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.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
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
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
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 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
(1) HIV and malaria in pregnancy component reprogrammed to JHPIEGO in FY08; no new funding for FY09
(2) Central level support component to be reprogrammed for implementation in FY09
April08 Reprogramming Changes: This reprogramming request is to split the TBD, with $135,000 for HIV
and malaria in pregnancy activities to JHPIEGO.
This activity, which is new in the PMTCT program area, represents initial steps for strengthening the
linkages between HIV and malaria prevention, diagnosis and treatment services. Experience from this
activity can be used to create the foundation for improved linkages between HIV and malaria components.
Objectives: A) Strengthen the linkages between HIV and malaria prevention, diagnosis and treatment
services; B) Improve coordination of PMTCT and malaria mitigation activities.
Main Activities will be: (1) Complete HIV and malaria health services assessment, including documentation
of current malaria and HIV prevention, diagnosis and treatment services conducted in PMTCT settings in
selected provinces, with additional focus on linkages between services; (2) Complete analysis of
assessment findings, develop and disseminate recommendations; (3) Develop updated service delivery
guidelines for malaria, HIV/AIDS, and reproductive health; (4) Based upon results of assessment, create
plan for next steps for development/adaptation and pilot test of materials and recommendations for
strengthening of linkages between malaria and HIV prevention, diagnosis and treatment services.
This activity is composed of two distinct pieces: the first focusing on HIV and malaria in pregnancy
[$135,000], and the second focusing on central-level support for PMTCT policy development, including
mother support groups and integration with child health [$203,000].
HIV and malaria in pregnancy
It is well-known that malaria and HIV are devastating global health problems. Less is known about the
interaction of the diseases or treatment choices for co-infected individuals; however, the current information
reveals a very serious public health problem given the wide geographic overlap of the diseases in sub-
Saharan Africa. HIV and malaria are highly endemic in Mozambique. HIV prevalence is 16.2%, and more
than 90% of the population is exposed to malaria. Malaria is the largest single cause of mortality in
hospitals: it is responsible for over 40% of outpatient visits and for 30% of recorded hospital deaths. The
population is thus not only at severe risk of ill-effects of each disease, but for co-infection by both of them.
Pregnant women are especially vulnerable to these diseases. Malaria during pregnancy increases the risk
of maternal anemia, spontaneous abortion, still birth, low birth weight, and neonatal death. It is responsible
for the death of approximately 10,000 African women and 200,000 infants each year.
The activity described so far will provide a foundation for future revision of training materials and service
delivery guidelines beyond the PMTCT setting, with latest evidence relating to the interaction between HIV
& Malaria.
Central-level PMTCT support
This is a new activity designed to strengthen national PMTCT leadership and guidance by creating
opportunities with a TBD partner with central-level influence and experience in Mozambique, such as
UNICEF or other potential applicants. The TBD partner will be in a unique position to influence MOH policy
at central level, including finalization of outstanding PMTCT norms and standards, as well as a systematic
approach to integrating PMTCT and child health (IMCI) activities, thereby creating a stronger link between
PMTCT and child survival efforts.
Key activities will include A) Support for central-level finalization and dissemination of PMTCT norms and
standards; B) Support for coordination of PMTCT and child health integration, including IMCI; C)
Collaborate with I-TECH in development and implementation of mother support groups for PMTCT.
Coordination between stakeholders started in FY07 with planning for a support group assessment activity,
and FY08 activities will include development of a standard model, pilot phase, and implementation.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16309
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16309 16309.08 HHS/Centers for To Be Determined 6412 3640.08 TBD
Disease Control & Cooperative
Prevention Agreement
Table 3.3.01:
This is a new activity. The Families Matter! Program (FMP) is an evidence-based, parent focused
intervention designed to promote positive parenting and effective parent-child communication about
abstinence, sexuality, decision-making and sexual risk reduction for parents of 9-12 year olds. FMP is an
adaptation of the US-based "Parents Matter" curriculum which CDC has implemented and evaluated in the
US with various partners. This community-based family prevention program strives to foster enhanced
protective parenting practices and promote parent-child discussions about abstinence, sexuality, decision-
making and sexual risk reduction. The ultimate goal of FMP is to support sexual abstinence and reduce
sexual risk behaviors among adolescents, including delayed onset of sexual debut, by giving parents tools
to deliver primary prevention to their children.
FY09 funds will be used to conduct a formative assessment to culturally adapt and pilot test the program
materials that are currently being used in Kisumu, Kenya. We propose to implement the FMP in the
province of Zambézia and the Beira and Maputo corridors, where HIV prevalence among women aged 15 -
14 years old is high and above the national prevalence with some surveillance sites showing rates close to
20% - 25% or more in 2007. The 2003 DHS data suggest that high HIV prevalence in Zambézia and Beira
corridor may be associated with factors such as early sexual debut (15.7% vs 16.1% nationally) and high
level of women engaged in intergenerational sexual relations. In Maputo and Gaza provinces (Maputo
corridor) HIV incidence continues to increase and have high levels of reported risk behaviors among young
women and men like multiple sex partnerships and low level of condom use. Activities promoting abstinence
and delay of sexual debut in young people have been key in a multi-component intervention program to
improve adolescents' sexual and reproductive health in areas such as those proposed for Mozambique. A
preliminary analysis of an assessment conducted in Kenya 15 months post-intervention, found sustained
positive effect in terms of parenting and communication skills reported by participants and their children
separately.
Following the formative assessment and material adaptation, the TBD partner implementing FMP will train
facilitators to deliver the five consecutive, three-hour sessions for parents and caregivers. The intervention
curriculum focuses on: raising awareness about the sexual risks many teens face today; encouraging
general parenting practices (e.g., relationship building, monitoring) that increases the likelihood that children
will not engage in risky sexual behaviors; and improving parents' ability to effectively communicate with their
children about abstinence, sexuality and sexual risk reduction. An additional emphasis will be placed on
training parents to address the role of gender-based norms in adolescent sexual decision-making and risks
associated with transgenerational sex for girls. FMP uses a mixture of structured learning experiences,
discussion, audiotapes, role plays, and group exercises. In addition, a combination of both verbal and
visual instruction techniques was incorporated in the program in an attempt to address auditory versus
visual learning preferences.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Alcohol consumption and its consequences together with HIV/AIDS are major public health burdens in
many parts of the world. There is overlap between persons at risk for alcohol-related problems and
individuals at risk for HIV infection. Regardless of the level consumed, alcohol is likely to influence the
health status and behaviors of persons infected with HIV and those whose behaviors place them at risk for
acquiring the virus.
As HIV/AIDS research becomes more focused, there is growing evidence that alcohol consumption may
play an important role in sexual transmission, susceptibility to infection, and progression of HIV disease. In
addition to being a possible risk factor in the transmission and progression of HIV disease, alcohol misuse is
likely to impact adherence to complex HIV medication regimens and to physician advice.
There is a growing evidence that alcohol consumption in African countries is becoming an important public
health problem and year 2000 estimates from World Health Organization (WHO), 2004) indicate that the
eastern and southern Africa have the highest consumption of alcohol per drinker in the world associated
with the prevalence of hazardous drinking patterns.
It is therefore important to conduct an assessment which seeks to clarify the role of alcohol in HIV
transmission and disease progression, and to develop and test preventive interventions which both reduce
the risk of alcohol-related HIV transmission and improve the treatment of HIV infected alcohol abusing
and/or alcohol dependent individuals.
To date, there are no data on the magnitude and patterns of alcohol consumption in Mozambique that can
be used for planning HIV prevention and control activities. In order to establish effective interventions that
address the role of alcohol in HIV transmission and control, there is a need to evaluate the current pattern of
alcohol consumption and explore related sexual risks contributing to HIV transmission in the country. In
April 2006, the Mozambique's National AIDS Council convened the first meeting in the country to start
addressing alcohol consumption, where besides generalized alcohol consumption different stakeholders
expressed their concerns regarding high level of consumption of locally brewed beverages mainly in peri-
urban and rural areas. It has however stressed that the real magnitude of this problem as well as the
associated HIV risk behaviors are unknown.
In order to start establishing effective interventions that address the role of alcohol in HIV transmission and
control, there is a need to evaluate the current pattern of alcohol consumption and substance abuse, and
explore related sexual risks contributing to HIV transmission in the country.
Table 3.3.03:
This is a new activity in that it is organized as its own separate activity, but is a continuation of the
subactivity listed as Activity 4993.08 in COP 08.
Mozambique has not yet implemented a round of Behavioral Surveillance. A pre-formative project was
conducted in FY08 to help the Government of Mozambique and other stakeholders to identify and prioritize
key risk groups (Phase 1). Current groups proposed for inclusion in BSS include female commercial sex
workers, young women involved in transactional sex, miners and their partners, and long distance truck
drivers. This will be followed by the formative phase to develop plans and protocol for BSS+
implementation (Phase 2). Ultimately 3-4 groups will be included in the BSS; final selection of these groups
will be dependent on Phase 2 activities including an assessment of feasibility of inclusion of each group.
Phase 2 will be followed by Phase 3, the survey implementation phase. Currently it is planned that the
survey will include a biomarker to estimate HIV prevalence for these groups. Funds will be used for
technical assistance needed to plan and implement Phase III, required commodities and lab supplies for
BSS implementation, contracting of local field teams for data collection and entry, and technical assistance
for data analysis and dissemination.
Some funds were allocated for BSS with 07 Plus-up monies ($422,000) and COP 08 monies ($578,000).
However, based on the experiences of other countries implementing BSS (including Angola), and that fact
that some characteristics of Mozambique including limited physical infrastructure compounded with the
need to coordinate a complex survey in Portuguese, we anticipate that a minimum of $2.225 million will be
needed to implement a survey that includes four groups.
$450,000 is being requested in COP 09 through the Other Prevention program area to support this activity.
Data collected in the United States and throughout Africa consistently demonstrates that many HIV-infected
persons continue to engage in high-risk sexual behaviors that may transmit HIV, despite knowledge of their
HIV infection. Anecdotal evidence suggests that the same is true in Mozambique; however, there are only
limited efforts implementing prevention techniques in HIV care settings and capitalizing upon provider
interactions with HIV-infected patients in order to stop the transmission of HIV.
These reprogrammed funds ($500,000) will be used to scale-up and expand existing, pilot Postive
Prevention (PP) efforts in Mozambique. The goals of the PP intervention are to prevent morbidity among
persons living with HIV/AIDS (PLHA), prevent HIV transmission to sexual partners and children of PLHA,
and reduce stigma for PLHA in service settings. The PP project is targeted toward providers within clinical
and community-based sites in Mozambique to encourage them to address the prevention and care needs of
those living with HIV in Mozambique. Working under the assumption that the patient-provider relationship
contains vast opportunities to carry-out HIV transmission interventions, existing partners developed provider
and patient specific goals and objectives to track behavior changes in both populations. This includes
discussions about:
HIV risk behavior (risk reduction techniques)
Encourage partner testing
Counseling and support
How to disclose HIV to partners and family members
How to produce or maintain healthy families
Individualized prevention plans and risk reduction techniques
The TBD partner would use existing, Mozambique-specific materials developed by the University of
California at San Francisco (UCSF) to implement PP activities in high prevalence provinces of the country.
This partner and activity will complement the ongoing work of UCSF by expanding to additional provinces
and/or districts and focusing more extensively on community-based PP efforts. The focus of the program is
to provide healthcare workers at facility-based sites and PLWHA and counselors at community-based sites
with competencies, comfort and skills to discuss risk behavior, risk reduction techniques and prevention
needs, thereby decreasing HIV transmission and encourage partner and family testing.
The additional funds will be used to expand the PP program to two additional provinces, Gaza and Manica,
which have high HIV prevalence.
Deliverables and Products
Number of sites supported and activities developed in the sites and number of existing PLWHA groups
supported
Number of staff trained from Clinical Care & Treatment partners
Number of staff trained from HBC/community Care partners
Number of staff from Mozambican PLWHA Organizations or groups trained and received some mentorship
on PP with these organizations
M&E for scale -up of PP activities: (1) Routine monitoring of basic process indicators (e.g. # partners
involved, # sites, # staff trained); (2) Program evaluations (TBD, possibly annually)
Collaboration with MATRAM, by integrating PP messages in the treatment education/literacy activities
THIS IS A NEW ACTIVITY
Until October 2008, Early Infant Diagnosis (EID) capacity was limited to a single reference laboratory (INS)
in the capital city of Maputo, in the southernmost region of the country. Testing capacity was expanded in
October 2008, when a second laboratory in the Northern region of the country was opened. Dried Blood
Spot specimens from every Province in the country are referred to one or the other of these laboratories for
testing. As a result, long delays often occur in getting test results back to health facilities for communication
to patients and follow up. To improve the timeliness and access to EID, FY09 funds will support expansion
of EID to an additional laboratory in the Central region of the country. FY09 funding to TBD-Brazilian
Partner will support a laboratory mentor for the new laboratory for one year. This laboratorian, with expertise
in DNA PCR and specimen management will support Mozambican laboratory technicians who will be
trained to perform testing. Mentor will ensure good laboratory practices are being followed, including use of
SOPs and internal quality assurance. Mentor will also facilitate participation of the laboratory in the EQA
program with INS. Mentor will monitor activities, identify problems, and seek solutions as needed. S/He will
transfer skills and knowledge and build capacity in technical staff through on the job training and coaching.
13208 8547.08 HHS/Centers for JHPIEGO 8784 8784.08 $1,047,000
Disease Control &
Prevention
8547 8547.07 HHS/Centers for To Be Determined 4879 3640.07 TBD
Estimated amount of funding that is planned for Human Capacity Development
Table 3.3.11:
ACTIVITY UNCHANGED FROM FY2008 (No new funds for FY09)
This PHE activity, "The validation, acceptability and feasibility of oral fluid based rapid antibody testing in
Mozambique", was approved for inclusion in the COP. The PHE tracking ID associated with this activity is
MZ.07.0075
Continuing activity - FY 07 COP activity number: 8633 - Title: The validation, acceptability and feasibility of
oral fluid based rapid antibody testing in Mozambique.
Principal Investigators:
Cynthia Sema - National Institute of Health, Ministry of Health (MOH)
Kenete Mabjaia - Counseling and Testing (CT) Program, MOH
Project description: The purpose of this study is to evaluate the performance, acceptability and the
feasibility of two HIV 1/2 oral fluid test (Oraquick® and Calypte Advance) in Mozambique. The tests'
performance, as compared to the gold standard, will be evaluated in a first stage with specimens collected
from clients at selected Counseling and Testing (CT) centers in Maputo City and processed at the
Mozambique National Health Institute reference laboratory for HIV testing. After this validation, the test's
acceptability and feasibility will be assessed in remote areas and communities within the context of
youthfriendly
HIV/AIDS services and community-based CT (CCT).
Progress to-date: Turnover of staff at the Ministry of Health including a new CT Program Director delayed
the development of this protocol during the first year. Substantial progress has been made since new MOH
Principal Investigators have been identified, and support for development of the study protocol been
providing through USG supported consultancies and fellowships. The protocol and tools are now in final
stages and expected to be submitted for reviews in the US as well as the Mozambican Bioethics Committee
in country late September/early October 2007. An in-country working group has been formed, composed of
MOH laboratory and CT program staff, USG supported CT stakeholders (JHPIEGO, PSI and Pathfinder),
and USG technical staff. Preliminary preparations at sites selected and identification of staff to be involved
has started and will be in place for implementation once approval has been obtained.
Lessons Learned: Frequent changes and transfers of MoH personnel require constant re-briefing of new CT
personnel coming from a variety of professional backgrounds and potentially limited prior CT experience.
Recruitment for a USG study coordinator is in process and expected to be completed by end of FY07. This
staff will ensure continuity of activities, briefing of new MOH personnel and working group members, and
helping to move this activity forward without major delays in the future.
Information Dissemination Plan: Stakeholders that are also part of the MOH lead study working group will
participate in the planning and presenting of the data at meetings and conferences. Results of the study will
be disseminated to all participants including counselors in the study. Possibilities to publish results in a peer
reviewed journal will be explored.
Planned FY08 activities: The study will be comprised of two phases. The first phase will consist of a
laboratory-based evaluation of the test performance of the two oral HIV tests, i.e., its sensitivity, specificity
and predictive values. Approximately 400 HIV-positive samples will be required and will be collected at
Counseling and Testing (CT) sites in Maputo City. Two sites with high client volumes have been selected as
sites for collection of samples. Besides the oral fluid test, to be performed at the facility, whole blood
samples will collected using Dried Blood Spots (DBS) and sent to the National reference laboratory for HIV
testing. It is anticipated that this phase will take approximately 3 months. The second phase will entail taking
the test into communities with little or no access to facility-based HIV testing as well as to youth services.
Qualitative methods, specifically group interviews and semi-structured individual interviews will be
conducted in order to obtain in-depth information about community members' and youths' views regarding
rapid oral HIV testing. It is estimated that this second phase will take approximately 4 months, including the
analysis of the qualitative data collected.
Budget Justification for FY08 monies: While funding from previous years will contribute to completion of the
1st phase of this study and cover expenditures such as the procurement and importation of Oraquick® test
kits, procurement of supplies for testing and implementation of adequate biosafety measures, transport of
samples between sites and the reference laboratory, training and contracting of short-term laboratory
personnel for study-related HIV testing; funding requested for FY08 will cover costs for the second
qualitative phase such as training and contracting of interviewers for the qualitative assessment, travel and
per diems for in-country travel, short-term local contracts for transcription, translations, data entry and data
analysis.
Activity Narrative: Salary/fringe benefits: not applicable (na)
Equipment: $ 15.000
Supplies: $ 20.000
Travel: $ 30.000
Participant incentives: na
Laboratory testing: na (covered through previous years funding)
Other: $ 25.000 (Meetings and results dissemination)
Total: $90,000
Continuing Activity: 15737
15737 15737.08 HHS/Centers for To Be Determined 6412 3640.08 TBD
Table 3.3.14:
PARTNER IS SOUTH TO SOUTH PARTNER TBD. Activity in 2008 was 12276.08 (Mech ID: 6128.08).
Below is a modified version of the COP08 Narrative:
This activity is related to lab capacity building activities implemented by APHL, ASM, MoH, and SCMS.
This activity has several different components of continuing and new activities with emphasis on in-service
training, capacity building at Central and Provincial Levels, and technical assistance to support quality
assurance and biosafety at Central Level. This support will utilize partnership through South to South (S to
S) collaboration, taking advantage of Portuguese language proficiency and experience developing
laboratory capacity in resource-limited settings. The goal of this activity is to provide laboratory expertise to
the Mozambican Ministry of Health to improve national laboratory service capacities. Activities will be
implemented through a Cooperative Agreement to a "To Be Determined" South to South Collaboration
Partner This TBD partner will support the Ministry of Health to implement its Strategic Plan for Laboratory in
collaboration with other PEPFAR partners working in the area of laboratory strengthening. FY2009 funding
will support the following activities:
1 - Continuation of technical training for Mozambican Lab Technicians in Brazil.
This training will provide a four month technical/practical training in immunology, biochemistry, hematology,
microbiology, as well as laboratory and quality management training for 15 (superior and medium level)
Mozambican Lab technicians. Training will be conducted in laboratories using modern instrumentation and
information management systems to provide trainees with optimal conditions to learn good laboratory
practice, work flow, quality assurance, information management, and professionalism. Training will be
supervised by specialized professionals and will include participation in daily/weekly laboratory sessions of
lecturing, case studies (including preparation of case studies by Mozambican trainee for presentation to the
group), and laboratory results review and interpretation. Post-training, Mozambican lab technicians will be
assigned to work in renovated and/or specialized laboratories within the Laboratory Network and will play
increasingly greater roles in the development and facilitation of in-country trainings in their area of expertise.
As technical capacity is built within this cadre of superior and medium level staff, and physical infrastructure
improvements at Provincial Hospital laboratories and Health Science Institute training labs is improved,
more of the technical training that is currently taking place outside of Mozambique can be shifted back to
Mozambique.
2 - Continuation of technical assistance (TA) to the National Immunology Reference Laboratory (INS) to
maintain and expand the national HIV rapid test serology External Quality Assurance (EQA) Program. Four
rounds of proficiency test (PT) panels (liquid) for HIV serology have been completed. Starting in round
three, samples positive for hepatitis B antigen (HBsAg) were included. Blood banks and clinical laboratories
routinely perform HBsAg testing and the addition of this parameter is essential to monitor quality of
screening and diagnostic procedures for Hepatitis B antigen. Starting with the next round of PT, dried tube
spots will be included along with liquid samples and an assessment of results using this alternative sample
type will be performed. In FY2009, TA will focus on scale up and decentralization of HIV serology EQA to
Provincial Level, including transfer of capacity and responsibility for HIV rapid test serology sight
supervision and training to Provincial Level laboratory staff. This will support the MoH's desire to increase
the routine training of staff performing HIV rapid tests as well as the efficiency and frequency of intervention
and re-training for testing sites that fail a given PT panel. TBD partner will collaborate with APHL, who will
receive FY09 funds to continue support to the logistics system to distribute panels and collect reports from
the provinces. Finally, TA will focus on simplified HIV sub typing methodologies to be transferred to INS
lab. This is to address the discrepancy whereby distribution of HIV-1 sub-type in Mozambique is very
heterogeneous and yet, most HIV rapid test technology is based on sub-type B. An important goal of TA
will be to address whether PT panel samples of different sub-types will perform equally well across the
country. As the INS lab maintains responsibility and expertise for characterization of samples which are
selected for PT panels, building capacity for sub-typing in the INS lab is crucial.
3 - Continuation of the In Country Project Manager (ICPM)
Two portuguese-speaking laboratory professional will be stationed in Mozambique as In Country Program
Managers (ICPMs). Their responsibilities will include: liaising between MoH, the US Government (USG),
USG Treatment Partners, and Project Directors in Brazil to ensure activities are implemented and results
are being achieved; preparing and facilitating Mozambican lab technicians for technical training in Brazil and
organizing training and mentoring by Brazilian experts in Mozambique; supervision visits to laboratories to
monitor performance of staff that have participated in the technical training in Brazil and/or been trained and
mentored through the laboratory mentorship program; participation in laboratory training activities with other
PEPFAR lab partners through curriculum development, course facilitation, and lecturing; and support to
MoH lab section in planning and implementation of National Strategic Plan.
4 - Continuation of Laboratory Mentorship in MoH laboratories performing CD4 lymphocyte count by flow
cytometry, biochemical and hematological tests. Three trainings for a period of 6-9 months will be
conducted with FY09 funding with 45 people trained. The goal of this program is build capacity through on-
the-job training in technical skills, biosafety, quality assurance processes, communication skills,
organization of work flow, lab inventory management, lab information management, daily equipment
maintenance and troubleshooting, time management and professionalism. Mentors will give weekly
seminars on relevant laboratory topics and encourage lab staff to participate in discussion and debate.
5 - Conduct a workshop to promote collaboration between clinicians and laboratorians. Results of previous
mentorships revealed that provision of quality laboratory testing services was impeded by the lack of
communication and collaboration between clinicians requesting lab tests and laboratorians performing tests.
Workshop organization will be lead by Mozambican physician being trained in clinical pathology who has: a
passion and understanding for the need to improve communication, respect among Mozambican
physicians, and the necessary experience to lead this effort. A small working group including clinical lab
Activity Narrative: directors, hospital medicine directors, and medical school faculty will be formed to develop scientific
program and follow up on impact, post-workshop. Participants in workshop will include laboratories,
physicians, medical school students and faculty, and laboratory training faculty from Health Science
Institutes.
6- FY2009 funds to TBD partner will support a technical advisor position within the MoH Laboratory section,
to build capacity of the department in strategic program planning and implementation. The Laboratory
Section staff are promising, but relatively inexperienced with little laboratory training and no laboratory
management or quality assurance management training. The proposed advisor will be a senior level
person with several years experience managing a laboratory network and will work with Laboratory Section
Head and his/her staff to define roles and responsibilities, processes, tools, and communication channels to
effectively manage the quality of the national laboratory network, in line with the National Laboratory
Strategic Plan.
Other activites to be implemented by this partner in other program areas include: $56,250 to laboratory
mentor for new Early Infant Diagnosis laboratory in Beira; $200,000 to support Counseling and Testing
Table 3.3.16:
Many care and treatment sites in Mozambique have been scaled up with the support of one of 6
USG/PEPFAR-supported care and treatment partners as well as two non-USG funded external partners.
While many sites are using the standardized MOH-developed tools for data collection and reporting, in
some cases, these tools have substituted and/or additional paper based tools have been introduced by
partners. In some sites, only paper-based systems are used, while in other cases, partners have introduced
electronic systems for data management and reporting.
To better support MOH in improving quality of care, integrating HIV care and treatment services, and
ensuring sustainability of systems, USG PEPFAR is conducting an assessment with COP 08 funds to
generate recommendations so that PEPFAR-supported sites are better aligned with MOH systems and
standards, including the use of standardized MOH tools, flow of data from PEPFAR-supported sites through
national reporting systems, and more cost/resource-effective use of electronic patient monitoring systems.
Furthermore, activities currently under discussion by MOH to review and update the national M&E system
provide an opportunity to develop national guidelines or standardized operating procedures related to M&E
for care and treatment services, as well as a set of national standards for electronic data systems for HIV
care and treatment.
This activity will help to generate recommendations on:
1) New or modified data elements to be included as part of the minimum data set for patient monitoring in
Mozambique;
2) Best practices or recommended standards for paper-based and electronic data systems in Mozambique.
COP 09 funds are requested to support implementation of recommended priorities generated from the
assessment. Recommendations from the assessment with be reviewed and prioritized in consultation with
USG, implementing partners, and the Ministry of Health. These might include development of national
standards for electronic HIV information (e.g. HL7 standards for ART minimal data set), development and
dissemination of national protocols on data quality protocols, and/or technical assistance in modifying
existing partner systems to be more in line with the national standards and guidelines. It is expected that
preliminary recommendations will be generated by mid-FY09, at which point the partner and specific scope
of work will be determined.
Table 3.3.17:
BACKGROUND AND SUMMARY
Measurement of mortality is an important aspect of HIV surveillance. The Government of Mozambique is
working to improve mortality surveillance systems through strengthening of the hospital based reporting
systems, by improving collaboration between ministry of justice, national statistics institute, and ministry of
health, by revising the official death certificate, by implementing health and demographic surveillance sites,
by increased participation in WHO mortality reporting activities, and conducting special surveys. The
current process by which death registration moves from community, to health facility, to civil registry, to vital
statistics is not well understood. Further, these processes vary from province to province, with Maputo
demonstrating death registration rates ten times higher than Nampula in 2001, and with no estimates
available of registration rates in rural areas. This activity will cover expenses related to coordination
between these various activities.
ACTIVITIES and EXPECTED RESULTS:
Funds may be used to assess how death certificates currently flow through the health system and civil
registry system. Funds may be used for diverse activities related to death registration, including to increase
collaboration between ministries by sponsoring meetings and workshops on death and birth registration,
and to sponsor participation by local counterparts in regional and international meetings related to vital
statistics.
Through this activity it is expected that there will be both increased awareness of the limitations of traditional
vital registration among ministry technical staff, and improvements in registration rates leading to better
estimation of cause and age-specific mortality.
Continuing Activity: (No new funds in FY09)
SUMMARY AND BACKGROUND:
This activity is associated with Mozambique's SI five year strategy to technically and financially support
surveillance to monitor HIV/AIDS-related illnesses, understand the behaviors that influence transmission,
improve access to and use of care and treatment services, strengthen the effectiveness of program
activities, and ensure a supportive environment for USG efforts.
MOH, in coordination with donor and technical assistant partners, began implementing routine HIV sentinel
surveillance among pregnant women in 1998 in 10 sites. Since 2001, CDC has provided complete financial
and technical support for sentinel surveillance activities in Mozambique. In 2007 during the latest round,
sentinel surveillance was conducted at 36 sites throughout the country and dry blood spot (DBS)
technology, BED incidence assays, and threshold ARV resistance monitoring were introduced.
Funds will be used to train survey personnel including maternal and child health nurses, laboratorians,
district and provincial supervisors, as well as prepare data collection instruments, move supplies to and
from surveillance sites, and conduct site assessments and supervision for the 2009 sentinel surveillance
round. This activity is related to activities 15916.08 and 8639.08.
Continuing Activity: 19911
19911 19911.08 HHS/Centers for To Be Determined 6412 3640.08 TBD
Mozambique will conduct its first population-based AIDS Indicator Survey (AIS) in early 2009. Further, this
is the Ministry of Health's first attempt to conduct a national seroprevalence survey. Conducting this survey
in Mozambique is presenting many challenges that lead to uncertainty regarding budgeted activities. These
uncertainties are due in part to fluctuating fuel prices, delays which have led to implementation during the
rainy season, lack of infrastructure, concerns about social mobilization, and the need to produce materials
in English and Portuguese.
While the survey fieldwork is funded via the NAC, and technical assistance and laboratory support,
including procurement, is funded in COP08, this activity will provide additional funding to cover unexpected
expenses associated with the survey.
Activities to be conducted with these funds include translations, development of informational materials,
purchase of test kits and reagents, travel expenses related to supervision, dissemination activities and a
national prevalence estimation workshop to combine results from ANC sentinel surveillance and the AIS.
Through this activity it is expected that the AIS survey will be successfully completed leading to improved
national and provincial HIV prevalence estimates and updated behavioral data that is critical to assessing
prevention activities in Mozambique.
This activity is related to activity 10211.08.
In previous years, all administrative and logistical support for in country surveys, including surveillance
systems, have been done through the General Services Office (GSO). The volume of these purchase
orders (PO) has increased drastically in the last year and these POs have become increasingly complex
and complicated to award through the GSO. We anticipate the work load to further increase in FY09 as
described below.
The Ministry of Health, with technical assistance from the Centers for Disease Control and Prevention
(CDC), is currently working on the implementation of several surveys, and surveillance activities.
Currently, the MOH with assistance from its partners have 17 surveys in progress , and the PEPFAR team
has applied for 8 multi country public health evaluations (PHEs), and 3 Mozambique specific PHEs.
The Mozambique program needs a flexible and quick mechanism that will enable the USG to help the
Ministry of Health implement the above mention surveys and PHEs in a timely fashion. To help with the
logistical and administrative support for Mozambique's multiple surveys, surveillance activities (including
BSS) and potential PHEs, the CDC is developing a new competitive indefinite delivery, indefinite quantity
(IDIQ) contract. An IDIQ contract works through task orders that can be awarded with a short turn around
allowing for services to be delivered in a timely manner.
The contractor is expected to coordinate and implement all logistical and administrative aspects of the
surveys (including, surveillance systems, BSS, PHEs and additional assessments needed such as a
national alcohol assessment). Some of the funds will be used for start up expenses of a local contractor;
the rest of the funds will be used for first year programmatic expenses which include:
- data collection services for surveys, including PHEs
- data cleaning, management, analysis, and entry
- rapid turn around translations
- logistical support for multiple surveys in multiple sites (i.e. coordination of staff and questionnaires,
coordination and overseeing of data transport, data entry, cleaning, etc)
- potential transport of survey and admin coordinators
- survey instrument development and validation
- statistical support
- other logistical and administrative services as needed
Expected deliverables: identification of local contractor to provide services covered in the activities above.
contractor may also need to subcontract with other smaller local service providers to address needs in
different provinces.
This is a new activity but received initial start-up money in COP 08 as activity 19910.08.
As noted in other sections in this COP, a key focus for COP 09 is increasing SI capacity, specifically
building a cadre of Mozambicans with appropriate and adequate skills to carry out necessary strategic
information activities in Mozambique. The USG team is using a variety of shorter- and longer-term
strategies and activities to support this capacity. While some other SI capacity building activities (e.g.
strengthening M&E curriculum at Masters of Public Health Program at the University of Eduardo Mondlane
and Field Epidemiology Training Program) will be expected to increase the number of and skills of
Mozambicans in Strategic Information, the M&E Fellowships Program recently initiated as part of South
Africa's PEPFAR Program provides an opportunity to increase M&E and other SI related skills among
Mozambicans in the shorter term (1-2 year timeframe.)
The University of Eduardo Mondlane School of Medicine has the only MPH program in Mozambique. It
began in 2001 and typically has enrollment of 30 students from Mozambique and other African countries.
The program received support from NORAD to develop an informatics track but that support has ceased.
Emory University also provides support in the form of student scholarships around the area of injury
prevention.
There is a need for a cadre of health care workers trained in public health and UEM is currently the sole
source of a degree in this field. In years previous, CDC was approached by UEM to provide support to this
program but there was instability within the organizational capacity of the program making it difficult for them
to develop an list of areas where they needed support. The faculties were all part time and therefore no one
of them was able to focus more than part of their time on the program. In FY08, CDC met with the
University of Eduardo Mondlane -MPH program to discuss the status of the program, their needs and how
we might work with them. Given favorable progress on the limited scope of FY08 activities, in FY09, we will
seek to provide support directly.
In FY09, funds will be used to develop a sole source RFA for continuing support to the MPH program. The
use of these funds will be defined according to the scope of the RFA and needs of the program.
Deliverables:
RFA developed and awarded
Estimated amount of funding that is planned for Education
Table 3.3.18:
This is a new activity.
This activity will contribute to capacity building of the MoH staff, with the goal of producing highly qualified
medical personnel to provide health care services and assume leadership roles within the health system
particularly with respect to Tuberculosis, HIV, malaria and other infectious diseases.
The Ministry of Health provides in service training in HIV/AIDS and management for medical doctors
immediately after the general medical training. This is a 3 week intensive course that covers several
aspects of HIV such as virology, nutrition, PMTCT, M&E and prevention. Upon completion, the medical
doctor is certified to provide ARV therapy in the health facilities. There is no infectious diseases
specialization program in place at any of the medical schools in Mozambique. The Ministry of Health has
been exploring possibilities of sending students abroad to receive this training.
The proposed activity is to support the development of an infectious diseases fellowship program that would
be offered at post-graduate level to medical doctors. This activity will help build clinical capacity in
Mozambique with respect to management and leadership in the three main endemic diseases (HIV, malaria
and TB), as well as other infectious diseases of public health significance in the country.
The USG will collaborate with the Ministry of Health, Medical Council of Mozambique (Ordens dos
Medicos), Universities and other partners to develop and implement a training program defining the
curriculum content, target group and duration of the program.
During FY09, the following will be achieved with the funding proposed: an assessment to define curriculum,
and complete the training curriculum and materials for a post graduate Infectious disease fellowship
program for Mozambique. Funding in subsequent years will be used for implementation of actual training
courses, course evaluations and expansion as appropriate.
Products/Deliverables
Assessment concluded
Fellowship plan developed
Curricula content defined
Training material developed
Partnerships with relevant Mozambican and other (Brazilian, Portuguese, USA) training institutions
strengthening M&E curriculum at Masters of Public Health Program at the University of Eduardo Mondelane
Mozambicans in the shorter term (1-2 year timeframe). Furthermore, Mozambique's participation in the
South Africa Fellowship program provides an opportunity for Mozambique to determine if and how a
Mozambique-specific Fellowship can be developed within Mozambique in the coming years.
In this six-month fellowship program, graduates of Masters in Public Health programs are matched with
PEPFAR partners that are in particular need of M&E support. This program is aimed to create opportunities
for Masters of Public Health students to gain practical experience in monitoring and evaluation within a
mentorship work environment. This is a strategy to provide career development opportunities that help to
improve retention of local (Mozambican) staff with these "scarce skills" sets.
These Mozambican M&E Fellows will be placed with South African PEPFAR Partners during their Masters
degree study period in order to gain practical experience. These practical skills may then be ploughed back
into Mozambique when Fellows return home after study completion.
This activity is currently listed out as TBD until the appropriate mechanisms can be worked out with the
PEPFAR South Africa office, and the Foundation for Professional Development (FPD) who is administrating
the Program on behalf of PEPFAR South Africa.
In accordance with the policy used in the South Africa Fellowship Program, each Fellow will have to enter
into a contract that will oblige them to a specific period of skills transfer and capacity building within
Mozambique. The criteria developed for an individual receiving a scholarship for long term education will be
referred to in developing this contract.. This could be done by means of an intra-african parallel transfer by
a PEPFAR Partner within South Africa to their relevant branch in other African countries as part of the
Africans Building Human Capacity in Africa "scarce skills" retention initiative.
Funds requested will cover the logistical costs related to such fellowship placements for African students.
With $100,000 in COP 09 funds, we anticipate that approximately 5 Mozambican fellows can participate in
this critical capacity building project.
Establish mechanism for M&E fellowships
Select and send 5 Mozambicans to begin their fellowship
In 2007, the sentinel surveillance results in Mozambique estimated that the HIV prevalence among women
and men aged 15-49 to be 16% overall with actual provincial figures ranging from 20%-9%. Surveillance
results also showed that the epidemic is still on the rise in most provinces. According to other national and
regional analyses show that the key driver for Mozambique is the pervasive practice of multiple and
concurrent partners. Other drivers of the epidemic include early sexual debut, low condom use, low rates of
male circumcision, high level of women engaged in intergenerational sexual relations, low level of HIV
knowledge and gender-based violence.
In Mozambique, there are a number of pre-service training institutions where teachers and health care
workers receive their initial training. These institutions are located in urban and rural settings and tend to
serve more than one province. In order to gain education, young people may travel a significant distance
from their homes for up to 30 months in order to attend a pre-service education institution. The quality of
infrastructure and resources available at each training institution varies with some possessing renovated
accomodations, classrooms and humanistic lab while others are still in need of much repair. Recreational
facilities are scarce among the training institutions so students must either make due with what is at the
training institution or travel to a nearby town for recreational opportunities.
Although students are being prepared to educate others either in the classroom or as clinicans, they are not
recepients of HIV prevention education while in pre-service education. While frequently there are provisions
to prevent students from catching malaria in the form of mosquito nets for their beds, there seems to be a
dearth of information and resources around HIV/AIDS, TB, and OIs. Given the social mores in Mozambique,
the percentage of HIV+ individuals in the general population and the huge need for health care workers and
teachers, it does not seem prudent to fail educating students as they attend pre-service, typically for 18-30
months. Also PEPFAR partners have anecdotally reported that they have seen first year nurses and
teachers die from AIDS related illnesses.
This RFA would look at how a TBD partner could work across ministries (Minstry of Health, Ministry of
Education and Ministry of Defense) to assess suitability of educational campaigns educating students on
abstience and being faithful; HIV/AIDS, TB, OIs; identify sites for testing and treatment and developing a
system for condom distribution. Information from the health worker KAP study, where knowlege, behavior
and attitudes was measured in existing health care workers along with assessment results from the Ministry
of Education and Military will be utilized as background information.
Products/deliverables
Assessment of suitablilty of educational campaigns/activities and feasibility of providing testing and
treatment services for students at pre-service institutions
Developing an implementation plan for moving this overall project from concept to implementation
Funds will be reprogrammed as programmatic need arises in the systems strengthening technical area.
Possible uses of funds include additional support for newly competed country managed co-ags, Field
Epidemiology and Laboratory Program, and support for emergent Ministry of Health priorities.
