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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008
Pharmaceutical Sector Support from Site to National Levels
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a continuing activity from COP07 and COP08; the activity has been renamed, changing from
Rational Pharmaceutical Management Plus to Strengthening Pharmaceutical Systems (SPS).
The activity will no longer handle Site-Level Inventory Management, or other supply chain management-
related activities that were addressed by SPS (as the former RPM Plus) under COP06, COP07 and COP08.
While SPS has been very effective in supporting site-level pharmacy and inventory management, funding
decreases and the Ministry of Health (MOH) restructuring process have dictated a shift in allocation of
responsibilities for PEPFAR partners.
In this transition, under Cop09 facility level stock management will pass to the Supply Chain Management
System (SCMS), including prevention of drug and other commodity expiry by shifting stock among facilities.
The Pharmaceutical Supplies and Logistics Department (PSLD), formerly a major counterpart, seems likely
to disappear under the Ministry of Health's Business Process Reengineering (BPR) restructuring, and will
likely no longer be a major counterpart. In any case, collaboration with this entity or successor agencies will
not include supply chain or inventory control activities.
For example, SPS will not support facilities in submitting monthly orders using facility-based data.
In collaboration with the Drug Administration and Control Authority (DACA), Abt Associates and as part of
the public-private partnership (PPP) effort, SPS will provide technical assistance (TA) to Kenema (City
Council), Red Cross and selected private pharmacies in storing and dispensing ARV and related
commodities, with $500,000 of dedicated COP09 funding for that purpose under this activity.
Activities under COP07 and COP08 in improving quality assurance of ARV and related commodities will
shift to a new partner, the United States Pharmacopeia (USP), in a decision coordinated with
USAID/Washington technical staff.
As described above, activities in strengthening site-level pharmaceutical and laboratory information
management will shift to a pharmaceutical and laboratory management focus, with supply chain, logistics
and inventory control functions supported through SCMS. Links between the functions will be maintained
and strengthened through close collaboration between SCMS and SPS, who are co-located. SCMS will
assure that there are no treatment interruptions due to stock-outs of vital products, will minimize expiry of
expensive drugs, will support health facilities in preparing scheduled orders of HIV commodities, and will
support the Pharmaceutical Fund and Supply Agency (PFSA) in distributing these items from regional
stores to facilities. SCMS will build on SPS' experience to date, scaling up inventory management and
reporting at facility level, and will ensure that facility level data is compiled, analyzed and shared with
relevant agencies for quantification and redistribution, replacing SPS in this function. SCMS will continue
the SPS activity of implementing an electronic laboratory commodities information management tool.
Data clerks deployed in previous years are expected to be transitioned to MOH support under COP09.
ART site staff will no longer be trained in supply management by SPS - this activity will be handled by
Activities from COP08 centered on establishing Drug and Therapeutic Committees (DTC) and Drug
Information Centers (DIC), promoting rational drug use, inhibiting antimicrobial resistance will continue to be
supported by SPS, as will most capacity building at DACA with the exception of efforts to improve drug
quality, which will be handled by USP.
Collaboration with the MOH, DACA, SCMS, and the USAID/DELIVER in the implementation of the
Pharmaceutical Logistics Master Plan will be limited to pharmaceutical management areas that link with
logistics management, with SCMS assuming the former SPS roles in logistics management, primarily at site
Wrap around with other PEPFAR activities
Presidential Malaria Initiative (PMI). For FY2009, PMI will be supporting MSH/SPS for implementing
activities to rationally manage anti-malarial drugs. Support to this activity includes the placement of a
resident advisor specifically to support malaria drug logistics management at the Oromia Regional Health
Bureau (RHB). Ongoing support at health facility level to ensure anti-malarial drug availability, per protocol
dispensing and reporting of stock-outs will be continued in hospitals, health centers as well as health posts
in Oromia, i.e. those health facilities where MSH/SPS is already implementing activities with PEPFAR
FY2009 PMI activities to ensure the quality of anti-malarial drugs in both the private and public sectors
throughout Ethiopia will be jointly implemented by USP with funding from both Presidential Initiatives.
Dispensing, Rational Use and Site-level Inventory Management of Antiretroviral (ARV) Drugs and Related
This activity focuses on facility-level stock management of essential HIV commodities, such as ARV and
opportunistic infection (OI) drugs, lab supplies; prevention of drug expiry by shifting stock among facilities,
and raising the current low standard of dispensing to acceptable levels. The activity is related to good
Activity Narrative: clinical and pharmacy practice and is a component of the rational use of drugs (rational prescribing, rational
dispensing and rational use by the patient). MSH/RPM PLUS will continue to collaborate with the Drug
Administration and Control Authority (DACA), the Provisional Supplies and Logistics Department (PSLD) of
the Ministry of Health (MOH), the Partnership for Supply Chain Management (PSCMS), as well as new
entities such as the U.S. President's Malaria Initiative(PMI) and the MSH Care and Support Program, and
other relevant organizations, to implement rational HIV commodity dispensing and use for ARV, OI drugs,
malaria and tuberculosis (TB) products, PMTCT supplies, laboratory reagents and test kits at ART facilities
It will support facilities in submitting monthly orders using facility-based data; in collaboration with DACA,
Abt Associates and as part of the public-private partnership (PPP) effort, it will provide technical assistance
(TA) to Kenema (City Council), Red Cross and selected private pharmacies in storing and dispensing ARV
and related commodities.
Improving Quality Assurance of ARV and Related Commodities
Quality assurance of ARV and other drugs plays a vital role in guaranteeing favorable treatment outcomes
and decreasing toxicity. This is a continuing activity from COP06 and COP07. MSH/RPM PLUS will
continue to provide TA to DACA by seconding Quality Control/Quality Assurance (QC/QA) pharmacists,
supporting regional activities to ensure the quality, safety and efficacy of HIV/AIDS, TB, malaria and OI
drugs. DACA's capacity to monitor and control the movement of counterfeit pharmaceuticals will be
strengthened. DACA's drug QC laboratory will be supported in the proper storage of reagents and
chemicals, record keeping, and provision of reference books and standards, computers and accessories,
TA in the development of new standard operating procedures (SOPs) and in managing an electronic data
base and reporting system for their QC Laboratory. In collaboration with PSMCS, MSH/RPM PLUS will
support DACA and PHARMID's efforts in post-marketing surveillance of drugs, establishing six QC mini-
labs at selected sites.
Strengthening Site-Level Pharmaceutical and Laboratory Information Management
This activity will assure that there are no treatment interruptions due to stock outs of vital products, will
minimize expiry of expensive drugs. RPM PLUS has implemented pharmacy-based patient medication
records for more than 70,000 ART patients nationwide; some are computerized. Facilities have been
provided with over 50 computers and printers and 62 pharmacy data clerks have been deployed to hospitals
and health centers to ensure quality data entry and reporting. These activities will be maintained and further
expanded during FY08. RPM PLUS will support health facilities in preparing scheduled orders of HIV
commodities, and will support PSCMS in distributing these items from PHARMID regional stores to facilities.
MSH/RPM PLUS will build on the experience to date, scaling up inventory management, patient pharmacy
records and reporting at facility level and ensuring that ART Standard Operating Procedures (SOP) and
pharmacy-related formats and registers are available at all ART/PMTCT sites. Routine commodity audit
systems will be introduced at all ART sites. Target facilities will be provided with computers and printers.
Access to telephones and internet will continue to be supported to facilitate reporting and track defaulters. In
order to ensure ownership and utilization of data, data managers will be recruited and deployed at RHB.
Facility level data will be compiled, analyzed and shared with relevant agencies for quantification and
redistribution. Monitoring of ARV drug management and use will be supported. In consultation with PSCMS
and other partners, MSH/RPM PLUS will continue to work on implementing an electronic laboratory
commodities information management tool.
Strengthening Pharmacy Human Resource Capacity
This activity is part of an overall human resource (HR) capacity building effort with local and U.S.
universities, the Clinton HIV/AIDS Initiative (CHAI) and JHPIEGO). HR-related constraints are perhaps the
greatest challenge for the health system at present. Through pre-service and in-service training (PST/IST)
in conjunction with the Ethiopian Pharmaceutical Association, training will be provided to pharmacy
personnel and students. To date RPM PLUS has trained more than 1400 pharmacy and allied professionals
in HIV product management and rational drug use. Refresher trainings need to be conducted to update staff
and address high staff turnover. ART site staff will be trained in supply management, pharmaceutical care
and RDU as well as basic computer skills. Training will be followed by supportive supervision and
mentoring. External short-term training in relevant areas will be facilitated for selected participants. In
collaboration with DACA, RPM PLUS will promote public awareness and education by training media
personnel to promote RDU, including containment of antimicrobial resistance (AMR), adherence,
awareness about counterfeits, etc., and providing up-to-date specialty books and reference materials to
health facilities. A critical task assigned to MSH/RPM PLUS by the MOH during the plan year is the
assessment of pharmaceutical HR needs and development requirements of the pharmaceutical sector as
outlined in the Pharmaceutical Sector Master Plan.
Provision of Technical Assistance and Coordination
RDU is a key element to maximize treatment options for chronic diseases such as HIV/AIDS. Monitoring
and minimizing adverse drug reactions (ADR) is instrumental in increasing adherence to treatment, which
supports the success of treatment. Clients will get improved pharmaceutical care, and the development of
viral or AMR will be minimized. TA will be provided in the following areas: 1) RDU, (2) establishing Drug and
Therapeutic Committees (DTC) and Drug Information Centers (DIC), in collaboration with DACA, PSLD,
RHB, CHAI's Hospital Improvement Initiative and others (3) AMR containment, (4) ADR monitoring and, 5)
adherence monitoring and promotion through workshops, studies and development of facility level action
plans. Activities envisaged include collaboration with programs such as the new Care and Support Program
at health centers, at community and household levels with health extension workers; through HIV/TB drug
management, with PMI in management and rational use of malaria products; and by linkages to with
stakeholders to conduct drug-related operational research. Working closely with DACA and PSLD, RPM
Plus will support improved governance in the pharmaceutical sector by providing TA in pharmaceutical
policy, regulation and quality services in support of the national pharmaceutical and logistics master plans,
and will collaborate with the MOH, DACA, PSCMS, and the Implementation Support Team (IST) of the
Logistics Master Plan in the transformation of PSLD to the "New PSLD" and Pharmid to the new Agency.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16678
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16678 10534.08 U.S. Agency for Management 7500 3798.08 RPM Plus $4,130,000
International Sciences for
Health-related Wraparound Programs
* Malaria (PMI)
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $929,357
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $27,907,714
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Laboratory organizational and physical infrastructure, procurement systems, supply availability, equipment, and trained staff are
critical for PEPFAR Ethiopia's program implementation. It is necessary to strengthen the laboratory infrastructure at all levels to
improve service quality and achieve targets. PEPFAR Ethiopia, in collaboration with the Ethiopian Ministry of Health (MOH), is
strengthening facilities at regional, hospital and health center levels to support HIV/AIDS prevention, care, and treatment
programs. The laboratory still faces several challenges, including upgrade or refurbishment of physical laboratory infrastructure,
expansion of laboratory quality assurance programs, sustaining sample referral testing, capacity building, reliable equipment
maintenance policy and expansion of laboratory information system. Accordingly, PEPFAR Ethiopia supported the comprehensive
renovation of the Ethiopian Health and Nutrition Research Institute (EHNRI) reference laboratory and five hospital and regional
laboratories. These laboratories have been furnished with standard laboratory furniture and equipment. Six regional laboratories
have been completely renovated, furnished and equipped in FY08, and are performing DNA Polymerase Chain Reaction (PCR)
testing for Early Infant Diagnosis (EID), in addition to other standard tests.
PEPFAR Ethiopia supported the development of standardized curricula for in-service training on chemistry, hematology, CD4,
laboratory management, facility level laboratory management and, health center level laboratory technician training, opportunistic
infections (OI) diagnosis including tuberculosis (TB) microscopy, HIV rapid testing, EID and quality systems. In addition,
development of guidelines, operational plans, log sheets, standard operating procedures (SOPs), test request and record forms
have been supported. PEPFAR has trained more than 1,400 laboratory technologists, supervisors, and directors on laboratory
diagnosis of HIV, TB, sexually transmitted infections (STI), laboratory management and quality systems, as well as laboratory
monitoring (chemistry, hematology and CD4 count) of ART. A decentralized approach was used for training, in which most training
was conducted at regional and site levels.
Laboratory quality assurance for both methods and data are high priority for PEPFAR Ethiopia and EHNRI. PEPFAR has
established external quality assurance (EQA) for CD4, chemistry, hematology and HIV rapid testing at 52 ART sites. Additionally,
PEPFAR is preparing to decentralize EQA further down the tiered laboratory network. For ease of management, quality of
laboratory data, and to improve efficiency, PEPFAR Ethiopia supported pilot implementation of a Laboratory Information System
(LIS) at selected hospitals, national referral and regional laboratories. As part of the LIS implementation, more than 25 working
stations were networked with broadband internet service at EHNRI HIV reference laboratory.
PEPFAR purchased and distributed essential laboratory equipment to regional and hospital laboratories, including automated
clinical chemistry, hematology analyzers, FACSCount machines, biosafety cabinets, incubators, centrifuges, PCR machines and
accessories for EID at 6 regional labs. PEPFAR Ethiopia supported the maintenance of all the equipment through EHNRI and
provided technical and logistic support for transportation and installation of laboratory equipment purchased by the MOH with
funds from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for 63 ART hospitals. Effective referral testing has
been provided to more than 240 health centers for CD4 and ART.
PEPFAR Ethiopia also supports laboratory-based targeted evaluation of laboratory diagnosis and disease monitoring. Procedures
for HIV pro-viral DNA PCR detection from dried blood spots (DBS) has been validated and implemented nationwide at ART sites.
PEPFAR is preparing to establish testing centers at six other sub-regional reference or hospital laboratories and to scale up
diagnostic services through DBS sample referral linkages. PEPFAR has supported training in the use of and implementation of a
WHO recommended commercially-based kit for HIV-1 drug resistance monitoring. Furthermore, PEPFAR is implementing an "in
house HIV-1 drug resistance genotyping assay" at the EHNRI HIV Reference Laboratory. PEPFAR has also successfully piloted a
standardized HIV rapid test results logbook at sites in Addis Ababa, with next phase being expansion to sites. In the area of
logistics supply chain management, PEPFAR has seconded an advisor to EHNRI to support quantification for laboratory reagents
and supply procurement, and has also placed five Regional Laboratory Logistics Associates (RLLAs) in key regions to support
One of PEPFAR Ethiopia's goals in FY09 is to access majority of HIV infected pregnant women whom without any intervention
may have a high risk of transmitting HIV to their child in utero, intrapartum and during breast feeding. These efforts aimed at
reaching pregnant women by the prevention unit will be strongly coordinated with PEPFAR Ethiopia laboratory. Several reasons
make it compelling for joint coordination with laboratory. First, this new pool of pregnant women once accessed should be offered
HIV testing and counseling. Secondly, the laboratory would determine eligibility of the pregnant women for antiretroviral
prophylaxis as well as monitoring them while on ARV. Sample referral system and results reporting will ensure specimens are
appropriately transported to maintain their integrity and tested and results returned within specified turn around times for
appropriate interventions for PMTCT.
Furthermore, an estimated 2.3 million children worldwide are living with the HIV. Almost half of these children will die before
turning 2 years of age, if left untreated. By age 5 years, 75% of these children will die if they fail to receive treatment. PEPFAR
Ethiopia's goal is to rapidly scale up pediatric care and treatment services. This program will liaise and coordinate with the PMTCT
and laboratory programs. That way, infants can be accessed and quickly diagnosed. Laboratory capacity for DNA PCR testing for
EID will be increased by adding six new DNA PCR testing sites to already existing ones to match the increase in access and
identification of infected infants. Coordination of Dried Blood Spot (DBS) sample referral with facilities lacking this technology will
be implemented and monitored.
PEPFAR Ethiopia aims at improving the low case detection rate for TB. Laboratory capacity will be strengthened for intensified TB
case finding. Training on TB smear microscopy and quality assurance will continue. PEPFAR Ethiopia will implement capacity for
liquid culture at regional laboratories for TB detection.
In FY09, PEPFAR Ethiopia will continue to implement the quality assurance (QA) program with emphasis on sustainability and
integrated laboratory service delivery. PEPFAR will strengthen tiered, quality-assured laboratory networks and implement
nationally developed policies and strategic planning across the network. Integrated laboratory services and referral linkages will
be implemented across the tiered laboratory network. This network will provide an efficient mechanism for providing integrated
services to expand ART programs. PEPFAR Ethiopia will also continue to support all laboratory trainings, external quality
assessment (EQA) and site supervision at 138 ART health networks (including 138 hospitals and 281 health centers). PEPFAR
will train more than 1,800 laboratory professionals on HIV rapid testing, diagnosis of TB/OI, STI, laboratory monitoring of ART and
laboratory quality, information, logistic system and management systems. The national "training of trainer (TOT)" based trainings
will be conducted by EHNRI in collaboration with CDC, the American Society of Clinical Pathologists (ASCP), and the Association
of Public Health Laboratories (APHL). Regional laboratories, US-based universities and Management Science for Health (MSH)
will be involved in regional and site level trainings. The Clinical Laboratory Standard Institute (CLSI), the American Society for
Microbiology (ASM), ASCP, and APHL will assist in developing, customizing, and standardizing different training modules.
Additionally, PEPFAR will coordinate with the President's Malaria Initiative to leverage funds for quality laboratory diagnosis
especially as an integrated laboratory service approach is sought.
In FY09, PEPFAR will support EHNRI in the implementation of the "Maputo Declaration on strengthening laboratory systems".
PEPFAR will assist EHNRI to establish a national equipment maintenance policy. This will involve training of engineers at different
levels, making available spare parts and a proper equipment inventory. PEPFAR will support establishing a "bundling" mechanism
that ties purchase of selected reagents to equipment maintenance with vendors of equipment as well as by consolidating
maintenance contracts with equipment manufacturers or their local representatives especially as laboratory services with
numerous equipments are expanding.
PEPFAR Ethiopia will also support implementation of the National Master Plans for Laboratory Services and Logistics
Management. The Supply Chain Management System (SCMS) will provide logistics support for the transportation and distribution
of all laboratory commodities to all 138 ART hospital networks. PEPFAR will support reagent management needs, while inventory
and forecasting of supplies will be supported through technical assistance, with these efforts coordinated with other governmental
and donor stakeholders. For example, coordination with or leveraging GFATM monies for purchase of some test kits will occur,
particularly with HIV rapid test kits. PEPFAR will continue to develop the capacity of personnel at the national, regional and local
levels to implement an efficient supply chain management system for laboratory commodities. SCMS will work to develop the
capacity of the Pharmaceutical Funds and Supply Agency (PFSA, the national medical stores) to strengthen its central and
regional hub capacity to handle the special logistics needs for laboratory supplies, including cold chain requirements. SCMS will
deploy three additional RLLAs, and will supply CD4, chemistry and hematology commodities per the National HIV Commodity
Quantification Exercise, in coordination with EHNRI and Clinton HIV/AIDS Initiative staff jointly undertaking quantification.
With the support of CDC, EHNRI will provide national leadership in strategic planning, laboratory policies, guidelines, integrated
services and testing, and ensure implementation of laboratory standards. With EHNRI support, regional reference laboratories will
coordinate activities, including regional training, reference testing, EQA services, viral load and EID. APHL, ASCP, ASM and CLSI
will provide technical assistance at several levels for quality improvement, EQA data analysis and interpretation and evaluation of
programs, networking, referral linkages, developing and standardizing of training modules, SOPs, development of laboratory
policies and guidelines, guidance towards accreditation, and certification of clinical laboratory services. CDC, with partners, will
support EHNRI to establish a national accreditation committee, using the WHO laboratory accreditation guidelines/checklist to
support accreditation of national, regional, district and health center laboratories. The WHO accreditation system provides a cost
effective approach for different levels of laboratories.
PEPFAR Ethiopia partners will support standard clinical laboratory services for HIV/AIDS at the site level. U.S. universities will
work closely with laboratories at the regional level to provide technical assistance (site level training, laboratory management, and
follow up of implementation of standardized laboratory services) within their respective regions and health networks (hospitals and
health centers). University partners will also be involved in providing technical assistance for referral linkages between hospital
and health centers, including specimen management and transport, sample tracking, and recording and reporting systems. They
will work in close collaboration with, and under the leadership of EHNRI and regional labs in implementation of the Maputo
recommendations. They will work to integrate OI and STI diagnosis with the existing HIV/AIDS laboratory support. At the health
center level, MSH will support laboratories in training, sample referral testing, implementing quality assurance based on national
plans, minor renovation and furnishings, coordination of referral testing in collaboration with university partners, establishing
simple diagnostic techniques for OIs at facilities, and providing comprehensive laboratory site-level support at health centers in
major regions and Addis Ababa.
By the end of FY09, diagnosis of HIV/TB/OI/STI and laboratory monitoring services (hematology, biochemical, and CD4 profiles)
will be provided to more than 450,000 pre-ART patients on care and 210,000 patients on ART, as per the "National Guidelines for
Use of ARV Drugs". PEPFAR will support DNA-PCR based early virologic tests to approximately 48,800 infants. The revised
national HIV rapid testing algorithm and QA/QC program will be operational at all VCT sites. All major regional specialized referral
hospitals and regional laboratories will be networked and the laboratory information system will be operational for effective
implementation of QA, monitoring and evaluation of services. With PEPFAR Ethiopia partners, CDC Ethiopia will coordinate and
follow up integrated laboratory services including HIV/AIDS care, treatment, and prevention activities.
PEPFAR Ethiopia recognizes that sustainability of USG supported programs requires more than close collaboration with the GOE.
It also requires the support of non-governmental, indigenous organizations. As part of local capacity development and
sustainability, PEPFAR Ethiopia partners are required to work directly with such local organizations. ASCP and APHL will work
closely with local organizations including the National Reference and regional laboratories. APHL will support the Ethiopian Public
Health Laboratory Association and regional reference laboratories. ASCP will work with the Ethiopian Medical Laboratory
Association (EMLA) and laboratory schools. PSCMS will also work closely with the national supply chain management system
and ensure that local capacity is developed to implement the supply chain services. These efforts will ensure the development of
excellent laboratory capacity, including leadership, within the country.