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
The funding level for this activity in fiscal year (FY) 2009 will remain the same as in FY 2008. Only minor
narrative updates have been made to highlight progress and achievements.
This activity relates to activities in counseling and testing (CT), laboratory infrastructure, palliative care, and
basic health support activities.
Acute human resource shortages in Zambia, particularly in rural areas, necessitate the need for innovative
ways to deliver quality patient care and management. The Churches Health Association of Zambia (CHAZ)
is an interdenominational, non-governmental umbrella organization of church health facilities that was
formed in 1970. The organization has 133 affiliates that consist of hospitals, rural health centers and
community based organizations. All together these member units are responsible for 50% of formal health
care service in the rural areas of Zambia and about 30% of health care in the country as a whole. CHAZ
collaborates well with the Ministry of Health and other stakeholders including the USG in TB control.
CHAZ is one of the four Principal Recipients for The Global Fund to disburse resources in Zambia. Three
agreements in HIV/AIDS, tuberculosis (TB), and Malaria were signed. In July 2005, CHAZ signed as
additional agreement under Round 4 of The Global Fund to scale-up antiretroviral therapy (ART) services in
Church Health Institutions. Similarly, in FY 2008, the Global Fund approved the TB round 7 funding for
The comparative advantage that CHAZ has is its area of operation which is mainly rural. This has made
CHAZ to be heavily involved in the development and utilization of community level volunteers who assist
with TB treatment adherence and specialized community based volunteers who visits patients to ‘directly-
observe therapy' and to provide a basic check-up. This is an innovative and cost-effective way to address
severe health care human capacity shortages by multiplying skills and knowledge through the population
and further empowering community members to appropriately care for such patients. Evidence has shown
that such community-based treatment supporters have improved TB treatment adherence and outcomes.
The goal of CHAZ TB control program is to improve the quality of TB care in order to reduce the number of
TB related deaths and increase the cure rate through the Stop TB Strategy. With FY07 funds from the
United States Government (USG), CHAZ initiated the TB/HIV collaborative activities at its selected church
health facilities, 34 mission/church health institutions (CHIs) in four CDC priority Provinces (Southern,
Western, Eastern, and Lusaka). In this regard, 34 frontline health workers were trained in Provider Initiated
Counseling and Testing (PICT) commonly known as diagnostic counseling and testing (DCT). Training was
also extended to 115 TB community treatment supporters who were trained in DOTs and TB/HIV
implementation. Treatment supporters were also provided with bicycles to enhance community DOTs and
patient follow up at community level.
The National TB and Control Program in the Ministry of Health with partners embarked on revision of TB
training modules for health workers and training manual for community treatment supporters. The data
reporting tools (registers and report forms) were revised in 2006.
To further strengthen linkages between TB and HIV/AIDS activities and strengthen the Stop TB Strategy in
Zambia, CHAZ in FY 2008 continued with activities begun in FY 2007 in order to scale-up to 44 sites. This
geographic and programmatic expansion was accomplished by mobilizing communities, strengthening the
IEC component to include local languages; and continuing to build capacities of both CHIs and local
communities in the STOP TB Strategy. Specifically CHAZ continued to implement the following
•Facilitated and strengthened therapeutic TB/HIV meetings at community level for co- infected
•Strengthened integration of TB/HIV at all levels through quarterly meetings;
•Increased number of frontline health care workers trained in PICT from 34 to 250. The training addressed
issues related to TB and HIV treatment. After training, health facility workers provided support to community
treatment supporters through technical supervision as an on going activity to ensure maintenance of proper
standards in TB/HIV collaborative activities at community level. The trained health care providers received
follow-up technical supervision from the district, provincial, CHAZ and National program to sharpen their
•Increased number of community treatment supporters trained in basic TB/HIV link and counseling from 115
to 600. It was expected that these would supervise treatment in 1,309 co-infected patients that were unable
or unwilling to make regular visits to the health facilities;
•Designed and produced IEC materials using both electronic and print media on TB/HIV. Used local drama
performances to create awareness in TB control;
•Strengthened the referral systems to ensure that health care workers were competent in the use of data
collection and reporting systems at CHAZ health facilities and community levels.
• Enhanced the capacity for monitoring and evaluation of TB/HIV program the technical supervision visits
which included a component of training in the use of information for management decisions at health facility
•Improved infrastructure (minor renovations and improve ventilation) for TB/HIV services at CHAZ (mission)
health facility level: This activity facilitated reduction of transmission of infection from un diagnosed and
newly diagnosed smear positive TB patients to HIV infected clients and health care providers. The
renovations were specific to the sites and included improving the ventilation in waiting areas.
In FY 2008, activities were implemented in the same four Provinces (Southern, Western, Eastern, and
Lusaka). Support to community volunteers/treatment supporters was enhanced to provide quality home-
based care that included TB/HIV integration elements such as skills for linking home-based TB patients to
HIV counseling and testing and HIV care services including ART services. Despite the rural set-up of most
of the CHAZ health institutions, it was expected that about 75% of the TB patients referred to ART services
received care and support. The TB patients found eligible for ART were commenced on treatment according
to the National guidelines. A system to track the referrals and ART treatment was developed. Standardized
training was given to community-volunteers to provide home-based care for patients found to be TB/HIV co-
infected e.g. TB and ART treatment adherence, monitoring and management of side effects. This type of
Activity Narrative: service delivery was appropriate for TB/HIV patients who were not able to reach the health facilities.
In view of increasing job satisfaction and quality of services being delivered, each community treatment
supporter was provided with a bicycle and HBC kit. Utilization of already existing structures and systems
such as home care programs and involvement of community volunteers promoted community participation
and program ownership, thereby leading to program sustainability. CHAZ can boast of decades of
community mobilization and partnerships experience through mission hospitals and health centers in rural
Zambia. CHAZ will use this experience to mobilize local communities towards the Stop TB campaign and to
enhance TB/HIV collaboration. Weaknesses have been noted in the integration of TB and HIV/AIDS
programs at both the health facility level and community. It was hoped that the linkage between USG and
Global Funds would enhance the quality of TB and HIV/AIDS services being offered in the selected
Community Health Institutions (CHIs) and ensure continuity and sustainability of the program. Such a
partnership facilitated the support of activities which are not in the USG supported work plan and budget,
such as Income Generating Activities (IGAs) and funding to Faith Based Organizations. CHAZ was not
implementing the use of Isoniazid preventive therapy (IPT) to adult HIV infected clients since the National
guidelines recommends its use only in under five (5) children whose mothers are sputum smear positive for
TB. However had the Ministry of Health adopted this intervention, CHAZ would have implemented IPT. The
acute staff shortage at CHAZ made it difficult to implement some of the USG supported activities in FY 2006
-2007. The CHAZ TB Officer was overwhelmed with Global Fund activities in 133 member units which
included Community based organizations, Rural Health centers and Hospitals.
In FY 2009, the support from the USG will focus on staff placements. The USG will support the employment
of a TB/HIV officer who will work closely with the CHAZ TB Officer, Assistant Laboratory Officer. This Officer
will work closely with the CHAZ employed Laboratory Specialist to coordinate the laboratory activities and
(2) Assistant Information Technology (IT) Officer who will facilitate data entries and timely reporting to USG
requests from the sites. This officer will work closely with the CHAZ employed IT Officer. CHAZ through
global fund will facilitate funding for the activities that will be implemented by the USG employed staff. The
USG will continue paying for the remunerations for the three staff. In addition, the USG will support the
administrative component of the program.
Building on the already existing systems in the selected CHIs with the support of the officers to be
employed, CHAZ through Global fund is confident that FY09 activities will result in: (i) High quality of health
care delivery of CHIs providing counseling and testing according to the national guidelines; (ii) increased in
the number of HIV infected patients attending care / treatment services that are receiving treatment for TB;
(iii) increased number of health workers (100) and community volunteers (150) trained to provide treatment
for TB to HIV infected individuals and community treatment supporters; and (iv) increased number of
registered TB patients (2,000) who will receive counseling and testing for HIV and receive their test results.
To ensure sustainability, these activities are enshrined in the MOH District Plans.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15512
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15512 3651.08 HHS/Centers for Churches Health 7167 2976.08 CHAZ - $200,000
Disease Control & Association of U62/CCU25157
8992 3651.07 HHS/Centers for Churches Health 5000 2976.07 CHAZ - $200,000
3651 3651.06 HHS/Centers for Churches Health 2976 2976.06 CHAZ TB/HIV $200,000
Disease Control & Association of
Health-related Wraparound Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $200,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities