Reprogramming August08: Funding decrease $100,000. Funds reprogrammed to support Mission RFA

(RFA funded across 3 SOs to ensure an integrated package of services, leveraging each SO's strengths.

This is a continuing activity under COP08 with the same targets and budget as FY2007.

Under COP08 the program will create new, and utilize existing, community to clinic and clinic to community

referral systems to ensure that PLWHA are accessing treatment and other necessary services, particularly

food, to improve their health status. WFP, in conjunction with PEPFAR treatment partners including PSI,

will work to improve provision of food and nutrition to PLWHA registered at treatment sites based on clinical

and nutritional assessments. This model helps ensure that individuals are accessing health care and

receiving services along with food supplementation. The standard for determining malnutrition will be based

on adult non-preg/lact women patients with a BMI <18.5 at entry into the program. The food supplement

consists of short-term emergency food support. Please refer to the treatment activity sheet for WFP for

funding levels and targets.

The FY2007 narrative below has not been updated.

The activity is related to HKID 9213.

COP07 will be the first year that SAVE will support home-based care activities, which they requested to

supplement their OVC activities. With the Track 1 OVC activity ending in February 2007, USG has added

SAVE as a "new" partner and decided to broaden their program with an HBC component. The HBC

program will be implemented through community committees and local NGO partners. Community

volunteers will be trained based on the MOH guidelines and the HBC manual. Identification of HBC clients

will be done at both community level with the involvement of local leaders, traditional healers and faith

based groups. Other clients will be identified at health center and VCT sites ensuring a two way referral

system is established right from the outset. Family centered Positive Living will be promoted using peers

from amongst persons who are themselves living positively and also identifying ‘buddies' within the

community to provide support and encouragement which will also include observing taking of ART or TB

drugs. Wrap around HBC activities will include food security, malaria and diarrhea prevention and

psychosocial support to the client and family members.

In COP07, it is expected that 4,260 clients will receive home-based palliative care and 426 people will be

trained in HBC.

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

Activity Narrative: 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 is a continuing activity under COP08 with both funding levels and targets remaining the same. The

FY2007 narrative below, with the exception of the first additional paragraph, has not been updated.

In collaboration with PSI, Save the Children will distribute LLIN and Save Water Systems (SWS - "Certeza")

to OVC in an effort to improve the health of targeted children and their families. The program will also

partner with WFP to support the nutritional needs of the most vulnerable OVC and their families through

provision of short-term emergency food support. Please refer to the activity sheet for WFP for funding

levels and targets.

The below narrative from FY2007 has not been updated.

This activity is related to HBHC 9211.

Save the Children US and its sub-partners (HACI, SAVE UK and SAVE Norway) will continue USG-

supported to OVC programs in targeted districts in 7 provinces - Maputo City, Maputo Province, Gaza,

Manica, Inhambane, Sofala and Zambezia - building on services under PEPFAR which started under Track

1 in 2003 and expanded in 2004, 2005 and 2006. Based on this past experience of providing assistance to

over 14,228 OVC in the first half of FY06, SAVE will continue to identify and document promising practices

in OVC programming.

SAVE and its partners will continue to provide care and support to improve the lives of OVC through

provision of a comprehensive package of quality services. SAVE continues to work through its Community

OVC Committees to identify needy OVC and to provide support and assistance to them. Many Community

OVC Committees take into their own homes stranded OVC that have no other place to go.

SAVE has a strong program which offers technical assistance to over 90 local organizations. For example

they provided training to 50 community OVC committees in monitoring and evaluation, community

mobilization and child protection. Through the provincial MMAS staff, SAVE also supported training in

management to CBO. Because of another training with sub-grantees in report writing, notable improvement

were observed in report presentation, analysis and articulation of impacts of project interventions. A last

example was a training of 18 CBO/FBO in farming methods, conducted by a sub-grantee. The participants

used the new skills to improve their communal gardens that have been set up to support families affected

by HIV/AIDS.

During FY06, SAVE has provided psychosocial support services to over 12,579 OVC. This takes the form

of counseling during home visits, early childhood education activities, school and community-based OVC

clubs and general recreation. In addition, 3,049 caregivers received psychosocial support to help them

cope with their responsibilities. In Sofala Province, community leaders and caregivers meet regularly to

share concerns, support one another and seek solutions to problems they encounter. They assisted 3,675

children in gaining birth certificates. SAVE also continued their support to school children by providing

supplies and in successfully advocating for a waiver in other school-related expenses. In collaboration with

community groups, SAVE was able to provide 2,088 households (7311 OVC) with livelihood support and

vocational skills.

SAVE has an excellent system for tracking children age, gender, OVC status and services received. These

data are available in quarterly and semi-annual reports. SAVE will continue to assess the quality of

services provided to OVC and to more efficiently assess the impact of their work with OVC.

COP07 targets include reaching 35,000 OVC with all 6 services and training 2333 care providers to oversee

the OVC activities in the community and report results to their supervisors. They will also continue to build

the capacity of the communities to plan, implement and monitor activities aimed at providing quality holistic

care, protection and support to children. Communities will be encouraged and supported to form strategic

linkages for wrap-around services to ensure that the children receive 6 basic services.

Since 2006, Save the Children has been supporting the establishment of Community Based Child-care

Centers (CBCC´s) in Gaza province. The centers are an innovative way of providing a constructive

environment that promotes the physical, psychosocial and cognitive development of pre-school children.

Women from the surrounding area offer their time as CBCC facilitators while OVC committee members and

others contribute by establishing gardens and maintaining the centers. The program has partnered with

WFP to support the nutrition component of the CBCC´s. The children spending time at the center not only

meets the needs of children but of the caregivers as well who have free time to take up other

responsibilities.

Under COP07, this program will expand the number of centers, open up centers in Sofala Province and

focus on psychosocial support, education and food. Particular attention will be paid to the needs of children

in households with a sick family member who, in most cases, is a parent.

SAVE also plans to establish similar centers to meet needs of older children. Recreation, AB sensitization

messages, homework support, psychosocial counseling will be among the activities planned for these

centers. The older children will also receive training in livelihood skills and in psychosocial counseling for

OVC to become a community resource for PSS. Through the CBCCs, the program will ensure that linkages

are established with relevant institutions to ensure basic health care for children. Immunization and de-

worming programs will be promoted through the CBCC children and their guardians.

The Hope for African Children Initiative (HACI) Mozambique has been a sub-grantee of SAVE since 2004.

HACI plays a substantive role in providing capacity building for local NGOs to receive scale-up and quality

assurance grants. For instance, HACI has provided grants to 8 organizations, while Save the Children UK,

SAVE Norway and SAVE US have provided over 75 small grants to local organizations. HACI has also

served as a voice for civil society for OVC. Because of weak governmental leadership for OVC, this role is

becoming even more important and will continue to be supported by USG in FY07 through SAVE, who will

provide a substantial sub-grant to HACI for their activities in FY07.

In FY07 capacity building interventions will focus on organizational development (including strategic

planning; quality assurance; proposal development; report writing) as well as technical support focusing on

Activity Narrative: various OVC and AB issues. Various approaches will be used including formal training through workshops,

on-going mentoring, peer to peer support through learning visits. Linkages to coordinating bodies will also

be key. Deliberate effort will be made to identify some ‘umbrella local organization' whose skills will also be

passed on to smaller groups. This mentoring process will be done as the organizations are implementing

programs through small grants disbursed to them.

During COP07, Save will be working in collaboration with the Children and Family Initiative to assist the

Ministry with drafting, disseminating and implementing appropriate legislation consistent with international

standards for child protection ($30,000). Save's activities will also place a special emphasis on coordinating

and expanding existing programs of non-governmental organizations dealing with child protection and

family support in close collaboration with the Child and Family Initiative ($20,000).