Mozambique FY 2007 Country Operational Plan (COP)

MOZAMBIQUE

Project Title: Mozambique Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of March 2007			Notified as of June 2007			Notified as of November 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding	GAP	GHAI	New Subtotal: Field Programs Funding	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	0	793,000	793,000	0	793,000	793,000	0	793,000
DOL	0	0	0	0	0	0	0	0
HHS	2,337,000	42,348,669	44,685,669	2,337,000	52,154,434	54,491,434	5,100,000	59,591,434
Peace Corps	0	1,339,720	1,339,720	0	1,339,720	1,339,720	0	1,339,720
State	0	832,667	832,667	0	1,030,467	1,030,467	1,500,000	2,530,467
USAID	0	64,251,375	64,251,375	0	93,085,175	93,085,175	4,649,920	97,735,095
TOTAL Approved	2,337,000	109,565,431	111,902,431	2,337,000	148,402,796	150,739,796	11,249,920	161,989,716

HIV/AIDS Epidemic in Mozambique:
Estimated Population: 19,792,000^*
HIV Prevalence rate: 16.1^*
# of HIV infected: 1,800,000^*
Estimated # of OVCs: 510,000^*¥
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
^Prevalence is in adults only (15-49 years)
^¥Orphans aged 0-17 due to AIDS

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****	460,000	93,990
End of FY 2008****	580,000	123,000

^*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
^***Results. “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
^****FY 2007 Country Operational Plan targets

Program Description:

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 use 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 about 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 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 initiation of the President’s Malaria Initiative in Mozambique in FY 2007 will provide complementary resources that will link to this USG program.

Additional Funding: In June 2007, an additional $15,500,000 was allocated to significantly strengthen PMTCT, TB/HIV, pediatric AIDS and medical male circumcision efforts. Additional funding will expand and support improved quality of services for the targeted program areas in the new provincial focus areas, Sofala and Zambezia.

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

Prevention: $38,281,803 ($34,483,878 Field and $3,797,925 Central) (27.4% 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 with condoms and other prevention measures, and (4) ensure blood, biomedical, and injection safety. PMTCT sites will provide referral to nearby treatment and support programs to ensure successful antiretroviral therapy (ART) 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 fiscal year 2007, the USG will continue technical support for coordination, policy oversight, and updating of national guidelines and training materials on PMTCT.

With fiscal year 2007 funds, the USG will strengthen efforts to promote abstinence and delay sexual debut among youth, and reduce multiple partnerships and promote fidelity among adults in committed relationships. These AB activities will promote more equitable gender norms and behaviors, including reduction in gender-based violence and coercion. Partners will 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 fiscal year 2007, technical assistance and training will focus on implementing a standards-based approach for infection prevention and control. Injection safety technical assistance will expand to new health facilities, and additional Mozambican health workers will be trained to support injection safety.

With fiscal year 2007 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.

Principal Partners: MOH, Health Alliance International, Population Services International, Food for the Hungry, World Vision, Columbia University, National AIDS Council, Foundation for Community Development, Johns Hopkins University, Family Health International, JHPIEGO, Elizabeth Glaser Pediatric AIDS Foundation, Project HOPE, World Relief, Samaritan’s Purse, Academy for Educational Development, Constella Group, and International Broadcasting Bureau.

Care: $39,537,920 ($36,585,925 Field and $2,951,995 Central (28.3% of prevention, care and treatment budget)

The USG will build on the achievements of the last three 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 fiscal year 2007, local CBOs and FBOs will continue to receive training and mentoring to strengthen their operations and monitoring capacity. With fiscal year 2007 funds, USG partners will 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. 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 fiscal year 2007, USG resources will help complete the transition to an opt-out approach for HIV counseling and testing (CT) in the clinical setting, with an emphasis on integrating CT services in TB clinics, youth-friendly health services, and antenatal clinics. The quality-control program will be rolled-out to all provincial capitals and HIV test-kit distribution will be integrated into the national distribution system with USG technical assistance.

In fiscal year 2007, USG-funded technical assistance will strengthen the integrated TB/HIV program by implementing TB drug resistance surveillance and treatment, improving TB laboratory services, and introducing an electronic TB register. All USG-funded ARV treatment partners will provide a minimum package of TB/HIV services including TB case finding and ART initiation in TB clinics. USG funding will also support TB treatment for HIV-infected clients.

Principal Partners: MOH, Ministry of Women and Social Action, Health Alliance International, World Vision, CARE, World Relief, Columbia University, JHPIEGO, Foundation for Community Development, World Food Program, Partnership for Supply Chain Management, Family Health International, Health Alliance International, and Population Services International.

Treatment: $62,048,143 ($57,548,143 Field and $4,500,000 Central) (44.4% of prevention, care and treatment budget)

In fiscal year 2007, the USG will provide technical assistance and training to strengthen pharmaceutical logistics information and control systems to ensure a reliable supply of ARV drugs for all sites delivering treatment services. Fiscal year 2007 funds will procure FDA-approved ARV drugs, including those for adults on second-line treatments, adults with TB/HIV co-infection, and infants and children on first and second-line pediatric ARV formulations.

Fiscal year 2007 funds will enable USG partners to support ARV treatment, 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 three regional pediatric reference centers, and will initiate or expand pediatric ARV treatment at all USG-supported ARV treatment sites. Fiscal year 2007 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 ARV treatment program in fiscal year 2007. Additional Mozambican technicians will receive training to manage and supervise the CD4, T-cell 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, and World Vision.

Other Costs: $22,121,850

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. Fiscal year 2007 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 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.

Principal Partners: MOH, National AIDS Council, JHPIEGO, American International Health Alliance, Johns Hopkins University, University of Washington, Abt Associates, Academy for Educational Development, and Catholic University of Mozambique.

The USG will support strategic information activities that improve Mozambique’s capacity to measure and interpret the impact of HIV/AIDS on the population. In fiscal year 2007, the USG will provide technical assistance and local cost support to conduct a post-census mortality survey that will provide statistics on the number and causes of deaths, including HIV. A Knowledge, Attitudes and Practices survey of health care workers and an HIV seroprevalence survey among the military and peacekeeping troops will also be conducted. 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, National AIDS Council, Ministry of Women and Social Action, University of North Carolina-Carolina Population Center, U.S. Bureau of Census, Constella Group, and New York AIDS Institute.

Fiscal year 2007 funds will support the in-country personnel needed for USAID, HHS, State, and Peace Corps. Funds will ensure program monitoring and accountability, 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 these and chairs the SWAP HIV/AIDS Working Group. The Global Fund Country Coordination Mechanism is being fit into existing structures to streamline management.

Program Contact: PEPFAR Coordinator Linda Lou Kelley

Time Frame: Fiscal year 2007 – fiscal year 2008

Approved Funding by Program Area: Mozambique