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NATIONAL AIDS COORDINATING AGENCYPrivate Bag 00463
Gaborone, BotswanaWestgate Mall, Western By-Pass, UNIT 9
Tel: +267 3710314 Fax: +267 3710312www.naca.gov.bw
The Second Botswana National Strategic Framework for HIV & AIDS 2010-2016
8
EXECUTIVE SUMMARY
The purpose of this document is to outline the national priorities for the national response to HIV and AIDS for the period 2010 to 2016. These priorities are based on the evidence accumulated locally and are augmented by international best practices. The overall philosophy behind the Second National Strategic Framework is one of prioritization, focus, and intensification. It is through collective and concentrated efforts around these priorities that we will be able to maximize the impact of the national response.
The process to develop this document was highly consultative, generating an in-depth picture of the epidemic and its response. The drivers of the epidemic, being verified through the consultation process and research, are generally understood to include: multiple and concurrent sexual partnerships; the low rates of male circumcision; adolescent and intergenerational sex; gender inequalities and violence; substance abuse, in particular alcohol; and stigma and discrimination. Despite some modest gains, significant gaps and challenges remain to be addressed or overcome. These main gaps and challenges include under funding of prevention; limited capacities for prevention as well as implementation and management; often competing communication strategies; weak community ownership and participation; insufficient targeting of prevention; prevention with positives; safe male circumcision; weak strategic information management; and insufficient scale up of treatment, care, and support.
Taking this situation as the starting point, the priority areas were built and refined through dialogue and inputs provided across sectors and at all levels of the national response. In order to maximize the impact over the next seven years, the following priority areas must be the focus of the national response:
Priority Area 1: Preventing New InfectionsPriority Area 2: Systems StrengtheningPriority Area 3: Strategic Information ManagementPriority Area 4: Scaling Up Treatment, Care and Support
The overall Goal of the national response is the Prevention of New HIV Infection by 2016 and efforts in each of these priority areas are critical to achieving it. The Overall Strategic Objectives of the national response under the second National Strategic Framework for HIV and AIDS, 2010-2016 that make a contribution to the goal are:
1. To reduce the incidence of sexual transmission of HIV among females and males aged 10-49 years
2. To increase access to health care services for HIV prevention
3. To strengthen community and health systems capacity for Universal Access to quality, comprehensive and sustainable HIV and AIDS services
4. To effectively coordinate, harmonize and align stakeholder support to the national response at all levels
5. To strengthen and sustain political leadership and commitment on HIV and AIDS at all levels
6. To improve the ethical and legal environment to support the national response
7. To strengthen the information management system of the national response to enhance information sharing and utilisation
8. To increase access to HIV and AIDS comprehensive quality treatment, care and support services.
The Second Botswana National Strategic Framework for HIV & AIDS 2010-2016
The NSF II is a forward looking document and frames the national response in terms of what it should look like by the year 2016. Thus, the Overall Strategic Outcomes for the period are:
1. Increased proportion of females and males aged 10-49 years practicing safer sexual behaviours.
2. Improved utilization of health care services for HIV prevention.
3. Communities empowered to effectively respond to HIV and AIDS.
4. Improved access to quality HIV and AIDS services.
5. Partners aligned to national priorities and held accountable.
6. National response adequately resourced
7. Ethical and legal environment for HIV and AIDS improved.
8. Increased availability of quality, comprehensive and harmonized information on the response to the epidemic.
9. Improved utilization of information by partners for policy development, advocacy and programming.
10. Improved basic and operational research, monitoring and evaluation of the HIV and AIDS response.
11. Improved access to comprehensive quality treatment, care and support services.
9
The
Sec
ond
Bot
swan
a N
atio
nal S
trat
egic
Fra
mew
ork
for
HIV
& A
IDS
2010
-201
6
AN
NE
X 1
: Nat
iona
l Str
ateg
ic L
ogic
al F
ram
ewor
k fo
r th
e N
SF II
201
0-20
16
GO
AL
Obj
ec v
ely
Verifi a
ble
Indi
cato
r (O
VI)
Targ
etM
eans
of V
erifi
ca o
n (M
OV
)A
ssum
p o
ns
Prev
ent n
ew H
IV in
fect
ion
by
2016
● H
IV in
cide
nce
rate
1.
4%(2
008
base
line
– 2.
9%)
BA
IS r
epor
tSe
ntin
el s
urve
illan
ce r
epor
ts
PR
IOR
ITY
1:
Prev
entin
g N
ew H
IV I
nfec
tion
Stra
tegi
c O
bjec
tive
s:(1
) To
red
uce
the
inci
denc
e of
sex
ual t
rans
mis
sion
of
HIV
am
ong
fem
ales
and
mal
es a
ged
10-4
9 ye
ars
(2)
To in
crea
se a
cces
s to
hea
lth c
are
serv
ices
for
HIV
pre
vent
ion
OU
TC
OM
ES
Obj
ectiv
ely
Ver
ifi ab
le I
ndic
ator
Targ
etB
asel
ine
Mea
ns o
f V
erifi
catio
n1.
1. I
ncre
ased
pro
port
ion
of f
emal
es a
nd m
ales
ag
ed 1
0 –
49 p
ract
icin
g sa
fer
sexu
al b
ehav
iour
● Pr
opor
tion
of m
ales
and
fem
ales
who
en
gage
in M
CP
● Pr
opor
tion
of p
eopl
e ag
ed 1
5-49
yea
rs
who
alw
ays
use
cond
oms
with
non
-re
gula
r pa
rtne
rs in
the
last
12
mon
ths
● Pr
opor
tion
of y
oung
peo
ple
aged
10
– 24
yea
rs w
ho c
orre
ctly
iden
tify
way
s of
pr
even
ting
sexu
al tr
ansm
issi
on o
f H
IV●
Prop
ortio
n of
per
sons
, 15-
49 y
ears
, w
ho w
ere
drun
k be
fore
thei
r la
st s
exua
l in
terc
ours
e a
nd u
sed
a co
ndom
● 5.
6%
● 60
%
● 65
%
● 75
%
● (P
roxy
) B
AIS
III
(20
08)
11.2
%
● B
AIS
III
(20
08)
39.6
%
● B
AIS
III
(20
08)
42.1
% (
for
15-2
4 ye
ar o
lds)
● B
AIS
III
(20
08)
62.9
%
● B
AIS
rep
ort
● B
AIS
rep
ort
● B
AIS
rep
ort
● B
AIS
rep
ort
1.2.
Impr
oved
util
isat
ion
of h
ealth
car
e se
rvic
es
for
HIV
pre
vent
ion
● Pr
opor
tion
of p
erso
ns a
ged
15-4
9 ye
ars
who
hav
e te
sted
with
in th
e la
st 1
2 m
onth
s an
d kn
ow th
eir
HIV
sta
tus
● Pr
opor
tion
of V
CT
clie
nts
who
acc
ess
HC
T a
s co
uple
s●
Prop
ortio
n of
0-4
9 ye
ar o
ld H
IV-
nega
tive
mal
es c
ircu
mci
sed
in h
ealth
fa
cilit
ies
● Pr
opor
tion
of H
IV p
ositi
ve p
regn
ant
wom
en a
cces
sing
Uni
vers
al H
AA
RT
● Pr
opor
tion
of M
AR
PS1 u
tiliz
ing
HIV
Pr
even
tion
serv
ices
● 60
%
● 30
%
● 80
%
● 90
%
● T
BD
● B
IAS
III
(200
8) 4
1.2%
● (P
roxy
) To
belo
pele
(20
08)
8%●
(Pro
xy)
BA
IS I
II (
2008
) 11
.2%
(fo
r al
l mal
es)
● (P
roxy
) PM
TC
T (
2009
) 28
%
● N
O B
ASE
LIN
E2
● B
AIS
rep
ort
● N
AC
Rep
orts
● B
AIS
rep
ort,
Prog
ram
me
repo
rts
● M
oH/ N
AC
rep
orts
1 C
urre
nt M
OH
defi
niti
on in
clud
es: s
ex w
orke
rs, t
ruck
driv
ers,
seas
onal
farm
wor
kers
, and
con
stru
ctio
n w
orke
rs b
ut c
an b
e ex
pand
ed
2 W
here
no
base
line
is in
dica
ted,
thes
e ar
e to
be
cond
ucte
d in
201
037
The
Sec
ond
Bot
swan
a N
atio
nal S
trat
egic
Fra
mew
ork
for
HIV
& A
IDS
2010
-201
6
PR
IOR
ITY
2:
Syst
ems
Stre
ngth
enin
gSt
rate
gic
Obj
ecti
ves:
(1)
To s
tren
gthe
n co
mm
unity
and
hea
lth s
yste
ms
capa
city
for
Uni
vers
al A
cces
s to
qua
lity,
com
preh
ensi
ve a
nd s
usta
inab
le H
IV a
nd A
IDS
serv
ices
(2)
To e
ffec
tivel
y co
ordi
nate
, har
mon
ize
and
alig
n st
akeh
olde
r su
ppor
t to
the
natio
nal r
espo
nse
at a
ll le
vels
(3)
To s
usta
in a
nd s
tren
gthe
n po
litic
al le
ader
ship
and
com
mitm
ent o
n H
IV a
nd A
IDS
at a
ll le
vels
(4)
To im
prov
e th
e et
hica
l and
lega
l env
iron
men
t for
the
natio
nal r
espo
nse
OU
TC
OM
ES
Obj
ecti
vely
Ver
ifi ab
le I
ndic
ator
Targ
etB
asel
ine
Mea
ns o
f V
erifi
cati
on
2.3.
1 C
omm
uniti
es e
mpo
wer
ed to
eff
ectiv
ely
resp
ond
to H
IV a
nd A
IDS
● Pr
opor
tion
of c
omm
unity
str
uctu
res3
prov
idin
g qu
ality
and
cos
t-ef
fect
ive
serv
ices
● 70
%
● (P
roxy
) B
AIS
II
(200
4) 3
7%4
● Su
rvey
s●
Dis
tric
t rep
orts
2.3.
2. I
mpr
oved
acc
ess
to q
ualit
y H
IV a
nd A
IDS
serv
ices
● Pr
opor
tion
of h
ealth
fac
ilitie
s pr
ovid
ing
qual
ity a
nd c
ost-
effe
ctiv
e se
rvic
es●
TB
D
● N
O B
ASE
LIN
E●
Surv
eys
● Pr
ogra
m r
epor
ts
2.4.
1 Pa
rtne
rs a
ligne
d to
nat
iona
l pri
oriti
es a
nd
held
acc
ount
able
● Pr
opor
tion
of p
artn
ers
alig
ned
to n
atio
nal
prio
ritie
s an
d st
rate
gies
● 10
0%●
NO
BA
SEL
INE
● N
ASA
rep
orts
● Su
rvey
s●
Prog
ram
me
repo
rts
2.5.
1 N
atio
nal r
espo
nse
adeq
uate
ly r
esou
rced
● Im
prov
ed r
esou
rce/
budg
etar
y al
loca
tion
for
the
natio
nal r
espo
nse
● T
BD
●
NO
BA
SEL
INE
● N
ASA
rep
orts
2.6.
1 E
thic
al a
nd le
gal e
nvir
onm
ent f
or H
IV a
nd
AID
S im
prov
ed
● N
umbe
r of
sup
port
ive
polic
ies
and
legi
slat
ions
rev
iew
ed a
nd/o
r en
acte
d●
Mea
ning
ful5 p
artic
ipat
ion
of c
ivic
bod
ies
in th
e re
view
and
/or
deve
lopm
ent o
f po
licie
s●
Stig
ma
and
disc
rim
inat
ion
inde
x6
● T
BD
● 10
0%
● T
BD
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● Po
licie
s an
d le
gisl
atio
ns
● Su
rvey
s
● Su
rvey
s
3 V
MSA
C, C
BO
s, FB
Os,
PTA
s and
oth
er lo
cal s
truct
ures
(e.g
. bur
ial s
ocie
ties,
co-o
ps, e
tc.)
4 P
erce
ntag
e of
peo
ple
surv
eyed
who
“pa
rtici
pate
d” in
HIV
pre
vent
ion
cam
paig
ns5
To
be d
efi n
ed6
Inde
x to
be
defi n
ed
38
The
Sec
ond
Bot
swan
a N
atio
nal S
trat
egic
Fra
mew
ork
for
HIV
& A
IDS
2010
-201
6
PR
IOR
ITY
3:
Stra
tegi
c In
form
atio
n M
anag
emen
tSt
rate
gic
Obj
ecti
ve:
To s
tren
gthe
n th
e in
form
atio
n m
anag
emen
t sys
tem
of
the
natio
nal r
espo
nse
to e
nhan
ce in
form
atio
n sh
arin
g an
d ut
ilisa
tion
for
evid
ence
bas
ed p
lann
ing
OU
TC
OM
ES
Obj
ectiv
ely
Ver
ifi ab
le I
ndic
ator
Targ
etB
asel
ine
Mea
ns o
f V
erifi
catio
n
3.7.
1: I
ncre
ased
ava
ilabi
lity
of q
ualit
y,
com
preh
ensi
ve a
nd h
arm
oniz
ed in
form
atio
n on
th
e re
spon
se to
the
epid
emic
.
● Pr
opor
tion
of p
rogr
amm
e M
&E
sys
tem
s al
igne
d to
the
Nat
iona
l M&
E f
ram
ewor
k ●
Tim
ely
and
cons
iste
nt d
eliv
ery
of q
ualit
y pa
rtne
rs r
epor
ts●
Prop
ortio
n of
HIV
and
AID
S bu
dget
al
loca
ted
to M
&E
● 90
%
● Q
uart
erly
● 10
%
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● Pr
og. M
&E
pla
ns;
repo
rts
● Pr
og. M
&E
pla
ns a
nd
repo
rts
● N
at. O
p. P
lan
3.7.
2 Im
prov
ed u
tiliz
atio
n of
info
rmat
ion
by
part
ners
for
pol
icy
deve
lopm
ent,
advo
cacy
and
pr
ogra
mm
ing
● N
umbe
r of
dis
sem
inat
ion
foru
ms
at a
ll le
vels
● Pr
opor
tion
of p
artn
ers
guid
ed b
y th
e na
tiona
l HIV
and
AID
S re
spon
se
info
rmat
ion
in th
e de
velo
pmen
t of
thei
r pr
ogra
mm
es
● T
BD
● 10
0%
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● D
isse
min
atio
n St
rate
gy7
● Su
rvey
s
3.7.
3 Im
prov
ed b
asic
and
ope
ratio
nal r
esea
rch,
m
onito
ring
and
eva
luat
ion
of th
e H
IV a
nd A
IDS
resp
onse
● Pr
opor
tion
of p
rogr
amm
es in
form
ed b
y ev
alua
tion fi n
ding
s●
Prop
ortio
n of
app
rove
d ev
alua
tion
reco
mm
enda
tions
impl
emen
ted
● Pr
opor
tion
of H
IV a
nd A
IDS
rela
ted
rese
arch
pro
posa
ls a
ppro
ved
by th
e re
leva
nt a
utho
rity
● Pr
opor
tion
of a
ppro
ved
HIV
and
AID
S re
late
d re
sear
ch c
ompl
eted
● 90
%
● 90
%
● 95
%
● 90
%
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● N
O B
ASE
LIN
E
● Pr
ogra
mm
e re
port
s ●
Com
pend
ium
of
cond
ucte
d re
sear
ch●
Perf
orm
ance
Ind
ex
7 T
o be
dev
elop
ed in
201
0
39
The
Sec
ond
Bot
swan
a N
atio
nal S
trat
egic
Fra
mew
ork
for
HIV
& A
IDS
2010
-201
6
PR
IOR
ITY
4:
Scal
ing
Up
Tre
atm
ent,
Car
e an
d Su
ppor
tSt
rate
gic
Obj
ecti
ve:
To in
crea
se a
cces
s8 to
HIV
/AID
S co
mpr
ehen
sive
qua
lity
trea
tmen
t, ca
re a
nd s
uppo
rt s
ervi
ces.
OU
TC
OM
EO
bjec
tivel
y V
erifi
able
Ind
icat
orTa
rget
Bas
elin
eM
eans
of
Ver
ifi ca
tion
4.8.
1. I
mpr
oved
acc
ess
to c
ompr
ehen
sive
qua
lity
trea
tmen
t car
e an
d su
ppor
t ser
vice
s●
Prop
ortio
n of
HIV
+ p
erso
ns a
cces
sing
in
tegr
ated
HIV
/TB
/SR
H s
ervi
ces
● Pr
opor
tion
of H
IV+
chi
ldre
n an
d ad
oles
cent
s ac
cess
ing
a pa
ckag
e of
HIV
/A
IDS
trea
tmen
t, ca
re a
nd s
uppo
rt9
● Pr
opor
tion
of p
opul
atio
n in
nee
d w
ho
acce
ss c
ompr
ehen
sive
qua
lity
CH
BC
se
rvic
es●
Perc
enta
ge o
f ho
useh
olds
with
OV
C
rece
ivin
g fr
ee b
asic
ext
erna
l sup
port
for
ca
re a
nd s
uppo
rt in
the
last
12
mon
ths
● 80
%
● 90
%
● 80
%
● 70
%
● V
CT
(20
09)
63%
● B
aylo
r (2
009)
22%
● (P
roxy
) B
AIS
III
(20
08)
49%
of
hous
ehol
ds
● B
AIS
III
(20
08)
31.2
%
● M
OH
/NA
C r
epor
t; M
oH B
NT
P re
port
● M
oH/N
AC
rep
ort
● B
AIS
rep
ort;
NA
C
repo
rt
● B
AIS
rep
ort
8 A
cces
s as d
efi n
ed b
y U
NG
ASS
and
con
text
ualis
ed9
A p
acka
ge h
as b
een
deve
lope
d an
d pi
lote
d al
low
ing
for t
he m
easu
rem
ent o
f all
thre
e el
emen
ts a
s a si
ngle
del
iver
able
40
41
NOTES
NATIONAL AIDS COORDINATING AGENCYPrivate Bag 00463
Gaborone, BotswanaWestgate Mall, Western By-Pass, UNIT 9
Tel: +267 3710314 Fax: +267 3710312www.naca.gov.bw