Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8176
Country/Region: Zimbabwe
Year: 2009
Main Partner: Abt Associates
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $3,380,000

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $1,200,000


New/Continuing Activity: Continuing Activity

Continuing Activity: 18316

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18316 12033.08 U.S. Agency for Abt Associates 8048 6034.08 USAID/abt/AB/C $1,500,000

International SH


12033 12033.07 U.S. Agency for Abt Associates 6034 6034.07 USAID/abt/AB/C $913,250

International SH


Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention

Total Planned Funding for Program Budget Code: $1,147,871

Total Planned Funding for Program Budget Code: $0

Table 3.3.03:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $550,000


New/Continuing Activity: Continuing Activity

Continuing Activity: 18317

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18317 12034.08 U.S. Agency for Abt Associates 8049 6035.08 USAID/Abt/OP/ $550,000

International CSH


12034 12034.07 U.S. Agency for Abt Associates 6035 6035.07 USAID/Abt/OP/ $553,559

International CSH


Table 3.3.03:

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $100,000


New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 08 - HBHC Care: Adult Care and Support

Total Planned Funding for Program Budget Code: $750,727

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Adult Care and Treatment Program Context

In spite of evidence of a sharp decline in HIV prevalence between 2001 and 2007, Zimbabwe still ranks among the highest HIV

burdened countries in the world, with an adult HIV prevalence of 15.6%. About 1.1 million adults and 133,000 children are

currently living with HIV and AIDS in Zimbabwe. Average life expectancy has dropped in the past two decades by over 20 years,

to 37 years in men and 34 years in women, largely due to HIV and AIDS.

As part of the national response to this burden, Zimbabwe's National ART Program, started in 2004, is designed as a

comprehensive care and treatment package of services that addresses medical, social, emotional, and economic needs of People

Living with HIV/AIDS (PLHA), and is a complement to prevention interventions. Currently, 113 public health sites (primarily

central, provincial, district and mission hospitals) offer ARV services. Out of an estimated 500,000 PLHA needing treatment, as of

September 2008, approximately 152,000 adults and children were on ART, including an estimated 10,000 in the private sector

and 6,000 NGO supported. As of September 2008, 11,020 children were receiving ART. Among children aged 0-14 years, there

are an estimated 17,000 new infections annually and 12,000 AIDS-related deaths occurred in 2007. All branches of the military

service have ART programs, including a model program in the Air Force, with access for all levels of personnel. The Government

of Zimbabwe goal is to provide 230,000 PLHA with ART by the end of 2009 and 285,000 by the end of 2010.

Zimbabwe's palliative care package includes psychosocial support, nutritional counseling and support, positive prevention

counseling, information on positive living, treatment for opportunistic infections (OI), Cotrimoxazole prophylaxis, bereavement

counseling, spiritual counseling, succession planning, hospice care, and PLHA groups. Over the past several years, access to

and quality of both non-clinical and clinical palliative care services have improved significantly. Non-clinical community-based care

and support is provided through PLHA support groups, faith-based networks, NGOs, and numerous other organizations

throughout the country, under the guidance of the National AIDS Council (NAC). The OI Clinic Model, developed by MOHCW with

USG support, serves as the basis for comprehensive clinical HIV service delivery and transition to the ART program. Currently,

366 OI clinics at MOHCW and mission hospital sites are operational, vastly exceeding the national targets of 110 for 2008 and

140 for 2009. In FY08 these sites provided Cotrimoxazole for OI to 177,959 adults and 28,558 children. The Pfizer Diflucan

donation program to Zimbabwe is now in its fifth year of operation, and between June 2007 and January 2008 provided 24,904

patients Diflucan at 125 OI sites.

Lack of financial resources, inadequate human resource capacity at all levels and inadequate laboratory services to support ART

and pre-ART patient monitoring have been the main factors limiting Zimbabwe's PLHA care and treatment program expansion.

Global Fund Round 1 (GF1) did not finance ARV drugs, and GF5 has encountered difficulties with disbursements. As described in

the HTXD ARV Drugs narrative, over the FY07-08 period the USG and other donors began providing ARV drugs, and the situation

for ARV drugs is relatively stable.

USG Program

USG's care and treatment program is of a scale appropriate to a mini-COP country and does not include widespread provision of

USG-direct clinical care and treatment services. USG continues to provide technical assistance (TA), advocacy, and program

support to the MOHCW and other partners to develop models and tools that can be replicated with non-USG leveraged funds to

strengthen systems for care and treatment of PLHA. The USG also provides limited capacity building (primarily training and TA)

so that systems can be sustained over time.

In FY08, USG funds for care and treatment supported the Supply Chain Management Systems (SCMS) mechanism to provide

long-term TA to the national ART program. The USG also supported the MOHCW and the University of Zimbabwe's Clinical

Epidemiological Resource and Training Center's HIV/AIDS Quality of Care Initiative (HAQOCI) to develop and provide pre- and in-

service training in OI/ART; the bilateral Partnership Project for provision of non-clinical care and treatment of PLHA; the National

AIDS Council (NAC) for training and supervision to support the roll-out of the national Community Home-Based Care (CHBC)

program; and USG staffing and technical assistance. As described below, in FY08, these partners trained about 480 (direct)

providers in PLHA care and treatment and reached 20,400 ( direct) and an additional 20,000 (indirect) PLHA with palliative care


Also in FY08, USG provided final funding to a 2 year pilot project tracking mother-infant pairs who were cross-referred through an

integrated PMTCT / Expanded Program of Immunization effort. The pilot achieved impressive results which will be fed into on-

going PMTCT and follow-up care programs. Planned FY08 funding to new civil society organizations for care and treatment was

not pursued, and funds were reprogrammed for training needs.

In FY09, the USG will continue support to SCMS, MOHCW, HAQOCI, Partnership, and NAC for Adult Care and Treatment, and

will initiate some efforts with the MOHCW and HAQOCI in the Pediatric sphere as well (see separate Pediatric Care and

Treatment program narrative).

FY08 Social, Economic, and Political Context

Implementation of the USG PEPFAR program in Zimbabwe during FY08 was subject to a number of severe stresses. From

January to March, during the run-up to the March 29, 2008 general elections, the highly charged political atmosphere led to a

number of disruptions and hampered implementation. The situation was even worse from April - June. Widespread Government

sponsored violence effectively closed most rural areas in the country and many urban areas. Hundreds were killed and tens of

thousands were displaced. A number of USG-supported community outreach activities were either suspended to protect staff and

potential participants, or shifted to urban areas that required less travel and exposure. On June 4, the Government of Zimbabwe

suspended most NGO activity for almost 3 months, until August 29, setting back many programs. Throughout the year the

continuing collapse of the Zimbabwean economy and inflation that reached billions of percent put severe strains on programming

and local partners. In general, the unprecedented hyperinflation and eventual collapse of Zimbabwean currency; lack of public

utilities (water and electricity); widespread violence; and extreme political uncertainty created barriers to all programs.

USG Adult Care and Treatment Program and Prospects

At the national level, in FY08, SCMS seconded two medical officer positions to the MOHCW Naitonal AIDS and TB Program: the

National ART Coordinator and the Assistant National ART Coordinator. SCMS also funded the training of 56 provincial ART team

members in conducting ART site readiness assessments, assisted MOHCW in conducting 36 ART site readiness assessments,

and funded 85 participants at HIV and AIDS provincial review workshops. In FY09, SCMS will continue similar support to the

National Program leadership through the HTXS budget code; its assistance to the national logistics management system is

discussed in HTXD.

To strengthen service delivery systems, the USG supports the MOHCW and HAQOCI for roll-out of the OI/ART clinical model. As

part of this work, HAQOCI provides facilitative supervision to 4 large ART sites: Harare Central Hospital, Parirenyatwa Hospital,

and Beatrice Road Hospital in Harare and Mpilo Hospital in Bulawayo. In FY08, HAQOCI provided coordination and

implementation of national and regional OI/ART adult training workshops, and conducted training-of-trainers (ToT) on OI/ART

management for 43 nurse tutors at the national level. In FY09, the partners plan to replicate the regional ToT workshops, reaching

a planned 120 participants. Additionally, HAQOCI will continue its partnership with the Hospice Association of Zimbabwe

(HOSPAZ) to train individuals to provide palliative care. In FY09, with USG funding HAQOCI plans to train 60 participants in two of

Zimbabwe's 10 provinces in comprehensive care, including care for children and TB patients. The activity is part of a longer term

program with HOSPAZ and NAC to improve home-based care (HBC).

With partial USG support, NAC is leading a multi-donor effort to improve the quality of Community HBC (CHBC) in Zimbabwe. The

program started in October 2006, and to date has formed one national and 10 provincial CHBC Task Forces; started roll-out to the

district level; and developed a national CHBC Strategy. As of September 2008, NAC supported 323 sites that provide HIV related

palliative care throughout the country. In FY09, NAC plans to increase coverage to 350 sites, and to train 4,000 providers in HIV

palliative care. USG will provide modest support to support NAC's cascade training to district CHBC Task Forces in all provinces.

NAC projects in FY09, 130,000 PLHA will be provided with care and support services.

Through its funding to the Partnership Project, the USG also supports care of PLHA before HBC is needed, promoting positive

living strategies through New Life counseling and support centers. From FY06-FY08 the USG supported expansion of the New

Life network from 10 to 16 sites, reaching a cumulative total of 123,052 individuals with care and support according to national

and international standards. The project also trained 500 individuals in HIV-related care and supportive counseling. (In general,

the NAC-supported CHBC clients are more end-stage PLHA, whereas the Partnership clients are early-post-test and those

receiving ART.)

New Life provides psychosocial, spiritual and preventive support to PLHA through post-test support centers that are staffed with

professional and PLHA peer counselors. Palliative care services are provided at both the New Life centers and through an

extensive outreach program whereby counselors provide palliative care services at public health care institutions in collaboration

with public sector personnel (ART adherence counseling program, psychosocial support program for HIV+ pregnant women,

mothers and their families enrolled in the national PMTCT program) as well as to employees at workplaces, to already existing

PLHA support groups and to church members at churches that request support through the program. These services are also

linked to PMTCT services to support outreach to PMTCT client partners and families. Currently 60-65% of New Life participants

are female.

In FY09, the Partnership Project will: (1) Expand care and support services through an enhanced outreach program that is closely

linked to the national PMTCT and CT programs. Among many other efforts, through linkages with the Partnership Project's New

Start CT network and the International Organization for Migration, this work will include intensification of its outreach program to

PLHA who are internally displaced persons and HIV-positive returned migrants, through two reception centers in Beitbridge and

Plumtree. (2) Maintain high quality of care and support service delivery. With wraparound funding provided by the Dutch

Government, during FY09 the project will provide intensive training in family planning (FP) to all counselors, with specific

emphasis on dual protection. Through a grant to the Zimbabwe Nurses Association (ZINA) the project will strengthen pre-service

training of nurse providers in the integration of FP and PMTCT. (3) Enhance referral and referral tracking system. The project will

ensure that HIV+ clients seeking counseling and support at New Life centers will receive comprehensive information on HIV

treatment, care and support services (including FP and PMTCT) and are appropriately referred for ongoing support. The project

will increase the percentage of referrals tracked from the current 45% to 50% through intensified direct linkages to other post-test

service providers. All identified TB suspects will be referred to TB diagnostic centers and referral tracking of TB referrals will be

strengthened. (4) Improve knowledge and understanding of HIV treatment, care and support services. The project will launch

generic communication campaigns through mass media and interpersonal communications to enhance understanding and to

create demand for treatment, care and support services, including ART. The campaigns will also improve understanding of

Positive Living and Positive Prevention.

FY09 funding is also allocated to the management firm Ernst and Young for select technical assistance and audit, and to USG

agencies for technical expertise and staffing.


USG support to Adult Care and Treatment leverages significant funding for all public sector ART, PMTCT, and HIV testing sites in

the country. For ART commodities alone, as described in the ARV Drugs (HTXD) program area narrative, this donor support has a

combined wraparound value of about $25.3 million in FY2009. The value of Cotrimoxazole for OI purposes in FY09 is estimated at

$4.6 million, as compared to only $560,000 in FY08. Cotrimoxazole donors include: ESP ($1.91 million); UNICEF ($0.96 million);

CHAI ($1.76 million). (Note: The US dollar values provided are estimates, based on actual shipments in 2008-2009, weighted by

targets. Unit costs by patients should not be compared since arrays of commodities supplied by each donor are not comparable.)

USG is also leveraging DFID funds to complement palliative care efforts. Approximately $450,000 will be allocated in FY09 to

support program activities of the New Life post-test support services program, including staff salaries, training costs of counselors

and other staff, M&E activities and furniture and equipment for the New Life centers. Several USG-supported partners will also

work in some of the 5 GF1 and 22 GF5 districts, although quantification of funds leveraged is not possible at this time.

Table 3.3.08:

Funding for Care: Adult Care and Support (HBHC): $450,000


New/Continuing Activity: Continuing Activity

Continuing Activity: 18318

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18318 12036.08 U.S. Agency for Abt Associates 8050 6036.08 USAID/Abt/Palli $600,000

International ative/CSH


12036 12036.07 U.S. Agency for Abt Associates 6036 6036.07 USAID/Abt/Palli $199,774

International ative/CSH


Table 3.3.08:

Funding for Testing: HIV Testing and Counseling (HVCT): $780,000


New/Continuing Activity: Continuing Activity

Continuing Activity: 18319

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18319 12035.08 U.S. Agency for Abt Associates 8051 6037.08 USAID/Abt/CT/C $880,000

International SH


12035 12035.07 U.S. Agency for Abt Associates 6037 6037.07 USAID/Abt/CT/C $881,555

International SH


Table 3.3.14:

Funding for Health Systems Strengthening (OHSS): $300,000


New/Continuing Activity: Continuing Activity

Continuing Activity: 18320

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18320 12038.08 U.S. Agency for Abt Associates 8052 6039.08 USAID/Abt/Polic $450,000

International y/CSH


12038 12038.07 U.S. Agency for Abt Associates 6039 6039.07 USAID/Abt/Polic $451,958

International y/CSH


Table 3.3.18:

Subpartners Total: $0
Population Services International: NA
Banyan Global: NA