1. President’s Emergency Plan for AIDS Relief (PEPFAR)
Lisa J. Nelson, MD MPH MSc
UEM/UCSD MEPI External Advisory Board Meeting
Maputo
March 14, 2011

2. Outline
President’s Emergency Plan for HIV/AIDS (PEPFAR) Overview and Coordination
Mozambique USG-GRM Partnership Framework Goals
PEPFAR Support to Health System Strengthening
Synergies between PEPFAR and MEPI Initiative

3. PEPFAR: the US Response to the Global AIDS Crisis
2003: PEPFAR was launched
2008: PEPFAR reauthorized through 2013
Committed $32 billion through FY2010
Interagency coordination model
2003: U.S. President's Emergency Plan for AIDS Relief launched
2008: Lantos-Hyde Act reauthorized PEPFAR for five additional years ( )
Through 2010, US is committing approximately $32 billion to bilateral HIV/AIDS programs, as well as contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria
Interagency coordination model: multiple agencies implement PEPFAR programs, under guidance and oversight of Global AIDS Coordinator at State Department

4. PEPFAR Mozambique Organization and Coordination
Interagency initiative lead by U.S. Ambassador
HHS (CDC, HRSA, NIH)
Department of Defense
Peace Corps
Department of State
USAID
Interagency management structures
Coordination Office
Senior Leadership
Technical Working Groups
Important to note that NIH is new sister agency to the USG/PEPFAR family in Mozambique

5. USG-Government of Mozambique HIV/AIDS Partnership Framework Goals 2009-2014
Reduce new HIV infections in Mozambique
Strengthen the multi-sectoral HIV response in Mozambique
Strengthen the Mozambican health system, including human resources for health and social welfare in key areas to support HIV prevention, care, and treatment goals
Improve access to quality HIV treatment services for adults and children
Ensure care and support for pregnant women, adults and children infected or affected by HIV in communities and health and social welfare systems
Partnership Frameworks: 5-year strategic agreements with partner nations to ensure the partner government leads the national response, with specific commitments on:
Service delivery
Policy reform, including addressing key structural drivers of epidemic
Financing
Under leadership of CNCS, was developed with stakeholders. Signed in August 2010.
O Quadro de Parceria é um plano estratégico quinquenal entre os governos do Moçambique e dos Estados Unidos
Foi alinhado e está baseado nos planos nacionais como o PEN III, e outros como o Plano Nacional de Saúde e de Desenvolvimento dos Recursos Humanos
Additional funding was made available as a part of the Partnership Framework. It is important to note that any and all funds are part of a unified PEPFAR program and that the Partnership Framework is not additional or separate.

6. Sustainability and Country Led Response
Governments and Civil Society empowered to lead, prioritize, implement, and be accountable for a country’s response to HIV/AIDS
Align with GRM priorities
Increase joint planning
Build capacity of national/ provincial systems
Provision of technical assistance, organizational capacity building
Use of government systems
Direct funding to regional governments and local partners
Support quality, sustainable services
Discuss MEPI as an example of moving toward more a more sustainable response and a country led response to the needs of Mozambique

7. Developing Efficiencies in Programs
Expanding use of costing studies and modeling
Coordinating our response with the Global Fund and other donors
Identifying, quantifying and disseminating potential structural and program efficiencies
Briefly mention Mozambique’s leadership in costing

8. Key Partners in Mozambique
Clinical Partners in 11 provinces
Columbia University/ICAP
Family Health International (FHI)/Abt Associates
Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)
Vanderbilt University/Friends in Global Health
CARE
Funding directly to Mozambican institutions
MISAU (2), INS + CMAM
UEM (MPH)
Provincial Health Directorates (2)
M-OASIS
Ministry of Women and Social Action (MMAS)

9. Key Partners in Mozambique
American International Health Alliance (UCLA, ANEMO)
American Society for Microbiology
Universidade Federal do Rio De Janeiro
Food and Nutrition Technical Assistance (FANTA)
Health Systems 20/20
IntraHealth International
ITECH
JHPIEGO
New York AIDS Institute (HIVQUAL)
Pathfinder
Partners for Appropriate Technologies
SCMS
Strengthening Pharmaceutical Systems (SPS)
Association of Public Health Laboratories (APHL)
American Society for Clinical Pathology
Clinical Laboratory Standards Training Institute

10. PEPFAR Support 2010 Annual Progress Report
Supported HIV prevention, care and treatment services in all 11 provinces in Mozambique
Provided direct support to >138,000 persons on ART
(70% of national total on ART)
Counseled and tested >600,000 persons for HIV in facility-based and community counseling settings
Support prevention of mother-to-child transmission (PMTCT) services at 338 clinical sites (>30% of all PMTCT sites nationally)
Provided HIV counseling, testing and results to >500,000 pregnant women

11. HIV Prevalence by Province
Cabo Delgado
9.4%
Niassa
3.7%
Percentagem de mulheres e homens de anos com infecção por HIV
Nampula
4.6%
Tete
7.0%
Zambézia
12.6%
Sofala
15.5%
Manica
15.3%
Moçambique
11.5%
Inhambane
8.6%
Gaza
25.1%
Maputo
Província
19.8%
Maputo Cidade
16.8%
Source: INSIDA

12. Health Systems Strengthening
Goal: Strengthen the Mozambican health system, including HR for health and social welfare in key areas to support HIV prevention, care and treatment goals
Increase # of health care and social workers and improve the capacity and quality of pre-service, in-service training, faculty development and post-graduate training
Improve management capacity, motivation and retention of health and social workers
Improve supply chain system at all levels
Health Information System (HIS)
Improve and expand the public health infrastructure

13. USG Systems Strengthening Support
HSS budget in million $
PEPFAR II: focus on HSS
Strong HR component: HCW target
Huge infra-structure investments (training facilities, rural health centers, warehouses, lab, etc)
GHI: improve and sustain health outcomes through strengthened HS (beyond HIV)
U.S. Fiscal Year
PEPFAR Funding (USD)
2006
2.0
2007
2.8
2008
6.8
2009
8.7
2010
41.4
2011
39.4

14. Existing Conditions

15. Recent Improvements in Lab Infrastructure

16. Current HIV-Related Lab Capacity in Mozambique
41 CD4 instruments
PIMA point of care CD4 instrument currently in pilot sites in Maputo city (2) Maputo province (2) Sofala (2) and Niassa (2).
Plans underway to expand to 9 sites in Gaza
4 labs performing DNA PCR for early infant diagnosis (EID)
1 labs with viral load capacity

17. Male Circumcision (MC)
3 clinical trials demonstrated >60% effect in preventing HIV transmission
Completed surgical capacity assessment in 2008
Pilot project in 6 sites approved by MOH6000 procedures to date
Expanding to 24+ sites in 2011
MOH approved demonstration project to assess the feasibility of scaling up MC within minor surgical wards
Five sites (4 MOH and 1 military)
Services initiated in Hospital Militar de Maputo
100 males circumcised Nov-Dec 2009
Training for staff at two additional sites (Boane and Chokwe) to begin in March

18. Systems Strengthening – Human Resources
Support the MOH Dept of Human Resources’ (DRH) National Strategic Plan for HR development (PDRH )
Support to MoH in-service training institutions: faculty development and scholarships
Strengthen the Community Health Worker (CHW) program
Support MPH degree in epidemiology and lab (FELTP) at UEM
Support in-service training activities
Strengthen the HR Information System (HRIS)
Mechanisms of Support
Cooperative Agreement with Implementing partners
Direct Technical Assistance (Technical Advisor) to CHW program
Cooperative Agreement and Technical Support to UEM (FELTP)

19. USG Strategic Information - HIS
Support the MOH Dept of Health Information’s (DIS) National Strategic Plan for Health Information Systems (HIS) ( )
Securing sufficient qualified human resources for the HIS activities at all levels
Improving management of the HIS
Securing appropriate infrastructure & information and communication technology at all levels
Mechanisms of Support
Cooperative Agreement with MOH DIS
Direct Technical Assistance (Technical Advisor) to DIS
Cooperative Agreement and Technical Support to M-OASIS (Mozambique node of Open Architecture and Standards in Information Systems, based at UEM)

20. Areas for Potential Coordination/Synergy with MEPI (1)
Maputo Central Hospital (MCH)
MOH DIS is developing a patient-level medical record system at MCH
CDC support for lab information system (NetAquire) at MCH
Health training institutions
Support faculty development in surgery technicians courses

21. Areas for Potential Coordination/Synergy with MEPI (2)
Strengthening Human Resources in HIS
Coordination of HR development with M-OASIS
Financing courses for Health Statistics Technicians (Técnicos Médios de Estatística Sanitária) at Maputo’s Institute for Health Sciences (ICS)
Responding to for identified HIS needs (e.g. at Provincial level)
Enterprise Architecture
MOH DIS (with M-OASIS support) is in the early stages of developing an enterprise architecture for HIS in Mozambique
Importance of inclusion of various HIS initiatives to ensure overall coordination and ultimately interoperability

22. Key USG PEPFAR Contacts for MEPI Collaboration
Overall Contact: PEPFAR Country Coordinator, April Kelley,
Human Resources Contact: Shirley Eng-Breard,
HMIS Contact: Strategic Information Branch Chief, Amy Dubois
USAID IHO Lead: Polly Dunford,
CDC Mozambique Director: Lisa Nelson,

23. For further information, please visit:
Thank You
For further information, please visit: