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
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 18652
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18652 11691.08 U.S. Agency for Partnership for 8188 6003.08 USAID/PFSCM/ $500,000
International Supply Chain ARV Services
Development Management (clinical services
TA)
11691 11691.07 U.S. Agency for Partnership for 6003 6003.07 USAID/PFSCM $2,061,000
International Supply Chain S/ARV Services
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $174,909
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In spite of evidence of a sharp decline in HIV prevalence between 2001 and 2007, with a drop of approximately 1.8 percentage
points/year, Zimbabwe still ranks among the highest HIV burdened countries in the world, with an adult HIV prevalence of 15.6%.
About 1.1 million adults and 133,000 children are currently living with HIV and AIDS in Zimbabwe. Average life expectancy has
dropped in the past two decades by over 20 years, to 37 years in men and 34 years in women, largely due to HIV and AIDS.
As part of the national response to this burden, Zimbabwe's National ART Program, started in 2004, is designed as a
comprehensive care and treatment package of services that addresses medical, social, emotional, and economic needs of People
Living with HIV/AIDS (PLHA), and is a complement to prevention interventions. In 2005, the Government of Zimbabwe made a
deliberate effort to scale up pediatric HIV and AIDS care and treatment with the Clinton Foundation HIV/AIDS Initiative (CHAI)
support of 1,000 pediatric formulation based treatments offered for 2006. A national task force, comprising of members from the
Ministry of Health and Child Welfare (MOHCW), the PMTCT Partnership Forum, and the Pediatric Sub-Committee on HIV/AIDS
Care, developed the initial plans and drafted training materials for pediatric care that were pre-tested at 11 learning sites
designated to receive CHAI-purchased drugs. The MOHCW and the Pediatric Sub-Committee on Care, along with USG technical
staff and partners EGPAF and the University of Zimbabwe's Clinical Epidemiological Resource and Training Center's HIV/AIDS
Quality of Care Initiative (HAQOCI), collaboratively reviewed these training materials. USG technical assistance enabled the
MOHCW to complete the layout, design, and full production of the materials. This national training in pediatric care has been
conducted since early 2007.
Currently, 113 public health sites (primarily central, provincial, district and mission hospitals) offer ARV initiation or follow up
services, with 31 of them having specific OI/ART pediatric clinics. Out of an estimated 500,000 PLHA needing treatment, as of
September 2008, approximately 152,000 adults and children were on ART, including an estimated 10,000 in the private sector
and around 6,000 NGO supported. As of September 2008, 11,020 children were receiving ART. Among children aged 0-14 years,
there are an estimated 17,000 new infections annually and 12,000 AIDS-related deaths occurred in 2007. The Government of
Zimbabwe goal is to provide 230,000 PLHA with ART by the end of 2009 and 285,000 by the end of 2010, of which 70,000 will be
children.
Zimbabwe's palliative care package includes psychosocial support, nutritional counseling and support, positive prevention
counseling, information on positive living, treatment for opportunistic infections (OI), Cotrimoxazole prophylaxis, bereavement
counseling, spiritual counseling, succession planning, hospice care, and PLHA groups. Over the past several years, access to
and quality of both non-clinical and clinical palliative care services have improved significantly. Non-clinical community-based care
and support is provided through PLHA support groups, faith-based networks, NGOs, and numerous other organizations
throughout the country, under the guidance of the National AIDS Council (NAC).
The OI Clinic Model, developed by MOHCW with USG support, serves as the basis for comprehensive clinical HIV service
delivery and transition to the ART program. Currently, 366 OI clinics at MOHCW and mission hospital sites are operational, vastly
exceeding the national targets of 110 for 2008 and 140 for 2009. In FY08 these sites provided Cotrimoxazole for OI to 177,959
adults and 28,558 children. The Pfizer Diflucan donation program to Zimbabwe is now in its fifth year of operation, and between
June 2007 and January 2008 provided 24,904 patients Diflucan at 125 OI sites.
Recently, the Pediatric Sub-Committee for Care has piloted early infant diagnosis in three central hospitals around the country,
with CHAI support, and there are plans for roll out to other institutions for 2009.
Lack of financial resources, inadequate human resource capacity at all levels and inadequate laboratory services to support ART
and pre-ART patient monitoring have been the main factors limiting Zimbabwe's PLHA care and treatment program expansion.
Global Fund Round 1 (GF1) did not finance ARV drugs, and GF5 has encountered difficulties with disbursements. As described in
the HTXD ARV Drugs narrative, over the FY07-08 period the USG and other donors began providing ARV drugs. CHAI is the
main supplier for children's drugs, diagnostic tests, reagents for monitoring tests and therapeutic food for HIV positive
malnourished children.
Summary USG Program
USG's care and treatment program is of a scale appropriate to a mini-COP country and does not include widespread provision of
USG-direct clinical care and treatment services. USG continues to provide technical assistance (TA), advocacy, and program
support to the MOHCW and other partners to develop models and tools that can be replicated with non-USG leveraged funds to
strengthen systems for care and treatment of PLWHA. The USG also provides limited capacity building (primarily training and TA)
so that systems can be sustained over time.
In FY08, USG funds supported the MOHCW and the University of Zimbabwe's Clinical Epidemiological Resource and Training
Center's HIV/AIDS Quality of Care Initiative (HAQOCI) to provide pre- and in-service training in OI/ART pediatric management;
the bilateral Partnership Project for provision of non-clinical care and treatment of PLHA; the National AIDS Council (NAC) for
training and supervision to support the roll-out of the national Community Home-Based Care (CHBC) program; supporting the
MOHCW development of guidelines for pediatric testing and counseling and USG staffing and technical assistance within the
pediatric subcommittee for the new protocols on early infant diagnosis.
Also in FY08, USG provided final funding to a 2 year pilot project tracking mother-infant pairs who were cross-referred through an
integrated PMTCT / Expanded Program of Immunization effort. The pilot achieved impressive results which will be fed into on-
going PMTCT and follow-up care programs. This is a key step to catch up earlier infected children into the pediatric care and
support programs.
FY08 Social, Economic, and Political Context
Implementation of the USG PEPFAR program in Zimbabwe during FY08 was subject to a number of severe stresses. From
January to March, during the run-up to the March 29, 2008 general elections, the highly charged political atmosphere led to a
number of disruptions and hampered implementation. The situation was even worse from April - June. Widespread Government
sponsored violence effectively closed most rural areas in the country and many urban areas. Hundreds were killed and tens of
thousands were displaced. A number of USG-supported community outreach activities were either suspended to protect staff and
potential participants, or shifted to urban areas that required less travel and exposure. On June 4, the Government of Zimbabwe
suspended most NGO activity for almost 3 months, until August 29, setting back many programs. Throughout the year the
continuing collapse of the Zimbabwean economy and inflation that reached billions of percent put severe strains on programming
and local partners. In general, the unprecedented hyperinflation and eventual collapse of Zimbabwean currency; lack of public
utilities (water and electricity); widespread violence; and extreme political uncertainty created barriers to all programs.
USG Pediatric Care and Treatment Program and Prospects
In FY09, the USG will continue to support the MOHCW within the pediatric sphere through the MOHCW-led roll-out of the new
child counselling guidelines to the district level with the training of 150 health care workers. The USG will also support Training-of-
Trainers for 30 participants on early infant diagnosis as a key step to expanding these services to additional pediatric OI/ART
sites. USG will provide direct technical assistance (TA) to the MOHCW, including the Pediatric and Early Infant Diagnosis Sub-
committees, and will also support the national public laboratory systems to develop its capacity to perform early infant diagnosis.
All these activities are a contribution to Zimbabwe's national objective of providing support services to at least 80% of all children
under 15 years by the end of 2010, in the context of universal access, with the overall aim of improving child survival among HIV
infected and affected children by at least 50%.
To strengthen service delivery systems, the USG supports the MOHCW and HAQOCI for roll-out of the OI/ART pediatric clinical
model. As part of this work, HAQOCI is providing facilitative supervision to 4 large ART sites: Harare Central Hospital,
Parirenyatwa Hospital, and Beatrice Road Hospital in Harare and Mpilo Hospital in Bulawayo. Renovations to the Beatrice Road
Hospital for the pediatric clinic are ongoing and FY09 should see the initiation of child services in the renovated building. TB
services provided in this hospital should facilitate comprehensive HIV/TB care for children in the same place. Additionally, as
described under the Adult Care and Treatment program narrative, HAQOCI will continue its partnership with the Hospice
Association of Zimbabwe (HOSPAZ) to train individuals to provide palliative care. HAQOCI will include pediatric care within their
curriculum.
FY09 funding is also allocated to the management firm Ernst and Young for select technical assistance and audit, and to USG
agencies for technical expertise and staffing.
Wraparounds/Leveraging
Through development of models and support to leadership, the USG support to Pediatric Care and Treatment leverages
significant funding for all public sector ART, PMTCT, and HIV testing sites in the country. This includes commodities provided by
CHAI (1,636 patients - $4 million), Medecins Sans Frontieres and Swiss Foundation as well as private sector donations such as
Pfizer and Axios/Abbott.
Table 3.3.10:
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $4,058,889
In spite of evidence of a sharp decline in HIV prevalence between 2001 and 2007, Zimbabwe still ranks among the highest HIV
burdened countries in the world, with an adult HIV prevalence of 15.6%. About 1.1 million adults and 133,000 children are
currently living with HIV and AIDS in Zimbabwe. Average life expectancy has dropped in the past two decades by over 20 years,
to 37 years in men and 34 years in women, largely due to HIV and AIDS.
Living with HIV/AIDS (PLHA), and is a complement to prevention interventions. Currently, 113 public health sites (primarily
central, provincial, district and mission hospitals) offer ARV services. Out of an estimated 500,000 PLHA needing treatment, as of
and 6,000 NGO supported. As of September 2008, 11,020 children were receiving ART. Among children aged 0-14 years, there
are an estimated 17,000 new infections annually and 12,000 AIDS-related deaths occurred in 2007. All branches of the military
service have ART programs, including a model program in the Air Force, with access for all levels of personnel. The Government
of Zimbabwe goal is to provide 230,000 PLHA with ART by the end of 2009 and 285,000 by the end of 2010.
have been the main factors limiting ARV service expansion. Global Fund Round 1 (GF1) did not finance ARV drugs. The drugs
were instead to be purchased by the GOZ, supplemented by ad hoc supplies from donors. By late 2006, because of the rapidly
devaluing Zimbabwe dollar, the GOZ was having serious difficulties in purchasing ARV drugs to maintain patients who had been
started on ART. There was an imminent danger that 40,000 patients who had started on ART would have to discontinue because
of lack of drugs. USG collaborated closely with the GF CCM and OGAC and in mid-2007 received a commitment from OGAC to
provide ARV drugs for 40,000 existing patients for a three-year period, through 2010. The 4,500 patients in the GF1 focus districts
are among those covered. The first shipments arrived in early July 2007 and the 40,000 patients are assured of a continuous
supply of life-saving medicines for the near-term.
Zimbabwe's GF Round 5 (GF5) foresees supporting 54,000 patients (2008) and 74,000 patients (2009) in 22 districts on ARVs
and is regularly financing ARV drugs for those patients. However, GF5 disbursements have been slow due to problems with
Zimbabwe's exchange rate mechanisms and other financial management factors. In October 2008, a GF Inspector General Audit
was particularly damaging regarding GF procurement and accountability of ARVs. Zimbabwe's Expanded Support Program (SP)
foresees supporting 48,000 patients (2008) and plans to continue supporting the same number of patients in 2009. The ESP is led
by the British Department for International Development (DFID) and includes participation of Canadian, Swedish, and Irish aid
agencies. Thanks to the support from the three main donors (USG, GF, ESP), MOHCW targets will probably be achieved in 2008.
ESP and GF funding, however, is focused on specific districts, while USG is able to fill gaps nationally. Even with all these
resources, an estimated 20,000 PLWA who need ART will not have access. The USG's support for ARV drugs in Zimbabwe is
expected to remain essential to the national response through at least 2010.
USG Program Summary
The USG continues to undertake ARV procurement in order to "fill in the gaps" in the national ARV program. This approach is
consonant with the PEPFAR Zimbabwe Five Year Strategy. In addition technical assistance (TA) and training provided through
the Supply Chain Management Systems (SCMS) mechanism will significantly strengthen national ARV delivery systems and build
Zimbabwean capacity to continue the program when PEPFAR funding ceases.
potential participants, or shifted to urban areas that required less travel and exposure.
On June 4, the Government of Zimbabwe suspended most NGO activity for almost 3 months, until August 29, setting back many
programs. SCMS is not an NGO, and was able to continue providing vital ARVs throughout the country. In order to limit risks of
incidents around the run-off elections, however, SCMS completed HIV commodity deliveries prior to the last week of June and
resumed normal activities on July 7. During the final week of deliveries prior to the election, SCMS truck drivers were stopped on
several occasions and ordered to unload everything to prove they were not distributing food aid. In each instance, the delivery
vehicles were allowed to proceed with their delivery routes after the forced inspections.
Throughout the year the continuing collapse of the Zimbabwean economy and inflation that reached billions of percent put severe
strains on programming and local partners. In general, the unprecedented hyperinflation and eventual collapse of Zimbabwean
currency, lack of public utilities (water and electricity), widespread violence, and extreme political uncertainty created barriers to all
programs.
As of October 2008, hyperinflation and the coexistence of multiple exchange rates are increasingly complicating financial
operations for SCMS and local suppliers (and other USG partners), resulting in a rapidly degrading supply of products and
services. Unfavorable exchange rates have recently led to the postponement of key activities. For instance, the Logistic Support
Unit's support and supervision visits to ARV treatment sites could not take place in October due to cash challenges, and the
Harare city OI/ART training workshop had to be cancelled. In spite of these challenges, drugs are getting out and being accounted
for, and SCMS and the USG team are committed to keep ARV drugs available to PLWH for as long as conditions permit.
USG ARV Drug Program and Prospects
The USG commitment for ARV drugs is to provide first-line ARVs to support 40,000 patients from July 2007 through June 2010.
These patients are on the following regimens: (1) stavudine + lamivudine+ nevirapine; (2) stavudine + lamivudine + efavirenz; (3)
zidovudine + lamivudine + nevirapine; and (4) zidovudine + lamivudine + efavirenz.
In FY08, SCMS procured and distributed the following medicines: Lamivudine/Stavudine/Nevirapine 150/30/200mg for 37,000
patients on the standard first line regimen and 3,000 Lamivudine/Stavudine 150/30mg and Efavirenz 600mg for first line patients
with tuberculosis. SCMS also supplied an emergency shipment of 10,000 bottles of Zidovudine 300 mg, an alternative first line
drug, to help MOHCW preventing stock-out due to delay with shipments from other donors. These drugs are all FDA-
approved/tentatively-approved.
Project activities supported the MOHCW's national ART Programme, with a focus on scaling up ART, the national quality of care
initiative, and decentralization of ARV treatment.
For FY09, to quantify the number of drugs needed to support these patients, the following regimen breakdowns were used: (1)
stavudine + lamivudine+ nevirapine, 90.7% (2) stavudine + lamivudine + efavirenz, 3.7% (3) zidovudine + lamivudine +
nevirapine, 4.8%; (4) zidovudine + lamivudine + efavirenz, 0.8%. This regimen breakdown is based on the September 2008
Logistic Management Information System (LMIS) reports.
In FY09, SCMS will procure the following medicines: Lamivudine/Stavudine/Nevirapine 150/30/200mg for 38,000 patients on the
standard first line regimen and 2,000 Lamivudine/ Stavudine 150/30mg and Efavirenz 600mg for first line patients with
tuberculosis. These drugs will be FDA-approved/tentatively-approved generics, whenever possible and logical, and will be
procured at a cost of approximately $4 million per year. Any FDA-approved/tentatively approved generics that are not registered in
Zimbabwe can still be imported under a Section 75 waiver.
(Although the ARV logistic management and support is funded under the OHSS budget code, in accordance with COP Guidance
it is described in detail herein below.)
To assure efficient procurement, storage, and distribution of these drugs, the USG will continue to fund SCMS to provide ongoing
TA and resource support to the MOHCW AIDS & TB Logistics sub-unit, based at National Pharmaceutical Corporation
(NatPharm) which is the national drug warehouse. The eight current staff positions of the Logistics sub-unit are funded through
SCMS, as is the HIV/AIDS Logistics focal person based at the MOHCW Department of Pharmacy Services. The Logistics sub-unit
manages the supply chain for the national MOHCW ART program, which includes products supplied by the GOZ, USG, Global
Fund, the ESP, the Clinton HIV/AIDS Initiative (CHAI), European Union (EU) and other donors such as Direct Relief International
(DRI). SCMS and MOHCW colleagues utilize tools such as Quantimed and PipeLine to assist in supply chain management. The
AIDS & TB Logistics sub-unit, along with the Department of Pharmacy Services, chairs the Procurement and Logistics sub-
committee of the ART Partners Forum, one focus of which is donor and partner collaboration and communication. The sub-unit
has designed a new logistics system, which has been implemented since late 2007, through the development of standard
operating procedures, site trainings, and ongoing distribution.
SCMS through its support to the Logistics sub-unit (LSU) of the MOHCW AIDS & TB program provides support to the steps in the
procurement cycle as follows:
(1) Product Selection: The LSU provides review of national treatment guidelines, offers logistics considerations of choosing
products, and works to minimize pack size proliferation
(2) Quantification (Forecasting and Supply Planning): The LSU leads and manages quarterly updates of quantifications for ARV
drugs, HIV test kits, TB drugs, cotrimoxazole, and fluconazole. Adult ARV quantification is disaggregated per main donor group
(MOHCW including USG/SCMS, EU and Medecins du Monde; GF and ESP) in order to highlight donor specific issues, such as
under- and overstocking that were harder to identify in a national quantification and allow the LSU to discuss supply plan
adjustments with each particular donor.
(3) Procurement: The LSU prepares procurement plans for all USG funded products; assists other donors in the development of
their procurement plans; highlights any supply gaps and mobilizes resources to fill these gaps
(4) Warehousing: The LSU is based at NatPharm, where all MOHCW HIV & AIDS commodities are stored. In 2008, SCMS
performed an assessment of the physical infrastructure of NatPharm Harare warehouse for managing the vastly increased
quantities of HIV & AIDS commodities projected to transit through the warehouse in the next 3 years and managed to leverage
DFID/ESP and European Community Humanitarian Office (ECHO) funds for the implementation of the recommendation. In 2009,
SCMS will second a part-time project coordinator to NatPharm to assist with the purchase and installation of a full racking system
and mounting of a radiation heat barrier to preserve the quality of ARV medicines stored at the warehouse.
(5) Distribution: The LSU is supporting NatPharm with the national bi-monthly distribution of ARV drugs and OI drugs by providing
3 delivery trucks, fuel and maintenance, drivers, and per diem.
(6) Logistics Management Information System: Information generated by the LMIS managed by the LSU (patient data,
consumption, and stock on hand data) is used for informed decision-making. The LMIS was computerized at central level in 2008
and SCMS will continue to support operation and maintenance of the computerized LMIS in
(7) Capacity Building: The LSU has been trained in logistics, inventory management, and warehousing. In 2009, the LSU will
conduct system-specific trainings on logistics for ART sites as necessitated by addition of new sites and personnel attrition
In addition to funding for SCMS, FY09 funding is also provided for direct USG technical expertise and staffing.
SCMS provides technical assistance and support to the Logistics Sub-unit (LSU) that is responsible for managing the HIV/AIDS
commodities supply chain that serves all public sector ART, PMTCT, and HIV testing sites in the country. The LSU also
coordinates (but does not procure) the various sources of donor support for commodities, with a combined wraparound value of
about $25.3 million in FY2009, as follows: Global Fund (74,000 patients supported by the end of 2009 - $11 million); ESP (48,000
patients - $10 million); the European Union (3,000 patients - $300,000); CHAI (1,636 patients - $4 million), Medecins Sans
Frontieres and Medecins du Monde and private sector donations such as DRI, Pfizer and Axios/Abbott. (Note: The US dollar
values provided are estimates, based on actual shipments in 2008-2009, weighted by targets. Unit costs by patients should not be
compared since arrays of commodities supplied by each donor are not comparable.)
Table 3.3.15:
