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
TITLE: Scaling up of the ARV services and HIV care in Dar es Salaam
NEED and COMPARATIVE ADVANTAGE:
Out of the 2.5 million population in Dar es Salaam region, 272,000 (10.9%) are estimated to be the people
living with HIV/AIDS (PLWHA). Of these it is estimated that 54,000 (20%) will need ART.
MDH is a collaboration between the Harvard School of Public Health, Dar es Salaam City Council and
MUHAS which has been ongoing for more than 15 years in training and research. This collaboration has
improved the health system including space, laboratory facilities, training base, patient monitoring and
tracking loss to follow up. There is strong commitment from the local authorities to advance HIV care and
treatment services.
ACCOMPLISHMENTS:
By end of FY 2007, 25 sites will be providing comprehensive care and treatment services. The 25 sites
include three district hospitals, an Infectious Disease Clinic, three refilling health centers upgraded to initiate
ART, Muhimbili National Hospital and 17 private facilities, to boost public-private partnership. A total of
15,000 (30% of eligible in Dar) patients will be actively on ART, of which 3,750 (25%) will be children. The
male to female ratio would be 1:1. Additional 8,000 clients not on ART will be on care.
ACTIVITIES:
(i) Expansion of comprehensive ART services including prevention among positives:
Additional five sites (Kimara, Tabata, and Tandale dispensaries. Mnazi Moja and Kigamboni health centers)
will be included. Thus, MDH will put 5,000 more patients on ART; and by end of FY 2008, 20,000 (40% of
eligible in Dar) patients will be actively on ART and additional 10,000 not on ARVs will be on care using pre-
ART registers.
(ii) Staffing support -MDH will support the human resource requirements in the city through recruitment and
hiring of necessary staff within the government system, creating a conducive working environment, training
and career plan to ensure job satisfaction and retention.
(iii) Strengthening pediatric AIDS care and treatment - pediatric enrollment will increase from 10% to 25%.
MDH will strengthen linkages between PMTCT (using ANC and immunization care to identify HIV exposed
infants), maternal & child health clinics, inpatient and care and treatment centers (CTC). Sick children
attending immunization clinics will be evaluated and referred for HIV testing. Improving infant HIV diagnosis
through DNA-PCR will be emphasized. Practice of pediatric only day for patients under 15 years will be
promoted. All health care workers (including non-pediatricians) will be trained to provide care and treatment
for pediatric AIDS patients including co-trimoxazole prophylaxis.
(iv) Procurement and provision of various non-ARV medications - MDH will support sites in procuring and
stock managing non-ARV drugs for treatment of opportunistic infections including pediatric preparations.
(v) Laboratory services - MDH lab support will be coordinated and synchronized with the national program
- the Ministry of Health and Social Welfare (MOHSW) and the national referral lab. We will support
procurement of essential Lab equipments, reagents and supplies for the 30 sites. We will support quality
assurance & quality control programs as well Lab automation. MDH will also continue to build capacity of
human resource within the labs by hiring and training.
(vi) Quality management program (QMP) - MDH has indicators incorporating PMTCT, care & treatment
and TB/HIV programs to collect data and make use of this information for monitoring the quality of patient
care. QMP will cover all the existing as well as new sites. All the national M&E indicators are included in our
QMP.
(vii) Tracking patients lost to follow up: MDH has a patient tracking system to trace those missed their
scheduled visit, lost to follow up and with abnormal laboratory results. Currently the team has 30 nurses and
additional 40 will be recruited. We will also involve PLWHA and volunteers on ART in the tracking system.
MDH will strengthen linkages with organizations providing home based care.
(viii) Training: In order to continuously build the capacity of all the MDH health care providers and the district
health management team, a cascade of year round training sessions (intro and refresher) on the full
spectrum of HIV treatment and care will be conducted using the national curricula. On site training and
follow up, supportive supervision together with District Health Management (DHM) teams (monthly),
preceptorship, system strengthening and logistical improvement will be prioritized. In consultation with the
DHM, further training opportunities for selected MDH staff will be offered.
(ix) Nutrition: Currently, MDH is providing nutritional information and counseling to all patients. It is proposed
that nutritional supplements (plumpynut) be given to the severely malnourished patients (BMI <16) on care
and ART (10% of 38,000) for three months. A nutrition coordinator and assistant will be recruited. One
nutritionist per site (total of 14) will also be recruited and trained.
LINKAGES:
MDH will map and document available services for PLWHA. Referral systems will be strengthened to
enable patient's access to various levels of services provided by the health facilities and other organizations
particularly those of PLWHA and OVCs that provide clinical, psychological, spiritual, social, preventive and
palliative care in the communities. Linkages within health facilities particularly between CTCs, TB, PMTCT,
outpatient and inpatient departments will be strengthened. Provider initiated counseling and testing (PICT)
will be strengthened to minimize missed opportunities. Patients will be linked with various wraparound
programs - nutrition, reproductive health/family planning, malaria control, water and sanitation.
CHECK BOXES:
Human capacity development activities revolve around in-service training of health care workers. HIV
testing and enrollment into treatment will focus on the general population with specific emphasis on
pregnant women and children. Linkages with PLHA groups will be formed and/or strengthened.
M&E:
MDH will collaborate with the NACP/MOHSW to implement the national M&E system for care & treatment.
Activity Narrative: Patient records at all sites will be managed electronically using a well-developed electronic medical record
system linked with the National CTC3 database for generation of NACP and USG reports. In order to
promote data use, MDH will provide regular feedback to CTCs and build capacity to synthesize data to
inform patient management and district/regional planning. We will support training of 50 HCWs in SI and
provide TA to all 30 CTCs, three district offices and one regional office. MDH will regularly perform data
analyses to evaluate treatment outcomes and to document the lessons learnt which will be shared through
various forums including conferences and publications.
SUSTAINAIBLITY:
MDH is working with regional and district authorities in the day to day activities of the program within the
existing system. Planning, implementation and monitoring of the activities are done jointly with the district
staff. All MDH activities will be in line with the Council Health Plans. MDH will continue with district capacity
building in infrastructure and human resource. Financial and program management system capacities will
be strengthened through training and technical assistance.
NEED and COMPARATIVE ADVANTAGE: Out of the 2.5 million population in Dar es Salaam region,
272,000 (10.9%) are estimated to be the people living with HIV/AIDS (PLWHA). Of these it is estimated that
54,000 (20%) will need ART.
Activity Narrative: MDH will collaborate with the NACP/MOHSW to implement the national M&E system for care & treatment.
Patient records at all sites will be managed electronically using a well-developed electronic medical record
SUSTAINAIBLITY: MDH is working with regional and district authorities in the day to day activities of the
program within the existing system. Planning, implementation and monitoring of the activities are done
jointly with the district staff. All MDH activities will be in line with the Council Health Plans. MDH will continue
with district capacity building in infrastructure and human resource. Financial and program management
system capacities will be strengthened through training and technical assistance.
