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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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
USG Malawi put into place a Counseling and Testing Agency staff member beginning in 2000 to provide
technical leadership and program management in CT, as well as in TB/HIV and PMTCT. The CT specialist
works directly with the Government of Malawi (GoM) and implementing partners to provide technical
assistance (TA) on national policy, produce policy documents, guidelines, training packages, and to
manage USG CT programs.
Using FY 2008 funds, the USG country team will continue to maintain a CT Specialist within its
multidisciplinary technical team. As a member of the USG interagency team, the CT specialist will provide
up-to-date technical information relating to CT, monitor CT activities of local partners to ensure adherence
to prescribed standards, and work with the GoM to develop and change policies in CT. Other core
responsibilities of activities of the CT specialist will include collecting and analyzing performance information
to track progress toward planned results, use performance information to inform program decision-making
and resource allocation, and communicate results achieved for all CT partners.
This activity is linked to, and will complement, the NAC-supported full time CT Technical Assistant (TA)
within the MoH (Activity ID#10711). The NAC-supported TA will work within the MoH structure directly
coordinating all CT activities and leading day-to-day implementation of activities at all levels. The USG CT
specialist will work within the USG country team to strategically support Malawi's national CT program and
ensure that activities meet quality standards for the USG emergency Plan (EP) plan for Malawi.
During FY 2007, the CT specialist provided significant technical input for landmark CT activities in Malawi
including the second round of the National CT week campaign, the change in policy to switch from parallel
to serial testing, development of guidelines for HIV testing in Children, the revision of national curricula for
training CT counselors, and the incorporation of CT as part of the standard package of care for TB and STI
Activity 1: Full-Time CT Specialist within USG Malawi Technical Team
USG will use FY 2008 funding for CT to maintain a full time CT specialist within USG Malawi's interagency
team. In FY 2008, the CT specialist will continue to support policy development including review and
revision of existing national CT documents. Specific tasks in FY 2008 will include guiding the transition
from parallel to serial testing, and further developing provider initiated CT in Malawi. The activities of the CT
specialist are as follows:
i) Technical Assistance (TA)
The CT specialist will provide TA to NAC, the MoH, NGOs, and other collaborating organizations in the
planning and implementation of CT activities in Malawi. S/he will assist the Interagency team in ensuring
that priorities, goals, and objectives consistent with the USG policies, international guidelines, and those of
host country are established and followed. The CT specialist will advice on appropriate quality assurance
procedures, staffing, facilities, patient information, client confidentiality, outreach efforts, reporting, and
record keeping procedures. Other activities will include promoting collaborative efforts with minimal overlap
by collaborating organizations, promoting coordination with lab support staff to ensure quality assurance for
HIV testing as required, serving as the primary contact for all CT collaborators within Malawi to the USG
team assisting in resolving significant issues arising in the implementation and delivery of CT services in
Malawi and advising the USG inter-agency on the key issues related to the planning and implementation of
ii). Program Planning
The CT specialist will plan and monitor activities and budgets with USG CT partners, assist partners with
development and monitoring of work plans, assist in writing the technical aspects of funding mechanisms
(such as cooperative agreements and contracts) and budgets with partners. The CT activities will include
ensuring that partners' quarterly reports are timely and accurate. On a regular and on-going basis, the CT
specialist will assess partners' progress in meeting program targets, goals ,and activities; recommends
corrective action if a partner fails to perform well; promote and monitor the routine offer of HIV Testing and
Counseling from services such as STI treatment, PMTCT, and TB treatment; promote and monitor that CT
providers refer clients and patients to appropriate services; and ensures that partners perform regular
supervision and quality assurance activities for counseling and testing consistent with MoH and USG
iii). Monitoring and Evaluation
The CT specialist will collaborate with the USG M and E officers; monitor CT programs and activities carried
out by USG partners in Malawi; and review CT data collected, record keeping procedures, and
methodologies and approaches used in the delivery of CT services. The CT Specialist will analyze data
collected to assess accuracy, trends, and quality of services; develop, monitor, and present special studies/
evaluations to inform site, district and national level; review efforts by collaborators to maintain quality
assurance in the delivery of services; assist in analyzing the effectiveness of activities in terms of their
appropriateness, methodology and coverage; and evaluate activities of collaborators in reaching agreed-
upon goals and objectives and recommend actions to enhance and improve CT services and activities.
Where appropriate, participates in and supports dissemination efforts to inform CT practice and policies.
The USG team will hire a US board-certified Medical Officer with expertise in AIDS care and infectious
diseases management to provide leadership, expert advice, and direct technical support to the USG team in
all matters relating to ART treatment and clinical care. The incumbent will be the Project Officer that
provides technical oversight to the USG cooperative agreement with the Lighthouse Trust and the National
Malawi is making considerable progress towards achieving its target of enrolling 250,000 individuals into the
ART program by 2010. By June 30, 2007, 114,375 patients had been enrolled into the ART program in both
public and private sector institutions. Management of existing patients at the 146 public and private sector
sites is anticipated to become increasingly complex as the Malawi program transitions from acute to chronic
care. Changing from standard first line drug regimens to alternative first line drugs increasingly will be
challenging. Viral resistance to first line drugs and switching to second line drugs is a cause for concern for
those that have been on treatment for a long time. Even though resistance to ART drugs may not be an
immediate threat, we will continue to conduct active surveillance and support the early warning system for
drug resistance. The issues of TB/HIV co-infection and the management of multi-drug resistance for TB
including X-DR TB is a looming specter in Malawi. This is further compounded by the changing treatment
options for pregnant and breast feeding mothers as well as the proper management of infected infants.
The USG Malawi has supported the Ministry of Health (MoH) with ART service deliver by mostly investing in
the management and coordination of the service and monitoring the service outcome. This has been done
without a resident Medical Officer on the USG team. With the anticipated complexity of the ART service in
Malawi, the USG team thought it prudent to recruit a Medical Officer that would play a leadership role in not
only in advising the USG team on clinical matters relating to AIDS case management but would work
actively with counterparts especially to TA that will be placed in the MOH to support the Government of
Malawi (GoM) efforts at reaching the target of enrolling 250,000 patients on ART by 2010. The incumbent
would provide technical input to any policy changes associated with the management of AIDS cases in the
general adult population, pregnant women, and children
Activity 1: Clinical care
• The incumbent will represent the USG in all matters pertaining to HIV/AIDS treatment and care as well as
provide expert advice and direct technical support to the GoM and private as well as Mission efforts at
expanding ART services from the current 114,375 patients at 146 sites to 250,000 patients at 150 sites by
2010. This is in concert with Malawi's aspiration for Universal Access to ART services by 2010.
• The incumbent will provide expert advice in the development and implementation of a GoM strategy that
would increase the number of children less than 15 years of age accessing ART services from 6% to 15%
by 2010. This will be part of a broader PMTCT program.
• The incumbent will provide advise and actively provide support for the expanded management of
opportunistic infections in AIDS patients, including wide spread use of cotrimoxazole.
• The incumbent will participate in the ART drug resistance monitoring effort in partnership with the
epidemiology and laboratory teams. He/she would be a resource for any change in policy with regard to
drug regimen changes.
Activity 2: Project officer
• The incumbent will be the Project Officer managing the Cooperative Agreement between USG and the
Lighthouse Trust, the single largest provider of treatment and care services in Malawi. The incumbent will
also oversee the new agreement in FY 2008 with NTP
• The incumbent will consider providing direct patient care at the Lighthouse, if so desired, as part of
Continuing Medical Education.
Activity 3: Applied Research
• The incumbent will advise the USG on priorities for public health evaluations and and targeted operations
research. In partnership with others in both the public and NGO sectors, the incumbent conduct applied
scientific research targeted at improving clinical management and care for AIDS cases.
• The incumbent will work with the MoH and other partners to organize research findings dissemination
meetings and workshops.
The USG Malawi Monitoring and Evaluation (Mand E) Officer provides technical leadership and program
management for M and E and Health Management Information System activities, including strategic
planning, routine monitoring and evaluation, capacity building, and data quality assessments. USG provides
technical assistance to partners in order to assist Malawi in meeting its SI goals of generating empirical
information about HIV and AIDS that informs policy, practice and interventions, building capacity at national,
district and community levels, and pursuing one of the ‘three ones', one harmonized and functional M and E
system for the national response to HIV and AIDS.
The PEPFAR team employs two full-time M and E personnel (CDC M and E Officer and USG SI Liaison
Advisor). The CDC M and E officer functions as an integral member of the GAP office in Malawi, and
initiates, conducts, and coordinates complex HIV/AIDS M and E program activities in collaboration with the
Ministry of Health (MoH), its National AIDS Commission (NAC), nongovernmental, multinationals, and
bilateral organizations. In FY 2007, the M and E Officer advised the USG on matters related to the
measurement of its contribution toward achieving PEPFAR's targets, translated M and E and other Strategic
Information (SI) into improved programming and delivery of services, strengthened systems of
accountability for use of PEPFAR resources, contributed to a single national monitoring and evaluation (M
and E) system in Malawi and strengthened systems and capacity among partners to collect, manage, and
use quality M and E data to inform program and policy in the national response to HIV and AIDS.
Activity 1: Country Operation Plan Development (COP)
In FY 2008, the M and E Officer will ensure systems are in place at USG and USG's implementing partners
to effectively plan and monitor programs for the Emergency Plan (EP) requirements. In close collaboration
with the USG HIV/AIDS Coordination Team (HCT), and in collaboration with the USG/Malawi Strategic
Information Liaison, the M and E Officer manages and coordinates M&E-related processes required for the
development of the annual COP for CDC-funded partners and provides technical guidance on M and E
needs of the EP in Malawi. The M and E Officer will build implementing partner capacity to respond to
planning and reporting requirements, review and assess the targets set by individual partners and ensure
that they are ambitious, yet reasonable. The M and E Officer will track the progress of results achieved by
implementing partners against their targets and track overall progress in achieving the EP goals as outlined
in the Malawi strategy and, when needed, recommending adapting targets to be consistent with
appropriated budgets, country constraints, and new opportunities.
Activity 2: Coordination for Monitoring and Evaluation
In FY 2008, the M and E Officer will continue to provide technical support to the ongoing implementation
and enhancement of the National HIV/AIDS M and E System, including harmonization of national indicators,
data sources, and reporting systems to assess progress and report on HIV/AIDS programs in Malawi. The
M and E Officer will also participate in key technical working groups (the Monitoring and Evaluation and
Information Systems Technical Working Group at NAC and the Monitoring, Evaluation, and Research
Technical Working Group at MoH) to ensure enhanced coordination, harmonization, and strengthening of M
and E Systems. The M and E Officer is expected to establish and maintain close relationships with all
international development partner representatives and GoM officials working in these areas to ensure
consistency and harmony of results reporting and to develop shared languages around issues of attribution.
The M and E Officer is also expected to participate in the collaboration and coordination of activities with
other international partners present in country (e.g., World Health Organizations (WHO), UNAIDS, Global
Fund to Fight AIDS, TB and Malaria (GFATM), and the World Bank).
Activity 3: Strategic Planning
In FY 2008, the M and E Officer will assist with the coordination of strategic planning, monitoring, and
evaluation of programmatic activities of USG, including the development of M and E plans and standardized
program monitoring systems. The M and E Officer will work closely with USG staff across HIV/AIDS
technical areas supported by USG to ensure that data generated by the M and E systems are useful and
used for program planning, policy development, advocacy, and program evaluation.
Activity 4: Technical Leadership and Coordination of EDS
In FY 2007, USG played a critical leadership role on the Electronic Data System Task Force, and provided
technical input on the evaluation of the EDS system. A detailed evaluation protocol has been developed
outlining the methodology and timeline for the pilot of the Electronic Data System (EDS) for ART. The tools
for data collection include a time-flow survey tool, a quality of care observation form, user surveys and
system error log forms. The evaluation protocol and tools have been shared with a broader audience,
including a presentation at the HIV implementers meeting. Additionally, USG facilitated a detailed and
systematic beta testing for the two systems under development.
In FY 2008, the M and E Officer will continue to provide technical leadership and coordination to Electronic
Data System for ART pilot and roll-out, including the coordination of the EDS Task force, the coordination
and implementation of the EDS pilot evaluation, the finalization of data transfer/exchange (HL7, Data
Repository), roll-out planning (site development, evaluating EDS roll-Out), and documentation and
dissemination of Malawi EDS as Best Practice.
Activity 4: Program Monitoring and Reporting
The M and E Officer will continue to be responsible for timely compilation and reporting of indicators for
monitoring the progress of the Emergency Plan for USG-funded partners. This requires the updating and
dissemination of country M and E guidelines, standards, and manuals to partners and ensuring consistency
with the latest Emergency Plan M and E guidelines. In FY 2008, the M and E Officer, in collaboration with
the HCT team, will ensure that the Emergency Plan data and indicators meet benchmark data quality
standards; and will be the point of contact for auditors and program reviewers addressing reporting
Activity Narrative: The M and E Officer will also provide technical oversight to activities and milestones agreed upon with the
partners and the USG management team. As the primary point of contact, the M and E Officer will meet
with the partners on a regular basis to review progress, and provide technical input to strengthening the
implementation and coordination of partner activities.
Activity 5: Systems Strengthening/Partner Capacity Building
In FY 2008, the M and E Officer will work with USG funded partners, including National AIDS Commission
and Ministry of Health, to strengthen their M and E capacity. The M and E Officer will support partners in
their efforts to better plan and monitor programs using M and E and other strategic information. Assistance
may include training or technical assistance in data collection, data management, analysis, data use and
dissemination. The M and E Officer will provide assistance to USG partners to enhance M and E systems
through the use of innovative technologies. The Officer will support CDC partners to better understand
implications of M and E data and translate M and E findings into meaningful programs and practices.
Activity 6: Data Quality Assessment Tools
In collaboration with the OGAC SI Liaison and USG SI Liaison Advisor, the M and E Officer will work with
local partners to implement data quality assessment activities to assess the data collection, reporting, and
management systems in place to measure indicators of program and project success.
The USG Malawi Epidemiologist provides technical leadership and program management over all HIV/AIDS
surveillance, public health evaluations and management for a subset of USG partners in Strategic
Information - related activities. This is an integral part of the USG team core competencies provided by
CDC. USG provides technical assistance to partners in order to assist Malawi in meeting its SI goals of
generating empirical information about HIV and AIDS that informs policy, practice and interventions,
building capacity at national, district and community levels, and pursuing one of the ‘three ones', one
harmonized and functional M & E system for the national response to HIV and AIDS.
PEPFAR supports implementation of these activities through partner organizations such as the HIV Drug
Resistance Monitoring Survey (National AIDS Commission (NAC), Ministry of Health (MoH)), Data
Triangulation (NAC), and Operations Research (NAC, Lighthouse).
The PEPFAR team employs one full-time Epidemiologist who works as an integral member of the USG
Malawi. The Epidemiologist initiates, conducts, and coordinates complex HIV/AIDS epidemiologic program
activities in collaboration with the MoH, NAC, nongovernmental, multinationals, and bilateral organizations;
and provides epidemiologic advice and consultation as a national and internationally recognized expert.
In FY 2007, the USG Epidemiologist provided technical support on several major activities, including the
HIV Drug Resistance Threshold Survey (HIVDR) and Early Warning Indicator (EWI) Report, the Behavioral
Surveillance Survey (BSS), the Demographic Health Survey (DHS) Lilongwe re-sample, and National
Triangulation and Impact Assessment Workshops. The Epidemiologist served as a mentor to an
Association of Schools of Public Health (ASPH) Strategic Information Fellow, also supported through
PEPFAR, who assisted with implementation of these activities.
Activity 1: Technical Support for HIV Surveillance
In FY 2008, the USG Epidemiologist will provide direct technical support for a variety of HIV surveillance
and epidemiology activities planned for Malawi, including the HIVDR Surveillance Activities (Prospective
Monitoring Survey, Early Warning Indicator Reports), Data Synthesis and Triangulation, Behavioral Sentinel
Surveillance (Interpretation of FY 2007 results, planning for FY2009 activities), and HIV Prevalence National
Estimates Workshops. The epidemiologist will also continue to work with primary partners on reviewing the
national surveillance plan, identifying gaps that require additional attention.
In addition to supporting these large surveillance activities, the epidemiologist will provide technical support
as needed as a member of the Research Technical Working Group, BSS Technical Working Group, and
HIV DR Task Force.
Activity 2: Assist Develop a National Surveillance Plan
The USG Epidemiologist will continue to work with MoH, NAC and other stakeholders to develop a national
surveillance plan that includes both sero/biological surveillance as well as behavioral surveillance. This
includes the development of an operational plan for the MoH Epidemiology Unit as it takes responsibility for
conducting and or assuring HIV Surveillance
Activity 3: Maintain Collaborative Relations
The USG Epidemiologist will maintain collaborative working relationships and promote mutual sharing of
surveillance data and analysis from HIV/AIDS programs with other USG partners, local NGOs, and donors.
The Epidemiologist will provide technical assistance for planning, analysis and use of existing data as part
of on-going 2nd Generation Surveillance, e.g. Triangulation analysis.
This activity is linked to the activity narrative in HTXS ID# 15422 describing the USG intergagency team
USG Malawi plays a critical role in providing technical assistance to the Ministry of Health (MoH) in planning
and implementing HIV/AIDS programs. Therefore, in FY 2008 CDC will hire a Medical Officer to provide
senior technical leadership and management to the inter-agency USG team and its partners, including the
National AIDS Commission (NAC) and MoH, in the provision of quality HIV/AIDS treatment and care
The Medical Officer will provide expert advice and direct technical support as it relates to training clinical
officers, nurses, and other service providers in the management of AIDS cases; will represent the USG
team on several Technical Working Groups; and will be critical to the overall USG strategy of strengthening
capacity and systems for AIDS patient care provided by the Government of Malawi and other partner
Activity 1: Training support to MoH staff
i). The USG Medical Officer will provide USG technical leadership for training clinical officers, nurses, and
other service providers in the management of
ii). The USG Medical Officer will mentor key staff of USG partner institutions for leadership roles in clinical
HIV/AIDS service provision.
Activity 2: National Policy Development
i). The USG Medical Officer will participate as a subject-matter expert in the development and
implementation of national policies for the proper
management of TB/HIV co-infection.
ii). The USG Medical Officer will participate as a subject-matter expert in the development and
implementation of policies that greatly increase access to
ART services by eligible pregnant women.
Activity 3: Technical Working Groups
The USG Medical Officer will represent the USG team on several technical working groups including:
i). Care and Treatment
ii). Pediatric Diagnosis and Referral
iv). Scientific Planning and Information Dissemination
This narrative describes the CDC Malawi M and S needs for both GHAI and Global AIDS Program (GAP)
funds. The CDC Malawi M and S budget, including GHAI and GAP funding, has been vetted through the
interagency decision making process and agreed to as presented in the FY 2008 COP submission.
Malawi is not a PEPFAR focus country but Malawi receives significant resources from the Global Fund for
AIDS, TB and Malaria (GFATM). Because of the very limited human and technical capacity to implement
programs in Malawi, the GFATM depends on the USG to complement their efforts by providing critical
technical staff to assist with program design and implementation. The USG Malawi team's M and S goals
reflect a strategic approach to both addressing the needs of the GFATM programs and that of the programs
directly supported by the USG. The M and S plan for the HHS/CDC office in Malawi, is designed to have
sufficient staff during the FY 2008 period and beyond, to provide appropriate technical and programmatic
oversight and assistance to all implementing partners in Malawi. The CDC M and S budget in FY 2008
COP supports the USG interagency team process of providing technical assistance and monitoring of
PEPFAR activities across a significant array of implementing partners in Malawi. CDC has seven
cooperative agreements supporting a broad range of implementing partner activities including GFATM
activities in nine program areas. Upcoming RFA awards will add two new partners in calendar year 2008.
To achieve the goals of effective technical assistance to the Government of Malawi and its' implementing
partners, the CDC GAP Office in Malawi had planned for fifteen positions in FY 2008. This is an increase of
one technical position (Medical Officer) over the previous year. Two technical positions were originally
planned for in 2008 however limits in our budget did not permit the addition of the second position, a
Laboratory Specialist. If funding is available and the entire PEPFAR USG team is in concurrence we will be
able to fill this position in FY 2009.
The FY 2008 COPHHS/CDC staffing plan includes four USDH that are comprised of the Chief of Party,
Deputy Director, Medical Officer, and Epidemiologist. No new USDH positions are sought in COP 2008.
The current HHS/CDC staffing plan also includes two non PSC contractor positions; a Monitoring and
Evaluation Officer and a Counseling and Testing Specialist (both supported through Comforce) and one
ASPH fellow. We are currently converting both our Comforce non PSC contractors to US PSC positions in
FY 2008. Additionally we have eight FSNs which include a Program Management officer, an Administrative
Officer, two IT support staff, three drivers and one custodian.
M and S costs are inclusive of rent for offices, utilities, office operational costs, M and S specific equipment,
travel for M and S staff, training for M and S staff, residential leases and post allowance for the 2 USDH M
and S positions, and increased communications costs related to enhancement of office communications
and connectivity. This FY 2008 COP submission does not include HQ TA support in keeping with FY 2008
COP guidance that this will be funded through the Headquarters Operational Plan process.
ICASS charges of $366,000 and CSCS charges $178,525 are budgeted separately in their own activities
with the prime partner listed as State as required by FY 2008 COP guidance.