Mozambique - FY 2009 Approved Funding by Program Area, Agency and Funding Source
*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.
Due to civil war in Mozambique, almost 50% of the country's entire public health sector infrastructure was destroyed, leaving the country with only 3 medical doctors and 21 nurses per 100,000 people. U.S. Government support through PEPFAR has expanded the number of PMTCT service delivery sites from 16 in 2004, with only 901 women receiving a complete course of ARV prophylaxis, to 316 sites with 31,200 women receiving ARV prophylaxis. About two-thirds of all clients receiving services at USG-supported facilities are seen in the ANC setting. More than 80% of pregnant women attend at least one ANC visit, while about 54% have a facility-based delivery. HIV counseling and testing uptake among ANC clients is approximately 90% at USG-supported sites and 75% nationally. USG support currently covers nine of 11 provinces in Mozambique, however all provinces will be covered with FY 2009 PEPFAR support.
Under the USG prevention portfolio a new set of highly targeted prevention programs will be delivered in the most epidemiologically significant, highest prevalence regions of the country. This set includes: targeting multiple concurrent partnership contact patterns; expanding HIV positive prevention programs; and intensifying mobilization of communities in epidemiologically significant provinces and among MARPs. The USG will also support PMTCT services through expansion of better prophylaxis and treatment regimens for pregnant women, and improved follow-up of HIV-exposed infants and early infant diagnosis. Additional funding has been reprogrammed to support voluntary medical male circumcision services, in response to growing demand for this important prevention service. USG activities will continue the standards-based approach for infection prevention and control and procurement of equipment to upgrade remaining reference blood banks.
USG partners will continue to expand the delivery of care to PLWHA at facility and community levels and advance policy initiatives through direct service delivery and capacity building. Pediatric palliative care will continue to be provided in coordination with PMTCT and OVC programs and in coordination with the MOH and other partners. These programs will ensure that both adults and children living with HIV have access to services for improved diagnosis and treatment of sexually transmitted and OIs, as well as prophylaxis for OIs, including cotrimoxazole. Greater emphasis will be placed on promoting intensified TB case finding, isoniazid preventive therapy (IPT) and infection control. A new CT data system is expected to enhance MOH capacity to collect quality data and use that data for program monitoring and intervention design. Key provinces where coverage of orphans and other OVC programs is low will be targeted.
Priorities for 2009 include improving the quality of treatment services, strengthening government ownership and oversight of these services through greater decentralization, and supporting national monitoring and evaluation systems to monitor progress. The USG will focus on implementing a new pharmaceutical logistics information and control system to ensure a reliable supply of ARV drugs for all sites delivering treatment services. The USG will also support the development of regional pediatric reference centers, and will initiate or expand pediatric ART at all USG-supported ART sites. USG funds will also provide training for nurses and other health workers, and technical assistance and training to improve ARV drug procurement, distribution, and storage. Laboratory infrastructure funding will address improving quality of testing services with emphasis on strengthening national systems' quality assurance, monitoring of network laboratories and strengthening the laboratory commodity logistics systems.
Infrastructure development coupled with human resource strengthening is a top priority for the MOH and the PEPFAR team. USG funds will support activities to strengthen human resources for health through pre-service training; revitalize the community health worker cadre; and build the capacity of Mozambican NGOs and the professional nursing association. An Interagency Annual Program Statement will be launched to encourage innovation and greater participation of local NGOs in the PEPFAR portfolio. Additionally, PEPFAR funds will support the development and negotiation of the Partnership Framework and the Partnership Framework Implementation Plan, expected in early 2010.
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