PEPFAR Technical Leadership and Support Expenses: FY 2009


Project Title: Department of Defense (DoD), Technical Leadership and Support

Table - FY 2009 Approved GHCS-State Funding

Department of Defense (DoD), Technical Leadership and Support, Table - FY 2009 Approved GHCS-State Funding

Projects planned in FY 2009 to support PEPFAR in response to the field program needs include:

In order to support comprehensive prevention efforts, headquarters will provide funding to initiate male circumcision programs in countries where other funding is not available and will provide technical assistance.

Headquarters Strategic Information efforts include supporting the attendance of partner-country military staff at monitoring and evaluation trainings. A regional military surveillance meeting will be held in 2010. Funding will support training on surveillance-related data entry, data quality assurance and quality control, basic data analysis and report writing for militaries conducting seroprevalence surveys. Funding will also support HMIS TWG member costs.

Project Title: Department of Health and Human Services (HHS): Centers for Disease Control and Prevention (CDC), Technical Leadership and Support Projects

Table - FY 2009 Approved GHCS-State Funding

Department of Health and Human Services (HHS): Centers for Disease Control and Prevention (CDC), Technical Leadership and Support Projects, Table ? FY 2009 Approved GHCS-State Funding

HHS/CDC supports PEPFAR's prevention goals by working with partners on scaling up PMTCT programs, implementing evidence-based prevention programs, including new biomedical interventions and those that those that prevent medical transmission of HIV, expansion of counseling and testing and prevention with positives programs. Projects planned in FY 2009 will work toward supporting Early Infant Diagnosis activities, updating PMTCT/Pediatric guidelines, policies, and programming tools; evaluating interventions and providing technical assistance on programs for people living with HIV/AIDS and other high-risk populations; developing training materials for prevention of medical transmission of HIV/AIDS; and strengthening quality assurance of male circumcision service delivery and counseling and testing.

Funds will also support the CDC/GAP headquarters Blood Safety team as it expands the scope of its technical assistance activities beyond the 14 original PEPFAR focus countries. Funds will cover staff travel for technical assistance TDYs and supplement, as needed, activities described in the Headquarters Operational Plan. These activities include the approved technical assistance contract mechanism, which will replace the Track 1 blood safety TA cooperative agreements; linkages with the Strategic Information branch and WHO for evaluations related to the use of blood in PEPFAR-supported countries, as well as blood safety's broader impact strength of healthcare systems; and the development of electronic data monitoring tools with Georgia Tech and WHO.

In terms of support PEPFAR's treatment goals, HHS/CDC works with partners on strengthening laboratory systems, scaling up TB infection control activities in HIV care and treatment sites, developing/revising of guidelines and tools, strengthening of TB/HIV surveillance and M&E, supporting Ministries of Health to scale-up TB/HIV activities, and, building human resource capacity. Projects planned in FY 2009 will work toward overall laboratory support, including equipment and facility maintenance, and sharing of supplies and technical expertise in support of the activities related to TB/HIV, developing a training program based on TB infection control guidelines, and supporting local capacity to scale-up TB/HIV activities.

HHS/CDC works with partners on the development and strengthening of laboratory capacity, systems and networks is essential to a strong response to HIV/AIDS in support of PEPFAR's care goals. Without laboratory support, it is difficult to diagnose HIV infection and provide high-quality care and treatment for people living with HIV/AIDS (PLWHA). With the rapid expansion of HIV treatment in resource-poor countries, and the accompanying need for HIV diagnosis and associated care, there is a need for the purchase of equipment and commodities and provision of quality assurance and control, staff training and other technical assistance. HHS/CDC, through PEPFAR, works with partners to support a diverse range of strategies for building laboratory capacity. Projects planned in FY 2009 to support laboratory capacity building strategies in response to the field program needs including strengthening laboratories serving global public health; evaluating test kits currently being used in support of country HIV algorithms; purchasing test kits, equipment, maintenance agreements, and other key supplies for the laboratory; and supporting quality assurance and control activities that are complementary to laboratory activities.

In addition, HHS/CDC works with partners on strengthening program monitoring, impact evaluation research and improvement in health systems, infrastructure and workforce thereby increasing partner countries capacity to measure health status at the individual and population level and to improve the process, outcomes and impact of their HIV programs. Projects planned in FY 2009 support include: sharing best practices of strategic information methods and systems across countries; providing technical assistance; conducting program evaluation; strengthening public health capacity of partner country governments to implement health information systems; and measuring results to analyze data to demonstrate health impact over time; providing communication and technical support services and web site development and maintenance services to effectively implement PEPFAR activities and the PEPFAR extranet are critical to the implementation of HIV/AIDS activities across the globe; supporting protocol development, implementation, and data management of impact evaluation research; and building of in-country management capacity building programs that develop a skilled cadre of public health leaders and managers who can deliver evidence-based public health interventions.

Additional projects planned in FY 2009 to support PEPFAR in response to the field program needs include:

Renovation of PEPFAR Offices in Democratic Republic of the Congo

In support of the PEPFAR interagency team and the need for the USAID to have additional office space, the HHS/CDC office in the DRC will relocate from the first floor, where HHS/CDC and USAID have been co-located for five years, to the ground floor of the Mobil building. Currently, USAID has already expanded to fill the first floor of the building and HHS/CDC is temporarily being housed offsite awaiting permanent relocation to the ground floor. A full building assessment of all buildings in the city was conducted and no other suitable, secure building could be identified for HHS/CDC's use. However, by relocating the HHS/CDC office to the ground floor, the classification of the Mobil building has changed to a USG Sole Occupancy Building. Based on a security assessment conducted by USAID and Office of Overseas Building Operations between May-June 2009, it was determined that numerous changes to the physical structure would be required to be in compliance with Overseas Security Policy Board guidance and 12 FAH-6 H-113.6, Physical Security (Sole Occupant of Building or Compound). This funding will support the renovations made necessary by the expansion of the USAID offices and the relocation of the HHS/CDC offices.

Health Informatics System (HIS)

National health information systems are too often disease specific, fragmented, inefficient, contain inaccurate or missing data, and typically burdensome to health workers to maintain with less than optimal utility to enable timely decision making at all levels of the health system. PEPFAR will foster country ownership of HIS by contributing to the adoption of a systematic approach (enterprise architecture methodology) to guide planning, development, and management of the complex components of existing and enhanced national HIS. These catalytic resources will be used to support key local organizations and technical assistance providers to utilize this holistic, health-sector wide approach to advance the Global Health Initiative (GHI) and derive an end-to-end national HIS framework, leverage existing private sector investments in IT infrastructure, implement an integrated solution to address a priority component of the HIS (initially planned to address patient-level data tracking and use between community-level and facility-based systems), and support public health informatics training capacity within local institutions. PEPFAR will aid local coordination and organizational capacity to initiate rollout of fully integrated HIS solutions using consistent standards for data collection, management, reporting, and use in one or two countries as a learning framework on country ownership of HIS. The intent is to catalyze and leverage existing locally coordinated resources more effectively and prioritize potentially new investments in strengthening the national health information system. Expected impacts are better information for decision making to address continuity of care of individuals between HIV and primary care services with increased efficiency and quality of data collection and use.

Project Title: Department of Health and Human Services (HHS): Health Resources and Services Administration (HRSA), Technical Leadership and Support Projects

Table - FY 2009 Approved GHCS-State Funding

Department of Health and Human Services (HHS): Health Resources and Services Administration (HRSA), Technical Leadership and Support Projects, Table - FY 2009 Approved GHCS-State Funding

Projects planned in FY 2009 to support PEPFAR in response to the field program needs include:

The American International Health Alliance Twinning Center increases and strengthens the role of institutional relationships and long-term volunteers in supporting capacity development needs for in-country partners. It expands the pool of trained providers, managers and allied health staff who can deliver quality HIV/AIDS care to patients and their families. It further promotes long-term sustainability through on-going "north-to-south" and "south-to-south" partnerships.

I-TECH, in partnership with University of Washington, provides technical assistance and builds the capacity of the Caribbean HIV/AIDS Regional Training Network (CHART) to strengthen the capacity of national healthcare personnel and systems to provide access to quality HIV/ AIDS prevention, care, treatment and support services for all Caribbean people through the development of a sustainable training network.

Columbia University will strengthen the overall capacity of the health care delivery system by cultivating a network of nurses to increase the quality of care; mentoring; integrating HIV/AIDS education into nursing curricula; and developing a regional, African association of nurses in HIV/AIDS care.

As part of the Site Assessment Tool, adapted from HRSA's Primary Care Assessment Tool, I-TECH is developing, in collaboration with the University of Washington, an evaluation protocol for training associated with PEPFAR. The Site Assessment Tool will be used at the individual health center level to perform a comprehensive assessment that will include an evaluation of the results of any training that has occurred and will also identify areas where training is needed.

Project Title: Department of Health and Human Services (HHS): Office of Global HIV/AIDS (OGHA), Technical Leadership and Support Projects

Table - FY 2009 Approved GHCS-State Funding

Department of Health and Human Services (HHS): Office of Global HIV/AIDS (OGHA), Technical Leadership and Support Projects, Table - FY 2009 Approved GHCS-State Funding

Projects planned in FY 2009 to support PEPFAR in response to the field program needs include:

Transition of the Track 1 Treatment Services

Transitioning HIV care and treatment services from central mechanisms to leadership and management of these services in partner countries through local indigenous partners is critical to the sustainability of PEPFAR programs. This incremental transition is a complex process that requires developing the technical capacity of local partners, as well as developing the institutional capacity of these partners to manage the programmatic and financial aspects of USG-funded programs. Specifically, these technical leadership and support activities would include training local partners to build program management skills and implement sustainable systems in financial management, human resource management, grants management skills, commodities, equipment logistics and facilities management, grants-related property management, and M&E quality management.

Project Title: Department of State (DOS) - Office of the U.S. Global AIDS Coordinator (OGAC), Technical Leadership and Support

Table - FY 2009 Approved GHCS-State Funding

Department of State (DOS) ? Office of the U.S. Global AIDS Coordinator (OGAC), Technical Leadership and Support, Table - FY 2009 Approved GHCS-State Funding

Projects planned in FY 2009 to support PEPFAR in response to the field program needs include:

Country Operational Plan Reporting System

With reauthorization of the next five years of PEPFAR in place, significant changes to the FY 2010 COP and reporting process are under way, including new guidance, indicators, and a database Information Technology (IT) solution, as a means to streamline and better integrate PEPFAR planning and reporting, as well as address alignment with wider foreign assistance policies and systems. Design, development, and implementation of the modified Country Operational Planning and Reporting System (e.g., COPRS II) to meet short- and long-term PEPFAR systems support strategic needs is necessary. Resources for contractor support apply to improving data capture, analysis, report generation and minimizing burden to the field by developing the next generation PEPFAR planning and reporting database and software tools to meet broad stakeholder- and user-defined requirements. Resources also include complying with the Office of Management and Budget (OMB) and DOS IT systems development requirements, such as independent verification and validation (IV&V) and certification and accreditation (C&A). Deployment of the PEPFAR planning and reporting IT solution for use in FY 2010 COP preparation and support review and approval processes is anticipated for July 2009.

Local Capacity Initiative

Local Capacity Initiative (LCI) is a follow-on program to the New Partners Initiative which began in December 2005 and held three rounds of competition resulting in 56 awards to 54 new prime partners. LCI is a supplementary, yet distinct, competitive round that reflects changes in program goals, geographic coverage, and evaluation to support the broader goals of the next phase of PEPFAR. In supporting the principles of the second phase of PEPFAR of country ownership and sustainability, LCI will support and build the capacity of local PEPFAR NGO and commercial sector partners in coordination with public systems and networks. LCI is a means of addressing country ownership at the local level by establishing a competitive grants process for organizations with local HIV/AIDS programs that seek to further develop their efforts in coordination with partner country strategies and programs as a PEPFAR prime partner. The objective of LCI is to increase PEPFAR's ability to support local ownership in the provision of needed services by: further developing local capacity (organizational and technical) to address HIV/AIDS in a sustainable manner; and ensuring coordination, direct linkages, and support for local government entities engaged in the HIV response. LCI will engage organizations that are capable of working effectively in the areas of prevention and care, particularly organizations with the capacity to additionally support and strengthen local health systems.

Inspector General Funding

On July 30, 2008, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 was signed. This reauthorization of the PEPFAR program includes a requirement for the Inspectors General of the Department of State and Broadcasting Board of Governors, the Department of Health and Human Services, and the United States Agency for International Development to jointly develop 5 coordinated annual plans for oversight activity in each of the fiscal years 2009 through 2013.

The reauthorization language stipulates that the Global AIDS Coordinator and the Coordinator of the United States Government Activities to Combat Malaria Globally shall make available necessary funds not exceeding $15,000,000 during the five-year period beginning on October 1, 2008 to the Inspectors General for the audits, inspections, and reviews.

Strategic Realignment with the World Health Organization

In recognition of its critical international norm setting and technical support provision role, the USG has provided long-standing support to the World Health Organization's (WHO's) efforts, including technical and financial resources. With the passage of P.L. 110-293, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, PEPFAR seeks to further develop its strategic relationship with WHO with whom it closely collaborates on a range of HIV-related issues. To streamline and strengthen cooperation, and improve effectiveness of the overall partnership, PEPFAR and WHO are in the process of developing a four-year framework. The framework outlines a 4-year strategic, implementable roadmap, which will support a more collaborative relationship with specified objectives and timeline to guide both WHO and PEPFAR planning and budget allocations based on the jointly-identified priority areas of: anti-retroviral therapy, male circumcision, TB/HIV integrated programs, health systems strengthening, with a focus on human capacity development, and strategic information. These funds will begin work in priority areas agreed upon by PEPFAR and WHO and identified in the strategic framework. The work will address normative program or policy guidance and/or technical support.

Public Health Evaluation

This funding would be used to evaluate the impact of HIV/AIDS interventions, including those supported by PEPFAR, at the population level. This research plays a key role in adjusting programs to better meet the needs of those they serve.

Scale-Up of Gender-Based Violence Programs

Gender-based violence (GBV) contributes to increased risk of HIV. PEPFAR has been able to support a number of programs to address this risk factor. However efforts to date have been small scale compared to high rates of sexual and gender-based violence within the countries that PEPFAR helps support. Given that sexual violence is ubiquitous, and that no country is untouched by the problem, coupled with the reality that globally one third of women describe their first sexual encounter as being forced, there is a growing imperative to significantly ramp up the reach and scope of sexual and gender-based violence services.

Headquarters Staffing for Results

These funds will support a Staffing for Results (SFR) exercise to complete a comprehensive and effective analysis of PEPFAR HQ to insure that the interagency team is fully functioning to jointly plan, implement, and evaluate its programs with appropriate technical leadership and management oversight.

Infections Averted Modeling and Other Census Support

This funding will support the development of a model that estimates HIV infections averted due to behavior change associated with program interventions. The linking of behavioral change with a reduction in HIV incidence is a priority area for PEPFAR as the knowledge gained in the area of HIV prevention and control can be used to more effectively target funding to where it is needed the most. In addition to infections averted modeling, the Census supports PEPFAR through participation in strategic information groups, providing senior systems analyst support for programming and data extraction, assisting in developing a data repository for population and health data in PEPFAR countries, enhancing of the HIV/AIDS surveillance database, and producing subnational files with linked population data. Funding is provided to Census via a 632(B) transfer from the Office of the Global AIDS Coordinator.

Technical Assistance Support to S/GAC

Contracted technical assistance provides technical, programmatic, and acquisition expertise and support to on-going S/GAC changes and programs. Technical assistance includes areas such as advice on the ongoing development of country-specific planning systems, facilitation of current and future international public-private partnership development, participation in inter-agency and international data harmonization efforts, and determination of a draft knowledge management strategy for S/GAC. Additional rapid response will be provided at S/GAC request to host countries to help strengthen in-country systems. Assistance will also be provided in training and other technical aspects of deployment of new COPRS II and extranet software. Programmatic support will include areas such as providing staff for the program management function for software development, support for teams determining policies and programs, and facilitating business processes throughout S/GAC. Acquisition support will include assistance in developing the acquisition strategy, plan, and associated documents for replacement of the existing extranet contractor, as well as procurements needed to complete the current COPRS II development and deployment effort.

Project Title: Department of State (DOS) - Africa Bureau, Technical Leadership and Support

Table - FY 2009 Approved GHCS-State Funding

Department of State (DOS) ? Africa Bureau, Technical Leadership and Support, Table - FY 2009 Approved GHCS-State Funding

Projects planned in FY 2009 to support PEPFAR in response to the field program needs include:

Complex public health jobs in support of PEPFAR activities are not widely understood in the DOS Human Resources position classification process. The position classification of the work performed by locally employed staff in support of PEPFAR varies widely between Posts and Agencies. This initiative aims to standardize through framework job descriptions (FJD) the classification of 50 complex PEPFAR position descriptions while correcting misclassified positions impacting recruitment and retention. This interagency initiative requires extensive coordination with technical and programmatic subject matter experts and DOS HR professionals, as well as with experts from USAID and HHS in particular. Interagency FJD implementation training workshops will ensure uniform classification accuracy across the PEPFAR programs.

This is the continuation of a project that has been funded by CDC through an Inter-Agency Agreement with State Africa Bureau, and will now be funded by the GHCS-State account. This one-time funding request will extend the project through 2010 in order to finish up a second-batch of FJDs at grades 9-11. Fourteen FJDs have already been completed at grades 12-13, of which 11 have been cleared and disseminated for use.

Project Title: U.S. Agency for International Development (USAID), Technical Leadership and Support

Table - FY 2009 Approved GHCS-State Funding

U.S. Agency for International Development (USAID), Technical Leadership and Support, Table - FY 2009 Approved GHCS-State Funding

Technical Leadership and Support programs fund technical assistance and other activities to further PEPFAR policy and programmatic objectives in the field, at headquarters, and internationally. In addition to supporting USG technical assistance, this program utilizes existing contractual and grant mechanisms within USAID.

  • Using standing contracts and grants to facilitate access to technical expertise for program design, strategy development, and general support of field programs and policy development
  • Directing and providing scientific and technical assistance and monitoring of central cooperative agreements for field programs (e.g., abstinence and be faithful, orphans and vulnerable children, and safe medical injections programs)
  • Providing technical assistance to country programs (e.g., through direct assistance by USAID program and scientific experts from a variety disciplines including medical officers/physicians, health scientists, epidemiologists, public health advisors, AIDS education and training experts, statisticians and informaticians)

USAID contracts with the Partnership for Supply Chain Management (SCMS), a consortium of sixteen organizations, to procure essential medicines and supplies at affordable prices for HIV-infected individuals receiving treatment and care. This project is funded by a combination of central funding and country buy-in (funds requested by each country, for SCMS, which is listed in each country's description in the country program activities section. By strengthening and building reliable, secure, and sustainable supply chain systems, SCMS ensures that essential medicines, HIV test kits, laboratory supplies and other health products are continuously available when they are needed. SCMS reduces the price of essential medicines by working closely with in-country partners to plan for procurements, by establishing long-term contracts with manufacturers and by purchasing generic drug alternatives whenever possible. PEPFAR funds are used by SCMS at the central level to support global innovations, multi-country indicatives and a small amount of buffer stock. An emergency commodity reserve will be set up within the Working Capital Fund to provide SCMS with central funding to respond to ARV drug emergency requests. Additional information about the emergency commodity reserve is noted below.

South Africa ARV Procurement

South Africa has the world's largest population of people living with HIV/AIDS and also the largest treatment program. There are over 726,000 current and 30,000 new South Africans on treatment each month; however, these represent less than 40% of those who need it. The South African Government (SAG) supports the majority of treatment costs including procurement of almost all of its own ARVs. Historically PEPFAR has supported less than 10% of ARV needs. The prior SAG administration's denialist views contributed to slower rollout of services, resulting in hundreds of thousands of needless deaths. After years of neglect, the new SAG leadership is committed to reforming HIV/AIDS policies, and the USG has a unique opportunity to support this government's efforts. Given drastic increases in demand for ARV services coupled with the current economic downturn, the SAG faces immediate-term financial challenges. The estimated gap in overall funding for treatment services for the current SAG fiscal year is $250 million, and next fiscal year is $507 million, for a total shortfall of $757 million. The National Department of Health (NDOH) has requested $533 million from the SAG Treasury over the next two fiscal years, however there continues to be a shortfall of $224 million even with the additional funds. The SAG has formally asked PEPFAR to provide additional funding for ARVs during this two-year financial shortfall. PEPFAR will meet a portion of this request by providing $60 million in both FY 2009 and FY 2010 (subject to the availability of funds), for a total of $120 million. This support is contingent upon 1) demonstrated progress by the SAG in establishing a financial plan to avoid future shortfalls, and 2) obtained agreement to establish a national HIV/AIDS/TB/STI oversight office in the NDOH. The SAG is taking measures to build capacity within its national and provincial Departments of Health to strengthen logistics and forecasting capacities. The NDOH has already initiated costing efforts through an ARV costing group (in which the USG/PEPFAR participates), sent teams to each province to work with leadership to strengthen budget forecasting, and has begun a review to modify their tender policies to reduce drug procurement costs in the future. In addition, the SAG National Treasury is engaged in the ongoing costing and analysis that will allow planning for additional resource allocation beyond these next two years and incorporate all additional ARV costs in their current budget planning for FY 2012 - FY 2013.

PEPFAR/USAID/General Mills Partnership

These funds will help to provide technical assistance to food processing companies in PEPFAR countries so that they can meet international standards for safety and quality and compete for tenders for therapeutic and supplementary foods that our programs provide for Food by Prescription patients (clinical nutrition support) and OVC. This funding will be used as seed money for a public-private partnership between PEPFAR, General Mills, USAID/Economic Growth and Trade Bureau and USAID/Office of HIV/AIDS.

Emergency Commodity Reserve

Partner governments, funders and implementing partners report that the current economic environment and associated financial shortfalls are threatening to cause future stock outs of ARVs and, therefore, the continuity of HIV/AIDS treatment for tens if not hundreds of thousands of people. PEPFAR is aware of and often directly involved in the resolution of numerous close-call or actual stock-out situations of ARVs or other critical medicines necessary for effective treatment, and recognizes that these situations will continue on a rolling basis and could increase in frequency and dollar value. Many of these situations are caused by poorly performing procurement systems and gaps in countries' receipt of financing from the Global Fund. Establishment of an emergency commodity reserve within the HIV/AIDS Working Capital Fund will allow the USG to assist in maintaining the continuity of services for persons reliant on daily life-saving medicine during a period of enormous global financial uncertainty, evolution in global treatment guidelines, and continued interdependence of donor funding.

Scale-Up of Gender-Based Violence Programs

GBV contributes to increased risk of HIV, which fuels the spread of HIV/AIDS in many countries. PEPFAR has been able to support limited programs to address this risk factor, but by making this additional funding available to country programs, PEPFAR seeks to enable broad scale-up of a larger number of programs to reduce, and mitigate the HIV-related impacts of, GBV. These funds will be used to take existing models and improve quality and scale in countries to ensure both services for survivors and rape prevention are more widely available.

Local Capacity Initiative

Local Capacity Initiative (LCI) is a follow-on program to the New Partners Initiative which began in December 2005 and held three rounds of competition resulting in 56 awards to 54 new prime partners. LCI is a supplementary, yet distinct, competitive round that reflects changes in program goals, geographic coverage, and evaluation to support the broader goals of the next phase of PEPFAR. In supporting the principles of the second phase of PEPFAR of country ownership and sustainability, LCI will support and build the capacity of local PEPFAR NGO and commercial sector partners in coordination with public systems and networks. LCI is a means of addressing country ownership at the local level by establishing a competitive grants process for organizations with local HIV/AIDS programs that seek to further develop their efforts in coordination with partner country strategies and programs as a PEPFAR prime partner. The objective of LCI is to increase PEPFAR's ability to support local ownership in the provision of needed services by: further developing local capacity (organizational and technical) to address HIV/AIDS in a sustainable manner; and ensuring coordination, direct linkages, and support for local government entities engaged in the HIV response. LCI will engage organizations that are capable of working effectively in the areas of prevention and care, particularly organizations with the capacity to additionally support and strengthen local health systems.

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