Authors: Courtney Irwin, Program Specialist in Office of HIV/AIDS and Mosarwa Segwabe, Health Office Deputy Director at USAID Mission in Botswana
The transition to fund more local organizations is crucial for building long-term program impact and sustainability, is cost efficient, and is pivotal to reaching sustained HIV epidemic control. In 2018, former Global AIDS Coordinator Ambassador, Deborah Birx, announced a goal to direct 70 percent of PEPFAR funding to local partners through direct awards by September 30, 2021. To achieve this goal, PEPFAR and USAID have steadily increased the delivery of HIV prevention, care, and treatment services by local partners and partner country governments. To date, USAID/PEPFAR has transitioned nearly $750 million (49%) of its annual budget to over 170 local organizations around the world.
Although the goal is agency specific, and does not require each country to individually meet the 70% mark, many, like the USAID Mission in Botswana, are eager to support their existing local partners to become direct recipients of USAID funding. In March 2021, USAID, in collaboration with the Government of Botswana, celebrated the successful transition of five USAID local sub-partners to becoming direct recipients of USAID/PEPFAR funding. The celebration included Botswana Minister of Health and Wellness Dr. Edwin Dikoloti, U.S. Ambassador to Botswana Craig Cloud, and National AIDS and Health Promotion Agency acting coordinator Mr. Robert Selato.
The transition to these local partners in Botswana is paramount to the country's health care agenda, according to Dr. Dikoloti, as it allows for expanded access to much needed HIV interventions and healthcare services. This success story details the prime recipients’ programs; what they will work to achieve as well as achievements thus far; how USAID/Botswana made the transition; and lessons learned to share with other USAID Missions.
WHO
The five former local sub-partners that transitioned to primary recipients of USAID/PEPFAR funding are:
- Stepping Stones International
- Hope Worldwide Botswana
- Tebelopele Wellness Clinic
- Humana People to People
- Botswana Christian AIDS Intervention Programme
The first two partners (Stepping Stones International and Hope Worldwide Botswana) transitioned during 2020, while the last three (Tebelopele Wellness Clinic, Humana People to People, and Botswana Christian AIDS Intervention Programme) transitioned to primary recipients of USAID funding in March of 2021. The direct awards are designed to implement a wide range of PEPFAR-funded programs including facility- and community-based care and treatment programs, as well as programs for orphans and vulnerable children (OVC) and prevention programming for adolescent girls and young women through the Determined, Resilient, Empowered, AIDS-free, Mentored and Secured (DREAMS) program.
WHAT
The new awards will:
- work to find undiagnosed men, women, and children;
- ensure linkage to care and treatment;
- help retain patients in care and treatment;
- provide an array of health, education, economic strengthening and social services to OVC and their families and keep adolescent girls and young women (AGYW) HIV-negative.
HOW
In an effort to make this transition happen, the USAID Mission in Botswana programmed $6.6 million of their fiscal year 2020 program investments to local entities. This resource allocation allows the USAID Mission in Botswana to direct over 60 percent of their PEPFAR funding to local partners starting in fiscal year 2022 (as of May, 2021).
Of note, the USAID Mission in Botswana’s local partner transition reflects years of working with these organizations as sub-partners to strengthen their organizational and financial capacities to the level needed to implement high quality health services and manage US Government resources. As sub-partners, these organizations demonstrated strong technical capacity. Their commitment to ensuring that clients receive the services they need was exemplified by their results in offering prevention services to orphans and vulnerable children, and adolescent girls and young women. They also excelled in identifying HIV cases among priority populations, linking them to treatment, and maintaining viral suppression. Lastly, these five local organizations were able to provide services that adhered to current Government of Botswana policies and guidelines, and developed a close working partnership with various levels of government ministries as a result.
ACHIEVEMENTS
Within the first quarter of implementation, Tebelopele Wellness Centers were able to exceed their goal for the number of patients currently on treatment. As of May 2021, they have provided HIV treatment to nearly 500 patients in their community, reaching 150 more than they had originally projected. To date, Hope Worldwide Botswana and Stepping Stones International have both excelled at providing support to their OVC patients, having reached nearly 5,000 and 6,000 individuals respectively.
As of December 2020, Botswana Christian AIDS Intervention Programme and Humana People to People followed up with patients who had an interruption in treatment, and successfully returned 73 percent of those patients to care.
LESSONS LEARNED
The USAID Mission in Botswana team, through the transition process, learned how essential technical assistance (TA) strengthens the capacity of local partner organizations to become leaders in reaching epidemic control. To determine readiness for direct US Government funding, each local partner organization undertook both an Organizational Capacity Assessment (OCA) and Non US Organization Pre-Award Survey (NUPAS) assessment, which led to key areas being identified for continued TA. In the ensuing years, as each organization continues implementation in a primary recipient capacity, targeted TA in financial management, human resources management, technical direction, monitoring and evaluation and other areas of support provided by international partners will be offered to ensure sustained capacity to maintain strong performance and results delivery. USAID/Botswana’s local partner transition provides lessons learned to share with other USAID Missions that are undertaking a similar process.