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: 2010
The SCIP Project optimizes PEPFAR funding by wrapping around funds from other sectors such as health, water and sanitation and Food for Peace, to impact on income growth, increased use of child survival and reproductive health services, community based safe-motherhood programs, improving uptake of HTC, reducing the transmission of HIV and distributing a package of home based services for People Living with HIV (PLHAs) and OVCs. The SCIP program aims to strengthen capacity of the public health system, NGOs, and CBOs to improve access to basic and life-saving health and social services, and to support a continuum of response that maximizes health outcomes for individuals, families and communities and minimizes loss to follow up (LTFU) of chronically ill patients. To improve the continuum of care for PLHAs, SCIP works with the provincial health office, district health directorate in 14 districts, and the community based ART committees.
The SCIP program is actively supporting a continuum of response by strengthening both the clinical and community-based capacity of health care workers; strengthening linkages between services for comprehensive health care; and strengthening decentralized health systems. Community based health workers and volunteers are trained to provide home based care, improve follow up of chronically ill people, and link with the facility and clinical partners to minimize LTFU
Twenty vehicles were procured in FY 2010 and 2011. No more vehicles are planned to be procured at this stage. Fourteen vehicles are based in each of the 14 districts to support implementation of activities. 6 vehicles are based in Nampula central office to conduct monitoring and supervision of activities by all 5 partners of the SCIP consortium.
To promote collaboration with other USG and GOM supported activities, the SCIP Program will aim to strengthen community-facility linkages and increase referrals and follow-up of patients by community workers for improved continuum of care, specifically through training on linkages with community services, home based care (HBC), antenatal care (ANC), antiretroviral therapy (ART), and child-at-risk testing and consultations. Community based health workers and volunteers are trained to provide home based care, improve follow up of chronically ill people, and link with the facility and clinical partners to minimize loss to follow up (LTFU). Pathfinder will work in close collaboration with organizations providing HBC services for PLHAs. Program beneficiaries who are sick will be referred to ART services and if needed, referred to a HBC program to ensure continuum of care. SCIP will complement the clinical partners efforts to reach the defaulters and lost to follow up (LTFU) to re connect them into the services through home based visits conducted by animadoras based on the list of defaulters with incomplete or incorrect address provided by the HF. SCIP will collaborate with the MOH HBC focal person, as well as with both focal PEPFAR supported clinical service partners in Nampula Province, to facilitate referrals and improve health outcomes of patients. SCIP will facilitate increased access to CT and provide counseling and referrals to facilities and HBC services for those who test positive. Pathfinder will help disseminate the GAAC (Grupo de Apoio a Adesão Comunitária, a community support group for positives) support group strategy at community level. This is a MOH strategy which aims to mobilize stable HIV patients on ART to organize themselves in groups, whose members take turns to collect their ARVs at the health facility. Pathfinder will support the distribution of the Basic Care Kit (condoms, water purification tablets, soap, IEC materials) promoted through community settings.
As an integrated health initiative, the SCIP Program will work with community/home-based interventions to improve nutrition; vaccinations; healthy spacing & timing of pregnancy; exclusive breastfeeding; complementary feeding/breastfeeding counseling; micronutrient supplementation; long lasting insecticide treated nets.
The lead partner and sub-partners implementing SCIP in Nampula are all International NGOs.
The goal of this project is to implement new methodologies for collaboration with existing programs, avoiding duplication of efforts and ensuring maximum impact. The SCIP program aims to strengthen capacity of the public health system, NGOs, and CBOs to support facility-based services through improved service delivery and management and supervision systems.
The SCIP project will establish linkages to OVC programming. Market driven economic strengthening will be addressed through support to the development of youth farmers clubs linked to schools and Community Youth Centers from Geração Biz, Community Leader Councils, OVC volunteers and other youth programs. The SCIP agricultural staff will learn from Multi Year Assistance Program (MYAP) agricultural extension agents and OVC will operate and make use of MYAP demonstration conservation farming plots. SCIP partners will identify OVC and their caregivers to participate in the MYAP farmer associations.
The YFC Youth Farmer Clubs will improve the livelihoods of the OVCs. YFCs are assisted by an agricultural extension worker that provides training in life skills, building on knowledge gained in school but presented in a way to make the activities both fun and educational. The products of the farming activity are primarily for consumption and the surplus for selling. The profits will be used to buy school materials and/or other priortity needs of the OVC participating in the Club. The Club is also a venue to learn other activities such as nutritional education for the OVC, sessions on Child Protection Laws, Childrens rights, address community gender norms and behaviors, and Prevention messaging.
Activities continue to include the identification of OVC and foster families and linking them with junior farmers associations, advocating on behalf of OVC during property right issues, and assisting them to obtain school and health documentation. They will also organize activities targeting project related health and livelihood support. Meanwhile care group animators when visiting households will initiate the identification of OVC and foster families, linking them with junior farmers associations, advocating on behalf of the OVC during property right issues, and assisting to get OVC school and health documentation, as well as the early diagnosis of adolescents living with HIV/AIDS and linkages to appropriate testing and complementary support services. The partner should continuously provide capacity building of care group animators in psychosocial support with special focus on adolescent living with HIV for issues such as disclosure to family and friends, addressing feelings associated with sexuality and others.
During the last year, the partner initiated a PPP with Coke, to support thirty OVCs and families in the pilot phase. The aim of this PPP is to boost the income of the families and ensure that older OVC learn business skills in balance with their education. The YFC are seen by communities and children as safe spaces where positive behavior an agricultural techniques are acquired. The challenge has been the implementation of OVC minimum standards of care, and this is will be followed up with the partner to ensure that OVC capacity building is planned for all care group animators based on the needs.
These funds will be used to strengthen local leadership councils at community and district level. These councils are composed of community leaders and civil society members, and in theory (though not always in practice) they are the civil society counterpart to local government as part of Mozambiques decentralization strategy. SCIP has been helping these councils assess local problems and solutions, although more work is needed to make these councils representative of their communities and to link them to government. There are other possible civil society-local government coordination fora that may also be relevant to support, such as Provincial Development Observatories and local health steering committees.
SCIP will assess the best way to provide support to local councils (or other civil society-government fora) and the most relevant districts to focus on. SCIP will assess priority capacity-building needs (such as advocacy, planning, access to information, and community organizing) and facilitate training and mentoring to address them.
This activity contributes directly to the Global Health Initiative Governance area, by improving planning and budgeting at local levels, and by strengthening the capacity of civil society to advocate for its concerns and hold government to account.
Amount reduced to cover ARV drug cost scale-up
The SCIP Program in Nampula combines funding from the AB and the OP budget codes to continue implementing a comprehensive HIV prevention program, aiming to reach adults and young people in selected districts of Nampula and Zambezia. SCIP has recently opted to focus on "depth of interventions" over "breadth of coverage" for behavior change. After a rigorous review of its behavior change approaches, the SCIP program has opted to use a more systematic strategy , and is currently implementing a "Pathways for Change" model to behavior change, and relying on a set of reinforcing tools, including home visits, theater, and community debates to reach its targeted population across the 14 districts. Key populations that are the focus in the HIV prevention activities include adults, and young people, with a particular effort made to reach young men, for example through the establishment of young farmers clubs. SCIP is targeting delayed sexual debut as a key prevention behavior among the adolescent population, and has a specific focus on improving male involvement, starting with youth. HIV prevalence in Nampula is higher among young women (6.5%) and older men (3.3%) , compared to young men ( 1.6%) and multiple partnerships are reported more often by men (25%) than by women (3%) , SCIP is working to reach young women and older men with messages to increase risk perception of multiple partnerships, particulalry as Nampula is home to a large port and transport corridor with increased potential for transactional sex between young women and older men. SCIP has a sound performance monitoring plan, which includes outcome and impact indicators, and is the basis for their data collection efforts, their targeting, and the design of and adjustments to approaches and strategies. USG will work with the partner (Pathfinder) to ensure routine monitoring and assessment of data quality including monthly data analysis at the district level,and quarterly and annual review meetings. An external mid-term evaluation of the overall SCIP program is currently being planned by USAID and will yield results for refining program interventions in FY12.
SCIP Nampula will continue to provide community-based counseling and testing for the general population, and will have a stronger focus on reaching men in the workplace by targeting men participating in USAID Agriculture, Trade and Business projects. Other target populations include pre- and in-service teachers linked to the USAID Education portfolio; partners of PLH and adolescent girls. Nampulas HIV prevalence is 4.4%; . In 2009, 10% of women and only 4% of men age 15-49 in Nampula reported having had a test in the last 12 months. SCIP Nampula will continue its door to door home-based CT for general populations and using the national testing algorithm.
All CT partners will benefit from QA support to the central public health institute. The lead clinical partner in Nampula will receive funds to support EQA logistics for all CT partners, including SCIP Nampula. The SCIP Program will mobilize communities and District Health Associations (DHAs) to increase the demand and use of CT services and coordinate with care, support and treatment providers to establish a two-way referral system of clients. Clients who test positive (including pregnant women) will be counseled to seek PMTCT services, pre-ART, ART and FP counseling, care, and support, referred to existing community volunteers, and made aware of existing support groups for PLH. Planned HVCT trainings include quality assurance and control, supply planning and forecasting, gender and gender-based violence (especially due to disclosure), linkages/continuum of care, and data management. The COP 12 community CT target of 11,550 individuals reached with counseling, testing and results is much lower than last years target of 45,000. This is due to limited service delivery HVCT funds and low-prioritization of community CT and Nampula province in the PEPFAR Mozambique CT and GHI strategy. SCIP Nampulas past year results (SAPR 11 + Q3) is 47,131 individuals counseled, tested and received results (104% achievement). SCIP Nampula will continue to ensure quality assurance through monitoring and supervisory visits, use the national referral documentation system to track and monitor HIV+ clients. SCIP Nampula will continue to participate and support the NIH biannual EQA panels and utilize standardized quality management tools for CT. They may opt to utilize the JHPIEGO model of peer supervision or consider implementation of client exit interviews and provider self-reflection tools for monitoring and improving counseling quality.
The SCIP Program in Nampula combines funding from the AB and the OP budget codes to continue implementing a comprehensive HIV prevention program, aiming to reach adults and young people in selected districts. After a rigorous review its behavior change approaches, the SCIP program has opted to use more systematic strategy , and is currently implementing a "Pathways for Change" model to behavior change, and relying on a set of reinforcing tools, including home visits, theater, and community debates to reach targeted population across the 14 districts. SCIP has recenlty opted to focus on "depth of interventions" over "breadth of coverage" . Key populations that are the focus in the HIV prevention activities include adults, with a particular effort made to reach men, for example through the establishment of young farmers clubs, and by partnering with a USAID Agriculture activity to reach men working in cashew factories. The SCIP Program will also coordinate with USAID's Education program to reach pre and in-service teachers in training institutes, pedagogical zone networks (ZIPs) and school councils. Mainly relying on interactive theatre, messages will focus on importance of knowing the dynamics of HIV transmission, finding out ones HIV status, the importance of condom use for HIV prevention, risks associated with multiple partnerships, and gender dimensions of the HIV epidemic. The overall goal of this coordination with the Education sector is to address knowledge and attitudes of the trainees to prepare them to be good teachers and role models .
USG will work with the partner (Pathfinder) to ensure routine monitoring and assessment of data quality including monthly data analysis at the district level,and quarterly and annual review meetings. An external mid-term evaluation of the SCIP program is currently being planned by USAID and will yield results for refining program interventions in FY12.
Under this activity, the SCIP project will address PMTCT activities aiming to promote demand creation, and those that support the integration of exposed children to access OVC basic services. The activities will be standardized across the project target districts in Nampula province using pipeline from FY 2011.
SCIP will strengthen communities for effective linkages needed with ANC where PMTCT services are being provided to improve the continuum of care for HIV-exposed and infected children, their mothers and/or fathers, including infant-feeding counseling or risk assessments.
In addition to strengthening facility-community linkages and focusing on the role of civil society, psychosocial support will be provided in all PMTCT settings. There is a recently developed national framework for psychosocial support groups that is currently being rolled out. The community mobilization for demand creation will be in close collaboration with community leaders. Work with traditional birth attendants will be continued to support uptake of and adherence to facility-based services, and linkages to community-based services (including home-based care and community testing and counseling for HIV) will be strengthened. Activities will also include prevention and reduction of gender-based violence.
Mozambique is currently piloting AIDS treatment support groups at community level , and a similar model will be explored for PMTCT. Known as "Grupos de Apoio a Adesão Comunitaria (GAAC), this approach will be part of the PMTCT strategy, and SCIP will be expected to improve referral and service linkages through coordination with implementing clinical partners, and other community organizations who are being directed to scale up existing approaches (fast tracking, escorted referrals) and implement innovative approaches.
Infant follow up has been identified as a particular weakness in Mozambique. Implementing daily NVP during breastfeeding will create additional need for an effective follow up system, to promote adherence and prevent loss to follow up. Addressing the challenge of providing services for infants is linked to overall efforts to reduce loss to follow up
Two mechanisms for encountering pre or post-partum women to refer to PMTCT services through the ANC clinics will be used. One is through the HBC activistas coming across them among their HBC client base, the other is through community mobilization activities intended to publicize the MNCH clinics/PMTCT services and encourage uptake of those services through referrals. In communities where Mother to Mother (M2M) groups already exist, the sub-partner CSOs will help to strengthen them; where there is no M2M group, the CSOs will help to create them.
Nutritional support will be emphasized through referrals to clinical Nutrition Rehabilitation Units where they exist. Training on balanced meals and utilization of local nutritional foods will be provided through various opportunities the mother-to-mother groups, the community committees for child protection, household visits, and community mobilization activities.