Project Concern International

Project Concern International QUARTERLY PROGRESS REPORT 1 April 30 June 2009 Submitted: 24 July, 2009 By: Karen Romano Country Director, PCI Botswana Bonokopila House, Plot 53957 Unit A Off Samora Machel Drive Fairgrounds, Gaborone Botswana

Tel: (+267) 319 0198 Fax: (+267) 319 0398 TABLE OF CONTENTS I. Program Overview...3 II. Administration...3 III. Human Resource Development.5 IV. Program Progress...7 V. Implementation Challenges...17 VI. Plans for Next Quarter...18

I. PROGRAM OVERVIEW In October 2008 Project Concern International (PCI) was awarded from USAID a threeyear follow-on grant of $9,999,787 to continue and build upon work started with initial one-year funding through PEFPAR Botswana (USAID, CDC, HRSA/ITECH). The PCI Building Bridges program will continue to strengthen the role played by civil society organizations (CSOs) in the delivery of integrated palliative care, OVC support, and ART treatment support services in Botswana. Special focus will be placed on the needs of children and adolescents, using a family-centered approach that builds the capacity of affected families to care for their children. Goal & Objectives Goal: Improved and expanded CSO delivery of integrated HIV/AIDS services for affected/infected children and families. Objectives: 1. Strengthened technical capacity of CSOs to deliver integrated HIV/AIDS services; 2. Strengthened organizational capacity of CSOs to manage and sustain integrated HIV/AIDS service delivery; 3. Strengthened collaboration and referral among government and CSOs to deliver integrated HIV/AIDS services; 4. Strengthened government capacity to support the delivery of integrated HIV/AIDS services; 5. Improved documentation and sharing of promising practices and lessons learned in delivering integrated HIV/AIDS services. To achieve these objectives PCI has provided sub-grants to and continues to strengthen the organizational and technical capacity of 12 NGO partners to deliver a comprehensive package of integrated prevention, palliative care, OVC, and ART treatment support services to affected families. PCI is working in collaboration with and will provide technical assistance to three of the major CSO umbrella bodies BONASO, BONEPWA, and Marang Trust, and to government counterparts at MOH and MLG (DSS and PHCS) at national and district level, with focus on district level. II. ADMINISTRATION Staffing: Two vacancies were filled this quarter -Finance and Administration Manager and Monitoring and Evaluation Officer -both of whom will assume duty in July and August 2009 respectively. With the vision to grow and scale up in Botswana, PCI created the position of Director of Programs. A suitable candidate was found and she will also assume duty in July 2009. However, the data entry assistant who had not completed

probation with PCI left during the quarter. When the new M&E Officer is in place, the M&E unit will review its staffing needs and decide whether a data entry position will be required. The following table lists the current PCIB staff by position held, name of individual, qualifications and start date. Table 1: Current PCI Botswana Staff Position Employee Start Date Country Director Karen Romano, MPH 17 Jan 2008 Finance & Administration Arun Sharma, CPA 23 Feb 2008 Director Programs Director Dorothy Tlagae, BSW, MADVS To start 15 July 2009 Program Manager Olive D Mello, MSc PH 11 Feb 2008 Finance & Administration Manager Aucillia Letshwiti, ACCA To start 06 July 2009 Senior Capacity Building Ann Fitzgerald, MPH, L.Ac. 1 June 2008 Advisor (short-term position through Sept 09) Organizational Capacity Davies Mpofu, MSW, MBA 1 Dec 2008 Development Officer OVC Program Officer David Kanje, MA 10 Mar 2008 Palliative Care Officer Tumalano Sekoto, BA, 01 Feb 2009 RN/MW, FNP M&E Officer Reggie Moatshe, MSc Computer Science To start 3 August 2009 Assistant M&E Officer Watipa Gaogane, BSc 1 Mar 2008 Associate Program Officer Kenalemodisa Pati, BSc 1 Feb 2008 Accountant Letlhabile Modikwa, BA, 1 Feb 2008 Accountant CIMA stage 2 Kgololo Lephole Part qualified ACCA Part 3 ACCA 11August 2008 Administration Officer Refiloe Aphiri, MBA pending 1 July 2008 Receptionist/Office Assistant Tshepang Mothei 1 Feb 2008 Administrative Sylvia Tshoswane 1 Feb 2008 Assistant/Driver Driver Bofelo Moilatshimo 1 Feb 2008 Performance Management System (PMS) PCI started implementing the new PMS that was finalized in quarter two. Staff appraisals were done for those that had reached their anniversary dates with PCI and performance objectives set for the following year. PCI also finalized its internal salary structure which was based on the results of the salary survey that was conducted early in the year and disseminated to staff. PCI now has in place a complete human resource management

system that will allow employees to meet their performance targets and also facilitate growth in their careers. III. HUMAN RESOURCE DEVELOPMENT Palliative Care Training. The Palliative Care and Associate Program Officers attended a three week community care training of trainer s course in Uganda. The main aim of the course was to enable health workers involved in community HIV/AIDS related work to contribute to the establishment of effective HIV/AIDS prevention, care and support interventions for improving the quality of life of those infected and affected by HIV/AIDS. Skills gained from this course include: Facilitating development of appropriate trainings required by community based organizations to support those infected and affected by HIV/AIDS Enhanced competencies in developing appropriate interventions to manage HIV/AIDS related challenges Enhanced skills in basic counseling, ART support for PLHIV and prevention of the spread of HIV/AIDS Improved leadership and management skills for sustainability of community care programs Improved ability to develop action plans for intervention of community care programs in local settings Knowledge and skills gained from this training will be used to improve planning and implementation of community led HIV/AIDS programs through on-going technical assistance to NGO partners. Food Security and Nutrition- Africa Forum 2009 in Malawi, June 2009. PCI s Organizational Development Officer attended the Forum, which was hosted by Project Concern International and partners. The forum used PCI s Community of Practice (CoP) model as it focused on the three thematic areas of integrating Food & Nutrition Security in HIV/AIDS programming; promoting livelihoods programs to support vulnerable children and families; and promoting food assistance vis a vis food aid in light of the current world food crisis. Summary of key observations and lessons learnt from the forum: That a lack of integrated Food & Nutrition Security in HIV/AIDS programs results in the inability of the organization to assess and determine the nutritional status of PLWA and to recognize clinical symptoms that may indicate malnutrition requiring dietary supplementation. This leads to continuous discharge and readmission of PLWA into HIV/AIDS programs Vocational skills such as tin-smithing, carpentry, tailoring and computer skills have in some countries enabled OVC to raise money for their educational and

other family needs, as well opening other economic opportunities for them in the formal labor market. A successful program called Livelihood Improvement and Diversification Programs working with vulnerable families, especially women, has raised US$503, 148 and is presently being rolled out to other provinces in the country. The community groups were mentored towards establishing and contributing to a common Fund. The contributions are loaned out to members with interest (microcredit scheme). Members have used the loans to engage in small stock farming, start micro-enterprises, acquire household assets, and pay insurance (against repossessions) for their assets, among others. The program has also contributed towards preventing the onset of risky sexual behaviors, especially by young women. In view of the global food crisis, it was observed that development partners need to re - think their OVC Food Assistance programming. In this regard, World Food Program shared its recommended 5 step programming process for OVC food assistance. Possible options for PCI - Botswana Given that PCI recently entered into a Memorandum of Understanding with BONEPWA+, a network of people living with HIV (PLWA) to strengthen its institutional capacity to provide quality services to its membership, including food and nutrition, there is an opportunity for PCI to pilot some of the promising practices learnt at the Forum, notably, the Livelihoods Improvement & Diversification Program of Ethiopia and the Keyhole Gardening Model of Lesotho. This can be piloted in the four Centres of Excellence (COE). Exchange of Best Practices with PCI staff from the regional office- Zambia During the quarter, PCI Botswana hosted the PCI Africa Regional Director and Regional HIV Technical Advisor both based in Zambia. The two teams shared experiences on programs being implemented by PCI in Botswana and in other countries in Africa region. Promising practices shared included the use of recreational activities in Zambia to reach more OVC in communities, the savings scheme used by women groups in Ethiopia as a livelihood intervention, working with community schools in Zambia and Ethiopia to reach more children and volunteer led ART adherence program in Zambia. The Zambia team had the opportunity to visit one partner, BAPR and one of their support groups in Peleng in Lobatse, which gave them an insight into the environment PCI is working in Botswana. The outcomes of the discussions and observations opened ways of communication and on-going consultation between the two offices for continuous technical support.

IV. PROGRAM PROGRESS In this reporting period, 01 April to 30 June 2009, progress has been made towards capacity building for NGO partners in different technical areas to ensure delivery of quality services; institutional capacity strengthening through governance training, provision of guidelines on human resource and finance management and strengthening; collaboration with key government departments at national and district level. Memorandums of Understanding were signed with BONASO & BONEPWA+, two key umbrella organizations and a new sub-awardee was added to the PCI Building Bridges Program, the Botswana Association for Positive Living. PCI Building Bridges Program Management Stakeholders Meeting April, 2009. PCI held a Stakeholders meeting in late April 2009 to present the Building Bridges workplan that had been jointly developed by PCI Program Officers with their Government counterparts and other stakeholders. The meeting provided lively discussion and further input from the participants. Specific points for clarification recommended by the MOH were to seek clarification from Dr. Jibril on pediatric ART adherence support and to include the strengthening of the coordination of the MOH NGO coordination unit in the plan. It was recommended that the workplan and narrative be reformatted along technical areas, grouping activities by their target audiences NGOs, District, and Central Government. PCI was asked to follow up with individual ministries as those present at the meeting didn t have the authority to speak for their ministry as well as to share simplified quarterly reports with key Government stakeholders. PCI is in the process of revising the narrative and workplan. Development of program M&E indicators PCI M&E staff from San Diego joined the Botswana team for 10 days in May. A full Program Monitoring & Evaluation Plan for all draft indicators including proposing draft operational definitions for key indicator terms were finalized. The results framework for Building Bridges was also reviewed and finalised by the team. It was agreed to ask partner NGOs to send in their data on a monthly rather than quarterly basis in order to improve data management and quality of reporting. The Botswana team continues to develop data collection tools for the new indicators as well as finalise the Indicator Performance Tracking Tool (IPPT). Technical Capacity Building for NGO partners Training in Pediatric ART support for NGO staff and District Officers PCI, in collaboration with Baylor University, trained a second group of NGO partner staff alongside nurses & social workers from PCI supported districts. This strategy is designed to strengthen collaboration between NGOs and local health facilities. This brings the total number of people trained to 40. (24 staff from PCI supported NGOs, six

from other NGOs namely: Light & Courage, Hope World Wide, Stepping Stones and 10 Government staff). In June 2009, 12 participants of the 40 trained above met to brainstorm on the content outline to start the process of developing a training package for community volunteers. A draft outline has been submitted to Baylor for review and refinement, after which it will be sent to the reference group for further review. In addition, individuals from the 40 trained have been identified to be trained as master trainers. This TOT training is scheduled for August 11-13 at Baylor Clinic. The trainers, together with MOH MASA pediatrics and Baylor, will form a reference group to develop a curriculum for volunteers. A plan for post-training technical assistance will be developed in the next financial year, alongside a plan for strengthening referral and case-management partnerships among the trained NGOs and health facilities in selected districts (prioritizing districts where Baylor has been training clinic staff in pediatric HIV). Community Mobilization Training During the quarter, PCI, in collaboration with OVC focused partners, organized and conducted community mobilization training using the Journey of Life tool (JoL). The collaborative process brought together PCI, DSS, Childline Botswana, MARANG, and REPSSI - Zimbabwe and was supported by PCI s International OVC consultant. The seven day program was held in Selibe-Phikwe in April. The thirty three (33) participants trained in JoL included fifteen (15) participants from seven NGOs supported by PCI, five Government District Officers from Mahalapye and Selibe Phikwe districts; four staff from two non- PCI supported NGOs from Phikwe on recommendation by DAC, PCI staff, staff from DSS staff Child Line, Marang and Hope World Wide also attended the training bringing. The training was structured into two parts. The first part oriented participants to OVC basics and was facilitated by DSS, Child Line and PCI. The second part focused on community mobilisation using the JoL which included theory and practical. The JoL training was facilitated by the OVC consultant and staff from REPSSI- Zimbabwe. Two teams were formed at national and district level and will receive further training including TOT skills in JoL and will in future oversee the roll out of this training in the country. Following the training, participants formed five groups according to their districts (Selebi Phikwe, Mahalapye, Gaborone, Lobatse and Kanye) to create action plans and budgets which were submitted to PCI. The district teams have started conducting JoL trainings for the communities in different areas and are expected to conduct at least two trainings in each district (thus starting JoL in ten communities) before the second follow-on training planned during the fourth quarter. These interventions are designed to get communities to understand issues affecting children in their own communities and to help them find lasting solutions to those problems.

OVC Basics Training Those PCI Partner NGOS who didn t attend the JoL training received training in OVC Basics to enhance their capacity to work with children. They will participate in a JoL training next fiscal year. PCI, in collaboration with DSS, conducted a five day training around the following major thematic areas: understanding children needs and rights, understanding the situation of OVC, different ways to care for OVC, the roles of families, communities, NGOs and Government in child care and designing and implementation of effective OVC care interventions. Twenty five participants (15 PCI supported NGOs, 5 Government staff & 5 non-pci supported NGOs) attended the workshop. Pre test and post test results showed high levels of knowledge gain. The PCI NGO staffs trained are expected to pass on the knowledge and skills to the rest of their co-workers, including volunteers, in order to improve the quality of services provided at family and community level. NGO partners sharing forum and planning meeting for FY 09/10 During the quarter, PCI NGO partners met for two days to review progress made in program implementation in the first six months of FY 09. They shared experiences in the implementation of new strategies and started on the process of developing new implementation plans (IPs) for the following year (FY2010). PCI program performance for the first six months of FY 09 (October 08 to April 09) in regard to meeting targets were reviewed. Remarkable achievements were with the OVC targets where 71% of the target set for the year had been met by mid year and 51% of the target set for adults on ART. However, total individuals provided with palliative care was at 40%; caregiver training for OVC and palliative care was at 28% and 19% respectively while children provided with ART was 20% of the target set for the year. The discussion helped participants to reflect on more creative ways to meet the targets set for FY 08/09 and as well as to plan for the following year. In the same meeting, participants shared creative approaches they have used in the first six months to increase reach to more families with children and PLWHA in need of care and support services using more cost effective ways while maintaining quality. Almost all organizations reported to have engaged new volunteers in service delivery. House of Hope and BOCAIP Tumelong decentralized their kids clubs from the centre (NGO office) to community based premises such as churches, VDC buildings. These are run by youth with support from NGO staff. BBM identified church women who will be trained to provide care and support services to OVC during Sunday school activities. Similarly, Holy Cross Hospice has formed coalitions with women s groups in the community who will also be trained in service delivery. Tsholofelo Trust in Lethlakeng and BAPR in Lobatse have formed PLWHA support groups who, in addition to supporting themselves to live positively within their groups, will be trained to provide services to families in their communities. After training in Journey of Life (JoL) tool, Mothers Union in Mahalapye, Silence Kills and Humana Child AID in Selibe Phikwe have all started working with guidance and counseling teachers and youth groups in schools within their communities.

NGO partners will build on these initiatives as they develop their implementation plans and targets for FY 09/10. PCI will continue to organise such gatherings and facilitate exchange visits amongst organizations to promote peer learning and collective problem solving. Institutional Capacity Building for NGO partners Governance and Leadership training Recognizing the critical role that governance and leadership plays in organizational development and growth, PCI, in partnership with BONASO, organized a week long training workshop for partner organizations on governance and leadership. The training took place from 25 to 29 May 2009 in Palapye and was attended by a total of 34 participants. This workshop brought together board members and management staff to help them appreciate each others roles through sharing experiences and learning from each other. The objectives of the workshop were to: Equip the participants with basic knowledge and understanding of governance and leadership issues among civil society organizations in Botswana; Increase knowledge and understanding of the Board and management about their roles and responsibilities in order to improve organizational performance and management; Apply the acquired knowledge and understanding in planning, implementing, monitoring, evaluation and generally providing oversight to the organizations; The workshop adopted interactive adult learning approaches such as presentations, brainstorming, group work and plenary discussions. Topics covered included defining governance and leadership, roles and responsibilities of the Board, common civil society challenges in governance and leadership in Botswana, basic organisational management functions, financial management, human resource management, including Botswana labour laws requirements, resource mobilisation and sharing lessons learnt from implementation of the Building Bridges program. The outcome of the workshop was action plans by participating organizations which outlined priority activities to be implemented by end of the current FY (Sept 2009). Priority activities were identified under four thematic areas: Governance, Human Resources Management, Resource Mobilization and Financial Management. Rapid Organizational Capacity Assessment (ROCA) As had been reported in quarter two 09, the ROCA tool that was developed and tested last fiscal year by PCI was revised and enriched with the Care Initiative and AED OCAT tools. This tool will be administered to 10 NGOs supported by PCI in the fourth quarter. FMR Management Consultants Company was selected among 25 submissions who responded to an advert that PCI placed in one of the newspapers for a short term consultancy to conduct ROCA. The consultancy will be supervised and guided jointly by PCI and BONASO. The deliverables of the consultancy will be 1) an assessment report

2) individual NGO Capacity Building Plans and 3) a consolidated Capacity Building Plan of 10 PCI partner organizations. Dissemination of guidelines in Human Resource (HR) Management During the quarter, PCI developed and disseminated generic HR procedures to partners. These included guidance on recruitment processes, handling grievances, raising awareness about labour requirements in Botswana and recruitment of volunteers. In the past there have been inconsistencies and lack of reference points in regard to human resource management by the partners. These procedures have been very helpful to partners in handling their day-to-day HR needs. The procedures have been shared with PCI regional office in Zambia and they intend to disseminate them to other partners in the region that need such support. Similarly, generic job descriptions spelling out the core functions of key positions of coordinator, finance and program manager were developed and disseminated to partners. The aim was to assist NGOs find suitable candidates. Mothers Union, Mahalapye was assisted to review its constitution. With this support, it is hoped that NGO partners will be more stable and be able to sustain service delivery in their communities. PEPFAR OVC Implementer s meeting PCI made a presentation on strategies for scaling up comprehensive, quality services for vulnerable children at the meeting held in May. PCI shared progress made to supporting 12 NGO partners to increase reach to more OVC and their families with quality services while using cost effective approaches. These approaches include: Helping NGOs integrate services and target the entire family; Moving NGO partners from centre-based to home-based/volunteer approaches; Creating stronger linkages between NGOs and other implementing structures in the community (schools, clinics, S&CD), to create a network of support for families; Activating the community to take voluntary action (Journey of Life) and tap into existing resources (VDC, Churches, retired professionals, small businesses, etc); Engaging PLHA support groups in service delivery; Equipping adolescents with life skills and engaging them in service delivery to peers and younger children and Strengthening district structures for organizational linkages, referrals, and scaleup. All these approaches are still in their infancy and PCI will continue to work with Government and other stakeholders to support partners to develop models that are culturally appropriate and which will be replicated in the country. Supporting BORNUS and OHBC transition to the New Partners Initiative (NPI) During the quarter, BORNUS and Otse received their first disbursement of funds from New Partners Initiative (NPI). PCI embarked on the closeout process and held meetings with the two organisations to explain all the requirements and procedures for a successful close out. The process is close to completion with PCI left with reviewing the final financial report for Otse.

As reported in quarter two, PCI will continue to provide technical assistance to Otse and BORNUS in palliative care, OVC and ART programming. During the quarter, Otse and BORNUS benefited from trainings in community mobilisation using Journey of Life tool, ART adherence and access support, orientation to OVC basics, psychosocial support and governance and leadership. PCI will track the technical support to BORNUS and Otse under its capacity building indicators which will be refined and shared with USAID. Participation in the day of the African Child celebrations: PCI joined other organisations involved in child care in commemorating June 16, Day of the African Child in Jwaneng. PCI put up a stall to raise awareness about the work of PCI global and Building Bridges Program in Botswana. PCI also used this opportunity to interact with other stakeholders in child care and create network opportunities. New Sub-award potential PPP PCI has requested and received authorization to extend an additional sub-award to the Botswana Association for Positive Living (BAPL) to complete the Kgakololo Project (which is Setswana for to remind ). The project will pilot the use of text messaging to support PLHA (adolescents and adults) in ART adherence. Partners to the project are the Ministry of Health/MASA program, a local telecommunications company, MASCOM, and the Compton Foundation from the USA. The eleven month study will enroll 550 patients half of whom are adolescents. The project will be housed in the Ministry of Health s MASA program office. Total value of the project is $258, 766. PCI has granted a $102,325 sub award for the eleven month project, MASCOM has committed to a similar amount. This could potentially qualify as a PPP project for PEPFAR. PCI s work with key government stakeholders Ministry of Health (MOH) - Department of HIV Prevention & Care (DHAPC) PCI and MOH technical Officers have had several meetings during the quarter to agree on activities that will be conducted jointly. Some of the activities planned for the remaining period this FY include: Joint PCI/ MOH roll out of MOH Palliative care training package- PCI staff to facilitate at training in July. PCI/MOH training for PCI NGO staff, 3 non- PCI NGO staff and BONEPWA+ in palliative care using the national palliative care training curriculum for allied professionals PCI/MOH roll out of the Comprehensive HIV/AIDS manual for CHBC volunteers PCI and MOH MASA pediatrics to develop and assist in implementation of the Pediatric/ Family ART adherence training package for CSOs. Ministry of Local Government- Department of Social Services (DSS) During the quarter, PCI has worked in close collaboration with MLG- DSS to jointly organize and conduct community mobilization training, orientation of partners to OVC basics and planning for psycho-social support training which will take place in July 09.

The PCI-DSS collaboration demonstrates PCI efforts to support government programs, rather than duplicate efforts. The collaboration will further strengthen the relationship between NGOs, S&CD and other government offices to enhance ongoing technical support and effective referral. Ministry of Local Government- Primary Health Care (PHC) PCI has worked in collaboration with MLG PHC in an effort to link NGO partners to district government service providers such as clinic health workers. In consultation with MLG PHC, PCI has organized and conducted trainings that involved both Government officers and NGO staff to strengthen this collaboration and referral. Such trainings included the community mobilization training and the ART access and adherence trainings implemented this quarter. PCI s work with umbrella organizations BONASO PCI and BONASO signed an MOU in June 2009. The MOU runs from June 1 Sept 30 2009. As noted in last quarter s report, there are two key areas of support covered in this fiscal year: 1) Strengthening the institutional capacity of BONASO and 2) improving NGO coordination at the district level to strengthen OVC and palliative care interventions. BONEPWA+ Meetings were held in April and May with the BONEPWA+ technical team to determine specific areas of collaboration. As a result an MOU was signed in June. BONEPWA+ and PCI commit themselves to improve the quality, availability, and accessibility of care and support services in the community through PLWHA support groups by strengthening the technical capacity of the Coordinators at BONEPWA+ s Centres of Excellence (COE). To date there are four COEs: Kasane, Nlaphkwane, Radisele and Kang. There are four more COEs in the planning stages: Lentswelatau, Maun, Tshabong and Good Hope. Each COE coordinator manages the operation of the Centre, and supervises volunteers who carry out community work in home based care, economic empowerment, prevention education, advocacy, community mobilization and ARV treatment literacy. At the Secretariat level, PCI will support a National Training Coordinator position, and an IT consultant to audit their current system, develop an association focused database and update the database. Delivery of integrated services through partnership with 10 NGOs During the quarter, PCI dedicated substantial amount of time and other resources to training partners in the different technical areas that make up the integration package namely; OVC, palliative care and ART and community mobilization as a separate strategy. Training focused on NGO staff who are mainly nurses, social workers and lay counselors. The aim was to increase understanding and improve skills in the different technical areas; to ensure quality service delivery at the family level; and to create a supportive environment around the family through community mobilization. The plan is

to support NGOs as they extend the trainings to community volunteers who are at the centre of service delivery to the family, and this process will continue through next quarter and part of the next fiscal year. i) Orphans and Vulnerable Children Progress has been made towards achievement of targets as detailed in this quarterly report. The program targeted to reach 929 OVC with direct services in quarter three (April-June, 2009). The program reached 2090 OVC (972 males and 1118 females of which 1510 are reported as having received primary direct support while 581 received supplemental direct support. The total number of OVC reached comprises of existing and new beneficiaries in the quarter. Services provided include psychosocial support, food and nutritional support, health care, education support and economic strengthening support to OVC and their families. In addition to approaches used in the past such as day care centres, pre-school, after school kids clubs and PSS camps, NGOs continue to come up with more creative and cost effective approaches to reach more children such as kids clubs held concurrently at different points in the community, engaging community groups to reach more children and families, increasing number of volunteers and scaling up services to new locations in their communities. With the training in community mobilization using Journey of Life (JoL) tool, the program envisages reaching many more children with both direct and indirect support services. The program is working on mechanisms of quality assurance as well as data collection and reporting especially for indirect services. Progress has been made towards training of care givers with a total of 399 trained against a target of 281 for the quarter. There has been significant improvement in OVC caregiver training from the previous two quarters where 158 and 293 caregivers were trained respectively. However, the total number of children reached with ART access and adherence support has remained low with only 103 children reached with adherence support against a target of 179 set for the quarter. This indicator remains unclear as one target figure was set for both access and adherence support yet the two variables (access and adherence) are tracked separately. PCI is in the process of refining the ART indicators and in future should be able to set and track the two variables separately.

The table below summarizes the OVC required PEPFAR indicators compared to numbers reached. Summary of PEPFAR required OVC Indicators Indicator Actual Planned for Quarter 3 (April June 09) Number of OVC served during the reporting 2090 929 period Male 972 Female 1118 Total number of OVC receiving primary direct 1510 support (3 or more services) by OVC program Male 674 Female 836 Total number of OVC receiving supplemental 581 direct support (1 or 2 services) by OVC programs Male 299 Female 282 Total number of OVC receiving food and nutritional supplementation through OVC program 0 # of OVC provided with treatment access (this is a subset of the total number served) # of OVC provided with adherence support(this is a subset of the total number served) Male 0 Female 0 92 179 Male 48 Female 44 103 Male 51 Female 52 Number of providers/care takers trained in caring 399 281 for OVC Male 39 Female 360 Number of providers/caretakers trained in providing treatment access and adherence support to OVC. 129 201 Male 14 Female 115

ii) Palliative care During the quarter, the program reached 960 beneficiaries (259 males and 701 females) with palliative care services against a target of 936 set for the quarter. House of Hope and BOCAIP Tumelong, who in the past have been OVC only providers, have during the quarter managed to recruit 90 and 32 palliative care clients respectively. However, PCI was not able to train NGO staff in palliative care in the reporting period as planned but has made headway with plans to train NGO staff in quarter four with support from Ministry of Health. NGOs continue to report challenges with recruitment of males into the palliative care program as well as stigma. However, the formation of support groups, introduction/strengthening of HIV counseling and testing among five of the ten NGOs should to a certain extent help address issues of stigma and male involvement. The program has consistently met its quarterly targets for adults on ART with 618, 647 and 673 for quarter one, two and three respectively against a quarterly target of 235. This is because majority of clients enrolled in the palliative care program are on ART and these come out voluntarily and disclose their status. More needs to be done to identify children through linkages with PMTCT program, IDCC clinics, under fives clinics and intensified home visits. Similar to what was reported under OVC, PCI is in the process of refining ART indicators and will verify these numbers accordingly for future reporting purposes. Number of care givers trained for provision of both palliative care and ART access and adherence support indicators have been low with 95 care givers trained under each indicator compared to 312 and 219 target set for palliative care and ART access and adherence support respectively. The challenge has been the PEPFAR requirements for qualifying training where there should be a curriculum followed and specific number of hours covered by the training. Most NGOs have been training caregivers during home visits but do not count them as trained. PCI, in consultation with PEPFAR advisors, will work with key partners and NGOs to come up with a guideline and or checklist highlighting major areas to be covered when working with caregivers so that their efforts are rewarded as well as quality ensured.

Below is a table summarizing the PEPFAR required palliative care indicators and numbers reached during the quarter. Summary of PEPFAR required Palliative Care Indicators Indicator Actual Planned for quarter 3 (April-June 09) Number of individuals provided with general 960 936 HIV-related palliative care during the reporting period Male 259 Female 701 Number of individuals provided with treatment 324 235 access support (this is a subset of the total number served) Male 87 Female 237 Number of individuals provided with treatment adherence support (this is a subset of the total number served) 673 Male 193 Female 480 Number of individuals trained to provide general 95 312 HIV related palliative care during the reporting period Male 15 Female 80 Number of individuals trained to provide 95 219 treatment access and adherence support to palliative care clients Male 15 Female 80 V. IMPLEMENTATION CHALLENGES Complexity of integration concept at the family level Integration in the PCI context involves three technical areas: OVC, palliative care and ART adherence support. Each of the technical areas requires specialized skills which require individualized training with different curricula. The challenge is bringing all these services together at the family level without compromising quality. In addition, since the integrated package is provided by volunteers at the family level, there is need to simplify information in three areas to come up with a simplified integrated tool/guideline that will be used by volunteers at the family level. Involvement of PCI staff at different levels of program implementation- national, district and NGO (community) level: Managing relationships with key government ministries

and other stakeholders at national and district level while providing adequate support to the NGO partners without compromising output at each level remains a challenge. PCI will in the second year work more with the district structures such as NGO coalitions that bring together district officers and NGO staff. Coordinating the training and technical assistance activities without overwhelming the NGO Partners. Finding the right mix of training, technical assistance that supports the partners to implement their workplans continues to be a challenge. As this first year involves training, the expectation is that next year the focus will be on technical assistance to implementation and quality control. VI. PLANS FOR NEXT QUARTER Program/Technical Work with Baylor to train TOT from NGO staff and together develop curriculum and plan of how to cascade pediatric ART adherence support training to volunteers. Work with MOH to conduct palliative care training for allied professionals (social workers and lay counselors) from PCI supported NGOs. Work with DSS to conduct follow-on training in community mobilization using JoL tool Work with DSS to conduct PSS training for NGO partners Support NGOs partners to develop their implementation plans and budgets for FY2010 Work with PCI International Office (IO) staff to conduct an assessment of livelihood opportunities in Botswana to inform the livelihood strategy development Begin work with new sub-awardee, BAPL in the rollout of the Kgakololo Project with MOH and MASCOM. Program/Organizational Development Conduct Rapid Organizational Capacity Assessment (ROCA) with 10 NGO partners Monitor implementation of action plans put together by NGOs during the governance workshop in May 2009 Key Stakeholders Provide technical and financial support to the development of the National Civil Society capacity building strategy Support DSS in establishment of District NGO coalitions for Kasane and Selebi- Phikwe regions Provide technical and financial support to DSS to the development of the Community Carers Model for Orphans and Vulnerable Children s Protection.

Provide technical assistance to BONASO and BONEPWA+ to implement tasks outlined in their MOUs including hiring of staff, IT strategy and strengthening work in the districts.