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
This USG-supported activity through CDC's Sustainable Management Development Program (SMDP) will
train District Health Managers build management capacity for the Ministry of Health (MoH) zonal support
offices, and the Malawi Institute of Management (MIM).
Following the enactment of the Local Government Act in 1998, the MoH accelerated its pace and the
manner of decentralizing its decision making and functions to the district level. To move towards this goal
the Ministry abolished its regional offices in 1999. Effectively, district health service functions are under the
management of District Health Management Teams (DHMTs). Decentralization has transferred powers,
functions and decision-making to the district level in a radical manner with substantial independence of the
central level. However, these District level authorities are still within the public administration and operate
within the context of ultimate central control through policy cohesion, regulatory systems and monitoring
together with central planning control and allocation of resources.
Decentralization of health management is increasingly recognized internationally as a prerequisite for
efficient and effective management and planning in addition to enhancing local participation. The system is
also considered as a strategy for improving the performance of the civil service as well as having the
potential to reducing number of staff and costs by making more efficient use of the remaining staff. The
functions in the health sector have been devolved based on the assumption that the system has the
potential to achieving increased equity in terms of access and coverage, improved efficiency in the use of
resources and delivery of health services, enhanced accountability, improved quality of care as well as
improved health outcomes. Management of HIV/AIDS programs at district level stands to gain in terms of
efficiency and effective use of resources by devolving functions to the assemblies (districts).
The DHMTs develop plans and budgets at district level using the "District Implementation Plans" (DIPs), a
process that the MoH, through its Department of Planning and Policy Development with assistance from
Management Sciences for Health (MSH), partners of the Sector Wide Approach (SWAp) Common Fund
and technical assistance provided by Overseas Development Institute fellowship, has developed. On an on
going basis, the ministry provides guidelines and orientation to DHMTs for every annual circle.
A meeting of the Management Training stakeholders was held in May 2006. The meeting recommended
that DHMTs needed additional training in health sector planning and budgeting. In response to this need,
USG supported a training needs assessment, with collaborative input from MSH in November 2006. The
training needs assessment confirmed the stakeholders view and revealed that knowledge, skills and
performance gaps in public health program management existed among DHMTs. Furthermore, MoH and
MSH officials were in agreement with the view that DHMTs need a wider and complete understanding of
public program management if they are to meaningfully fulfill their role of managing functions of the health
sector at district level in addition to the DIP guidelines and orientation sessions that are provided to them.
Activity 1:Training District Health Managers
The Emergency Plan (EP) seeks to assist the Malawi Government achieve its goal by training district-level
decision-makers to plan and manage public health programs more effectively using SMDP management
training tool called, Healthy Plan-it. The training for DHMTs will improve the effectiveness of public health
programs in Malawi by empowering District Health officials with better management and decision-making
skills and stimulating creativity and innovation in problem-solving. The training will build the skills of local
public health managers to prioritize, plan, organize, monitor, and evaluate the use of organizational
resources (time, personnel and money) to prevent or control diseases, disabilities and premature mortality.
In FY 2007, 30 district health personnel (all being members of DHMTs) from 15 district hospitals across the
country were trained and assisted with local public health prioritization, planning, organizing, monitoring,
and evaluating the use of organizational resources (time, personnel and money) to prevent or control
diseases, disabilities and premature mortality. All the 15 teams were followed up and mentored in the
application of the skills. The DHMTs are keen in using the management skills that they obtained from the
training. In FY 2008, the project will train and mentor 26 district health personnel from the remaining 13
Activity 2: Build Management Capacity of the MoH Zonal Support Offices and Malawi Institute of
To enhance the in-country management training capacity, the program trained two locals (a faculty member
of the Malawi Institute of Management (MIM) and one Ministry of Health Zonal Support Officer) in training of
trainers in FY 2006. In FY 2007, the program will train one staff member from Central Office of the
Department of Planning and Policy Development in Ministry of Health. These trainings last for 6-weeks in
Management for International Public Health (MIPH) and are offered each fall in Atlanta by the CDC in
collaboration with the Emory University Rollins School of Public Health. The course trains participants in a
broad variety of public health management skills, including practical exercises and innovative training
techniques, and provides them with fully-developed training materials for participants to use in their own
country training programs. The two locals that were trained in FY 2006 facilitated the training and mentoring
of DHMTs in FY 2007 with technical support and guidance from SMDP who provided quality assurance of
the training and mentoring processes.
Plans to establish MIM as a local faculty and institutional home for Healthy Plan-it training will be
discontinued in FY 2008. This decision was made due to poor management of logistics of the training
program in FY 2007 by MIM. Instead, the program will begin to build the capacity of both the Ministry
Central Office and Zonal Support Offices to lead the processes of training needs assessment, conducting
trainings and providing follow-up, mentoring and supervisory visits to district hospitals.
CDC-SMDP will continue to provide technical support to MoH in conducting in-country training needs
assessments, developing locally appropriate curriculum, planning in-country workshops, and supervising
applied management learning projects that provide a practicum for trainees.
The program will continue to work with key stakeholders and the donor community to ensure the long-term
sustainability of the program and address issues such as local funding for recurrent costs, integrating the
program with MoH SWAp work plans, and evaluating impact. It will also ensure that past experiences shape
the manner in which future activities of the program are managed.
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.