PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
This activity now includes 5,291,000 additinoal funds (moved from SCMS) towards the reginoal warehosue
construciton.
Renovations - Health Facility ART: Technical Assistance to Support MOH Construction
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This activity will be modified under COP09 to focus on technical assistance to the Ministry of Health's
Planning and Program Department (MOH/PPD). MOH/PPD has developed a Project Management Unit
(PMU) to oversee the conversion of 891 health stations to "Nucleus B" health centers. These smaller health
centers are a centerpiece of the MOH's efforts to achieve universal access to primary health care in the
country, including HIV services.
A USAID/Washington Infrastructure and Engineering (I&E) team assessment of MOH/PPD capacity to
implement the planned infrastructure improvements revealed that most sites will require new construction,
as
Efforts will be shifted from direct facility assessment and renovation, to capacity building and support for
MOH efforts to carry out these activities. A major focus on developing maintenance programs for existing
and future facilities will also be included, as lack of preventive maintenance has been cited as a major
cause of dysfunctional basic systems such as water, electricity, waste water and waste disposal, as well as
threats to the structural integrity of health facilities in some cases.
Short-term technical assistance to staff the MOH PMU will be provided, with a transition plan for assumption
of these positions by MOH staff as part of the new activity design.
Technical assistance to Regional Health Bureaus (RHBs) building "matching" Nucleus B Health Centers will
also be included in this support, including training human resources such as engineers and architects, as
well as maintenance staff.
Coordination of health construction efforts will continue to be a focus, and coordination with new USG
partners carrying out inspections of facilities constructed by the MOH with PEPFAR funds will be included.
This activity is expected to be competed in the coming months.
COP 08 Narrative:
In 2007, this continuing activity provided technical support for renovation of selected health centers targeted
to receive comprehensive ART services. To date, 70 engineering assessments have been conducted and
23 health centers renovated in the four most populous regions and Addis Ababa. As such, the activity is
ahead of its original targets and work plan.
The purpose of this activity is to harmonize and coordinate various health center renovation and
construction initiatives supporting improved HIV/AIDS and associated chronic disease services in Ethiopia
and to carry out selected renovations, filling gaps when other funds are not available.
Previously, an assessment compiled by Family Health International (FHI) in FY06 identified infrastructure
deficiencies as a major obstacle impeding sustained progress in achieving ART targets. In particular, ART
services require adequate infrastructure to support the sizeable increase in ART clients (about 200/site)
expected at the PEPFAR priority health centers. In FY07, these findings were confirmed and extended by
Crown Agents based on an assessment of 44 health centers currently providing ART services in four
PEPFAR priority regions and Addis Ababa. Nearly all were found to have major physical (structural) and/or
essential functions problems (e.g., lack of water, blocked waste water disposal lines, overflowing dry pit
latrines) as well as space limitations that compromise patient care and the safety of clients and healthcare
providers.
Successful transfer of HIV/AIDS and associated chronic disease services from hospitals to health centers
requires bringing health centers up to a minimum performance standard for safe and quality delivery of ART
services through: a) repair of major physical (structural) problems; b) improvements in essential functions;
c) more effective use of existing space to facilitate patient care and safety; d) provision of basic hygiene and
environmental health controls to minimize the risk of transmitting TB and other serious co-infections to
patients, other clients and healthcare providers; e) upgrading maternity (labor and delivery) and newborn
units to promote PMTCT services as well as the care and treatment of HIV/AIDS infected mothers, infants
and young children; and f) replacement of destroyed or non-repairable furniture and fittings. To keep
facilities fully functional post-renovation, it also will be necessary to implement and to support a modest
maintenance management training program and mentoring of selected healthcare staff. This on-the-job
training is needed to ensure that renovation works, patient flow and space use improvements are sustained
and that basic hygiene, environmental health control and recommended infection prevention practices are
understood and routinely adhered to by both professional and housekeeping staff.
Working in close coordination with the Federal Ministry of Health (FMOH) and regional health bureaus
(RHB), Crown Agents will continue to provide support for procurement of health center renovation services,
materials and project management services, including managing contracts with local building supply and
service providers and ensuring these contracts are legally binding and adhered to by all parties. These
procurement services will gradually be transitioned to the FMOH, initially with seconded staff supporting
government personnel, with these positions eventually to be assumed by the FMOH. Through close
monitoring and quality checks, Crown Agents will support the FMOH to ensure compliance with local (or as
required, international) standards, and ensure clear and transparent reporting. Further, Crown Agents will
support the FMOH in providing technical mentorship to RHB and other stakeholders regarding systematic
health facility renovation, strategic planning and renovation management. As needed, staff may be
seconded to RHB supporting these functions, with a clear understanding that they would eventually be
assumed by the regions. Finally, the strengthening of formal communication channels that began in FY06
will continue to ensure that PEPFAR Ethiopia partners, the FMOH, RHB and any other stakeholders
Activity Narrative: involved in health facility renovation are consulted throughout the life cycle of the project.
Currently, bilateral and multilateral agencies, as well as non-governmental organizations (NGO), many of
these PEPFAR partners or USG-supported institutions supported with non-HIV/AIDS funds, are working
independently to renovate health centers and other health facilities. Although the Global Fund to Fight
AIDS, Tuberculosis, and Malaria (GFATM) supports limited renovation, systematic coordination of all these
efforts has been lacking. Moreover, block grants from the FMOH to RHB have resulted in somewhat
sporadic renovation, with limited impact in terms of supporting comprehensive HIV services including ART.
Structured coordination, therefore, is urgently needed between and among these agencies, the FMOH and
RHB to rationalize infrastructure improvements at health center facilities and expand sustainable ART
services nationally.
As part of its leadership role in health facility renovation, during FY2007 Crown Agents was charged with
being responsible for harmonizing and coordinating health center renovation activities of all PEPFAR
Ethiopia partners. This activity ties in directly with the project's continuing assistance to further the FMOH
efforts to coordinate and standardize health center renovation by all organizations - both USG and non-
USG. In addition, support for compiling existing health center assessment information, as well as tracking
renovation activities and resources by PEPFAR Ethiopia partners, will continue to be carried out by Crown
Agents. This tracking and coordination function, carried out in conjunction with the FMOH, with the ultimate
goal of passing complete responsibility for the activity to FMOH Planning and Program Department (PPD),
will expand to coordinate and map renovation at other types of health facilities during FY08.
Because several PEPFAR Ethiopia partners are included among those institutions currently engaged in
health center renovation activities, closer harmonization and coordination of these activities at the service
delivery level is needed. To date Management Sciences for Health's Rational Pharmaceutical Management
Plus (RPM Plus) project has renovated pharmacy stores as well voluntary and counseling testing (VCT) and
ARV dispensing rooms at 23 health centers, while IntraHealth has renovated selected rooms for PMTCT
and antenatal care at 18. Other key PEPFAR Ethiopia partners involved in renovation include the new Care
and Support Project (lead: Management Sciences for Health), ART service expansion (Family Health
International), JSI/Deliver (health center stores) and the USG Regional Procurement Supply Office (RPSO)
which renovates hospitals in conjunction with PEPFAR-supported university partners. RPSO may renovate
health centers in the remaining five regions of Ethiopia during FY08. In FY08, most of these partners will
continue to be involved in health center renovation and refurbishing that will be coordinated under the
umbrella of FMOH/PPD, with technical support from Crown Agents. Ultimately, however, the critical
coordination role Crown Agents now fills, due to the lack of FMOH staff, will be transferred to FMOH
counterparts for long-term sustainability.
In FY08, Crown Agents will continue to support renovation of selected urban and peri-urban health centers
with high HIV prevalence that are initiating or continuing ART services. This will be accomplished through
the following activities: 1)targeted assessment and renovation of an additional 70 health centers to allow
effective/efficient services to be provided in a safe environment, thereby helping to ensure the quality of
HIV/AIDS and associated chronic disease services; 2) coordination of PEPFAR Ethiopia partners'
renovation efforts at the health center level; 3) support to the FMOH PPD in coordinating existing health
facility renovation efforts; standardizing renovation approaches, guidelines and designs; and
institutionalizing practical maintenance management and environmental health control practices.
Accomplishing these will assist the FMOH in effectively decentralizing ART and associated chronic disease
services in a sustainable manner. The HIV/AIDS Prevention and Control Office (HAPCO) is also requesting
support for construction of residences for staff at health centers and remote hospitals, and Crown Agents
will at a minimum support the coordination and planning for this staff retention mechanism.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16664
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16664 6460.08 U.S. Agency for To Be Determined 7495 4067.08 Health Center
International Renovations
Development
10485 6460.07 U.S. Agency for Crown Agents 5501 4067.07 Renovations - $3,300,000
International Health Center
Development ART
6460 6460.06 U.S. Agency for Crown Agents 4067 4067.06 Renovations - $900,000
Emphasis Areas
Construction/Renovation
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
involved in health facility renovation are consulted throughout the life cycle of the project.
Activity Narrative: these PEPFAR partners or USG-supported institutions supported with non-HIV/AIDS funds, are working
New/Continuing Activity: New Activity
Continuing Activity:
