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.
USAID/Uganda plans to award a five-year contract to Strengthen Decentralization for Sustainability (SDS). The purpose of the SDS project is to improve the results and sustainability of decentralized service delivery, with initial emphasis on health and HIV/AIDS services, at Local Government levels in Uganda through:
Improved coordination among all USAID-supported partners at the district level;
Strengthened capacity of districts and sub-counties to plan, budget, implement/coordinate, monitor and evaluate decentralized services by efficiently utilizing the Government of Uganda's administrative and fiscal decentralization framework;
Provision of grants to districts to complement resources needed for effective and efficient management of programs and services; and
Facilitated strategic innovations to improve district leadership and sustainable financing of health, HIV/AIDS and other social sector services.
The proposed activities are to be done with full collaboration of the Ministry of Local Government, the Local Government Finance Commission, relevant line ministries, local governments, and existing or planned USAID implementing district-based partners providing technical assistance to decentralized service delivery. USAID District Based Technical Assistance (DBTA) partners will include but are not limited to the Northern Uganda Malaria, AIDS and Tuberculosis (TB) project (NUMAT), the two recently-awarded cooperative agreements to Management Sciences for Health (Strengthening TB and HIV/AIDS Responses in Eastern Uganda STAR East) and John Snow (Strengthening TB and HIV/AIDS Responses in East Central Uganda STAR East Central) to strengthen service delivery for HIV/AIDS and TB in selected districts in the their respective regions, a planned award to cover HIV and TB services in the South Western Region of the country, STOP Malaria, as well as other USAID-supported activities with a district focus. Initial activities will focus on approximately 45 districts. Expansion to additional districts will depend on availability of funds and progress made under the terms of this award.
The SDS project will focus on effective, efficient and sustainable results by:
Putting financial resources and support as close to implementers and beneficiaries as possible (that is, at district and sub-district levels and below);
Improving local government management and accountability for financial inputs, including those from USAID/Uganda;
Improving local government management of limited resources with the expectation that these improvements will produce better programs and services, and better health outcomes for people;
Improving local government ownership, leadership, governance, and management innovation.
Specific roles and responsibilities for the SDS project will include but not be limited to:
Coordination
Coordinate and collaborate with all USAID partners working at district level to improve synergy and impact of USAID supported activities.
Take the lead in facilitating and tracking coordination among USAID partners and between USAID partners and districts and other stakeholders.
District work plans and budgets
Provide grants to local governments to complement the technical assistance being provided by the DBTA partners (approximately 45 grants one/district).
Develop one agreed-upon costed work plan reflecting the work of all USAID activities to be funded through the districts; ensure that USAID partners' work plans and budgets fit into the district development plans (DDPs) and budgets.
Facilitate USAID activities supporting but not funded through the districts to be captured through the DDPs and budgets.
Technical Assistance
Provide technical assistance to local governments in the area of resource management (including but not limited to participatory planning, budgeting, managing funds flow and procurements, coordination at service delivery levels, monitoring and supportive supervision and measuring outputs and results).
Sustainability
Take lead in developing innovative approaches in close partnership with local governments, DBTA partners, and other key partners to strengthen local leadership and facilitate sustainability of USAID supported activities.
Develop meaningful exit strategies, with clearly defined expectations and results, for each district supported.
It is expected that SDS will work in close partnership with the Ministry of Local Government, Local Governments (LGs), relevant line ministries, USAID implementing partners supporting district based activities and other key stakeholders supporting district activities. SDS project is intended to eliminate duplication and improve complementarity among USAID supported partners and improve collaboration and communication with local governments and other stakeholders working at the district level. This activity will facilitate USAID implementing partners to ensure that their support to districts is timely, supportive of the district planning and budgeting processes and integrated into district development plans and budgets. The partner will work equally closely with respective GOU counterparts and other implementing partners supporting national initiatives at the district level through complementary and congruous efforts including but not limited to leadership, local government resource management and governance, and overall systems strengthening.
SDS will expand delivery of HIV/AIDS care and treatment services by strengthening district leadership and management, health management information systems (HMIS), as well as improvements in human resources for health, supply chain management systems, strategic information, infrastructure and laboratories. The primary emphasis will be on strengthening care and treatment service delivery systems at health center IV's, III's and work with other district-based programs to build community outreaches that serve to provide intermediate care and generate demand for facility based services. SDS will also work with facilities on other initiatives aimed at improving quality and efficiency of care and treatment services within health facilities, promote community-facility linkages to enhance referrals as a way of improving access to, coverage of and utilization of care and treatment services.
The primary emphasis by the SDS project will be strengthening care and treatment service delivery systems at health center IV's and III's. The program will also support systems that work with facilities on other initiatives aimed at improving quality and efficiency of care and treatment services within health facilities and community organizations, building of community-facility linkages to enhance referrals as a way of improving access to and coverage of and utilization of care and treatment services. In addition to supporting expanding delivery of HIV/AIDS services, SDS will support the capacity of decentralized health delivery systems to improve uptake of services at lower level facilities. Support will focus on areas of leadership, management, health management information systems (HMIS), and human resources for health, supply chain management, strategic information, infrastructure and laboratories.
The SDS project will support the national efforts to improve the systems that monitor the quality, utilization and sustainability of services delivered in the areas of counseling and testing in an integrated manner at both facility and community levels. In partnership with the Government of Uganda and other stakeholders, the SDS project will strengthen the national response to the HIV/AIDS epidemic. Within the National Strategic Framework, SDS will continue to work through local governments, the private sector, other USG and non-USG implementing partners and civil society organizations (including faith-based and community based organizations) towards improved quality of life and increased equitable access to preventive and clinical services at both district and lower-level facilities. Key activities at the district level include technical support at the policy and technical level, systems strengthening including quality assurance, M&E and support supervision as well as financial resources for services delivery.
Several district-based programs have previously made significant progress of increasing access to HIV care and treatment for children. The SDS project will further support some best practices to be incorporated into district work plans. Best practices include: integration of ART and PMTCT services in all public facilities; assessment of infants and children for ART eligibility in every clinic visit under district supervision; routine counseling of adults to encourage the testing of children, intensified case findings of exposed infants within immunization units, scheduling the same appointment dates for children and parents/caretakers, and introduction of specific clinic days for children. SDS will support districts and health facilities to implement proven innovations and practices.
Rolling out of pediatric HIV/AIDS care and treatment to lower level facilities is hampered by lack of adequate counseling and clinical skills among health workers and suboptimal access to laboratory services and suboptimal linkage to services. SDS activities will build the skills of health workers on pediatric care, and treatment through didactic and on-the-job trainings, clinical mentoring and availing simplified tools and aides.
Several programs have made significant progress of increasing access to HIV care and treatment for children. SDS will support district systems that promote some of the best practices which include: integration of ART and PMTCT services; assessment of infants and children for ART eligibility in every clinic visit; routine counseling of adults on bringing children for testing, intensified case findings of exposed infants within immunization units, scheduling the same appointment dates for children and parents/caretakers, and introduction of specific clinic days for children. The SDS activity will support districts and health facility systems to implement proven innovations and practices.
The roll out of pediatric HIV/AIDS care and treatment to lower level facilities is hampered by lack of adequate counseling and clinical skills among health workers and suboptimal access to laboratory services and suboptimal linkage to services. The SDS activity will build the skills of health workers on pediatric care, and treatment through didactic and on-the-job trainings, clinical mentoring and availing simplified tools and aides
The SDS project is intended to assist the local government to conduct assessments of the district systems (M&E, procurement, etc) that need to be enhanced. The results of these assessments should help design district-specific system improvement plans. Some of the district systems improvement may include development of simple monitoring tools and institutionalizing these so that multi-sectoral data can be captured and used for monitoring service delivery and making district planning evidence-based. The process of conducting these systems assessments will involve training of at least two relevant district staff on identifying and understanding key M&E/information concepts and principles as applied to district program planning (total 90 trained in strategic information).
In order to promote evidence-based planning, SDS will work in partnership with the STAR E project that will support the Government of Uganda to institutionalize the carrying out of the Lots Quality Assurance Sampling (LQAS) at national level and ensure that the data generated is used. The SDS project will also support the key national HIV/AIDS data use (including reporting) processes and activities taking place at the district in order to build sustainability. Evidence-based planning and decision making will be achieved through regular measurement of program performances and progress at the districts and lower levels. Regular and timely feedback to the supported local governments, non-governmental organizations and civil service organizations will be provided through systems strengthening of district-level monitoring and reporting systems including HMIS and PMMP. While the LQAS results will be used to inform district-level work planning in order to identify intervention areas and sub-counties on which to focus in the future, this USG investment goes beyond this and achieves one other objective i.e. support is to ensure that these district-based programs support the existing national data collection, collation, use, and reporting systems at the district and lower levels for purposes of building sustainability i.e. strengthening the local government's capacity to coordinate the collation, management, and use of multi-sectoral data for monitoring performance of service delivery as well as for the overall district planning. Coordination at the district also includes ensuring that the existing supply of, and demand for, ICT (information, communication, and technology) resources (that includes human) are optimized.
Since a supportive policy environment is very important for the implementation of activities, the SDS activity will complement the efforts of the Ministry of Health (MOH), Ministry of Gender, Labor and Social Development (MGLSD) and other national bodies like Uganda AIDS Commission and National TB and Leprosy Programs towards the dissemination of policies that are relevant to the activities that the program will support. For example, SDS will support the continued roll out of the revised policies of PMTCT, RCT, ART, TB and any other policies as they get approved. SDS will also build on past efforts by the AIDS District Model (AIM) project, Uganda Program for Human and Holistic Development (UPHOLD) and Uganda AIDS Control Program (UACP) to strengthen district planning through continued support to the District AIDS Committees. The support will facilitate streamlining district capacity to manage HIV/AIDS structural plan development, coordination of activities and monitoring progress. Other activities to be supported will include:
Once completed, the dissemination of the following policies and/or guidelines will be undertaken: integrated TB/HIV management, management of opportunistic infections, scaling up of the utilization of co-trimoxazole prophylaxis among people living with HIV/AIDS (PLHAs) as well as the provision of isoniazd prophylaxis in PLHAs at high risk of acquiring tuberculosis.
Supporting the printing and distribution of policies and implementation guidelines and the re-training and orientation of health workers to improve service delivery in HIV/AIDS management targeting private and public health facilities. The training will benefit at least 500 persons (health workers and CSO staff).
SDS support in the area of sexual prevention: Abstinence and Be faithful will focus on supporting the district education system and civil society to improve on the gains attained through the existing abstinence programs for the 10 -19 year olds, through a combination of in-school and out-of-school programs, media and community mobilization approaches. The in-school abstinence programs that will be closely monitored by the district education office will be complemented by other USG partners programs that focus on strengthening and scaling up of the national Presidential Initiative for AIDS Strategy.
The SDS project will use its financial and technical support to provide resources to district offices like the fisheries department, education department, health department and agricultural department to monitor and make sure that the district based projects are providing adequate services to the most-at-risk populations with HIV/AIDS education, counseling and testing as well as condom education and distribution services in collaboration with other key stakeholders such as Ministry of Health and organizations involved in social marketing.
It is expected that SDS will work in close partnership with the Ministry of Local Government, Local Governments (LGs), relevant line ministries, USAID implementing partners supporting district-based activities and other key stakeholders supporting district activities. The SDS project is intended to eliminate duplication and improve complementarity among USAID-supported partners and improve collaboration and communication with local governments and other stakeholders working at the district level. This activity will facilitate USAID implementing partners to ensure that their support to districts is timely, supportive of the district planning and budgeting processes and integrated into district development plans and budgets. The partner will work equally closely with respective GOU counterparts and other implementing partners supporting national initiatives at the district level through complementary and congruous efforts including but not limited to leadership, local government resource management and governance, and overall systems strengthening.
SDS support in the area of PMTCT will focus on expanding delivery of PMTCT services in districts by strengthening systems in the areas of district leadership and management, health management information systems (HMIS), as well as improvements in human resources for health, supply chain management systems, strategic information, infrastructure and laboratories. The primary emphasis in districts will be to directly support PMTCT program systems to provide Opt-out HIV counseling and testing, ARV prophylaxis, HAART, psychosocial support, community follow-up and mobilization, training, adequate counselor and laboratory technician staff, upgraded laboratory facilities and counseling rooms, management information systems and strengthened MCH/FP services. The above technical assistance will be provided through direct technical assistance (TA) and grants depending on the prevailing need.
SDS will expand delivery of TB/HIV/AIDS care and treatment services by strengthening health management information systems (HMIS), as well as improvements in human resources for health, supply chain management systems, strategic information, infrastructure and laboratories. The primary emphasis will be on strengthening support supervision for care and treatment service delivery systems at health center IV's and III's. SDS will also provide support supervision facilities aimed at improving quality and efficiency of care and treatment services within health facilities and ensuring that community-facility linkages to enhance referrals as a way of improving access to, coverage of and utilization of care and treatment services by district based programs is done.
SDS will also support integrated support supervision conducted quarterly within each health sub district; work with district based partners to establish or maintain facility based quality improvement teams; and introduction of continuous ART quality improvement tools in coordination with HCI or HIVQUAL.
