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
08.P0210 PCI - Integration of Prevention into Palliative Care
This activity will strengthen the integration of prevention interventions and messages within the palliative
care and orphans and vulnerable children (OVC) programs they will support.
Through its work in OVC, Palliative Care, and ART Access & Adherence, the USG expects to begin 2008
with approximately 15-20 civil society organizations (CSO) partners. The ultimate aim is to strengthen the
capacity of all the partners to provide integrated services across all three areas. This will be a phased
process that will continue through 2008. Partners entering the program with palliative care strengths, for
example, will have been assisted in year one to strengthen the quality, range and reach of their work, while
beginning to incorporate OVC and ART access & adherence services. Conversely, partners entering the
program with OVC strengths will be assisted to build those strengths and incorporate palliative care and
ART access & adherence services.
The USG therefore does not expect to increase the absolute number of CSO partners in 2008, but rather
extend OVC capacity building and sub grants to an additional 5 CSOs within the 15-20 current partners. At
the same time, PEPFAR will assist CSO partners that received OVC support in year one to scale-up their
work in year two, through increased sub grants and technical assistance, and to improve their service
quality and linkages.
Part of the aim is integrated services, and to that end, the USG will also support appropriate integration of
primary prevention interventions and messages into those OVC and palliative care programs. In 2008,
PEPFAR will identify and adapt appropriate interventions and tools that could be successfully integrated into
the existing CSO partner programs they will support. Then PEPFAR will train two CSO program officers per
CSO, to deliver those interventions and follow up at the project sites to support implementation and assess
unexpected barriers or opportunities.
Funding for this activity comes from the AB (66%) and C/OP (33%) program areas. Young orphans and
vulnerable children will receive age-appropriate interventions and messages related to abstinence and
related life skills. Older vulnerable children, such as adolescents, and people living with HIV, many of whom
are sexually-active, will receive comprehensive HIV prevention interventions to reflect their age-appropriate
needs, including promotion of correct and consistent condom use and alcohol use risk reduction.
08.P0510 PCI - Integration of Prevention into Palliative Care
In this activity, Project Concern International (PCI) will strengthen the integration of prevention interventions
and messages within the palliative care and OVC programs they will support.
Through its work in OVC, Palliative Care, and ART Access & Adherence, PCI expects to begin the COP08
period (project year two) with approximately 15-20 Civil Society Organizations (CSO) partners. The ultimate
aim is to strengthen the capacity of all the partners to provide integrated services across all three areas.
This will be a phased process that will continue through y2008. Partners entering the program with
palliative care strengths, for example, will have been assisted in year one to strengthen the quality, range
and reach of their work, while beginning to incorporate OVC and ART access & adherence services.
Conversely, partners entering the program with OVC strengths will be assisted to build those strengths and
incorporate palliative care and ART access & adherence services.
PCI therefore does not expect to increase the absolute number of CSO partners in the 2008, but rather
the same time, PCI will assist CSO partners that received OVC support in year one to scale-up their work in
year two, through increased sub grants and technical assistance, and to improve their service quality and
linkages.
Part of PCI's aim is integrated services, and to that end, they will also support appropriate integration of
primary prevention interventions and messages into those OVC and palliative care programs. In 2008, PCI
will identify and adapt appropriate interventions and tools that could be successfully integrated into the
existing CSO partner programs they will support. Then PCI will train approximately 2 CSO program officers
per CSO, to deliver those interventions and follow up at the project sites to support implementation and
assess unexpected barriers or opportunities.
related life skills. Older vulnerable children, such as adolescents, and PLWHAs, many of whom are
sexually-active, will receive comprehensive HIV prevention interventions to reflect their age-appropriate
08.C0614: Project Concern International - Pediatric Palliative Care
The HIV/AIDS epidemic in Botswana is taking a toll on the capacity of the health and social welfare systems
to respond, and straining the capacity of extended families to care for infected/affected family members.
ART alone will not ensure the health and wellbeing of people living with HIV/AIDS (PLHA) and their families.
A comprehensive approach is needed emphasizing palliative care in the home and in the community,
including psychosocial support, treatment adherence support, positive living education and support, nutrition
support along with basic health care and referral. Coverage of comprehensive palliative care services is low
relative to the needs, tends to focus on adults rather than children, and tends to be geared towards end-of-
life care rather than promoting wellness.
Stronger linkages between CT, PMTCT, ART, and palliative care services that reach into the home are
needed, as are stronger partnerships between government health and social welfare services and CSOs.
CSOs are well placed to serve as a bridge between facility-based services and the communities and
households they serve. Yet the CSO sector in Botswana is young and needs significant capacity building to
play this role.
During the COP07 period (project year one), PCI expects to strengthen palliative care services through 8
CSOs in Francistown and Gaborone, and to train 40 individuals to provide palliative care, reaching 800
adults and/or children infected/affected by HIV.
Building upon the foundation established in 2007, PCI will continue and expand the provision of technical
and organizational capacity building services and sub grants to the initial 8 CSOs, and will extend palliative
care capacity building to an additional 11 organizations. PCI will also continue and expand its partnership
with BONASO, enabling BONASO to manage small grants and capacity building services for up to 4
partners. PCI in FY08 will support other local organizations that have previously been supported with USG
support.
Program objectives: 1) improved and expanded CSO delivery of palliative care services; 2) strengthened
capacity of local government agents (MOH, MLG) to deliver palliative care; 3) strengthened collaboration
and referral among government services and CSOs in the delivery of palliative care services; 4) improved
documentation and sharing of promising practices and lessons learned among CSOs and government
counterparts.
Partners: Through its work in OVC, Palliative Care, and ART Access & Adherence, PCI expects to begin
the COP08 period (project year two) with approximately 15-20 CSO partners. The ultimate aim is to
strengthen the capacity of all the partners to provide integrated services across all three areas. This will be
a phased process that will continue through the second year. Partners entering the program with palliative
care strengths will have been assisted in year one to strengthen the quality, range and reach of their
palliative care work, while beginning to incorporate ART access & adherence and OVC services.
Conversely, partners entering the program primarily with OVC strengths will be assisted to build those
strengths and incorporate palliative care and ART access & adherence services into their work.
PCI therefore does not expect to increase the absolute number of CSO partners in the second year, but
rather to extend palliative care capacity building and sub grants to an additional 5 CSOs within the 15-20
current partners. At the same time, PCI will assist CSO partners that received palliative care support in
year one to scale-up their activities in year two, through increased sub grants and technical assistance, and
to improve their service quality and linkages.
Capacity Building: During the first year, PCI will have identified specific technical and organizational
development (OD) needs among the CSO partners, as well as gaps in palliative care service delivery in the
project communities. This information will inform the design of specific technical and OD inputs to be
provided in year two. As in year one, capacity building is expected to balance technical and OD, and to
emphasize tailored, one-on-one mentoring and peer learning approaches, strategically combined with larger
group training activities.
Palliative care interventions to be strengthened include the full range of physical, psychological, social and
spiritual support activities needed by adults and children infected/affected by HIV/AIDS, guided by the
nationally-defined minimum essential package, and delivered collaboratively by government and CSO
agents from both health and social sectors. Palliative care service strengthening will emphasize tailored
approaches depending on the age, gender and life situation of clients.
The Family Care approach will continue to serve as the guiding framework for service delivery, focusing
interventions holistically on the family rather than singling out individual members based on which "target
group" they belong to. CSO partners will continue to be facilitated to develop project plans that emphasize
the family as the focal point for integrating palliative care, ART support, OVC, and other HIV/AIDS services.
PCI will continue to strengthen the capacity of CSO partners to utilize Participatory Learning for Action
(PLA) techniques, such as Journey of Life (REPSSI, 2006) or other context-appropriate methods identified
in year one, to change community attitudes, reduce stigma, and build community support and utilization of
HIV/AIDS services. Through PLA and other processes, PCI will continue to catalyze and strengthen
participation and resource mobilization from diverse public and private entities to strengthen palliative care
services, including commercial private sector.
Government partnership: Staff from district and community health centers, social workers, family welfare
educators, and government HBC volunteers, are considered key partners in this project. Support to
government may include inviting government personnel to attend CSO training activities; assistance with
rolling out new government-led training programs; assisting in the development/implementation of quality
standards for nationally-defined minimum packages of essential services; and other strategies to be
determined in consultation with government counterparts. Linkages between government and CSOs will
continue to focus on ensuring that all eligible families and children are registered and receiving all available
social welfare and health services, and that benefits such as food are being utilized appropriately
Documentation/Dissemination: In year one PCI expects to convene, with partner BONASO, a Learning
Forum to bring together CSOs, government and other key stakeholders to share promising practices in
delivering integrated palliative care, ART access & adherence, and OVC services. In year two PCI will
develop and disseminate case studies and other documentation of promising practices generated through
this event as well as through ongoing program M&E/documentation, and to find practical ways of sharing
such documentation locally as well as disseminating internationally.
Activity Narrative: 08.C0614: Project Concern International - Pediatric Palliative Care
08.C0811: Project Concern International - OVC
Children who are orphaned or otherwise made vulnerable by HIV/AIDS have benefited from government
services such as the food basket, support for school supplies, and free health care. However, needs such
as psychosocial support for children and succession planning are not being well met.
Barriers to children's access to education are also broader than school costs; a range of interventions are
needed with affected families to ensure that children stay in school over the long term. While the social
welfare system works to provide food support to the most needy children and adults, the number of children
in need in affected households is growing, stressing the capacity of this system.
ART coverage for adults is high (90%), with a relatively low treatment failure rate (4%, IRIN/AllAfrica.com, 6
June 2006); however treatment failure rates for children are significantly higher, estimated at 15% (verbal
estimate, ART Program Coordinator, May 8, 2007), suggesting a need for adherence support closer to the
home. There are no formal systems for follow up of children on treatment in the home after they leave the
hospital/clinic. Adherence among adolescents is also an emerging concern, as teenagers tend to have
compliance difficulties with medicines.
A comprehensive approach is needed which integrates ART access and adherence support with palliative
care and OVC support services. CSOs are well placed to serve as a bridge between facility-based services
and the communities and households they serve. The CSO sector in Botswana is young and needs
significant capacity building to play this role.
2008 Plans
Building upon the foundation established in the FY07 period, PCI will continue and expand the provision of
technical and organizational capacity building services and subgrants to the initial 10 CSOs, and will extend
OVC capacity building to an additional 5 organizations.
Program objectives: 1) improved and expanded CSO delivery of OVC services; 2) strengthened capacity of
local government agents (MOH, MLG) to deliver OVC services; 3) strengthened collaboration and referral
among government services and CSOs in the delivery of OVC services; 4) improved documentation and
sharing of promising practices and lessons learned among CSOs and government counterparts.
Partners: Through its work in OVC, Palliative Care, and ART, Access and Adherence, PCI expects to begin
the 2008 period (project year two) with approximately 15-20 CSO partners. The ultimate aim is to
a phased process that will continue through year two. Partners entering the program with palliative care
strengths, for example, will have been assisted in year one to strengthen the quality, range and reach of
their work, while beginning to incorporate OVC and ART access and adherence services. Conversely,
partners entering the program with OVC strengths will be assisted to build those strengths and incorporate
palliative care and ART access & adherence services.
rather extend OVC capacity building and sub grants to an additional 5 CSOs within the 15-20 current
partners. At the same time, PCI will assist CSO partners that received OVC support in year one to scale-up
their work in year two, through increased subgrants and technical assistance, and to improve their service
Technical service strengthening will continue to focus on ensuring the health, development, education,
protection, socialization, and emotional well being of children infected/affected by HIV/AIDS. Services will
continue to be tailored to the age of the child, with specific interventions for under-fives, primary school age
and pre-teen children, and for adolescents.
Volunteers will be trained to provide PSS tailored to the needs of children. Sensitization and skills building
with parents will help them understand the psychosocial needs of infected/affected children and what
parents can do to support children's well-being, while also taking care of their own well-being. Parents will
be educated about succession planning and assisted to develop wills and take actions to protect children's
inheritance rights, and ensure that children participate in decisions about who will become their guardians
after parental death. Local traditional leaders and other influential members of society will be sensitized
about women's and children's property rights. Birth registration will be promoted through collaborative
activities among CSOs, government agents, and other relevant stakeholders
Linkages between government and CSOs will continue to focus on ensuring that all eligible families and
children are registered and receiving all available social welfare and health services, and that benefits such
as food are being utilized appropriately.
08.T1106: PCI - Pediatric Uptake and Adherence
Botswana was the first country in Africa to roll out a national ART program, reaching 85% of those in need
through over 32 ART sites nationwide (WHO 2005). A relatively low treatment failure rate for adults,
approximately 4% (IRIN/AllAfrica.com, 6 June 2006), suggests that adherence has not been a major
problem for adults; however, among children treatment failure rates are estimated at 15% (verbal estimate,
ARV Program Coordinator, May 8, 2007), suggesting a need for adherence support closer to the home in
between scheduled hospital/clinic visits.
Adherence among children is complicated by their dependence on parents and guardians to bring them for
treatment and to care for them once on medications, parents who are themselves struggling with HIV
infection and its consequences. Palliative care programs are not equipped to focus on the distinct needs of
children on treatment, and there are no formal systems for follow up of children on treatment in the home
after they leave the hospital/clinic. Adherence among adolescents is also an emerging concern, as
teenagers tend to have compliance difficulties with medicines.
ART alone will not ensure the health and well-being of people living with HIV/AIDS (PLWHA) and their
families. A comprehensive approach is needed which integrates ART access & adherence support with
palliative care and OVC support services. CSOs are well placed to serve as a bridge between facility-based
services and the communities and households they serve. Yet the CSO sector in Botswana is young and
needs significant capacity building to play this role.
During the COP07 period (project year one), PCI expects to strengthen ART Access & Adherence services
through 8 CSOs in Francistown and Gaborone, and to directly train 80 individuals to provide ART access &
adherence services, reaching 300 adults and/or children infected/affected by HIV.
Proposed Activities
Building upon the foundation established in the COP07 period, PCI will continue and expand the provision
of technical and organizational capacity building services and sub grants to the initial 8 CSOs, and will
extend ART access & adherence capacity building to an additional 5 organizations.
Program objectives: 1) improved and expanded CSO delivery of ART access & adherence services; 2)
strengthened capacity of local government agents (MOH, MLG) to deliver ART access & adherence
services; 3) strengthened collaboration and referral among government services and CSOs in the delivery
of ART access & adherence services; 4) improved documentation and sharing of promising practices and
lessons learned among CSOs and government counterparts.
their work, while beginning to incorporate ART access & adherence and OVC services. Conversely,
palliative care and ART access & adherence services into their work.
rather extend ART access & adherence capacity building and sub grants to an additional 5 CSOs within the
15-20 current partners. At the same time, PCI will assist CSO partners that received ART access &
adherence support in year one to scale-up their work in year two, through increased sub grants and
technical assistance, and to improve their service quality and linkages.
Capacity Building: During the first year PCI will have identified specific technical and organizational
development (OD) needs among the CSO partners, as well as gaps in ART access & adherence service
delivery in the project communities. This information will inform the design of specific technical and OD
inputs to be provided in year two. As in year one, capacity building is expected to balance technical and
OD, and to emphasize tailored, one-on-one mentoring and peer learning approaches strategically combined
with larger group training activities.
ART access & adherence capacity-building will include continuing to strengthen referral partnerships and
collaboration among a broad array of government and CSO agents at multiple levels, who are critical to
facilitating the identification of HIV-infected individuals, in particular infants and children, linking them to
treatment services, and for ensuring optimal care and treatment adherence after they leave a treatment
facility. HBC caregivers will continue to be equipped to act as the "eye of the ART center" in the
community, not only to provide ART adherence support, but also to refer patients who miss clinic
appointments and those with severe side effects to health centers. In year one PCI will have explored the
feasibility of placing "Community Liaison Officers" in ART sites to strengthen the linkage between the clinic,
the client, and community CSO support services; if this approach is successful it will be scaled up in year
two.
Families and communities will be sensitized about the importance of early intervention with adults and
children, educated about testing and treatment, and motivated to take advantage of CT, PMTCT, ART, and
other services. Linkages with PMTCT services will include follow-up with parents of children on treatment,
and building treatment literacy and adherence support skills using a family care approach that enlists all
family members in monitoring and supporting treatment adherence.
ART clients will continue to be assisted to form Self-Help Groups (SHG) as a platform for providing
treatment literacy education, counseling, and ongoing support for adherence. SHG members will be trained
as peer educators, who will work in coordination with existing CSO outreach workers, to reach out to and
support new ART clients as well as PLHA that are not yet on ART.
Activity Narrative: interventions holistically on the family rather than singling out individual members based on which "target
group" they belong to. PCI will continue to strengthen the capacity of CSO partners to utilize Participatory
Learning for Action (PLA) techniques, such as Journey of Life (REPSSI, 2006) or other context-appropriate
methods identified in year one, to change community attitudes, reduce stigma, and build community support
and utilization of HIV/AIDS services. Through PLA and other processes, PCI will continue to catalyze and
strengthen participation and resource mobilization from diverse public and private entities to strengthen
ART access & adherence services, including commercial private sector.
social welfare and health services, and that benefits such as food are being utilized appropriately.
