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
Zambia continues to face an acute shortage of health care personnel which severely constrains the scale-
up of anti-retroviral therapy (ART). The most limiting factor is lack of trained providers - physicians, nurses,
clinical officers, laboratory personnel, and others. The priorities of the National Human Resources Strategic
Plan include recruitment, deployment, and retention of health workers. The Health Services and Systems
Program's (HSSP) role in the ART program is to support the Ministry of Health (MOH) to retain critical staff
in areas of greatest need and provide support in performance improvement and quality assurance. In FY
2005, HSSP recruited and placed nine Provincial Clinical Care Specialists (CCSs) to enhance ART
coordination and quality assurance; initiated the recruitment of doctors under the rural retention scheme;
and developed the minimum criteria for certification of providers and accreditation of ART sites. A certified
HIV/AIDS care and ART provider is a physician, a medical licentiate, clinical officer or a nurse who has
successfully completed MOH approved ART/OI in-service training program (short courses, on-the-job
training and updates) which is recognized by an appropriate regulatory authority e.g. Medical council of
Zambia or General Nursing Council.
In FY 2006, HSSP's focus was on continued support to CCSs and placement of medical doctors to serve in
remote areas; recruitment of non-physician health care workers for the retention schemes; recruitment of
nurse tutors; and development of minimum criteria for certification of providers and accreditation of ART
sites. Modalities of recruitment and management of retention schemes for doctors, nurse tutors and other
cadres were finalized by HSSP and MOH. Agreement on modalities of recruitment and management of
doctors' retention scheme has been slow with the dissolution of the Central Board of Health - the managers
of the existing retention scheme; further, there was an upward adjustment of the package by the MOH
necessitated by the sudden appreciation of the local currency against the US dollar.
In FY 2007, HSSP continued to support the nine CCSs and the retention scheme for doctors, non-
physician health providers and nurse tutors. HSSP paid the salaries and provided maintenance and fuel
expenses for supervision trips of the CCSs in the nine Provincial Health Offices (PHOs). The CCSs
continued to provide technical backstopping and supervision to junior doctors implementing HIV/AIDS
activities in the districts as part of human resource capacity development. They also worked with the PHOs
to coordinate ART scale-up in hospitals and health centers, served as provincial ART trainers, and
monitored and supervised the private sector ART provision. CCSs assisted other USG programs in the
provinces, including Zambia Prevention, Care and Treatment Partnership (ZPCT), Health Communication
Partnership, and Centre for Infectious Disease Research in Zambia. CCSs served as a conduit for
provincial coordination and quality assurance.
In FY 2008 HSSP will continue to support the nine CCSs through payment of salaries and provision of fuel
expenses for supervision and coordination of ART scale up in hospitals and health centers. The Rural
Retention Scheme for medical doctors, nurse tutors and other health workers will be supported using
funding already received from FY2005, FY 2006 and FY 2007.
In FY 2006, HSSP supported MOH and Medical Council of Zambia (MCZ) to develop an ART accreditation
plan, consensus-building on ART standards and accredit 21 private ART sites. In FY 2007, HSSP
continued to roll out the accreditation system to more districts. An additional 21 private ART facilities were
accredited. In FY 2008, HSSP will support MCZ to monitor, document and improve the overall functioning of
the accreditation system. HSSP will continue to work closely with the CDC, ZPCT and the WHO to support
the MOH in improving services for HIV/AIDS patients in health facilities.
In FY 2007, HSSP and other partners supported the integration of HIV/AIDS services into MOH
Performance Assessment tools and developed minimum quality assurance standards for HIV/AIDS
services. The tools and minimum standards were approved by MOH and are in use in all districts. In FY
2008, HSSP will focus on monitoring of implementation of the Performance Assessment tools and
standards and strengthening supervisory services that focus on case management and quality
To ensure sustainability, HSSP works within the existing GRZ structures and plans. HSSP facilitates the
development and dissemination of appropriate standard guidelines, protocols, plans, and budgets. The
tools and guidelines are disseminated for use by relevant MOH structures. This enables them to plan and
implement activities independently. HSSP also assists GRZ in implementing a facility-level quality
improvement program. All project activities are integrated into the existing programs and structures to
ensure continuity of services after HSSP concludes.
All FY 2008 targets will be reached by September 30, 2009.
The Health Services and Systems Program (HSSP) works with the Ministry of Health (MOH), and in
collaboration with other partners to develop and disseminate standard data elements, data collection, and
reporting tools, and to train health facility staff. In FY 2008, in the area of strategic information, HSSP will
develop and strengthen an anti-retroviral therapy (ART) data collection and reporting system to improve
overall program management for the MOH. HSSP will also continue to link with other partners engaged in
service delivery and strategic information.
During FY 2004, technical assistance was provided to MOH to develop the national ART Information
System (ARTIS) in provincial and tertiary level hospitals. In FY 2005, HSSP provided technical assistance
focused on: rolling out the paper-based ARTIS to all public health facilities providing ART; integrating ART
data into the Health Management Information System (HMIS); developing an inventory of existing
prevention of mother to child transmission (PMTCT) and counseling, testing, and care (CTC) indicators; and
producing a Health Statistical Bulletin that includes ART Information. HSSP trained 72 district and 9
provincial data managers in the paper-based ARTIS, achieving 100 percent coverage.
During FY 2006, HSSP's role was to assist the Ministry of Health (MOH) and partners to ensure that all
HIV/AIDS service delivery data are reported through the MOH national HMIS. A major challenge was to
integrate public and private sector HIV/AIDS data on PMTCT, CTC, and tuberculosis (TB) into the
mainstream HMIS. To address this challenge, HSSP assisted the MOH to revise existing HMIS data
collection and reporting tools to integrate CTC, PMTCT, and TB services. A total of 81 data managers (9
from the provincial level and 72 from the district level) were trained to use the new tools. In FY 2007 HSSP
supported the 72 districts in the utilization of information to plan for HIV/AIDS services and develop
quarterly and annual reports based on action plans. One hundred and eighty two (72 District Information
Officers, 72 Managers of Planning and Development, nine provincial data managers, 18 Clinical Care
Specialists, and 11 Hospital Information Officers) were trained in information utilization. Two thirds of ART
sites are currently using ARTIS. In FY 2008, HSSP will continue to support and supervise districts and
hospitals to improve data quality and enhance utilization of data for informed decision making by
strengthening the provincial structures and competencies in supervision and technical backstopping for
ARTIS/HMIS. Nine provincial health staff and three MOH - headquarters staff will be trained for this
purpose. HSSP will also work with CDC to aggregate facility data (SMARTCARE CARD) and facilitate
overall integration into the HMIS. Currently, the European Union (EU) provides HMIS support to the MOH;
HSSP will work closely with the EU and MOH to ensure HIV/AIDS indicators are included in the national
HMIS system. Additionally, HSSP will provide support to MOH to develop an integrated package of HMIS
reference materials for HIV/AIDS services. It is expected that there will be improvement in the quality of
action plans, implementation, and services in general. Reviewing district action plans has revealed that
planning is not based on evidence or sound epidemiological data, hence the need to focus on improving
data utilization at service delivery level.
As part of the sustainability plan, HSSP works closely with the Ministry of Health, Provincial Data
Management Specialists, and other partners (ZPCT, CDC, CIDRZ, and the World Health Organization) to
develop, disseminate, and maintain the HIV/AIDS reporting systems which are integrated into the overall
Zambian Government HMIS. HSSP's mandate is to ensure integration of ART, PMTCT, CTC, and TB into
the mainstream HMIS and build capacity of the health workers and data managers in the use and
maintenance of the developed information systems.
All FY 2008 targets will be reached by September 30, 2009.
In FY 2008, the Health Systems and Services Program (HSSP) will continue to work with the Ministry of
Health (MOH) to build on FY 2005, FY 2006, and FY 2007 activities of strengthening policy and systems
that support HIV/AIDS services in the following areas: 1) planning; 2) human resource planning and
management (HRPM); 3) pre- and in-service training; and 4) HIV/AIDS coordination and Sector Wide
Approach (SWAP). In the area of planning, HSSP will continue to provide routine support to the MOH to:
develop annual technical updates for annual health sector planning based on priorities and objectives of the
National Health Strategic Plan; compile a summary of national health priorities integrating information on
HIV/AIDS; and conduct a desk review of 72 district action plans and 22 hospitals to assess the quality of
plans and the extent to which HIV/AIDS services are incorporated in the action plans. By linking with
HSSP's Strategic Information activity, district level managers and planners will improve their skills in using
data for planning especially as it relates to HIV/AIDS information and budgeting of HIV/AIDS-related
services to ensure efficient use of scarce resources.
In FY 2007, HSSP worked with the MOH to disseminate HIV/AIDS human resource (HR) planning and
projection guidelines and plan for HR requirements to deliver a minimum package of HIV/AIDS services.
HSSP supported Provincial Health Offices (PHOs) to assess their district HR needs and developed 72
district HR staffing plans. In FY 2008, HSSP will support MOH and PHOs to strengthen the role of
Technical Supportive Supervision (TSS) in HR planning and management. Specifically, HSSP will review
72 district action plans to determine the level of inclusion of HR requirements and participate in the
provision of TSS to districts that do not comply with HR planning guidelines. It is expected that the support
system for the utilization of HR planning guidelines will be strengthened in all the nine PHOs.
In the area of Pre and in service training HSSP will provide ongoing assistance to the MOH to ensure that
all training is coordinated among partners and that skills enhancement is linked to strategic information as
well as anti-retroviral (ARV) service provision. In FY 2007, HSSP supported MOH to integrate HIV/AIDS
and related teaching modules into pre- and in-service programs, develop training materials and teaching
guides, and train 160 teachers from Chainama College (Clinical Officers) and nursing schools on the
revised curricula. The curriculum for the Clinical Officer General was developed and is currently being
implemented. In FY 2007, the nurses' curriculum was revised and work on the Physicians' curriculum
began. Twenty-one organizations (the MOH and all the 20 training schools for clinical officers, doctors, and
nurses) received technical assistance for HIV/AIDS-related institutional capacity building, thus achieving
100% coverage. In FY 2008, HSSP will continue to support the same 21 organizations as it works
collaboratively with the MOH to strengthen the quality of training and supervision for the 20 training
institutions. HSSP will continue to work with Chainama College and General Nursing Council (GNC) to
evaluate the implementation of the revised Clinical Officer General (COG) and nurses' curricula. Additional
training activities for 160 teachers will include strengthening teaching methodologies, reorienting faculty,
and monitoring implementation of the physicians' curriculum.
Parallel to curricula review process, in FY 2005/FY 2006 HSSP supported the training of 637 graduates in
the provision of HIV/AIDS services. A follow up assessment of these students was conducted in 2006 to
facilitate lesson learning. In FY 2008 HSSP will also continue to strengthen the role of the Human Resource
Development Committees (HRDCs) through technical support supervision in order to improve planning and
coordination of HIV/AIDS training activities in all 72 districts. This support will include building capacities of
HRDCs, to effectively utilize the national in-service training coordination system and the national training
In regards to HIV/AIDS coordination and SWAP, in FY 2008 HSSP will continue to assist the MOH and
partners (USG, cooperating partners and UN agencies) that support HIV/AIDS service delivery to
coordinate activities among themselves and with the private sector. Activities will include: providing
technical assistance to the Sector Wide Approach Program (SWAP) to assist MOH to meet milestones
under the Sector Program Assistance (SPA) and ensure collaboration and effective coordination of
HIV/AIDS services. Specifically, HSSP will continue to assist the MOH to: improve HIV/AIDS work plans;
provide technical support supervision; mobilize resources through the Global Fund to Fight HIV/AIDS,
Tuberculosis and Malaria; monitor implementation of the HIV/AIDS coordination mechanism for the health
sector and sustainability framework; and maintain a partners' database for HIV/AIDS service delivery. In
FY2006 HSSP supported MOH to develop the HIV/AIDS coordination mechanism which serves as a guide
for coordinating HIV/AIDS services in health institutions.
To ensure sustainability, HSSP works within the existing government structures and plans to develop and
disseminate appropriate standard guidelines, protocols, and strategic plans. HSSP also assists the
government to build the capacity of training schools through curricula development and dissemination. To
avoid duplication of efforts, HSSP implements project activities in collaboration with USG partners and other
stakeholders. HSSP will support MOH to provide leadership in planning, thereby paving the way for HSSP
exit. HSSP will also work extensively with the MOH planning unit to strengthen and further decentralize the
district planning process. The Provincial Health Office will be encouraged to play a stronger role in the
review and monitoring and evaluation of their respective district action plans.