DRC INTEGRATED HIV/AIDS PROJECT

PROJET INTEGRE DE VIH/SIDA AU CONGO (PROVIC) SEMI-ANNUAL REPORT

March 2010

This publication was produced for review by the United States Agency for International Development. It was prepared by the PATH Consortium.

DRC INTEGRATED HIV/AIDS PROJECT

PROJET INTEGRE DE VIH/SIDA AU CONGO (PROVIC) SEMI-ANNUAL REPORT

Contract # GHH-I-00-07-00061-00, Order No. 03

The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

LIST OF ACRONYMS AIDS Acquired Immune Deficiency Syndrome AMITIE AIDS Mitigation Initiative to Enhance Care and Support in Bukavu, Lubumbashi and Matadi AMO Congo Avenir Meilleur pour les Orphelins au Congo ART antiretroviral therapy BDOM Bureau Diocésain des Oeuvres Médicales BCC behavior change communication C-Change Communication for Change CIELS Comité InterEntreprise de Lutte contre le Sida CCLD/Midema Corporate Commitment for Local Development/Minoterie de Matadi DRC Democratic Republic of Congo DIVAS Division des Affaires Sociales ECC Eglise du Christ au Congo EU European Union GTZ German Technical Cooperation HCT HIV counseling and testing HIV human immunodeficiency virus HMIS Health Management Information System(s) IHP DRC Integrated HIV/AIDS Project IR intermediate result M&E monitoring and evaluation MARP most at-risk populations MINAS Ministère des Affaires Sociales MONUC Mission des Nations Unies au Congo MSH/SPS Management Sciences for Health/Strengthening Pharmaceutical Systems MOH Ministry of Health MOPH Ministry of Public Health NGO nongovernmental organization OVC orphans and vulnerable children PEPFAR US President’s Emergency Plan for AIDS Relief PALS/FARDC Programme de l’Armée de Lutte contre le Sida/Forces Armées de la RDC PLWHA people living With HIV/AIDS PMEP Performance Monitoring and Evaluation Plan PMILS/PNC Programme du Ministère de l’Intérieur de Lutte contre le Sida/ Police Nationale Congolaise PMTCT prevention of mother to child transmission PNLS Programme National de Lutte contre le SIDA PNMLS Programme Nationale Multi-Sectorielle de Lutte contre le SIDA PSI/ASF Population Services International/ Association Santé Familiale TB tuberculosis

UCOP+ Union Congolaise des Organisations des Personnes Vivant avec le VIH UNC University of North Caroline UNFPA United Nations Fund for Population Activities UNHCR United Nations of High Commission Refugees UNPC Union Nationale de la Presse Congolaise TOT training of trainers USAID United States Agency for International Development USG United States Government WHO World Health Organization WFP World Food Programme

The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

TABLE OF CONTENTS

EXECUTIVE SUMMARY ...... 1

INTRODUCTION ...... 2

SECTION I. OVERVIEW AND GENERAL CROSS-CUTTING ISSUES ...... 3 Overall progress toward results ...... 3 Planning ...... 3 Administration ...... 3 Project monitoring and evaluation...... 4 Grants management ...... 7

SECTION 2. REPORTS BY TECHNICAL COMPONENT ...... 9 HIV counseling and testing and prevention services expanded and improved ...... 9 PMTCT services improved...... 11 Care, support, and treatment for people living with HIV/AIDS and for orphans and vulnerable children improved in target areas...... 14 Strengthening of health systems supported...... 16

ANNEX A. SITES SELECTED TO DATE ...... 18

ANNEX B. TRIP REPORTS ...... 19

ANNEX C. FINANCIAL REPORTS ...... 29

ANNEX D. PARTNER AND COLLABORATION MATRIX ...... 30

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 vi

EXECUTIVE SUMMARY The purpose of the Democratic Republic of Congo (DRC) Integrated HIV/AIDS Project (Project Integré de VIH/SIDA au Congo; PROVIC) is to reduce the incidence and prevalence of HIV and mitigate its impact on people living with HIV/AIDS (PLWHA) and their families.

The first six months of project implementation was dominated by start-up activities. This included developing the initial work plan and performance monitoring and evaluation plan (PMEP) as well as the PEPFAR country operational plan and grants management manual. The project also opened offices in Kinshasa, Lubumbashi, Matadi, and Bukavu and hired all but a few open positions. To build the partnerships that will ensure success, the project team held numerous consultative meetings with other groups, sharing the project’s vision and strategy as well as looking for opportunities for collaboration.

To continue some services offered under previous projects, PROVIC issued a series of bridge grants to maintain HIV counseling and testing (HCT) services and support for PLWHA and orphans and vulnerable children (OVC). These bridge grants will maintain services for vulnerable populations while PROVIC establishes its own request for application (RFA) for the new grants program.

In addition, the project team carried out a needs assessment to determine the current status of activities in the four intervention areas. The findings have informed project site selection and the development of intervention approaches.

During this first six months, PROVIC has built a solid foundation for successful project implementation. This work will bear fruit in the coming months through the achievement of project results that prevent HIV/AIDS and support those who are infected.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 1 INTRODUCTION The purpose of the Democratic Republic of Congo (DRC) Integrated HIV/AIDS Project (Project Integre de VIH/SIDA au Congo; PROVIC) is to reduce the incidence and prevalence of HIV and mitigate its impact on people living with HIV/AIDS (PLWHA) and their families. We will achieve this objective by improving HIV/AIDS prevention, care, and treatment services in the selected areas; increasing community involvement in health issues and services beyond facility-level services through sustainable community-based approaches; and increasing the capacity of government and local civil-society partners (and thus empowering new local organizations) to plan, manage, and deliver high-quality HIV/AIDS services.

PROVIC was awarded in October 2009 to a consortium led by PATH. Partners include Chemonics International, Catholic Relief Services (CRS), the Elisabeth Glazer Pediatric AIDS Foundation (EGPAF), and the International HIV/AIDS Alliance (IHAA). The consortium initiated rapid project start-up in October 2009, completing the year 1 work plan by October 30 and the project monitoring and evaluation plan (PMEP) by the end of November. The team opened offices in all four project sites—Kinshasa, Bukavu, Matadi, and Lubumbashi—and hired most of the required project staff. Led by Chief of Party Mbella Ngongi, the team spent the first six months laying the groundwork for successful project implementation by developing relationships with partners, conducting site visits in the four provinces to establish needs and collect baseline data, and issuing the bridge grants to previous partners whose services needed to be continued in the short term.

Section 1 of this report describes the general and cross-cutting activities, including grants and monitoring and evaluation (M&E), and details the accomplishments of the administrative start-up. Section 2 details technical activities by component: accomplishments, challenges and solutions, and plans for the coming six months. Annexes include details on sites selected, trip reports, financial information, and the partner matrix developed so far.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 2

SECTION I. OVERVIEW AND GENERAL CROSS- CUTTING ISSUES

Overall progress toward results In the first six months we have been principally in startup mode; setting up 4 offices, recruiting staff, building partnerships, and laying the groundwork for project activities. As such, and since the M&E plan and related indicators have yet to be finalized, we are not specifically reporting on results in this first semi-annual report. However, we have achieved several critical benchmarks to date, such as conducting a needs assessment and baseline analysis, identifying target geographical zones, setting up our grants mechanisms, developing the PMEP, establishing MOU’s with strategic partners, etc. which inform our progress toward project objectives. These are discussed in greater detail throughout the body of this report in their appropriate sections.

Planning Start-up workshop and stakeholder consultation . Within two weeks of contract award, PROVIC organized a start-up workshop and stakeholder consultation to design the year 1 work plan. Project staff, consortium members, local partners, and other key stakeholders were invited to participate in the weeklong event to discuss the project’s core objectives and implementation of activities. A week after the workshop, the PROVIC team successfully developed a detailed work plan document that was submitted to USAID.

Work plan update . In March 2010, the team conducted a second workshop and stakeholder consultation to review the work plan and update it for the rest of the year. The workshop was highly participatory and included staff from government agencies, local organizations, other USAID projects, and donors. The workshop also included the full project team from all four regions. The result of the workshop is this updated work plan.

Administration Summary of Activities and Achievements Administrative start-up . A team from the Chemonics home office traveled to the DRC during October and November 2009 to open the headquarters office in Kinshasa and three satellite offices in Bukavu, Lubumbashi, and Matadi. The start-up team procured office space for the headquarters office at a central location; opened a bank account; and worked with a local facilitator to identify reputable vendors and seek quotations for office make-ready, internet and network installation, office and IT equipment, and vehicles. The start-up team also worked closely with a local labor lawyer to draft an employment agreement to hire local staff in accordance with DRC labor laws. This process required a number of in-depth conversations with the local labor lawyer, who provided useful guidance on issues ranging from what benefits were required to how employment agreements needed to be registered with the government.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 3 Recruitment. The start-up team worked on recruitment of remaining open positions by placing ads, reviewing CVs, interviewing shortlisted candidates, checking references, and communicating offers to top candidates. As of March 2010, the project is nearly fully staffed, with fully operational teams working in all four regions.

Establishment of project financial systems . The Finance and Administrative Director and the local team have been working to establish strong financial management procedures that ensure compliance with USAID regulations and transparent accountability for project funds. All four project accountants and office managers were trained by a Chemonics field accounting specialist in the use of financial accounting software and in the required practices for accounting for project funds.

Problems Encountered and Proposed Solutions The slow and bureaucratic process required to register a project in the DRC delayed the hiring process and hindered consortium members’ ability to establish their presence in the country by opening bank accounts, shipping effects, and undertaking other essential activities. This process has improved with the completion of preliminary registration steps, and many of these actions should move forward now.

Anticipated Activities/Plans for Next Six Months Over the next six months, the project will complete recruitment for the remaining positions—including a community mobilization specialist and some regional M&E and grants positions. The project will also complete the rest of the administrative steps needed to set up offices. This will include establishing a server and project internet address, as well as completing the partitioning of the offices and the remainder of the purchases.

Project monitoring and evaluation Summary of activities and achievements PROVIC’s M&E is reliant on collecting, analyzing, and sharing existing data, and developing indicators that are fully harmonized with both USAID and national and sub- national counterparts. From discussions with stakeholders and early evaluations, a key obstacle for the project is the lack of reliable and consistent M&E data that are available in real time. To that end, we have proposed a series of activities that will help the project gather critical data and establish a collaborative structure to gather, analyze, and share M&E data that are both generated by PROVIC activities and sought by our project team from other implementing partners. Below are some of the key M&E-related activities PROVIC has conducted to date.

Year 1 PROVIC work plan developed . Covering October 2009 to September 2010, this work plan provides detailed descriptions for technical activities to be completed under each intermediate result. The work plan was approved for a six-month period, and a revised version was developed and submitted at the end of March 2010.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 4

Performance Monitoring and Evaluation Plan (PMEP) developed . The PMEP is a tool that articulates the project’s approach to ongoing systematic M&E throughout the lifecycle of the project. It includes targets of key PEPFAR indicators and the data flow scheme. During the designing of PMEP, PNMLS and PNLS were involved to make sure national indicators were integrated into the project reporting system. The reporting and feedback system between different partners was identified and the flow of M&E data was illustrated.

Country Operational Plan (COP) developed . This is the document for the request for funding for the PEPFAR program. It includes activity description and targets of PEPFAR indicators. Ms Ndagano met with PEPFAR/CDC-DRC/SI focal points and the COTR (Contracting Officer’s Technical Representative) to present project targets of PEPFAR indicators during the designing of the COP.

Orient national and provincial stakeholders to project M&E. Since November 2009, the project team, led by the Chief of Party and Deputy Chief of Party and technical leads, have been working with key national and provincial stakeholders, including PNLS, PNMLS, PNSR (the Ministry of Health National Reproductive Health Program), PNT (the Ministry of Health National Tuberculosis Program), PRONANUT (the Ministry of Health National Nutrition Program), health zones, and implementing partners, to orient them to the project.

Baseline assessments conducted. Between January and March 2010, technical leads conducted baseline assessments to identify the basic situation in terms of health, demographic, and administrative data in the existing health facilities and health zones for potential intervention by PROVIC in Bukavu, Kinshasa, Lubumbashi, and Matadi. The quantitative and qualitative data gathered relating to PMTCT, HCT, and care and support helped the team better understand specific gaps or areas where more reliable data is needed to identify the project’s sites and estimate targets.

The quantitative guide (questionnaire) was developed to include questions for PMTCT providers, Responsible Officers for PNLS at the provincial level, pregnant women, and men and women in the community in general. The qualitative survey was conducted from March 3–11, 2010 in the four PROVIC areas: Katanga, Sud Kivu, Kinshasa, and Matadi. We are now entering data and analysis is ongoing. The qualitative survey was influenced by the quantitative data. A detailed report is being completed.

The team conducted focus group discussions for health service providers and members of the communities (women and men), as well as in-depth interviews with those responsible for health zones, the PNLS provincial coordinator, and provincial nurse supervisors. The guides (questionnaires) were adapted to the targets and related to the challenges found during the quantitative assessment.

This exercise also enabled us to determine the management capacities available in the intermediary structures (provinces, districts) in terms of supervisory staff, and health care providers in the health zones in terms of planning, monitoring, supervision, and

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 5 coordination of integrated activities pertaining to HIV/AIDS control. It also helped us identify partners and the types of intervention needed in order to secure synergy in the HIV/AIDS activities in a given health zone. The findings have helped inform the revisions to the work plan and PMEP, and a detailed report will be available in April 2010.

Aligned M&E collection and reporting with USAID implementing partners. We have been creating linkages between the project’s M&E objectives and those of the partner organizations. M&E tools have been collected from our partners including PNLS, PMLS, health zones, and potential implementing partners for harmonization, and Ms. Ndagano is working with specific M&E counterparts to vet project indicators, facilitate the exchange of pertinent baseline data, and identify synergies between the project M&E system and those of national and sub-national organizations to identify the best and most efficient methods of collecting, analyzing, and exchanging data.

Technical Workshop held. Meeting the PMEP targets will depend heavily on developing strategic collaborations with stakeholders and partners. In March, PROVIC conducted a four-day workshop to bring partner agencies and organizations together, including USAID implementing partners, to review PROVIC’s objectives and identify areas for collaboration. The discussions helped complete PRIVIC’s partnership framework and harmonize the project’s planned activities with those of our partners. The work plan was revised accordingly to reflect these synergies.

Problems encountered and proposed solutions The following challenges were encountered during this reporting period: • The implementation of activities took longer than expected to start due to the delay in issuing bridge grants to implementing partners. As a result, the target indicators for year 1 have had to be adjusted, and we have done this in collaboration with USAID. • There was a poor availability of data during the needs assessment in Kinshasa. Much of the data (e.g., for PMTCT) was missing at the PNLS provincial level. Some data was not desegregated which made analysis difficult for some sites, and the data collection tools were different at facilities and health zones, making the harmonization of data at the site level challenging. ProVIC will be working with these entities to build their capacity with data collection, so this challenge will be addressed through the course of the project. • The recruitment of M&E staff at the regional level has been challenging due to the salary caps found in the contract for these positions. The salary range for regional M&E officers was underestimated in the proposal budget, and identifying qualified personnel to fill these positions under the salary caps is proving difficult. We have discussed this with USAID’s CO and COTR, and anticipate that we may request approval to exceed these salary caps to attract appropriately qualified candidates.

Anticipated activities/plans for the next six months PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 6

The following M&E activities are anticipated to occur in the next six months: • Provide harmonized M&E data collection tools to implementing partners. • Build capacity at local levels in M&E. • Support M&E reporting systems. • Technical assistance support provided to MINAS.

Grants management Summary of activities and achievements PrOVIC conducted a workshop in December 2009 to introduce organizations that previously received funding from Family Health International (FHI) and Catholic Relief Services (CRS) to the PrOVIC grants program and to establish grants for continuation of activities. This five-day grants application workshop for select participants enabled them to successfully apply for PrOVIC bridge funding for the continuation of their services. The participants included representatives from HCT centers that were supported by FHI under the USAID-funded predecessor project and select PLWHA and OVC beneficiaries that were supported by CRS under the same predecessor project.

Two to four representatives from each of the following organizations attended the workshop: • Corporate Committee for Local Development (CCLD) Midema – Matadi • BDOM Codilusi – Lubumbashi • World Production – Lubumbashi • AMO-CONGO – Kinshasa, Lubumbashi (Kasumbalesa), Matadi • HGR Kenya – Lubumbashi • HGR Nyatende – Lubumbashi • HGR Kiamvu – Matadi • Centre de Sante Mvuzi – Matadi • World Vision International in DCR – Bukavu, Kinshasa, Lubumbashi • HGR Panda – Lubumbashi (Likasi) • Femme Plus – Bukavu, Kinshasa • Eglise du Christ au Congo/Sante en milieu Rural (ECC/SANRU) – Matadi

Each organization produced an application and the Grants Evaluation Committee scored the applications with each one receiving at least the acceptable minimum score of 75 points. However, after discussions and negotiations with the Grants Evaluation Committee, all organizations were asked to revise their budgets to better reflect a continuation—not an expansion—of their FHI and/or CRS grant-funded work under the predecessor project. This exercise took considerable time and repeated explanations emphasizing PrOVIC intentions to, at least initially, provide funding for only the continuation of existing activities.

To date, eight grants have been presented for approval and we have received CO approval for all but one. We are awaiting approval for the CCLD Midema grant. After receiving grant applications from the HGRs and the Centre de Sante Mvuzi and

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 7 evaluating their capacity to manage grant funds, we came to the conclusion that supporting these groups though the grant program is not practical. Instead, we will support the HGRs and Mvuzi through a system of direct in-kind procurement.

In late January, a two-week short-term assignment was conducted to provide support to the PrOVIC team to prepare the program’s first Request for Applications (RFA)/Program Statement to solicit Grants Applications. After preparing an outline of the RFA following ADS 303 guidelines, group and individual discussions were conducted with each of the technical component teams, the chief of party, and the technical director. These discussions helped identify strategies to emphasize and communicate in the RFA and Public Notice. The discussions also helped the team to better understand their roles and responsibilities in the grants process. The RFA was recently finalized and approved and we expect to publish in the local media by the end of March or early April.

Problems encountered and proposed solutions • The transition in funding between AMITIE and the new bridge grants has been challenging for the implementing partners. Although bridge grants are used to expedite issuing funding to pre-identified partners. These still go through a rigorous review and approval process which partners and staff may not have anticipated. As a result, there is a perception that these were significantly delayed. Managing expectations has been a challenge here.

• There were also actual delays with the bridge grants. These typically are issued within three to four months from project inception, yet in this case they took five months, which delayed the start of some activities. Part of the reason is that the original budgets submitted by partners were significantly higher than the funding they’d received to date. Several weeks were spent negotiating budgets down and realigning expectations that these bridge grants were to ensure the continuation, not expansion, of activities that had been funded by AMITIE. The approval process also took over five weeks which was longer than anticipated.

Anticipated Activities/Plans for the Next Six Months The next six months will see significantly expanded activity in the PrOVIC grants program. In addition to working with the recently approved grantees to monitor and evaluate their activities, we will move forward with supporting the HGRs through direct procurement. We will also complete the process of evaluating concept papers received resulting from the RFA and invite applications from selected groups.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 8

SECTION 2. REPORTS BY TECHNICAL COMPONENT In this section, we explain activities completed according to each project technical component, challenges, progress toward results, and plans for the next six months.

HIV counseling and testing and prevention services expanded and improved Summary of activities and achievements During the first six months of this project, HIV counseling and testing (HCT) and prevention activities were centered around providing continuity in technical support to previous HCT partners from Family Health International (FHI). In addition, the PROVIC project also began to develop relationships and contacts with partners that will be invaluable in moving forward with implementation. Major activities from this period are summarized below.

Development of relationships with partners . The HCT/Prevention Specialist has contacted several partners and stakeholders focusing on HIV/AIDS prevention. Over the past six months, PROVIC staff have contacted PNLS to ensure national coordination and to discuss potential support for the Matonge Center and its activities to treat and educate commercial sex workers about sexually transmitted infections (STIs). They also met with PNMLS to discuss national coordination, PSI/ASF to plan joint field visits to coordinate activities, and with FHI to gain feedback on previous activities. This information allowed PROVIC to contact supported sites and understand the progression of activities in the field.

Issuance of bridge grants . Bridge grants to HCT partners were negotiated in December 2009 and issued in March 2010 immediately after receiving USAID approval. Grants were issued to two grantees in Bukavu, two in Lubumbashi, three in Matadi, and one in Kinshasa. Grantees have included health facilities, nongovernmental organizations (NGOs), and community-based organizations.

Assessment of commodities situation . After targets were agreed upon with the HCT grantees, the PROVIC team faced the challenge of determining how to source commodities necessary for HCT. The team put together a framework to determine the need for test kits and other commodities in HCT centers. This framework was sent to each of the regional coordinators, who then worked with local organizations to ground- truth their actual needs. The regional coordinators then carried out a forecasting exercise. The team in Kinshasa coordinated the overall process and drafted a commodities and inputs plan for three months. The first round of kits has been procured, and a more detailed commodities plan is being developed.

HCT site supervision. The ten HCT sites were supervised by provincial teams. Supervision consisted of providing technical assistance to partners in the field, assisting

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 9 them in achieving results, improving the quality of services, and improving their method of data collection. It also presented a clearer picture regarding the progression of field activities and how to correct gaps with respect to HCT norms.

Site selection and needs assessment . To work more effectively in the field, the PROVIC team developed a qualitative and quantitative needs assessment to gather information on existing HCT structures and organizations in project intervention zones. In conjunction with leaders of partner organizations, PROVIC staff developed the questionnaire and sent it to the provinces for data collection on potential structures. Data were collected in 28 sites in three provinces—9 around Matadi, 10 around Lubumbashi, and 9 around Bukavu. Data were not collected for Kinshasa because the project is not building on past activities there.

A qualitative assessment was also undertaken using a separate questionnaire on the quality of offered services and problems encountered at HCT sites in the four cities. Collection of information began in March and is ongoing. Combining data from both the qualitative and quantitative studies, the team has created a preliminary list of “zones de santé” and sites where we expect to work. Based on field visits and the results of the needs assessment, the team has selected the public-sector facilities that will be supported by the project for integrated HCT services, using the approach Provider Initiated Counseling and Testing (PICT). These sites are listed in Annex A.

The needs assessment gathered data through focus groups with service providers of HCT and with beneficiaries (those tested). Following that, we interviewed key figures at PNLS and PNMLS. Difficulties included the following: • Poor functioning of the reference and counter-reference systems for positive-tested clients even though the tools are available; also, no involvement by care and support structures or the private sector. • Frequent stock-outs of supplies, including tests and other inputs for HCT. • Poor involvement by health zone staff in supervision of HCT sites. • Lack of confidentiality in certain HCT sites. • Lack of communication materials on the importance of testing at the community level and at care facilities. • Poor coordination of HCT activities with PNLS and PNMLS. • No involvement of PLWHA in HCT activities. • Stigmatization of clients at community-based HCT. • Limited access to treatment services (especially antiretroviral therapy [ART]) and laboratory follow-up. • Frequent changes in staff trained in HCT. • Lack of motivation of service providers.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 10

Problems encountered and proposed solutions In the first six months, the team encountered several challenges, which are outlined below along with the proposed solutions: • Disruptions in financing and inputs to HCT sites have been challenging. The project is putting in place a good procurement and distribution system for the necessary inputs for HCT by identifying local and international suppliers. • To date, there has been poor coverage of community-based and mobile HCT in the potential intervention sites. There has also been a lack of coordination and support from health authorities for staff in the community and mobile HCT centers who don’t report to the zones de santé. The project will strengthen the capacity of teams in the zones de santé where the project is working to better cooperate with civil society organizations. • Structures for reference and cross-reference testing are not working well, even though the tools are available. The project will strengthen the reference and counter-reference systems for those who test positive and involve the public, private, and community sectors. • HCT centers are not adapted to the needs of confidentiality and struggle with transient testing staff at the community and mobile HCT centers. These issues will be considered as the project evaluates new grantees.

Anticipated activities/plans for the next six months The main activities for the next six months include: • Conduct further discussions with PSI and C-Change to plan methods for collaboration and review their available materials and services. • Adapt the champion community strategy to the Congolese context and the goals of the project. • Perform follow-up supervision of grantees implementing HCT activities. • Continue the evaluation of HCT services and determine gaps to be filled and capacity needs to be addressed. • Continue to identify international and national suppliers of commodities and develop a procurement plan for inputs. • Organize training of trainers for HCT testing staff in all provinces.

PMTCT services improved Summary of activities and achievements Participation in national-level consultations. PROVIC staff engaged many national partners in discussions on issues relevant to prevention of mother-to-child transmission (PMTCT). These included consultations on supply chain management for PMTCT, discussions with PNLS on implementation of the revised WHO recommendations, training sessions on updating the national PMTCT providers manual, and meetings with the Clinton Foundation to discuss collaboration on pediatric HIV/AIDS.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 11 Site selection and needs assessment. In coordination with the needs assessment discussed in the HCT section, a PMTCT assessment was conducted to identify potential PMTCT sites and to collect both quantitative and qualitative data. In the two provinces where PROVIC overlaps with the AXxes project (Katanga and Sud Kivu), the team focused on the health zones where AXxes is working. For selection of other health zones and facilities, PROVIC considered the accessibility of the site, the proximity to one of the targeted cities, accessibility for follow-up, integration of antenatal care (ANC) activities and maternal and child health (MCH) services in general, and integration of PMTCT activities into ART or STI treatment. PROVIC will implement PMTCT activities in 16 PMTCT sites and provide technical assistance to 8 AXxes sites in a total of 17 health zones as listed in Annex A.

The quantitative and qualitative survey data were collected by the provincial PNLS staff, PNMLS, and PROVIC provincial staff. The assessment covered 89 facilities from 23 health zones; 29 facilities in Katanga, 29 in Bas Congo, 24 in Sud Kivu, and 12 in Kinshasa. We included 18 AXxes sites among the 89 sites. Forty-four facilities (49 percent) were public, 30 (34%) were faith-based, 12 (13 percent) were private, and 3 (3 percent) were supported by NGOs. The team used the criterion of having at least 500 ANC visits a year to preselect potential PROVIC PMTCT sites. We also took into account the amount of support from other partners for each facility. We subsequently preselected 38 sites and discussed these with PNLS and the health zone Responsible Officers to narrow the list to 24 sites (15 non-AXxes and 9 AXxes sites). The proportion of pregnant women who tested HIV-positive at these sites ranges between 0.9 percent and 2.6 percent.

The main gaps we found based on the quantitative data were as follows: • The proportion of pregnant women tested and informed of their HIV test result was between 48 percent and 86 percent. • The proportion of HIV-positive pregnant women delivering in the PMTCT health facility was low, ranging from 12 percent to 48 percent. This means that most of the HIV-positive women deliver elsewhere, maybe in non-PMTCT sites. • Male participation in PMTCT and HCT during PMTCT is in general very low, between 0.8 percent and 2.4 percent. This is expected to have a negative impact on the PMTCT intervention uptake. • ARV uptake for PMTCT is low for mothers and infants. It ranges from 30 percent to 82 percent for mothers and from 13 percent to 47 percent for infants. • Infant diagnosis is very low: 0 percent for early-infant diagnosis and about 5 percent for diagnosis within 18 months of age.

The qualitative guide was developed to include questions for PMTCT providers, Responsible Officers for PNLS at the provincial level, pregnant women, and men and women in the community. Twelve focus group discussions were conducted for 37 PMTCT/ANC health service providers; eight were conducted for 48 pregnant women at ANC/PMTCT, including 7 HIV-positive pregnant women; and four were conducted for PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 12

25 community members (women and men). In-depth interviews were also conducted: three for those in charge of health zones, two for the PNLS provincial coordinators, and one for a provincial AXxes nurse supervisor in south Kivu. The guides were adapted to the targets and related to the challenges found during the quantitative assessment. We are analyzing the data, and a detailed report will be made available in April 2010.

Mapping exercise. Under this activity, PROVIC started working with PNLS and the Clinton Foundation to collect data regarding the pediatric care and treatment sites in the provinces in which PROVIC will be working. We received from PNLS the previous mapping, which showed PMTCT, adult care and treatment, and pediatric care and treatment sites in-country. We are now working with the PNLS provincial coordinators to update this mapping, which was done in 2008. The Pediatric Specialist will visit most of the pediatric sites to establish the collaborative framework with these sites for infant care and treatments in the PROVIC areas.

Problems encountered and proposed solutions • Poor availability of data during the needs assessment in Kinshasa was a challenge. Most of PMTCT data were missing at the PNLS provincial level. Some data were not desegregated, which made things difficult to analyze at some sites. Also, the PMTCT data collection tools were different at facilities and health zones. This made it difficult to harmonize data at the site level. The project will have to collect its own data over time. • The project is still working on identifying partners or sources for medicines and lab analysis such as CD4 counts and other lab tests for ARV eligibility. • In Bas-Congo, all the PMTCT sites in Matadi or Boma are supported either by UNICEF or by GTZ. Most of the partners supporting the PMTCT sites are located in the town, and the rural PMTCT sites are neglected by the partners because of lack of accessibility. Therefore, PROVIC will support PMTCT in sites outside Matadi town.

Anticipated activities/plans for the next six months Planned activities to promote PMTCT over the next six months include: • Assessing of the state of PMTCT in DRC compared to international best practices. • Mapping of both AXxes sites and other public, private, faith-based, or other community-based sites. • Developing capacity-building plans for improving PMTCT that will be delivered by trainers from provincial PNLS, Program National de Sante de Reproduction (PNSR), and health zone management teams through a cascade training approach. • In collaboration with a gender and family planning consultant, ensuring gender approaches are integrated into PMTCT strategies. • Working with commodities specialists and other partners to determine a strategy for assuring the flow of commodities to PMTCT sites.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 13 Care, support, and treatment for people living with HIV/AIDS and for orphans and vulnerable children improved in target areas Summary of activities and achievements In the first half of the year, care and support activities focused on ensuring continuity of services at the former AMITIE partners as well as conducting consultations around defining a new care and support package for people living with HIV/AIDS (PLWHA) and orphans and vulnerable children (OVC).

Bridge funding for AMITIE grantees . To ensure continuation of services for PLWHA and OVC, PROVIC invited all former AMITIE partners to attend a workshop to help them develop new proposals and budgets for a period of bridge funding. The PROVIC team has established targets and expected results with each grantee based on the PMEP indicators and the authorized budget. The five grantees have begun implementing activities according to the new grant and will continue until the new RFA for activities is released, evaluated, and awarded. Grantees implementing care and support activities include: • ECC: targeting 600 PLWHA and 799 OVC in Bas Congo. • AmoCongo: targeting 1,236 PLWHA and 1,200 OVC in Bas Congo and Katanga. • World Vision: targeting 750 PLWHA and 1,500 OVC in Katanga. • Fondation Femme Plus: targeting 893 PLWHA and 1,416 OVC in Bukavu. • BDOM CODILUSI: targeting 852 PLWHA and 1,195 OVC in Bas Congo.

Needs assessment. PROVIC staff carried out a needs assessment of existing care and support services. We gathered data from three provinces (Bas Congo, South Kivu, and Katanga), though data from Kinshasa are still incomplete. The quantitative data collected focused on the number of PLWHA and OVC enrolled, the types of services provided to them (number of beneficiaries per service), and local partners providing those services.

The qualitative data were collected through focus-group discussions and individual interviews with different parts of the population: PLWHA, OVC, community members, implementing partners, and staff from PNMLS, PNLS, and DIVAS. These discussions/interviews allowed us to explore the actual needs of PLWHA/OVC, understand the local, everyday realities, and to solicit suggestions concerning the services PROVIC is intending to deliver. There were some conflicting responses—and that is why triangulation of information is important (bearing in mind that all responses still need to be considered). Examples of this include stigma (at home versus at health facilities), home-based care (important versus unnecessary), and income generating activities (IGA) (individual versus collective). Feedback included:

• PLWHA expressed that they are in a better position to know and make decisions about activities that need to be carried out for them, and they wish to be fully involved at different levels (from planning to implementation).

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 14

• Although home-based care is not yet fully functional, many people would like this and could identify a family member to be trained and then implement this. • PLWHA recommended that community volunteers be supported by their peers without preference for age and gender. • Legal assistance was strongly recommended to increase awareness of laws on protection of PLWHA and OVC. • Medical support, including clinical check-ups, remains a crucial issue for PLWHA. • School assistance and education support are a high priority for OVC. • PLWHA recommended combining short-term nutrition assistance with long-term agriculture activities for sustainability. • PLWHA and OVC recommended an approach based on family support. • Focus groups and interviews suggested that linkages between the three levels (home, community, and health facilities) should be effective.

Design of a new PLWHA care and support package and a needs-based, comprehensive, OVC package . In February, the project team completed an evaluation of AMITIE’s’ best practices and lessons learned to inform the development of the support package for PROVIC. As part of this process, focus groups and individual interviews were held with PLWHA, OVC, PNMLS, PNLS, the Ministry of Social Affairs (MINAS), community members, and opinion leaders to explore PLWHA and OVC needs, their coping mechanisms, the level of community involvement, and the problem of stigmatization. In addition, meetings were held with national authorities and governmental structures to review existing mechanisms for support and to identify gaps.

Based on the analysis of information collected, PROVIC, through support from CRS, is finalizing the comprehensive, needs-based package. This care and support package will include six components: psychosocial, nutrition, economic strengthening, protection, palliative care (which includes home visits, managing pain, and facility referral), and education and shelter for OVCs. As part of the analysis process, the team will look closely at how the package positively affects or engages all members within the PLWHA or OVC household.

Development of a Positive Living Strategy . This cross-cutting issue is being developed in collaboration with UCOP+. A short-term technical consultant is currently elaborating a draft version of this strategy in close collaboration with PROVIC. Technical review and finalization will be supported by CRS experts in this area.

Problems encountered and proposed solutions Challenges during the first six months of implementation include the following: • The transition in funding between AMITIE and the new bridge grants has been challenging for the implementing partners. PROVIC will review indicators and targets to ensure they are realistic.

• Certain aspects of the care and support package need further planning and design work. One example is addressing the feasibility of income-generating activities that

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 15 require access to land and ensuring protection support that responds to the needs of OVC who have been victims of violence by foster-family care providers. These issues will require further discussion with partners and reflection in the next quarter as part of the articulation of the care and support package. • PROVIC is still determining the best way to support medical care at the facility level, given project resources. This will be addressed through further consultations and also through the upcoming short-term technical assistance related to commodities and logistics.

Anticipated activities/plans for the next six months • Develop a Positive Living Strategy and supports organizations to implement this strategy. • Brief community groups and partners on the new PLWHA care and support strategy. • Support implementation of the need-based standard package of care for PLWHA. • Strengthen the supply chain of HIV related commodities. • Integrate family planning into palliative care services. • Improve links between community and clinic-based care. • Roll out Child Status Index and OVC Well-Being Tool. • Brief community groups and partners on the new OVC care and support strategy. • Link grant recipients to Champion Communities and Community Care Coalitions.

Strengthening of health systems supported Summary of activities and achievements During the first six months of the project, activities in this component focused on assessments and consultations to further define the high-priority activities under this component.

Needs assessment conducted to identify existing gaps in capacity of provincial government. In the second quarter of this year, the team assessed provincial government capacity. Findings from field visits suggested the following gaps in the health system: • The Medical Provincial Inspection is not able to provide strong support or technical assistance to the health zones. Training, supervision, coordination, and monitoring and evaluation functions are not fully provided to the health facilities. There has been little investment in human resources to allow staff to update their skills. Provincial Medical Inspectors noted their inability to provide supervision to health zones because they don’t know the intervention package provided by the donors. • MINAS does not have a strong structure at the provincial level. Personnel are insufficient and poorly trained to face problems in the provinces. Most competencies and skills are located at the central level. • The Heath Zones depend on aid from donors, and health interventions are not sustainable. For example, there is a shortage of printed forms in the facilities at the end of any support from a donor.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 16

• There are a number of weaknesses in the referral system between community-based organizations and health facilities. There are also frequent stock-out problems for ARVs, cotrimoxazole, and other important medicines. • There is a need to train provincial government staff from PNLS in an integrated way so they can provide support to HCT, care and treatment activities; prevention; and other aspects of HIV/AIDS programming.

Development of partnership matrix. The project team developed a partnership framework to describe the types of collaborations with various partners. This document maps out all project collaborations and describes the methods that will be used to ensure good coordination. The framework will be shared with project partners to solicit feedback and to ensure common agreement. PROVIC staff conducted several meetings with USAID partners (MSH/SPS, C-Change, AXxes, Health System 20/20), the Clinton Foundation, government organizations and structures, UN agencies (UNAIDS, UNICEF), the European Union, and other bilaterals (GTZ) to share the framework.

Problems encountered and proposed solutions Vision, values, and perceptions of the project vary among partners involved in the project’s development, particularly on issues concerning systems strengthening. The project needs to establish a common understanding with all partners and stakeholders involved in planning, implementation, and M&E. The matrix of collaboration developed by PROVIC staff will help to reach a common understanding and agreement.

Anticipated activities/plans for next six months • Develop a capacity-building plan for provincial governments. • Support development and implementation of evidence-based polices and guidelines. • Build capacity of NGO providers in grants management and reporting requirements. • Conduct training-of-trainers (TOT) training with provincial MINAS teams in the standard need-based OVC package. • Harmonize data collection tools among NGO partners. • Strengthen the quality assurance system. • Support M&E reporting systems.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 17 ANNEX A. SITES SELECTED TO DATE

PROVINCE ZONES DE SANTE INTEGRATED HCT/PICT PMTCT KINSHASA NSELE METHODISTE KINSHASA GOMBE KINSHASA KINSUKA KINSHASA LINGWALA KINSHASA KINGASANI KINGASANI MATERNITE KINSHASA BINZA METEO BINZA MATERNITE KINSHASA MONT NGAFULAI KIMWENZA HC BAS CONGO KIMPESE LAMBA MATERNITE BAS CONGO LUKULA CH, LUKULA PATU HC BAS CONGO BOMA KALAMU HC BAS CONGO MATADI HGR KINKANDA, CSR MVUNZI BAS CONGO NZANZA BAS CONGO MBANZA NGUNGU BAS CONGO SEKEBANZA KATANGA HGR KENYA, KENYA KENYA GH MARY ELMER KATANGA KAMPEMBA KAMPEMBA GH,MARY EME R HC HGR KAPEMBA KATANGA SAKANIA KASUMBALESA HC CSR KASUMBALESA KATANGA PANDA PANDA GH HGR PANDA KATANGA MANIKA MANIKA HC/AAXXES KATANGA LWALABA LWALABA HC/AAXXES KATANGA KINKULA/LIKASI CSR KIKULA KATANGA PANDA/LIKASI KATANGA KIPUSHI SUD KIVU UVIRA HGR UVIRA, CH KALUNDU ETAT, CS KILOMONI, CEPAC SUD KIVU BAGIRA HGR BAGIRA HGR BAGIRA SUD KIVU CS MALKIA WA AMANI, CS MUHUNGU, CHCELPA, PHILADELPHIE IBANDA CH FARDC BIOPHARMA SUD KIVU KADUTU CS NYAMUGO SUD KIVU NYANTENDE HGR NYANTENDE

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 18

ANNEX B. TRIP REPORTS

TRIP REPORT

Trip Dates: October 11–November 1, 2009 Traveler: Scott Pflueger, Kathryn Goldman, Valerie Hovetter Purpose: Project Technical Start-up and Work Planning

Introduction As part of the start-up process, there have been a number of international technical assistance assignments underway. To consolidate reporting on these assignments, we provide combined trip notes for the following travelers. Additional trip notes will follow for the team of administrative start-up specialists when their assignments are complete.

• Scott Pflueger, PATH Project Administrator (Oct 11–13) • Kathryn Goldman, Chemonics Project Director (Oct 11–23) • Valerie Hovetter, Workplanning facilitator and specialist (Oct 18–Nov 1)

Trip objectives 1. To coordinate the technical project start-up and facilitate the start-up workshop. 2. Complete the first-year work plan.

Accomplishments in the technical start-up The technical start-up team participated in the post-award debrief at USAID and was able to meet the key USAID contacts for this project. The debrief included details on the AIDSTAR task order and what to expect during implementation. Mr. Ngongi and Ms. Goldman followed up with a meeting with Michele Russell and Robert Kolesar about the stakeholders’ consultation and the work plan format where they received feedback on how to proceed. COTR Laurent Kapesa coordinated introductory meetings for the COP with key government partners such as PNLS and PNMLS. In addition, the COP and Ms. Goldman met with a number of other HIV/AIDS partners including PSI, AmoCongo, AXxes, and CRS.

Ms. Goldman and Ms. Hovetter co-facilitated a start-up workshop which included team- building sessions, introductions to the project SOW and deliverables, and discussions of the work plan. Each component was presented and discussed along with the proposed activities and timing. The workshop gave the staff a chance to get to know each other, to delve into the technical content of the project, and to begin planning. On Thursday of the workshop week, the project organized a stakeholders consultation and invited key partners from government, other USG projects, local NGOs, and international organizations to hear a presentation of the project activities and ask questions or provide

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 19 comments. Partners also provided feedback in small groups to component teams. This workshop succeeded in giving the project staff a sense of how they will work with these key partners and what the issues of coordination and overlap will be so that they could be reflected in the work plan.

Lastly, Ms. Goldman and Ms. Hovetter coordinated the writing of the work plan document by soliciting input from consortium members, writing background sections, and taking the content developed during the start-up workshop and turning it into detailed text and Gantt charts. The work plan was submitted to USAID on October 30.

Issues for follow-up Following this trip, the project will await comments from USAID on the work plan and will be ready to make any changes or modifications as necessary. In addition, the administrative start-up is continuing as planned and a separate report will be provided on that. The COP Mbella Ngongi has been continuing to network with partners and attend meetings to establish good relationships for coordination.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 20

TRIP REPORT

Trip Dates: November 14––December 1, 2009 Travelers: Janina Khayali and Margaret Waithaka Purpose: PMEP Development

Introduction Prior to the submission of the Performance Monitoring and Evaluation Plan (PEMP) a “ground-truthing” of the matrix components was required in order to create an implementable plan based on the realities faced on the ground.

Trip objectives • Work under guidance from PATH M&E Officer based in Seattle, including daily communication to develop and deliver the DRC IHP project performance monitoring and evaluation plan (PMEP). • Work with the existing team to identify core project indicators for each intermediate result and sub-IR area in the existing project results framework. • Refine performance indicators helping to articulate the definition and rationale for use. • Cross-reference and ensure harmonization between project indicators, PEPFAR 2nd Generation Indicators, and performance indicators tracked by the DRC MOH/PLNS. • Work with team members to identify project M&E plan components for each indicator, including but not limited to: frequency of data collection, data sources, and responsible personnel and annual targets for the next five years. • Draft sections of the PMEP using existing guidance from PATH and in accordance with USAID requirements. • Coordinate with PATH, Seattle, to solicit and incorporate guidance and feedback into the draft project M&E plan. • Make final revisions (based on feedback) to the final document and prepare for submission by the DRC-based team to USAID by November 30, 2009.

Accomplishments The M&E advisors worked closely with the project staff in-country to fully develop and adjust the PMEP document to reflect project activities and set realistic targets for the first two years of the project for each indicator. Both the PATH M&E specialist based in Seattle and the Chemonics project director in Washington, DC also provided input.

During the first week of the assignment, the team worked closely with the original list of indicators proposed in the RFP in addition to developing other indicators that would appropriately measure our work and be in line with PEPFAR requirements. The team worked out indicator definitions, availability of baseline data, collection methods, data sources, and proposed targets for each indicator. Once a draft of the indicator table was

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 21 complete, a meeting with USAID was established to discuss the draft. It was in this meeting that the team learned that USAID preferred the project use a new indicator matrix that had been developed between PEPFAR and the GDRC and included the new set of PEPFAR indicators for the country and project.

Once the new indicator matrix was received, the team reworked relevant information from the first matrix into the second and underwent a series of consultations on the additional indicators in the new list. During this second week of the assignment, when the PATH M&E specialist who had a background in similar HIV/AIDS programs and in setting appropriate targets arrived, the team was able to finalize targets for the indicators to be included and to decide which indicators posed challenges for measurement based on the project scope of work. This led to the development of the final product, the PMEP document submitted on November 30.

Issues for follow-up Following the submission of the final version of the PEMP to USAID for approval, the project staff expects to have further discussions and answer any queries from USAID regarding indicators and targets included in the PMEP. Once the PMEP is approved, the project leaders will need to set baselines and revise targets. The project scope will also include assessing the M&E systems requirements needed for project data collection, verification and reporting, and beginning to formalize data collection relationships with partner organizations and counterparts.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 22

TRIP REPORT

Trip Dates: December 3–23, 2009 Travelers: Doug Petrie and Rhett Gurian Purpose: Grants Application Workshop Design & Delivery

Introduction The grants component of the PrOVIC project is a key element in the achievement of the project’s objectives.

The purpose of this assignment is to provide support to the IHAP team, with a Chemonics short-term grant advisor, to design and deliver a five-day grants application workshop for select participants, enabling them to successfully apply for IHAP bridge funding for the continuation of their services. These participants include representatives from HCT centers that were supported by the FHI under the USAID-funded predecessor project and select PLWHA and OVC beneficiaries that were supported by CRS under the same predecessor project. The PATH staff member will also work with the IHAP finance and administration manager, the short-term grants advisor from Chemonics, and other IHAP team members to identify ways to streamline grants procedures and functions, as necessary.

Trip objectives 1. Work with the PrOVIC team to establish procedures for grants application, evaluation, award, and management under the contract to ensure compliance with USAID regulations and PATH’s standards. 2. In conjunction with the Grants Manager(s) and Finance and Administration Specialist, create a grants policies and procedures for the project based on the grants management plan submitted to USAID. 3. With the finance and administration specialist and another short-term grants specialist, design and deliver a five-day grants training workshop for representatives from grantees that were previously supported by the FHI/USAID-funded project and CRS.

Accomplishments The purpose of the IHAP grants workshop was to bring all of the grantees to a central location for the following purpose and objectives:

1. Present the IHAP project. 2. Describe the process for soliciting, awarding, and managing grants to be disbursed by IHAP to its partners. 3. Develop grant application forms.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 23 The first three days of the workshop involved structured facilitation and group work. Day one focused on developing grant objectives and indicators. Day two focused on developing the implementation plan, while day three was devoted to developing the detailed budget. During the last two days of the workshop, the grantees further developed and refined their grant applications and received one-on-one guidance and mentorship from the PATH and Chemonics grants specialists.

Two to four representatives from each of the partner organizations attended the workshop. Each organization produced an acceptable application, and the feedback from the participants was overwhelmingly positive. The grantees noted that the methodology for developing grant applications was effective, and overall all of their expectations were met. In addition to the substantive and technical skills they gained in grant writing, gathering the partners in a central location contributed to building important relationships between IHAP staff and partners and served as a means of knowledge-sharing and transfer, which further strengthened the grant applications. The only negative comments about the workshop reflected a general dissatisfaction with the quality of the sleeping accommodations at the Centre Catholique Nganda.

In the end, the Grants Evaluation Committee scored all of the applications at a minimum of 75 points. However, after discussions and negotiations with the Grants Evaluation Committee, several organizations had to re-do their budgets to better reflect a continuation—not an expansion—of their FHI and/or CRS grant-funded work under the predecessor project.

The following is a list of the partner organizations and their target region. During the next three months, the PATH/IHAP grants management team should closely monitor the performance and reporting of these organizations and think proactively about building longer term relationships and grant agreements after this initial three-month period of bridge funding.

Application Number ─Organization Name ─IHAP Target Region 001-2009 ─Corporate Committee for Local Development (CCLD) Midema ─Matadi 002-2009 ─BDOM Codilusi ─Lubumbashi 003-2009 ─World Production ─Lubumbashi 004-2009 ─AMO-CONGO ─Kinshasa, Lubumbashi (Kasumbalesa), Matadi 005-2009─HGR Kenya ─Lubumbashi 006-2009 ─HGR Nyatende ─Lubumbashi 007-2009 ─HGR Kiamvu ─Matadi 008-2009 ─Centre de Sante Mvuzi ─Matadi 009-2009 ─World Vision International in DCR ─Bukavu, Kinshasa, Lubumbashi 010-2009 – HGR Panda – Lubumbashi (Likasi) 011-2009 – Femme Plus – Bukavu, Kinshasa 012-2009 – Eglise du Christ au Congo/Sante en milieu Rural (ECC/SANRU) – Matadi

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 24

Calendar of Activities

Date Activities Wednesday, December 2 9:00pm: Rhett Gurian arrived in Kinshasa. Thursday, December 3 7:00am: Doug Petrie departed from Seattle. Friday, December 4 7:30pm: Doug Petrie arrived inKinshasa. Saturday, December 5 1:00-3:00pm, Overview, update with Dan Grimshaw, the project’s finance & administration specialist. Sunday, December 6 1:00-3:00pm: Doug Petrie and Rhett Gurian met to outline priority activities resource needs. 3:00-5:30pm: Created draft grant applicant pre-award questionnaire to be emailed later this week. 6:30-900pm: Dinner with Dan Grimshaw and his wife and children. Monday, December 7 Visited workshop venue with administrative person. Purchased workshop materials and supplies. Completed grant applicant pre-award questionnaire. Tuesday, December 8 Revised grants management plan per RCO feedback. Liaised with translator on workshop printed materials. Prepared workshop agenda and facilitation materials. Wednesday, December 9 Finalized grants management plan & emailed to PATH/DC. Liaised with translator on workshop printed materials. Prepared workshop agenda and facilitation materials. Thursday, December 10 Visited workshop venue with driver. Liaised with translator on workshop printed materials. Prepared workshop agenda and facilitation materials.

Friday, December 11 Completed workshop materials, including handouts.

Saturday, December 12 Visited workshop venue to finalize room set-up.

Sunday, December 13

Monday, December 14 Workshop: Day One. Objectives and Indicators. Tuesday, December 15 Workshop: Day Two. Implementation Planning. Wednesday, December 16 Workshop: Day Three. Budgeting and Evaluation. Thursday, December 17 Workshop: Day Four. One-on-one tutorial with applicants. 9:00pm: Rhett Gurian departed Kinshasa. Friday, December 18 Workshop: Day Five. Facilitated Grants Evaluation Committee sessions: 10 applicants. Saturday, December 19 Worked on trackers and started to set up grants files. Sunday, December 20 Updated trip report.

Monday, December 21 Facilitated Grants Evaluation Committee sessions: 2 applicants. Continued setting up grants files. Tuesday, December 22 Completed this Trip Report. 9:00pm: Doug Petrie departed from Kinshasa Wednesday, December 23 5:30pm: Doug Petrie arrived in Seattle

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 25 TRIP REPORT

Trip Dates: January 27 – February 13, 2010 Travelers: Doug Petrie Purpose: Development of the Grants RFA

Introduction The objective of the USAID-funded Integrated HIV/AIDS Program (ProVIC) in the Democratic Republic of Congo is to (1) reduce the incidence and prevalence of HIV/AIDS; and (2) mitigate its impact on people living with HIV/AIDS and their families. This contributes to the US Government’s goal in the Democratic Republic of Congo (DRC) to improve basic health conditions for the Congolese people. The grants component of the PATH/ProVIC project is a key element in the achievement of the project’s objectives.

The PATH/ProVIC Grants program helps achieve the overall objective by funding activities in integrated programs that aim to: • Expand and improve HIV/AIDS counseling and testing and prevention services in the targeted areas; • Improve care, support, and treatment for people living with HIV/AIDS and orphans and vulnerable children; and • Support the strengthening of home-, facility-, and community-based health systems.

ProVIC works in four geographic areas: Bukavu, Kinshasa, Lumbumbashi, and Matadi.

A grant is a funding mechanism whereby funds are provided to eligible organizations to carry out activities that are consistent with the objectives of PATH/ProVIC and of its technical components. Grant funds do not have to be paid back to the PATH/ProVIC Project if the funds are properly used to implement the program, and if the program is implemented in a manner fully consistent with the ProVIC Grant Applicant and Recipient Handbook.

The PATH/ProVIC Grants Program is designed to fund activities that help achieve the above results through three types of grants: Standard Project, Simplified, and Fixed Obligation grants. However, based on knowledge and understanding gained by the ProVIC team about the organizations in the DRC that are potential Grant Recipients, we anticipate that all organizations will require advances, instead of reimbursements. Therefore, we anticipate all grants will be Standard Project Grants.

ProVIC Grants will provide assistance to programs that address in integrated ways the following results:

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 26

• Communities’ abilities to develop and implement prevention strategies are improved • Community- and facility-based HIV/AIDS counseling and testing services are enhanced • Prevention of mother-to-child-transmission services is improved • Care and support for orphans and vulnerable children are strengthened. • Capacity of non-governmental organizations that are HIV/AIDS service providers is improved thus increasing their abilities to provide quality services to people living with HIV/AIDS, including through home-, facility-, and community-based care • Strategic information systems at community and facility levels are strengthened.

II. Scope of work

Purpose and objective The purpose of this assignment is to provide support to the ProVIC team to prepare the project’s first Request for Applications/Program Statement to solicit Grants Applications for activities that address the grant objectives.

Tasks Work with the ProVIC team to prepare a solicitation for grants applications, which is a two-step process. First, ProVIC requests Applicants that are eligible organizations to submit a two- to four-page Concept Paper that addresses ProVIC objectives in an integrated fashion. If ProVIC accepts the concept, ProVIC then invites the Applicant to submit a full, formal application, per the format and procedures outlined in the ProVIC Grant Applicant and Recipient Handbook .

In conjunction with the finance and administration specialist and other ProVIC technical advisors, further refine grants policies and procedures for the project based on the grants management plan submitted to USAID.

Deliverables 1. The text for an RFA announcement to be placed in newspapers and on websites that are read by potential Grant Applicants in the DRC 2. An RFA/Program Statement that will help Applicants prepare their Concept Papers. 3. ProVIC staff members further trained in USAID and PATH grants-under-contract systems, guidelines, and procedures.

III. RFA to award process After preparing an outline of the RFA following ADS 303 guidelines, I participated in group and individual discussions with each of the technical component teams, the chief of party, and the technical director. These discussions helped identify strategies to emphasize, such as the integration of technical areas, and communicate in the RFA and Public Notice. The discussions also helped the team to better understand their roles and responsibilities in the grants process (see IV. Training/Orientations below).

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009 –MARCH 2010 27

We agreed that we wanted the RFA to provide potential applicants with examples of activities and/or programs that could be funded via a ProVIC grant. These examples are included.

An outstanding issue is the recruitment, hiring, and training of grants managers in each of the target regions. That recruitment process is underway. The chief of party, technical director, and I interviewed three candidates in the two-week period that I was there.

IV. Training/orientations In various one-on-one and group meetings with the technical team, I oriented them to their grants-related roles and responsibilities. These responsibilities are at several stages of the grants process. First, when Concept Papers are received, appropriate technical advisors will assess the relevance of each concept to ProVIC’s overall objectives, as well as to the objectives of the applicable technical component. If the concept is accepted, then ProVIC will invite the organization to submit a full application. Second, when a grants application is received, technical component advisors will review its technical merits, including the implementation plan and the indicators and milestones the applicant aims to achieve under the ProVIC grant. Third, any of the technical advisors may be requested to serve on the three-person Grants Evaluation Committee that does a formal assessment of the application to determine whether to recommend to USAID that a grant be awarded. Fourth, if a grant is awarded, technical advisors will help monitor and evaluate the technical achievements of the grant-funded activities by reviewing the periodic programmatic reports the grantee is required to submit to ProVIC. Finally, as a part of the grants close-out process, the technical advisors will help assess the grantee’s overall results.

The flow chart entitled, Process for Standard Project Grants, shows the steps from the solicitation being advertised to the Grant completion and close-out.

On the page following the flow chart is an outline of the timeframe of the process starting with the placement of the RFA announcement, culminating with the signing of Grant Agreements with selected organizations, which initiates Recipient’s implementation of the grant-funded activity. We estimate the time from the publication of the Public Notice announcing the RFA to the signing of Awards to take between nine to 12 weeks.

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 28

ANNEX C. FINANCIAL REPORTS Below is a summary of ProVIC’s total and year one budget, current obligation, and expenditures to date.

Expenditures To Current Year 1 Budget Remaining Budget Line Items Total Budget Year 1 Budget Date 9/30/09 - Obligation Remaining Obligation 3/31/10

Salary and Wages $ 2,724,498 $ 621,710 $ 124,121 $ 497,589 Fringe Benefits $ 817,349 $ 186,513 $ 37,125 $ 149,388 Travel and Transportation $ 723,607 $ 213,435 $ 52,769 $ 160,666 Supplies $ 13,622 $ 3,109 $ - $ 3,109

Contractual $ 25,672,205 $ 6,121,009 $ 2,048,016 $ 4,072,993

Other Direct Costs $ 10,504,103 $ 2,231,072 $ 114,440 $ 2,116,632

Indirect Costs $ 2,922,696 $ 701,136 $ 120,669 $ 580,467

Subtotal Project Costs $ 43,378,080 $ 10,077,984 $ 2,497,140 $ 7,580,844

Fixed Fee @ 4% $ 1,495,123 $ 403,119 $ 87,735 $ 315,384

Totals $ 44,873,203 $ 10,481,103 $ 6,688,923 $ 2,584,875 $ 7,896,228 $ 4,104,048

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 29 ANNEX D. PARTNER AND COLLABORATION MATRIX

Partners The Aim of Collaboration Types of Information to be Shared Mechanism for Coordination Frequency State Institutions PNMLS/Presidency/Prime Capacity-building for coordination; Evolution/course of the disease in Coordination meetings, sharing of Monthly, quarterly, Minister’s Office policy formulation; and guidelines intervention sites; mapping/ lessons learned, joint planning, annually intervention, policies/norms/ working sessions and meetings standards, gaps, tools; priority needs with national counterparts of program; intervention strategies and directives PNLS Idem Evolution/course of the disease in Coordination meetings, sharing of Monthly, quarterly, intervention sites; mapping/ lessons learned, joint planning, annually intervention, policies/norms/ working sessions and meetings standards, gaps, tools; priority needs with national counterparts of the program; intervention strategies and directives Ministry of Health Designing norms and policies, Health-related directives and policies; Meetings convened by the Ministry, As needed guidelines; capacity-building priorities of the program visits, meetings with specialized programs (PNSR, PRONANUT, PNAMES) Ministry of Social Affairs Implementing activities defined in Evolution/course of the disease in Coordination meetings, sharing of Monthly, quarterly, the plan of action for OVC; intervention sites; mapping/ lessons learned, joint planning, annually determining high-risk groups; intervention, policies/norms/ working sessions and meetings defining the OEX package standards, gaps, tools; priority needs with national counterparts of the program; intervention strategies and directives Ministry of Gender and Incorporation of gender issues into Gender-related policies; directives, Working sessions with the Ministry, As needed the Family activities tools, and strategies joint planning of activities Education Identifying, developing, and Mapping interventions, gaps, tools; Meetings, joint planning, follow-up Monthly, quarterly, disseminating BCC messages priority needs of the program; and joint supervision annually within specific groups intervention strategies Congolese Armed Forces Supporting their AIDS control Identifying the organizational pattern Meetings, working sessions, Weekly, monthly, program through PSI adopted for AIDS control; mapping progress reports, joint planning quarterly interventions; sources of funding; needs Police Nationale Supporting their AIDS control Identifying the organizational pattern Meetings, working sessions, Weekly, monthly,

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 30

Partners The Aim of Collaboration Types of Information to be Shared Mechanism for Coordination Frequency Congolaise program through PSI adopted for AIDS control; mapping progress reports, joint planning quarterly interventions; sources of funding; needs Kinshasa School of Developing a protocol for research, Reports of surveys and investigations Meetings, exchange of information, Monthly, quarterly Public Health investigation, baseline surveys, conducted among high-risk groups working sessions integration of sites

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 31

Partners The Aim of Collaboration Types of Information to be Shared Mechanism for Coordination Frequency General Reference PMTCT/PF, CDV, PLWHA Progress reports; work plan; project Working sessions, joint planning of Monthly Hospital in Kiamvu proposals activities, mid-term and annual reviews, regular field visits Reference Health Center PMTCT/PF, CDV, PLWHA Progress reports; work plan; project Working sessions, joint planning of Monthly in Mvuzi proposals activities, mid-term and annual reviews, regular field visits Matonge Health Center Supporting their AIDS control through PNLS program through PSI United Nations Agencies United Nations Children’s Gathering information and securing Experiences with PMTCT and OVC; Exchange of experiences, Quarterly Fund collaboration for PMTCT and OVC, reports; mapping of interventions meetings, working sessions MII; access to potable water; programs for displaced persons Country Coordination Learning the mapping of List of entities engaged in HIV-related Working sessions, harmonization of Quarterly and as Mechanism/Global Fund intervention and gaps; activities under the sponsorship of the intervention programs, exchange of needed to Fight AIDS, complementarity, synergy, Global Fund information Tuberculosis and Malaria capacity-building World Health Coordination of drug management; Policies for the supply and Working sessions, exchange of Monthly Organization designing norms management of drugs and other information and reports, pharmaceutical products; norms and participation in the creation and directives functioning of the national mechanism for coordination and management of drugs and HIV/AIDS-related laboratory products United Nations Sharing knowledge on mapping of Their experiences in HIV/AIDS Working sessions, harmonization of Monthly at first, then Population Fund interventions and gaps; control; exchange of reports; mapping intervention programs, exchange of quarterly complementarity and synergy of interventions information Mission des Nations Sharing knowledge on mapping of Their experiences in HIV/AIDS Working sessions, harmonization of Monthly at first, then Unies au Congo interventions and gaps; control; exchange of reports; mapping intervention programs, exchange of quarterly complementarity and synergy; of interventions information sharing experiences with ongoing gender, sexual violence, and HIV interventions in the country United Nations High Sharing knowledge on mapping of Their experiences in HIV/AIDS Working sessions, harmonization of Monthly at first, then Commissioner for interventions and gaps; control; exchange of reports; mapping intervention programs, exchange of quarterly Refugees complementarity and synergy of interventions information Other International Organizations

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 32

Partners The Aim of Collaboration Types of Information to be Shared Mechanism for Coordination Frequency Organizations of the Learning the mapping of Their experiences in HIV/AIDS Working sessions, harmonization of Monthly at first, then European Union (Belgian, interventions and gaps; control; exchange of reports; mapping intervention programs, exchange of quarterly German, and Italian complementarity and synergy of interventions information Cooperation) Clinton Foundation Management of pediatric HIV/AIDS Mapping of interventions; information Working sessions, joint planning of Quarterly cases about inputs activities, mid-term and annual reviews USAID Partners University of North Supporting PMTCT in Bas Congo Progress reports; work plan; list of Working sessions, joint planning of Monthly Carolina and Kinshasa maternity wards; project proposals; activities, mid-term and annual publication of research findings and reviews, regular field visits success stories PSI/Association Santé Identifying, developing, and Progress reports; work plan; Joint planning of activities, joint Weekly during the Familiale disseminating BCC messages in intervention zones and executing supervision, exchange of reports first six months; the target community partners; audio-visual props and documentation on best monthly thereafter practices Communication for BCC, social mobilization, training of Progress reports; work plan; Joint planning of activities, joint Weekly during the Change trainers in intervention zones intervention zones and partners; supervision, planning, exchange of first six months; audio-visual props reports on best practices monthly thereafter AXxes project PMTCT, capacity-building Progress reports; work plan Working sessions, joint planning of Weekly during the activities, mid-term and annual first six months; reviews monthly thereafter MSH/SPS Sustainability of development Progress reports; work plan Working sessions, joint planning of Weekly during the support; mechanisms for activities, mid-term and annual first six months; management of drugs and other reviews monthly thereafter laboratory products; pharmaceutical policy documents Health Systems 20/20 Protocol for research, investigation, Progress reports; work plan; Joint planning of activities, joint Quarterly and capacity-building intervention zones and partners; supervision, planning, exchange of audio-visual props reports on best practices World Food Program Food Kit; support for agricultural Mapping of interventions; criteria for Working sessions, joint planning of Weekly during the projects run by the PVV, OVC eligibility; orienting intervention zones activities, memorandum of first six months; collaboration monthly thereafter Sub-beneficiaries of Projects by USAID Partners Femmes+ Care and support to PVV and OVC; Progress reports; work plan; Joint planning of activities, joint Weekly during the treatment; CDV intervention zones and partners; supervision, planning, exchange of first six months; audio-visual props; monthly reviews reports on best practices monthly thereafter Avenir Meilleur pour les Care, support, treatment, CDV Progress reports; work plan; Joint planning of activities, joint Weekly during the

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 33 Partners The Aim of Collaboration Types of Information to be Shared Mechanism for Coordination Frequency Orphelins au Congo intervention zones and partners; supervision, planning, exchange of first six months; audio-visual props reports on best practices monthly thereafter Mobile phone companies Raising awareness among Transmission of texts; priorities; Working sessions, memorandum of Monthly subscribers; sponsoring some of policies; BCC messages; clarifying understanding our projects the mechanism for collaboration

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 34

Partners The Aim of Collaboration Types of Information to be Shared Mechanism for Coordination Frequency Corporate Commitment PMTCT/PF, CDV, PLWHA Progress reports; work plan; project Working sessions, joint planning of Monthly for Local Development/ proposals activities, mid-term and annual Minoterie de Matadi reviews, regular field visits Mutombo Hospital PMTCT/PF, CDV, PLWHA Progress reports; work plan; project Working sessions, joint planning of Monthly proposals activities, mid-term and annual reviews, regular field visits World Production Identifying, developing, and Progress reports; work plan; Joint planning of activities, joint Weekly during the disseminating BCC messages in intervention zones and partners; supervision, planning, exchange of first six months; the target community audio-visual props reports on best practices monthly thereafter Civil Society Union Congolaise des Capacity-building for coordination Mapping; membership; needs in Meetings, reports, joint planning Quarterly Organisations des of member structures capacity-building for advocacy; Personnes vivant avec le developing and managing AGR VIH Comité InterEntreprise de Gathering information on activities Progress reports; identification of Exchange of experiences, Quarterly Lutte contre le Sida pertaining to AIDS control in the priorities meetings, working sessions (CIELS) enterprises; reducing gaps; reinforcing CIELS capacity in leadership and coordination Religious organizations Care, support, treatment, CDV Progress reports; work plan; Joint planning of activities, joint Quarterly (Bureau Diocésain des intervention zones and partners; supervision, planning, exchange of Oeuvres Médicales, audio-visual props reports on best practices Eglise du Christ au Congo) Media Okapi Involvement of the media in the Organization of media into groups for Working sessions, collaboration Monthly fight against HIV/AIDS; the fight against HIV/AIDS; airing of agreement, review of activities, dissemination of project activities programs on health and AIDS progress reports Associations des Involvement of the media in the Organization of media into groups for Working sessions, collaboration Monthly journalistes Congolais fight against HIV/AIDS; the fight against HIV/AIDS; airing of agreement, review of activities, dissemination of project activities programs on health and AIDS progress reports Radio and television Involvement of the media in the Organization of media into groups for Working sessions, collaboration Monthly stations fight against HIV/AIDS; the fight against HIV/AIDS; airing of agreement, review of activities, dissemination of project activities programs on health and AIDS progress reports

PROVIC SEMI-ANNUAL REPORT OCTOBER 2009–MARCH 2010 35