Office (WPHO) recognizes the
PMTCT program's role as a gateway to HIV/AIDS prevention, care and treatment services.
During FY 2008, the goal of the program was to increase the number of outlets providing the minimum
package of PMTCT services, the number of women provided with a complete course of antiretroviral
prophylaxis and the number of pregnant women who received HIV counseling and testing for PMTCT and
received their test results. In order to achieve this goal, the WPHO worked in partnership with the Center
for Infectious Disease Research in Zambia (CIDRZ) and Churches Health Association of Zambia (CHAZ).
In FY 2009, the WPHO in collaboration with its implementing partners will focus on improving the quality of
care for antenatal and postnatal women in the PMTCT program through the following activities:
In an effort to support the Zambia national framework and build capacity of the national system to provide
sustainable HIV/AIDS services, the United States Government (USG) through Centers for Disease Control
and Prevention (CDC) aims to provide direct support to Western Provincial Health Office (WPHO) to build
its capacity to coordinate and oversee PMTCT services in the province, provide training, and expand
PMTCT trainings to health centers currently not covered by CIDRZ.
Up to the end of FY 2006, 132 health providers were trained under different programs. At the end of FY
2007 an additional 75 health providers were trained making a total of 207 trained providers in PMTCT. By
the end of 2008, an extra 50 health workers were trained making a total of 257. In FY 2009, the WPHO will
train 40 more health providers. The providers to be trained will include newly qualified trained staff and
other staff without PMTCT skills.
At the end of FY 2007, 20 community based volunteers (CBV) were trained in PMTCT. During FY 2008, an
additional 125 lay PMTCT counselors were trained making a total of 145. The WPHO would like to have
two lay counselors in each of the 133 PMTCT sites. To this effect during FY 2009 an additional 121 lay
counselors will be trained to cover both new and old sites. Due to the health worker shortages currently
being faced in the province, this cadre has been identified to provide counseling and testing services.
Initially this cadre was only allowed to counsel, however with the new MOH guidelines, their role has been
revised to include testing.
In FY 2009, WPHO will orient health providers from all the PMTCT sites on the MOH Integrated
Reproductive Health supervisory tool which is a tool with performance standards that are used to monitor
the quality of services being provided as stipulated in the PMTCT module. This will assist the WPHO
improve the quality of PMTCT services being offered and secondly standardize the PMTCT package in the
province. The PHO will provide quarterly supervision while DHOs will conduct supportive supervision to
PMTCT sites monthly.
At the end of FY 2007, the number of sites providing PMTCT services was 97. During the FY 2008, the
WPHO in collaboration with CIDRZ and CHAZ continued to scale-up PMTCT services to 121 sites which
translate to 81% coverage of health facilities.
During FY 2009, the WPHO and its partners would ideally have scaled up PMTCT services to all 148
(100%) health facilities, however, out of the 148 health facilities, 31 (21%) have no trained staff such as a
nurse, clinical officer or an environmental health technician. In addressing the human resource constraints,
the WPHO will also scale-up PMTCT services to 12 sites directly. The scaling up to 12 more health
facilities will result in an increase in the number of health facilities providing a comprehensive package of
PMTCT from 121 (81.7%) to 133 (90%).
The 12 sites that WPHO will scale-up to using PEPFAR resources have a total population of 290,850.The
expected number of women who will be pregnant is estimated at 15,307. Given the health provider
constraints the province is experiencing, it is estimated that 12,245 (80%) of pregnant women in the new
site catchments population will access PMTCT services. Counseling of women will continue during
antenatal care (ANC); labor and delivery and postnatal periods. Those women testing positive will be
assessed and provided with appropriate HIV prophylaxis, care and these will be linked to the ART clinic for
further management.
In FY 2009, the WPHO plans to provide a package of PMTCT and tuberculosis (TB) services in 114 (77%)
health facilities that currently offer only PMTCT services but have no TB diagnosis facilities. This package
Activity Narrative: will include training health workers in TB screening for mothers enrolled in PMTCT and preparation of
sputum smears, which will be transported to the nearest diagnostic centers for processing. This activity will
be linked to the TB/HIV program and Lab infrastructure to ensure quality of services. Further, WPHO will
strengthen linkages between PMTCT, TB and ART services by developing a system that will enable
providers identify clients that are unable to access services that they have been referred for. WPHO also
plans to establish provision of comprehensive package of TB/HIV collaborative activities (PMTCT, TB and
ART services) on site in 29 (19.6%) health facilities. The facilities earmarked are Zonal health centers and
hospitals.
Early infant diagnosis will be strengthened by building health provider capacity in collection of DBS
specimens and putting in place an effective courier system for sample transportation from all the 133 sites
providing PMTCT services to district hospitals and Lewanika general hospital. Currently, the DBS transport
system needs strengthening from facility-level to the district hub. Further, WPHO will strengthen care for
exposed infants through follow up activities which will also be strengthened by use of new children's clinic
card. The new children's clinic card has provision for follow up and monitoring exposed children both at
health facility and community.
Some of the sites earmarked for roll-out have no trained health providers and are manned by untrained
personnel. The WPHO in FY 2008 recruited eight retired health providers to provide PMTCT services under
this activity. During FY 2009 the WPHO will recruit 12 more retired providers to meet the critical human
resource gap for the most rural health facilities.
The WPHO attaches great importance to quality of services that are provided to clients. In addition to
training of health providers, the WPHO will ensure that all the inputs required for provision of quality PMTCT
services are provided to all the sites. The inputs will include strengthening linkages between critical
services that compliment the provision of quality PMTCT services such as malaria in pregnancy (insecticide
treated nets (ITN) and IPT), Safe motherhood services (ANC, labor and delivery, postnatal care, neonatal
care, and management of complications of pregnancy and delivery including newborn complications). This
entails improvement of infrastructure and provision of equipment and other supplies such as Hemacules,
test kits (RPR and HIV) prophylaxis ARVs. Further more the referral system between related services as
well as evacuation to higher levels of care will be strengthened. Given the amount of financial resources
required, these activities will be wrapped around other activities.
During FY 2009, the WPHO will focus on strengthening collaboration and coordination as in the FY 2007
and FY 2008. WPHO will work with CIDRZ who will continue to provide PMTCT services in districts as per
their mandate. During FY 2009, WPHO will continue to provide leadership to ensure uniformity and
standardization for PMTCT services. WPHO, CIDRZ and CHAZ will continue to collaborate in providing
technical assistance to PMTCT sites. However, the WPHO will report only on the number of health workers
trained for the other districts were they train and report on all the PMTCT targets for the 12 sites.
Further, WPHO will continue holding coordination meetings with other partners providing PMTCT services.
The meetings will provide an opportunity to share experiences and other emerging issues to ensure
effective synergies. The WPHO will also hold quarterly technical review meetings which will bring together
all MCH coordinators and selected PMTCT providers to discuss progress, constraints, challenges and
emerging issues pertaining to the program.
To ensure sustainability of the program, the WPHO will devolve implementation responsibilities to the
respective districts and ensure that districts include PMTCT services in their annual plans. Western
provincial health's role will therefore be to provide technical support, mentoring and monitoring and
evaluation. With the Human Resource strategic plan of the Ministry of Health being implemented, there will
be doubling of intakes and outputs from the training institutions which will ultimately improve the availability
of human resource in the province.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15555
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15555 9744.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $225,000
Disease Control & Office - Western PS000646
Prevention Province
9744 9744.07 HHS/Centers for Provincial Health 5025 3082.07 WPHO - 1 U2G $225,000
Emphasis Areas
Health-related Wraparound Programs
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $140,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This activity is linked with the other activities for the Western Province Health Office including counseling
and testing (#9047), IntraHealth (NEW), School of Medicine (#17574) and the CDC activity for WPHO
focused on prevention for positives in antiretroviral (ARV) services (#9769).
This activity has been modified as follows:
Expand access of prevention activities from one to two additional districts. Promote community
engagement in prevention activities including involving people living with HIV and AIDS in the planning,
implementation, and monitoring of HIV prevention activities. Strengthen the capacity of the provincial health
office and its districts to effectively address sexually transmitted infections (STIs) through community
awareness and treatment for STIs.
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 (CT), prevention of mother-to-child (PMTCT), tuberculosis treatment, and
antiretroviral therapy (ART). Youths will be recruited to ensure their longevity with the programs. A radio
program will be implemented to increase community awareness around prevention.
Western Provincial Health Office (WPHO) recognizes the important role of behavior change in preventing
new infections given the very high HIV (28.2%) and syphilis prevalence (11.7% according to the Antenatal
Clinic Sentinel Surveillance, 2004) among pregnant women aged 15-44 years in the province.
In FY 2007 and FY 2008, respectively, WPHO supported Mongu District Health Office (DHO) to strengthen
the existing youth friendly services and scale up services to new sites, increase condom service outlets,
increase number of individuals reached through community outreach and increase number of individuals
trained to promote HIV/AIDS prevention through behavior change. These services have been provided
through creating working space for youth friendly health services, training peer counselors, training adult
mentors as behavior change agents, supporting the Diocese and traditional leaders in implementing youth
prevention activities in four major churches in Mongu, communities, and supporting the Diocese youth
resource center. As a result of this intervention, a total of 40 have been trained in peer counseling, 10
teachers have been trained in counseling, 32 condom distribution sites have been established and 1,500
youths counseled, tested, and received their test results. Youths that test HIV positive are linked to the ART
clinic for ART services.
WPHO's strategic plan for implementation of prevention activities will be two pronged. 1) WPHO will begin
to phase out support to Mongu DHO by facilitating the DHO to include in the district action plans funded
through the Ministry of Health the prevention strategy in strengthening and scale up of prevention activities
in the district while the WPHO will scale-up prevention activities to four other districts, namely; Kaoma,
Sesheke, Senanga, and Lukulu in order to reach more people. The selection of new districts is based on
population and HIV prevalence. 2) WPHO will expand services to risk groups irrespective of age. The
selection of risk groups will be guided by the 2007 Zambia Demographic Health Survey.
Training of Trainers (TOT) in behavior change communication - Continuing
This is an on going activity. In FY 2008, WPHO trained 40 behavior change agents from schools, churches,
government departments, youth friendly health providers, community leaders and people living with HIV
AIDS. In FY 2009, WPHO will support training of trainers for 40 Community leaders in behavior change
communication. The TOT will target church leaders, traditional leaders, People Living with HIV/AIDS,
school leaders, civic leaders, neighborhood committee members, women and youth groups drawn from four
new districts.
The WPHO will collaborate with CT, PMTCT and ART service providers to integrate behavior change
activities at these points of care as well as in the community. The TOT approach will be adopted in order to
ensure that the trainers in each district train members in their respective communities to facilitate behavior
change in their communities using participatory learning activities.
Adult mentoring is one of the strategies beyond abstinence and or being faithful used to promote prevention
of HIV/AIDS. The objective is to improve communication between adults and young people when
discussing issues related to sexuality and HIV and ultimately contributing to the reduction of new infections
in the province.
FY 2008 WPHO supported Mongu district in trained 20 adult mentors. During the FY 2009, an additional 20
adult mentors (five per district) will be trained.
During the FY 2007, WPHO trained 51 peer counselors. At the end of FY 2008, and additional 20 peer
counselors will be trained; resulting in a total of 71 peer counselors trained.
In FY 2009, in collaboration with District AIDS Task forces, the WPHO will support the four new districts
(Kaoma, Sesheke, Senanga, and Lukulu) in training peer counselors targeting churches, youth groups, sex
workers, women groups, fishing groups, and traditional leaders. A maximum of 15 peer counselors per
group except for churches and youth groups which will have 35 each, based on the size of the group and
the population served by the group.
In FY 2008, WPHO implemented prevention for positive component working with both youths and adults.
WPHO will work with the University of Zambia (UNZA) School of Medicine (SOM) (activity 17574.08) 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 ART that refer those who are
positive and negative to the prevention workshops. Funds for FY 2008, were used to build the PHO's and
DHMT's 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.
Activity Narrative: In FY 2009, WPHO will work with IntraHealth and SOM build the provincial health facilities' capacity to
deliver prevention for positives and negatives program to an additional 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 component will be initiated to track program outcomes.
Training of health providers in adolescent and reproductive health including management of STIs is also a
focus. By the end of FY 2008, Mongu DHO will have 16 trained health providers in providing youth friendly
services. In FY 2009 WPHO will support training of 40 health providers in the four new districts (12 for
Kaoma, 12 in Senanga, eight for Lukulu and eight for Sesheke).
The WPHO will identify already existing drama groups and train them in effective community mobilization
regarding HIV/AIDS and STIs sensitization. WPHO will support the new districts in supporting drama
groups, anti AIDS clubs, radio programs, translation and production of information education and
communication (IEC) materials in local languages for distribution among the identified risk groups in the two
districts. The IEC production activity will be undertaken in partnership with working on communication is the
districts. WPHO will support districts participation in the national HIV/AIDS awareness campaigns such as
the World AIDS and National VCT Days as well as traditional ceremony Kuomboka and Kazanga and sports
events.
To reach the out of school youths and adults 13 sensitization and preventive radio programs for youths on
TB/HIV/AIDS/STIs will be aired. The media will provide a forum to educate the community in local
languages on STIs and HIV/TB and where to find relevant health services. Topics to be covered will include
the following; importance of VCT, Couples VCT, PMTCT, condom service outlets, 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 WPHO in collaboration with the provincial prevention
technical working group will identify experts in the areas above to lead the discussions.
By the end of FY 2009, the WPHO will support the four new districts in establishing 50 condom sites (six in
Sesheke, 10 in Kaoma, 10 in Senanga and seven in Lukulu).
During FY 2009, the WPHO will support renovations of the four new health facilities in the new districts (one
per district) to make room for youth friendly health and STI services.
During the FY 2009, the WPHO will continue supporting Mongu, Sesheke, Kaoma, Senanga, and Lukulu
district health offices to carry out supportive supervision (will be integrated with other components) on
monthly basis to all the health centers providing youth friendly services and prevention for positive and STI
programs. The WPHO will provide technical support on quarterly basis.
In FY 2009, the Provincial Health Office (PHO) will continue to support DHOs in strengthening the linkages
and partnership between other stake holders in preventive services such as Concern Zambia; Health
Communication Partnership; Fala Mwalilangu; and the Barotse Royal Establishment, and create synergy in
the provision of these services. The coordination meetings will provide an opportunity to ensure that all
efforts related to HIV prevention are directed towards the same goal. The meeting will also provide an
opportunity for partners to share experiences, discuss and find ways of addressing concerns and
constraints.
respective districts and ensure that districts include prevention activities at both health and community
levels as priority areas in their annual plans. The PHO's role will therefore be providing technical support,
mentoring and monitoring and evaluation. With the Human Resource strategic plan of the Ministry of Health
being implemented, there will be doubling of intakes and outputs from the training institutions which will
ultimately improve the availability of human resource in the province. Furthermore, assuming that the
improved funding is sustained, infrastructure development will also improve which will ultimately increase
access to services as well as providing space for more service provision in existing facilities.
Continuing Activity: 15556
15556 9648.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $140,000
9648 9648.07 HHS/Centers for Provincial Health 5025 3082.07 WPHO - 1 U2G $100,000
Construction/Renovation
Estimated amount of funding that is planned for Human Capacity Development $85,000
Table 3.3.03:
THIS IS A NEW ACTIVITY:
•Increased access to Male Circumcision (MC) services
This activity will be linked to the TBD former JHPIEGO and University of Zambia (UNZA) School of
Medicine (SOM) MC training center activity CDC activity.
From FY 2007 to FY 2009, TBD (former JHPIEGO) have trained provincial health offices to build their
capacity to provide safe, quality, and effective male circumcision (MC) services. The expectation is that
after the training the provincial health offices take the lead in scaling up MC services at their district health
facilities.
This funding is for the Western Provincial Health Office (WPHO) to expand the provision of MC services in
at least five of the district health offices. The funds will be used to duplicate MC materials, build the
capacity for an MC team at each of the five selected district facilities to MC services, as well as to renovate
space for MC, translate, and reproduce MC information, education and communication (IEC) materials and
to procure necessary equipment. Supportive supervision will be provided by UNZA SOM and TBD who
have been funded to do training and provide supportive supervision until the province is confident to take
over such role. Training in some of the five districts will be conducted in conjunction with TBD who will be
funded to do training and provide supportive supervision until the province is confident to take over such
role.
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. 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.
Targets set for this activity cover a period ending September 30, 2009.
New/Continuing Activity: New Activity
Continuing Activity:
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.07:
ACTIVITY NARRATIVE HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
1. Upgrading of some health centers to zonal health centers in order to improve and ensure uninterrupted
and sustained supply of antiretroviral therapy drugs (ARV) during the flooding season.
2.Focusing on ensuring constant and uninterrupted supply of antiretrovirals (ARV) to clients living in areas
which are cut off during the flood season by powering air conditioners to enable health facilities stock
sufficient drugs to last throughout the flood season.
3.Improving access to ART services by supporting recruitment of retired health providers to provide ART
services and renovation of selected health facilities in order to ensure that more health centers meet the
criteria for being an ART site according to the Medical Council of Zambia standards.
4.Improving of monitoring and tracking of efficacy and adverse effects of ARV and timely informing the
Pharmacy Regulatory Board.
5.Strengthening implementation of Co-trimoxazole prophylaxis guidelines and linkages between prevention
of mother to child HIV transmission (PMTCT) and TB clinics
6.Strengthening patient tracking to ensure retention and improve on patient follow-up
7.Actively engaging the community in patient tracking and follow-up
8.Actively engaging people living with HIV/ AIDS in prevention activities
The Western Province of Zambia has a prevalence rate of 13.1 % in the general population between 15 -
49 years of age (Demographic and Health Survey 2002). The province consists of savannah woodlands in
sandy plateau and plains, traversed by the Zambezi River. Deep, sandy terrain and flood plains make
communication and food production extremely difficult. Most areas of the province can only be reached by
4 x 4 vehicles all year round and some only by canoes and speed boats in the rainy season making the
logistics of service delivery challenging and the cost much higher than most provinces in Zambia. The
floods and the difficult terrain also limit the access of the local population to the health facilities.
Storage of essential drugs and antiretroviral therapy drugs (ARVs) is a challenge in the sense that all the
Health Centers do not have enough power supply to sustain the air-conditioners. Some Health Centers do
not have adequate space for storage of drugs and other medical supplies
The province has 11 hospitals and 137 Rural Health Centers (total of 148 health facilities). The vastness of
the province and the low population density makes it difficult to scale up services to the population, which
has been compounded by low staffing levels and insufficient infrastructure. Currently, 59 (43%) of health
centers have only 1 trained health worker. Twenty-five (18%) are managed by untrained health providers
(CDE). Shang'ombo, Lukulu, Kalabo, and Sesheke are especially limited in their efforts to scale up
HIV/AIDS services due to staff shortages, inadequate infrastructure and laboratory facilities.
The goal for FY 2009 will be to increase the number of facilities providing ART services, the number of
individuals accessing ARV therapy, the number of health workers trained to deliver ART services according
to national standards and also to maintain acceptable quality of care in all the outlets providing the service.
To achieve the above goal, the Western Province Health Office (WPHO) will undertake the following
activities:
1 Scaling up of ART Services - by the end of FY 2007, 20 (13.5%) out of 148 health facilities were offering
ART services. At the end of FY2008, the WPHO will expand to five (Kahare, Nalikwanda, Nangula,
Libonda, and Kalabolelwa) more new ART sites giving a total of 25 (16.9%) in the province. Of these, nine
(36%) sites are supported by the WPHO using USG funds. The rest, 16 (64%) sites are supported by other
partners [Center for Infectious Disease Research in Zambia(CIDRZ), Catholic Relief Services(CRS), and
Churches Health Association of Zambia (CHAZ)]. Realizing the power of partnership in scaling up ART
services, the WPHO will continue work closely with partners; CIDRZ, CRS, and CHAZ. The partners are
expected to fill in the gaps caused by WPHO limitations in human resource and infrastructure.
In FY 2009 the WPHO plans to scale-up ART Services to four (4) new sites in Shang'ombo (Mulonga and
Mutomena Rural Health Centers) and Sesheke
(Katima, and Mulobezi Rural Health Centers) districts. This will result in 29 (19.6%) out of 148 health
facilities in the Western Province offering ART with 13 being supported directly by the provincial health
office using USG funding.
Prevention of positives; In FY 2009, the WPHO will collaborate with ART treatment department to integrate
behavior change through prevention of 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 in the
importance of a couple knowing their status together 2) couples will be enrolled and engaged in discussions
for two hours once a week for four weeks exploring HIV/STI/TB prevention and to come up with ways to
limit new infections 3) after the four sessions, couples/individuals will be referred to community discussion
groups formed and trained to promote prevention. Community groups will be led by community leaders
trained in prevention and behavior change using participatory learning activities.
HIV/AIDS patients on ART: By end of FY 2008, assuming the prevalence remains at 13.1% and a
population of 946,323 then 123,968 people will be living with HIV/AIDS. Assuming that 20% of these
people have clinical AIDS, then it will be expected that 24,793 people will need ARVs. In FY 2008 the
WPHO will put 15,000 (60.5%) patients on ARVs. Of these, 1, 800 (12%) will be from the provincial sites
supported by USG funds.
Activity Narrative: In FY 2009 assuming the prevalence remains at 13.1% and with a projected population of 975, 358, then
127,772 people will be living with HIV/AIDS and 25,554 (20%) will need to be put on ART. The WPHO
plans to reach the target of putting an extra 600 patients on ART sites supported by USG funds. WPHO
will strengthen the retention and follow up of patients by strengthening the quality of adherence counseling,
improving data management and actively engaging communities through Home Based Care providers and
treatment supporters in tracking patients that miss follow up appointments. WPHO will also support roll out
of the SmartCare application in order to ensure continued care for patients when switching from one facility
to another.
Training: To achieve the goal of scaling up to four new sites in FY 2009, the WPHO will undertake the
following trainings: 1.) Refresher course in Adult and Pediatric ART; In FY 2009, WPHO will conduct
refresher workshop for 75 health providers from ART sites trained before FY 2008 in both adult and
pediatric ART.
2. Pharmacovigilance; In FY 2009, WPHO will train 15 health providers and Pharmacy personnel in
pharmacovigilance. The training will equip the trainees with knowledge and skills required to recognize,
track adverse effects of side effects and monitor the efficacy of ARVs. Using the MOH guidelines on
reporting adverse effects, timely inform the Pharmaceutical Board of Zambia.
3. Adherence counseling: At the end of FY 2008, 20 health providers would have been trained in
adherence counseling. In FY 2009 WPHO will train 20 more health providers in adherence counseling.
4. ARV Logistics Management: WPHO will in FY 2009 train 15 pharmacy personnel and health providers in
health centers that are stocking ARVs in ARVs logistics management
To enhance the expansion of ART services, the WPHO will in FY 2009 refurbish and renovate four new
sites where ART will be scaled up. These are Mulonga and Mutomena Rural Health Centers (RHC) in
Shangombo district and Katima and Mulobezi RHC in Sesheke district.
At the end of FY 2008, four clinical officers will be recruited to provide ART services. In FY 2009, WPHO
will continue supporting the five clinical officers recruited in FY 2008 and will employ four (4) more staff
(clinical officers or nurses) and four data clerks for the four new sites in order to reinforce the staffing levels.
This will improve the quality of care and availability of accurate and timely data.
During the FY 2009 the WPHO will continue supporting and supervising the ART services to the nine sites
established in the FY 2007 and 2008 and the four new sites in addition to the other sites supported by
partners. The new established ART sites will also be supported and supervised by the district health
management teams (DHMT) and Hospital staff.
Accreditation of the new sites will be carried out by the WPHO team, in line with the Medical Council of
Zambia standards. The Provincial Mentoring Team will continue to update the staff and ensure the MOH
guidelines are adhered to. The WPHO will also convene quarterly review meetings for the ART staff.
Technical Supportive Supervision (TSS) to strengthen Quality Assurance will be provided directly by the
WPHO and the respective DHMT. This will be integrated into the quarterly TSS and Bi-annual Performance
Assessment. Pharmacovigilance will be reinforced during these visits.
WPHO 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 component will be initiated to tract program outcome.
WPHO recognizes the challenges the province is experiencing (long distances between facilities and
ineffective feed back mechanism for referred patients) in the referral system. In FY 2009, WPHO will
develop a strategy for strengthening the referral to ensure that there are no missed opportunities.
Strengthening the referral system will also improve on the follow up activities.
To ensure sustainability of services provision, Ministry of Health has embarked on a program to train more
nursing staff by increasing the intake and reopening of nursing schools that were closed. It is therefore
assumed that the numbers of staff coming to the Western Province will increase and therefore will take over
from the hired staff in running the ART programs in the various districts. This will ensure continuity of the
program in all the ART sites. The MOH funding for infrastructure has also increased and this will sustain
the started renovations which will be on-going.
Continuing Activity: 17817
17817 17817.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $250,000
Estimated amount of funding that is planned for Human Capacity Development $58,000
Table 3.3.09:
THIS IS A NEW ACTIVITY FOR FY 2009
Activity Narrative
This activity is related to WPHO partner supported activities under pediatric treatment (EGPAF/CIDRZ
#NEW, and AIDS Relief # NEW) as well as all direct CDC supported activities in Western Province in
prevention (# NEW MC WPHO, HVOP #9648.08), counselling and testing # 3792.08, care and treatment for
adults (HTXS #17817.08,) laboratory services (#9799.08) and strategic information (#9696.08).
By the end of 2007 a total of 12,638 patients were on antiretroviral treatment (ART) in the Western
Province, and out of these, only 679 were children (0-14 years). This is 5.4% of all persons receiving
antiretroviral (ARV) drugs, meaning that the rates of coverage of paediatric ARV treatment relative to the
need for treatment (10%) are relatively low. Paediatric HIV management is currently being offered in the
existing ART sites, which also offer adult ARVs management although on a limited scale. By the end of FY
2007, only 88 health providers were trained by Cooperating partners (CIDRZ, UNICEF and Clinton
Foundation) in the management of Paediatric HIV.
The reasons for low coverage could be attributed to inadequate numbers of staff trained in Paediatric HIV
Management, complexities in the diagnosis of Paediatric HIV infection especially in infants, social barriers in
enrolling children to care and treatment, weak linkages between prevention of mother-to-child transmission
(PMTCT), maternal and child health (MCH), and out-patient department (OPD) and paediatric ART
services.
Given the low Pediatric ART coverage, WPHO will in FY 2009 undertake several activities including training
of health workers in early infant diagnosis (EID) and pediatric counseling, scale up early infant diagnosis
and infant treatment for all confirmed cases, rolling-out provider-initiated testing and counseling (PITC),
strengthening the implementation of PITC and EID, strengthening linkages and referral systems with
various service areas (MCH, PMTCT, OPD, and the Paediatric Wards), strengthening supervision and
monitoring of Paediatric HIV care services through clinical mentorship and Paediatric ART supervision,
scaling up dry blood spots (DBS) to all ART and PMTCT sites. The DBS courier system will also be
strengthened and family centered approach for identification, diagnosis and treatment will be rolled out.
Scaling up of Paediatric ART Services
Sites
At the end of FY 2008, the same 25 sites providing adult ART services will be providing paediatric services
because the two services are integrated. In FY 2009, WPHO will scale-up ART services to four new sites
and will continue strengthening the services in the old sites.
Pediatric Patients on ART
The target for WPHO, in line with the national objective, is to provide ART to at least 75 per cent of HIV-
positive children in need of ART by 2010.
In FY 2009, assuming that a total of 25,554 people will need ARVs, then the number of paediatric patients
needing ARVs will be 10% (2,555) of the 25,554. WPHO will therefore aim at a provincial target of putting
1,916 (75%) children on ART by the end of FY 2009. Of these, 230 (12%) will be from WPHO sites
supported by USG funds. Zambia has adopted the new WHO recommendation to ensure treatment for all
children below 12 months with confirmed positive HIV on treatment. This will allow for earlier treatment,
better survival and more children on treatment. With the roll-out of DBS to all ART sites, it is anticipated
that WPHO will achieve their target.
Training
Pediatric counseling
Currently the province does not have health providers trained in pediatric counseling. In FY 2009 WPHO
will support training of 30 child counselors to cover every ART site. This training will improve the skills of
counsellors in dealing with particular issues around children: HIV/AIDS information, disclosure, adherence,
adolescence growth and development, support to parents, etc.
Given that the paediatric ART services will be provided within the adult ART sites, the issues of
infrastructure, human resource, supportive supervision, monitoring and referral system will be the same as
for adult ART. Efforts will be made however to ensure that services are child friendly within this integrated
approach.
Sustainability
respective districts and ensure that districts include paediatric ART services in their annual plans. Western
of human resource in the province. Furthermore, assuming that the improved funding is sustained through
national resources, infrastructure development will also improve, ultimately increasing access to pediatric
ART services.
* Child Survival Activities
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Human Capacity Development $5,000
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $11,186,777
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Tuberculosis (TB) is a leading cause of morbidity and mortality in adults living with HIV/AIDS in Zambia. Despite minor reductions
in TB patient notification during the last three years, the TB notification rate has increased five fold since the beginning of the HIV
epidemic in the mid 1980s. Recent data show that in 2007, 50,264 TB patients were notified, compared with 51,179 in 2006 and
53,267 in 2005 (representing a notification rate of 484 cases per population of 100,000 people vs, 500 cases per population of
100,000 in 2006 and 2007). The World Health Organization (WHO) estimates that up to 70% of all adults with active TB are also
co-infected with HIV. Zambia's most recent data show that of the 23,356 TB patients (49%) who were counseled and tested for
HIV, 16,240 (68%) were found to be infected with HIV. Because of the close opportunistic link between TB and HIV (double
burden of disease), the Government of the Republic of Zambia (GRZ's) National HIV/AIDS/STD/TB strategic plan (2006-2010)
has identified the treatment of TB as one of the key objectives in mitigating the spread, limiting the co-morbidity, and minimizing
the socio-economic impact of HIV/AIDS in Zambia.
The implementation of the GRZ's HIV/AIDS/STD/TB national strategic plan is a collaborative effort between the GRZ, the Global
Fund to fight AIDS, Tuberculosis and Malaria (Global Fund), the President's Emergency Plan for AIDS Relief (PEPFAR), the
Tuberculosis Control Assistance Program (TBCAP) which is funded by USAID through a global cooperative agreement with the
Royal Netherlands Tuberculosis Foundation (KNCV), and other implementing partners. Funds from the Global Fund have been
supporting and will continue to support the national TB program (NTP) to implement all six components of the ‘Stop TB' strategy,
including the Directly Observed Treatment Short-course (DOTS) strategy. All partners in the TB and TB/HIV programs buy into
the planned NTP activities in the National strategic plan; the Ministry of Health National TB program sources high quality drugs
from WHO Global Drug Facility (GDF).
PEPFAR supports the integration of TB/HIV service delivery through the following activities: development of linkages between TB
and HIV services, human capacity development, improvement of physical infrastructure, improvement of the TB/HIV health
information system, strengthening of the laboratory system, and provision of technical support. To promote collaboration with the
GRZ and other partners, the U.S. Mission in Zambia has been and will continue to be represented on the National TB/HIV
coordinating committee, a committee that initiates TB/HIV policies and oversees their implementation.
PEPFAR activities support the GRZ through direct funding to the MOH and U.S. partners implementing TB/HIV activities in
Zambia. From FY 2005 through FY 2008, the U.S. Mission in Zambia has supported the MOH and private health care providers
to integrate TB and HIV activities, including the: provision of voluntary and provider-initiated counseling and testing (PICT) to all
TB patients; and referral of HIV-infected TB patients for HIV services, including anti-retroviral treatment (ART).
In FY 2006, the U.S. Mission in Zambia provided support to the MOH to develop guidelines for the implementation of TB/HIV
activities in Zambia, focusing on routine opt-out HIV counseling for all TB-infected patients, and the screening of HIV-positive
clients for TB (also known as Diagnostic Counseling and Testing (DCT)). In FY 2007, the U.S. Mission in Zambia helped the
MOH develop guidelines for TB infection control to address TB transmission in health care settings (nosocomial infections). The
guidelines will be finalized and disseminated in FY 2009. In 2007, the U.S. Mission in Zambia also supported the GRZ to develop
a PICT training manual for Zambia and supported the MOH to train 500 front-line health-care workers in PICT across Zambia. In
FY 2008, the U.S. Mission in Zambia supported the MOH to train an additional 3,985 providers in PICT and included other
trainings linked to collaborative TB/HIV activities. PICT training increased the capacity of the Zambian health care system to scale
up the provision of routine counseling and testing for HIV for TB-infected clients.
In FY 2007 and FY 2008, the U.S. Mission in Zambia supported the MOH to strengthen the capacity of its national reference
laboratory, the Chest Disease Laboratory (CDL) and a regional TB reference laboratory to develop and enhance Zambia's
capacity to provide quality-assured TB microscopy and culture services. The regional TB reference laboratory has greatly
improved equity of access to quality-assured TB microscopy and culture services to the northern provinces of Zambia.
Before FY 2007, Zambia faced major challenges in collecting TB/HIV data because the TB data collecting and aggregating tools
(TB patient cards and TB patient registers) did not have a provision for entry of HIV data. In FY 2006, the U.S. Mission in Zambia
supported MOH revision of the TB patient card and TB patient register to include data on HIV. The U.S. support covered the
development, production, and distribution of patient cards and registers to provinces and districts. In FY 2007, the U.S. Mission in
Zambia supported MOH evaluation of its TB/HIV surveillance system in the Southern, Copperbelt and Lusaka provinces by
analyzing the quality of data captured through the TB/HIV data collection tools that had just been developed. The evaluation
demonstrated that the availability of revised patient cards and registers had enabled the NTP to collect better data on TB/HIV
activities in Zambia. In FY 2008 the U.S. Mission in Zambia provided direct support to the Ministry of Health National TB Program
to conduct the same evaluation in Lusaka, Western and Eastern provinces. In FY 2009, the U.S. Mission in Zambia will work with
the MOH to conduct similar activities in the remaining provinces.
In FY 2008, with U.S. support, the MOH conducted supervisory visits to support TB/HIV activities from central level to provincial
level and from provincial level to district level. The U.S. Mission in Zambia also strengthened the central level's capacity to
provide support supervision to the lower levels through direct support to the MOH for the hiring of a TB/HIV focal person.
Additionally, the U.S. Mission in Zambia and the MOH held quarterly TB/HIV data review meetings. The U.S. Mission in Zambia
also provided direct funding to four provinces to improve the human resource base, through supervision, training and employment
of additional staff as well as infrastructure, and space for VCT within the facilities. The remaining five provinces were supported
by the U.S. through TBCAP. With this support, the number of outlets providing TB/HIV services was 645, and the number of HIV-
infected clients attending HIV care/treatment services that received treatment for TB disease was 22,485. The U.S. Mission in
Zambia also provided direct funding to the NTP to support TB/HIV collaborative meetings at the national, provincial and district
levels. Additionally, the U.S. Mission in Zambia enhanced NTP's capacity to manage multi-drug resistant TB (MDR-TB) through
the development of guidelines, training, and provision of suitable infrastructure. In FY 2009, the U.S. Mission in Zambia will
continue to support the MOH in the management of MDR-TB.
The physical separation of TB and HIV services continues to be a big challenge in the implementation of TB/HIV activities in
Zambia. ART is often provided in ART-specific clinics, which are often far from TB service centers. Patients with TB/HIV co-
morbidity are in practice referred to ART service centers to be cascaded through evaluation for HIV services. There is great
potential for loss of patients to follow-up during the referral process. In order to reduce the burden on patients with TB/HIV co-
morbidity, the U.S. Mission in Zambia will continue to strengthen the link between TB and HIV services to ensure effective cross-
referral between the two services. Initiatives will include human capacity development in TB/HIV surveillance, use of reflex CD4
counts, and treatment of TB in ART centers for patients receiving treatment for both TB and HIV. Coordination and linkages
between the TB and ART clinics will further be strengthened to facilitate the screening of HIV positive patients for active
tuberculosis disease in ART clinics. In addition, health-care workers will continue to receive training in providing cotrimoxazole
prophylaxis to HIV-infected patients (in consistent with national guidelines).
In addition to direct grants to the GRZ, the U.S. Mission in Zambia supports several implementing partners to support TB/HIV
activities. These activities include: community awareness through development, production, and dissemination of TB/HIV
information, education, and communication materials; and commodity support, including procurement of rapid HIV test kits and
other laboratory supplies through the Supply Chain Management Services (SCMS) project, training, and supervision.
To strengthen the community response to the TB and TB/HIV program, in FY 2005, the U.S. Mission in Zambia and other partners
developed and printed 2000 copies of a facilitator's manual for training Community TB treatment supporters. The demand for this
manual was overwhelming. In FY 2008, the National TB/HIV Coordinating body revised the manual and developed a participant's
handbook.
In FY 2009, the U.S. Mission in Zambia will continue to support the Ministry of Health to strengthen TB/HIV integration, promote
the counseling of TB patients for HIV and the screening of HIV patients for TB. Working closely with the MOH, the TB/HIV
coordinating bodies at the different levels will be strengthened through the provision of technical support and through support for
meetings. The U.S. Mission in Zambia will cooperate with MOH on developing guidelines, providing technical supervision, and
supporting TB/HIV technical meetings and renovations of infrastructure in the TB and HIV settings. The MOH has no guidelines
on infrastructure renovation, however, partners work closely with the Provincial, District health offices and the Ministry of Works
and Supply to ensure that required standards for health facilities are met. In FY 2009, 832 U.S. sites will be caring for 24,212 HIV
infected clients that are receiving TB treatment, 30,413 TB patients receiving counseling and testing for HIV, and 3,188 health
care providers trained to provide care.
The above activities will continue to be implemented in a manner that ensures sustainability beyond PEPFAR support. The
strategies for sustainability include: human capacity development, stimulating community involvement and ownership of activities,
evoking political commitment through the involvement of managers at various levels, and devolution of decision-making to as near
as possible to where TB and HIV patients live, work and go to school. The U.S. Mission in Zambia will also promote the
integration of TB/HIV activities between U.S. Mission in Zambia and non-U.S. partners involved in the world of TB and HIV.
Table 3.3.12:
This activity relates to activities in counseling and testing, laboratory infrastructure, palliative care, and basic
health support activities.
The activity has been modified in the following:
1.Reduction of districts from seven to four in order to allow TBD to concentrate on three districts (Kalabo,
Lukulu, and Kaoma) while the rest will be supported by the WPHO
2.Refocusing from further training of health providers in TB/HIV collaborative activities to strengthening
community response activities
3.Focus on ensuring quality of TB microscopic services.
4.Construction of three laboratories in the three zonal health centers.
Western Province has an HIV prevalence of 13.1% and reported tuberculosis (TB) incidence rate of
327/100,000 in 2007 of all forms of TB. Outside the provincial capital of Mongu, which has an HIV
prevalence rate of 22%, access to health care facilities and services are limited. Many TB/HIV patients have
to travel 20-25 km to the nearest health facility. TB is still the leading cause of morbidity and mortality
among people living with HIV/AIDS.
In FY 2009, Western Provincial Health Office (WPHO) will allocate three (Kaoma, Kalabo, and Lukulu)
districts to TBD. The sharing of districts will allow for more resources for the WPHO which will be used to
support other critical areas in the provision of TB services among other activities such as construction of
laboratory facilities in three Zonal health centers. However the goals for both the WPHO and TBD will be to
increase access to TB/HIV collaborative activities by strengthening service outlets providing treatment for
TB to HIV-infected individuals, increase number of HIV-infected clients attending HIV care/treatment
services that are receiving treatment for TB disease, train health providers in Provider Initiated Testing and
Counseling (PICT) and increase the number of registered TB patients who receive HIV counseling, testing,
and receive results..
Scaling up of TB/HIV collaborative activity sites:
In FY 2006, the plan was to scale-up TB/HIV collaborative activities to 22 (15%) new sites from five (3%)
sites out of the existing 148 health facilities, and scale-up to 20 more new sites in FY 2007 which would
have resulted in 47 (32%) new sites. To this effect by the end of FY 2006 there were 77 (52.3%) sites
providing TB/HIV/STI collaborative activities. By the end of 2007, the number of sites increased to 87 (59%)
and increased by 27 sites by the end of FY 2008 making a total of 114 (77.5%) sites. In FY 2009, TBD will
take over the 42 sites from Kalabo, Kaoma, and Lukulu districts. The WPHO will remain with 72 sites.
For FY 2009, the WPHO will not open new sites but concentrate on technical support, mentoring, and
supervision to the existing sites in order to strengthen the quality of services.
Construction/ Infrastructure:
In FY 2006, two health facilities (Mitete and Muoyo) were renovated and extended using funds solicited by
CDC from CARIS Foundation. In FY 2007, Nalwei Health Center was renovated to provide space for VCT
and TB/HIV collaborative activities.
In FY 2008, four additional health facilities (in Mbanga, Mulobezi, Mutomena, Libonda, and Sihole) were
renovated and strengthened in the provision of TB/HIV collaborative activities.
In FY 2009, two district chest clinics (Sesheke and Senanga) will be renovated to address issues of TB
infection prevention. Infrastructure in the ART settings will also be improved in order to prevent TB
transmission. Further, three Laboratories will be constructed in zonal health centers with critical lab space
for TB microscopy and diagnosis. Three of the Zonal health centers (Mutomena, Mulobezi, and Itufa) have
no laboratory facilities. In FY 2009, WPHO will construct laboratory facilities to facilitate diagnosis and follow
up on treatment.
TB/HIV Patients /Clients:
In FY 2007, a total of 3,032 TB patients were notified in the province, out of which 2,256 (74%) were
screened and tested for HIV and collected their results. Of these, 1,249 were HIV positive (55%). Of HIV-
positives, 474 (38%) were put on HAART and only 252 (20%) received co-trimoxazole preventive therapy
(CPT). Very few TB patients received CPT because the guidelines were not available. Further, CD4 testing
is currently only carried out in district hospital laboratories and CPT is done in ART clinics.
In FY 2008, it was estimated that 3,000 TB patients were to be notified in the seven districts. The overall
notifications for the province have been showing a downward trend since 2003, hence the precaution in
intensified case finding. Due to limitations in counseling and testing facilities, it was estimated that 70%
(2,100) would have received counseling and testing. An estimated 55% HIV positive prevalence in TB
patients was expected and this would have resulted in 1,500 HIV infected individuals receiving treatment for
TB. These would be referred for appropriate HIV care including ART. TB screening of HIV infected patients
would be a key component of these activities for an estimated 1,500 (50%) people accessing HIV services.
According to the provincial TB quarterly data in 2008, by the end of June 2008 (2008 quarters 1 and 2), a
total of 1,438 new TB patients were notified, out of which 1,194 (83%) were counseled and tested for HIV
using PICT approaches; of these, 666 (56%) were HIV-positive. Of HIV-infected persons, 211 (32%) were
put on CPT and 290 (44%) on HAART. The main problem has been with data recording and reporting.
WPHO has resolved that the care providers in ART and TB clinics meet on a weekly basis to capture this
data.
A total of 2,076 TB cases were notified in FY 2007 in Mongu, Senanga, Sesheke, and Shangombo districts,
this was 68.5% of 3,032 total notifications of the province. In FY 2009, it is estimated that almost the same
notifications will be made and 1,868 (90%) of these patients will be counseled and tested, about 55%
(1,027) are expected to be sero-positive. These patients will need care and support at ART services.
Activity Narrative: .
There are no gender disparities in the provision and access to TB/HIV diagnosis and treatment in Zambia.
Human Resource:
In FY 2006, the program recruited and supported five staff in the following locations: WPHO (1), Chest clinic
at the Mongu Urban Health Center (HC) (1), Sikongo Health Center in Kalabo (1), and Luvuzi and Mitete
Health Centers in Lukulu (2). In FY 2007, WPHO continued supporting one counselor at Mongu Chest Clinic
and one at WPHO. This supportive activity will continue in 2008. In addition, six health providers (clinical
officers or nurses) will be recruited in five zonal health facilities (Mbanga, Mulobezi, Mutomena, Libonda,
and Sihole) to boost staffing levels.
In FY 2009 the human resource support will continue to the province as in FY 2008.
Training:
In FY 2006, 131 Health Care Workers (HCWs) were trained in TB/HIV activities including: 95 in provision of
PITC, 20 in DOTS provision; and 16 lab staff in AFB slide preparation and microscopy and HIV testing. In
FY 2007, an additional 240 HCWs were trained in TB/HIV collaborative activities including 50 HCWs from
HIV care and treatment sites in TB screening; 20 HCWs in DOTS provision; 120 community TB treatment
supporters and 50 in PICT. In FY 2008, 111 health providers were trained (45 in PICT, 20 in DOTs, 20 in
TB screening and 26 community supporters). As a result of these trainings, the services expanded to 27
new outlets. It is anticipated that 2,400 HIV-infected clients attending HIV care and treatment facilities
received TB screening, diagnosis and treatment.
In FY 2009, WPHO will concentrate on strengthening community partnerships by community capacity
building. Since 2004, the province has only trained 500 Community Based Volunteers (CBVs) as treatment
supporters some of whom have left the system.. It is expected that in FY 2009 140 CBVs will be trained as
TB treatment supporters.
In addition, 100 HCWs will be trained in the following areas: 20 HCWs located in ART, PMTCT, VCT sites in
TB/HIV collaborative activities; 20 HCWs in PICT provision; 30 in WHO TB modules; and 30 HCWs in TB
infection control.
Refresher course in TB/HIV collaborative activities:
In FY 2009, 30 health providers will be re-oriented in PICT and training will also include screening HIV
positive patients for TB disease.
Program monitoring:
In FY 2006 and FY 2007, supportive supervision was integrated into the PHO routine performance
assessment. In FY 2008, this supportive supervision was conducted quarterly to all the seven districts.
During the FY 2009, the WPHO will continue to provide the same support to the DHMTs to carry out
supportive supervision to health facilities quarterly in the four districts.
Logistics management training:
In FY 2008, in order to strengthen the availability and management of equipment, drugs and other supplies,
32 health providers will be trained in logistics management. In FY 2009 training in logistics management
will be conducted for about 30 additional health workers.
Pharmaco vigilance:
In FY 2008, in order to strengthen monitoring of adverse drug reactions, 32 health providers were trained in
pharmacovigilance. In FY 2009, WPHO will train an additional 21 staff at hospitals and health centers.
Infection prevention:
In FY 2008, WPHO renovated Mongu Urban Health Center chest clinic to provide an enabling environment
for TB infection control practices and oriented health providers. WPHO will work in partnership with
JHPIEGO to support training of staff in ART clinics and pilot the TB infection control guidelines in three ART
sites (Lewaninka, Sesheke, and Senanga hospitals).
Coordination and collaborative activities:
In FY 2007, one provincial and seven district coordination committees were established. In FY 2008,
support to the committees will continue giving strategic direction to the activities implementation.
In FY 2009, the province will concentrate on strengthening the provincial TB/HIV coordinating committee
and support the four district committees and a few health center committees.
Community sensitization:
In FY 2008, in order to increase community awareness on the TB/HIV collaborative activities quarterly
sensitization meetings were held in each district for sensitization of community gate keepers including
Chiefs, Indunas (Chief's Trustees), and headmasters. WPHO supported 14 drama groups (two in each
district) as well as developing IEC materials in the local language.
In FY 2009. the above activities will continue in the four districts supported by the WPHO.
To ensure sustainability of the program, the WPHO will ensure that the respective districts include TB/HIV
prevention and control activities at both district and community levels as priority areas in their annual plans
to ensure incorporation of activities in PHO and DHO services.
Targets set for this activity cover a period ending September 30, 2010.
Continuing Activity: 15557
15557 3791.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $400,000
9046 3791.07 HHS/Centers for Provincial Health 5025 3082.07 WPHO - 1 U2G $240,000
3791 3791.06 HHS/Centers for Provincial Health 3082 3082.06 Western $150,000
Disease Control & Office - Western Provincial
Prevention Province Health Office
Estimated amount of funding that is planned for Human Capacity Development $144,000
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
•Offer testing for children who accompany their parents to all counseling and testing (CT) sites.
•Build capacity of CT staff to integrate prevention for positives and negatives into CT as well as promote
couples CT.
•Engage in active community sensitization through working with local leadership on issues surrounding CT
such as stigma reduction, benefits of accessing services, availability of services and location, and couple
counseling.
•Actively play a coordination and capacity building role among other partners delivering CT in the province
to ensure equitable coverage.
•Ensure out of school youth are reached with CT and associated prevention messages.
This activity is related to WPHO partner supported activities under counseling and testing (CIDRZ
#19501.08, JHPIEGO # 4527.08 and AIDS Relief # 9713.08) as well as all direct CDC supported activities
in western province in prevention (# NEW MC WPHO, HVOP #9648.08), care and treatment for both adults
and children (HTXS #17817.08, PDTX # NEW), laboratory services (#9799.08) and strategic information
(#9696.08).
Western Province has HIV prevalence of 13.1% (Zambia Demographic Health Survey (ZDHS) 2002).
Institutional data (from hospitals and health centers) indicate that the prevalence of HIV among patients
varies from district to district with Kaoma being highest at 48 % and Kalabo lowest at 25 %. The Ministry of
Health through the Western Province Health Office (WPHO) would like to reduce the high prevailing
prevalence to as low as possible. The effort will be collectively achieved by working with other partners in
HIV prevention in sensitizing the people of western province about the importance of knowing their HIV
status and seeking timely treatment and other services. Further more, HIV CT is one of the entry points for
ART services and offers an opportunity to disseminate education information on prevention to individuals
and couples.
In FY 2009, the objective remains to increase the number of individuals counseled, tested, and receiving
their test results through improving access to CT. In order to achieve the above objectives the following
activities will be undertaken by the WPHO.
SCALLING-UP OF COUNSELLING AND TESTING SERVICE SITES
This will be an on going activity which was started in FY 2006. At the beginning of the program, there were
16 (10.8%) active sites out of 148 health facilities in the province providing CT services. During the FY
2006, WPHO opened an additional 16 new sites and reactivated 25 sites which were inactive. In 2007 the
WPHO continued to scale up to 19 more new sites. By the end of FY 2008 WPHO will have scaled up to an
additional eight new sites giving a total of 84 (56.8%) health facilities providing CT services.
In FY 2009 WPHO will increase the number of CT sites by 39 in an effort to cover all centers that have
trained health providers. This will result in 123 (83.1%) health facilities providing CT services. A number of
new sites will require renovation or minor construction to ensure that CT services operate within the national
accreditation criteria. In addition, WHPO will continue to strengthen the existing sites.
In line with the government Provider Initiated Testing and Counseling (PITC) policy, WPHO will reinforce the
policy by ensuring that all TB, STI patients and all clients including children accompanying their
parents/care takers to health facilities providing CT services are offered an opportunity to know their HIV
status through counseling and testing. All patients/clients including children who will test HIV positive will be
linked to ART services. WPHO will further support the districts to address the challenges related to stigma
and apathy on CT.
COUNSELLING, TESTING AND CARE
By the end of FY 2006 11,009 clients were counseled and tested and received their results. In 2007, the
number increased to 24, 076. During the FY 2008, WPHO will support counseling, testing and giving of
results to 8,400 giving a total of 43,485 clients counseled and tested.
Western province has a projected population of 955,297. Given the necessary and adequate resources
(human, financial, and infrastructure) WPHO would like to counsel and test at least 50% of the population.
In FY 2009, WPHO plans to counsel and test 14,000 clients including children which will result in 57, 485
(6.6%) individuals counseled and tested. This percentage falls far below the desired number individuals
that require counseling and testing. The number will be achieved by actively engaging the communities
through use of trained lay counselors in addition to counseling and testing in health facilities by trained
health providers. Use of lay counselors is in line with the Ministry of Health (MOH) policy of empowering lay
counselors to undertake counseling and testing which will also bring services as close as possible to
households.
WPHO will also focus on working with HIV positive clients in order to prevent transmission and re infection.
People living with HIV will also be given an opportunity to participate actively in prevention activities such as
drama and giving health education during traditional and church gatherings.
TRAINING
WHPO will support districts to ensure that the hospitals, health centers and other new sites are sustained
through training at both facility and community-level.
a) Training in Counseling, Testing and Care
In FY 2006, WPHO trained 59 health providers and 40 Classified Daily Employees (CDE's) and Community
Based Volunteers (CBV's) from the seven districts. By the end of FY 2007, an additional 50 health care
providers were trained in CTC (Lukulu (twenty) Kalabo (five) Sesheke (five) Senanga (two) Kaoma (one)
and Shangombo (one) giving a total of 109 health providers trained. Furthermore, 10 CDEs and 20
Activity Narrative: community based volunteers were trained giving a total of 70 CDEs and community volunteers trained.
By the end of 2008, WPHO trained an additional 20 health care providers, (Clinical Officers, Nurses and
Environmental Health Technicians) giving a total of 129 trained, using CDC funding. An extra 200
counselors were trained by other partners making a total of 329 (54.8%) health providers trained in CT out
of an estimated number of 600 health providers currently in the province. An additional 19 Lay Counselors
will be trained giving a total of 89. The number of counselors in the province could be higher given that
other components (TB- DCT and PMTCT) also train providers in counseling.
In FY 2009, WPHO will train 100 health providers surpassing the target of 55 resulting in a total of 429
(66.7%) of providers trained in CT in the province. The reason for increasing the number of trainees is to
address the gap (approximately 85%) in the number of individuals that require counseling and testing
against those that will be counseled and tested 57, 485 (6.6%) by the end of FY 2009. WPHO will also
train 100 community based volunteers to support both the 15 new sites and the existing sites (five/new site.
remaining 25 will from health centers where they will be critical staff shortage) resulting in 189 community
volunteers trained in CT. Global funds will complement the provincial CDC funds in training by supporting
training of 100 CBVs and CDEs while the health providers will be trained using USG funds.
b) Training for orientation and updates
WPHO will support districts to carry out refresher courses for health providers trained, community based
volunteers including CDEs trained in FY 2006, 2007 and 2008. WPHO will also continue providing updates.
c) Community training and sensitization - New
In FY 2009, WPHO will give awareness of available CT services a priority given that CT is an entry point for
encouraging individuals, couples, and communities in knowing their status thus facilitating timely access to
treatment and other related services. In addition, the WPHO will support districts to carry out CT
campaigns in high risk communities such as fishing camps, Mongu harbor, communities living around
border areas, and timber logging camps in the province including saw mills in Sesheke district. WPHO will
also develop activities for the radio programs which will be integrated with other components of the
cooperative agreement.
HUMAN RESOURCE
Support for human resources is on-going. In FY 2006 the WPHO recruited two counselors to mitigate the
impact of shortage of staff in the province (Luvuzi and Mitete health centers in Lukulu). The support for the
two counselors continued in FY 2007. However an additional counselor was recruited during the same
financial year for Sikongo rural health center in Kalabo district. During the FY 2008, WPHO did not recruit
any counselor but supported selected health centers where there is only one health provider through paying
of overtime allowances for 20 health providers.
In FY 2009, WPHO using the same criteria will continue paying over time allowances to selected health
centers. In addition, the WPHO plans to recruit three full time counselors for health centers serving
communities at high risk of HIV transmission. The identification of the three health centers will be guided by
the 2007 ZDHS findings.
MONITORING AND EVALUATION ACTIVITIES - New
With the current MOH policy in place that has allowed lay counselors to carry out HIV testing in addition to
counseling, there is need to have an effective system of capturing community data on counseling and
testing and ensuring quality of CT services. In FY 2009, WPHO is planning to develop data collection tools
that will facilitate capturing of community data that is not captured by the current national HMIS tool. With
all the counseling activities that the WPHO is planning to undertake including mobile CT, WPHO will
develop a quality assurance tool that will be used to support districts in ensuring that CT services at both
facility and community levels are of the desired quality. The WPHO will monitor CT services quarterly and
biannually during performance assessment. Districts will be supported to monitor the facilities monthly.
SUSTAINABILITY
respective districts and ensure that districts include CT activities in their annual plans. The WPHO's role
will therefore be providing technical support, mentoring, monitoring and evaluation. With the human
resource strategic plan of the MOH being implemented, there will be doubling of intakes and outputs from
the training institutions which will ultimately improve the availability of human resource in the province.
Further, assuming that the improved funding is sustained, infrastructure development will also improve
ultimately increasing access to CT services as well as providing space for more service provision in existing
Continuing Activity: 15558
15558 3792.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $100,000
9047 3792.07 HHS/Centers for Provincial Health 5025 3082.07 WPHO - 1 U2G $100,000
3792 3792.06 HHS/Centers for Provincial Health 3082 3082.06 Western $100,000
Table 3.3.14:
April '09 Reprogramming: Increase in funding by $150,000 bringing the new total to $400,000.
This activity is linked to Western Provincial Health Office, (WPHO) TB/HIV, ART, CT, PMTCT activities, and
Comforce (8996), Chest Diseases Laboratory (CDL #5510), Centers for Disease Control and Prevention -
Technical Assistance (CDC-TA #9022), EGPAF -CIDRZ (#16956), Supply Chain Management System
(SCMS #9524) and University Teaching Hospital (UTH #9042) Virology within the Laboratory section.
This activity will provide support directly to the Western Provincial Health Office (WPHO) for implementation
of a laboratory quality assurance (QA) program within the province. The goal of this activity is to build
capacity and sustainability at the local level by training and providing support for activities to be conducted
by local staff within the province for PMTCT, CT, ART, as well as care and treatment support. It will also
assist in the integration of the TB/HIV activities in the province.
Western province is a predominantly rural province with an HIV prevalence of 13.1%. It is estimated that
40% of the population are living more than 12 kilometers from the nearest healthcare facility therefore
limiting access to healthcare facilities and quality laboratory services. This has negatively impacted on the
provision of such services. The human resource constraints in Western province have also compounded
the difficulties in providing quality laboratory services.
At the end of fiscal year (FY) 2008, in collaboration with the Ministry of Health (MOH), PEPFAR partners,
Chest Diseases Laboratory (CDL), and CDC, WPHO expects to finalize the following activities: 1) scale-up
the TB smear microscopy services to 20 new sites; 2) renovate six more district hospital laboratories in
order to provide basic bacteriological investigations; 3) employ three laboratory technologist for Mangango,
Sichili, and Yuka Mission hospitals; 4) procurement and provision of service maintenance of equipment; 5)
support laboratory staff; and 6) conduct quarterly supervisory and technical support to all laboratory facilities
within the province.
In FY 2009, to continue to improve the quality of laboratory testing in Western Province, the WPHO will
coordinate closely with the MOH, UTH, CIDRZ, the provincial lab chief and CDC field officer, to conduct the
following activities;1) select appropriate trainees from the province to be trained as trainers for rapid HIV
testing organized by the MOH, UTH, CDC, and other partners; 2) Hiring of a QA/QC Provincial Laboratory
coordinator and additional laboratory staff 3) support coordination for the national QA and EQA programs,
with attendance at regular meetings for both HIV and TB and related laboratory topics; 4) support the
national HIV rapid test roll out program in Western province; 5) identify training sites, participants, dates,
and time; 6) liaise with the Zambian National Blood Transfusion Service (ZNBTS) for testing panels; 7)
Strengthen TB EQA activities at district levels using panels generated from CDL 8) support participant
transportation to training sites and training materials to ensure smooth, effective and efficient subsequent
roll-out in all sites in Western province; 9) support monitoring and evaluation of all sites through the
provincial lab manager, its staff, and technical support from CDC using the MOH standardized forms; 10)
procure laboratory equipment and supplies; 11) support attendances of laboratory staff for continued
training, conferences, and workshops; and 11) communicate with partners regularly to allow dissemination
of activity and improve collaboration to avoid duplication of activities and encourage feedback.
In addition, in FY 2009, the WPHO will assist the MOH, CDL, UTH, CIDRZ, and CDC with its national QA
activities in other laboratory testing including CD4. The WPHO will strengthen TB diagnostic capabilities
within the laboratory network in the province by supporting trainings for HIV/TB, EQA for acid fast bacilli
(AFB) smear microscopy, improving sensitivity of TB smear diagnosis by using LED microscopy, and
participating in the national QA for TB microscopy. WPHO will support specimens collection and
transportation; data collection, and report dissemination. The WPHO will work with SCMS for commodity
procurement to prevent stock out in its region. WPHO will also support training of ten people in TB
microscopy at Evelyn Hone College and employ a laboratory technologist for Sioma Mission Hospital, which
serves as a zonal centre providing a comprehensive package for TB, HIV and, Sexually Transmitted
Infections.
Finally, the WPHO provincial lab chief and CDC field officer will have regular meetings for updates,
assistance and to include information on target review, and finances for the CDC reports. The activities will
compliment and support the MOH national laboratory QA program to help build local capacity and
sustainability.
Continuing Activity: 15560
15560 9799.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $250,000
9799 9799.07 HHS/Centers for Provincial Health 5025 3082.07 WPHO - 1 U2G $250,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.16:
ACTIVITY UNCHANGED FROM FISCAL YEAR (FY) 2008.
This activity relates to: Ministry of Health (MOH) (#3713.08), and Centers for Disease Control and
Prevention (CDC) (#3714.08).
This activity relates to activities in Strategic Information to support the sites supported by the cooperative
agreement (CoAg) established with the Western Provincial Health Office (WPHO) to strategically collect and
use information in support of the TB and HIV response. This will assist the sites to respond appropriately
with sustainable, evidence-based information that will guide development, and cost-effective program
interventions.
Through the National Health Management Information System (HMIS), sites will be assisted to monitor
results, report results, analyze, and disseminate data with emphasis on routine evaluation of program areas.
The National HMIS was revised in 2007. Following the revision, WPHO rolled-out to all the health centers
within the province in December 2007. This was done simultaneously with the roll-out of SmartCare in
Western Province in April 2008. SmartCare complements the HMIS in that, other than its use to monitor
individual patient progress, it will generate antiretroviral therapy (ART), prevention of mother-to-child
transmission of HIV, and voluntary counseling and testing reports for programmatic monitoring and
evaluation. It is important to not that SmartCare provides the patient level basis on which the aggregate
HMIS relies for reporting. The two activities mentioned above are stated in FY 2008 and will continue in FY
2009.
In FY 2008 the WPHO planned to institutionalize healthcare information systems through provision of
technical support to existing staff and training of newly qualified staff. The Provincial Health Office provided
technical support to Districts on the use of the new HMIS tools and SmartCare. The PHO supported the
Districts to provide technical support to the health facilities. Support will be provided to all seven districts
and 148 health facilities.
WPHO will produce monthly, quarterly, and ad-hoc reports for programmatic monitoring. During FY 2009,
the PHO plans to support production of reports and analytical tools at all levels. The bulletin will reflect
statistics on activities under the CoAg during the FY 2009 period.
The PHO will conduct quarterly data review meetings where District Health Information Officers will attend.
The meetings will address issues of timely reporting, data quality checks, and data usage. Four quarterly
review meetings will be held during the funding period.
In FY 2009, the PHO plans to train 70 health workers in the revised HMIS tools and Smart care. In FY 2009
PHO will train an additional 70 health workers.
The activities for implementation in the FY 2009 will compliment the Ministry of Health activities in Western
Province and therefore be an integral part of the PHO and DHO activities.
WPHO under FY 2006 VSAT installed internet facility in four districts of the Province. The remaining three
districts have been included for VSAT installation in FY 2009. This will bring to a total of seven sites to be
supported by WPHO. In FY 2009 WPHO will provide technical support and pay for annual bandwidth costs
for the seven sites.
Continuing Activity: 15561
15561 9696.08 HHS/Centers for Provincial Health 7181 3082.08 WPHO - 1 U2G $100,000
9696 9696.07 HHS/Centers for Provincial Health 5025 3082.07 WPHO - 1 U2G $50,000
Table 3.3.17:
