Executive Summary For the period 2010-2014, Pact is undertaking a new five year associate Cooperative Agreement which seeks to provide a mechanism for implementing a grants management program that includes targeted technical assistance and capacity development for HIV/AIDS programs. The program is aimed contributing to the achievement of the goals of the Lesotho Partnership Framework (2009-2014); PEPFAR Strategy and the Lesotho's National AIDS Strategy (2006-2011). In collaboration with partner organizations, Pact's program specifically contributes to the realization of goals 1, 2, and 4 of the partnership framework. The overall goal sought is to "Reduce the impact of HIV and AIDS and improve health care for Lesotho". Pact's primary objectives are:

1. To prevent HIV transmission through multiple strategies that promote abstinence, faithfulness, partner reduction and other prevention activities including promotion of condom use 2. To provide quality, comprehensive and compassionate care and support services for orphans and other vulnerable children

Pact's partners will be awarded PEPFAR funding through a competitive process to implement programs in Sexual and other Sexual Prevention; Orphans and Vulnerable Children (OVC) services and Health System Strengthening (HSS). Through the sub-granting mechanism, Pact will build capacities of community based organizations to provide HIV services to the communities. To ensure adequate and quality technical support to the grantees, Pact will provide on-going technical support to implementing partners through training, mentoring and supportive supervision. In addition, technical input to strengthen national HIV/AIDS strategies and policies will be provided.

Pact's program shall include cross cutting mechanisms for economic strengthening, and HIV/AIDS workplace programs. With regard to gender-based violence, Pact shall implement interventions aimed at raising community awareness and mobilizing communities to undermine societal and community norms that perpetuate violence against women and other marginalized populations. Workplace programs shall target both small and medium enterprises to implement HIV/AIDS care, treatment and prevention interventions for their members, and employees.

The Pact program will contribute towards Health System Strengthening within Lesotho by building the technical capacity of partner organizations through on-going formal trainings and customized on-the-job support in the areas of strategic information, technical expertise, organizational development, and financial management. In-service trainings provided to both community volunteers and health professionals engaged in partner programs also go a long way in contributing to the development of human resources for health within Lesotho. Pact aims to promote the establishment and strengthening of viable and a sustainable civil society to address the HIV/AIDS epidemic in Lesotho. As a strategic entry, Pact will work with selected umbrella and network organizations with a view to broadening HIV and AIDS service base while developing lasting capacities of networks and their members to ensure sustainable institutions. While Pact is committed to ensuring provision of quality services that comprehensively meet the needs of targeted beneficiaries, it also strives to promote efficiency within its programs. Partner organizations are guided in the design of cost-effective programs where program targets and costs per person served are carefully considered to ensure that they are in-line with similar program costs in the Southern African region. To further promote program efficiency and cost effectiveness, Pact will network with other partners working within the same communities and leverage available resources.

Pact's grant monitoring strategy focuses on results-based management and ensures that program processes, products and services contribute to the achievement of clearly stated results. Pact implements a Performance Monitoring Plan (PMP) that tracks project outputs towards PEPFAR goal achievement as well as progress on building grantees' capacity and organizational effectiveness.

Through comprehensive compliance reporting, and periodic site visits, Pact ensures that technical programs are implemented as proposed, funds are properly expended, and that necessary and timely program adjustments are made appropriately. Pact supports grantees in the development of their monitoring, evaluation and reporting (MER) systems for tracking relevant PEPFAR-specific indicators.

Pact's PMP tracks and evaluates all key program concepts by utilizing various approaches including: routine program performance reviews, capacity assessments, and targeted studies. Overall administrative, financial, technical and organizational systems development capacities are evaluated at regular intervals during the grant period using various Pact capacity assessment tools, while special areas of interest for learning can be investigated using targeted studies. Pact proposes to engage a team of external experts that are technically competent to periodically review program progress to inform program direction.

For sustainability, Pact will ensure that partners are supported to align their programs with national systems: partners' plans will be aligned with district health management team priorities and partner results are reported through existing government structures. To further ensure that work done by Pact partners continues after the PEPFAR grant, partners shall be equipped with resource mobilization skills, to avoid reliance on PEPFAR funding. With an increased number of CSOs with strengthened capacity to provide services, there will be a reduced burden on government for service provision, and a stronger voice for advocating for HIV/AIDS policies and general health systems development in Lesotho.

Context and background

Lesotho has an estimated population of 1.88 million with 60% living below the poverty datum line (OVC NAP: 2006). The number of Orphans and vulnerable children is estimated at 210,000 (Lesotho Populations & Housing census, NBS 2006). This situation calls for more focused interventions which address the needs of orphans and vulnerable children (OVC). According to NSP 2006-2011, one of the targets being emphasized is to increase percentage of AIDS orphans in need of accessing OVC services to 90% by 2011.

In this regard, Pact is committed to implementing an OVC program that contributes to the achievement of the goals of the Lesotho Partnership Framework (2009-2014); PEPFAR Strategy and the Lesotho's National AIDS Strategy (2006-2011).

Accomplishments since last COP

During the period under consideration, Pact through its partner SWAALES) served a total of 888(M 431, F457) OVCs and trained 20 individuals to provide OVC care and support. OVCs were served through home-based care visits and received services including psychosocial support; preparation for death counseling, grief counseling, HIV and AIDS counseling, treatment adherence, and follow-up on immunizations and referrals to health facilities. OVCs were also served with supplementary feeding consisting of one meal a day for five days a week. Other services provided to OVCs included educational support (school fees, scholastic materials), and life skills education.

Challenges:

As indicated in the prevention budget code, Pact faced the same challenge of delay in awarding sub-grants thus having no partners to implement program activities.

Goals and Strategies for the Coming Year

Pact's goal is to develop and strengthen capacity of its partners to provide quality, comprehensive and compassionate care and support services for orphans and other vulnerable children.

Pact is committed to improving the quality of life of OVC and to address social and cultural norms that undermine the situation of OVCs in Lesotho. Partners programs will focus on addressing community support and coordination to meet OVC needs, strengthen capacity of households and families to care for OVCs and improve the quality of OVC service delivery. The program targets orphans and vulnerable children aged 17 years or younger; particularly those orphaned due to HIV related causes, HIV positive children and most vulnerable children who live without adequate support from adults. Special emphasis is placed on OVCs in very remote areas with a shortage of trained social welfare staff and with limited access to quality, comprehensive OVC social and health care services and support.

Pact will provide local community based organizations with technical and organizational development support to increase their capacity to effectively and efficiently reach OVCs. Pact supports partners to design and implement programs that address individual risk of targeted beneficiaries, as well as societal factors that increase OVC vulnerability. Where possible, programs will link with relevant partners to address OVC stigma and social neglect, abuse and exploitation, trafficking, loss of inherited property, harmful gender norms, alcohol and substance abuse. To mitigate challenges related to volunteer recruitment and retention, Pact will provide volunteer management training and support to enable partners provide on-going training, motivation, on-site mentoring and supervision for effective program delivery.

Pact's partners will focus on providing OVCs with care and support services which include; basic psycho-social support and life skills, OVC household economics strengthening, referrals for medical treatment, educational and vocational services, and HIV prevention education, referrals for legal support, material support, supplementary feeding and nutritional support. Community volunteers will be trained in various OVC care and support components to equip them with necessary skills to assess and provide for OVC needs through timely and regular home visits.

SWAALES will support OVCs in thirteen villages of Berea, Maseru and Leribe districts. SWAALES' OVC program focuses on delivering quality care and support services to 1,000 OVC through trained service providers by improving access to education, referrals for health services, and increasing OVC's access to basic social services including psychosocial and nutritional support. SWAALES' program also aims to counter stigma and discrimination against OVC, and building life skills for OVCs and their guardians in order to contribute to the socio-economic welfare of OVC and reduction of child abuse in the communities.

SWAALES' program provides direct support to OVCs, their caregivers, families and community members, and focuses on ensuring OVCs have basic needs and safe environment which is conducive to their growth and development. OVCs are provided with supplementary feeding consisting of one meal a day for five days a week, OVC weighed monthly, data recorded in the community monitors' registers and educational support i.e. scholastic materials and uniforms. OVC caregivers provide one-to-one basis mentoring, referrals and follow-ups with program beneficiaries and their households. At family level, the program supports OVC households (heads and/or guardians) in basic OVC care and support. Support OVC with after-school homework and encourage child-to-child discussions. SWAALES will also strengthen economic capacity of older OVC and that of their households through provision of support to establish vegetable gardens and other Income generating activities. To ensure quality programming, caregivers are trained to ensure proper assessment of OVC needs, identifying needs for referrals and follow up on health status/referrals through home visits. SWAALES will train both its staff and community monitors in counseling, prevention in sexual abuse, TB/HIV and AIDS literacy, psychosocial counseling, income generating skills, basic hygiene and also train children's' club leaders in leadership and psychosocial support.

SWAALES will strive to improve on its volunteer management strategy, motivate staff and volunteers for higher retention and lower volunteer turn-over. Pact intends to acquire at least five more partners to implement OVC activities during the course of FY11.

Other Potential Partner Activities:

Partners are anticipated to implement in districts of Berea, Leribe, Mafeteng, Thaba Tseka, and Quthing

OVC service package will include the following services: Referrals for health care services, educational support, social protection services, nutritional support and psychosocial support. Referrals for health care services, support OVC community committees, support OVC with accessing their birth certificates and death certificates of their parents/guardians; provide scholastic materials to facilitate school attendance; facilitate establishment of kids club and related club activities; support establishment of households gardens; and training of caregivers in OVC psychosocial support and provide counseling to OVCs in need.

Context and Background: With nearly a quarter of Lesotho's adult population estimated to be HIV positive, AIDS constitutes an alarming threat. According to the National AIDS Commission (NAC) and UNAIDS, approximately 29,000 new infections occurred in 2007. Absence, illness, premature death, and early retirements lead to loss of skills and experience and declining productivity, affecting development, damaging an already strained economy, and placing high demands on the health care system.

Pact's primary goal is to build the institutional capacity of partners in order to increase their effectiveness and capacity in achieving expanded and quality services, while strengthening the management of organizational financial and human resources. Pact will engage technical expert organizations to support improved capacity in the design and delivery of planned services and interventions by implementing partners.

Goals and Strategies for the Coming Year

Organizational capacity assessments and individualized capacity building plans:

Pact will conduct organizational assessments by analyzing key areas of risk in organizational management including finance and strategic planning. Every year organizations will be reassessed to determine progress made and outstanding areas of weakness that need to be addressed. Pact will work with each partner to develop a tailored plan that institutes a phased capacity building agenda based upon the results of the reassessments.

Organizational development and capacity building interventions:

Capacity building interventions will include formal training and on-site customized mentoring, and supportive supervision targeting strengthened financial management, accountability and monitoring systems. Other support includes human resource system development, good governance and resource mobilization. Partners will receive training in Organizational development (OD); Financial management; Grants Management; Project Management (3 day); Resource Mobilization (3 day); Governance and Leadership; and Volunteer Management.

Technical Assistance:

Pact through its technical partner organizations will ensure that implementing partners are provided with assistance in assessing weakness and strengths of the technical aspects of their programs. All partners will receive direct one to one technical assistance in enhancing the design of their overall programs which will result in improved quality of service delivery. The technical assistance provided will also enable the partners to improve efficiency of their programs by identifying opportunities through which more clients can be reached with more services. This technical assistance will be provided through Pact's partnering with other technically resourced organization as well as through regional and international technical experts where required.

Network Strengthening

Nongovernmental organizations (NGOs), governments, and international donor agencies collaborate in networks and partnerships with visions of improving the delivery of social services and catalyzing transformative social change. Partner organizations expect benefits such as increased outreach to poor communities, improved quality of services through more rapid development and dissemination of 'best practices', and greater efficiencies through resource-sharing and coordination of activities.

Pact will aim to support partners as they adopt more collaborative approaches in order to maximize leveraging of partnerships and resources, while mitigating potentially negative outcomes. Pact's approach will focus on building a strong, well-functioning civil society network at the national level who can advocate for improved policies and services for HIV/AIDS infected and affected Basotho. The national network will represent local NGO, CBO and FBO and serve on national Technical Working Groups and other technical committees expressing the interests and needs of all civil society.

Through strong grant making compliance and program monitoring mechanisms, Pact will strengthen capacity and service delivery within Lesotho's civil society to respond to the epidemic by expanding, improving, and replicating existing service and integrating new and complementary services into a well-coordinated response. Where practical, public-private alliance will be sought to bring together partners who will jointly define the problem, strategize a solution to capitalize on combined knowledge, skills expertise, and resources.

Monitoring and Evaluation

Pact will continue prioritizing building and strengthening of community based monitoring and evaluation systems through: training, supportive supervision, and mentoring of community-based service providers in basic M&E and organizational development related to M&E functions within their organizations. In all technical assistance, Pact targets wider organizational rather than project-specific systems strengthening in order to ensure sustained and institutionalized MER systems improvements.

Additional capacity building interventions will include development of knowledge management processes which will contribute to improvements in organizational learning and use of data to improve performance. These include:

MER Capacity Assessments which provide benchmark information on the status of human capacity and systems development;

Formal training in Basic MER Principles and Concepts, Data Quality Management, and Program Evaluation; and

On-going mentoring and supportive supervision tailored to individual partner needs.

Partner data quality assessments will also be conducted to ensure that data generated meets quality requirements for reporting to PEPFAR.

Context and Background

Lesotho's estimated population stands at 1.88 million, 59.8% of which is aged between 15-64 years, and 35.3% aged 0-14 years (US Census Bureau 2008 estimate).

This most recent estimate shows that Lesotho's HIV prevalence rate increased by 0.4% from 2007 and now stands at 23.6% and total HIV-positive population is approximately 280,000 (Lesotho UNGASS Country Report 2009). The 2009 UNGASS Report also shows that there is ongoing disproportionate impact of HIV as 57.7% of all HIV-positive adults are female while only 42.3% are male.

The generalized epidemic, necessitates broader, far reaching strategies that have been incorporated into the revised Lesotho National HIV and AIDS Strategic Plan, 2006-2011 which become a results-based plan (2009 UNGASS Report)

With this background, Pact is committed to implementing a sexual prevention program that contributes to the achievement of the goals of the Lesotho Partnership Framework (2009-2014); PEPFAR Strategy and the Lesotho's National AIDS Strategy (2006-2011).

Accomplishments since Last COP

During this reporting period, Pact through its partners (ADAAL, CRS,) working in 5 districts (Leribe, Maseru, Mohales' Hoek, Mafeteng, Quthing) reached a total of 1,352 individuals with Abstinence and Being-faithful messages.

ADAAL implemented a school-based peer education program in 20 schools of Mafeteng, Mohale's Hoek and Quthing districts contributing a total of 932 individuals; while CRS which worked for only two months before the end of their grant reached 420 individuals.

Partners' sexual prevention outreach activities were guided by manuals that provide interactive and participatory techniques such as stories and discussion questions to guide benficiaries' understanding of sexuality and HIV/AIDS. Beneficiaries were reached through group discussions in HIV/AIDS club meetings and classroom visits.

A total of 124 individuals were trained to promote HIV/AIDS prevention programs through AB by ADAAL. One of the main challenges experienced by Pact's program this FY has been absence of partners to work with due to the slow APS process. Pact signed a cooperative agreement with USAID in October 2009 to implement a five year capacity building grant. In preparation for issuing sub grants under the new award, Pact administered an Annual Program Statement (APS) which served as a solicitation for prospective local and international NGOs to apply for USAID funding through Pact. By mid December 2009, Pact had reviewed all submitted round 1 concept papers and full proposals from applicants. However, towards the end of December 2009, USAID advised Pact to put the APS process on-hold until further notice because USAID implementation priorities and strategy had changed. In January 2010, USAID advised Pact to re-issue the APS and this required redeveloping the APS from scratch and sharing the draft with USAID for concurrence. Starting the whole process all over again meant program delivery was delayed since no sub- grant awards were issued. This negatively affected implementation and explains the underperformance. ADAAL which is the only prevention partner retained by Pact also implemented for few months due to delay caused the elaborate processes of closing out the old grant and being enrolled on to the new grant.

Goals and Strategies for the Coming Year

Objectives:

To develop and strengthen capacity of its partners to prevent HIV transmission through multiple strategies that promote abstinence, faithfulness, partner reduction and other prevention activities including promotion of condom use

Pact's overall strategy is to facilitate civil society to implement a focused sexual prevention program that:

Address larger socio-cultural and societal contexts which can influence HIV risk and vulnerability in Lesotho

Prioritize key risk groups

Address key behavioral outcome through emphasis on behavioral change instead of mere knowledge and awareness creation

Promote combination prevention through linkages with other HIV services

Pact will support partners to design and implement programs that not only address individual risk of targeted beneficiaries but also through structural interventions which address societal, cultural and economic contexts which contribute to increase in risk for HIV transmission in communities. Interventions targeting socio-economic and cultural norms include but not limited to; early marriages, partner reduction, gender-based violence, intergenerational and transactional sex, private sector involvement and stigma-reduction. Partners will undertake interventions to make school environments safer for girls, reduce risks for factory workers, reduce harmful gender norms, and reduce alcohol and substance abuse. Other factors to be addressed include; stigma and discrimination associated with HIV/AIDS, low levels of consistent and correct condom use, cross generational sex, transactional sex and multiple concurrent partnerships (MCP).

Program activities will be designed to facilitate behavior change. Beneficiaries will not only be provided with useful information on HIV/AIDS to increase their awareness, but also with the skills and motivation needed to adopt positive behaviors. Program activities will be designed to involve regular contact with targeted beneficiaries through on-going support and guidance aimed at facilitating the adoption and continued application of adopted positive behavior

Youth aged 10-14 years will be targeted with interventions promoting abstinence and/or the delay of sexual debut; individuals aged 15 years and above will be appropriately targeted with partner reduction, abstinence and mutual monogamy interventions. Most at risk groups including factory workers, sex workers and their clients, mobile population, shall be targeted with special interventions aimed at increasing their access to quality HIV/AIDS prevention. Correct and consistent condom use, sexual partner reduction, alcohol abuse reduction/prevention and effective use of available health care and other support services are likely to be critical HIV prevention themes in these interventions. Pact anticipates acquiring four new partners during the course of FY11 to implement program activities.

Partners' programs shall also incorporate interventions aimed at increasing community empowerment, participation and involvement in reducing the spread of HIV. Parents and guardians will be assisted to improve communication with youth about HIV/AIDS, as well as their mentoring role in relation to adolescents. Behavior change interventions will be delivered through peer groups, media campaigns, national events, community mobilization and interpersonal communication efforts will be used in concerts to encourage individuals, families, and communities to adopt and maintain healthy behaviors and norms. Prevention of sexual abuse activities will also supplement sexual prevention in communities by addressing sexual abuse and violence/ coercion which also contribute to spread of HIV transmission in Lesotho

Targeted beneficiaries are enrolled into HIV discussion groups/clubs through which they are routinely reached with curriculum-based activities that are rich in technical content and methodology.. The manuals use interactive and participatory techniques such as stories and discussion questions to guide participants' understanding of sexuality and HIV/AIDS. Youth and adult groups will provide fora for discussions and skills building, particularly around decision making, peer pressure, family life, and body changes for youths, sexuality and HIV/AIDS. Participatory learning approaches including games, role plays and stories to practice and help internalize positive behavior change are very useful in this regard. Below are specifics of partner sexual prevention interventions:

ADAAL will continue to implement a school-based peer education and drug abuse program in 20 schools of Mafeteng, Mahale's Hoek and Quthing districts. ADAAL's primary target are youth of both gender aged between 10-24 years and their teachers. ADAAL promotes abstinence among youths and teachers using school-based peer educators utilizing the "Choose Life" Manual. Students are reached through school HIV/AIDS clubs, classroom visits, and use of drama and sports which motivates student participation. The program also involves school-based counseling provided by a trained focal teachers and peer counselors to provide one-on one support to students in need. Teachers on the other hand are reached with AB interventions to address multiple concurrent partnerships, unprotected sex, transactional and cross-generational sex by their peers using "Keys to a healthy relationship" curriculum.

With the aid of a "Peer educator pocket booklet" and an "Anti drug abuse and HIV/AIDS" training guide, youth and teachers will be helped to understand the linkage between substance abuse and HIV/AIDS. School communities and parents are to be targeted with activities aimed at promoting their engagement in creating safe environments for the youth (both at school and within their communities).

Other Potential Partner Activities: Pact anticipates acquiring more partners to implement prevention interventions. Partner activities are anticipated to cover all districts of Lesotho namely; Berea, Maseru, Mokhotlong, Mafeteng, Mahale's Hoek, Leribe, Butha Buthe, Qacha's Nek, Thaba Tseka and Quthing districts. Community outreach programs will appropriately target specific audiences and age groups through the use of volunteer peer educators. Some will target youth, women, school youths; out-of school youth; and factory workers with their partners etc.

Their expected program activities are summarized below:

Partners' programs shall incorporate interventions aimed at increasing community empowerment, participation and involvement in reducing the spread of HIV.

Parents and guardians will be assisted to improve communication with youth about HIV/AIDS, as well as their mentoring role in relation to adolescents.

Behavior change interventions will be delivered through peer groups, media campaigns, national events, community mobilization and interpersonal communication efforts will be used in concerts to encourage individuals, families, and communities to adopt and maintain healthy behaviors and norms.

Prevention of sexual abuse activities will also supplement sexual prevention in communities by addressing sexual abuse and violence/ coercion which also contribute to spread of HIV transmission in Lesotho

Partners will be assisted to train their program staff and community volunteers in behavior change counseling. A "Motivational Interviewing" (MI) curriculum will be used to impart participants with basic behavior change counseling techniques to reinforce behavior change activities. The curriculum helps trainees to discuss MI principals and techniques, recognizing resistance to behavior change and overcoming such resistance, as well as helping youth/adults create plans for behavior change.

Influential community members will be trained in Prevention of Sexual Abuse. Influential adults are people who can develop policies, referral systems, and speak into the social systems that allow sexual abuse to happen. The training helps key influential individuals understand the concept of sexual abuse, link stories of sexual abuse to real life scenarios, identify abuse signs, as well as counseling skills to handle post-sexual abuse related trauma within communities.

At program level, Quality Improvement and Verification Checklists (QIVCs) will be used by program management staff for support supervision of community-based trainers and peer educators. All partner programs will focus on ensuring linkages with other HIV services to foster complementarities and efficiency in service delivery. This may include providing access to HCT, PMTCT, Male circumcision, and other appropriate services through collaborations and referrals.

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