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.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
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
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
n/a
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $35,000
OVERVIEW
With about 71,000 HIV infected patients in need of clinical palliative care in Ghana, laboratory services are an essential
component in the implementation and scale-up of HIV/AIDS and other related diseases programs. The current public health
system is structured in three levels that include hospitals, health centers and polyclinics. The national public health laboratory
system in Ghana is defined by a pyramid structure which includes a tertiary or reference level, a secondary or intermediate level,
and a primary or peripheral level. At the tertiary level, there the two university teaching hospitals laboratories and four public
health reference laboratories including the Public Health Reference Laboratory (NPHRL). Along with the Health Laboratory
Service (HLS), the NPHRL, under the GHS Institutional Care Division, has the overall responsibility of managing national
laboratory services in Ghana, including the three zonal public health laboratories.
The laboratories are located within the 119 government regional hospitals at the secondary level and 69 peripheral hospitals at
the primary levels. Within the private sector, the health system is comprised of 215 non-governmental and private mission
hospitals, military and para-statal facilities, and private clinics which provide a range of laboratory services. Presently, the
laboratory infrastructure for HIV, malaria, and TB testing and quality assurance remain weak in Ghana resulting in limited access
to quality laboratory services. Therefore, there is an urgent need to strengthen the laboratory capacity to expand testing programs
and establish quality management systems.
KEY INTERVENTIONS
The USG promotes quality laboratory services to ensure effective diagnosis, quality patient care, blood safety services,
conducting intervention assessments, and epidemiologic surveillance of the epidemic.
In FY2007, USG provided support to design a Logistics Management and Information System (LMIS) and inventory control
system for laboratory reagents and consumables for the HIV/AIDS, TB, malaria, and other programs laboratory services. This
system plays a key function to improve the availability of supplies and test kits required for the scale up of the ART program in
Ghana. Also, this same system has played a critical role to scale-up Rapid Diagnostic Tests (RDTs) for the Malaria program in
Ghana.
In FY2008, the USG provided support to assess and evaluate several functioning laboratories in Ghana as a first step to improve
laboratory services and a logistics information system. The purpose of these assessments was to evaluate laboratory capacity
and develop a plan for systematically improving the laboratory system. The reports generated from these assessments will be
used to formulate the new National Strategic Framework for HIV, Malaria, Tuberculosis and other related diseases.
Lastly, an assessment tool for malaria laboratories was developed by Improving Malaria Diagnostics Project (IMaD) in
collaboration with staff of the NPHRL. USAID/Ghana assisted IMaD in the assessment methodology and provided invaluable
technical support. The tool was designed to collect data in various sections. Moreover, a complete National Guidelines for
Laboratory Diagnosis of malaria has been developed with collaboration of NMCP and stakeholders.
CURRENT USG SUPPORT
USG continues to provide assistance to improve laboratory capacity in Ghana to support Care and Treatment, PMTCT,
Counseling and Testing, and routine HIV surveillance programs. In FY2008, USG provided a tremendous support for conducting
series of laboratory assessments for HIV, malaria and tuberculosis. The findings of these assessments will guide the development
of a national laboratory policy and a collaborative five-year national strategic laboratory plan that will serve as the basis for the
development of a sustainable national laboratory system.
USG efforts focus on providing technical assistance to the Ghana National Tuberculosis Program (NTP) in the development of an
operational plan for laboratories. This operational plan will include the following components: implementation of laboratory
commodity and information management systems, biosafety, quality assurance for sputum smear microscopy and supervision.
USG also provided technical support in the development of the NTP Strategic Plan 2008 - 2012 that includes a laboratory
component.
The assessments focused on gathering data on the capacity to perform quality microscopy-based malaria diagnosis in
laboratories country-wide with clear guidance for program strengthening. The purpose of the assessment was to provide
information on the status of laboratory-based malaria diagnosis in Ghana, and thus guide the definition and development of future
activities of the IMaD project working with the National Malaria Control Program (NMCP) to improve the reach and quality of
laboratory-based malaria diagnosis in Ghana.
USG FY09 SUPPORT
USG agencies will continue to work with the national HIV, TB and malaria programs to integrate laboratory services (TB, HIV, and
malaria) and identify the most efficient ways to use of the funds allocated for laboratory activities, by coordinating between the
different programs, including the Presidential Malaria Initiative.
Working in collaboration with all laboratory stakeholders and national programs, USG agencies will provide technical assistance to
establish national laboratory policies and guidance including a five-year strategic laboratory plan to develop a sustainable national
laboratory system.
Furthermore, Standard Operating Procedures (SOPs) and Job Aids will be developed for both clinical and laboratory staff
appropriate for all HIV, TB and malaria-related laboratory procedures.
Recent laboratory assessments have noted need for improved management of sharps and blood and needle safety training. DOD
would support infection control/blood borne pathogen assessments at all 9 clinical sites and on site training for staff. In addition,
funds will be used to supply gloves, sharps boxes and other safety equipment for all sites.
Lastly, USG will provide technical assistance and support training for an incidence study.
Also, USG agencies will assist to develop a national monitoring and evaluation plan for laboratory activities with clear laboratory
indicators.
LEVERAGING AND COORDINATION
USG will continue assisting the MOH in identifying additional and complementary funding from the Global Fund and other
agencies aimed at supporting supervision and quality assurance monitoring for laboratory services
USG will leverage Global Fund resources to assist NACP in disseminating all national procedure and guidelines related to
laboratory activities (i.e. national laboratory standards operating procedures (SOPs), standardized laboratory request forms and
inventory control card, standardized laboratory logbook).
Through, the Cooperative Agreement between the Safe Blood for Africa Foundation and the U.S. Centers for Disease Control,
funding could be leveraged to carry out training in all aspects of blood safety.
EXPANSION OF PROGRAM WITH ADDITIONAL COMPACT FUNDING
Quality Management Systems (QMS) are an essential component of a laboratory services, therefore additional USG efforts will be
concentrated on providing technical support to implement quality assurance activities in provincial hospitals and key laboratory
sites and work closely with the PHNRL to establish and reinforce existing quality assurance and quality control programs. MOH
has already developed laboratory logbooks that need to be reviewed and adapted to the needs of the various programs. There is
an urgent need to standardize laboratory data collection support.
PRODUCTS/OUTPUTS
An assessment tool for malaria laboratories developed by IMaD in collaboration with staff of the NPHRL.
Training for 40 regional laboratory supervisors in the development and ground testing of the IMaD assessment tool.
40 laboratories surveyed, representing 10% of all national laboratories.
9 DOD sites: DOD trains 18 laboratory personnel in sharps, blood and needle management
Funding: $35,000 GHAI funding though DOD.
CDC will use core funding to carry out the proposed activities.
Table 3.3.16:
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $1,088,400
In line with Staffing for Results approach, USG Ghana implements its PEPFAR HIV/AIDS program through an inter-agency
process of strategic planning, collaborative implementation and coordinated management and oversight. The US Ambassador
and USAID Mission Director guide the USG/Ghana team in leading high level activities to combat stigma and discrimination.
USAID/Ghana acts as the technical lead agency, with DOD, Peace Corps and Department of State having active HIV/AIDS
programs in-country. CDC currently does not have in-country presence but plans to have advisors to implement PMI and PEPFAR
activities during the year. In FY09, all USG Ghana implementing agencies will be involved in semi-annual implementing partners
meetings to further refine and coordinate the implementation of the COP. Once the staffing levels have been increased, USG
Ghana agencies will meet at regular intervals to discuss progress, further opportunities for collaboration and address any
significant issues that arise from its program monitoring and oversight activities.
Department of State activity narrative: The State Department implements the Ambassador's HIV/AIDS Self Help Fund which is a
small-grant activity that is critical to USG Ghana's engagement of new partners, particularly for local FBOs and CBOs, and
sustainability efforts through capacity-building to grant recipients. While a portion of GHAI funds allocated for Self-Help (10%, or
$5,000) support the overall management and administration of the PEPFAR Self-Help Program, including travel costs to supervise
and oversee grantees, PEPFAR funds do not directly support staffing costs of the Self-Help Program and no new staffing
positions are proposed. Those who will spend a percentage of their time on HIV/AIDS are: The Self-Help Coordinator (40% of
their time); the ECON assistant (10% of their time) and the ECON chief (5% or less of their time), all financed by DOS funds.
Through the Front Office and the Public Diplomacy Department, the State Department is informing the Ghanaian Public of the
activities and impact of the PEPFAR Program, as well as other programs such as the Presidential Malaria Initiative. The Office
Chief uses about 5% of their time for this function. The State Department will use early Compact funding to support a staff
member to strengthen public knowledge of the PEPFAR Program in Ghana.
United States Agency for International Development activity narrative: USAID provides leadership in USG Ghana's prevention,
pediatric and adult care and treatment, TB/HIV, orphans and vulnerable children, C&T, ART and policy/systems strengthening
efforts. USAID uses PEPFAR funds to support its HIV/AIDS Advisor, a TCN PSC position, and one full time FSN who work across
all program areas. In addition, due to the small size of USAID/Ghana and the high burden of PEPFAR on the Mission's support
staff, PEPFAR funds are used to support a portion of administrative support functions. A Contracts Officer, a Financial Officer and
a Program Officer each contribute 10% of their time. In addition, using early Compact FY09 funding, USAID/Ghana will continue
to fund an Administrative Assistant to assist with administrative tasks; and a Systems Strengthening Specialist to ensure
sustainability of the entire program.
Department of Defense activity narrative: DOD supports the Ghana Armed Forces' efforts in HIV/AIDS prevention, care and
treatment. Currently, DOD does not use PEPFAR funds to support any of its management and staffing costs but anticipates
recruiting one full-time FSN Advisor in addition to one M&E Advisor at Ghana Armed Forces with FY08 funding to implement its
HIV/AIDS program. DOD will not use FY09 funding to support these functions.
Peace Corps activity narrative: The Peace Corps engages its volunteers and their Ghanaian counterparts in HIV/AIDS training
resulting in community outreach activities to promote HIV prevention indirectly supporting ARV treatment and reducing stigma and
discrimination. The Peace Corps will use PEPFAR funds to support a Program Assistant position to assist with PEPFAR
administrative tasks. All Peace Corps volunteers spend less than 50% of their time on PEPFAR-related activities. Peace Corps is
developing an important collaboration with USAID and its implementers to shape the training program and to administer its small
grants program. The Assistant-Peace Corps Director for Health, Water and Sanitation is spending about 20% of their time on
HIV/AIDS, financed by Peace Corps operating expenses.
Centers for Disease Control and Prevention (CDC) activity narrative: CDC under PEPFAR in Ghana is leading efforts in
Laboratory Support and Strategic Information. Early FY08 Compact funding has been requested to finance one Epidemiologist
especially to lead the SI activities and this will continue using early FY09 Compact funding. CDC will support a temporary public
health advisor to help develop laboratory and SI activities in collaboration with the in-country team until a permanent staff person
is identified. However, final placement of the epidemiologist is subject to Embassy concurrence and is dependant on the
resolution of NSDD-38 issues.
Ghana's experience with interagency collaboration: SECSTATE cable 112759 dated October, 8th, 2008, requested lessons
learned with inter-agency collaboration through PMI and PEPFAR Phase I. USAID/Ghana manages and implements both
PEPFAR and PMI activities. PMI experiences will be reported elsewhere. This is the report on PEPFAR inter-agency experiences.
PEPFAR experience in Ghana is based on two year knowledge only with relatively small funding of up to 7.5 million USD per
year. The USG agencies involved in management of PEPFAR funds are USAID, the U.S. Departments of State and Defense,
and the U.S. Peace Corps, who work closely together on budget and programming coordination.
To date Center for Disease Control (CDC), an important player in HIV/AIDS assistance has no presence in Ghana. This creates
challenges with accessing CDC's expertise in critical technical areas but critical NSDD-38 issues hinder an early deployment of
CDC PEPFAR technical staff.
Recommendation: for smaller programs like the Ghana program, working with TDY CDC staff from neighboring Focus Countries
should be considered as an option.
Secondly, the remaining three USG agencies are understaffed, resulting in coordination problems, especially difficulties with
scheduling meetings, program evaluation and monitoring. The PEPFAR/Ghana program is working on addressing the above
challenges. For example, CDC is currently communicating with the U.S. Embassy on expanding the USG presence in Ghana for
CDC and most other agencies are increasing their staffing with regular or early Compact funding.
Recommendation: Inter-agency collaboration needs to go hand-in-hand with scaling up staffing to handle the increased workload.
Coordination is time-consuming.
Existing Positions:
USAID HIV/AIDS Advisor
New Positions:
New positions were requested through the FY08 and FY09 early Compact funding at USAID, DOD and CDC.
List of Partners (from Table 3.1) working in M&S, including budget for each partner in M&S
1. Mechanism:Management and Staffing
Agency: USAID
Partner: USAID
M&S Budget:$ 350,000
Account:CSH (USAID)
2. Mechanism:Management and Staffing
M&S Budget:$ 95,000
Account:GHCS (sate)
3. Mechanism:Management and Staffing
Agency: CDC
Partner: CDC
M&S Budget:$ 481,000
Account:GHCS (Sate)
4. Mechanism:Management and Staffing
Agency: DOD
Partner: DOD
M&S Budget:$ 53,000
Account:GHCS (State)
5. Mechanism:Management and Staffing
Agency: Peace Corps
Partner: Peace Corps
M&S Budget:$38,400
6. Mechanism:Management and Staffing
Agency: STATE
Partner: STATE
M&S Budget:$ 20,000
Table 3.3.19:
