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.
Health Information Network and Tele-health centers support
This is a continuing activity from FY07. In this continuing activity, Tulane University (TUTAPE) supports the
Ethiopian Ministry of Health (MOH) to establish health information networks and telehealth centers. In FY07,
a National Computer Resources Mapping Survey, which will map out all districts where the Government of
Ethiopia's high-speed communications network exists, human resource capacity, and hardware and
software resources will be finalized. This information identifies the Information and Communication
Technology (ICT) infrastructure and resources for use of telemedicine and distance-learning technologies
that will directly support improved care and treatment throughout the health network. In continuation of this
activity, in FY08, the facility mapping survey will be linked to this activity (ID10371, ID10510).
In FYO7, TUTAPE, in collaboration with US Army Telemedicine and Advanced Technologies Research
Center (TATRC), supported the expansion of tele-medicine and information sharing by establishing network
systems in nine institutions: MOH, the Federal HIV/AIDS Prevention and Control Office, the Ethiopian
Health and Nutrition Research Institute, the Drug Administration and Control Authority, ALERT, and
Defense, Jimma, Mekele, and Debub Universities. These included PEPFAR-supported, technology-assisted
In FY08 support will continue and additional technology-assisted learning centers will be established at 20
ART-providing hospitals and two additional universities (Gondar and Harmayia). Depending on connectivity
at each site, all the centers will have capacity to support 30 users (for the additional universities) at one time
in state-of-the-art, technology-assisted learning centers that include video-conferencing. These centers will
enable the institutions to access resources for telemedicine and tele-education. Related hardware and
software will be procured, and training will be provided to enhance the use of these resources. The national
fiber-optic network, currently under construction, will be tapped. In FY07, TUTAPE completed an initial
assessment to form the HealthNet, a virtual network which uses available technologies to connect health
institutions throughout Ethiopia.
In FY08, TUTAPE will conduct assessment, evaluation, and deployment of appropriate and cutting-edge
technologies for telemedicine and information-sharing. In FY08, TUTAPE will support and strengthen the
HealthNet through capacity building and technical assistance. This will enable the hospital sites to have an
active connection with nearby hospitals/universities, creating the opportunity for telemedicine, tele-
education, and a virtual referral system.
In FY07, based on the assessment conducted on regional health bureau (RHB) ICT capacity, TUTAPE has
enabled video-conferencing at RHB to strengthen information-sharing between MOH and ART data-
reporting systems at all levels. This has directly supported the MOH's identified need for expansion of
efficient telecommunications within regions, with the aim of improving data flow linkages with the data
In FY08, TUTAPE will also address gaps identified by the National Computer Resources Mapping survey on
connectivity of MOH with RHB and health facilities. This activity will leverage Global Fund for AIDS, Malaria,
and Tuberculosis resources for hardware distribution for RHB, districts, and health facilities and will
supplement any additional gaps identified in the survey.
Development of Healthcare Data warehousing and Electronic Medical Record System
These are two continuing activities (ID 5724 and ID1095) from FY07. In FY06, the National Computer
Resources Mapping Survey mapped the districts where the Government of Ethiopia's (GOE) high-speed
communications network (funded by the World Bank) exists, their human resource capacity, hardware, and
software resources. The information gathered has identified available information and communication
technology (ICT) infrastructure and resources for the implementation of the data warehouse and electronic
medical records (EMR).
There are two sub-activities:
1) Development of an EMR system to support HIV/AIDS care and treatment. In FY07, this was expanded to
include other activities at health facilities, including health management information systems (HMIS).
2) Design and development of a data warehouse for the Ethiopian Federal Ministry of Health (MOH) and
regional health bureaus (RHB) that included strengthening the geographic information system (GIS) and
spatial analysis in health.
The MOH is expanding ART services rapidly and needs a robust patient information system that improves
care and programming. The MOH, facing the challenge of improving the quality of ART services while also
rapidly scaling up capacity, is trying to ensure that ART patients are not lost to follow-up and their medical
information is not lost as they visit various clinics over time and distance. The relatively new technology of
EMR is a complement to the national HMIS, which can record and track the provision of quality medical
service at the individual client level. Using EMR, it becomes possible to record and track each individual's
care, as well as collective or aggregate patient information for HMIS purposes. For clinics using an EMR
system, many HMIS indicators can be produced automatically, without further burden to staff. The system is
needed to assure continuity of patient care over time and place, and across types of service and levels of
care. It enables: standardization and collection of health information data for decision-making; timely data-
capture at a point of care; and data access and reuse at a subsequent point of service, hence improving
care quality and reducing costs of repeated tests. Furthermore, it can report in "real-time" indicators such as
patient count by sex and age categories, geographic distributions, longitudinal cohort data, health
demographics, and adherence and cost statistics, which are accurate, valid, reliable, and timely. It also
helps in preventing duplication of patient counts and linking of patient information to currently separate
‘vertical' paper systems such as tuberculosis (TB), HIV/ART, antenatal clinics (ANC), PMTCT, voluntary
counseling and testing (VCT), and sexually transmitted infections (STI)—thus improving the efficiency of
decision-making. Electronic data reduces human error and the burden of manual aggregation for HMIS
In FY07, EMR implementation began in 35 ART networks; in FY08, it will expand to include 50 networks.
The system will cover all patients enrolled in comprehensive ART services, as well as mothers attending
ANC and receiving PMTCT, and spouses seeking VCT. The inclusion of ANC services is to reduce the
possible stigmatization of the smart card that might occur if EMR is used only for those patients who are
taking ART. Further TB, family planning, outpatient departments, laboratory departments, in-patient
department modules will be included. The program expansion will require investment in hardware, including:
computers and monitors; uninterruptible power supplies; printers (for all 50 networks); and consumables,
including paper, toner, and cards. Adaptation of the software will continue and will draw technical assistance
(TA) from other countries implementing such a system. Related costs include: recruitment and salaries for
new software programmers, salaries for data clerks; training on use of the system, and a series of staff
sensitization interventions at facilities selected for implementation. The data flow between the EMR system
at facilities and the HMIS system at the facility, district, and regional levels will also continue to be
implemented. Ongoing support will continue to all sites. Seconded staff to MOH will be a continuing
component, including capacity building at MOH for development and expansion of EMR in the country.
The data warehouse is a central data repository that collects, integrates, and stores national data with the
aim of producing accurate and timely health information which will support evidence-informed data analysis
and reporting on HIV/AIDS care, treatment, and prevention. Relevant sources for the data warehouse
include the national monitoring and evaluation (M&E) program reports, population-based surveys, non-
identifiable aggregated data from EMR, and data from routine national HMIS reporting.
In FY07, a data warehouse architecture system study was completed and assistance was provided to
redesign the MOH website that links to the data warehouse for data mining, analysis, and reporting. This
activity was also extended to regional health bureaus (RHB). MOH and RHB staff were trained to maintain
the website. In FY08, MOH and RHB will continue to receive TA on the development of electronic data
warehouse systems, using the latest technology available and integrating HMIS, including the HIV/AIDS
information system, surveillance, surveys and other related data sources. This system also includes routine
and survey information on HIV/AIDS and other related diseases from various government organizations,
nongovernmental organizations, research institutions, and the private health sector. This activity also
includes integrating the national information and communication technology resource-mapping database,
CostET, and district-based planning application database with the MOH intranet. In FY08, support will
include human resource capacity building, hardware acquisition, and software licensing and application
development to strengthen the data warehouse. In support of this activity, mapping and unique identification
of all health institutions will be conducted as outlined in "The Signature Domain and Geographic
Coordinates: A Standardized Approach for Uniquely Identifying a Health Facility". This will be in
collaboration with the MOH, the Ethiopian Central Statistical Agency, and the National Mapping Authority.
The support includes strengthening GIS capacity through human resource capacity building, hardware
acquisition, and software licensing. In FY08, all information and communication technologies activities will
have continued trainings as part of capacity building.
National Monitoring and Evaluation System Strengthening and Capacity-Building
Development of Ethiopia's National HIV/AIDS Monitoring and Evaluation (M&E) system is a sub-set of the
comprehensive Health Management Information System (HMIS) strategy and master plan being developed
by the Federal Ministry of Health (MOH). M&E is an increasingly important subject in present-day Ethiopia,
as it has made great strides in implementing the Third One—One National M&E System with the support of
Tulane University Technical Assistance Program Ethiopia (TUTAPE). To this end, Ethiopia has redesigned
its M&E/HMIS system, which includes all HIV/AIDS indicators.
In the past, Ethiopia suffered from a poorly functioning, manual data collection and reporting system that
lacked standardized indicators and formats. Reports were untimely and often incomplete. While efforts to
improve this are ongoing within the MOH, the need for technical assistance and support for the new HMIS
and M&E system is evident. PEPFAR Ethiopia recognizes this need and supports in its five-year plan the
goal of the Third One—One National M&E System.
The new national HMIS, which is currently in the piloting phase, standardizes, integrates data
collection/reporting, and harmonizes the information needs of all HMIS consumers. In FY07, TUTAPE's
technical assistance to MOH extended to successfully integrating the National HIV/AIDS M&E system into
the newly developed national HMIS, leading toward national harmonization and sustainability. TUTAPE
assisted MOH to identify core health indicators, including those for HIV/AIDS and TB/HIV, for HMIS
reporting and to improve capacity to collect patient information and use the information generated to
enhance decision-making at the local level. With MOH and partners, TUTAPE revised HIV/AIDS and related
disease-reporting formats. Support also included technical assistance to the national HIV/AIDS Prevention
and Control Office (HAPCO) to develop M&E training modules for the grassroots level. This will help
HAPCO to expand comprehensive HIV/AIDS patient monitoring services to the district health centers.
In FY07, based on the design of the MOH, TUTAPE is supporting the new HMIS by developing website and
intranet tools to access data collected from several sources: HIV/AIDS service delivery, finance, human
resources, and logistics, including information from other governmental organizations and the private
sectors. HMIS data will also be harmonized with health-related and multisectoral data collected by other
organizations, such as vital-events registration, census, survey, etc. The HMIS will also establish common
data definitions and understanding on how to interpret the information.
The new M&E/HMIS reforms are directed toward ensuring data quality to strengthen local action-oriented
performance monitoring. To that end, MOH is putting into place trainings to improve M&E/HMIS tools and
methodologies, including the use of information for data and service quality improvement and evidence-
informed decision-making. In FY07, TUTAPE developed the training modules and conducted training in a
cascaded manner for the national HMIS, including data-quality assurance for decision-making associated
with performance monitoring. TUTAPE assisted the MOH in the national rollout of HMIS to 35 ART
networks and will expand that rollout to 100 in FY08. This enhances the HIV/AIDS M&E by introducing and
reinforcing structure and methods for data quality and use and performance monitoring.
In FY07, TUTAPE also introduced HIVQUAL, a service-quality improvement system for MOH and the
HIV/AIDS Prevention and Control Office (HAPCO). At the request of MOH, TUTAPE supported the initial
exchange of experiences on HIVQUAL between Ethiopia, New York, and Thailand. HIVQUAL enables the
data generated by the HMIS to be used for improvement in data and service quality. In FY07, HIVQUAL
was implemented in 35 HIV networks; in FY08, it will expand to include 100 networks. TUTAPE provides
training-of-trainers on HIVQUAL.
The MOH recognizes the need to institutionalize M&E/HMIS responsibilities in the staffing structure at all
levels. In FY07, the MOH endorsed the training of new HMIS cadres. TUTAPE will continue to support
participants from local partners for the pre-service HMIS training program to build a sustainable M&E
system that will support the newly designed HMIS. The MOH plans to train more than 2,000 HMIS cadres in
FY08. TUTAPE will expand its HMIS pre-service training from 100 in FY07 to 500 new cadres by using
technical educational and vocational training schools (TEVT) around the country. TUTAPE will renovate the
institutions as state-of-the-art, multifunctional training institutions for HMIS and other allied health
The MOH program links integrated supportive supervision (ISS) as part and parcel of the M&E/HMIS
reform. In FY07, to strengthen the new M&E/HMIS, TUTAPE provided technical support for ISS strategy
development. This activity will continue through FY08 for concurrent implementation of ISS with HMIS in
In FY07, TUTAPE supported HAPCO management to bring the information monitoring and evaluation to
department level. In FY07, TUTAPE's short- and long-term consultancies, fellows, and M&E specialists
were seconded to the HAPCO M&E department and quality team. In FY07 and FY08, TUTAPE will work to
improve organizational structures by seconding staff within the Ethiopian Health and Nutrition Research
Institute (EHNRI), local hospitals, and higher learning institutions.
TUTAPE continues to provide technical support for human capacity building for M&E at the national, sub-
national, and service-delivery levels. TUTAPE, in collaboration with Jimma University (JU), launched the
first postgraduate degree in health M&E and postgraduate diploma program in Africa. The first group of 31
students started in February 2006 and will graduate in FY07. Graduates will form the first Ethiopian M&E
network, a forum for sharing ideas and experiences, and mentor RHB, nongovernmental organizations
(NGO), faith-based organizations (FBO), and other local stakeholders. In January 2007, the second class of
38, including candidates from NGO and organizations for people living with HIV (PLWH) were enrolled. A
third cohort of 40 is expected to enroll in FY08. In FY08, institutional support to JU will continue, including
joint appointments of academics and technical assistance to create a sustainable integrated master's
program at JU. That technical assistance will support course coordinators, administrative staff, and other
aspects of the program. In addition, in FY08, JU will receive support to enroll paying international students
(including other PEPFAR countries) and host international short-courses in M&E.
In FY07 a summer institute for faculty for training and sharing experiences will be established. As JU has a
critical shortage of teaching staff, lecturers amongst the first M&E cohorts will be recruited as part of a staff-
Activity Narrative: retention mechanism. In FY08, this support will continue.
In FY08, a fellowship will be initiated for PLWH who will be trained in multi-sector HIV/AIDS program design,
implementation, and M&E. This will be linked to all activities at JU and All Africa Leprosy Rehabilitation and
Training Center (ALERT), with credit counted towards an advanced certificate/ degree. In addition, to
support the national HMIS and health systems, biostatisticians will be trained. These efforts will provide
didactic, as well as practical, experience for further career enhancement.
In FY07, short-term training programs (e.g., M&E for program improvement and use of data for decision-
making, program improvement and other related trainings) were provided to MOH/HAPCO, the Drug
Administration and Control Authority, EHNRI, RHB, the Christian Relief And Development Association, the
PLWH network, and the Central Statistical Agency to improve M&E knowledge and skills at national and
regional levels. Scientific writing workshops will be offered to larger audiences and will expand from 30
people in FY07 to include 100 in FY08. Participants will continue to be supported to publish their work in
peer-reviewed journals. In FY08 the short-term trainings, including M&E/HMIS, program, and HR
management and data use/quality, will be extended to cover regions.
In FY08, in order to reach a much larger audience of government, NGO/FBO, and community participants,
teaching materials from JU will continue to be converted into e-materials to support e-learning.
TUTAPE will conduct process evaluations of the HMIS reform, the data-quality system, the HIV/AIDS
committee at health facility, and other program evaluations as it becomes necessary in the course of
program implementation. TUTAPE continues to provide technical assistance to EHNRI for heath facility
survey, national -level surveys and health-impact evaluations.
HAPCO conducted the first round National AIDS Spending Assessment (NASA) in FY07 and TUTAPE
supported the intervention mapping component. In FY08 the intervention mapping would be updated for the
MOH/HAPCO and uploaded on to the MOH intranet TUTAPE is establishing in FY07.
In FY08, support will be provided to the Federal Ministry of Health, Program and Planning Department
(MOH/PPD), and HAPCO in costing programs, for use in program planning as well as in development of
funding proposals. Support will also be provided to finalize the inputs needed for the costing tool developed
TUTAPE, in FY06 and 07, provided technical assistance to MOH/HAPCO in producing the first and second
Annual HIV/AIDS M&E Reports. In FY08, technical and financial assistance will be given to MOH/HAPCO to
produce monthly, quarterly and annual M&E/HMIS updates and reports.
Human Resource Requirement for Meeting Targets by 2010
This is a continuing activity from FY07 (10510) which addresses the human-resource requirement for
meeting targets by 2010. Ethiopia is committed to the global initiative of universal access to HIV/AIDS by
2010 and Millennium Development Goals (MDG) 2015. To meet this target, MOH is implementing massive
ART scale-up. The most prominent challenge to this endeavor is a human resource shortage. In FY07,
TUTAPE supported a targeted evaluation to explore the human-resource requirements for meeting
PEPFAR goals and universal access by 2010. There are two evaluation questions: what is the gap in
human resources for meeting PEPFAR and universal access targets by 2010, and what strategies and
innovative solutions should be adopted if the country is to meet them?
Based on the evaluation, in FY08, TUTAPE will support MOH to develop a human-resource information
system and also provide technical assistance for the human-resource strategy implementation to address
the human resource requirement for PEPFAR targets and universal access for health. The database will be
updated annually by using university student going to their home districts during summer vacation. TUTAPE
will also support all regions to adopt the MOH system and populate and maintain the database.
TUTAPE is leading the human resource for the Technical Working Group (TWG), and this data base will be
used by the TWG to monitor human-resource dynamics and analyze the trend over time.
The national ART implementation guidelines propose that teams of two doctors, one nurse, one counselor,
one pharmacist, one lab technician, one administrator, and one data clerk are needed to manage ART
services at a facility. These health care workers will be the population of interest.
The Ethiopian minister of health requested in a meeting to the Ambassador and the PEPFAR coordinator
that PEPFAR makes funds available to this activity as it is a top priority for the Government of Ethiopia
represented by the Ministry of Health.
The Presidents Emergency Plan for AIDS Relief (PEPFAR) recognizing the severe HRH crisis in Sub-
Saharan Africa has led the initiative to address the international HRH crisis.
Ethiopia is committed to the global initiative of Universal Access to HIV/AIDS by 2010 and Millennium
Development Goals (MDG) by 2015 with the support of initiatives like
PEPFAR. To meet this target, FMOH is implementing a massive ART scale up of which the most prominent
challenge is the human resource shortage. The densities of health workers per population remain among
the lowest in the world, and inadequate to reach health status goals of the Health Sector Strategic Plan.
With 0.3 physicians and 2.05 nurses per 10,000 population, Ethiopia ranks in the lowest HRH density
quintile of African nations and far below WHO estimate of 2.1 minimum workforce required per 10,000
population. To assess the current HRH situation, an assessment has been undertaken with an adapted tool
developed by WHO, initially by consultants from Harvard in 2003 and as a first step of the HRH Business
Process Re-engineering (BPR) in 2006. George Washington University has also conducted a multi-country
study that included Ethiopia to identify legal and policy bottlenecks for task shifting for HIV/AIDS services.
The findings from these assessments, as could be anticipated, suggest that the key problems are shortage
of health professionals, poor performance, inequitable distribution of the available health workforce among
regions and health facilities. The FMOH and the Ministry of Education have limited technical capacity to
coordinate, supervise and evaluate basic health training programs resulting in poor quality of training for the
main HRH categories. Furthermore, medical education curricula are not aligned with current and future
health system needs and health policy. There is a lack of standardized accreditation and national
examination for licensing. This is compounded by poor planning, coordination & quality of in-service training
programs (mostly donor driven training activities) and little opportunity for young health professionals to
benefit from continuing staff development. Health professionals have low levels of remuneration and lack
conducive working conditions which correlates to the poor general performance of the available health
professionals, manifested as poor handling of patients, absenteeism and shirking of duties, pilfering of
drugs and materials and internal or external migration.
Recognizing the shortcoming of the system the FMOH has embarked on a Civil Service reform along the
lines of business process reengineering (BPR) to revamp the health system. This is pursued along seven
interrelated core themes: access and quality, financial utilization, health management information system,
logistics, emergency response and human resources for health (HRH).
Though HRH core process was initiated in 2005 it has not been progressing as anticipated. Initially an HRH
Observatory and BPR team was established but the process
was delayed for various reasons and as a result disbanded by FMOH.
The FMOH high level management, cognizant of the urgency of the HRH situation in the country and in an
attempt to find a workable solution has identified Tulane University as
its lead partner to develop the country's HRD strategy and implementation plan up to 2020.
Tulane, as part of its PEPFAR funded activities develops human resources and expertise for Monitoring and
Evaluation and had completed a national assessment and strategy
of the health sector HRD for HMIS. Moreover, Tulane in FYO7 through PEPFAR/CDC funding is working to
address the Human requirements for Meeting targets by 2010
which would enable to answer two evaluation questions and as a result develop a HRIS database. These
activities position Tulane with the expertise and know-how to provide
the FMOH with the technical expertise it needs.
Tulane has assumed the responsibility of leading the FMOH HRH strategy and implementation with
PEPFAR support. Tulane's technical assistance will include but are not limited to alternative methods for
estimating detailed densities of health workforce over time; education, training and skill development;
analysis of policy, legal and financial framework; assessment of political feasibility of different reform
options; sequencing of investment options in HRH and develop monitoring and evaluation activities needed
to support the above areas. Tulane will also develop human resource management capacity of the FMOH
as well as develop the necessary tools including software and applications.
This request is for a new funding to support these activities and to mobilize national and international
experts in various aspects of human resources development including experts in health policy, law, costing,
workforce forecasting, management and education to support this effort. At the request of the Ministry,
Tulane will second HR experts.