Zambia Fiscal Year 2008 Country PEPFAR Operational Plan (COP)

ZAMBIA

Project Title: Zambia Fiscal Year 2008 Country PEPFAR Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs
	Notified November 2007			Notified February 2008			Notified as of February 2008	Allocations to Date
Implementing Agency	GAP	GHCS - State	Subtotal: Field Programs Funding	GAP	GHCS - State	Subtotal: Field Programs Funding	Subtotal: GHCS Central Programs	Grand Total:  Field & Central Funding
DOD	-		-	-	7,105,000	7,105,000	-	7,105,000
DOL	-		-	-	-	-	-	-
HHS	-	5,962,000	5,962,000	2,914,000	65,439,000	68,353,000	24,120,022	98,435,022
Peace Corps	-		-	-	3,888,100	3,888,100	-	3,888,100
State	-		-	-	1,570,000	1,570,000	-	1,570,000
USAID	-	14,700,000	14,700,000	-	126,421,342	126,421,342	10,212,530	151,333,872
TOTAL	-	20,662,000	20,662,000	2,914,000	204,423,442	207,337,442	34,332,552	262,331,994

HIV/AIDS Epidemic in Zambia:
Adults (aged 15-49) HIV Prevalence Rate: 17% (UNAIDS, 2006)
Estimated number of People Living with HIV: 1,100,000 (UNAIDS, 2006)
Estimated number of Orphans due to AIDS: 710,000 (UNAIDS, 2006)

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

Zambia	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of FY 2004*	300,300	13,600
End of FY 2005**	321,300	36,000
End of FY 2006***	467,700	71,500
End of FY 2007****	627,000	122,700
End of FY 2008*****	607,666	120,000
End of FY 2009*****	823,361	228,450

^* "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:

Zambia is facing a critical health, development, and humanitarian crisis. An estimated 15.6% of the adult population is infected with HIV; in a total population of 11.7 million people, 920,000 Zambian adults and children live with HIV/AIDS, and 98,000 lives are lost each year (UNAIDS, 2006). Women represent over half of those infected with HIV. In addition, it is estimated that over 50% of tuberculosis (TB) and HIV cases are co-infected with both diseases. The Government of Zambia (GOZ) estimates that the country has 1.2 million orphans, of which 801,000 are orphaned by AIDS.

In Zambia, HIV is primarily transmitted through heterosexual sexual activity and from mother to child; there are, however, clearly identifiable high risk groups that warrant special attention: HIV discordant couples; sex trade workers and their clients and partners; long distance truck drivers and bus drivers; migrant fish camp traders and agricultural workers; prisoners; refugees; and members of the military and police forces. HIV sero-discordant couples are estimated to make up 21% of all married couples. The strong relationships between gender inequality, alcohol and substance abuse, high risk sexual behavior, and sexual violence fuel the transmission of HIV. Those diagnosed with sexually transmitted infections are especially susceptible. Orphans and vulnerable children (OVC) are at risk of homelessness due to property grabbing by relatives, sexual exploitation, and physical abuse. Adolescent youth are also at risk, particularly girls aged 15-24 years, who are nearly twice as likely to be HIV positive as males in the same age group.

PEPFAR funding for FY 2008 will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $56,457,157 ($47,978,416 Field; $8,478,741 Central) (25.2% of prevention, care and treatment budget)

Prevention activities in Zambia include increasing access to quality prevention of mother-to-child transmission (PMTCT) services; promoting healthy behavior for youth through abstinence and faithfulness programs; encouraging fidelity among adults; improving blood and injection safety practices in health facilities; and providing counseling and testing services, condoms, and behavior change interventions including activities targeted at high risk populations to reduce HIV transmission.

Expanding and increasing prevention efforts will be a cornerstone of FY 2008 funding in Zambia. The USG will continue to improve the quality of existing PMTCT programs, fully integrate PMTCT with other maternal and child health services, and increase access to high quality PMTCT services, including in areas that serve military personnel. In addition, the USG will intensify prevention efforts with messages targeting youth, military, uniformed services, prisoners, and refugees. These activities will train individuals to promote a comprehensive ABC approach (abstain, be faithful, and correct and consistent use of condoms), targeting high-risk populations. Support will result in behavior change interventions and the establishment of condom outlets at targeted sites, reaching high risk groups such as HIV discordant couples, people in prostitution, police, military, refugees, victims of sexual violence, and prisoners. Blood and injection safety practices will be strengthened to prevent HIV transmission through transfusions and injuries. The USG will continue to provide Post Exposure Prophylaxis protocols and guidelines in all antiretroviral therapy (ART) sites.

Principal Partners: Academy for Educational Development, American Institutes for Research, Boston University, CARE International, Catholic Medical Mission Board, Chemonics International, Churches Health Association of Zambia, Cooperative League of the USA, Development Alternatives, Inc., Elizabeth Glaser Pediatric AIDS Foundation, Family Health International, International Youth Foundation, JHPIEGO, Johns Hopkins University, John Snow Research and Training Institute, Kara Counselling Centre, Luapula Foundation, Mothers 2 Mothers, Nazarene Compassionate Ministries, Pact Inc., Partnership for Supply Chain Management, Peace Corps Population Services International, Program for Appropriate Technology in Health, Project Concern International, Research Triangle Institute, Tulane University, United Nations Children’s Fund, United Nations High Commissioner for Refugees, University Teaching Hospital (Lusaka), , World Vision International, Zambia Ministry of Health (MoH), Zambia National Blood Transfusion Service

Care: $68,043,258 ($62,309,469 Field; $5,733,789 Central) (30.3% of prevention, care and treatment budget)

Care activities in Zambia include counseling and testing (CT), provision of basic health care and support, delivery of integrated TB/HIV services, and expanded programs supporting OVC.

In FY 2008, the USG will emphasize improving the quality of CT services and placing high priority on effective networks and referral linkages to other care and treatment services. Palliative care activities will reach HIV-positive individuals at service delivery sites by providing nursing/medical care, treatment of opportunistic infections, pain relief, nutritional supplements, psycho-social support, referral to ART and ART adherence programs, pediatric and family support, and training of caregivers and service providers. To address the high proportion of TB and HIV co-infection, the USG will continue to enhance the linkage between TB and HIV services. PEPFAR support will provide OVC with improved access to educational opportunities, provision of food and shelter, psychosocial support, health care, livelihood training, access to microfinance, and training for caregivers.

Principal Partners: American Institutes of Research, American International Health Alliance, CARE International, Catholic Medical Mission Board, Catholic Relief Services, Christian Aid, Columbia University Mailman School of Public Health, Cooperative League of the USA, Development Aid from People to People Zambia, Educational Development Center, Elizabeth Glaser Pediatric AIDS Foundation, Family Health International, HOPE Worldwide Zambia, JHPIEGO, John Snow Research and Training Institute, Johns Hopkins University, Kara Counseling Centre, Luapula Foundation, Nazarene Compassionate Ministries, Opportunity International, Partnership for Supply Chain Management, PLAN International, Population Services International, Project Concern International, Research Triangle Institute, Tulane University, United Nations High Commissioner for Refugees, University Teaching Hospital (Lusaka), World Concern, and World Vision International.

Treatment: $99,706,179 ($79,586,157 Field; $20,120,022 Central) (44.5% of prevention, care and treatment budget)

As of March 31, 2007, Zambia has 293 ART centers which are receiving USG support, either directly in the form of technical assistance or indirectly through procurements of ARV drugs and overall national system strengthening activities, with over 118,000 individuals receiving ART in the public sector. The USG will continue to collaborate with the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) to coordinate the purchase of antiretroviral drugs (ARVs) for the public sector. Through this collaboration, the Global Fund will purchase appropriate, approved first line regimens (comprised of generic ARVs), while the USG will procure second line ARVs, pediatric formulations, and one first line drug.

In FY 2008, the USG will continue to provide comprehensive ART services to public and private sector hospitals, clinic sites, and provincial and district public sector facilities. In addition to ART procurement, the USG will support comprehensive care and treatment services for infants and children; health care provider training on provision of quality ART services; strengthened effective service delivery networks and linkages; strengthened laboratory, logistics, and health information management systems; and implementation of ART adherence activities. Zambia’s human resource crisis will be addressed by supporting the MoH with human resource planning and management, hiring, and seconding key technical staff to provide HIV/AIDS service

Principal Partners: Abt Associates, Academy for Educational Development, American International Health Alliance, American Society for Microbiology, Catholic Relief Services, Chest Diseases Laboratory, Columbia Mailman School of Public Health, Elizabeth Glaser Pediatric AIDS Foundation, Family Health International, JHPIEGO, John Snow, Inc., Partnership for Supply Chain Management, Tropical Diseases Research Centre, Tulane University, University of Nebraska (Lincoln), University Teaching Hospital (Lusaka), World Vision International, and Zambia Ministry of Health.

Other Costs: $38,125,400

To promote sustainability, PEPFAR funding will support strategic information, policy analysis and systems strengthening, and management and staffing. FY 2008 funds will strengthen local health management information systems, expand use of quality program data for policy development and program management, upgrade quality assurance procedures, provide essential training and support, build the capacity of local partners to implement and sustain programs, provide technical assistance in developing sustainable monitoring and evaluation systems and information and communication technology.

The USG will expand policy and advocacy efforts to reduce stigma and discrimination within communities and in the workplace, encourage strong national and local leadership among traditional, religious, and political leaders, and increase financial and human resources for HIV prevention, care, and treatment services. Sub-grants and technical support will be provided to HIV-positive people’s networks and to community and national leaders for HIV/AIDS prevention, care, and treatment advocacy.

Principal Partners: Abt Associates, Academy for Educational Development, Catholic Relief Services, Central Statistics Office, Elizabeth Glaser Pediatric AIDS Foundation, JHPIEGO, John Snow, Inc., John Snow Research and Training Institute, Macro International, National Association of State and Territorial AIDS Directors, National HIV/AIDS/TB/STI Council, Partnership for Supply Chain Management, Project Concern International, Tropical Diseases Research Centre, University of North Carolina Chapel Hill, University of Zambia, U.S. Department of Defense, Vanderbilt University, Zambia Ministry of Health and Zambia National HIV/AIDS/STI/TB Council.

Management and staffing funds will support the in-country personnel needed for USAID, Department of Health and Human Services, State Department, Department of Defense, and the Peace Corps. Funding will support program monitoring and accountability, ensure USG policy and technical leadership within the Zambia national response, and cover compensation, logistics, and office and administrative costs.

Other Donors, Global Fund Activities, Coordination Mechanisms

To date, the Global Fund to Fight HIV/AIDS, TB, and Malaria has provided a total of $477.9 million to Zambia in Round One and Round Four funding, of which $346.5 million is for HIV/AIDS activities. Nearly half of the funds go through the MoH for public sector services, including $10.4 million of Round Four monies that will be used for ARV procurement. Other major donors working in the HIV/AIDS sector are the World Bank (whose Multi-Country HIV/AIDS Program is scheduled to close at the end of 2007) and UNICEF, as well as the British Department for International Development (DFID), which supports PMTCT, workplace prevention and treatment programs, condoms, and sexually transmitted infection drug procurement.

The USG shares the donor seat on the Global Fund Country Coordinating Mechanism and participates in the various national sector coordinating committees, national technical HIV/AIDS working groups, the UNAIDS Expanded Theme Group, and the GRZ Partnership Forum. The USG and DFID serve as the co-chairs in the UNAIDS Cooperating Partners on HIV/AIDS Group.

Program Contact: PEPFAR Coordinator, Cristina Garces

Time Frame: FY 2008 – FY 2009

Approved Funding by Program Area: Zambia