Mozambique FY 2008 Country PEPFAR Operational Plan (COP)

MOZAMBIQUE

Project Title: Mozambique FY 2008 Country PEPFAR Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Total Funding
	Allocated as of February 2008			Allocated June 2008			Allocated as of June 2008
Implementing Agency	GAP	GHCS - State	Subtotal: Field Programs Funding	GAP	GHCS - State	Subtotal: Field Programs Funding	New Subtotal: Field Programs Funding	Subtotal: GHCS Central Programs	Grand Total:  Field & Central Funding
DOD	-	751,000	751,000	-	-	-	751,000	-	751,000
DOL	-		-	-	-	-	-	-	-
HHS	2,337,000	81,590,057	83,927,057	-	-	-	83,927,057	5,800,000	89,727,057
Peace Corps	-	1,770,000	1,770,000	-	-	-	1,770,000	-	1,770,000
State	-	1,367,760	1,367,760	-	380,000	380,000	1,747,760	1,000,000	2,747,760
USAID	-	127,841,183	127,841,183	-	-	-	127,841,183	5,787,654	133,628,837
TOTAL	2,337,000	213,320,000	215,657,000	-	380,000	380,000	216,037,000	12,587,654	228,624,654

HIV/AIDS Epidemic in Mozambique:
Adults (aged 15-49) HIV Prevalence Rate: 16.1% (UNAIDS, 2006)
Estimated number of People Living with HIV: 1,800,000 (UNAIDS, 2006)
Estimated number of Orphans due to AIDS: 510,000 (UNAIDS, 2006)

Country Results and Projections to Achieve 2-7-10 Goals:

Mozambique	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of FY 2004*	74,200	5,200
End of FY 2005**	187,500	16,200
End of FY 2006***	323,400	34,200
End of FY 2007****	669,000	78,200
End of FY 2008*****	540,357	123,315
End of FY 2009*****	793,981	156,820

^* "Engendering Bold Leadership: The President’s Emergency Plan for AIDS Relief.” First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005.
^** “Action Today, a Foundation for Tomorrow: The President’s Emergency Plan for AIDS Relief.” Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February 2006.
^*** "The Power of Partnerships: The President’s Emergency Plan for AIDS Relief.” Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007.
^**** "The Power of Partnerships: The President's Emergency Plan for AIDS Relief." 2008 Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, January 2008.
^***** Projections from FY 2008 Country Operational Plan

Program Description/Country Context:

Mozambique has a severe, generalized HIV/AIDS epidemic. HIV prevalence among men and women aged 15-49 is estimated at 16%, with a projected 1.8 million Mozambicans living with HIV/AIDS in 2005. Areas of high HIV prevalence correspond roughly to areas of high population mobility. Mozambique has high rates of high-risk behavior, and current norms are deeply interwoven in cultural, social, and economic patterns. Compared with many other focus countries, Mozambique has a lower age of sexual debut, a smaller proportion of young unmarried adults abstaining from sex, a higher proportion of young adults with multiple sex partners, lower use of condoms with higher-risk partners, and a lower rate of HIV testing.

Mozambique’s national response has made progress in the last year; however, scarcity of skilled human resources and inadequate institutional capacity and infrastructure persist. With a population of more than 20 million and an estimated 650 doctors, many rural areas in Mozambique have just one physician per 60,000 people. Health infrastructure is poor, and even many provincial referral hospitals have limited access to water and electricity. Only about half of Mozambicans have access to a health facility. Co-epidemics of tuberculosis (TB) and malaria exacerbate the impact of HIV/AIDS. The USG will continue to pursue a balance between meeting immediate needs and building long-term capacity to effectively address the HIV/AIDS epidemic in Mozambique. The President’s Malaria Initiative in Mozambique and Millennium Challenge Corporation will provide complementary resources that will link to this USG program.

PEPFAR funding will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $48,481,956 ($42,852,042 Field; $5,629,914 Central) (24.8% of prevention, care and treatment budget)

PEPFAR activities in Mozambique that prevent the spread of HIV will continue to include programs that (1) prevent mother-to-child transmission (PMTCT), (2) promote abstinence, faithfulness, and delay of sexual debut (AB), (3) specifically target high-risk or high-transmitter groups with condoms and other prevention measures, and (4) ensure blood, biomedical, and injection safety. Activities this year will also include program assessments to determine the next steps for a Mozambican response to HIV/AIDS.

PMTCT sites will provide referral to nearby treatment and support programs to ensure successful antiretroviral therapy (ART) for HIV-infected mothers and their HIV-infected children and partners. Depending on the site, other programs may provide wrap-around services such as nutrition education, birth spacing, postnatal care, and malaria prevention and treatment. During FY 2008, the USG will continue technical support for coordination, policy oversight, and updating of national guidelines and training materials on PMTCT.

With FY 2008 funds, the USG will strengthen efforts to promote abstinence and delay sexual debut among youth; reduce multiple partnerships and promote fidelity among adults in committed relationships; and improve and expand activities that directly address behaviors, norms, and contextual factors that lead to new infections. These AB activities will promote more equitable gender norms and behaviors, including reduction in gender-based violence and coercion. Partners will continue to reach Mozambicans with AB messages through peer-to-peer youth groups, parent-teacher-child discussions, pastor networks and other community-based programs. New mass media activities will include community radio programs that create a supportive environment for adopting AB behaviors. Finally, training programs will expand the cadre of individuals to lead and promote AB activities.

Medical transmission prevention programs will improve blood safety, infection control, and injection safety. In FY 2008, technical assistance and training will focus on implementing a standards-based approach for infection prevention and control. Additionally, the USG will continue to procure equipment to further upgrade remaining reference blood banks. Injection safety technical assistance will expand to new health facilities, and additional Mozambican health workers will be trained to support injection safety.

With FY 2008 funds, the USG will continue its support of condom procurement for free distribution through public facilities. USG funds will also maintain condom social marketing and behavior change communication activities that focus on the most-at-risk and high-transmitter population groups, including migrant workers and uniformed service members, specifically young police and military recruits. Besides large scale media and local mobilization campaigns, USG funds will sustain ongoing capacity building for private sector HIV/AIDS workplace programs. The USG will provide technical support for MOH efforts to develop new policy, services and prevention messages for male circumcision.

Principal Partners: MOH, Health Alliance International, Population Services International, Food for the Hungry, World Vision, Columbia University, Foundation for Community Development, Johns Hopkins University, John Snow Inc., Family Health International, Elizabeth Glaser Pediatric AIDS Foundation, World Relief, Samaritan’s Purse, Academy for Educational Development, Constella Group, EngenderHealth, and AID for Development People to People, Mozambique.

Care: $52,209,319 ($49,751,579 Field; $2,457,740 Central) (26.7% of prevention, care and treatment budget)

The USG will build on the achievements of the last four years to deliver care by (1) mobilizing and supporting local responses, (2) standardizing essential services for orphans and vulnerable children (OVC), and (3) strengthening the enabling environment and government response. In FY 2008, local CBOs and FBOs will continue to receive training and mentoring to strengthen their operations and monitoring capacity. With FY 2008 funds, USG partners will continue to expand the delivery of palliative care to people living with HIV/AIDS (PLWHA) at facility and community levels and advance policy initiatives through direct service delivery and capacity building. This year, the USG will provide more pediatric palliative care in coordination with PMTCT and OVC programs. Additionally, the USG will work closely with the MOH, partners and other stakeholders to create a better system for ensuring that both adults and children living with HIV have access to prophylaxis medicines to prevent opportunistic infections, as well as better diagnosis and treatment. A Mozambican nurses’ association will continue to receive technical and financial support to complete training of accredited home-based care (HBC) trainers, who will in turn train volunteers.

In FY 2008, USG resources will help complete the transition to provider-initiated HIV/AIDS counseling and testing (CT) in clinical settings, with an emphasis on integrating CT services in TB clinics, youth-friendly health services, and antenatal care clinics (ANC). The quality-control program will be completely rolled-out to all provincial capitals and HIV test-kit distribution will be integrated into the national distribution system with USG technical assistance by the end of this fiscal year. In addition, CT and national blood transfusion program staff are planning to introduce CT and blood donor notification in blood banks in FY 2008.

In FY 2008, USG-funded technical assistance and training will strengthen the integrated TB/HIV program by expanding HIV counseling and testing for TB patients, strengthening referral mechanisms between TB and HIV services, improving TB screening for HIV-infected patients, and reinforcing infection control in health settings. All USG-funded ART partners will provide a minimum package of TB/HIV services.

In FY 2008, the USG will continue to provide OVC with six essential services: safety and security, education, health, food and nutrition, psychosocial support and mental health, and civil rights and responsibilities. This will be accomplished through direct collaboration with CBOs, FBOs, and local communities. This fiscal year, attention will be directed at additional focus provinces where coverage is low yet the opportunity for linkages with other prevention, care and treatment programs is encouraging. This year’s OVC funding will improve and ensure the quality services USG offers to OVC, disseminate programmatic lessons learned across all partners providing OVC services, enhance coordination with other non-PEPFAR programming such as the President’s Malaria Initiative, and continue to bolster the institutional and programmatic capacity of partners providing OVC services.

Principal Partners: MOH, Health Alliance International, World Vision, CARE International, World Relief, Columbia University, Foundation for Community Development, World Food Program, Project HOPE, Partnership for Supply Chain Management, Family Health International, Africare, Save the Children US, Vanderbilt University, Academy for Educational Development, and Population Services International.

Treatment: $95,039,669 ($90,539,669 Field; $4,500,000 Central) (48.6% of prevention, care and treatment budget)

In FY 2008, the USG will continue to provide technical assistance and training to strengthen pharmaceutical logistics information and control systems to ensure a reliable supply of antiretroviral (ARV) drugs for all sites delivering treatment services. FY 2008 funds will continue to procure FDA-approved ARV drugs, including those for adults on first and second-line treatments, adults with TB/HIV co-infection, and infants and children on first and second-line pediatric ARV formulations. Additionally, the USG will assist with the start-up of modern warehousing operations and their direct management by MOH staff.

FY 2008 funds will enable USG partners to support ART, including pediatric treatment, and the strengthening of national human resource capacity, infrastructure, and support systems to deliver these services. The USG will support the development of regional pediatric reference centers, and will initiate or expand pediatric ART at all USG-supported ART sites. FY 2008 funds will provide training for nurses and other health workers, renovation and construction of health and training facilities, and technical assistance and training to improve ARV procurement, distribution, and storage.

The USG will expand capacity at clinical laboratories to support implementation of the ART program in FY 2008. Additional Mozambican technicians will receive training to manage and supervise the CD4 and HIV serology quality assurance programs. USG-funded technical assistance will also assist in the development of strategic plans for a national laboratory network and for pre- and in-service training of laboratory technicians.

Principal Partners: MOH, Partnership for Supply Chain Management, University of Washington Population Services International, Association of Public Health Laboratories, Elizabeth Glaser Pediatric AIDS Foundation, Columbia University, Health Alliance International, Federal University of Rio de Janeiro, World Food Program, American International Health Alliance, Family Health International, Vanderbilt University, World Vision, and the American Society for Microbiology.

Other Costs: $32,893,710

As Mozambique rapidly scales up its HIV/AIDS program, strengthening human resources and institutional capacity will be vital for the success of the National HIV/AIDS Strategy. FY 2008 funds will support pre-service courses and training material revisions, expand the training information system database, procure essential training equipment, and aid in development of a national HIV workforce policy. Technical assistance will continue to strengthen the capacity of national leadership and improve coordination of the HIV/AIDS response. Technical assistance and twinning will strengthen the capacity of Mozambican NGOs and the professional nursing association. Technical assistance will also be provided for Global Fund implementation and workplace HIV policies and programs.

The USG will continue to support strategic information activities that improve Mozambique’s capacity to measure and interpret the impact of HIV/AIDS on the population, including and AIDS indicator survey. The USG will also support public health evaluations to measure and improve the quality of national care, prevention, and treatment services and compare costs of different models to deliver HIV care.

Principal Partners: MOH, American International Health Alliance, Johns Hopkins University, University of Washington, Abt Associates, Academy for Educational Development, and Catholic University of Mozambique, National AIDS Council, Ministry of Women and Social Action, Constella Group, Association of Public Health Laboratories, UNICEF, New York AIDS Institute, and University of North Carolina, Carolina Population Center.

FY 2008 funds will support the in-country personnel needed for USAID, HHS/CDC, Department of State, and Peace Corps. Funds will ensure program monitoring, accountability and oversight; ensure USG policy and technical leadership; and cover compensation, logistics, and office and administrative costs.

Other Donors, Global Fund Activities, Coordination Mechanisms:

Donors supporting HIV/AIDS efforts include the United Kingdom, Ireland, Sweden, Denmark, the Netherlands, Norway, Canada, the European Union, World Bank, UN agencies, and the Global Fund. Coordination of activities is facilitated by the HIV/AIDS Partners Forum and the Health Sector-wide Approach (SWAp) Working Group. The USG actively participates in the SWAp, most notably the HIV/AIDS Working Group. The Global Fund Country Coordination Mechanism is linked to existing structures to streamline management.

Program Contact: PEPFAR Coordinator Irene Benech

Time Frame: FY 2008 – FY 2009