Mozambique FY 2006 Country Operational Plan (COP)

MOZAMBIQUE

Project Title: Mozambique FY 2006 Country Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of May 2006			Current Notification August 2006			Current Notification August 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding by Account	GHAI	GAP	New Subtotal: Field Programs Funding by Account	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	0	887,000	887,000	0	0	887,000	0	887,000
DOL	0	0	0	0	0	0	0	0
HHS	2,337,000	29,015,458	31,352,458	0	0	31,352,458	6,176,440	37,528,898
Peace Corps	0	473,200	473,200	0	0	473,200	0	473,200
State	0	905,000	905,000	-150,000	0	755,000	0	755,000
USAID	0	48,319,342	48,319,342	150,000	0	48,469,342	6,305,429	54,774,771
TOTAL Approved	2,337,000	79,600,000	81,937,000	0	0	81,937,000	12,481,869	94,418,869

HIV/AIDS Epidemic in Mozambique:

Adult HIV Prevalence Rate: 16.1% [12.5-20.0%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 1,800,000 [1,400,000-2,200,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 510,000 [390,000-670,000] (UNAIDS 2006)

*Results. "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
**Results. "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
***Projections from FY 2006 Country Operational Plan

Program Description:

Mozambique has a severe, generalized HIV/AIDS epidemic. Additional data indicate that HIV prevalence among men and women aged 15-49 was 16.1% [12.5-20.0%] (UNAIDS 2006). Areas of high HIV prevalence correspond roughly to areas of high population mobility. Officially, there are 470,000 orphans and vulnerable children (OVC) due to AIDS in Mozambique, estimated to reach one million by 2010. Mozambique has high rates of high-risk behavior and current norms are deeply interwoven in cultural, social, and economic patterns. Compared with other focus countries, in Mozambique the age of sexual debut is lower, a smaller proportion of young unmarried adults abstain from sex, the proportion of young adults with multiple sex partners is higher, condom use with higher risk partners is less common, and the rate of HIV testing is lower.

Mozambique’s national response has made progress in the last year; however, a scarcity of skilled human resources, institutional capacity, and adequate infrastructure persists. With a population of about 19 million and only 650 doctors (200 of them in the capital city), many rural areas in Mozambique have just one physician per 60,000 people. Health infrastructure is poor, and even provincial referral hospitals have limited access to water and electricity. Only about 68% of Mozambicans live within ten kilometers of any type of health facility. Mozambique suffers from co-epidemics of tuberculosis (TB) and malaria, which exacerbate the impact of HIV/AIDS. The USG program will continue to pursue a balance between meeting immediate needs and building longer-term capacity to effectively address the HIV/AIDS epidemic in Mozambique.

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

Prevention: $24,193,551 as of August 2006 ($18,754,936 Field and $5,438,615 Central) (29.6% of prevention, care and treatment budget)

Emergency Plan 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 (e.g. uniformed services, mobile populations, and migrant workers), and (4) ensure blood, biomedical, and injection safety. With FY 2006 funding the USG will continue direct support to 52 PMTCT sites, expand coverage of the number of women counseled and tested for HIV, and provide a complete course of anti-retroviral (ARV) prophylaxis to 10,000 mothers who test seropositive and their newborns. In addition, these PMTCT sites will provide referral to nearby treatment sites and follow-up support to ensure successful ARV therapy for HIV-positive mothers and their HIV-positive children and partners while other programs provide them with wrap-around services including nutrition education, birth spacing, postnatal care, and malaria and TB prophylaxis and treatment. During FY 2006, the USG will also continue providing technical support to the Ministry of Health (MOH) for coordination, policy oversight, and updating of the national PMTCT guidelines and training materials.

Using FY 2006 funds, the USG will rapidly increase efforts to trigger community support for abstinence and faithfulness programs in seven provinces, reaching approximately 1.7 million Mozambicans and training another 12,000 to promote abstinence and faithfulness at the community level. Implementing partners, including faith, community and non governmental organizations (FBOs, CBOs, and NGOs) will continue to train peer-to-peer youth groups, carry-out parent-teacher-child discussion activities, and work through pastor networks and other community-based programs to address risk perception, build the sense of self-efficacy needed for behavior change, and encourage dialogue on community norms and practices to protect young people, especially vulnerable groups.

Medical transmission prevention programs will continue to facilitate and promote blood safety, infection control, and injection safety through technical assistance and training, specifically focused on implementing a standards-based approach for infection prevention and control (IPC) in 13 hospitals and expanding to six new hospitals in FY 2006. Injection safety technical assistance and training will continue in 39 health units and will be expanded to 30 more with FY 2006 funds. MOH staff trained to support IPC and injection safety will more than double with the addition of 52 Mozambican trainers, 605 health workers, and 260 support staff who will be trained with FY 2006 funding.

The USG is the sole provider of condoms to the Ministry of Health for free distribution in hospitals, health facilities, clinics, and counseling and testing centers. Behavior change communication (BCC) activities will focus on most at-risk and high HIV transmitter population groups including migrant workers, mobile populations, and uniformed service members, specifically young police and military recruits. Thirty-six new peer educators selected from among young police recruits will work in three provinces, reaching 18 police squadrons, or roughly 50,000 individuals; and BCC on HIV/AIDS will be integrated into training for all new military recruits.

In the May 2006 notification, an additional $4,055,000 was allocated for prevention activities. The additional funds will expand efforts to supporting additional partners to provide AB messages to reach an additional 400,000; expand the number of PMTCT sites by four; develop a strategy and guidance for delivering PMTCT services in maternity wards; train maternity staff in three maternity wards to deliver PMTCT services; continue targeted BCC and condom social marketing for high-risk groups, including 500 seropositive military personnel; improve coordination and evaluation of the national blood safety program; and conduct a feasibility and acceptability study of male circumcision in Mozambique. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: Ministry of Health, Health Alliance International, Columbia University, Population Services International, World Vision, Foundation for Community Development, Johns Hopkins University, Elizabeth Glaser Pediatric AIDS Foundation, the National AIDS Council, Project Hope, JHPIEGO, Ministry of the Interior, Ministry of Defense, Samaritan’s Purse, World Relief, and the American Association of Blood Banks.

Care: $27,916,338 as of August 2006 ($25,373,084 Field and $2,543,254 Central) (34.1% of prevention, care and treatment budget)

The USG will build on the significant progress achieved in the last two years to deliver care by maintaining efforts to (1) mobilize and support local response, (2) standardize essential services for OVC, and (3) strengthen the enabling environment and government response. In the first half of FY 2005, 65,231 OVC received services through USG-supported NGO, CBO and FBO partners. With FY 2006 funding support, USG partner organizations will deliver services as needed to approximately 140,000 OVC (over 10% of OVC in Mozambique). The USG will support logistics for supply management and delivery in collaboration with other donors including the World Food Program to provide a basic food ration to 12,000 of the most vulnerable children and 1,500 people living with HIV/AIDS (PLWHA) and their families. The Ministry for Women and Social Action will receive technical assistance to develop a monitoring and evaluation system and roll out the OVC and home based care (HBC) implementation plans.

With FY 2006 funding, the USG will expand palliative care to PLWHA at both the facility and community levels and advance policy initiatives in support of palliative care through direct delivery of services and capacity building. A total of 17,500 Mozambicans will receive direct home-based care through FBO, NGO and CBO partners. The Mozambican Nurses Association will receive technical and financial support for six HBC master trainers who will train and supervise 84 accredited trainers of volunteers.

With FY 2006 funds, the USG will reach 321,750 HIV counseling and testing (CT) clients through: direct support for 61 counseling and testing sites; procurement of HIV test kits (for nationwide CT services); training of 112 counselors; and technical and financial support to the MOH and National AIDS Council (NAC) to improve oversight. Technical assistance to the NAC will develop community-based counseling and testing, and train 225 additional trainers and counselors in community-based CT. The USG will also expand CT in military hospitals serving both Defense personnel and civilians.

In addition, the USG will provide technical assistance to the MOH to develop two TB/HIV model centers and, by the end of the fiscal year, integrated TB/HIV programs will be implemented at all USG-supported treatment sites.

In the May 2006 notification, an additional $4,810,400 was allocated for care activities. Additional funds will go toward expanding the national reach of OVC and community- and home-based care services by building capacity within local organizations and training community caregivers and service providers. Other activities include developing a package of tuberculosis (TB) treatment and care services for children; supporting the overall national TB program; providing wrap-around services for OVCs; purchasing care commodities; expanding counseling and testing services by establishing additional testing sites and training additional counselors; developing guidance to standardize care and support networks; expanding HIV testing in TB sites; and piloting routine HIV testing at eight clinical sites. In August 2006, there was no change in the amount of funding allocated for care.

Principal Partners: Ministry of Health, Ministry of Women and Social Action, Health Alliance International, Crown Agents, Population Services International, World Vision, CARE, Ministry of Defense, World Relief, Save the Children U.S., Columbia University, JHPIEGO, Foundation for Community Development, and the World Food Program.

Treatment: $29,660,521 as of August 2006 ($25,160,521 Field and $4,500,000 Central) (36.3% of prevention, care and treatment budget)

Using FY 2006 funds, the USG will provide technical assistance and training to strengthen pharmaceutical logistics information and control systems to ensure a reliable supply of ARV for all sites delivering ARV treatment services. There will be up to 60,000 patients on antiretroviral therapy (ART) by the end of 2007, including 700 on second-line and 3,000 on pediatric ARV. FY 2006 funds will procure FDA-approved ARV needed in FY 2007.

FY 2006 funds will enable the USG to provide ARV treatment to over 30,000 patients. Support will be continued at 18 existing sites and expanded to 35 new ARV treatment service sites. These will be primarily rural facilities in seven provinces that will provide follow-up and treatment of patients initiated on ART at referral facilities. Three new implementing partners will be funded to develop ARV treatment services in five of the seven provinces. Pediatric treatment scale up will include introduction of pediatric ARV treatment at two model PMTCT centers.

The USG will improve and expand clinical laboratory capacity to support implementation of ARV treatment programs in FY 2006 by delivering support to ten clinical laboratories to support AIDS and opportunistic infection diagnosis and management. In addition, 35 Mozambican technicians will be trained in clinical assay techniques, biosafety, good laboratory practices, CD4 testing, molecular biology and opportunistic infection diagnosis. Supervision and mentoring programs are planned in all renovated laboratories to benefit 70 technical laboratory staff.

In the May 2006 notification, an additional $6,313,000 was allocated for treatment activities. The additional funds will expand efforts to address transportation needs of PLWHAs; procure additional second line and required branded adult anti-retroviral drugs for 350 adults; provide additional fiscal support to the Ministry of Health to build safety stocks of first line drug regimens and strengthen drug logistics; renovate and equip one provincial laboratory and several smaller district laboratories in remote regions; undertake an evaluation of simpler CD4 testing techniques for use in smaller more remote settings; build the capacity of the national laboratory program; train health cadres to work with HIV affected people; and develop, implement and maintain a patient tracking system. In August 2006, there was no change in the amount of funding allocated for treatment. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: Ministry of Health, Association of Public Health Laboratories, Columbia University, Ministry of Defense, FIOTEC Institute/Oswaldo Cruz Foundation, Health Alliance International, and the Elizabeth Glaser Pediatric AIDS Foundation.

Other Costs: $12,648,459 as of August 2006

As Mozambique moves towards rapidly scaling up HIV/AIDS programs, strengthening Mozambican human resources and institutional capacity will be vital for the success of Mozambique’s National HIV/AIDS Strategy. FY 2006 funds will establish standards for pre-service training activities, develop training materials, procure essential equipment, and aid in developing HIV workforce policies for the MOH and the Ministry of Defense. Technical assistance will enhance the NAC capacity to provide leadership, manage financial resources, and support the new communication strategy. The USG will also extend direct support to the Business Against AIDS Forum (ECoSIDA) to strengthen the services and support that ECoSIDA can provide to its members and to mobilize private companies to address HIV/AIDS through comprehensive workplace and outreach programs.

The USG will continue strategic information (SI) activities that improve capacity within Mozambique to understand, interpret, and measure the impact of HIV/AIDS on the population. Most notably, the USG will support the 2006 sentinel surveillance round, introducing HIV incidence and ARV resistance testing and new methods for projections and estimates. Data will also be collected to improve understanding of the impact of HIV/AIDS on mortality, addressing a notable gap in data now available in Mozambique.

FY 2006 funds will support the in-country personnel needed for U.S. Agency for International Development (USAID), Health and Human Services (HHS), Department of State, Department of Defense, and United States Peace Corps. Funds will ensure program monitoring and accountability, ensure USG policy and technical leadership within the Mozambique national response, and cover compensation, logistics, and office and administrative costs.

In the May 2006 notification, an additional $1,255,600 was allocated for strategic information and policy and/or systems strengthening activities. The additional funds are needed to support one or two twinning projects for building NGO capacity for training nurses; complete renovations of a clinical teaching clinic dedicated to HIV care; strengthen NAC; enhance implementation of HIVQUAL Program; conduct formative research to design a response to alcohol and other substances abuse among vulnerable populations; and assist the development and implementation of Mozambique’s 2007 national census. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners: Ministry of Health, National AIDS Council, Ministry of Defense, JHPIEGO, Catholic University of Mozambique, Mozambican Federation of Business Associations-CTA, Johns-Hopkins University, Ministry of Women and Social Action, University of North Carolina-Carolina Population Center, Crown Agents, and New York AIDS Institute.

Other Donors, Global Fund Activities, Coordination Mechanisms:

Donors supporting HIV/AIDS efforts include the United Kingdom, Ireland, Sweden, Denmark, the Netherlands, Norway, Canada, the EU, World Bank, U.N. agencies, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Most provide resources through four Common Funds. The HIV/AIDS Partners Forum that supports the NAC and the Health Sector Wide Approach (SWAP) Working Group, which supports the MOH, facilitates coordination and harmonization of activities. The USG actively participates in these and chairs the SWAP HIV/AIDS Working Group. GFATM Country Coordination Mechanism is being reorganized to fit into existing structures to streamline management.

Program Contact:

Ambassador Helen R. La Lime and USAID Mission Director and Interagency Working Group Coordinator, Jay L. Knott

Time Frame: FY 2006 – FY 2007

Approved Funding by Program Area: Mozambique

August 2006 Operational Plan Main Page