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: 2007
Per July 2007 reprogramming; This addition of resources will allow FHI to reach an additional 1,000 women with counseling and testing and an additional 100 women who receive a full course of ARV prophylaxis. The funds will also make it possible for assistance with the District Director of Health in overseeing ongoing PMTCT activities at FHI dedicated sites.
Plus-up change:Utillizing plus up funding, FHI will expand its PMTCT intervention to include three additional sites in the province of Zambezia and begin to offer PMTCT services in two sites in Niassa province. The sites in Zambezia are Alto Benfica in Mocuba district, and Micaune and Chinde Sede in Chinde District, which have been strategically identified due to their high HIV prevalence. In Niassa, FHI will strengthen MOH response at the provincial level in two sites, one in Massangulo with a 16% HIV prevalence; the HIV prevalence in Massangulo is on the upward trend due to commercial activity and the high mobility of the population. The second site in Niassa will be Cuamba, which currently has a 14% prevalence of HIV; Cuamba is characterized by economic activity suroundingwood extraction. FHI will also hire a PMTCT technical advisor for the province of Zambezia to assist the DPS improve the quality and quantity of PMTCT services within the province, especially in sites that receive no direct NGO support. FHI will support the provincial PMTCT advisor with funds to assist in supervisory visits, petrol, and communication expended related to said visits. This activity is related to a palliative care activity 9209. FHI will continue to provide comprehensive, integrated PMTCT services in 10 existing sites and expand coverage to 7 additional sites, to serve a total of 17 sites in Zambezia province. Collaborating closely with MOH and central level and with health teams at provincial level, FHI will provide training to health workers including nurses, counselors, and physicans, in state-of-the-art PMTCT services to urban and rural pregnant women at antenatal facilities. Community mobilization and primary prevention of MTCT also will take place through sub-partners. Using a national protocol, CT is offered to all antenatal attendees and their partners. Nevirapine, infant feeding education, exclusive breastfeeding education, and referral to treatment sites are offered to all pregnant women who test positive. During postnatal follow-up, continued counseling and advice on infant feeding, nutrition, and family planning are provided to mothers. Seropositive women are referred to facilities offering HIV/AIDS care and treatment services, for CD4 counts and enrollment in ART as appropriate within the integrated HIV/AIDS services network. HIV-positive pregnant women and their newborns receive Nevirapine, as well as 18 months of follow-up education, counseling, and support. This activity further supports seropositive women and infants at facility and community levels through the organization and implementation of mother-to-mother support groups, and helps reduce stigma and discrimination. FHI intends to establish both PMTCT and CT services in every suggested site in order create or meet (depending on the site) the demand of services.Additionally, the MOH has set ambitious targets for provision of bednets and IPT for ANC, and PMTCT will benefit from this program. However, it will take some time for the malaria initiative to get up and running, and for bednets and IPT to flow to all parts of the country. FHI should plan for a 3-6 month supply of bednets and IPT to assure that the minimum package of PMTCT includes these malaria interventions.
With the total of 17 sites (10 existing and 7 new), FHI expects to reach 35,459 pregnant women with counseling, testing and receiving results. Depending on actual HIV prevalence rates, an estimated 3,530 HIV+ pregnant women are expected to receive a full course of ARV prophylaxis; and 60 health workers will be trained.
Per 07/07 reprogramming; Family Health International will reach an additional 1,000 people with home-based health care services and train an additional 40 activists to provide care within communities. The additional resources will also allow FHI more staff to properly oversee home-based care activities and strategically improve the quality of care clients receive from FHI's partners.
This activity is related to HVCT 9111, HVTB 9206, and MTCT 9223.
FHI is currently providing HBC services to clients in Zambezia Province (Quelimane, Nicoadala, Mocuba, Ile, Inhassunge) and Inhambane (Zavala and Inharrime). They have started an innovative program with the police by delivering palliative care to 1000 HBC clients. FHI trained 100 police family members and community care workers for this effort. FHI provides technical assistance to the national level MOH STI and HIV/AIDS programs for improved linkages and integration including 1) establishment of integrated HIV-STI service models at 18 sites (16 in Zambezia, 2 in Inhambane); 2) support for courses on STI diagnosis and treatment for HIV/AIDS service providers in Zambezia and Inhambane; 3); assistance in syphilis prevalence among pregnant women accessing PMTCT services at ANC/maternities and congenital syphilis among newborns of HIV+ mothers.
In COP07, FHI will continue to provide home-based care activities for HIV/AIDS-infected and affected households in the sites were HBC services were provided with PEPFAR funds during COP06 including selected sites in Quelimane, Mocuba, Nicoadala and Ile and expand to four new sites within these districts. FHI will sign a Memorandum of Understanding (MoU) with PSI to continue the distribution of mosquito nets and "certeza" which will complement the benefit of those served under the HBC program. They will attempt to establish collaboration with WFP to provide food to patients in selected cases. Through these efforst 2,083 PLWH will receive palliative care.
FHI continues to strengthen local capacity and has trained 79 individuals in HIV-related community mobilization for prevention, care and treatment. In addition, they trained 55 person in institutional capacity. One of FHI new FBO partners is the Association of Muslim Women. In FY07, an additonal 200 people will be trained to provide palliatev care.
The identification of additional entry points to the continuum of care (e.g. PMTCT, CT and linkages for clinical care to PLWHA) will be encouraged through FHI's facilitation of linkages between health facilities and programs. The DPS-Zambézia and local partners will benefit from technical assistance to bolster their capacity to implement, monitor, improve, and evaluate service delivery for chronically ill individuals as well as share innovative caring practices for these populations.
Under COP07, mechanisms will be put in place to improve the community to clinic linkages. Although, NGOs were encouraged to liaise with local clinics, many volunteers were comfortable working at the community level only. In FY07, volunteers will be required to work along with clinics in caring for PLWHA on ART, with TB patients, patients with OI, STI and other conditions. At least 50% of all HBC clients will need to have a clinic record. Treatment adherence also will be supported by a related USG activity to ensure TB and HIV patients are taking their medicines and not experiencing any overt reactions. In addition, volunteers will be trained to further recognize OIs and to refer clients to the clinic for proper follow-up. Coupons for transport or use of bicycle ambulances will be used to ensure clients attendance. Further training will be held to ensure that HBC supervisors, and volunteers have the necessary skills to handle these new activities.
Under COP07, capacity building of local CBO/FBO will continue with fervor. With a UGS funded AED program, tools and materials will be available for NGOs to use with their nascent CBO in provide quality services and assess and manage outside funding. AED will also provide training on several general topics (on functional organizations, strengthened management, leadership, advocacy, financial management, etc.) which will be open to all NGOs and their partners.
General Information about HBC in Mozambique: Home-based Palliative Care is heavily regulated by MOH policy, guidelines and directives. USG has supported the MOH Home-Based Palliative Care program since 2004 and will
continue with the same basic program structure including continued attempts of strengthening quality of services to chronically ill clients affected by HIV/AIDS. In FY02, the MOH developed standards for home based care and a training curriculum which includes a practicum session. Trainers/supervisors receive this 12 day training and are then certified as trainers during their first 12 day training of volunteers. A Master Trainer monitors this first training and provides advice and assistance to improve the trainers' skills and certifies the trainer when skill level is at an approved level. All volunteers that work in HBC must have this initial 12 training by a certified trainer and will also receive up-dated training on a regular basis. The first certified Master Trainers were MOH personnel. Then ANEMO, a professional nursing association, trained a cadre of 7 Master Trainers who are now training Certified Trainers, most of whom are NGO staff who provide HBC services in the community. In the next two years, ANEMO will train and supervise 84 accredited trainers who will train 7,200 volunteers, creating the capacity to reach over 72,000 PLWHA.
In addition, the MOH designed 4 levels of "kits" one of which is used by volunteers to provide direct services to ill clients, one is left with the family to care for the ill family member, one is used by the assigned nurse which holds cotrimoxazole and paracetamol and the 4th kit contains opiates for pain management which only can be prescribed by trained doctors. The kits are an expensive, but necessary in Mozambique where even basic items, such as soap, plastic sheets, ointment, and gentian violet are not found in homes. USG has costed the kits and regular replacement of items at $90 per person per year; NGOs are responsible for initial purchased of the kits and the replacement of items once they are used up except for the prescription medicine, which is filled at the clinics for the nurses' kits. An additional $38 per client per year is provided to implementing NGOs to fund all other activities in HBC, e.g. staff, training, transport, office costs, etc.
MOH also developed monitoring and evaluation tools that include a pictorial form for use by all volunteers, many of whom are illiterate. Information is sent monthly to the district coordinator to collate and send to provincial health departments who then send them on to the MOH. This system allows for monthly information to be accessible for program and funding decisions.
In FY06, the initial phase of the assessment of home-based care will be completed. Recommendations from this assessment will inform the MOH on how to improve the palliative care services delivered at community level and what is needed to strengthen the caregivers. Training in psychosocial support is beginning to roll out and is meant to support HBC caregivers as well as the clients and their families. In Zambezia, it was reported that 40% of the HBC clients died during a recent 3 month period. This puts a lot of stress on the volunteer caregiver, who needs support to continue to do his/her job faithfully. A pilot project in three locations will support an integrated care system, strengthening relevant government offices as well as NGOs. The more varied resources, such as food, education, legal and other social services, that are available to the chronically ill, the stronger the overall program.
This activity is related to HBHC activities 9207, 9209,9132, 9133, 9139, 9126 and HTXS Activity 8545.
A new activity, which will be initiated during FY07 addresses the need for a more collaborative processes between clinic based and community based palliative care, especially in relationship to treatment adherence for TB and ARV. Although this has been the focus of community based care since the beginning, improvements can be made in the areas of collaboration and communication with NGO partners that are working in both clinic and community sites. Small amounts of funding will be provided to five partners who offer palliative care under the home-based care (HBC) model. HBC volunteers and their supervisors will receive training on treatment adherence for ARV and TB. Columbia University will develop training materials for ARV adherence under a separate USG supported activity and provide hands-on training to HBC volunteers so that they can assist their HBC clients to adhere to treatment drugs and determine if there is some reaction to the treatment regime. In addition, collaboration will occur with the MOH's TB program to ensure that HBC volunteers are correctly trained concerning the DOTS model and the MOH's vision for improving case detection and treatment success rates.
This activity was designed in collaboration with the emphasis in COP07 on improving TB/HIV programming. The activity is deemed important because of the recent information of mutated strains of TB found in neighboring countries that can easily cross the boarders.
Directly funding the NGO partners will help to build their own capacity in ARV and TB adherence support, creating a permanent buy-in to the importance of this effort. Thus it is expected that all HBC providers will receive training and that at least half of the HBC beneficiaries will be recipients of this expanded community-based service on treatment adherence.
This activity relates to HBHC 9209 and MTCT 9223.
Continuation of 3 CT services (Nicoadala, Ile, Quelimane) and 9 new sites in Zambezia - integrated into other existing health services such as TB, OI and STI treatment (request from the DPS in Zambezia to have the same NGO support CT and PMTCT); This activity is expected to reach 48,960 individuals with C&T results and to train 27 individuals in C&T.
FHI is planning to carry out the following activities under COP07:
1. Technical assistance to the MOH, through support in the conceptualization and conducting program and monitoring and evaluation supervisions
2. Implement a model for the integration of STIs, PMTCT, CT, ART and management of opportunistic infection including TB in Zambezia, moving towards the MOH's goal of creating Counselling and Testing in Health units.
3. Conduct trainings using newly developed syndrome approach in at least 8 sites
4. Conduct community activities for HIV and STI prevention in partnership with local organizations, using and reproducing materials centrally produced
5. Maintain a buffer stock of test kits and materials, to avoid stockouts in the sites where implementing the integrated model.
The second activity will allow FHI to continue to provide home-based care and support activities for HIV/AIDS-infected and affected households in the sites were HBC services were provided with PEPFAR funds during COP06 including selected sites in Quelimane, Mocuba, Nicoadala and Ile and expand to four new sites within these districts. FHI will sign a Memorandum of Understanding (MoU) with PSI to continue the distribution of mosquito nets and "certeza" which will complement the benefit of those served under the HBC program and in addition will try to establish collaboration with WFP to provide food to patients in selected cases.
The identification of additional entry points to the continuum of care (e.g. PMTCT, CT and linkages for clinical care to PLHA) will be encouraged through FHI's facilitation of linkages between health facilities and programs. The DPS-Zambézia and local partners will benefit from technical assistance to bolster their capacity to implement, monitor, improve, and evaluate service delivery for chronically ill individuals as well as share innovative caring practices for these populations ($1,200,000).