ENHANCING COUNTRY OWNERSHIP:

AN ANALYTICAL REVIEW OF COUNTRY HIV PROGRAMMES

Dr. Morris Edwards: Head, Strategy and Resourcing Division, PCU

Dr. Ingrid Cox Pierre: Strategy and Resourcing Officer, Care, Treatment and Support

Focus of Presentation Role of the PANCAP Coordinating unit in

achievement of the goals of Caribbean

Regional Strategic Framework (CRSF) 2008

– 2012

Analysis of country needs for achieving

these goals.

Challenges encountered in the process

BackgroundVision of the Caribbean Regional Strategic

Framework (CRSF) 2008 - 2012

“Substantially reduce the spread and

impact of HIV in the Caribbean through

sustainable systems of universal access

to HIV prevention, treatment, care, and

support”.

Assigned roles PANCAP Coordinating Unit (PCU)

Coordination of regional response

Resource mobilization

Advocacy

PANCAP 10th AGM identified critical areas

for emphasis to achieve the goals of the

CRSF.

Reduction of new HIV infections by 50%.

Elimination of mother to child transmission of HIV.

Increased access to treatment by 80%.

Accelerate the agenda to achieve human rights for

PLHIV including the elimination of travel restrictions for

PLHIV.

Elimination of travel restrictions for PLHIV.

For the PCU to effectively perform

its role, it must be able to collect

information at country level and

from partners on: Ongoing initiatives

Available resources

Gaps in implementation of national

strategies

Activities conducted by PCU to support its functions

Development of the PANCAP Biennial

Operational Plan (PBOP)

Country assessments to ascertain implementation

gaps in their NSP

Convening a Partners meeting and development

of an implementation matrix of ongoing activities

in countries by partners

Activities conducted by PCU to support its functions……..

Establishment of a lab partners working

group

Review of financial resources available

at country level for implementation of

NSP and their contribution to the

achievement of the Tenth AGM targets.

Resource mobilization by PCU Estimated (under estimate) US$58 M required

for implementation of the CRSF.

The PCU has mobilized approximately US$47

M

of this estimate

However priority areas of prevention and

treatment and care have secured resources

in

excess of that budgeted for by the CRSF

PRIORITY AREACRSF ESTIMATED NEEDS (US$)

FUNDING SECURED (CRSF)

FUNDING GAP (CRSF)

PA1 6,337,300 2,951,189 3,386,111

PA2 9,156,900 912,208 8,244,692

PA3 11,287,600 25,573,778 -14,286,178

PA4 2,000,000 3,467,415 -1,467,415

PA5 9,208,050 4,126,858 5,081,192

PA6 7,730,000 4,250,203 3,479,797

Coordinating & Monitoring Bodies 8,027,360 6,343,344 1,684,016

IEC Strategy supporting CRSF 2,000,000   2,000,000

Contingency (5%) 2,787,360   2,787,360

Total 58,534,570 47,624,995 10,909,575

Source: Progress Report and Financial Analysis of Implementation of the CRSF for 17th Executive Board Meeting

COMPARATIVE ANALYSIS OF FINANCIAL SUPPORT TO THE CRSF 2008-2012

Inadequacy of resource mobilization effortsAlthough secured funds are in excess of that budgeted for in these two areas, regional reports have identified that: Some areas in prevention, especially interventions

with MARPS (other than MSM and CSWs) and

PMTCT are critical areas or gaps in the

response. The area of treatment and care is inadequately supplied as

many countries are below the required coverage for

persons who require ARVs

Inadequacy of resource

mobilization…….

This emphasizes the importance of

information to guide the resource

mobilization process and focus

efforts where needed

Country Analysis Methodology

1. Available country NSPs were evaluated for alignment with the CRSF

2. Country assessments were conducted from 2010 to 2011 looking at gaps in implementation of country NSPs or implementation plans

The reports were presented at prior meetings and to the PACC

Country Analysis Methodology…..

3. A financial review of allocated resources at country level in relation to the tenth AGM targets

Template designed to collect information on areas of focus under the individual 10th AGM targets noting:

Area of strategic focus Source of funding (whether govt. or donor) Specific area funded e.g prevention programmes for MARPS Budget allocated Timeframe of support Identified gaps in the response and associated funding

Results9 countries responded:

Antigua and Barbuda Dominica Jamaica Suriname Belize St. Kitts and Nevis Montserrat Tortola Trinidad and Tobago

Results….. Countries are at different stages in reaching

the 2015 targets.

Main issue is sustainable funding, especially of commodities such as ARVs.

Funding in most of the reporting countries is still largely supported by donor agencies.

Results….. The areas highlighted as deficient in the

funding of the CRSF correspond closely to

those that are being reported in countries.

There is the need to include stigma and

discrimination in the area of human rights

There is a need for targeted prevention

interventions especially for groups such as

youth, with critical focus on minors

because of early sexual debut.

Prevention Targets

Prevention Target Gaps AB Bze Dom Jam Mon Sur Tor SKN TT

Strategic information related to prevention efforts especially MARPs

X X X X X X X

Models for development of prevention strategies especially in MARPs

X X X X X

Support to HFLE programme for sustainability and technical assistance (TA) for expansion of education sector response

X X X X

Expansion of STI services and integration into existing services e.g PHC

X X X X

Prevention Target Gaps AB Bze Dom Jam Mon Sur Tor SKN TT

BCC especially with reference to a communication strategy for the target groups and programme planning

X X

Support for expansion of testing sites including test kits and training of providers

X X X

Programmes for drug users and interventions for incarcerated youth and inmates.

X X X X

Prevention Target Gaps AB Bze Dom Jam Mon Sur Tor SKN TT

Prevention interventions in youth such as SRH interventions for parents, support for adolescent PLHIV, comprehensive programmes to respond to sexually active minors in the school setting

X X

Development of gender based interventions

X X X

Prevention in positives

X X X

Prevention Target Gaps

AB Bze

Dom

Jam

Mon

Sur

Tor SKN TT

Strengthening the NGO,CBO and CSO contribution to the prevention response

X

Strengthening universal access to social support services for PLHIVs

X

Legislation and policies related to testing of minors.

X

Elimination Target

Elimination target

Many countries did not outline deficiency in funding in this area however regional data available shows that the coverage is not optimal

Elimination Target Gaps AB Bze

Dom

Jam Mon

Sur

Tor SKN

TT

Drugs for PMTCT X X X X

Financial resources for procurement of testing supplies, testing at least twice during pregnancy and partner testing

X X

Programmes to improve adherence to PMTCT drugs by Positive mothers

X

Follow up of exposed infants

X

Integration into MCH programmes

X

Surveillance X X

Elimination Target Gaps

AB Bze

Dom

Jam

Mon

Sur

Tor SKN TT

Drugs for PMTCT X X X X

Financial resources for procurement of testing supplies, testing at least twice during pregnancy and partner testing

X X

Programmes to improve adherence to PMTCT drugs by Positive mothers

X

Follow up of exposed infants

X

Integration into MCH programmes

X

Surveillance X X

Treatment and Care Target

Treatment & Care Target Gaps AB Bze Dom Jam Mon Sur Tor SKN TT

Diagnosis and treatment of Opportunistic infections (OI).

X X X

Strategies including policies for integration of HIV/STI care into existing services

X

Sustainability of treatment

X X X X X X X X

Laboratory tests for monitoring ARV treatment

X X X X X

Research on drug resistance

X X

Treatment & Care Target Gaps AB Bze Dom Jam Mon Sur Tor SKN TT

Social support programmes for adolescent, orphans and children living with HIV

X X

Capacity building in forecasting for procurement of ARV drugs to prevent stock outs

X

Capacity building in laboratory surveillance, internal quality control documentation and implementation, external quality assurance

X X X

Human Rights Target

Human Rights Target Gaps

AB Bze Dom

Jam Mon Sur Tor SKN TT

Funding for expansion of initiatives: development of polices and legislation as well as advocacy

X X X X X X X

Development of a framework and policies to encourage support and empowerment of PLHIVs

X

Capacity building for monitoring and advocacy of the policy and legislative arena

X

Training of CSOs, NGOs etc and other partners within the multi-sectoral response in advocacy

X X

Human Rights Target Gaps AB Bze Dom Jam Mon Sur Tor SKN TT

Capacity building for redress mechanisms

X X

Sensitization of health care workers

X

Development of sector wide change agents

X

Gender agenda with focus on gender violence related to women and sexual orientation

X X

Human Rights Target Gaps

AB Bze Dom

Jam Mon Sur Tor

SKN TT

Removal of punitive laws related to same sex relationships

X

Research related to S&D X

Advocacy to include developed policies in the legislative agenda

X

Capacity building of administrative and financial abilities is essential to improve the effectiveness of their advocacy agenda.

X

M&E reporting and management capacity of CSOs

X

Challenges

ChallengesMain challenges encountered in gathering the

data were: Regional level:

Difficulty in getting the required data from regional partners and donor agencies.

National level Poor response from member countries possibly due to:

– Competing interests: Harmonization of donor efforts at country level is needed

– Unavailability of data or information needed at country level

THE MEETING is invited to: (i)Advise on mechanisms to overcome the

challenges with information sharing; and (ii) Agree on the strategic objectives, regional

public goods and services and activities to be included in the Biennial Operational Plan, 2012-2013