Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 10419
Country/Region: Mozambique
Year: 2009
Main Partner: FHI 360
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $3,833,941

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $855,655

August08 Reprogramming: Though the proposed re-programming will moderately increase FHI's funding

level, a decrease in two PMTCT indicators is requested. The original calculation, undertaken by USAID,

was incorrect in the percentage of women, relative to population size, who would be pregnant in the districts

where FHI works. The numbers within the algorithm have been changed and the adjusted targets are

reflected above. USAID is certian that FHI will fully meet, if not exceed, the targets listed above.

This is a continuing activity under COP08.

FHI will expand to include four additional sites in Niassa province, which will serve as key entry points to

ART treatment and community-based care and support. FHI will also work to strengthen food security by

creating a twenty hectacre community farm, benefiting HIV-positive pregnant and lactating women in

Quelimane and Nicodalawill, using land ceded by the Governor of Zambezia province. Once these women

are trained, the Governor has committed to providing them land so that they may use their skills to provide

for the nutritional needs of their families and themselves.

The program will continue to foster linkages with the Child at Risk Consult (CCR) as well as treatment

services. The referral system between PMTCT, treatment services, and the CCR will be the first line of

approach, which has broad Governmental support. However, the program will also explore manners to

reinforce testing and treatment linkages with vaccination campaigns, well baby visits, and weighing stations.

Using COP 07 plus up funds, PSI will map existing PEPFAR and non-PEPFAR partner interventions in

PMTCT and overlay this map with mosquito net distribution data from the President's Malaria Initiative (PMI)

and other donors and partners (Malaria Consortium, Government of Japan, the Global Fund, etc). The

assessment will be a gaps analysis of where present activities under PEPFAR, PMI, and other partners are

taking place and where, geographically and programmatically speaking, more concerted and coordinated

action is needed by the consortia of actors. PEPFAR and PMI will leverage each others' resources with

PMI providing the vast amount of LLINs for distribution to pregnant and lactating mothers. However,

PEPFAR, through PSI, will provide a buffer stock of LLIN for PMTCT partners to ensure that all pregnant

women receive a mosquito net. Finally, PMTCT partners will be crucial partners to PMI for the routine

integration of at least two doses (of the recommended three) of SP.

The program will also partner with WFP to support the nutritional needs of the most vulnerable PMTCT

clients 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.

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

Activity Narrative: be trained.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15860

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15860 5269.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $3,249,270

International International Health

Development International-

GHAI-Local

9223 5269.07 U.S. Agency for Family Health 5078 5078.07 USAID-Family $2,618,850

International International Health

Development International-

GHAI-Local

5269 5269.06 U.S. Agency for Family Health 3666 3666.06 Follow-on to $1,274,000

International International IMPACT

Development

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $0

This is a continuing activity under COP09.

ACTIVITY UNCHANGED FROM FY2008

Reprogramming August08: New activity - $249,795 reprogrammed funds are part of ABC Prevention

component and FHI will focus on multiple concurrent partnerships, gender norms, and cross-generational

sex as well as informal transactional sex. Interventions that also address adult-focused behavior change

and risk perception as well as encourage males (and couples) to be tested will be looked upon.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21255

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21255 21255.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $249,795

International International Health

Development International-

GHAI-Local

Table 3.3.02:

Funding for Care: Adult Care and Support (HBHC): $100,000

Reprogramming August08: Funding decrease $400,000. 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.

FHI will expand to an additional three sites in Zambezia; FHI will also add six sites in Niassa province and

offer a comprehensive package of services including counselling and testing, PMTCT, palliative care,

TB/HIV, and ART treatment. FHI will continue to provide technical assistance and support to the HBC

provincial program in Zambezia and initiate support of the HBC program in Niassa while also strengthening

the integration of HBC and OVC programs.

Quality assurance in the delivery of home-based care is of particular importance and FHI will be actively

assessing how to monitor and improve its clinical and community services. The issue of quality is of shared

concern of all palliative care partners; all of whom will participate in technical meetings and roundtables to

ensure a cohesive, singular, and quality approach in the future.

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.

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

Activity Narrative: (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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15861

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15861 9209.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $1,525,000

International International Health

Development International-

GHAI-Local

9209 9209.07 U.S. Agency for Family Health 5078 5078.07 USAID-Family $1,679,735

International International Health

Development International-

GHAI-Local

Table 3.3.08:

Funding for Care: Adult Care and Support (HBHC): $0

This is a continuing activity under COP08, linked to the FY07 activity # 9209.07.

This study concerns the assessment of partner notification after introduction of HIV and syphilis rapid

testing at Antenatal Care/Prevention of Mother-to-Child (ANC/PMTCT) service sites with/without 1-minute

reinforced counseling.

Title: Rapid Syphilis Testing and Counseling

Time and Money Summary: This study is currently being reviewed for reprogramming given ongoing

concerns about utility of results.

Local Co-Investigator: Elisabeth Inglesi, FHI

Project Description:

Study Question: What are the best practices in the integration of syphilis screening and treatment within

ANC/PMTCT services?

Study Design:

1. All pregnant women visiting ANC/PMTCT services in selected sites; 1)Quelimane City/17 de Setembro;

2)Nicoadala Sede and 3) Mocuba Sede will be checked for STI symptoms and signs.

2. All pregnant women will be screened for syphilis with the use of rapid non treponemic tests.

3. All pregnant women identified with an STI or reactive to syphilis testing will be treated according to

National Protocols for syndromic approach.

4. Reactive samples will be confirmed with a TPHA test. A number of randomly selected negative samples

also will be tested for quality control purposes.

5. A code will be written in the ANC cards and STIs registration book available at the selected sites.

Importance of Study: The Mozambican Ministry of Health launched its National PMTCT program in July

2004. UNICEF states that many newborns have died after completion of PMTCT due to congenital syphilis.

720,000 infants were born with HIV worldwide in 2001. Large sums of donor funds are rightly being made

available for PMTCT programs, yet many of the infants in whom HIV is prevented may die of syphilis.

Between 10% and 15% of pregnant women have syphilis in Zambezia Province and infant death from

congenital syphilis can be prevented by linking ANC/PMTCT services and syphilis diagnosis and treatment.

Syphilis in pregnancy causes stillbirth, spontaneous abortion, intrauterine growth retardation, or preterm

delivery in up to 50% of cases. In sub-Saharan Africa, syphilis is responsible for 20-30% of perinatal

deaths.

Planned Use of Findings: The findings of this study will be useful in formulating efficient policies with the

GRM regarding the identification, care and treatment of syphilis among ANC attendees.

Status of Study: Protocols are currently being established with the Ministry of Health and a decision

should be made soon as to whether this PHE should be pursued further.

Lessons Learned: Research in Mozambique takes longer than anticipated due to long processes of

review and authorization by the Ethics Committee and the Minister of Health.

Information Dissemination Plan: The results will be publicly announced at both provincial and federal

levels.

Planned FY08 Activities: If it goes forward, the study will be completed and the results will be

disseminated by the beginning of FY08.

Budget Justification for FY08: There is no FY08 funding.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16381

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16381 16381.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $0

International International Health

Development International-

GHAI-Local

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $1,464,253

This is a new activity under COP08.

Family Health International (FHI) will begin to provide treatment services in Niassa province. FHI will be

cross-funded across HBHC, OVC, CT, and PMTCT to offer a comprehensive package of services in the

province. Niassa, being of considerable distance from Maputo, has few partners providing services and the

province as a whole poses a real challenge for implementation. However, FHI will provide technical support

at the central, provincial, and district levels to scale up ART services in the province. FHI will support the

district level health officials' ability to adequately monitor and supervise implementation throughout the three

districts they will work in as well as contribute towards quality management approaches and technical

quality assurance. FHI will use its relationship with direct service providers to improve the testing,

diagnosis, care, and referral of patients with opportunistic infections, including tuberculosis, to treatment

services.

FHI will emphasize the integration of mother and child care and treatment and will support the integration of

pediatric services in both treatment facilities as well as PMTCT Plus sites in order to maximize on PMTCT

interventions. Special attention will be given to HIV exposed infants by establishing early infant diagnostic

capabilities at the model centers to allow for early identification of HIV infected children, and ensuring they

are engaged in care and treatment. Provincial trainings will be held on ART management, which will also

include a component on linkages and referral mechanisms with HIV/AIDS clinical and community services.

Finally, FHI will improve the conditions of the provincial laboratory to enhance its capacity for CD 4 testing.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16310

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16310 16310.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $925,000

International International Health

Development International-

GHAI-Local

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $46,188

NEW ACTIVITY

This new activity will allow FHI to provide support in the following areas: exposed infant follow-up and care

and support of HIV-infected children.

Integration of exposed infant follow-up and timely identification of HIV-infected infants:

The timely initiation of ART in HIV-infected children, preferably before six months of age, has clearly been

demonstrated to improve quality of life and to reduce morbidity and mortality. The national treatment

guidelines for children are currently being revised in accordance with WHO recommendations to incorporate

the initiation of ART for all HIV+ children under one year of age and for children exposed to nevirapine

through PMTCT or maternal treatment.

In Mozambique, HIV-exposed infants are followed at high risk consultation clinics (CCR). The CCR provides

care services for all high risk children (very low weight children, in treatment for TB, etc), including HIV

exposed children. The care services include growth and development monitoring, provision of PlumpyNut

for HIV infected children who have weight for height ratio < 80% of the median and provision of

cotrimoxazole for all HIV exposed and infected children following national guidelines.

These clinics are critical points of entry for early identification of HIV in infants through routine clinical and

growth and development monitoring and HIV testing for HIV exposed infants. HIV exposed infants are

referred from PMTCT services to CCRs. The referral is still weak and there is limited data on how pediatric

care services are provided at CCR and how they are linked with ARV services. There is currently no

standardized system for identifying HIV-exposure or infection status of children coming for immunization or

for curative outpatient services. This, combined with slow implementation and expansion of early infant

diagnosis (EID) through PCR dry blood spots (DBS), due in part to a complex and challenging logistics

system and low human resource capacity, has hindered timely identification of HIV infected infants and their

referral for treatment.

FHI in partnership with local health authorities (i.e. DPS/DDS), will support health facilities to strengthen the

quality of HIV-exposed infant follow-up at CCRs, as well as to integrate identification and follow-up of HIV-

exposed infants in all pediatric settings, including immunization/well-baby clinics, nutritional centers,

outpatient and inpatient settings, and other points of entry for identification of exposed infants. FHI will

support the DPS and DDS to implement universal use of the updated childhood growth and immunization

card that now includes PMTCT information (mother HIV status, ARV prophylaxis or ART). This will facilitate

health providers in different settings to identify HIV exposure among infants and to provide appropriate

services and referrals. In addition, FHI will work with the DDS and MISAU to orient health staff and to

implement the new flow chart and algorithm currently being developed by the National PMTCT and Child

Health technical working groups. This tool helps to link the HIV exposed and infected infant into care and

treatment through referral from PMTCT, immunizations and well child clinic.

Early Infant Diagnosis (EID) is a priority for the Ministry of Health. In order to improve the DNA PCR DBS

logistics the partner will support the DPS and DDS to establish a functional logistics system for the process

of samples collection, transportation and returning of results and also support a focal person for the

province to coordinate the logistics for these samples to be processed in a timely manner. In addition, it will

ensure orientation and implementation on all nationally-developed EID tools, including training tools,

consumption tracking tools and other tools for tracking EID testing that are developed during FY 08.

Support the DPS and DDS to provide enhanced training in line with national training protocols on exposed

infant follow-up and pediatric care, including growth and development monitoring and provision of

cotrimoxazole preventive therapy for HIV-exposed infants, referrals and linkages with ART clinics and

community-based social support services, HIV testing of suspected infants and children, and family based

testing of children, and management of opportunistic infections among children and infants infected with

HIV.

In addition to identification of exposed infants through different entry points, the partner will provide support

to facilities and districts to strengthen clinical diagnostic testing of children and infants and to integrate a

family based approach of HIV testing into care and treatment settings.

Almost 100% of pediatric cotrimoxazole needs and a portion of the priority OI drugs for pediatrics are being

donated by the Clinton Foundation/CHAI through UNITAID. SCMS will support other OI drug needs. FHI

will coordinate with the provincial pharmaceutical logistics and the laboratory advisors in the province to

ensure a continuous supply of basic commodities, in particular cotrimoxazole, at district and facility levels.

Provide significant support and TA to the DPS and DDS for implementation of activities, with eventual

graduation of sites to full DDS support. Will also subcontract and support the DDS/DPS to conduct

integrated supervision of clinical services and the network model; monitoring and evaluation, in particular

analysis of facility level data for monitoring performance of individual sites, districts and provinces; financial

planning and budgeting; and annual workplanning and quarterly monitoring of implementation of activities.

Work with the DPS to strengthen existing supervision tools to ensure the most recent technical updates of

the national program have been incorporated. This will be done in a harmonized fashion with support from

the MOH to ensure the use of standardized tools for supervision. The contracting mechanisms will include

key indicators for performance monitoring of DPS and DDS activities.

In addition, FHI will work with provincial clinical mentor advisors to ensure that PMTCT services are

integrated into clinical mentoring activities.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $337,951

NEW ACTIVITY

This new activity will allow FHI to support the USG and the Ministry of Health's prioritization of pediatric HIV

care and treatment services in FY09. Partner will strengthen health systems to decrease HIV-related

morbidity and mortality and improve overall child well-being in the four targeted provinces. FHI will extend

pediatric ART to all existing USG-supported sites currently providing ART in province of Niassa, with the

objective of having 10% of all current ART patients being under the age of 15 (i.e. 4,757 children on ART)

by the end of FY09. This scale-up of pediatric ART will be reinforced through concomitant improvements in

the quality of pediatric HIV service delivery.

The timely initiation of ART in HIV-infected children, preferably before six months of age, has clearly been

demonstrated to improve quality of life and to reduce morbidity and mortality. The national treatment

guidelines for children are currently be revised in accordance with WHO recommendations to incorporate

the initiation of ART for all HIV+ children under one year of age and for children exposed to nevirapine

through PMTCT or maternal treatment. The partner in partnership with local health authorities (i.e.

DPS/DDS), will support local clinicians to implement these guidelines through dissemination of revised

guidelines, trainings, on-site mentoring, and supportive supervision. This partner will also support local

healthcare providers to establish identification systems for exposed and infected children, including through

the use of the IMCI algorithm. IT will also support a focal person in the province to coordinate the logistics

for these samples to be processed in a timely manner. Other laboratory services to support pediatric ART

clients will be strengthened through the provision of equipment and the training of staff.

Support psychosocial and adherence services specifically tailored to this target group. Parents of younger

children on ART will be supported through counseling and the production of low-literacy materials to

administer ART, particularly the more complicated syrups. Older ART patients will be assisted to accept

and disclose their status. Likewise, adolescents will receive Positive Prevention (PP) messages specifically

targeted for their age group.

Support patient tracking systems to ensure pediatric patient follow-up and retention of children on ART.

These systems will also assist the identification of children of adults enrolled in HIV care and treatment to

come forward for testing and care. FHI will also participate in the national pediatric HIV program evaluation

to help identify best practices and key indicators for pediatric ART.

FHI will work with the DPS/DDS to link pediatric ART services to other HIV and child welfare services.

Linkages with PMTCT services, EPI services and well-child clinics will be strengthened to reduce drop outs

and missed opportunities. Support government partners to strengthen the links with maternal and child

health programs and the child at risk clinics (CCR) through staff training and the introduction of job

aides/algorithms. Linkages between pediatric ART sites will also be strengthened with community partners

providing relevant child support services including educational support, housing, HBC and legal support

(e.g. obtaining birth certificates). Lastly, children enrolled in ART will benefit from a minimum package of

health services including insecticide treated nets (ITN), sprinkles for water purification and nutritional

support.

The primary emphasis of partner intervention will be placed on building the capacity of provincial and district

health authorities to support the integration of pediatric ART into the district model of care. Build the

capacity of local clinicians in pediatric ART through the dissemination of guidelines, on-site mentoring,

formative supervision, and the development of relevant job aides and IEC materials. Provide specific

training modules on pediatric ART for lower level clinicians such as Tecnicos de Medicina. Activistas (HIV+

community support personnel attached to health facilities) will also be supported to provide basic care to

pediatric ART patients and to educate parents on the importance of their children's treatment. Technical

support will also be provided to DPS and DDS to reinforce pediatric-specific aspects of care including the

laboratory, pharmacy and commodity management

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $140,092

This is a continuing activity under COP08.

FHI will leverage TB-CAP funds to advance the integration of TB and HIV services, with special focus on CT

for HIV in TB patients and linkages/referrals to ART services. Trainings on TB infection and control will take

place across staffing in clinics and hospitals to include training on TB detection within HIV-related services.

FHI will continue to collaborate closely with community-based organizations to enhance TB/HIV follow-up

and adherence as well as assist in the strengthening of the monitoring and evaluation and supervision of

the integration of TB/HIV services. In selected sites in Nampula, Zambezia, Sofala, and Gaza FHI will fortify

community-based linkages between palliative care services and TB DOTS, including sub-agreements with

Mozambican NGOs. Finally, FHI, again leveraging TB CAP funds, will finalize the rehabilitation of the Beira

reference laboratory as well the Maputo central laboratory; FHI will also rehabilitate and equip one

counseling and testing sites at the TB clinics in each province.

The narrative below from FY2007 has not been updated.

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15862

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15862 9206.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $1,062,135

International International Health

Development International-

GHAI-Local

9206 9206.07 U.S. Agency for Family Health 5078 5078.07 USAID-Family $6,509

International International Health

Development International-

GHAI-Local

Table 3.3.12:

Funding for Care: Orphans and Vulnerable Children (HKID): $0

This is a continuing activity under COP09.

ACTIVITY UNCHANGED FROM FY2008.

This OVC intervention is a new activity for Family Health International (FHI). FHI has provided PMTCT,

HBC and treatment services with PEPFAR funding in four districts in Zambezia province in close

cooperation with the Provincial Health Directorate.

In FY08, FHI will provide PMTCT, ART, HBC and OVC services in Niassa province, modeling a

comprehensive package of care.

Although providing OVC services is a new activity for FHI in Mozambique, FHI as an organization has

demonstrated a strong background in this program area. In 2007, UNICEF contracted FHI to conduct

regional workshops to improve mechanisms for monitoring and reporting at the regional levels and

coordinated monitoring and evaluation (M&E) efforts among stakeholders (which included Mozambique)

involved in the implementation of each member country's National Plan of Action. The general objective of

these workshops was to strengthen in-country capacities in M&E of orphans and vulnerable children

programming and frameworks.

Building on the lessons learned and experiences shared in the 2007 workshop, FHI is well positioned to

work with the Provincial Ministry of Women and Social Action (MMAS). During this workshop, Mozambique

acknowledged their relatively low level of preparedness in monitoring and evaluation in OVC programming.

MMAS identified the following technical assistance needs: 1) harmonizing OVC indicators in order to ease

the flow from specific project indicators to more general HIV/AIDS indicators; 2) learning about mechanisms

to create interconnected systems of data collection; and 3) providing support to implementers in order to

advise them on how M&E activities should be performed.

Under this activity FHI will provide direct OVC services. FHI strives towards two goals in OVC care: 1)

providing compassionate and comprehensive care and 2) strengthening and improving program quality.

Their approach is to work with FBO/CBO to develop long term responses to OVC needs by building their

capacity to coordinate and sustain OVC services. FHI also aims to strengthen linkages among service

providers to coordinate coverage and ensure sharing of lessons learned. The specific approach used in

Niassa will be developed in close collaboration with local communities and district and provincial authorities.

FHI will 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. In collaboration with PSI, FHI will distribute LLIN and Safe Water Systems (SWS

- "Certeza") to OVC in an effort to improve the health status of targeted children and family members.

FHI will reach 650 OVC with the six essential services and train 35 individuals to provide OVC services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15880

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15880 15880.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $630,000

International International Health

Development International-

GHAI-Local

Table 3.3.13:

Funding for Testing: HIV Testing and Counseling (HVCT): $91,578

This is a continuing activity under COP09.

ACTIVITY UNCHANGED FROM FY 2008.

This is a continuing activity under COP08

FHI will continue to provide technical resources and information, by supporting policy development, and by

documenting best practices in relationship to counseling and testing. The objective is to strengthen quality

counseling and testing services offered in Zambezia while expanding to three new sites. This activity will

also include establishing comprehensive and integrated counseling and testing services in Niassa province.

To better ensure access to comprehensive services FHI uses moments within pre and post-test counseling

to appropriately refer HIV positive clients to other health services of importance such as family planning,

MCH, TB, etc. HIV-negative clients are also referred but more active referral mechanisms are either being

developed or are already in place for those who are HIV-positive.

The activity narrative below from FY2007 has not been updated.

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).

New/Continuing Activity: Continuing Activity

Continuing Activity: 15863

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15863 6429.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $1,300,000

International International Health

Development International-

GHAI-Local

9111 6429.07 U.S. Agency for Family Health 5078 5078.07 USAID-Family $1,200,000

International International Health

Development International-

GHAI-Local

6429 6429.06 U.S. Agency for Family Health 3666 3666.06 Follow-on to $300,000

International International IMPACT

Development

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $28,333

THIS IS A NEW ACTIVITY UNDER FY 09.

With this new activity FHI will be able to provide support in the following areas, in Niassa Province:

The laboratory Technical Advisor based at the partner will be responsible for overseeing the laboratory

component of the Care and Treatment Program within the partners' supported sites and supporting

partner's staff in providing supervision of laboratory services within the program. In addition, S/he will

function as a counterpart for the Provincial Laboratory Technical Advisors based in DPS in the province.

The Laboratory Advisor will liaise and coordinate activities related to laboratory services with NGO's and

partners assisting the MOH in laboratory issues such as Clinton Foundation, SCMS, and APHL. The

Laboratory Advisor will identify weaknesses in laboratory processes, procedures, and logistics, propose

adequate strategies for improvement, and contribute to a plan towards building capacities at national,

provincial and district levels. S/he will give specific attention to realities and problems emanating from field

level, communicate needs and priorities identified and channel solutions to adequate forum and authorities.

The work of the laboratory advisor shall be integrated with on-going or new MOH national and provincial

laboratory activities and policies. S/he shall also respond to priorities identified by the partner team(s) or

other direct implementers in the Province. Overall, the Partner Laboratory Technical Advisor will improve

laboratory services as a crucial component of quality care in the provinces supported by the Partner.

This will complement the Partner funding of Provincial Laboratory Advisors to support the organization and

provision of high quality clinical laboratory services through technical assistance to the Direcção Provincial

de Saude (DPS). The Provincial Laboratory advisors will work directly with the Section Chief of the

Provincial Laboratory to improve the quality and coordination of laboratory services in the entire province.

Specific activities include: assistance in planning and implementation of laboratory activities; technical

assistance and supervision to laboratory personnel at district and provincial levels; development of SOPs

and routine work flow, systems for patient registration, increasing access to testing, and reduction in turn

around time for test results, and develop a program for equipment maintenance.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.16:

Funding for Strategic Information (HVSI): $278,691

A portion of these funds ($28,691) is a continuation of the sub-activity listed as Activity 8639.08 in COP 08

(Provincial M&E Officers). Ministry of Health has placed increasing focus on strengthening human and

technical resources at the provincial level to improve the coordination and delivery of services in the

province. In FY08, Ministry of Health developed a standard set of technical advisor positions to be placed

at the Provincial level; these four positions included advisors in Clinical Care, Laboratory, Pharmacy, and

Monitoring and Evaluation. USG was asked to assist with the funding and recruitment of these positions at

the provincial level. The primary partner responsible for providing technical assistance in the area of clinical

services in a province will also be responsible for the recruitment and support of the four technical advisor

positions, including this Monitoring and Evaluation Technical Advisor position.

As lead USG clinical partner in Niassa Province, FHI will be responsible for that province's M&E Provincial

Advisor as part of its overall clinical care program until a new agreement is awarded following a full and

open competition. He/she will provide support in the coordination of routine activities related to monitoring

and evaluation at the Niassa DPS, giving priority to endemic diseases, including HIV. This advisor will help

to reinforce and support the implementation of the decentralization of HIV services including related data

collection systems. S/he will provide leadership in the supervision and management of data to ensure the

quality of data at the district and site level, help to strengthen the flow of data to the district, provincial, and

central levels. Additionally this person will support the Provincial Directorate of Health in the analysis and

dissemination of data (for example, to the site level, Ministry of Health, and partners.) This person will sit

within the Provincial Department of Planning and Cooperation at the Provincial Directorate of Health in

Lichinga.

The remaining funds ($250,000) will be used to complement the USAID/W-funded Site Identification and

Development Initiative (SIDI). This project builds the capacity and infrastructure necessary for a viable

clinical research site. The secondary objective is to develop a "best practices" curriculum and technical

toolkit for site identification and development practices. The scope of the project includes: helping to hire

and train staff; enhancement of laboratory, clinical and data management infrastructure; working with local

ethical review committees; community outreach programs to raise awareness of HIV issues and the role of

prevention research; as well as the upgrading of actual facilities as appropriate.

INS Chokwe was identified as a site for the development of research capacity. Chokwe is an impoverished

rural community in which every existing facility is utilized beyond capacity. For example, hospital patients

are sometimes attended to outdoors, as during a recent cholera epidemic at the hottest time of year when

facilities included makeshift tents, a pit latrine, and no running water. COP09 funds are being requested to

help construct a facility for clinical research and for assisting with demographic surveillance surveys.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $491,200

This is a continuing activity under COP09. ACTIVITY UNCHANGED FROM FY 2008.

This is a new activity under COP08.

FHI will work with new partners to strengthen both their organizational and technical capacity in the

provinces of Zambezia and Niassa. As a first step the capacity development needs of possible

implementing partners will be identified. Secondly, the partners technical capacity will be built in pertinent

program areas such as: PMTCT, stigma reduction, and HBC. Finally, FHI will strengthen their institutional

capacity through the provision of technical assistance and trainings on management, financial management,

proposal development, and organizational development.

Deliverables/benchmarks

• Technical assistance and training to build organizational and technical areas in new provincial partners

New/Continuing Activity: Continuing Activity

Continuing Activity: 16294

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16294 16294.08 U.S. Agency for Family Health 7277 5078.08 USAID-Family $110,000

International International Health

Development International-

GHAI-Local

Table 3.3.18:

Cross Cutting Budget Categories and Known Amounts Total: $200,000
Human Resources for Health $200,000