RECENT HIV ACTIVITIES

1. OVC Technical Consultation Conference was a big hit!
2. Roles and functions of National AIDS Councils/Commissions and Ministry of Health AIDS Control Programs: Recommendations to the 36th ECSA Regional Health Ministers' Conference Entebbe, 18-22 November 2002

3. The 36th Health Ministers Conference of the East, Central and Southern Africa Health community, Entebbe, Uganda from 18 - 22 November 2002

4. Summary Report of the HIV/AIDS Policy Advisory Committee (HAPAC) Meeting 16/11/02, Hotel Africana, Kampala, Uganda

OVC Technical Consultation Conference was a big hit!

This high-level technical consultation on orphans and children affected by HIV/AIDS was held November 3-5, 2003 in Washington, DC. The response from participants was positive and USAID believed the Consultation to be very successful.

Day one (November 3), through plenary presentations, focused on the magnitude of the problem, global strategic approaches, principles for implementation, and programming issues. This day provided an introduction and overview for organizations that are new to this type of programming and a review of the basic tenets for those who are more experienced in working with children affected by HIV/AIDS.

Ambassador Randall Tobias gave the morning keynote address and Mrs. Graca Machel, Founder, Foundation for Community Development, Mozambique, was the afternoon keynote speaker. Other speakers included technical experts from UNICEF, UNAIDS and USAID as well as directors of model programs for children from Africa and Asia.

Days two and three (November 4-5), through a series of technical working groups, were devoted to discussing specific issues in greater depth. These issues include health, education, emotional well-being, models of community approaches, children without family care, HIV-positive children, and economic strengthening and food security. Ellen Piwoz, SARA Senior Nutrition Advisor, was a presenter in the small group session on health and nutrition. Dorcas Lwanga, SARA Nutritionist, was a presenter in the small group sessions on HIV-positive children.

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The CRHCS HIV/AIDS Policy Advisory Committee (HAPAC), at its meeting in Arusha, of 18-19 July 2002, noted the prevailing lack of clarity of roles and functions of the National AIDS Councils /Commissions (NACs) vis-à-vis those of Ministry of Health AIDS Control Programmes (MOH/ACPs). The HAPAC reported these concerns to the Directors' Joint Consultative Committee (DJCC).

The DJCC recommended at its meeting of 22-24 July 2002 that a joint meeting of NACs and MOH/ACPs be held as soon as possible. The purpose would be, inter-alia, to clarify the roles and functions of these two HIV/AIDS institutions and identify mechanisms to minimize duplication and gaps. This would enhance harmony and synergy for improved coordination, implementation, monitoring and evaluation of the national responses to HIV/AIDS.

Accordingly, the CRHCS organised a workshop for Directors of NACs and Programme Managers of MOH/ACPs. The meeting was attended by representatives from ten of the fourteen ECSA countries.

Findings from an electronic survey on roles and functions of NACs and MOH/ACPs; country experiences and models of good practice on multi-sectoral coordination by NACs; and perspectives from international agencies were presented and discussed at this meeting.

The key roles and functions of NACs and ACPs were identified and agreed upon. These are herewith appended in Annex 1.

The meeting further made the following broad recommendations:

1. NACs and MOH/ACPs within each of the Member States should hold joint consultation meetings as a follow up to the Regional workshop in Kampala, to re-examine and further clarify their roles and functions and mechanisms for coordination and implementation, respectively.

It is further recommended that CRHCS and other partners, including UNAIDS, WHO-AFRO, SADC, AED/SARA, USAID, be invited to join in the process at the national level consultations.

2. It was observed that most national responses in the region continue to be led and dominated by the health sector, without adequate participation of the other sectors. This has resulted in sub-optimal multi-sectoral responses to HIV/AIDS throughout the region.

It is, therefore, recommended that NACs facilitate a process for broader consultations with all sectors of society. This would lead to a more comprehensive multi-sectoral approach as the most effective national strategy.

In order for this to be achieved, however, it is recognized that there is need to strengthen national human and institutional capacities. The CRHCS and its partners should facilitate and support these processes.

3. NACs should facilitate and support all sectors, including the Health Sector, to develop HIV/AIDS Strategic and Action Plans according to their respective mandates.
4. As part of its core coordination role, the NAC should regularly monitor, review and disseminate information on Human and Financial Resource mobilisation, allocation, and effective utilisation for HIV/AIDS sectoral and thematic interventions.
5. In line with the United Nations General Assembly Special Session (UNGASS) declaration on HIV/AIDS, which obliges countries to report progress on national commitment and action by March 2003, the CRHCS and partners should urgently facilitate compilation and adoption of core indicators for monitoring and evaluation (M&E) at country level.

The CRHCS and partners should initiate a process of reviewing the current status of M&E systems for the national response with a view to supporting and facilitating the further development and application of the systems. The process should be informed by existing international, regional and national sets of indicators, e.g. the harmonized WHO/UNAIDS/USAID indicators.

6. The NACs and MOH/ACPs should regularly convene joint meetings at regional level to review and strengthen their national coordination and implementation mechanisms.
7. The CRHCS should develop a mechanism to regularly review and document progress made on the implementation of these recommendations.

1. Roles and Functions of NACs

1.1 Context and Rationale

• Facilitate HIV/AIDS policy development, adoption, dissemination, and periodic review.
• Spearhead advocacy and social mobilization on HIV/AIDS in all sectors at all levels.
• Build partnerships among all stakeholders in the countries with regional and international linkages.
• Lead resource mobilization allocation and tracking of effective utilization.
• Guide the development of HIV/AIDS National Strategic frameworks and plans.
• Facilitate and support the development of Strategic frameworks and plan throughout all sectors and decentralised units.
• Develop strategies for mainstreaming of HIV/AIDS in all sectors at all levels.
• Promote greater involvement of people living with HIV/AIDS (GIPA) through capacity strengthening, active participation in all decision and policy making fora, support and facilitation of PHA organizations.
• Develop a national HIV/AIDS Monitoring and Evaluation (M&E) system.
• Knowledge management through documentation and exchange of experiences, approaches, practices and promotion of best practices.
• Mapping of interventions indicating the geographical coverage and the scope of interventions and actors throughout a country.
• Facilitation and support for the development of human capacities for responding to HIV/AIDS at all levels.
• Identification of research priorities and use of findings for policy developments.

2.1 Context and Rational

• Planning and implementing the Health Sector HIV/AIDS Strategy.
• Initiating and provision of technical support for HIV/AIDS policy development.
• Coordination of thematic areas and stakeholders in the health sector.
• Providing relevant technical support to other sectors
• Surveillance of HIV/AIDS and STIs
• Behaviour Change Communication (BCC) interventions, including condom programming
• Adolescent sexual and reproductive health (ASRH) programming
• Workplace interventions within the health sector
• Prevention and management of STIs, TB, and other OIs.
• Voluntary Counseling and Testing (VCT)
• Prevention of Mother to Child Transmission (PMTCT) of HIV
• Continuum of care, including the provision of anti-retroviral therapy
• Human resource development within the health sector relevant to HIV/AIDS
• Infection control in health care delivery settings.
• Procurement of commodities for HIV/AIDS, STIs, TB, and other OIs
• Nutrition care and support for PHAs, including infant feeding
• Epidemiological and behavioural surveillance
•  Psychological support for the infected and affected
•  Blood safety
• Palliative Care
• Quality control and assurance relevant to HIV/AIDS services
• Monitoring and evaluation of HIV/AIDS programmes in health sector

3.0 Strategies to Improve Overall Coordination by NACs and Strengthen the Health Sector Response by MOH/ACPs:

3.1 Strengthening performance of MOH/ACPs

• MOH represented at the highest policy making level of NAC
• MOH representative on all relevant technical committees of NAC
• Clarify functional relationships between NAC and MOH
• Regular review and appraisal of respective roles and functions.
• Ensure adequate human and institutional capacities for management and implementation of health sector response.
• Ensure harmonization and clear linkages among the various thematic initiatives and interventions in the health sector.
• Palliative and HBC including counselling and psychosocial support
• Prepare for new and emerging challenges and innovations, e.g. access to HAART, HIV vaccines initiatives.
• Address issues of stigma and discrimination within the health care delivery system
• Provide Technical Support to NAC and other sectors

3.2 Mechanisms for improved coordination by NACs

• NAC should facilitate and encourage the coordination between multisectoral and inter sectoral stakeholders including various government sectors, donors, civil society, PLWHAs etc at all levels.
• NAC should establish and institutionalize formal partnership structures and functional procedures.
• Convene forums to establish a common understanding by all stakeholders of HIV/AIDS coordination.
• Regularly review the effectiveness of coordination, and update accordingly.
• Clear understanding and agreement of the roles of each (Team building meetings between NAC and MOH)
• Establish a national HIV/AIDS comprehensive communications strategy.
• NACs should be given a clear mandate, such as by legislation or other due processes, to coordinate across sectors.
• Establish committees comprising expertise needed for different functional areas such as M&E, resource mobilisation, policy, and other technical working groups (TWGs).
• Constant capacity building of the commissions to help them understand their roles
• Effective information sharing, and networking
• NACs should ensure that external partners should be part of the national HIV/AIDS national partnership arrangement.

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The 36th Health Ministers Conference of the East, Central and Southern Africa Health community, Entebbe, Uganda from 18 - 22 November 2002. 

Inaugurating the Conference His Excellency Yoweri Kaguta Museveni, President of the Republic of Uganda emphasized the need for health interventions to be relevant to and involve the communities. He said there has to be mass mobilization for the interventions to have the desired impacts. SARA was represented by Dr. Stephen Kinoti, Senior HIV/AIDS Advisor who presented a paper on, "Challenges of accessing Treatment for People Living with HIV/AIDS".

Seven resolutions were adopted by the Health Ministers covering HIV/AIDS; CRHCS Strategic Plan and Institutional reforms; Malaria Prevention and Control; Family Planning / Reproductive Health; Non-Communicable Diseases in ECSA; Food and Nutrition and Expression of Appreciation to the Government and People of the Republic of Uganda. SARA and ECSA Secretariat will identify areas from these for future collaboration.

As a special guest to the Health Ministers Conference, Dr. Crispus Kiyonga, the Chairman of the Fund presented progress in the disbursements from the Fund. The Global Fund has been in existence for one and a half years. The Fund exists to provide funding for projects aimed at alleviating the problems of HIV/AIDS, Malaria and TB. The first grant has been given to Ghana and the second was expected to go to Tanzania. He noted that given the extent of the burden of these diseases in Sub-Saharan Africa, the region should receive 70% of the money. However, in the first round only 53% of the applications and 63% of the approved grants were from the region. In the second round only 44% of applications and 56% of grants awarded were from Sub-Saharan Africa.

Dr. Kiyonga clarified that approval and disbursement of funds were not related to amount of funds available. The region should look to the reasons why the proportion of the applications did not match the disease burden in the region. One specific reason identified during the discussions was the lack of capacity and skills to prepare the proposals and to advocate for them. This is an area that the ECSA Secretariat and its partners could provide assistance in. Local capacity to utilize the funds efficiently is also needed. The issue of regional organizations such as CRHCS applying for money from the Fund was raised and the response was that, it was possible provided the proposal had the signed support of member countries and added value to the efforts in the member states.

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Summary Report of the HIV/AIDS Policy Advisory Committee (HAPAC) Meeting 16/11/02, Hotel Africana, Kampala, Uganda.

The HIV/AIDS Policy Advisory Committee (HAPAC) convened their second meeting on 16th November 2002, in Kampala, Uganda at the Hotel Africana. Members of HAPAC were in Uganda to attend the Joint Meeting of Directors’ of National AIDS Council/Commissions (NACs) and Managers’ of AIDS Control Programmes (ACPs) and the Regional Health Ministers’ Conference (RHMC).

The HAPAC meeting was dedicated to finalizing the recommendations from the Joint Meeting of Directors’ of NACs and Managers’ of ACPs for presentation at the RHMC the following week. However the group discussed some other key HAPAC agenda items.

The attendees discussed the timing of HAPAC meetings. With so many different donor meetings and various workshops throughout the year, HAPAC meetings need to occur around the principal ECSA Secretariat’s meetings to ensure participation and prudent use of resources. The group agreed to holding annual meetings a day or two before or after the Director’s Joint Consultative Committee meeting.

Another issue discussed was HAPAC’s review of ECA Secretariat’s HIV/AIDS technical reports and other products. It was felt that a the review process could be facilitated by ensuring that HAPAC members have reliable access to email and Internet especially because it was realized that not all HAPAC members have good internet connectivity, and this makes the dissemination of documents for review and other essential information difficult. It was also suggested that it would be very useful for the HAPAC members to be linked to the HIV/AIDS focal points say members of the Expert Committee in each country and to the Secretariat in Arusha. The Secretariat is undertaking an assessment on the connectivity of the focal points and Information Dissemination Centers in the ECSA member states. Based on the results, those that do not connected will be assisted to be connected and linked to the focal points and the ECSA Secretariat. A list serv will also be created for technical discussions and information dissemination.

Documents currently under HAPAC peer review are: Reports of the Voluntary Counselling and Testing review and the Adolescent Sexual and Reproductive Health Policies review. HAPAC is also going to work on a Prevention of Mother to Child Transmission (PMTCT) review. Before starting on the PMTCT project, however, CRHCS needs to know what SADC and other regional agencies are already doing on this topic in order to avoid any duplication of effort.

After these brief deliberations HAPAC focused on reviewing the draft report and synthesizing the recommendations from the Joint Meeting of Directors’ of NACs and Managers’ of ACPs for presentation at the Regional Health Ministers Conference (RHMC) the following week. The recommendations are presented in Annex 1.

Members of HAPAC in attendance: Dr. Bannet Ndyanabangi, ECSA secretariat; Prof. John Rwomshana, Uganda; Dr. Patrick A. Orege, Kenya; Ms. Anne Gabriel Gedeon, Seycheles; Dr. R.O. Swai, Tanzania Dr. Elizabeth Madraa,Uganda; Dr. Alex Simwanza, Zambia; Mr. Alfred Chingono, Zimbabwe; Prof. Stephen Kinoti, AED/SARA. This activity received technical and financial support from USAID through the SARA Project.

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