1. Funding Local NGOs In the Response to HIV/AIDS Under PEPFAR Pact Community REACH

2. Pact’s HIV/AIDS Global Grants Program Awarded in 2001 by USAID to rapidly make available HIV/AIDS funding to INGO & local NGOs – for care & support, prevention & VCT Community REACH consists of a global grants program (22 countries) & country & regional level HIV/AIDS grants programs in –South Africa- Cambodia –Botswana, Lesotho, Swaziland - Brazil –Vietnam –Greater Mekong Region

3. Global Outreach 7 global grants solicitations - 550 applications 2001 – 2003 – Pre-PEPFAR – Intl & local – 22 rapid scale up & intensive countries –Community HBC & support –Youth VCT – Linkages & Referrals –Reducing Stigma & Discrimination –Support to OVC 2004 – 2005 – PEPFAR – Local NGOs only –Positive Prevention, Care & Support for PLWHA – Focus Countries –Support to HBC Volunteers- Non-Focus Countries –Community Engagement in ARV Treatment – Non-Focus Countries

4. Why Grant to Local NGOs? Accountability and Commitment –Passion & involvement –Transparency –Respect & trust of participants –Culturally appropriate –Provide missing link between communities and formal treatment services Cost Effective –Embedded in local economy –Inspire volunteerism –Greater chance of sustainability

5. Grantee Results Prior to PEPFAR 2001-2004 $8 million in subgrant funds to 80 organizations in 22 countries (11 PEPFAR Focus Countries)-- 55 local new USG partners (Average grant size $200,00 for two-three year programs) Reached over 520,000 individuals w/ prevention messages & services through 40 outlets Provided care & support to 75,000 PLWHA & OVC through 28 programs Provided VCT services to over 27,000— primarily youth at 20 service points Trained nearly 10,000 HCWs & support staff

6. Transitioning to PEPFAR Challenges & Successes Challenges Of 20 grant programs in 11 Focus Countries – Only 25% picked up by the COP process 2004 Non-focus grantees roadblock to additional $ Procurement process of funds slow FY05 Grant Program Shifted to Non-Focus Countries: Malawi, Zimbabwe, Cambodia, India, Indonesia, Nepal, Dominican Republic, Honduras, Russia, Ukraine Successes/Adaptations PCI- Bwafwano – Zambia, HAPCSO Ethiopia Adapted global grant lessons learned in engaging local NGOs/FBOs/CBOs to country-level programs OGAC revised M&E Structure – M&E workbook

7. PEPFAR Focus Country & Regional Programs South Africa, February 2004 Program APS Process for INGO & local NGOs – large grants program avg. size $2.5 million for Pepfar activities Challenges South Africa NGO Country Portfolio transitioned from single agency (s) to inter-agency management Rigorous competition PEPFAR M&E reporting requirements—lack of understanding Successes Rapid funding of NGOs under PEPFAR Broad Outreach to NGO community

8. Botswana, Lesotho & Swaziland – January 2005 Program HIV/AIDS grants program to regional & local NGOs/CBOs/FBOs—avg. size $100,00 (1-3 years) for Prevention & Care Grants – 32 Botswana, 22 Lesotho,15 Swaziland Challenges Overwhelming response from CBOs- Capacities of local CBOs/FBOs varies– capacity building & TA key Successes Utilized lessons learned from South Africa APS process Articulated PEPFAR goals from solicitation process

9. Vietnam January 2005 Program Rapidly Fund & Start-up Program–One-year grants – Average grant size $300,000 to Intl and Local NGOs Activities funded range of Pepfar activities Challenges NGOS not familiar w/ PEPFAR goals & reporting Treatment issues & multi-year commitment & sustainability – Central procurement & ability to sustain drugs Procurement – Funds projected for April 2005 still not available September 2005 Successes Able to forward fund from central mechanism Two Treatment programs started

10. Implementation Issues 1.Procurement delays versus rapid implementation & start-up 2.COP process of identifying partners & local NGOS 3.Budgets remain fixed on preliminary plans & decided annually 4.Central procurement mechanisms for ARV drugs with separate NGOs & government agencies implementing programs 5.Treatment costs versus continuum of care