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: 2007 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Mpilonhle will continue activities described in COP 2008, but activities will be enhanced.
1. During Mpilonhle's Health Screening and Health Education activities its health counselors and health
educators will continue to emphasize the value of reducing multiple and concurrent partnerships, as well as
cross-generational and transactional sex. These issues are already addressed in Mpilonhle's COP 2008,
but these will be strengthened in line with the FY 2009 COP Technical considerations.
2. Mpilonhle will encourage the participation of school governing boards and parents in its training sessions
on HIV prevention, promotion of reproductive and general health, and care and support for people living
with HIV and AIDS and orphans and vulnerable children.
3. Mpilonhle will continue to improve its referral systems for linking up participants in programs with
community-based health facilities, support services, and support groups, particularly to access reproductive
health services, and services for substance abuse.
------------------------------
SUMMARY:
Mpilonhle is a new South African community-based organization registered in 2007 with the South African
Directorate for Non Profit Organisations (NPOs). It is dedicated to improving the health and well-being of
adolescents in high schools in Umkhanyakude District Municipality, KwaZulu-Natal (KZN) through its
"Mpilonhle Mobile Health and Education Project". Mpilonhle will become operational in late 2007 with a
single mobile unit funded with support from Oprah's Angel Network, and expand with two further mobile
units funded by PEPFAR. Mpilonhle expects to recruit and hire 40 staff members who will be based at
Mpilonhle offices in Mtubatuba, KZN.
Mpilonhle's Abstinence and Be Faithful (AB) prevention activities include school-based provision of (1)
health screening, (2) health education, and (3) computer-assisted learning, delivered through mobile clinic
and computer laboratory facilities to 12 secondary schools in the rural KwaZulu-Natal province. Emphasis
areas are gender, human capacity development, and education wraparound programs. Targeted
populations are adolescent males and females aged 10-24 and teachers.
BACKGROUND:
This is a new PEFPAR funded activity to be implemented under the FHI Umbrella Grants Mechanism
(UGM). Mpilonhle has the broad support from district and provincial South African Government (SAG)
leadership. AB prevention activities will be implemented in Umkhanyakude District Municipality, the poorest
and most rural district in KwaZulu-Natal that has extremely high HIV prevalence rates. Services will be
delivered using mobile units traveling to rural secondary schools. Students in these schools suffer from
physical remoteness, scarcity of health services and generally inadequate resources. Partners include the
Department of Education (DOE), the South African Democratic Teachers' Union (SADTU), District Health
Services, district and municipal leadership, including the Traditional Authorities. The local Department of
Education officials, school principals, district and municipal mayors, teachers and students have expressed
the acceptability of school-based voluntary counseling and testing (VCT).
ACTIVITIES AND EXPECTED RESULTS:
The AB prevention activities will be provided through mobile facilities beginning in January 2008. There will
be a cost sharing of resources through the Oprah Winfrey Angels funding. Each mobile health unit will have
four counseling rooms, a nurse room, and two group education areas - one for HIV and health education,
and one for computer training. Each mobile unit will be staffed by a primary health care nurse, four health
counselors, a health educator, and a computer educator. Each unit will serve four participating secondary
schools, staying at each school for one week per month during the eight-month school year. The project
will have three mobile facilities, allowing it to serve 12 secondary schools in total. Each participating
secondary school has an average of 800 students. Six of the 12 schools have been initially selected by
identifying principals who expressed interest in participation. With greater knowledge of the proposed
project there has been a greater expression of interest and the remaining six schools will be determined
through deliberations with the Mayors of Umkhanyakude District Municipality, Mtubatuba Municipality, and
Hlabisa Municipality, and with local officers of the Department of Education and the Traditional Authority.
Mpilonhle will conduct three main activities in the AB Program Area, as described below.
ACTIVITY 1: School-Based Health Screening
The health counselor will provide students with an annual individualized health screening that is
comprehensive, integrated, and appropriate; however the emphasis is on HIV prevention and promotion of
risk perception. It includes voluntary counseling and testing (VCT) and individualized AB counseling.
Through this activity, young people will be screened for tuberculosis (TB), sexually transmitted infections
(STIs) and other common health problems. Those who are HIV-infected will be referred for CD4 count and
further management at the nearest appropriate health facilities. The premise behind the health screening is
to ensure that young persons are reached before they begin having sex. The main messages will focus on
abstinence, delay of sexual debut for young people (10 -14years). For older youth (15 -19 years) who are
sexually active they will be encouraged to revert to secondary abstinence. For those most at risk sexually
active (20 -24 years) information on correct and consistent use of condoms will be given and encouraged to
limit number of sexual partners (i.e. be faithful). VCT will be an entry point to prevention programs,
especially for sexually active students, including in-school OVC.
Activity Narrative: ACTIVITY 2: School-Based Health Education
The health educator will provide students with four 90-minute small-group HIV, general health and life skills
education sessions per year that will discuss the basic facts about: HIV and STIs; VCT; TB; anti-retroviral
therapy (ART); prevention of mother-to-child transmission of HIV (PMTCT); a balanced Abstinence-Be
Faithful-Condoms (ABC) approach to HIV prevention; reducing stigma and discrimination against people
living with HIV/AIDS (PLHIV); promoting healthy lifestyles including the avoidance of substance abuse and
the promotion of exercise and good nutrition; and promoting mutual respect between men and women. An
age-appropriate curriculum on these topics has been developed by the Educational Development Center
(EDC) and the South African Democratic Teacher's Union (SADTU). Existing material developed by the
EDC and SADTU, and the World Health Organization (WHO), the summarized WHO publication "Teachers'
Exercise Book for HIV Prevention", will be used because it conforms to the SA DOE's Life Skills curriculum.
This curriculum will also be submitted to the SA DOE for approval, and for certification of conformity with the
Life Skills curriculum. The curriculum will also be sent to UNICEF for their inputs. This curriculum
emphasizes the traditional three-part public health theory of improving Knowledge, Attitudes and Practice
(KAP) skill-building methods in topics such as risk reduction, decision-making, and social responsibility, as a
way of preventing HIV infection, providing support to those infected and affected by HIV, fighting stigma and
discrimination, and dealing effectively with the challenges of everyday life. The skill-based HIV education
will provide focused messages about the benefits of delaying sexual debut and other safe sexual behaviors.
Activities will aim to develop students' self-esteem to build their resilience, assist them to make informed
choices and develop communication skills.
ACTIVITY 3: School-Based Computer-Assisted Learning
The computer educator will provide students in participating schools with four 90-minute small-group
computer education sessions per year. This training will focus on how to use computers, basic software, the
internet; and computer-assisted learning for improved school performance, HIV prevention, and general
health promotion. The computer-based health education lessons are packaged to address the life skills
needs of youth and are consistent with SAG guidelines. The AB messages are internationally recognized,
appropriately researched messages. This activity is intended to improve student learning, raise number of
pupils who graduate (graduation rates), and augment employability. These outcomes can in turn increase
women's socio-economic status, and reduces their vulnerability to coercive, cross-generational, and
transactional sex.
Sustainability will be achieved through (1) political commitment from district and municipal governments,
and the local Department of Education; (2) the relatively low-tech and easily replicable nature of many core
program features; (3) minimal dependence on scarce health professional such as doctors and nurses; (4)
the ability of rugged mobile facilities to reduce the need for additional investments in fixed physical
infrastructure; (5) the possibility of adapting the VCT service delivery model to workplaces as well as
schools; (6) the multi-dimensionality of program activities, which includes HIV and AIDS, general health,
and education related activities, and which broadens the scope of donors interested in funding continuation
and scale-up of activities.
Building human capacity in remote rural areas will occur by maximizing the capacities and skills of relatively
abundant lay health workers to enable them to perform critical yet scarce services such as VCT, health
screening and personalized risk assessment, and health education. This will help shift the burden of these
activities away from relatively scarce professional health workers such as nurses and doctors. The
organization will build the technical expertise and capacities of lay health workers through rigorous training
and regular refresher courses, and through the technological support provided by the Information
Technology components of the program.
This activity addresses gender issues through (1) the provision of AB education to large numbers of
adolescent males and females encouraging males to respect females, abandon gender stereotypes, and by
discouraging multiple sex partners; (2) computer education which promotes female educational attainment,
self-confidence and self-reliance, and employability, which in turn reduce vulnerability to HIV, in particular
coercive, cross-generational and transactional sex; and (3) health education that promotes safer behavior
and gender-sensitive attitudes among men and yield benefits to women when making informed choices with
regard to their sexual health.
These activities will contribute to 2-7-10 PEPFAR goals of preventing seven million new HIV infections.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14026
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14026 8238.08 U.S. Agency for Mpilonhle 6688 4755.08 $300,000
International
Development
8238 8238.07 U.S. Agency for Mpilonhle 4755 4755.07 New APS 2006 $200,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $21,541
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education $170,000
Water
Table 3.3.02:
Mpilonhle shall increase its efforts in the following areas:
ACTIVITY 1:
During Mpilonhle's health screening and health education activities its health counselors and health
cross-generational and transactional sex. These issues are already addressed in Mpilonhle's current
activities, as can be seen in the last paragraph of the activity narrative, but we shall emphasize them more
strongly in line with the FY 2009 COP technical considerations.
ACTIVITY 2:
Mpilonhle shall encourage the participation of school governing boards and parents in its training sessions
on HIV prevention, promotion of reproductive and general health, and care and support for PLWHA and
orphans and vulnerable children.
ACTIVITY 3:
Mpilonhle shall continue to improve its referral systems for linking up participants in its programs with
health services, and services as available in this rural area for substance abuse issues.
-----------------------
Directorate of NGOs. It is dedicated to improving the health and well-being of adolescents attending high
schools in Umkhanyakude District Municipality, KwaZulu-Natal (KZN) through its "Mpilonhle Mobile Health
and Education Project" whose key activities are described below. It will begin operations in late 2007 with a
units funded by PEPFAR funds. It is currently building up its staff, which is expected to be 40 persons
targeting 12 high schools with approximately 800 students, totaling 9,600. These activities will be based in
the Mpilonhle office in Mtubatuba, KZN.
Mpilonhle activities consists of community-based health screenings, which will be conducted by health
counselors at 24 community-based (non-school) sites, and will consist of a core of HIV preventive services
including individualized voluntary counseling and testing (VCT); personalized abstinence, Be Faithful and
correct and consistent condom use (ABC) counseling, and condom provision to sexually active youth and
adults; and group HIV and health education sessions. These services will be delivered through mobile clinic
and mobile computer laboratory facilities to 24 community (non-school) sites in rural KwaZulu-Natal.
Emphasis areas are: gender, human capacity development and strategic information. Target populations
are adolescents aged 15-24 and adults.
This is a new PEFPAR activity. Mpilonhle works with broad support from district and provincial South
African Government (SAG) leadership. The Condom/Other Prevention activities will be implemented in
Umkhanyakude District Municipality, the poorest and most rural district in KwaZulu-Natal, and one that has
extremely high HIV prevalence rates. Services will be delivered using mobile units traveling to rural
secondary schools. These schools and their students suffer from physical remoteness, scarcity of health
services and generally inadequate resources. Partners include the Department of Education, the South
African Democratic Teachers' Union (SADTU), District Health Services and district and municipal
leadership, including that of Traditional Authorities. School principals, local Department of Education
officials, district and municipal mayors and focus groups of teachers and students have expressed the
community acceptability of school-based VCT.
ACTIVITY 1: Community-Based Health Screening
Mobile community-based and community-focused health screenings will be conducted by HIV and AIDS
counselors at 12 school locations. Each mobile facility consists of a paired-up mobile clinic and mobile
computer laboratory, staffed by one primary care nurse, four health counselors, one health educator, and
one computer educator. Each mobile facility will rotate across four school locations, allowing three mobile
facilities to serve 12 sites in total. These community sites will be determined in collaboration with the mayors
of Umkhanyakude, Mtubatuba, and Hlabisa Municipalities. The OP activity will consist of correct and
consistent condom use programs which support the provision of accurate information about condom use to
reduce risks for HIV infection and support access for those most at risk populations.
Provision and promotion of information on correct and consistent condom use will be coupled with
information about abstinence and behavior change; the importance of HIV counseling and testing (CT),
knowing one's HIV status, partner reduction and mutual faithfulness as risk reduction methods. The HIV
preventive services include personalized ABC messaging, behavior change, HIV and AIDS counseling,
group computer trainings that include health messaging, and group HIV and health education sessions. In
addition to these services, Mpilonhle provides referrals to other community-based services for prevention of
mother-to-child transmission (PMTCT), antiretroviral treatment (ART), tuberculosis (TB) and psychosocial
support; referrals to a social worker for assistance with accessing government grants and support for
Activity Narrative: orphans and vulnerable children (OVC) or people living with HIV (PLHIV); general health screening and
referral for care and other services as required. These preventive services will be offered within the context
of a health screening service that provides other health services besides HIV prevention. The broadness of
these services, and the fact that it addresses other health concerns beyond HIV, is likely to attract a larger
number of students with non-HIV-related health concerns to Mpilonhle's services, thereby raising the
number of people they reach with HIV prevention.
ACTIVITY 2: School-Based Health Education
Mpilonhle health educators will provide students with four small-group HIV, health and life skills education
sessions per year that will discuss the basic facts about: HIV and STIs; CT; TB; anti-retroviral therapy
(ART); prevention of mother-to-child transmission of HIV (PMTCT); a balanced Abstinence-Be Faithful-
Condoms (ABC) approach to HIV prevention; reducing stigma and discrimination against people living with
HIV and AIDS (PLHIV); and promoting respect between men and women. The HIV preventive outreach is
not limited to the four health education sessions, but is supplemented by the health screening session
described in Activity 1 and the health messages in the computer-assisted learning. An age-appropriate
curriculum on these topics has been developed by the Educational Development Center (EDC) and the
South African Democratic Teacher's Union (SADTU), drawing on existing material developed by the EDC
and SADTU, and the World Health Organization (WHO) summarized in the WHO publication "Teachers'
Exercise Book for HIV Prevention", and in conformity with the SA DOE's Life Skills curriculum. This
curriculum will also be submitted to the SA DOE for approval, and for certification of conformity with the Life
Skills curriculum. This curriculum emphasizes the traditional three-part public health theory of improving
Knowledge, Attitudes and Practice (KAP) skill-building methods in topics such as risk reduction, decision-
making, and social responsibility, as a way of preventing HIV infection, providing support to those infected
and affected by HIV, fighting stigma and discrimination, and dealing effectively with the challenges of
everyday life. The skill-based HIV education will provide focused messages about the benefits of delaying
sexual debut and other safe sexual behaviors. Activities will aim to develop students' self-esteem to build
their resilience, assist them to make informed choices and develop communication skills.
An Mpilonhle computer educator will provide students in participating schools with four 90-minute small-
group computer education sessions per year. This training will focus on how to use computers, basic
software, the internet; and computer-assisted learning for improved school performance, HIV prevention,
and general health promotion. The computer-based health education lessons are packaged to address the
life skills needs of youth and are consistent with SAG guidelines. The AB messages are internationally
recognized, appropriately researched messages. This activity is intended to improve student learning, raise
number of pupils who graduate (graduation rates), and augment employability. These outcomes can in turn
increase women's socio-economic status, and reduces their vulnerability to coercive, cross-generational,
and transactional sex.
Sustainability of activities is facilitated by political commitment from district and municipal governments, and
the local Department of Education to scale-up and to fund-raise in support of such scale-up; the relatively
low-tech and easily replicable nature of many core program features, minimal dependence on scarce health
professional such as doctors and nurses; the ability of rugged mobile facilities to reduce the need for
additional investments in fixed physical infrastructure; declining prices over time for the program's
information technology (IT) requirements, the possibility of adapting the service delivery model to
workplaces as well as schools, the multi-dimensionality of program activities, which includes HIV and AIDS,
general health, and education related activities, and which broadens the scope of donors interested in
funding continuation and scale-up of activities.
Building human capacity in remote rural areas contributes to future sustainability of the program. Mpilonhle
will respond to this challenge by maximizing the capacities and skills of relatively abundant lay health
workers through rigorous training and regular refresher courses to enable them to perform critical yet
currently scarce services such as VCT, health screening and personalized risk assessment, and health
education, shifting the burden of these activities away from relatively scarce professional health workers like
nurses and doctors.
This activity will contribute to PEPFAR 2-7-10 goals of preventing 7 million new HIV infections, and
providing care and support to PLHIV. This activity addresses gender issues through the provision of ABC
education and services to large numbers of females in the general population; computer education which
promotes female educational attainment and employability, which in turn reduce their vulnerability to HIV,
and in particular to coercive, cross-generational and transactional sex; health education that promotes safer
behavior and gender-sensitive attitudes among men and yield benefits to women who become their sexual
partners. This activity will also promote consistent use of condoms and behavior change through the
reduction of sexual partners.
Continuing Activity: 14027
14027 8241.08 U.S. Agency for Mpilonhle 6688 4755.08 $250,000
8241 8241.07 U.S. Agency for Mpilonhle 4755 4755.07 New APS 2006 $200,000
Construction/Renovation
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $11,627
Estimated amount of funding that is planned for Education $83,000
Table 3.3.03:
ACTIVITY 1: Mpilonhle's school-based health screening now offers CD4 count results to all people living
with HIV (PLHIV). It continues providing referral services for all PLHIV to community-based health facilities
for further management, and to community-based support groups. It does this by drawing blood from all
learners who we identify as being HIV-infected and agree to and desire a CD4 count, by taking the blood
specimen to the local KwaZulu-Natal (KZN) Department of Health (DOH) clinic, by following up to ensure
that the blood specimen reaches the District Hospital where the CD4 counts are done, by then obtaining the
result from the laboratory or the clinic, and by then meeting with the learner to provide the result to them
(and if they wish their family).
Community members that are identified as HIV-infected are referred to the local KZN-DOH clinic that serves
their area. With the plan for the mobile units to return to the same location monthly, Mpilonhle may arrange
to provide CD4 counts to community-program users along the lines described above for learners.
Mpilonhle shall improve its referral systems for linking up participants in its programs with community-based
health facilities, support services, and support groups, particularly to access reproductive health services,
and services for substance abuse issues. Mpilonhle shall also strengthen its relationships with other
community-based organizations and faith-based organizations (FBOs) in the community involved in Care
activities for PLHIV and orphans and vulnerable children..
-------------------------------
This is a follow on PEFPAR-funded activity to be implemented through Mpilonhle. Mpilonhle is working with
the support from district and provincial South African Government (SAG) leadership. It will begin operating
in late 2007 with a single mobile unit funded with support from Oprah's Angel Network, and expand with two
further mobile unites funded by PEPFAR funds. It is currently building up its staff, which is expected to be
40, and is based in the Mpilonhle office in Mtubatuba, Kwazulu-Natal (KZN).
Mpilonhle will provide elements of HIV-related clinical care and social care through two main activities: 1)
provision of HIV-related screening, care and prevention, and 2) school and community-based HIV and AIDS
education. These activities will be delivered through mobile clinics deployed to secondary schools and
community (non-school) sites in rural KwaZulu-Natal. Emphasis areas are gender and human capacity
development. Target populations are adolescents aged 10-24, adults, and PLHIV.
Directorate of NGOs. It is dedicated to improving the health and well-being of adolescents in high schools in
Umkhanyakude District Municipality, KwaZulu-Natal through its "Mpilonhle Mobile Health and Education
Project" whose key activities are described below. The care activities will be implemented in Umkhanyakude
District Municipality, the poorest and most rural district in KwaZulu-Natal, and one that has extremely high
HIV prevalence rates, at 39.1%.
Implementation will take place in representative rural secondary schools and non-school sites that suffer
from physical remoteness, poor health conditions, and inadequate resources. Partners consist of the
Department of Education, PLHIV, the South African Democratic Teachers' Union, District Health Services,
and District Municipality and Municipal leadership, including that of Traditional Authorities. School principals,
local Department of Education officials, district and municipal mayors and focus groups of teachers and
students have expressed the community acceptability of school-based CT.
These activities will be provided through mobile clinics that visit schools to address the needs of PLHIV in
the secondary school population and that visit non-school sites to address the needs of adult PLHIV in the
general population. These activities will satisfy minimum requirements for Palliative Care by providing
PLHIV with clinical services, integrated prevention, psychological support, and support with social services.
Each mobile clinic is staffed by one primary care nurse, four health counselors, and one health educator.
Each mobile clinic will visit a participating secondary school one week per month for eight months per year.
ACTIVITY 1: Screening and provision of basic HIV-related clinical and social care and HIV prevention
messaging at schools and in communities
The first care component is the clinical aspect which includes HIV and AIDS counselors offering one-on-one
health screening, messaging and referrals for preventive care services at secondary schools via a mobile
clinic. This will include screening and treating for symptoms indicative of Opportunistic Infections (OI) and
other HIV-related illnesses (including TB); individualized counseling on HIV prevention and behavioral
change; provision of counseling and testing (CT); provision of counseling in nutrition and personal hygiene;
psychosocial support for students (including support for disclosure of status); and referral to essential HIV
and AIDS services such as PMTCT, ART, symptoms and pain (including screening and referral to TB
services). A mechanism will be established to provide parental consent and referrals for family members of
HIV-infected students. The partners and focus groups of teachers and students have expressed the
community acceptability of schools-based CT and HIV prevention and care services. Effort will be made to
ensure equitable access to care services for both males and females. The second care component is the
social aspect which includes screening of HIV-related social problems and referrals to a staff social worker
for assistance with accessing government grants and legal services for; PLHIV and their families.
ACTIVITY 2: Group HIV and AIDS education sessions
Activity Narrative: An HIV and AIDS educator will conduct group education sessions at secondary schools and in surrounding
communities that will discuss the basic facts about HIV prevention and care targeted. Topics include the
importance of HIV prevention (AB for adolescents and ABC for adults); CT; prevention and care of
opportunistic infections including TB, ART adherence; accessing PMTCT services; nutrition counseling; and
the importance of personal hygiene and utilizing safe water to reduce diarrheal disease. Information,
Education and Communication (IEC) materials will also be provided. Mpilonhle will work with community
leaders and PLHIV to reduce stigma and discrimination against PLHIV and raise community awareness to
mobilize for essential HIV prevention, care and treatment services. Efforts will be made to engage male
community members and promote respect between men and women in communities. Support will be
provided for disclosure of HIV status and strategies to reduce disclosure-related gender-based violence will
be encouraged. An age-appropriate curriculum will be developed by the Educational Development Center
(EDC) and the South African Democratic Teacher's Union (SADTU), drawing on material developed by the
EDC in collaboration with SADTU, and the World Health Organization. This curriculum emphasizes the
traditional three-part public health theory of improving Knowledge, Attitudes, and Practice, skill-building
methods in topics such as risk reduction, being faithful, decision making, and social responsibility, as a way
of preventing HIV infection, providing care to those infected and affected by HIV, respect for women,
fighting stigma and discrimination, and dealing effectively with the challenges of everyday life. Group health
education provides supportive social care in the form of efforts to reduce stigma and efforts to increase
community awareness of care, prevention, and treatment. Providing care to those infected and affected by
HIV, respect for women, fighting stigma and discrimination, and dealing effectively with the challenges of
everyday life.
Building human capacity in remote rural areas is a critical issue. Mpilonhle responds to this challenge by
maximizing the capacities and skills of relatively abundant lay health workers through rigorous training and
regular refresher courses to enable them to perform critical yet currently scarce services such as the
promotion of elements of the preventive care package, provision of screening for Opportunistic Infections,
basic pain and symptoms management, and health education thus shifting the burden of these activities
away from relatively scarce professional health workers. Gender issues will be addressed in the provision of
basic HIV screening and care and prevention messaging to large numbers of male and female adolescent
and adult PLHIV support for disclosure of HIV status and reduction of gender-based violence), involvement
of male adolescents and adults in the program mobilization of community leaders for promoting community
efforts against stigma and discrimination, and for raising awareness regarding HIV prevention, care and
treatment.
Sustainability of activities is facilitated by political commitment from District and Municipal governments, and
the local Department of Education to scaling-up and to fund-raising in support of such scaling-up; the
relatively low-tech and easily replicable nature of many core program features; minimal dependence on
scarce health professional such as doctors and nurses; the ability of rugged mobile facilities to reduce the
need for additional investments in fixed physical infrastructure; declining prices over time for the program's
information technology requirements; the possibility of adapting the service delivery model to workplaces as
well as schools; the multi-dimensionality of program activities, which includes HIV and AIDS, general health,
These activities will contribute to PEPFAR goals of providing palliative care to 10 million HIV-infected
individuals and their families.
Continuing Activity: 14028
14028 8243.08 U.S. Agency for Mpilonhle 6688 4755.08 $150,000
8243 8243.07 U.S. Agency for Mpilonhle 4755 4755.07 New APS 2006 $200,000
Estimated amount of funding that is planned for Human Capacity Development $6,483
Estimated amount of funding that is planned for Education $47,000
Table 3.3.08:
ACTIVITY 1: School-based health screening
This activity now assures that all HIV-infected learners get CD4 counts, which allows Mpilonhle to screen
them to see if they require ART. This is done as follows. Persons tested for HIV by Mpilonhle staff who are
HIV-positive are offered the opportunity for having blood taken by Mpilonhle staff if they desire to know their
CD4 count and need it for ART therapy. For those persons who agree and desire CD4 counts, the
Mpilonhle nurse obtains a blood sample. This blood sample is then taken to the appropriate (by geographic
region) KwaZulu-Natal Department of Health (KZN-DOH) clinic. From there it is sent by KZN-DOH staff to
the KZN-DOH district hospital where the CD4 test is performed. Mpilonhle staff follow up to assure that the
specimen makes it to the District Hospital, and then assure that the result is available to Mpilonhle staff.
Mpilonhle staff then arrange for the client to be seen in the Mpilonhle mobile clinic and the results of the test
result is communicated to the client. If need be, Mpillonhle staff visit the home of the client to provide the
result. They also involve family members in this process if required. At this time Mpilonhle staff discuss with
the client the management of their HIV infection, including the need, if required, for ART. Currently,
Mpilonhle staff does not provide the same service for community members determined to be HIV-infected.
With the PEPFAR-funded units now deployed, we are exploring having the units return to communities on a
regular basis. If this is successful Mpilonhle would be able to provide community members with the same
service described above for school learners.
Mpilonhle continues providing referral services for all PLHIV to KZN-DOH community-based health facilities
for further management. This includes referral for ART services, TB services, STI services, pregnancy
services, services for diarrhea and skin problems, and for a variety of other problems. Mpilonhle has an
established referral system for this process.
1. During Mpilonhle's Health Screening and Health Education activities described, its health counselors and
health educators will emphasize the value of reducing multiple and concurrent partnerships, as well as
activities, but it shall be emphasized more strongly in line with the FY 2009 COP Technical considerations.
2. Mpilonhle shall encourage the participation of school governing boards and parents in its training
sessions on HIV prevention, promotion of reproductive and general health, and care and support for PLHIV
and OVC. Mpilonhle shall also encourage the participation of members of other CBOs and FBOs in its
training activities.
3. Mpilonhle shall improve its referral systems for linking up participants in its programs with community-
based health facilities, support services, and support groups, particularly to access reproductive health
services including family planning, and services for substance abuse issues. Mpilonhle shall also strengthen
its relationships with other CBOs and FBOs in the community involved in care activities for PLHIV and OVC.
Mpilonhle clarifies that its Health Screening activity promotes HIV preventive behaviors among young boys
and men; that its Health Education sessions promote positive roles for members of both genders; and that
its Health Screening activity by a Primary Health Care Nurse involves treatments for symptomatic STIs, for
pains, and for simple skin conditions. Its Health Screening service also involves referrals to an on-site staff
social worker who helps OVC and PLHIV access grants, and obtain legal and social support for issues of
sexual violence and abuse. All these services are offered to all program participants, including all PLHIV
and OVC.
-------------------------
Umkhanyakude District Municipality, KwaZulu-Natal (KZN) through its "Mpilonhle Mobile Health and
Education Project. It will begin operations in late 2007 with a single mobile unit funded with support from
Oprah's Angel Network, and expand with two further mobile unites funded by PEPFAR funds. It is currently
building up its staff, which is expected to be 40, and is based in the Mpilonhle office in Mtubatuba, KZN. The
Mpilonhle program will provide orphans and vulnerable children (OVC) with support to access education,
economic support, psychosocial support, legal assistance. Mpilonhle will reach the OVC through the
implementation of three schools-based activities (1) health screening, (2) health education and (3) computer
-assisted learning. These services will be delivered through mobile clinic and computer laboratory facilities
to OVC in 12 secondary schools in rural KwaZulu-Natal, South Africa. The emphasis areas for the Mpilonhle
program will be on gender and local organization capacity building. The targeted populations are
adolescents aged between 10 and 24 years and OVC among secondary school students.
This is a new activity to be implemented by a local NGO, Mpilonhle, with support from the South African
Government leadership at the district and provincial level in KwaZulu-Natal. Activities will be implemented in
the Umkhanyekude District, the poorest and most rural district in KwaZulu-Natal province, with one of
highest HIV prevalence. Mpilonhle will implement activities in 12 rural secondary schools that have
inadequate resources in the Umkhanyekude District Municipality. Approximately 33% of secondary school
students have lost at least one parent. Partners consist of the Department of Education, the South African
Democratic Teachers' Union, District Health Services, and District and Municipal leadership.
Mpilonhle will conduct three schools-based activities for OVC: health screening, health education, and
Activity Narrative: computer-assisted learning. These count as OVC support since they provide supportive health care
services, increasing access to education, economic support, and supportive social services including legal
aid. These activities will be provided through mobile facilities. Each mobile facility consists of a paired-up
mobile clinic and mobile computer lab, staffed by 1 primary care nurse, 4 health counselors, 1 health
educator, and 1 computer educator. Each mobile facility will visit a participating secondary school one week
per month for eight months per year. This allows each mobile facility to serve 4 secondary schools per
school year. The project will have three mobile facilities, allowing them to serve 12 secondary schools in
total. Six of the 12 schools have been pre-selected. The remaining six schools and the 24 community sites
will be determined with the Mayors of Umkhanyakude District, Mtubatuba Municipality, and Hlabisa
Municipality and with local officers of the DOE.
ACTIVITY 1: Health screening
A health counselor will provide students with an annual individualized health screening that includes VCT;
individualized AB-counseling for HIV prevention and behavior change; counseling or referral to further
services for PMTCT, ART, TB and psychosocial support; and referral to a staff social worker for assistance
with accessing government grants and assistance with legal matters. School principals, local Department of
Education officials, District and Municipal mayors, and focus groups of teachers and students have
expressed the community acceptability of schools-based VCT. This activity provides support for OVC in the
form of improving their access to health care.
ACTIVITY 2: Health education
A Mpilonhle health educator will provide students with four 90 minute small-group HIV, health and life-skills
education sessions per year that will discuss the basic facts about HIV, VCT, STIs, TB, ART, PMTCT;
reducing stigma and discrimination against PLHIV; and promoting respect between men and women. An
age-appropriate curriculum on these topics will be developed by the Educational Development Center
EDC in collaboration with SADTU, and the World Health Organization (WHO). This curriculum emphasizes
the tradition of improving Knowledge, Attitudes, and Practice (KAP), skill-building methods in topics such as
risk reduction, being faithful, decision making, and social responsibility, as a way of preventing HIV
infection, providing support to those infected and affected by HIV, respect for women, fighting stigma and
discrimination, and dealing effectively with the challenges of everyday life. Group health education provides
supportive social care in the form of efforts to reduce stigma and efforts to increase community awareness
of care, prevention, and treatment. This activity will provide support to OVC in the form of psychosocial
support and HIV prevention messages.
ACTIVITY 3: Computer-assisted learning
An Mpilonhle computer educator will provide students in participating schools with four 90 minute small-
group computer education sessions per year that will provide training on how to use computers, basic
software, and the internet; and computer-assisted learning for improved school performance, HIV
prevention, and general health promotion. This activity is expected to improve student learning, raise
graduation rates, self-confidence and employability. This in turn increases self-reliance, self-confidence and
self-sufficiency and the socio-economic status of the females, thus reduces their vulnerability to coercive,
cross-generational, and transactional sex. This activity will improve educational development of OVC
through computer-assisted learning and will encourage OVC to stay in school and complete their education.
In addition, having computer skills will improve the market skills and employability of OVC that head
households.
Sustainability of activities is facilitated by building human capacity in remote rural areas. Mpilonhle
maximize the capacities and skills of relatively abundant lay health workers to enable them to perform
critical yet currently scarce services such as VCT, health screening and personalized risk assessment, and
health education, shifting the burden of these activities away from relatively scares professional health
workers like nurses and doctors. Mpilonhle will build the technical expertise and capacities of lay health
workers through rigorous training and regular refresher courses. Sustainability is also facilitated by political
commitment from District and Municipal governments and the local Department of Education to scale-up
and fund-raise for this activity.
Gender issues will be addressed in the provision of care and support to in-school OVC with special
emphasis on the girl child. The emphasis areas for this program are Human Resources in the form of
salaries for health counselors, health educators, and computer educators, Information, Education and
Communication in the form of resources for health education and computer education, Infrastructure in the
form of deployment of mobile clinics and computer laboratories and Development of
Network/Linkages/Referral Systems through the referral of OVC to the staff social worker.
Continuing Activity: 14029
14029 8246.08 U.S. Agency for Mpilonhle 6688 4755.08 $540,000
8246 8246.07 U.S. Agency for Mpilonhle 4755 4755.07 New APS 2006 $440,000
Estimated amount of funding that is planned for Human Capacity Development $9,471
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $19,664
and Service Delivery
Estimated amount of funding that is planned for Education $234,000
Table 3.3.13:
Activity 1, schools-based health screening, now assures that all HIV-infected learners get CD4 counts that
allow us to screen them to see if they require antiretroviral treatment (ART). Persons tested for HIV by
Mpilonhle staff who are HIV-infected are offered the opportunity for having blood taken by Mpilonhle staff if
they desire to know their CD4 count and need for ART therapy. For those persons who agree and desire
CD4 counts, the Mpilonhle nurse obtains a blood sample. This blood sample is then taken to the
appropriate (by geographic region) KwaZulu-Natal (KZN) Department of Health (DOH) clinic. From there it
is sent by KZN-DOH staff to the KZN-DOH district hospital where the CD4 test is performed. Mpilonhle staff
follow up to assure that the specimen makes it to the district hospital, and then assure that the result is
available to Mpilonhle staff. Mpilonhle staff then arrange for the client to be seen in the Mpilonhle mobile
clinic and the results of the test result is communicated to the client. If need be, Mpillonhle staff visit the
home of the client to provide the result. They also involve family members in this process if required. At
this time Mpilonhle staff discuss with the client the management of their HIV infection, including the need, if
required, for ART. Currently, Mpilonhle staff do not provide the same service for community members
determined to be HIV-infected. With the PEPFAR-funded units now deployed, we are exploring having the
units return to communities on a regular basis. If this is successful we would be able to provide community
members with the same service described above for school learners.
Mpilonhle continues providing referral services for all people living with HIV and AIDS (PLWHA) to KZN-
DOH community-based health facilities for further management. This includes referral for ART services,
tuberculosis (TB) services, sexually transmitted infection (STI) services, pregnancy services, services for
diarrhea and skin problems, and for a variety of other problems. Mpilonhle has an established referral
system for this process.
1. During Mpilonhle's health screening and health education activities, Mpilonhle's health counselors and
cross-generational and transactional sex. Mpilonhle shall also emphasize issues of positive roles for men,
dispelling HIV/AIDS myths, disclosure support, and more frequent VCT. These issues are already
addressed in Mpilonhle's current activities, as can be seen in the last paragraph of the FY 2008 activity
narrative, but they shall be emphasized more strongly in line with the FY 2009 COP technical
considerations.
sessions on HIV prevention, the promotion of reproductive and general health, and care and support for
PLWHA and orphans and vulnerable children (OVCs). Mpilonhle shall also encourage the participation of
members of other community-based organizations (CBOs) and faith-based organizations (FBOs) in its
services including family planning, and services for substance abuse issues. Mpilonhle shall also
strengthen its relationships with other CBOs and FBOs in the community involved in Care activities for
PLWHA and OVCs.
Mpilonhle clarifies that its health screening activity promotes HIV preventive behaviors among young boys
and men; that its health education sessions promote positive roles for members of both genders; and that
its health screening activity involves treatments for symptomatic sexually transmitted infections, for pain,
and for simple skin conditions offered by a primary health care nurse. Mpilonhle's health screening already
involves screening and referrals for TB. Mpilonhle's health screening service also involves referrals to an
on-site staff social worker who helps OVCs and PLWHA access grants, and obtain legal and social support
for issues of sexual violence and abuse. All these services are offered to all program participants, including
all PLWHA and OVCs.
-----------------------------
Mpilonhle is a new South African community-based organization (CBO). It was registered in 2007 with the
South African Directorate Non-Profit Organisations. Mpilonhle is dedicated to improving the health and well-
being of adolescents in high schools in Umkhanyakude District Municipality, KwaZulu-Natal through its
"Mpilonhle Mobile Health and Education Project". Operations will begin in late 2007 with a single counseling
and testing (CT) mobile unit funded by Oprah's Angel Network, and later, will expand with two further mobile
units funded by PEPFAR. The organization is currently recruiting and employing staff, which is expected to
grow to 40. Staff will be based in the Mpilonhle office in Mtubatuba in KwaZulu-Natal.
Mpilonhle's counseling and testing (CT) activities include (1) schools-based health screening, and (2)
community-based health screening. These services will be delivered through mobile clinics and mobile
computer laboratory facilities to 12 secondary schools and 24 community (non-school) sites at
Umkhanyakude District in rural KwaZulu-Natal province.
Emphasis areas include gender, human capacity development, and strategic information. Target
populations include adolescents aged 10-24 years and adults.
This is a new activity that will be implemented by the prime partner, Mpilonhle, a newly established non-
governmental organization (NGO). The program has broad support from district and provincial South
Activity Narrative: African government leadership. PEPFAR funds will be used to establish the infrastructure, to purchase
mobile vans, equipment and operational costs to run the program. Mpilonhle will implement activities in
Umkhanyakude District, the poorest and most rural district in KwaZulu-Natal province, and one with high
HIV prevalence. Activities will take place in 12 representative rural secondary schools that are affected by
physical remoteness, poor health conditions, and inadequate resources, and in 24 community (non-school)
sites. Partners include the Department of Education, the South African Democratic Teachers' Union, district
health services, and district and municipal leadership.
ACTIVITY 1: Schools-based Health Screening
A health counselor will provide secondary school students with (a) an annual individualized health screening
that includes CT, screening and referral for common health problems; (b) counseling or referral to further
services for prevention of mother-to-child transmission (PMTCT), antiretroviral treatment (ART), TB and
psychosocial support; and (c) referral to a social worker for assistance with accessing government grants
and support for people living with HIV (PLHIV). School principals, local Department of Education officials,
district and municipal mayors and focus groups of teachers and students have expressed the community's
acceptance of schools-based CT.
ACTIVITY 2: Community-Based Health Screenings
This activity will be conducted by health counselors at 24 community-based sites outside schools.
Community-based health screenings will consist of a core of HIV preventive services including
individualized CT; personalized ABC counseling, and condom provision to sexually active individuals;
referrals to other community-based services for PMTCT, ART, TB and psychosocial support; referrals to a
social worker for assistance with accessing government grants and support for orphans and vulnerable
children (OVC) or PLHIV; general health screening and referral for care and other services as required;
basic computer training to community members; and group HIV and health education sessions.
ACTIVITY 3: Mobile Facilities
These counseling activities will be provided through mobile facilities. Each mobile facility will consist of a
paired-up mobile clinic and mobile computer laboratory, staffed by one primary care nurse, four health
counselors, one health educator, and one computer educator. Each mobile facility will visit a participating
secondary school one week per month for eight months per year. This will allow each mobile facility to serve
four secondary schools per school year. The project will have three mobile facilities, allowing Mpilonhle to
serve 12 secondary schools in total. Each participating secondary school has an average of 800 students,
and will offer the first three activities described above. Six of the 12 schools have been pre-selected.
ACTIVITY 4: Counseling and Testing
CT will be conducted using South African Government (SAG) approved algorithms, test kits and guidelines
and procedures. Health counselors will be trained in SAG-approved CT programs and will use SAG-
approved HIV CT protocols. External Quality Assurance methods will be used to check the service quality.
Health screening will use an Electronic Medical Record (EMR) system implemented on handheld
computers, programmed with health screening guidelines, algorithms, and series of questions that must be
followed by the counselors. These will save individual screening results into a medical record. EMRs
facilitate collection of timely, high quality and easily analyzable data. EMRs also contribute to quality control
by minimizing missing data, and by enforcing and monitoring conformity to protocols and guidelines. The
data collected by the EMR system will include indicators of acceptance of pre-test counseling, testing,
results, post-test counseling, data on HIV status, and on sexual behavior.
Persons who are HIV-infected will be referred to the program nurse for further evaluation, including CD4
testing, which will be done at Department of Health laboratories. People who meet initial screening criteria
for antiretroviral treatment (ART) will be referred to the Hlabisa Health sub-district ART program at one of
the DOH clinics. Persons screened for TB will also be referred for TB management at district clinics.
ACTIVITY 5: Human Capacity Development
Sustainability of activities is facilitated by building human capacity in remote rural areas. Mpilonhle will
critical yet currently scarce services such as HIV counseling, health screening and personalized risk
assessment, and health education. This skills development in lay health workers will shift the burden of
these activities away from relatively scarce professional health workers like nurses and doctors. Mpilonhle
will build the technical expertise and capacities of lay health workers through rigorous training and regular
refresher courses and through the technological support provided by the information technology
components of the program. Sustainability is facilitated by political commitment from district and municipal
governments, and the local Department of Education to scaling-up and to fund-raising in support of such
scaling-up.
These activities will contribute to PEPFAR 2-7-10 goals of promoting counseling and testing for HIV among
secondary school students and adults in the general population.
Continuing Activity: 14030
14030 8247.08 U.S. Agency for Mpilonhle 6688 4755.08 $250,000
8247 8247.07 U.S. Agency for Mpilonhle 4755 4755.07 New APS 2006 $260,000
Estimated amount of funding that is planned for Human Capacity Development $14,533
Estimated amount of funding that is planned for Education $163,000
Table 3.3.14:
