Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 7527
Country/Region: Ethiopia
Year: 2010
Main Partner: Population Services International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $2,290,000

Funding for Care: Adult Care and Support (HBHC): $2,290,000


Preventive Care Package: Access to Home Water Treatment


This activity was awarded to Population Services International in 2008.

COP 08 Narratives:

This is a continuing activity from FY 2006 that received FY 2007 supplemental funding. The supplemental funding was recently obligated to the partner, and implementation is beginning in late FY 2007. Funding has been augmented to increase safe water access for ART, pre-ART and PMTCT clients.

People living in resource-poor settings often have limited access to safe water and basic methods of hygiene and sanitation. The situation in Ethiopia is no different as only 36% of the population has access to a safe and adequate water supply, and only 29% has access to excretal disposal facilities. The government is currently addressing this issue through the health extension program where Health Extension Workers (HEW) and health promoters educate, mobilize, and support communities in constructing safe excreta disposals and teaching about safe water storage (an activity supported by the USG with non-PEPFAR funds).

PEPFAR Ethiopia will build on the government's safe water initiative to improve safe water access among PLWHAPLWHAA. This is important as there is ample evidence that simple safe water interventions radically improve the quality of life for PLWHAPLWHAA. For instance, a study of HIV-positive persons and their families in Uganda showed that use of a simple, home-based safe water system reduced incidence of diarrhea episodes by 25%, and the cost was less than $5 per family per year.

This activity strongly supports a safe water program as an element of the preventive care package for PLWHAPLWHAA in adherence to OGAC guidance. This activity will work closely with PEPFAR Ethiopia partners operating at hospitals and health centers to build on their safe water efforts and strengthen their links with community-based initiatives and safe water outlets.

Thirty hospitals and ninety health centers providing ART, PMTCT and HIV/AIDS care services and their surrounding community networks will be targeted, with particular attention to high prevalence areas with poor water and sanitation services. It will include: distribution of a locally-produced point-of-use water treatment, WuhaAgar, which is a diluted sodium hypochlorite approved by Ethiopian authorities, at voluntary counseling and testing (VCT), ART, PMTCT and postnatal clinics; inclusion of a voucher entitling HIV/AIDS-affected clients to receive free bottled water disinfectant at a nearby commercial outlet to avoid travel to the health facility just for the sake of getting WuhaAgar; training of health providers at hospitals and health centers on hygiene and safe water counseling; consistent supply of WuhaAgar to the facility-based service outlets; sensitization of commercial providers to the voucher approach; monitoring of the voucher program at commercial outlets primarily through stock monitoring; support of existing community-based education on hygiene and safe water by the health extension workers and community health promoters; assessment and revision of existing teaching materials; and the design of new information, education, communication (IEC) and behavior change communications (BCC) resources for patient education at facilities and by community health extension workers and health promoters on personal hygiene, safe water storage, and home water treatment, including how to use WuhaAgar.

The implementing partner will coordinate with the Ministry of Health HIV/AIDS Prevention and Control Office (MOH/HAPCO), Health Education Center, AIDS Resource Centers, the non-PEPFAR USG Essential Services for Health (ESHE) project (now known as Integrated Family Health Program), and other relevant PEPFAR Ethiopia partners on designing the IEC materials.

The implementing partners will spearhead the social marketing of WuhaAgar through commercial market outlets in urban and per urban areas. It will work in partnership with other PEPFAR partners, including the US universities, the Care and Support Program, IntraHealth, Family Health International, Save the Children-USA, International Orthodox Christian Charities, World Food Program, and the Partnership for Supply Chain Management/Supply Chain Management Systems to distribute WuhaAgar to community and facility outlets providing HIV/AIDS care, treatment and PMTCT services.

The implementing partner will also ensure equity of availability for the product. Those not yet benefiting from PEPFAR Ethiopia programs or not yet aware of their status will have access to the products at affordable prices in local markets.

Please note that PEPFAR Ethiopia will not fund social marketing activities through this activity except to cover the cost of WuhaAgar utilized by PLWHAPLWHAA at health facilities or at commercial outlets through the voucher system.

This market-assisted approach will support sustainability, increase availability of the product through commercial outlets and reduce possible stigmatization of purchasers. Moreover, the implementing partners will collaborate with other USG partners, including the Millennium Water Alliance, to work on safe water and health promotion to maximize impact of this particular intervention. The point of use safe water product, WuhaAgar, is approved by Ethiopian authorities.

With plus up funding received in late FY 2007, and continuing into FY 2008, the project will produce and distribute a Preventive Care Package essential preventive care elements to pre-ART and ART clients through facility and community-based care programs. Distribution will be supplemented by the training and deployment of approximately 800 women living with HIV to counsel on using the prevention products and to sell items such as affordable home water treatment in the community to their peers living with HIV as well as the general community. This will create income generating activities for women living with HIV. Implementation will be as per national guidelines, will attempt to leverage existing MOH malaria and TB programs and will test various implementation models of delivery for cost and efficiency metrics.

The Preventive Care Package includes a range of services and items to reduce morbidity such as TB, diarrhea and malaria referral; home water treatment and locally available safe water storage vessels; oral rehydration salts; basic hygiene products including soap, bleach and antiseptic; multivitamins; antihelminthics; long-lasting insecticide treated nets (as required); and condoms for use by sexually active beneficiaries.

The package will include behavioral change and IEC elements meeting low-literacy levels regarding products described above in simple, pictorial form, as well as information and referral advice on cotrimoxazole prophylaxis, family planning methods to prevent unwanted pregnancy among women living with HIV, leaflets about STI treatment, referral for counseling and testing among family members over 18 months to know their HIV status, and referral of HIV-positive clients for TB screening.

Subpartners Total: $0
IntraHealth International, Inc.: NA
Population Council: NA
Cross Cutting Budget Categories and Known Amounts Total: $547,678
Economic Strengthening $6,270
Food and Nutrition: Policy, Tools, and Service Delivery $19,961
Gender: Gender Based Violence (GBV) $26,244
Human Resources for Health $131,004
Water $364,199
Key Issues Identified in Mechanism
End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services
Increasing women's access to income and productive resources
Child Survival Activities
Military Populations
Family Planning