Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 695
Country/Region: Zambia
Year: 2008
Main Partner: Population Services International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $4,195,877

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $392,854

This activity is an integral component of a prevention and care project strategically linked to HVAB, HVOP,

and HVCT interventions, including Society for Family Health (SFH) (#8926), Central Contraceptive

Procurement (#8872), Health Communications Partnership (HCP) (#8905), International Youth Foundation

(#8899), JHPIEGO (#9035), RAPIDS (#8945), Corridors of Hope II (#8939), and CHAMP.

In partnership with the Zambian Ministry of Health (MOH), the National HIV/AIDS/STI/TB Council (NAC),

JHPIEGO, and with the support of private funding, Populations Services International (PSI) has already

begun implementing a male circumcision (MC) pilot project in Lusaka through its local affiliate, Society for

Family Health (SFH). The objectives of this project are to assist in meeting current demand for MC services

and develop lessons learned regarding cost-effective, sustainable MC service-delivery models to rapidly

scale up services nation-wide. This project is operating in four sites: University Teaching Hospital urology

clinic, two private clinics, and a PSI/SFH "New Start" brand counseling and testing (CT) center.

Since the counseling that men receive before and after the MC procedure is an integral part of the MC

package, PSI/SFH will use this opportunity to deliver messages stressing the importance of abstinence and

being faithful to MC clients. The MC program will also focus on gender, addressing male norms, behaviors,

and male reproductive health (with an emphasis on risk reduction). PSI/SFH will use the FY 2008 COP

funding to support the implementation of the AB component of MC. Additional funds for MC-related

activities will come from other parts of the Country Operational Plan (HVCT and HVOP). PSI/SFH will reach

57,816 MC clients with AB messages by targeting adolescents; people living with HIV/AIDS (PLWHA);

incarcerated populations; persons in prostitution; and persons who exchange sex for money/goods,

especially individuals with multiple or concurrent partners.

PSI/SFH has already begun training New Start counselors in MC and will expand this training to all

counselors in the New Start network and possibly other organizations working in CT as well. With FY 2008

COP funding, PSI/SFH will implement the training of 79 CT counselors in MC so that more staff are able to

counsel clients on the benefits, risks, and availability of MC. PSI/SFH will also support the development,

printing, and distribution of MC information, education, and communication (IEC) materials promoting AB

messages in all of their sites. The development of IEC materials will be done in close collaboration with the


All doctors, clinical officers, nurses, and counselors involved in MC service-delivery at implementing sites

will successfully complete MC training. Moreover, frequent monitoring of service providers will promote high

-quality services. Service providers will be required to maintain the highest quality of service in order to

remain in the MC service-provision network. As part of the quality monitoring, client feedback will routinely

be reviewed and follow-ups with clients will be used to survey clients, to ensure service and counseling

protocols were followed.

All FY 2008 COP targets will be reached by May 30, 2009.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $2,183,179

This activity is an integral component of a prevention and care project strategically linked to HVAB and

HVCT interventions, including Population Services International/Society for Family Health (PSI/SFH),

Central Contraceptive Procurement, Health Communications Partnership (HCP), International Youth

Foundation, JHPIEGO, RAPIDS, Corridors of Hope II, and Comprehensive HIV/AIDS Management

Programme (CHAMP).

In FY 2008, Population Services International (PSI), through its local affiliate, Society for Family Health

(SFH), will expand and enhance outreach activities encouraging individuals to be faithful and promoting

consistent and correct condom use to specific populations. PSI/SFH is currently covering 60% of Zambia's

districts with intensive condom promotion and outreach activities. PSI/SFH is implementing lower-intensity

activities in the remaining 40% of districts which include hard-to-reach rural areas with poor infrastructure

and low-density populations.

In FY 2008, PSI/SFH's provincial outreach workers and volunteers will reach 298,655 individuals with

balanced HIV-prevention messages using interactive materials. Activities will specifically target: (1) sexually

active males and females, particularly youth in tertiary educational institutions; (2) men and women

engaged in concurrent sexual partnerships; (3) commercial sex workers and their partners; (4) men and

women at their workplaces; incarcerated persons; and (5) people living with HIV/AIDS (PLWHA). PSI/SFH

will continue to target these groups with risk-reduction messaging, condoms, and counseling and testing

(CT) promotion. Activities will promote consistent condom use, fidelity, they will help individuals complete a

personal risk assessment, and PSI/SFH will refer clients to facilities for CT and diagnosis and treatment of

sexually-transmitted infections (STIs). PSI/SFH's communication strategy involves a wraparound approach

where HIV-prevention messages are integrated into family planning, child survival, and malaria messages

for specific groups.

To reach high-risk groups, such as those engaging in transactional sex, PSI/SFH will conduct interpersonal

behavior-change outreach activities in locations frequented by high-risk target groups like bars, night-clubs,

filling stations, truck parks, fish camps, and hair salons. A fish-camp program will target migrant fish-camp

traders in Southern and Luapula Provinces with partner-reduction and condom-use messages through a

field office on the shore of Lake Mweru, a major seasonal fishing and fish-trading center.

PSI/SFH will increase the sustainability of the interpersonal communications programs by training and

supporting public sector health-care providers to disseminate prevention messages utilizing flipcharts and

materials developed in FY 2007. Close collaboration with the public sector and faith- and community-based

organizations will also enable PSI/SFH to target more PLWHA.

PSI/SFH's youth-focused behavior-change program targets 18-26 year olds in tertiary educational

institutions through a combination of interpersonal outreach activities, CT services, and peer education

programs. In FY 2008, PSI/SFH will train and support 100 campus-based peer educators and student

group leaders to disseminate prevention and CT messages. Trainings will build capacity in tertiary

educational institutions and associated student groups to coordinate sustainable HIV-prevention programs.

In FY 2007, PSI/SFH officially handed over the "Real Man, Real Woman" delayed sexual debut campaign to

the National HIV/AIDS/STI/TB Council (NAC). In FY 2008, PSI/SFH will continue to provide related

technical support and training to the NAC and other implementing partners.

In FY 2008, PSI/SFH will also enhance the impact of interpersonal communications with a mass media

campaign addressing concurrent relationships and partner-reduction. PSI/SFH will develop a robust

communication campaign based on evidence from qualitative and quantitative research, with an emphasis

on developing communication strategies that promote faithfulness. The campaign will address gender

equity by working towards revised male norms and societal behaviors around HIV/AIDS to help empower

women and to strengthen their decisions and negotiation skills relating to sex. PSI/SFH will work closely

with HCP in the implementation of this activity.

In FY 2007, PSI/SFH leveraged USAID support by signing a memorandum of understanding with UNFPA

for female condom procurement, promotion, and training. PSI/SFH will significantly scale up the promotion

of female condom distribution and promotion activities, particularly in Lusaka and Copperbelt Provinces.

Low- and middle-income women will be targeted in 150 hair salons. Training efforts will focus on 17

PSI/SFH CT counselors and 300 hair dressers, private clinic staff, community mobilizers, and other

implementing NGOs. Other distribution activities will include workplace programs that include uniformed

personnel and the integration of product promotion at PSI/SFH's "New Start" CT centers and "Horizon" post-

test programs.

Based on a couple-years protection figure of 120, PSI/SFH will distribute 10 million Maximum Classic male

condoms and 244,000 Care female condoms procured by USAID through its Central Contraceptive

Procurement mechanism with FY 2008 COP funding. This translates into 85,367 couple-years of

protection. PSI/SFH will ensure sustainability by establishing private sector partnerships with distributors

and wholesalers and by building the capacity of Zambian staff to increase their technical and management

capabilities. These condoms will be distributed to 2,060 outlets throughout the country, ensuring nationwide


In partnership with JHPIEGO, the Zambian Ministry of Health, the NAC, and using private funds, PSI/SFH

has already begun implementing a male circumcision (MC) pilot project in Lusaka. The objectives of this

project are to assist in meeting current demand for MC services and to develop lessons learned regarding

cost-effective, sustainable MC service-delivery models to rapidly scale up MC services nation-wide. This

project is operating in four sites: University Teaching Hospital urology clinic, two private clinics, and a New

Start CT center. PSI/SFH will reach 15, 580 men with MC messages through these sites; and 1,584 of the

men are expected to undergo circumcision. In addition, PSI/SFH will continue to develop MC services at

four additional New Start CT centers, depending on availability of funds.

Three components comprise this MC service delivery package: (1) provision of the male circumcision

procedure; (2) counseling and communications on HIV prevention and testing, STI evaluation and

treatment, men's general reproductive health, and family planning; and, (3) linkages to other reproductive

health and HIV/AIDS services, including CT. The MC program will focus on the emphasis area of gender,

Activity Narrative: addressing male norms and behaviors. Counseling includes a discussion of male reproductive health with

an emphasis on risk-reduction. Clients are encouraged to discuss safe sexual behavior and family planning

with female partners. All doctors, clinical officers, nurses, and counselors involved in MC service-delivery at

implementing sites will successfully complete MC training. Frequent monitoring of service providers will

promote high-quality services. Service providers will be required to maintain the highest quality of service in

order to remain in the MC service-provision network; client feedback and follow-up will be used to ensure

service and counseling protocols are followed.

While this activity's emphasis is on service delivery, PSI/SFH will coordinate with the MOH, JHPIEGO, and

HCP, to develop and disseminate communication materials. In collaboration with the national MC task force

and US Government MC implementing partners, an MC kit will be developed to ensure that providers have

the necessary supplies for one procedure. This kit will be available at subsidized rates or provided free of

charge, depending on the provider.

This activity will contribute to the Zambian Government's goals and vision outlined in its five-year National

HIV and AIDS Strategic Framework 2006-2010. It will contribute to the strategic objective of "intensifying

prevention with special emphasis on youth, women, and high-risk behaviors."

All FY 2008 targets will be reached by September 30, 2009.

Funding for Care: Adult Care and Support (HBHC): $155,570

This activity is linked to Palliative Care: Basic health care and support interventions that include Catholic

Relief Services (CRS)/SUCCESS (#9180), CARE (#8819), Project Concern International (PCI) (#8787), and

RAPIDS (#8946).

Launched in 1998 with technical support from CDC and funding from USAID, Population Services

International's (PSI) local affiliate, Society for Family Health (SFH), currently sells more than two million

bottles of Clorin brand safe water home treatment solution annually. PSI/SFH consistently promotes the

sale water treatment to urban and rural populations through drama and mobile video unit shows,

communication sessions, radio spots, and an animated TV advertisement. Clorin is sold through a variety

of channels—predominately wholesalers (37%), distributors (26%), public clinics (14%), and non-

governmental organizations (NGOs) (13%).

In March 2006, CDC conducted a targeted technical evaluation on Clorin. Based on the recommendations

from this evaluation, PSI/FSH contracted out the production of Clorin to a private Zambian pharmaceutical

company, Pharmanova. The partnership with Pharmanova uses a business model that ensures that

consumer prices remain low over time. One of the recommendations of the CDC evaluation was to

redesign the Clorin bottle and Clorin bottle cap to incorporate features that would make it easy for users to

measure and dilute the solution correctly. In FY 2008, PSI/SFH will launch the new Clorin bottle and bottle

cap that are more user friendly.

While the primary target of Clorin is households with children under five, an important secondary target is

people living with HIV/AIDS (PLWHA). Consequently, PSI/SFH intends to increase its distribution of Clorin

to PLWHA via home-based care (HBC) programs, public clinics, and through post-test clubs nationwide.

Traditionally, PSI/SFH has sold Clorin in bulk to organizations such as CARE, CRS/SUCCESS, and

RAPIDS for distribution in their home-based care (HBC) programs. PSI/SFH will donate Clorin to home-

based care programs rather than selling it. This requires the full cost of production and distribution ($0.33

per unit) be covered for PLWHA rather than being subsidized as it is to the commercial sector with partial

cost recovery. USAID Child Survival Health funds will continue to support the use of Clorin as a socially-

marketed product for other key target groups.

The distribution of Clorin has been and will continue to be augmented by the safe water education

campaigns conducted by the PSI/SFH's Horizon post-test program. In FY 2007, the safe water campaigns

reached an estimated 1,500 PLWHA in five PSI/SFH-run Horizon programs, and an additional 1,500

PLWHA through Horizon programs run through faith-based organizations and workplaces. In FY 2008,

PSI/SFH will support the training of approximately 93 HBC and public clinic staff on the importance and

benefits of consistently and correctly treating household drinking water. Special emphasis will be placed on

correct dosing using Clorin's specially-developed bottle cap. Further, PSI/SFH will train 10 Horizon post-

test program coordinators to conduct community education sessions in basic hygiene and correct and

consistent household drinking water treatment practices. Combined with communications encouraging

good hygiene, such as regular hand washing and proper storage, the USG expects that Clorin will play a

significant role in keeping PLWHA healthy.

PSI/SFH will ensure sustainability by providing partner organizations with the necessary materials and

guidance to educate PLWHA on the benefits, techniques, and importance of water treatment. With free

product available, Clorin will be more accessible to Zambian NGOs that support HBC initiatives, but cannot

afford to buy it for PLWHA. Given the wide availability and affordability of Clorin in the private sector,

beneficiaries beyond the scope of this program will also benefit. Further, the transfer of Clorin production to

a local, private-sector company not only establishes a unique public-private partnership model, but also

helps to ensure knowledge transfer and a more stable source of quality supply.

In FY 2008, PSI/SFH intends to distribute 440,000 bottles of Clorin via four key USG organizations: CARE,

CRS/SUCCESS, PCI, and RAPIDS. In sum, these bottles will treat an estimated 293,000, 000 liters of

water and prevent more than 577,988 episodes of diarrhea. This amount will provide 36,666 PLWHA and

their families with a one-year supply of Clorin.

This activity will contribute to the goals and vision of the Zambian Government outlined in the five-year

National HIV/AIDS Strategic Framework and to the strategic objectives of "strengthening home-based care

and support programs" and "promotion of appropriate nutrition and positive living for PLWHA."

All FY 2008 targets will be reached by May 30, 2009.

Funding for Testing: HIV Testing and Counseling (HVCT): $1,464,274

This activity is an integral component of a project linked strategically to HTXS, HVAB, and HVOP

interventions, including Population Services International/Society for Family Health (PSI/SFH), Centers for

Disease Control and Prevention (CDC), Peace Corps, the Centre for Infectious Disease Research in

Zambia CIDRZ, Catholic Relief Services/ AIDS Relief, Health Communications Partnership (HCP), Zambian

Prevention, Care & Treatment Partnership (ZPCT), the Comprehensive HIV/AIDS Management Programme

(CHAMP), and CARE International.

Population Services International (PSI), through its local affiliate, Society for Family Health (SFH), augments

the Government of the Republic of Zambia (GRZ) efforts to provide HIV counseling and testing (CT) to as

many Zambians as possible by implementing the "New Start CT Network." New Start is a socially marketed

service-delivery mechanism that promotes CT through mass media and interpersonal communication, while

simultaneously supporting a franchised network of branded, high-quality CT centers. As of July 2007,

PSI/SFH was already operating eight New Start fixed centers and seven New Start mobile units. By the

end of FY 2007, the network will comprise eight fixed centers and nine mobile units. The Kitwe and Lusaka

centers are directly managed by PSI/SFH and they operate as centers of excellence. All other sites are

managed through partnerships between PSI/SFH and public and private institutions. To address the

emphasis area of local organization capacity building, PSI/SFH provides human and operational resources,

technical assistance, monitoring and evaluation services, and training to partners in the network.

PSI/SFH produced operations manuals define standard procedures to help ensure consistent

implementation. The franchised network approach strengthens technical and human resource capacities

among public and private sector affiliates, ensures quality and consistency, and boosts demand for CT

services. It promotes coordination and collaboration among community- and faith-based organizations

(CBOs and FBOs) and public sector partners. PSI/SFH leads the entire network of franchises in reporting

under the national health management information system.

In FY 2008, PSI/SFH will emphasize increasing the quality of services by incorporate positive-living

counseling and a more client-centered approach to risk-reduction counseling (i.e. a focus on partner-

reduction and concurrent partnerships). PSI/SFH will train 33 counselors to provide client-centered post-

test counseling focusing on: the "Abstinence/Be faithful/correct and consistent Condom use" approach,

partner notification, and risk-reduction planning, with a focus on discordant couples. PSI/SFH will provide

special counseling training to its staff based at the two Lusaka-based New Start centers to address male

reproductive health issues and male circumcision (MC) as part of PSI/SFH's MC pilot activity. PSI/SFH will

also conduct routine surveys using trained counselors to ensure that facilities provide quality CT services.

PSI/SFH will continue to provide a supportive role to the Ministry of Health (MOH) by actively contributing

and advising on national developments related to CT. In FY 2007, PSI/SFH provided technical support in

developing a national quality assurance plan and national CT guidelines, including a policy shift to finger-

prick testing. PSI/SFH also promotes CT on behalf of the National HIV/AIDS/STI/TB Council (NAC).

In FY 2008, PSI/SFH will continue to promote and advertise the New Start brand through interpersonal

communication, radio and television broadcasts, and print media on behalf of all CT centers affiliated with

the network. The mass communication campaign entitled "Know for Sure", which seeks to regularize and

destigmatize CT among the general population, will also continue. To address the emphasis area of

gender, PSI/SFH will focus on increasing the number of men and couples accessing CT and will address

issues pertinent to discordant couples. Currently, 4% of PSI/SFH's clients are couples (an average of 196

couples per month).

Mobile CT services enable PSI/SFH to reach underserved and rural populations, and represent 60% of all

New Start client intake. Services will continue to target specific populations by working with key partners,

such as the International Organization for Migration, to reach refugees; Kanfinsa Prisons, for incarcerated

populations; private companies (e.g. Sandvik), to reach couples and individuals at their workplace; the

Ministry of Education, to reach teachers; and, CARE International, to reach people living with HIV/AIDS.

Post-test services remain an important component of the program. In FY 2008, PSI/SFH will also focus on

integrating services already provided by sub-grantees, including syndromic management of sexually-

transmitted infections, family planning, antiretroviral therapy, youth programs, and orphans and vulnerable

children support. Referrals for care after testing can be challenging as immediate referral systems and

established psycho-social and medical post-test services are limited in many areas served by mobile units.

To support mobile units, community mobilization and follow-up care and support will be accomplished via

linkages to other partners such as ZPCT, CARE, CIDRZ, CHAMP, and CRS.

As of June 2007, 318 individuals had graduated from New Start's comprehensive "Horizon" post-test

program, an intensive 10-week positive-living curriculum targeting HIV-positive individuals and discordant

couples to provide information, counseling, and skills to reduce risk to themselves and others. The program

also provides information about positive living, including legal and human rights issues—which, in turn,

helps to reduce stigma and discrimination. In FY 2008, the Horizon program will be expanded through

partnerships with local FBOs and CBOs. Synergies with other non-governmental organizations offering CT

services will be utilized to expand the Horizon network to other provinces.

The program will address the problems of stigma and discrimination through improved access to quality-

assured CT services and referral of all HIV-infected clients for treatment, care, and support. Already, in

rural and peri-urban areas, as well as in mobile CT programs, a decrease in stigma has led to an increase

in CT uptake. PSI/SFH plans to leverage other donor funds to offer expanded services at New Start centers

and mobile CT units. Integrating other critically-needed health services with CT will diminish potential

stigma issues in both urban and rural communities associated with attendance at a CT facility.

Finally, PSI/SFH will reach 52,800 Zambians with CT through New Start. By maintaining the sub-

grant/partnership model, PSI/SFH will continue to strengthen CT technical capabilities of Zambian

organizations by: (1) improving laboratory capacity to perform HIV testing; (2) increasing human resource

capacity through training; (3) developing CT protocols and procedures; (4) increasing the availability of CT;

and, (5) creating linkages to treatment, care and support services. The partnership model helps build a

foundation for a more straightforward exit strategy for PSI/SFH in CT service delivery and a more

sustainable transition to full service delivery by partnering organizations.

Activity Narrative:

This activity will contribute to the goals and vision of the Zambian Government outlined in the five-year

National HIV/AIDS/STD/TB Strategic Framework 2006-2010. Specifically, it will contribute to the strategic

objectives of "improving access to and use of confidential counseling and testing" and "mitigating stigma

and discrimination against HIV."

PSI/SFH will support the implementation of MC services described in its HVOP narrative. As CT is an

integral part of MC, PSI/SFH will leverage the skills and experience of its counselors to provide high quality

CT to MC clients.

All FY 2008 targets will be reached by September 30, 2009.

Subpartners Total: $523,487
Development Aid from People to People: $61,179
Youth Alive Zambia: $81,277
Mwami Adventist Hospital: $107,413
Livingstone Urban District Health Management Team: $100,711
University Teaching Hospital - Zambia: $98,437
Luapula Foundation: $74,470