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
Expansion of Integrated ANC/PMTCT Services
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a continuing activity from COP 08. Activities were formally implemented by Intrahealth.
Substantive changes were made in the COP 08 narrative and are as follows: This activity will provide a
comprehensive and tailored package of quality improvement support, training, supervision and technical
assistance in FY09 to existing community groups, Health Extension workers, (HEW's), Traditional Birth
Attendants, (TBA's), to support and increased uptake of PMTCT services at the community level. In
addition it will provide targeted promotion and community level campaigns to support PMTCT access and
understanding at the community level as well as expansion and scope of the Urban HEW program.
Trainings will be conducted for TBA's, HEW's, and community action facilitators on social mobilization for
PMTCT, referral of pregnant mothers for ANC/PMTCT, and male involvement. This training is an integral
part of a safe motherhood intervention aimed at averting new pediatric infections through linking community
and facility PMTCT endeavors. HEW and TBA are part of the community; they share local customs,
common values and norms, speak the local languages, and often have the trust and respect of the
community. These cadres can help mobilize the community to increase antenatal care-seeking behavior,
reduce stigma and discrimination, and increase male involvement. This activity will ensure collaboration with
EngenderHealth to incorporate Men as Partners activities into their program which are currently at health
posts. This activity will support facilities to significantly increase the number of male partners tested during
ANC visits.
Increasing the capacity of TBA and HEW to render household-level service delivery is vital to overcoming
the prevailing poor uptake of PMTCT services. This activity will work closely with Pathfinder on the new
FP/MCH program to ensure coordination and collaboration of community outreach efforts. The PEPFAR
partners will convene monthly forums with healthcare providers, including HEW, to review the ANC/PMTCT
intervention being executed at the facility and community levels. The HEW and TBA will have their own
mechanism to track referred mothers with community referral cards.
This activity will incorporate Men as Partners (MAP) program in Ethiopia. The program, established in
1996, works with men to promote gender equity and health in their families and communities. The MAP
curriculum will be adapted from two MAP manuals that were developed in Kenya and South Africa - both of
which were PEPFAR funded and have a heavy emphasis on HIV prevention. The four workshop modules
are 1) gender, 2) HIV and AIDS, 3) relationships, and 4) gender-based violence. Each module constantly
examines issues related to HIV prevention, which will encompass an ABC approach. The MAP workshop
reaches participants with 15 hours of interaction on these topics. The objectives of this activity is to provide
tools and technical assistance related to MAP to local partners and to reach communities, especially men
and young boys, with messages about the links between HIV/AIDS, STI, alcohol and ‘khat' chewing, and
gender-based violence. The intervention will primarily target unmarried, out-of-school young men with
multiple partners. This high-risk population is particularly vulnerable to HIV infection/transmission. The MAP
intervention will also target other key beneficiaries including older men, community leaders, parents, and out
-of-school young women.
COP08 ACTIVITY NARRATIVE
IntraHealth will continue to provide a comprehensive package of support for quality improvement, training,
supervision, and technical assistance in COP08 in a total of 150 new health centers and health posts.
IntraHealth will prioritize the expansion of PMTCT to the health-post and community level. IntraHealth will
expand the pilot home-based delivery of Nevirapine (NVP) while working to strengthen Mothers' Support
Groups at the community level to increase the overall quality, access, and use of ANC and PMTCT services
in Ethiopia. The breakdown of IntraHealth's FY08 funding by activity is as follows: $1,500,000 for MSG,
$1,700,000 for health center sites, and $1.8 million to expand the NVP home-delivery for a total of
$5,000,000.
IntraHealth currently supports 248 health centers as of the end of August 2007. IntraHealth will transfer the
supervision and support responsibilities in over 20 health centers in Gambella, Benishangul, and Somalia to
USG university partners in October 2007. In FY08, IntraHealth will pick up an estimated 200 new health
centers while transferring the current 248 sites to the Care and Support program under MSH. With FY08
funding, IntraHealth will maintain support to the 200 COP07 health centers until time to transition them to
MSH, while picking up 150 new sites in COP08. IntraHealth will assess the capacity of the 150 new health
centers and health posts in the areas of lab, staffing, equipment, etc. IntraHealth aims to train 320 new
health providers in PMTCT according to the new national PMTCT guidelines. IntraHealth will provide
additional refresher training in 2008 on the guidelines, covering such topics as the opt-out strategy, short-
course combined prophylaxis, and early infant diagnosis. In addition to providing training, IntraHealth aims
to improve the quality of the ANC and PMTCT services through the implementation of performance
standards, quality assurance tools, and sharing best practices, which include a family-centered approach.
IntraHealth will support the health facilities in initiating the integration of PMTCT services into existing MCH
services to ensure HIV+ women receive better referral linkages and increased access to a wide range of
health services, especially ART. Pregnant women will be routinely tested for HIV during ANC, L&D, and/or
postpartum, as appropriate. All HIV+ women should receive TB screening, FP counseling, clinical staging
and CD4 count when possible, treatment for STI and OI and IPT as needed. IntraHealth will prepare health
providers on how to better care for HIV+ pregnant women and their infants. Currently the health facilities
supported by IntraHealth are testing, on average, 62% of women attending ANC with a 5.5% HIV
prevalence rate. Of those testing positive, about 40% of mothers and 26% of infants receive NVP. There is
a significant cascade effect that IntraHealth will aim to address in the coming year.
A key strategy for providing better care and support to HIV-positive women will be the expansion of
Activity Narrative: Mothers' Support Groups (MSG). By the end of FY07, the MSG program under IntraHealth will expand to
reach a total of 64 ART health networks, and during FY08 another 50 networks will be added, for a total of
114 ART health networks offering MSG services. JHPIEGO will be supporting MSG programs in 35
hospitals in these networks. About 2,300 HIV+ women are expected to enroll in the MSG program
supported by IntraHealth during 2008. Given the chronic human-resource shortages health facilities are
grappling with every day, appropriately selected and trained Mother Mentors will continue to prove valuable
resources by serving as "expert patients." Mother Mentors and health providers will promote safe infant
feeding and be well informed on family planning methods in order to better counsel HIV+ mothers about
their options. The MSG program will continue to engage male partners of HIV+ mothers focusing on
behavioral issues related to testing and counseling, secondary prevention, and stigma reduction. The
activity will also be linked to IGA to improve women's access to financial resources and employment.
IntraHealth will provide on-site clinical mentoring, as well as routine supervision and site assessments, to
monitor progress. This partner will also be responsible for tracking the status of PMTCT supplies, including
test kits, infection-prevention materials, and drugs to make certain that PMTCT services are fully functional.
Part of the monitoring role will also involve strengthening the data surveillance system at the health-facility
level. IntraHealth will assist providers in collecting, reporting, and using data to evaluate the progress and
gaps in PMTCT services.
Over the past three years, IntraHealth trained 370 TBA, 732 HEW, and 560 community action facilitators on
social mobilization for PMTCT, referral of pregnant mothers for ANC/PMTCT, and male involvement. This
training is an integral part of a safe motherhood intervention aimed at averting new pediatric infections
through linking community and facility PMTCT endeavors. HEW and TBA are part of the community; they
share local customs, common values and norms, speak the local languages, and often have the trust and
respect of the community. These cadres can help mobilize the community to increase antenatal care-
seeking behavior, reduce stigma and discrimination, and increase male involvement. IntraHealth will
collaborate with EngenderHealth to incorporate Men As Partners activities into their program, which is
currently in communities around 270 health posts. IntraHealth-supported facilities are testing only around
15% of male partners during ANC visits and will aim to significantly increase this number in the coming
year.
Increasing the capacity of TBA and HEW to render household-level service delivery are vital to overcoming
the prevailing poor uptake of the PMTCT service. IntraHealth will work closely with the new FP/MCH
program to ensure coordination and collaboration of community outreach efforts. The PEPFAR partners will
convene monthly forums with healthcare providers, including HEW, to review the ANC/PMTCT intervention
being executed at the facility and community levels. The HEW and TBA will have their own mechanism to
track referred mothers with community referral cards.
In COP08, IntraHealth will expand the pilot of NVP home-delivery by training over 400 TBA and HEW to
educate and refer pregnant mothers for ANC/PMTCT and to administer NVP to the infant within 72 hours of
birth. This activity began in March 2007 in Tigray and Oromiya regions in six health centers and 30 health
posts. HEW take fixed doses of NVP from the health center or health post to the household to facilitate the
mother and baby receiving the medicine. Alternatively, HEW accompany pregnant HIV-positive women to
health centers/posts for delivery and follow-up visits to receive the NVP. The results from the first six
months of this activity will be available in early October 2007. Between April-June 2007, HEW made 895
household visits, referred 216 pregnant women to ANC services, and delivered NVP at the household level
to seven mothers and six infants. IntraHealth will work in collaboration with RHB, district health offices,
HAPCO, and others to monitor and build sustainability for this intervention. Supervision is an important
element of capacity building to ensure the proper application of the social mobilization and referral of
mothers for ANC/PMTCT services. IntraHealth will emphasize joint supportive supervision and regular
quarterly reviews in order to back up the duties of community actors. This activity will aim to refer and test
90,000 pregnant women, their partners, and HIV-exposed children. IntraHealth-supported facilities will
provide follow-up care and treatment for 3,500 HIV+ mothers and infants.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16721
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16721 5586.08 U.S. Agency for IntraHealth 7523 593.08 Capacity Project $1,000,000
International International, Inc (HCD)
Development
10615 5586.07 U.S. Agency for IntraHealth 5549 593.07 $2,670,000
International International, Inc
5586 5586.06 U.S. Agency for IntraHealth 3757 593.06 $2,600,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Linking Pediatric Clients to Treatment
This activity will remain unchanged from COP08 narrative, except that there will be a new focus on pediatric
care and treatment at high volume health facilities.
COP 08 NARRATIVE
This is a continuing activity from FY07.
The continuum of care during and after the postpartum period is an important time to keep a watchful eye
on the newborn's growth and development, ensuring the prevention, early detection and enrollment in
treatment of HIV. As the vulnerability of the child begins earlier than previously recognized, early detection
of HIV and initiation of ART and OI prophylaxis improves the chance for long-term survival in the youngest
children with HIV.
PEPFAR Ethiopia believes that prevention is only a half the battle, and that a full spectrum of HIV/AIDS
services is needed to effectively fight the pandemic. Prevention services must link to treatment and care
programs in order to keep families healthy, strong and together. Only 10% of pregnant women have access
to PMTCT services program in Ethiopia and only six percent deliver in a health institution. Children (under
15 years of age) born to HIV-positive mothers and children symptomatic with HIV infection are left without
access to testing or ART. Health extension workers and health providers at health centers and health posts
can play a central role, once they have received instruction/training to identify and diagnose infants who
have not been tested and/or are considered vulnerable.
In an effort to keep pace with the estimated 13% of new HIV infections occurring in children annually, at
least 15% of patients receiving treatment are expected to be children. During FY06, IntraHealth initiated a
comprehensive pediatric HIV/AIDS care and support (CPCS) activity. In the first six months of
implementation, the project covered 70 health centers and their respective three satellite health posts
reaching 210 health posts. IntraHealth and local partners trained 884 health providers at health centers and
health extension workers/community resource volunteers (HEW/CRV) to identify and refer children to
access testing and treatment. As a result, 1,378 children were identified and referred for testing from the
community and through provider initiated activity. Two hundred forty eight children tested positive among
whom, 157 were referred to hospitals for ART. Eighty-five HIV-positive children were referred back from
hospitals to health centers for chronic follow-up care. Pediatric HIV/AIDS referrals have improved from
almost null at the health-center level to over 1,000.
Building on the successful lessons and experience drawn from the pilot CPCS project, IntraHealth proposes
to scale up access of CPCS to communities around 50 health centers and the respective five satellite health
posts. IntraHealth will continue to strengthen the 90 existing sites from FY06 and the 40 additional sites and
respective five health posts that will be picked up under COP 07. As of the end of September 2009, this
partner would be supporting pediatric case follow-up in 180 health centers and 900 health posts in Addis
Ababa, Amhara, Oromiya, SNNPR, Dire Dawa, and Tigray.
Expansion will be carried out through five steps that will be well coordinated and will improve the quality of
services.
Step one - Orientation: IntraHealth will conduct decentralized orientation, baseline assessment and
resource mapping in the new sites. This step will only take one day and includes the participation of about
30 personnel from different levels of health structure.
Step two-- Training: The activity will provide a six day centralized training for health workers working in
pediatric units on integrated management of neonatal and childhood illnesses (IMNCI) and chronic
HIV/AIDS follow-up care using standard manuals. Other training will include decentralized one day training
for MCH entry unit health providers on case detection and referral, and a two days training for the
respective HEW/CRV on active case detection and referral, adherence to treatment and defaulter tracing.
Five days after the training, IntraHealth will undertake follow-up, which includes supportive supervision for
health managers at woreda level. Lastly, a two day refresher course for existing sites and respective health
posts will be conducted.
Step three-- Service implementation and reinforcement: Reinforcement of skills and knowledge learned will
be provided to each trained health worker post-training, to ensure that the quality of service delivery
conforms to established standards.
Step four-- Collaboration and harmonization of activities: At all steps of implementation, IntraHealth will
assure that its activities are harmonized with those of its partners to ensure the continuum of care.
IntraHealth will collaborate with partners by organizing and attending stakeholders meetings and working
together on complementary activities, as well as creating joint forums for discussion. Such advocacy will be
an important step to ensure the right of HIV-positive child for attending school without stigma and
discrimination and to benefit from inheritance.
Step five-- Monitoring and evaluation: IntraHealth will ensure the quality of reports and incorporate
additional indicators, to be consistent with the national HMIS and will harmonize the indicators of pediatric
follow-up with those of PMTCT to avoid duplications. This activity focuses on gather more strategic
information to inform PMTCT and ART efforts in Ethiopia. It also aims to shift tasks to HEW/CRV in order to
lessen the burden on clinic-based health providers and increase community outreach for pediatric case-
finding.
A practice of monthly meetings of referring units, particularly the health centers, the Woreda's and the
Activity Narrative: community (HEW/CRV) is well established in some areas, but needs strengthening in many places to
improve coordination between all levels of care. Strong work relationships are recognized between the
IntraHealth team and the personnel throughout the health structure. Effective information and data
exchange now exists between IntraHealth, government and PEPFAR Ethiopia partners. IntraHealth and its
collaborating partners jointly monitor progress and undertake supportive supervision visits with the
respective health managers, an outcome which is positively viewed by the officials of Ministry of Health.
IntraHealth will continue to collaborate with the US universities (Columbia, Washington and John Hopkins)
to link HIV exposed children 0-18 months for Dried Blood Spot analyses, and HIV positive children above 18
months to 14 years for CD4 counts and ART initiation. The activity will also continue to work with Save the
Children's PC3 Orphans and Vulnerable Children project (10396) to link clinically malnourished infants to
nutritional support and other community services. The ESHE project will also work to identify chronically ill,
malnourished, and/or HIV-exposed infants and children in order to refer them for testing and appropriate
treatment.
The targets for this activity will be counted by other PEPFAR clinical partners providing ART. IntraHealth will
590 health providers on identifying and providing pediatric ART. This program aims to help initiate ART for
2,000 infants and children.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.11:
