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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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
TITLE: Mildmay Maisha Kikamilifu Palliative Care Program in Kilimanjaro and Tabora Regions
NEED and COMPARATIVE ADVANTAGE: In the Tabora Region, there is no recognizable community-
based palliative care or an assigned implementing partner. Implementation of care guidelines has been
sporadic due to a lack of training and support of health workers at all levels. Mildmay has a model home-
based palliative care program comprising a cadre of trained health professional in Kilimanjaro, and
established patient support centers that act as referral hub for home-based care (HBC) services, especially
linking Care and Treatment Clinics (CTCs) and the community. To sustain the scale up of services and
quality, it is necessary to continue support for health workers, patient support centers. It is also essential to
consolidate linkages established with government structures, PLWHAs, community based trainers, carers
and treatment sites in Kilimanjaro and initiate new activities in the Tabora Region. Mildmay is well
positioned to address these needs based on their successful experience in Kilimanjaro to date.
ACCOMPLISHMENTS: Mildmay accomplishments in Kilimanjaro in the existing Maisha Kaikamililfu
(Kiswahili for "Life in its Fullness") include creating a pool of health workers well trained in the care and
management of people living with HIV/AIDS (PLWHA). Mildmay has provided 48 sub grants for HBC
activities, trained eight senior health workers at Diploma level, and forged sustainability linkages with
government and community-based/faith-based organizations (CBOs/FBOs). To date, over 2,500 clients
have received services through three patient support centers each month, 1,200 PLWHA have received
HBC, and 25 community support groups for PLWHA have been organized, and 16 income generating
activities (IGAs) have been organized for groups of PLWHA.
ACTIVITIES: With FY 2008 funding, Mildmay will:
1) Train health workers from Tabora Region in the care and management of people living with HIV/AIDS:
1a) train 15 health workers on design, set up and management of home based palliative care programs
using NACP curriculum; 1b) train 12 (eight new and four continuing senior health workers on the 18-month
Mildmay Diploma to provide the much needed management and leadership of HBC services at the district
2) Initiate HBC in Tabora Region with a model developed by Mildmay in Kilimanjaro to support the national
program, using the basic service package and wraparound possibilities in the community: 2a) carry out a
situation analysis of palliative care; 2b) initiate consultation with government structures on establishing HBC
services and parameters for work in the region; 2c) map out possible collaborators in training and provision
of HBC services; 2d) establish an operational base through office set-up, staff recruitment and orientation.
3) Support the continuum of care by strengthening the link between CTCs and the communities to facilitate
improved communication between the treatment provider HBC provider, and act as referral hubs between
clinic-based and community level initiatives: 3a) set up and support four new patient support centers, one
each in Rombo and Same districts of Kilimanjaro, and two in Tabora; 3b) continue support for three
patient support centers in Kilimanjaro;
3c) provide supervisory and technical support to home-based palliative care workers; 3d) provide 39 sub
grants to health workers trained on care and management of PLWHAs to establish home-based palliative
care initiatives within their facility's catchment area.
4) Strengthen district-level HIV/AIDS coordination mechanisms to help create a conducive environment at
the management level, ensuring that the trained health workers are supported in their development of the
home-based care programs and that HBC is integrated into existing local healthcare activities for quality
improvement: 4a) convene three workshops (one in Kilimanjaro and two in the Tabora Region) for senior
managers of partner organizations; 4b) facilitate an exchange visit of policy makers to the Mildmay
programs in Uganda.
5) Scale up greater involvement of PLWHA: 5a) provide support and training to registered groups of
PLWHA for initiatives aimed at community sensitization to reduce stigma and promote prevention
messaging, adherence, and self-empowerment for positive living.
LINKAGES: Mildmay works closely with the Ministry of Health and Social Welfare (MOHSW) in Tabora to
ensure compliance with the national health strategy. Because Elizabeth Glaser Pediatric AIDS Foundation
(EGPAF) is the lead partner treatment partner in Tabora providing the facility based care, Mildmay works
closely with EGPAF, as well as other providers in the same region to broaden the level and
comprehensiveness of the palliative care services. Health workers from various health facilities in Tabora
will benefit from Mildmay training and technical expertise in the design and delivery of HBC. In Kilimanjaro,
Mildmay works closely with Pathfinder, the lead palliative care partner for the region, in addition to EGPAF,
the lead treatment partner. In addition, they link with other palliative care providers in Kilimanjaro. Mildmay
will link with the bulk arrangements made by the USG for insecticide treated mosquito nets, nutritional
support, and home-based care kits. Mildmay also works with PLWHA groups to promote empowerment,
stigma reduction, food security, and income generation.
CHECK BOXES: Renovation may be necessary to prepare health facilities where the patient support
centers will be sited. Training enhances the skills of health workers and the capacity of District Health
Management Teams and other partners to provide HBC services. Adolescents and adults are targeted as
carers, HBC volunteers, to support for PLWHA and for prevention. PLWHA are direct beneficiaries of HBC
services and IGAs, potential HBC providers, and support group members.
M&E: Mildmay has developed monitoring tools for use by the community health workers, facility based
health workers who supervise HBC services in their catchment areas. Mildmay uses the aggregated
information for organisation decision making, donor reporting and feeding into the national reporting system.
The data generated monthly is plotted against targets to monitor performance and inform program decision.
Once the National AIDS Control Programme completes their new monitoring system, Mildmay will use the
national system. An M&E Officer will be recruited to oversee this program component.
To measure the program outcomes especially the improvement in the quality of life of PLWHAs, Palliative
Care Outcome Scale will be used. Localised surveys will measure others such as stigma and behavioural
change. Baseline surveys carried out by short courses and diploma students provide the baseline against
which to measure these outcomes.
Activity Narrative: SUSTAINAIBLITY: Mildmay activities aim at strengthening the health care system through capacity
development and establishing HBC models that are replicable and self-sustaining. By involving CBOs/FBOs
and volunteers, HBC services are integrated within communities that require minimal input after the initial
training and resource injection.