DISSEMINATION OF THE JOINT REVIEW OF THE HIV/AIDS NATIONAL STRATEGIC FRAMEWORK II

Presented by Dr Hugues LAGODr Agnes DZOKOTO-Dr Kwabena POKU-Dr Yao YEBOAH-Dr William BOSU

-Wednesday 14 June 2010-La-Palm Beach Hotel

OUTLINE OF PRESENTATION

Background

Objectives of the joint review

Team of Consultants

Methodology

Findings per thematic area Key achievements Key challenges Priorities to inform NSP 2011-2015

Conclusion

BACKGROUND

NSF I (2001-2005); NSF II (2006-2010)

1.9% (NACP 2009) estimated National HIV prevalence

2010: end of implementation of NSFII development of the NSP 2011-2015

OBJECTIVES OF THE REVIEW To assess the extent to which the goal and objectives of the NSFII were achieved:Relevance of interventions to the target groups

and the character of the epidemicCoverage and sustainability of

interventions/servicesKey achievements of the multisectoral responseKey challenges faced in the implementation of

interventionsGaps, barriers to services and emerging issuesBest practices and lessons learntPriorities for NSP 2011-2015

TEAM OF CONSULTANTS

Thematic Areas Name

1 Coordination and management of the decentralized multi-sectoral response

Dr Yao YEBOAH

2Prevention and Mitigation Dr Kwabena POKU

3Treatment, Care and support Dr Agnes DZOKOTO

4Research, surveillance, M&E Dr William BOSU

5 Policy, Advocacy and enabling environment + Lead Consultant Dr Hugues LAGO

METHODOLOGY Literature review

Steering committee meetings

Interviews with key informants

Focus group discussions

Field visits

Thematic working group meetings

Limitations:

Duration of review

Availability of key informants

FINDINGS

POLICY, ADVOCACY AND ENABLING ENVIRONMENT

KEY ACHIEVEMENTS1. Key national policies and documents developed,

reviewed, revised, updated – ART/CT/OI/PMTCT/STI,

HIV Work place

2. NSF II informed development of APOW (2006-2010)

3. Partnership Forum established (2006) and functioning

4. Stakeholders capacitated to create an enabling

environment – MARPs, PLHIV, Work place

5. Partnerships established/strengthened with key

stakeholders – Media, NAP+, Parliamentarians, Legal

& Human Rights Advocates, Religious & Traditional

Leaders

POLICY, ADVOCACY AND ENABLING ENVIRONMENT

KEY CHALLENGES

1. Even though there has been some level of political commitment and leadership, this has not been fully translated into action

2. The GAC Secretariat has led a multi-sectoral HIV/AIDS response, however , there is limited capacity on advocacy to sustain this momentum

3. Limited development and implementation of HIV/AIDS workplace polices & programmes

4. The degree of involvement of Policy makers throughout the policy formulation and dissemination process is limited

5. For a sustained political and policy environment, there is a need for the GAC Secretariat to create a policy forum for regular interactions with stakeholders

POLICY, ADVOCACY AND ENABLING ENVIRONMENT

PRIORITIES TO INFORM NSP 2011-2015

1. Strengthen GAC Secretariat’s capacity for enhanced advocacy and communication

2. Scale-up development and implementation of HIV work place policies

3. Creation of a forum to review HIV-related policy issues

4. Develop and/or strengthen partnerships with strategic stakeholders – media, traditional & religious leaders, Uniformed services, youth , CSO, PLHIV networks etc

COORDINATION AND MANAGEMENT KEY ACHIEVEMENTS

1. One HIV&AIDs National Framework as a Roadmap

for all Partners and Stakeholders

2. APOW (2006-2010) developed and implemented

3. A shared Responsibility to the National Response

4. Improved information sharing, networking and

stakeholder participation in the National Response.

5. Relevant skills acquired by Regional and District

AIDS Committee members.

COORDINATION AND MANAGEMENT KEY CHALLENGES

1. Unequal political & financial commitment at all levels

2. Funding for implementation- Insufficient; delayed release

3. The GAC Secretariat is perceived as an Implementer and not only as a Coordinating body

4. Coordination and management of the NSF II at the decentralized level was not implemented as planned

5. The potential of the Private Sector as a key actor in the national HIV&AIDS response has not been fully optimized

COORDINATION AND MANAGEMENT PRIORITIES TO INFORM NSP 2011-2015

1. A critical review of the roles and responsibilities of key actors

2. Strengthen capacity for improved coordination and management particularly at the district and community level

3. Increase Government allocation - national and decentralized level

PREVENTION KEY ACHIEVEMENTS

1. A stabilized generalized HIV epidemic with a low prevalence < 2% (2.22% in 2006 to 1.9% in 2009)

2. Significant decrease in HIV prevalence among MARPs (34.7% in 2006 to 25% in 2009) and in the Youth (1.4% in 2006 to 1.9% in 2009)

3. School HIV&AIDS programmes -National School HIV ALERT and Life Skills Based HIV&AIDS Education

4. Increased access to and uptake of health and social services - CT (71,307 in 2006 to 865,058 in 2009) and PMTCT (36,155 in 2006 to 381,874 in 2009) services

PREVENTION AND MITIGATION KEY CHALLENGES

1. Even though Ghana has a stabilized generalized HIV epidemic, however there are significant regional, district and community variations (2% in the Northern region to 4.2% in the Eastern region; 0.7% in North Tongu to 5.8% in Agormanya and Koforidua)

2. Reduced resources for implementation of prevention activities from 39% in 2005 to 12% 2007 and then increased to 22% in 2008

3. Even though there has been a significant increase in the number of persons accessing HIV prevention services (CT & PMTCT), less than 90% have ever tested for HIV and less than 30% of pregnant women benefit from MTCT services

4. Lack of gender specific goals, outcomes and indicators

5. Inadequate dissemination and use of 2006 National IEC/BCC Strategic framework

PREVENTION AND MITIGATIONPRIORITIES TO INFORM NSP 2011-2015

1. Financial commitment to implement targeted,

evidence-based and cost-effective HIV

prevention programmes/activities

2. Scaling-up of HIV prevention services – CT,

PMTCT, STI etc

3. Strengthen capacity (at all levels) to develop

and implement HIV prevention interventions

4. Meaningful involvement of persons infected

with and affected by HIV

MITIGATION ACHIEVEMENTS

Workplace programme contributed to

increase knowledge and create an enabling

environment

NSPS (LEAP programme) improved

livelihood of poor hence less vulnerable

Increased direct services to OVC and PLHIV

e.g. NACP, OICI, WAAF

High level goverment support e.g world

AIDS day

MITIGATION CHALLENGES

Workplace efforts commendable, but not

measurable in terms of outputs and outcomes

LEAP is a example of livelihood improvement, but

the sustainability is an issue

High political support, but not backed by funding

from GoG

HIV risk behaviour from sociocultural norms deeply

rooted in Ghanaian

MITIGATION PRIORITIES

Focus on socio-cultural variables affecting female HIV transmission through traditional authorities and legal bodies

To increase comprehensive knowledge among general population to reduce stigma and discrimination

Develop a minimum standard package of interventions for OVC

Livelihood improvement (e.g. LEAP) should be part of DA efforts to enhance sustainability and reach

TREATMENT, CARE AND SUPPORTKEY ACHIEVEMENTS

1. Increase in the coverage of ARV services 1. ART sites - 13 in 2005 to 138 in 2009 2. PLHIV initiated on ART - 6,736 PLHIV in

December 2006 to 31,977 PLHIV in 2009

2. 89.8% of clients remained on ART after 12 months

3. Over 2,000 persons trained in Treatment and care annually

4. Health system strengthened through HIV treatment programmes

5. 15,309 OVC received support in 71 districts

TREATMENT , CARE AND SUPPORTART COVERAGE

0.4

3.5

6.5

10.8

15.6

34.0

40.4

0.4

3.7

6.6

11.1

15.9

35.3

46.0

0.0

0.7

3.7

6.5

10.5

16.9

25.5

0.0 10.0 20.0 30.0 40.0 50.0

2003

2004

2005

2006

2007

2008

2009

children < 15

adults > 15

adults and children

percentageyear

TREATMENT , CARE AND SUPPORT

KEY CHALLENGES

1. Service providers expect extra funding for AIDS activities and are reluctant to implement activities without extra funding.

2. Inadequate funding for ARVs and declining government allocation for treatment

3. Inadequate number and capacity of human resources , esp. for HBC

TREATMENT , CARE AND SUPPORT

KEY CHALLENGES

• Only 50% of females and only 39% of males who needed ART had access to services.

• The long procurement process and supply processes leading to some irregular supply and stock-outs of ARVs

• Stigma and discrimination leading to reduced access to and uptake of services

• No national standard package for HBC and no national lead organization; weak linkages

• Dependency syndrome of PLHIV

TREATMENT,CARE AND SUPPORTPRIORITIES TO INFORM NSP 2011-2015

1. Resource Mobilisation for Treatment after 2011

2. Reassess the mechanism for the payment of fees for HIV clients

3. Expand testing to the CHPS compounds and Scale -up Provider initiated CT

4. Institute innovative training for strategies to build capacity( pre-service training, non technical staff, PLHIV)

5. Strengthen referral systems within and outside the health systems

TREATMENT, CARE AND SUPPORT

PRIORITIES TO INFORM NSP 2011-2015

1. Improve male involvement in treatment

through increased entry points

2. Inclusion of livelihood programmes into

support e.g. Microcredit services

3. Strengthen SWD to take the lead in

providing support services

4. Strengthen Psychosocial support

5. Develop a standardised programme for

HBC and nutrition

RESEARCH, SURVEILLANCE, M&EKEY ACHIEVEMENTS

Improving mechanisms for dissemination –

NHARCON 2008, NACP Bulletin, HSS reports, etc

Improving quality of HIV Sentinel Surveillance

BSS and IBBSS conducted in general population and

MARPs

Road Map on M&E developed

Capacity building on M&E

NSF II that builds on NSF I, supported with M&E Plan,

5YPOW and operationalised through APOWs

% of HIV Samples from PHRL Confirmed as True positive and True Negative at NMIMR, HSS 2003-

09

Abstinence in Adult Male and Females, (GDHS 2003, 2008)

Multiple Partners in Adult and Young Men and Women

Research, Surveillance, M&EKey Challenges

Sexual behaviour worsened between 2003 and 2008 Improving ethical approval processes and clarifying

roles of collaborating partners in research Uncoordinated schedule of evaluations or

assessments of the national response Parallel reporting systems and cumbersome tools for

reporting Weak or non-use of surveillance, M&E or research

findings Recurring challenges – research agenda, database

on HIV studies, weak M&E capacity

RESEARCH, SURVEILLANCE, M&E PRIORITIES TO INFORM NSP 2011-

2015 Implement research studies – MARPs, HIV incidence,

drug resistance and economics-related studies Develop guidelines and monitor use of these

guidelines for improved use of data for decision making at the local levels

Integrate reporting systems, review reporting tools and harmonised indicator sets

Motivate M&E Focal Persons Use epidemiological data for action

Syphilis prevalence in AOB district Projected increase in HIV exposure in oil-rich

districts Discrimination in funding allocation

RESOURCE MOBILIZATIONKEY ACHIEVEMENTS

0

10000000

20000000

30000000

40000000

50000000

60000000

2005 2006 2007 2008

Years

Amount

Internationalfunds

Private funds

Public funds

RESOURCE MOBILIZATIONKEY ACHIEVEMENTS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008

Years

%

HIV- and AIDS-Related Research

Enabling Environment

Social Protection and Social Services

Human Resources

Programme Management andAdministration

Orphans and Vulnerable Children(OVC)

Treatment and care components

Prevention Programmes

RESOURCE MOBILIZATIONKEY ACHIEVEMENTS

1. National AIDS Spending Assessment

(NASA) 2007 & 2008 conducted and

disseminated

2. Funding from multiple sources –

Government, GFATM, IDA, UN system,

Private Sector etc

RESOURCE MOBILIZATIONKEY CHALLENGES

1. 80%-90% of funds are from external sources

2. NASA not able to capture Out-of-Pocket expenditure

3. Capacity of Implementers to effectively utilize funds – low

absorptive capacity

4. Delayed released of funds from Government – national ,

regional and district level

5. Abrupt release of funds by DPs usually during Q3 & Q4

6. Unequal level of understanding of funding modalities –

direct, pooled and earmarked

RESOURCE MOBILIZATIONPRIORITIES TO INFORM NSP 2011-2015

1. Long term sustainability plan Creation of an AIDS Fund Mobilization at country level – Private Sector,

Government, DPs, UN system , Individual

2. Increase in Government funding from 10% to 15%

3. Continue to conduct NASA

4. Common understanding of funding modalities – direct funding

5. Alignment of funding to national priorities

6. Strategic partnerships – NHIS, Private Sector

7. Conduct operational and acturial studies

ACKNOWLEDGEMENTS GAC : Management and Staff

The NSF Secretariat

Ms Gertrude Adzo Akpalu*

Mr Emmanuel Larbi

Mrs Olivia Graham

Steering Committee members

Thematic working group members

All key informants interviewed

Thank you!!!