Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8747
Country/Region: Botswana
Year: 2009
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: HHS/CDC
Total Funding: $3,134,332

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $650,000

09.P.PM02: URC - Health Care and Training



From COP08:

Botswana's national PMTCT program has 100% geographic coverage, and midwives, nurses, and

counselors nationwide are trained in PMTCT. Training activities focus on new providers, evolution in

program guidelines, and solving of existing problems and weaknesses.

In 2008 the Francois Xavier Bayroud (FXB) Center from the University of Dentistry and medicine of New

Jersey (UMDNJ) will provide assistance to the PMTCT unit with curriculum development and maintenance

and training of staff. The FXB Center will evaluate the use and usefulness of existing training materials,

create new training materials and clinician support tools where needed, and revise generic international

training tools to meet local needs. In 2008, this may include adaptation of the new WHO infant and young

child feeding course, revision of existing PMTCT training manuals to incorporate new guidelines, and

increase emphasis on follow-up of mothers and infants.

The FXB center will also help maintain the currency of knowledge and skills among PMTCT staff by

conducting two trainings for national program staff on new developments in the field of PMTCT or areas in

which staff feel they had inadequate training. Three PMTCT training of trainers (TOT) sessions will also be

held on new PMTCT guidelines.

Finally, the FXB center will facilitate linkages between the PMTCT Unit and other relevant PMTCT

departments such as the Food and Nutrition Unit and the Sexual and Reproductive Health Unit on PMTCT-

related activities such as infant feeding and family planning for HIV-positive women. The FXB Center will

plan and implement two coordination workshops for MOH departments on PMTCT-related planning, training

and program management.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17290

Continued Associated Activity Information

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

System ID System ID

17290 4469.08 HHS/Centers for University of 8745 8745.08 UTAP $500,000

Disease Control & Medicine and

Prevention Dentistry, New

Jersey - Francois-

Xavier Bagnoud


9819 4469.07 HHS/Centers for University of 5284 1047.07 UTAP $300,000

Disease Control & Medicine and

Prevention Dentistry, New

Jersey - Francois-

Xavier Bagnoud


4469 4469.06 HHS/Centers for University of 3359 1047.06 UTAP $480,000

Disease Control & Medicine and

Prevention Dentistry, New

Jersey - Francois-

Xavier Bagnoud


Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $475,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $237,332

09.P.AB18: URC - Prevention Impact Assessment

The CDC/BOTUSA Prevention team has identified Makgabaneng (MKG), as a program which has been

running for five years and undertaking reinforcement activities, community-based activities that reinforce

messages from the radio drama. URC will work with MKG to conduct an outcome evaluation and followed

by an impact evaluation at a later stage. URC will review tools used to reinforce behave change messages

and develop a video that on Intergenerational sex, this video will be used in schools and during listening

and discussion groups. We see a need to continue the support for MKG with lessons learned as it is a mass

media program and has a component of community out reach. The other implementing partner, URC will

also work with Population Services International (PSI) whose interventions addresses Multiple Concurrent

Partnership, an impact evaluation will be done URC will work with PSI to conduct process evaluation as part

of the review.

We look to URC to develop a proposal for completing the following tasks, which themselves are open to

discussion at this point:

1. Contract local consultants or an agency with health research background to work alongside URC in

carrying out the reviews, including working with a technical advisory committee.

a. Identify through tendering advertisements and work with technical assistance (TA) for cross checking.

b. Mentor agency and individuals, as appropriate to skill and experience levels.

c. Craft a clear scope of work for the sharing of responsibilities.

2. Develop a general protocol for each partner review, including tools that will improve the program and the

reinforcement activities, such as a video addressing intergenerational sex or flip charts to help the Listening

and Discussions Groups, as tools to support the Reinforcement activities.

3. Document review, interviews with beneficiaries, including the Ministry of Health (MOH) stakeholders and


4. Tailor the general protocol to each organization in the review accordingly with input from the

organizations, namely MKG, PSI and CDC.

5. Carry out all the reviews over the six months, if possible. They can be done in a staggered manner,

depending on availability of staff to work simultaneously

6. Produce a readable, accessible final report for each partner organization, describing findings and specific

recommendations for future steps both short and long term.

7. Participate in meetings to disseminate the results to the organizations and to CDC.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $375,000

09.P.OP19: URC - Alcohol Activity

Alcohol is a mood altering drug and it can influence high-risk sexual behaviors, which can lead to HIV

infection. Alcohol substance abuse can impair a person‘s judgment and may lead to behavior that is often

contrary to socially learned behavior, for example, uninhibited high-risk activities, such as unsafe sexual

practices. It induces changes in thinking, judgment, and behavior. Alcohol abuse has caused many traffic

accidents, incidents of violent behavior, and rape. For HIV-infected persons, it is thought to depress the

CD4 count and facilitate HIV replication.

Surveys have been done in Botswana that describe the drinking patterns here and data from a 2006

population-based study show that 31% of men and 17% of women met criteria for heavy drinking behaviors.

Many other African studies have looked at the association between alcohol use and HIV and 20 of them,

including one study from Botswana, which concluded that alcohol use was associated with HIV infection in

Africa and alcohol-related interventions might help reduce further expansion of the epidemic.

Another study conducted in Botswana suggested that those patients who drank alcohol during treatment

were 3.8 times more likely to interrupt treatment than those who did not drink. All of these conclusions are

troubling and speak to the need for a comprehensive response to alcohol use and its risks.

Proposed Strategy:

1. Support structural interventions to reduce hazardous drinking.

a. Assist the Government of Botswana (GOB) to develop a draft National Alcohol Policy, which should be

based on the World Health Organization's (WHO) Best Evidence Policies. The process should be facilitated

by a reputable consultant who is conversant with alcohol and its implications for public health and


b. Review current enforcement of Liquor Act (2004), identify gaps, and make recommendations to

strengthen those areas.

c. Conduct qualitative study to assist in developing behavior change interventions for the different age


d. Collect data from Botswana Epidemiology Network on Drug Use (BENDU) and SENDU on the

epidemiology of alcohol use.

2. Support networks of organizations working in alcohol risk reduction:

a. Expand and support existing interventions within the GOB and civil society, e.g., Botswana Network on

Ethics, Law, and HIV/AIDS (BONELA), Botswana Congress of Non-Governmental Organizations

(BOCONGO), faith- based organizations (FBO), and community coalitions and infuse messages of alcohol

risk reduction into existing programs.

b. Develop appropriate interventions that target the youth, aged 13-24 years, including vulnerable youths

and their guidance

3. Train Health Care Workers and all relevant professionals and organizations on issues alcohol as a drug,

alcohol as a risk factor for HIV transmission, and prevention and management of HIV in the context of

alcohol use and abuse:

a. Introduce Screening and Brief Interventions (SBI) or Brief Motivational Intervention (BMI) in primary

health care facilities, for example, Voluntary Counseling and Testing (VCT) centers, and Sexually

Transmitted Infections (STI), Anti-retroviral Therapy (ART, and Infectious Disease Care Clinic (IDCC)

clinics, and among support groups to identify high risk drinkers better. Train current counselors and peer

educators on links between alcohol abuse and HIV/AIDS.

b. Integrate alcohol screening at all points of entry to the health care system, e.g., clinical notes, emergency

visits, and antenatal care (

c. Look for incidence and prevalence of Fetal Alcohol Syndrome (FAS).

d. Document concomitant use of alcohol for all police cases and accidents/injuries in the workplace.

e. Create alcohol referrals and collaborate with all counseling facilities.

f. Support AA recovery programs which are free and have demonstrated success. Develop referrals, attend

their meetings to see how they work, and invite speakers.

g. Create, outside of AA, appropriate 12 Step Programs and train leaders. These groups can operate from

the clinical areas and local meeting places, for example.

h. Develop interventions for drinking venues, i.e., bars or shebeens, with the collaboration of the staff

servers, owners and the alcohol industry, including education and awareness programs, warning posters

and labels, condom negotiation, and other life skills.

i. Support and sponsor the SAHIV clinicians and the Botswana Medical Association to hold continuing

medical education (CME) courses to empower their members with the confidence and skills to consult on


4. Universal alcohol and HIV messages to raise awareness:

a. Develop interventions for drinking venues, i.e., bars or shebeens, with the collaboration of the staff

servers, owners and the alcohol industry, including education and awareness programs, warning posters

and labels, condom negotiation, and other life skills.

b. In primary schools, begin to educate and empower children in life skills and emotional intelligence, for

example, managing emotions, like anger, fear, and loss and taking responsibility for one's feelings and

consequent behavior). Teach about alcohol in drama and on the radio.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas


* Addressing male norms and behaviors

* Reducing violence and coercion

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety

Total Planned Funding for Program Budget Code: $1,745,593

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

In response to the challenges that HIV and AIDS present to Botswana, efforts continue to be made to diversify approaches, fine

tune technical support, and plan for future program sustainability with the support of the Presidents' Emergency Plan for AIDS

Relief (PEPFAR). The national HIV prevalence rate is 23.9% among adults ages 15 to 49, according to recent UNAIDS data, and

an estimated 300,000 are living with HIV/AIDS. About 53.2% of Batswana know their HIV status up from 25% in 2004, 95% of

pregnant mothers gaining that information through the Prevention of Mother to Child Transmission program. The Botswana 2007

Sentinel Survey indicated that HIV prevalence among pregnant women (15-49 years) is 33.7%, though the overall trend appears

to be decreasing from 37.4% in 2003. The Department of HIV/AIDS Prevention and Care reports that, as of the end of July 2008,

a total of 109,991 patients were receiving HAART, 97% of the 113,000 patients estimated to require treatment. Challenges

remain, however, with prevention, particularly the issue of multiple concurrent partnerships, alcohol abuse, nascent civil society,

and human capacity development.

Blood Safety

The National Blood Transfusion Services (NBTS) is responsible for the provision of a safe, adequate and accessible supply of

blood and blood products in Botswana. According to the World Health Organization (WHO) recommendations, a country such as

Botswana with a population of 1.7 million, requires a total 34,000 usable units of blood per year to be self-sufficient.

The President's Emergency Program for AIDS Relief (PEPFAR) Blood Safety project was implemented in September 2004,

covering seven key areas which ensure a safe and adequate blood supply and include infrastructure, blood collection, testing,

blood utilization, training, monitoring and evaluation, and sustainability. The Safe Blood for Africa Foundation (SBFA) provides

technical assistance to the NBTS of Botswana and the African Comprehensive HIV/AIDS Partnership (ACHAP) has contributed to

the Blood Safety Program by funding the Blood Safety and Youth HIV Prevention Project in 2003 and 2004, which it will continue

to support along with the additionally important Pledge 25 strategy. Supply Chain Management Systems (SCMS) procures test

kits, reagents and supplies for overall blood safety. SBFA, ACHAP and SCMS will continue to work with PEPFAR funding on

blood safety issues in FY2009.

Since the inception of the PEPFAR Blood safety project the NBTS has undergone significant transformation and implemented a

number of projects successfully, including:

- An increase in the annual blood collections from 13,210 units in 2004 to 22,230 units in 2007.

- A decrease in donations reactive for transfusion transmissible infections (TTIs) from 9.9% in 2004 to 4.4% in 2007.

- A decreasing in the HIV prevalence in donated blood from 5.7% in 2004 to 2.1% in 2007.

- The acquisition of equipment for all of the thirty (30) outlets which undertake blood transfusion activities.

- The revision of the draft of the Blood Policy.

- The training of 623 blood transfusion staff in different aspects of blood transfusion, specifically laboratory staff, nurses and

doctors, blood donor recruiters and other healthcare workers.

- The development of information, education and communication (IEC) materials on blood donation and related topics,

- The renovation of National Blood Transfusion center, which was completed in June 2008, and started operations in July, 2008.

The center houses both the blood collection center and the laboratories.

- The introduction of Hospital Transfusion Committees in 28 hospitals with 16 hospitals now having functional committees which

have formed the National Committee on Clinical Use of Blood and Blood Products.

In FY2009, PEPFAR will continue to support the seven focus areas with activities that include increasing the blood collection from

28,000 to 30,000, increasing the pool of regular blood donors and improving donor retention, reducing HIV prevalence in donated

blood from 1.6% to 1%, training 200 NBTS staff and other health providers, completing construction of the Regional Blood Center

in Francistown and a blood depot in Maun, continuing to pay salaries of 21 project staff, implementing the revised blood policy and

usage guidelines, improving quality management systems at NBTC and monitoring the implementation of the revised TTI testing

strategy. Monitoring and evaluation will continue to be an integral part of the blood safety project and the Botswana government

will implement a process that will allow sustainability.

Injection Safety

The exceedingly high prevalence of HIV in Botswana calls for a comprehensive prevention strategy that takes into account

medical transmission, despite the relatively small proportion of HIV infections resulting from this type of transmission.

Prior to the implementation of the injection safety project, there was no policy articulating clear safety procedures in the healthcare

settings. Rapid assessments conducted in 2004, found that none of healthcare workers had received any in-service training in

injection safety. The national annual prevalence of needle-stick injuries among healthcare workers was 26%, a potential risk for

occupational infections such as HIV, hepatitis B and C. A rapid assessment indicated that 23% of injections administered in the

facilities were unnecessary, used sharps were disposed of inappropriately in the majority of facilities and waste was poorly

segregated at the source. In most facilities, there were no logistic management information system tools to manage the injection

commodities or the drugs and no educational or behavior change messages communicating the importance of infection

prevention and injection safety.

With PEPFAR funding, Botswana started implementing injection safety interventions to promote the safety of healthcare workers,

patients, and the community in 2004. The project has been implemented through a collaborative approach with Ministry of Health

(MOH), implementing partners that include John Snow, Incorporated, and sub-contractors Academy for Educational Development

(AED) and Program for Appropriate Technology (PATH). The National Injection Safety Advisory Group (NISAG), a consortium of

medical, nursing and public health professionals that advise and guide the implementation of the project, has been actively

involved since its inception in November 2004. Currently, the injection safety is working in four health districts and with the

Botswana Defense Force Health Corps (BDF Health Corps). It is expected to scale up the interventions in ten additional districts

by September 2009.

To date, the Botswana Injection Safety Program has achieved the following:

- The development of a policy on injection safety with guidelines, service norms and standards that was submitted to Ministry of

Health for approval.

- Capacity building, training and support for infection prevention and injection safety, specifically, 4,723 healthcare workers

engaged in in-service and pre-service training in injection safety as of August 29, 2008 and 450 diabetic patients were trained to

manage used syringes and needles at home safely.

- Procurement, distribution and management of injection devices, including the successful completion of a study evaluating the

contribution of retractable syringes for reducing needle-stick injuries among healthcare workers. Botswana's primary task was to

ensure adequate and continuous availability of retractable syringes in the pilot districts. There will be adequate retractable

syringes in the pipeline for FY 2009, during which time the districts will have the commodities while MOH decides to scale-up its

use or terminate it.

- Implementation of sustained healthcare waste management, such that segregation of waste at the source has improved and

injuries sustained by waste handlers have been dramatically cut, according to the supervisory monitoring (February 2007).

Additionally, incinerator breakdowns have been minimized and protective clothing provided to workers in selected risk areas,

especially in hospitals.

- Development of an injection safety advocacy toolkit and behavior change messages, which have reached approximately

260,000 community members with injection safety messages through drama, brochures, posters and other media

communications, as of June 30, 2007. In preparation for scaling-up injection safety interventions, a multi-year advocacy and a

Behavior Change Communication (BCC) strategy has been developed.

- Promotion of healthcare worker safety through the national policy, guidelines and service norms and standards for injections

safety, which articulate measures that promote and advocate for institutional administrative procedures and improved healthcare

worker safety.


The Injection Safety Program in Botswana works closely with Supply Chain Management Systems (SCMS), Safe Blood for Africa,

the National Blood Transfusion Services in the Ministry of Health, the Nurses Association of Botswana, several academic

institutions, notably the University of Botswana and the Institute of Health Sciences, other government ministries, including the

Ministry of Local Government (MLG) and the Ministry of Environment, Wildlife and Tourism (MEWT) and the World health

Organization (WHO).


In FY2009, the Government of Botswana (GOB) will scale-up the injection safety interventions to reach 54% national coverage by

September 2009. In the districts into which it expands, the project plans to train 1,070 healthcare workers, disseminate and

implement the national policy, guidelines and service norms and standards, replicate good practices for the sustained

management of healthcare waste, manage injection device supply, and produce behavior change communication messages.

Male Circumcision

Three recent rigorously conducted clinical studies done in South Africa, Kenya and Uganda suggest that male circumcision (MC)

can reduce HIV infection by up to 60%. These and other studies have led WHO, UNAIDS, PEPFAR and others to encourage

greater access to MC in countries of Africa where the current rates of MC are low and HIV infection rates high, Botswana being

one of these countries. Although traditionally MC was a part of some of the local cultural groups' practices, with the coming of the

missionaries and the British Protectorate in the 19th century, access to MC was greatly reduced. It is estimated that now less than

20% of males in Botswana are circumcised. A recent study by local and international researchers suggests, however, that the

potential to expand MC access rapidly would be favorably received by the population, if services were provided in a medical


In November 2007, then-President Mogae, in the face of increasing evidence of the potentially important role for MC in HIV

prevention, supported the idea that this intervention be part of Botswana's new Prevention strategy. The MOH, with the assistance

of WHO and UNAIDS, developed a Safe Male Circumcision Strategy which aims at reaching 80% of the male population in the

next five years at a cost of around US$25,000,000.

PEPFAR support for MC to date has included support for a MOH/JHPIEGO MC needs assessment in FY2006; support to the

Botswana Harvard Project for studying approaches to infant circumcision in FY2008; funding to the BDF for a conference on MC

and other prevention approaches for the militaries in all African PEPFAR countries to be held early in FY2009; funding to

Populations Service International (PSI) for an MC communications strategy and program; and funding to the MOH through the

CDC Cooperative Agreement for MC training and services. Also, a Public Health Evaluation (PHE) focused on adult MC has been

developed and approval is pending. Additionally, the Botswana PEPFAR program will be requesting US$ 2.6 million in FY2009 to

continue many of the above mentioned activities, including the recruitment of a staff member to manage the growing PEPFAR

Botswana MC portfolio.

Table 3.3.04:

Funding for Care: Adult Care and Support (HBHC): $300,000

09.C.AC12: URC - Nurses Association of Botswana, Caring for the Caregivers Program

The Nurses Association of Botswana (NAB) aims to continue to intensify its Caring for the Caregivers

activities through the employment of a dedicated project officer. The project officer will be responsible for

the following activities:

1. The continued roll out of the support groups' establishment and training to cover all health facilities in the

country in close cooperation with the relevant stakeholders in the Ministry of Health (MOH).

2. The monitoring and evaluation of the support groups' activities.

3. The determination the extent and impact of previous Nurses Association of Botswana (NAB) -Caring for

the Caregivers (CFC) activities, such as the publication of the various manuals and workshops.

4. The implementation of a research project on the impact of HIV/AIDS on the nursing profession.

5. The continuation of the current CFC projects, as well as the development and initiation of further CFC

activities, for example, the establishment of a pilot wellness center.

The purpose of the support groups for health workers is to provide and receive emotional, spiritual, social

and practical support from each other in health and professional related issues with emphasis on, though

not limited to, HIV/AIDS. Nurses and other health workers will be trained in how to organize and run support

groups, after which they will be assisted to establish support groups at their facilities and in their health

regions. The project will be implemented in close cooperation with the Wellness Program in the MOH. The

aim is for all health facilities to have sustainable support groups up and running, using guidelines and

training materials that have already been developed.

It is important to understand the extent and impact of previous CFC activities in terms of whether or not all

nurses have been reached, how nurses have directly benefited from these activities, and what other

activities nurses would like to see in place. This would go hand in hand with a research project, which aims

to determine the impact of the HIV/AIDS epidemic on the professional lives of nurses. An initial research

proposal has been drafted to this effect.

The Nurses Association of Botswana (NAB) aims to establish a Wellness Center of Excellence for Health

Workers. The purpose of such centers is to attend to the health and well being of health workers, to provide

professional development, and to establish a forum to address health issues and other concerns of the

health workers. It will deliver health and other professional services to all health workers and will serve as a

model of good practice. Through the provision of comprehensive, confidential health services to the health

workers outside of their workplace, the Nurses Association of Botswana (NAB) intends to sustain a healthy,

motivated and productive health work force. Services at the center would include testing, counseling and

treatment for HIV/AIDS and TB, antenatal services, PMTCT, stress management, Post-exposure

Prophylaxis (PEP), and screening, among other things. The center would also be a resource/ knowledge

center for continuous professional development. As has been suggested by research, nurses and other

health workers in Botswana are affected by HIV and AIDS at the same devastating rate as the general

population, but have the additional burden of care and treatment of the sick often in difficult working

conditions. The Wellness Center aims to address the issues of the health workers, who are increasingly

over-stressed, under-valued and often at risk for infection.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $280,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.08:

Funding for Care: Pediatric Care and Support (PDCS): $150,000

09.C.PC04: URC - Psychosocial & Home Visit Support to OVC

Catholic Relief Services (CRS) is implementing a multi-country PEPFAR Track 1 Orphan and Vulnerable

Children (OVC) program in Botswana in partnership with the Vicariate of Francistown (VoF).

The CRS-VoF project aims to provide as complete and holistic a package of OVC care and support services

as possible, by integrating activities and interventions across the PEPFAR domains of palliative care. This

project will directly provide Psychological Care in the form of psychosocial support (PSS) to OVCs and

guardians, Spiritual Care as part of home visits by trained community volunteers augmented by pastoral

visits, Social Care comprising several forms of prevention activities including OVC peer support groups

(PSGs) and broad based community sensitization, as well as assuring links to Government of Botswana

(GOB)-provided social services, food and education resources. Facilitating pre-school attendance is a

cornerstone of this project and will go a long way to reducing stigma against OVCs by integrating the

community's children in such a setting, while also serving as an entry point for PSS. The project will

indirectly provide Clinical Care by linking to the local health center in each project site for non-HIV health

care and its home based care (HBC) outreach service for HIV-related care and support.

Home visits lie at the heart of Palliative care programming. Regular home visits allow the project to provide

quality, holistic support to the OVC household and may include, for example, screening for health care

needs and appropriate clinical referrals, PSS, nutrition education or counseling. Depending on the

household situation, more extensive support may be needed for succession planning, will writing, and

understanding bereavement processes, which will augment guardian training. OVC home visits require the

identification and recruitment of respected, committed adult volunteers.

Given Botswana's extremely high HIV prevalence rate, and the GOB's commitment to provide anti-retroviral

therapy (ART) to its citizens, adherence to ART is an important issue, especially in the more distant areas.

Home visits are an ideal mechanism for identifying gaps in adherence support among people living with HIV

and AIDS (PLWHA). Especially where Home Based Care (HBC) for PLWHA is located in the same areas

with this OVC project, the OVC home visit volunteers can assure child and/or guardian referrals to HBC

providers and the clinics with which they are associated to assure adherence support.

Other emphasis areas will be HIV Prevention activities and nutrition education. The project will link to local

health centers and other reputable providers for voluntary counseling and testing (VCT) services, targeting

Tebelopele or local VCT providers. The project maintains monthly progress reports on all children attending

pre-school. This strategy provides an extra set of caring eyes for detecting any deterioration in nutritional

status. Since the Social and Community Development (S&CD) monthly food basket isn't available to all

OVC households who need it, its contents are not necessarily the highest nutritional quality, and rations are

pegged only to the registered OVC and not the entire household, the potential exists for poor nutritional

status among the three to seven year olds. The project will train the community volunteer caregivers to

provide nutrition education to the OVC households they visit, as well as to identify visually nutritional

problems present in the household. The project will utilize trainers from S&CD and district level nutritionists,

including the Nutrition Rehabilitation Project at Nyangabgwe Hospital in Francistown. The OVC project staff

will also facilitate referral links between communities, local hospitals and the Nutrition Rehabilitation facility

in Nyangabgwe Hospital.

The northern districts of Botswana vary as to risk levels for malaria. While the S&CD provides insecticide

treated bed nets (ITN) to registered OVC, a significant gap exists in terms of OVC registration. The project

will provide ITNs to its enrolled OVC households who cannot yet access them from S&CD.

The project will put great emphasis on setting up sustainable structures, such as Parish OVC Leadership

Committees and Community OVC Committees. Each parish in the project area will convene a committee

comprised of, for example, the parish priest, the local Chief, representatives from various churches, the

police, the Village Development Committee (VDC), the local clinic, Positive Living Groups, women's groups,

S&CD, and school headmasters. This Parish Committee might meet quarterly to determine its own

involvement in the oversight of the OVC project activities and outcomes. Such a committee will follow in the

project's founding principle of community participation, but would also build more structure into the OVC

project, which will assist in building sustainability. The Parish Committee will also serve as a model of

program integration, since it will comprise a cross-section of the community, including both civil society and

government representatives. Also, a Community OVC Committee will be formed in each ward in the project

area, which will serve as the unit of project intervention. This committee should include local leaders who

can be galvanizing forces in the support of OVC in their midst and assist with open and transparent

identification of those OVC most in need. Appropriate training will be provided, especially at the community

level, on group or organizational management to best insure low-stress committee participation and the

most effective building of community ownership of OVC care and support. The relationship between the

trained volunteer caregivers, the Community Committees, the Parish Committees and the project site staff

will need to be developed during FY2009. Ideally, the two levels of committees will determine their Terms

of Reference with project site staff.

While community awareness and sensitization efforts are well used strategies already in the project, there

will be a scaling up of such activities in FY2009, with a multi-sectoral emphasis.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000

Economic Strengthening


Estimated amount of funding that is planned for Education $30,000


Table 3.3.10:

Funding for Care: TB/HIV (HVTB): $245,000

09.C.TB17: URC - Strengthening Management of MDR TB and Cross Border Control

Supporting Multi-Drug Resistant (MDR)/Extensively Drug Resistant (XDR) and Infection Control at the

District and Facility Levels:

University Research Corporation, LLC (URC) is working with the Centers for Disease Control and

Prevention (CDC) to improve the quality of HIV/AIDS services in Botswana under a recently awarded grant.

URC has gained substantial expertise in the Southern African countries in strategies to improve TB,

including MDR/XDR prevention and control activities. Based on the lessons learned in the region, URC is

proposing to work closely with the Botswana National TB Program (BNTP) to strengthen MDR/XDR

prevention and control activities at the district and facility levels. URC proposes to cover three districts with

implementation of TB, TB/HIV and MDR/XDR initiatives. URC staff will help facilities identify programmatic

gaps for TB prevention and control and develop effective strategies for overcoming the same.

Strengthening national and district level response for preventing and controlling MDR/XDR TB:

URC will work with BNTP to strengthen the capacity at national and district levels to manage prevention and

control of MDR and XDR TB. Assistance will be provided to the BNTP to ensure proper training of staff to

diagnose and treat MDR TB appropriately, help the facilities to control primary transmission of MDR/XDR,

and implement initiatives to reduce development of resistance among TB patients treated with first and

second line drugs. Key activities will include the dissemination and implementation of MDR TB monitoring

tools by training healthcare workers and information officers on the use of the tools and by training medical

officers and nurses on clinical management of MDR TB.

Enhancing Implementation of Infection Control Policies and Guidelines:

Facilities will be assisted to conduct infection control risk assessments and to develop and implement

infection control plans. Technical assistance will be provided to districts and facilities in implementing TB

infection control strategies.

Strengthening Surveillance of MDR/XDR-TB:

URC will work with BNTP and local partners to improve and expand the surveillance of MDR/XDR-TB.

Assistance will be provided to design a simple framework to collect and analyze data on MDR/XDR patients

in each district. In addition, mechanisms will be developed and implemented for contact tracing of MDR

patients to minimize risk of nosocomial transmission.

Addressing cross-border issues related to the management of Drug Resistant TB:

URC will work with the BNTP and other PEPFAR funded partners to strengthen referral systems to

minimize spread of MDR TB to neighboring countries and to ensure continuous access to treatment and

laboratory services for migrant workers returning home after the diagnosis of MDR TB. Referral forms will

be developed.

Supporting Advocacy, Social Mobilization and Communication for MDR/XDR TB:

URC will help BNTP to increase awareness about MDR-TB through public education and social


New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* TB

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $245,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Program Budget Code: 13 - HKID Care: OVC

Total Planned Funding for Program Budget Code: $7,269,814

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

In response to the challenges that HIV and AIDS present to Botswana, efforts continue to be made to diversify approaches, fine

tune technical support, and plan for future program sustainability with the support of the Presidents' Emergency Plan for AIDS

Relief (PEPFAR). The national HIV prevalence rate is 23.9% among adults ages 15 to 49, according to recent UNAIDS data, and

an estimated 300,000 are living with HIV/AIDS. About 53.2% of Batswana know their HIV status up from 25% in 2004, 95% of

pregnant mothers gaining that information through the Prevention of Mother to Child Transmission program. The Botswana 2007

Sentinel Survey indicated that HIV prevalence among pregnant women (15-49 years) is 33.7%, though the overall trend appears

to be decreasing from 37.4% in 2003. The Department of HIV/AIDS Prevention and Care reports that, as of the end of July 2008,

a total of 109,991 patients were receiving HAART, 97% of the 113,000 patients estimated to require treatment. Challenges

remain, however, with prevention, particularly the issue of multiple concurrent partnerships, alcohol abuse, nascent civil society,

and human capacity development.

HIV/AIDS continues to debilitate many communities and families in Botswana. According to the Botswana National Situational

Analysis (NSA), the country is home to more than 130,000 orphans and vulnerable children (OVC). According to the UNAIDS, the

numbers of orphans will continue to rise even as rates of new infections level off and mortality rates will not plateau until 2020,

because of the unusually long incubation period of HIV, and as a result, the numbers of orphans will continue to increase for

several decades. UNICEF estimates that sub-Saharan Africa, especially Botswana, Malawi, Zambia and Zimbabwe will have the

highest proportions of orphans during this period. PEPFAR support serves this marginalized social group - children orphaned or

made vulnerable by HIV/AIDS - and bolsters their access to services, respect for their rights, identity and inheritance, tolerance

and inclusion, and education and health care.

The 2007 NSA, using the definition that an orphan is a child below 18 years who has lost one parent, when single, or both, if

married, either biological or adoptive, reported a prevalence rate of 6.5% or 51,806 children, and 3.1% of children had lost both

parents. The international definition, according to UNAIDS, states that an orphan is ‘a child below the age of 18 who has lost one

or both parents,' and using this, the prevalence of orphans is 17.2% (137,805. The 2001 Population and Housing Census Report

in Botswana indicated that there were 111, 828 orphans which included maternal, paternal and double orphans, similar to the

UNAIDS definition, out of a population of 737, 241 children or about 15%, which is slightly lower than the USAIDS rate, suggesting

that the number of OVC may be increasing. Children in Botswana are orphaned for the following reasons: 34% due to AIDS, 35%

due to chronic diseases, 25% due to accidents, and about 7% due to death of the mother during child birth.

The GOB provides care and support to orphans through the Short Term Plan of Action (STPA), launched in 1999 by the

Department of Social Services (DSS) under the Ministry of Local Government (MLG). The STPA serves as the normative

framework for responding to the immediate needs of orphans and has reached virtually all eligible registered orphans (50,000)

with key emergency services, a commendable accomplishment. It highlights the political will, leadership and management, and

financial commitment Botswana has made towards addressing the impact of HIV/AIDS on children.

Through the President's Emergency Program for AIDS Relief (PEPFAR) support both the GOB and the Civil Society

Organizations (CSO) have extended the scope of their combined efforts to address HIV and AIDS far beyond what either one

could have achieved individually. Collectively, they have leveraged their strengths to implement and deliver services more

effectively to OVC. Services that include: providing and ensuring OVC access to psychological and/or emotional care counseling,

education, including vocational skills training, nutritional support, succession planning; giving access to legal aid, including

protection from all forms of abuse including child labor and property grabbing; and assisting with access to health care, treatment

for HIV/AIDS-infected OVC, and shelter and related family care.

Major program accomplishments for FY2007 and FY2008 include the completion of the NSA, development of National OVC

Guidelines, Psycho-Social Support (PSS) National Training Manual, National Monitoring and Evaluation (M&E) Framework for

OVC, creation of linkages among OVC partners and government, and increasing the number of OVC benefiting from United

States Government (USG) support. In FY2009, it is expected that at least 30,000 OVC will be reached directly with services

through a mix of strategies, such as supporting activities within a geographic focus to attain higher coverage, investing in priority

sectors like social services, education and health, and making grants available to non-governmental organizations (NGO),

community-based organizations (CBO), and faith-based organizations (FBO).

The PEPFAR-supported partners and activities complement the GOB's efforts and strategies in implementing a truly

comprehensive national response to the HIV/AIDS epidemic by extending services to OVC who are almost always overlooked as

a result of programs attempting to cater for the more visible face of the disease - the adults living with HIV/AIDS. Additionally,

PEPFAR activities address gaps in OVC programming identified by the GOB and the 2007 NSA, which include PSS, improving

livelihoods, pre-school education, birth registration, and support and care in marginalized communities.

In FY2007 and FY2008, about 25,000 caregivers were trained to care for OVC on issues of PSS, child protection, and health care,

including anti-retroviral therapy (ART) adherence for infected OVC. In FY2009, 8,160 caregivers will be trained, a reduced

number due to the large pool of caregivers already trained. Follow-up activities will be initiated to assess the changes in OVC

services as a result of the trainings

Since 2005, the Marang Child Care Network has worked closely with DSS on policy issues as well as expanding its partner base

to 60 CBOs/NGOs/FBOs reaching over 10,000 OVC indirectly. Marang's work has gained recognition from the GOB such that

they have signed a Memorandum of Understanding with the network. One notable achievement is how Marang has managed

leverage PEPFAR resources to receive funds from the GOB. In a bid to expand the reach and strengthen the quality of service

provided by Marang, 24 member organizations will be assessed and given grants to provide comprehensive services to OVC at

the village level. The members will be selected on the basis of their geographical spread, program capacity and diversity to

include those working with OVC with special needs or disabilities

Despite the achievements made thus far, there still exists great potential capacity in communities to respond to the needs and

challenges of OVC. The major and most immediate challenge is scaling up successful community-based responses to match the

magnitude and extent of the HIV/AIDS epidemic. In that regard, capacity building efforts will be supported not as an end in

themselves, but as means to an end, the strategy being two-fold: capacity building on the one hand and service delivery on the


In FY2009, the USG support will continue to strengthen and scale-up the FY2007 and FY2008 activities by facilitating expansion

of OVC services and organizations working locally to address HIV/AIDS-related challenges, providing financial, material and

technical resources to organizations serving OVC, enabling them to better coordinate efforts and provide additional services, and

supporting the sharing of effective practices among stakeholders at all levels. They will build capacity, not as an end, but as a

means to improved service provision by investing in human resource development in technical and management support,

program design and implementation, mentoring and apprenticeships, logistical and equipment, and monitoring and evaluation.

Additionally, gender issues will be mainstreamed to ensure equal opportunities and access to basic services to reduce the

persistent and increasing burden of orphan hood and vulnerability in both boys and girls, and the discrimination against and

violation of the rights of the girl child.

Targeted interventions by the implementing partners resulting from the 2007 NSA, will increase access to birth registration,

education, adequate food, basic health services (including HIV services if appropriate), nutrition, PSS, succession planning, and

legal assistance. These interventions aim to improve income in affected households, build advocacy around inclusion and stigma

reduction, and catalyze public-private partnerships, which ultimately will be critical to expanding the resources available to

sustaining provision of the above services. Caregivers and guardians will benefit from training on the care of OVC. Parents and

Guardians, in particular those infected with HIV/AIDS, will be supported in writing wills and developing memory books.

In FY2009, the Ministry of Health (MOH) and the Ministry of Education (MOE) will each continue their particular roles in the

addressing OVC issues, including training caregivers and CSOs in the care of infected children, malnourished children, and other

childhood illnesses related to HIV/AIDS and ensuring access to education, specifically scaling up the Circles of Support program

to enroll and retain OVC in schools and train teachers in PSS.

In FY2009, DSS will implement the Community Carers Model (CCM) and Family Care Model (FCM) to assist families who have

little or no means of supporting the OVC and to ensure that all members of families with OVC are empowered and have their

needs addressed, respectively. Currently, the government provides basic needs to OVC; however, not all of the services reach

the intended children and families, especially the food basket support. In an effort to address this issue, the CCM, DSS and S&CD

at district level will identify community carers, through the existing community structures who will monitor the service delivery to

identified families to ensure that OVC receive quality care and support. The FCM will be used to ensure that the Marang Child

Care network, through its members, will assist DSS in monitoring the project and documenting the processes for continued project

improvement, so that the successes and lessons learned will be refined in preparation for replication and mainstreaming into

DSS's mandate.

The M&E Framework for OVC will be used to monitor and evaluate OVC programs and will include regular and systematic

assessments, structured quarterly meetings with partners, site monitoring, and semi-annual internal program reviews. The

Botswana ‘core indicators' on OVC have linkages with others being used by UNAIDS to assess global HIV/AIDS care and

prevention goals for 2005 and 2010. In FY2008, relevant stakeholders were trained on the M&E Framework and the application

indicators at different levels. DSS updated the OVC data base to capture the key national and program level indicators, including

the number of orphans, vulnerable children, children in need of care and support, and children registered and benefiting from

services. The update of the database has enabled DSS to capture, not only government data, but also data from the partners and

other stakeholders providing services to children. Facilitative supervision will continue to be provided in FY2009.

Efficient and timely transfer of lessons learned and best practices between programs will strengthen national strategies and

interventions in scaling-up of OVC programming by the GOB, CSOs, donors, and the private sector. To this end, an OVC National

Forum will be held with all relevant stakeholders in order to share best practices and lessons learned in OVC programming and

promote evidence-based programming.

Botswana has shown substantial commitment to the prevention of HIV infection and the mitigation of the impact of HIV/AIDS. DSS

collaborates with key stakeholders including the USG, Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), and

UNICEF. DSS with other local partners intends to ensure that policies and guidelines related to HIV/AIDS and OVC provide an

environment in which OVC needs are appropriately addressed. USG will support the strengthening of OVC coordination structures

both at the national, district and village level to ensure that OVC services are well organized and avoid duplication of efforts. In

addition to the coordination roles, these structures ensure that OVC continue to receive services in a timely manner and assist in

identifying OVC who require care and support. The activities supported by PEPFAR funds will continue to build capacities of

communities to maintain and sustain the interventions following the expiration of this grant

Referrals and Linkages were initiated in FY2007 and FY2008 with prevention, palliative care, treatment, and counseling and

testing and will be strengthened in FY2009. Some of the OVC activities have components of palliative child care, adherence to

treatment, counseling and testing and prevention for older OVC. Linkages with the PMTCT program will ensure that children

whose mothers are enrolled have access to basic essential services. NGOs/CBOs/FBOs will create linkages with local clinics to

ensure that families with infants who are diagnosed positive continue to access treatment.

Table 3.3.13:

Funding for Testing: HIV Testing and Counseling (HVCT): $200,000

09.C.CT05: URC - Child and Adolescent Counseling and Testing


In four districts, there will be a roll out of training for providers of voluntary counseling and testing (VCT)

services in the use of protocols for child and adolescent counseling.

Additionally, the capacity of facility and district staff to collect, analyze and use VCT data to plan and

allocate resources for child and adolescent counseling and testing services, including linkages to care and

pediatric treatment, will be strengthened.

From COP08:

In Botswana, counseling and testing for children and adolescents remains an area of critical gaps in legal,

policy and program issues. The legal age of consent for testing in Botswana remains at 21, although major

efforts are underway to reduce the age to 16. Policy and guidelines for C&T of children are unclear, if not

unavailable. There are no C&T protocols to guide service delivery to children and adolescents. In addition,

counselors lack the skills and the confidence to provide services to this group. A number of children are

infected, but their status is not known, yet they would benefit from pediatric treatment and other services to

improve their quality of life. Some children are on HIV treatment, without knowing their HIV status. This has

posed challenges in relation to adherence.

In 2007, the MOH is working to develop policy and guidelines for counseling and testing of children and

adolescents, as part of the process to review and update C&T guidelines in general. A review workshop is

scheduled to take place in September 2007. Technical assistance from WHO/AFRO region has been

obtained for this activity.

2008 plans

Funds will support technical expertise for the MOH and key partners in developing an HIV/AIDS counseling

protocol for children and adolescents. The contractor will be required to form a working group comprising of

key stakeholders in the development of protocols. These stakeholders will include MLG - OVC program,

MOH, Botswana-Baylor Children's Clinical Center of Excellence, UNICEF, and representatives of civil

society organizations.

The process will include the review of current practices and relevant policy and guidelines in counseling and

testing of children and adolescents. The review will also include existing guidance and protocols from

UNICEF, WHO, UNAIDS, CDC and other international organizations, including resources from the region. A

consultative and participatory process will be engaged, to draw from all the stakeholders to develop draft

protocols for pre-testing in relevant settings. It is expected that the protocol will address the needs of health

care workers in providing C&T services for children and adolescents, on-going psychosocial and preventive

support, support for disclosure and referrals, among other areas. A curriculum will be developed for the

training of health workers on the use of the protocols. PEPFAR funds will also support training of 75 trainers

(TOT) of health workers/counselors on child/adolescent counseling.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17744

Continued Associated Activity Information

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

System ID System ID

17744 17744.08 HHS/Centers for University 8747 8747.08 $600,000

Disease Control & Research

Prevention Corporation, LLC

Table 3.3.14:

Funding for Testing: HIV Testing and Counseling (HVCT): $627,000

09.C.CT11: URC -Strengthening Routine HIV Testing

In FY2008, the Counseling and Testing Team successfully accomplished the following tasks:

-a coordinator for the Routine HIV Testing (RHT) position was recruited;

-the Ministry of Health (MOH) and the Ministry of Local Government (MLG) were supported in the

adaptation of the RHT training materials;

-the MOH identified two districts for the RHT baseline assessments;

-a Technical Working Group (TWG) was formed;

-partnerships were forged with the District Health Teams, the District Multi-Sectoral AIDS Committees, and

the MLG.

At the same time, the MOH and the MLG have been working with University Research Corporation (URC)

to pilot test a strategy to improve Routine HIV Testing (RHT) or Provider Initiated Testing and Counseling

(PITC) services in two districts. The RHT improvement strategy assists facilities to improve the quality of

testing, as well as post-test counseling, which is critical for promoting risk reduction behaviors among

clients. The improvement interventions put emphasis on enhancing referrals for further care and treatment.

All categories of staff who are involved in HIV testing and counseling are being trained in each facility. After

completing the provider training, URC staff along with MOH and MLG staff, will provide on-site mentoring

and coaching of RHT providers to ensure that implementation occurs and is aligned with the training

objectives, and the national guidelines for HIV Testing and Counseling (HTC). Mentoring will ensure that

data management concepts are clearly understood and implemented by the facility staff. The URC staff will

also observe and assess counseling and testing procedures periodically to determine levels of compliance

among providers with the RHT protocols.

The objectives for the program are:

-to increase the number of public and private healthcare facilities offering and performing high quality RHT

and post-test counseling;

-to improve the capability and skills of health workers in RHT and post-test counseling;

-to increase the number of health care clinic attendees who receive high quality RHT services;

-to improve the capacity of facility and district staff to collect, analyze and use RHT monitoring and

evaluation data, then plan and allocate resources for RHT and HIV care, treatment and support services

based on timely and accurate information;

-to improve the coordination and support supervision of RHT both at the facility and district levels.

Plans for 2009:

Activities and Expected Results:

Activity 1: Establishment of Quality Improvement Teams at the Facility Level

URC will work with facilities to identify a core team representing staff from the various clinical services. The

facility-based teams, with support from URC and MOH/MLG staff, will be responsible for improving uptake

and the quality of RHT services in the various clinical settings. Each facility team will conduct a rapid

baseline assessment to identify quality gaps in its current RHT services, if it has not already completed one.

These assessments and additional quality assessment (QA) tools will be used to develop and implement a

quality improvement plan. URC will assist facility teams in developing strategic plans for improving access

to and quality of RHT services.

URC will also integrate routine HIV testing services into this strategic plan, thereby increasing access to HIV

testing in all clinical settings. Emphasis will be placed on increasing recruitment of couples and families,

including children and adolescents, to RHT services. Facility staff will: (1) promote access to and availability

of confidential HIV testing; (2) ensure that HIV testing is informed and voluntary; (3) ensure effective and

prompt provision of test results for all clients who undergo HIV testing; (4) utilize a prevention counseling

approach aimed at personal risk reduction for HIV-infected persons and those at a high risk of HIV

exposure; and (5) link HIV-infected individuals to care and treatment. URC will ensure that all facility staff

are aware that HIV prevention counseling should focus on each client's unique personal circumstances and

risk and help each client set and reach an explicit behavior-change goal to reduce the chance of acquiring

or transmitting HIV.

The program will be rolled out to two additional districts in the FY2009.

Activity 2: Human Capacity Development

The MOH has requested URC to support the hiring of two counselor trainer positions to be based at the

ministry, but work in the districts to support training and implementation of the quality of RHT services. Staff

will receive training that includes specifics on RHT quality, the meaning of quality in services, and

compliance with national guidelines. Health care workers with basic RHT knowledge and skills will be the

target of capacity building activities. Emphasis will be placed on indicators used to monitor clinical

performance, such as the presence of guidelines at facility level or the knowledge and skills of counselors.

Specific case studies will be presented during the training and participants will work in groups to identify

quality gaps and suggest possible solutions. URC will provide job-aids, such as wall charts, to improve

compliance with clinical and RHT guidelines. URC will visit each facility at least twice a month to provide on-

the-job support and mentoring to healthcare workers in participating facilities. Mentoring will focus on

improving skills of RHT and other high-volume clinical service staff on HIV counseling and referring. During

these visits, URC will also review program performance data.

Activity 3: Referrals and Linkages

Activity Narrative: URC along with MOH/MLG will promote a ‘continuum of care' model for all HIV-infected persons. The model

emphasizes the identification and early referral of all people living with HIV/AIDS (PLWHA) to care,

treatment, and other support services. As part of this mandate, URC will work to link different levels of care,

including facility, community-based organizations (CBO), faith-based organizations (FBO), home-based

organizations, and other different services, to minimize missed opportunities. In order to ensure that RHT is

widely available, various innovative counseling and testing (CT) approaches, such as family-based, door-to-

door, community-based, outreach , youth focused and home-based care services, will be incorporated into

existing programs. They will continue to expand this focus and promote available methods for prevention to

all clients, with a specific focus on discordant couples. In addition, URC will continue to work with local

CBOs and FBOs to increase community outreach and support for knowing one's HIV status and will train

facility, CBO and FBO staff in analyzing their performance and quality, or in other words, outputs and

compliance, indicators. The staff will use site-specific data to monitor uptake of basic healthcare and

support services on a monthly basis. Additionally, URC will ensure that there will be linkages established

with facilities that provide male circumcision services and follow up risk reduction counseling.

Activity 4: Building Sustainability

In order to promote sustainability, URC will train district and facility-level supervisors in QA methods and

facilitative supervision techniques for improving the quality of RHT services. URC has begun the process of

reviewing national RHT guidelines and evaluating the quality of CT at the facility level, in partnership with

the district health department, which will be a key focus area in the next twelve months. To ensure the

quality and reliability of data obtained at all URC supported sites, it has been necessary to ensure uniform

reporting structures, including the introduction of HTC-specific data collection tools. URC will conduct

quarterly assessments in each facility/CBO/FBO to assess whether staff is in compliance with MOH HTC

guidelines. At least once a year, sample-based surveys will be undertaken in a small number of URC and

non-URC sites to assess the differences in compliance and other performance indicators.

ACTIVITY 5: Development and operationalization of RHT Training Manuals

URC will assist the MOH and MLG to finalize the development of RHT Trainer and Participants Manuals

and to develop job aids to support providers in service delivery. These will include cue cards and posttests

for group information and counseling sessions. URC will support training in approximately four districts

within one year and will evaluate training material adequacy and relevance among participants and trainers

through pre and post surveys.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas


* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.14:

Funding for Health Systems Strengthening (OHSS): $0

09.X.SS20: URC - Targeted Evaluation



From COP08:

A number of PEPFAR-supported programs have been underway for several years now. Under this activity,

external process evaluations will be conducted on activities which have been supported for three or more

years and that are planned to continue in 2008. These activities include UMDNJ-FXBC Technical

Assistance to PMTCT, Pre-service Training and Health Worker Wellness, NASTAD Technical Assistance to

Community Planning and Community Capacity Enhancement Program (CCEP). Based on the scope of

work provided, URC will conduct site visits and interviews with key informants and beneficiaries of the

targeted partner activities in order to identify strengths and weaknesses of the program, and in turn, help

map the way forward. The focus of the evaluations will be on the technical content and management of the

activities, as well as the effectiveness of the interventions. Best practices and program challenges will be

documented and recommendations included.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19647

Continued Associated Activity Information

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

System ID System ID

19647 19647.08 HHS/Centers for University 8747 8747.08 $300,000

Disease Control & Research

Prevention Corporation, LLC

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $350,000

09.X.SS12: URC - Gender and HIV/AIDS



From COP08:

In support of the Botswana National Strategic Framework on HIV/AIDS (2003-2009), the U.S.

Ambassador's HIV/AIDS Initiative has supported local partners to mitigate and reduce the stigma related to

HIV/AIDS. In order enhance the work already undertaken by this Initiative the US Embassy plans to

support a new activity that will address the gender emphasis area to increase women's access to income

and productive resources. This is in recognition that women and girls' lack of economic assets increases

their vulnerability to HIV/AIDS. Therefore providing women with economic opportunities empowers them to

avoid high risk behaviors, seek and receive health care services and better care for their families.

Botswana has prioritized poverty alleviation in its national development plan; however, women in Botswana

tend to suffer poverty and economic marginalization more acutely than men. A number of factors contribute

to the differences in the experience of poverty and economic disadvantage between the two groups. These

factors include legal and cultural norms that restrict women's access to, and control of, productive


Gender inequalities also exist in the education system and these impacts negatively on poverty alleviation

strategies. In the area of women and health, it is important to bear in mind the fact that people's health and

well being are outcomes of the economic, social, political and cultural context in which they lead their lives.

In the case of Botswana, women lack full and equal participation in the cited context, and therefore,

experience different and additional health barriers. Nevertheless, Botswana has made some strides in this

area of Women and Health. Since 1995, Botswana has revised the Family Planning guidelines with the aim

of removing barriers to accessing health services by women and girls. There is also an integration of STI

and HIV/AIDS prevention with family planning services and reduction of mother to child transmission of HIV.

However violence against women is one of the pervasive and escalating social problems in Botswana.

Despite the commendable work and initiative by GOB, many young women in poorer, outlying communities

remain highly vulnerable to HIV because they lack access to independent income generating activities, and

thus have the potential to be abused and exploited in their relationships with male partners. Since many

adult women and adolescent girls continue to lack direct access to cash income, their ability to successfully

resist sexual demands from male partners is greatly undermined. Over 50% of people in Botswana live in

rural areas and most of them are women. Studies also show that HIV/AIDS prevalence is also high in rural

areas. Botswana‘s rural areas are endowed with natural resources that if prudently utilized, can carry

Botswana sustainably into the future. Women residing in rural areas, as custodians of the natural

environment, need to be empowered economically and politically to improve their livelihood systems.

NGO's like Women Against Rape (WAR) have tried to break the dependency syndrome that results from

women not having their own income and their own resources through an Africa Development Foundation

(ADF) funded project that included conducting research on viable small businesses for women in Ngamiland

(from cooking, and sewing, to basketry and other activities). Somarelang Tikologo (Environment Watch

Botswana) also engaged in a project called Green Shop Project for Women's Economic Empowerment

funded by the Women's Affairs Department in which they educated and trained women, and developed

marketing centers. Other organizations such as Bomme Isago Association, are working with women to

empower HIV positive women on their reproductive health rights and available services.

This activity introduces a unique project approach that aims at economically empowering the rural woman,

using raw material from the natural resource base by giving them the resources needed to establish them

as enterprises. The uniqueness of this project lies in the emphasis to utilize the natural resource base,

which if prudently used, will bear sustainable outputs. The project also moves beyond training and

educating, and gives rural women the chance to utilize skills and indigenous knowledge to finally run output

-oriented enterprises.

Rural Women Economic Empowerment Project seeks to provide opportunity for rural and peri urban based

women aged 25 years and above to engage in business, sustainably utilizing their natural resources to

attain independence over livelihood choices, socio-cultural and political choices. Specific objectives are:

--To educate and empower women on HIV/AIDS issues.

--To reduce vulnerability to HIV/AIDS amongst women by avoiding dependence on men in relationships.

--To economically empower women to have independence in decision making at household level.

--To provide women with seed money to start businesses to improve their rural livelihood.

--To use the rural woman to conserve the environment while at the same time benefiting from it.

The activity will be implemented by an experienced Non -Governmental Organization, which has experience

in Gender issues and natural resource management, it will coordinate the program and work closely with 3

NGO's in 3 regions in Botswana. Women will be provided with funds to start up or improve on projects that

have natural resources as their raw material. They will also be sensitized on HIV/AIDS issues and their

reproductive health needs. Linkages with other PEPFAR supported partners such as BONASO, BONELA,

Hope World Wild, Catholic Relieve Services and BONEPWA will be formed to leverage support and

utilization of available technical assistance. Additionally support will be sort from Peace Corps volunteers

working in the NGO and PMTCT programs in order to foster collaboration and maximize available


The activity will assist Botswana in addressing a number of policy priority areas including economic

diversification, poverty alleviation, women empowerment, sustainable environmental management and rural


New/Continuing Activity: Continuing Activity

Continuing Activity: 17922

Continued Associated Activity Information

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

System ID System ID

17922 17922.08 U.S. Agency for Constella Futures 7751 1339.08 GPO-I-00-05- $250,000

International Group 00040-00:

Development Health Policy


Emphasis Areas


* Increasing women's access to income and productive resources

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $350,000



Table 3.3.18:

Subpartners Total: $0
Rutgers New Jersey Medical School: NA
Catholic Relief Services: NA
Makgabaneng: NA
Nurses Association of Botswana: NA
Population Services International: NA
Cross Cutting Budget Categories and Known Amounts Total: $1,500,000
Human Resources for Health $475,000
Human Resources for Health $280,000
Human Resources for Health $100,000
Food and Nutrition: Commodities $20,000
Education $30,000
Human Resources for Health $245,000
Economic Strengthening $350,000