1. Pre-bidders workshops ; 12th October 2011
CIVIL SOCIETY FUND
Strengthening civil society for improved HIV/AIDS and OVC service delivery in Uganda
RFA # : Reduction Of New HIV Infections Through Enhanced Community Engagement In Combination HIV Prevention
Pre-bidders workshops ; 12th October 2011

2. WORKSHOP OBJECTIVES
Orient potential applicants on the RFA requirements
Share the national HIV Prevention Strategy;
Orient stakeholders about combination HIV Prevention and its package in the context of Uganda;
Discuss approaches for supporting convergence of partners and joint planning and partnerships frameworks for the 6 districts;

3. EXPECTED WORKSHOP OUTPUTS
Improved understanding the RFA requirements to enable them write appropriate concept papers/proposals
Improved understanding of the national HIV Prevention Strategy, and combination HIV Prevention including its package in the context of Uganda;
 Orient stakeholders on the design and methodology for the Combination HIV Prevention pilot program;
  Suggested approaches for supporting convergence of partners and joint planning and partnerships frameworks for the 6 districts;

4.   ..Expanding and doing HIV prevention better ….
UGANDA NATIONAL HIV PREVENTION STRATEGY
..Expanding and doing HIV prevention better ….

5. BACKGROUND Uganda’s HIV epidemic is mature, and generalised
Recent evidence shows that the epidemic has evolved – risk factors and drivers as well as population groups most affected have changed in recent years
Although various HIV Prevention Interventions have piloted / implemented for 25 yrs, Uganda still has a run away epidemic
Over 124,000 new HIV Infections in 2009
New Infections exceeding AIDS deaths by about X2
New Infections exceed annual ART enrolment by X3
HIV prevention is one of the priorities of the NDP ( )

6. TRENDS IN HIV PREVALENCE
About 731,000 potential new infection over next five years if status quo is maintained. Of these about 112,000 would be among children

7. HETEROGENEITY OF HIV BURDEN
Very High HIV Prevalence
Sex Workers, Partners of Sex workers, Individuals with history of same sex. Fishing communities
Average HIV Prevalence
Antenatal women, Boda boda cyclists, Plantation workers
Relatively low HIV Prevalence
University Students
Majority of new infections sexually transmitted
37% multiple partnerships
HIV discordant monogamous
Sex work and networks
Majority of sexual transmission among individuals over 25 years
MTCT about 20-25% infections
Negligible blood borne infections

8. SOCIAL/STRUCTURAL DRIVERS OF HIV
Socio-cultural drivers
Harmful cultural beliefs/practices e.g. polygamy, widow inheritance, courtship rape, rites of passage,
Gender Norms
SGBV, multiple partnerships among men, Permissiveness among women, Masculinity among men
Socio-Economic
Poverty/wealth, Dependency , mobility
Human rights violations especially for women/girls
access to justice- weak enforcement of existing laws
Inequities in access to health services
Stigma and Discrimination

9. WHY NEW HIV INFECTIONS REMAIN HIGH....
Current HIV Prevention not always aligned to epidemic drivers:
Relevant sexual behaviours. i.e. multiple concurrent partnerships, transactional sex, etc
Low coverage of male circumcision
Socio-cultural and gender norms often neglected
Coverage of key HIV prevention services still sub-optimal to make public health impact
Over 60% of adults never tested for HIV
Over 40% of antenatal mothers no access to PMTCT
Almost three-quarters of adult men not circumcised
Over half of risky sex not protected with condoms
Quality of HIV prevention services not optimal

10. CONSIDERATIONS IN THE NEW STRATEGY
Aligning HIV prevention efforts to drivers of the HIV/AIDS epidemic
Target population groups with the highest risk of new infections
Central theme of the new strategy is Combination HIV prevention approaches using proven interventions
Minimum HIV prevention packages for the general population and specific groups brought to critical coverage
Alignment to NDP NSP, HSSIP – i.e. the strategy to implement the HIV prevention component in these frameworks / strategic plans

11.  
THE NATIONAL HIV PREVENTION STRATEGY

12. MISSION & VISION
Mission The strategy is to serve as a resource to stakeholders to strengthen planning, implementation, coordination, and monitoring of HIV prevention programmes to significantly reduce new infections Vision “Uganda where new HIV infections are rare, and where everyone regardless of age, gender, ethnicity or socio-economic status has uninterrupted access to high quality and effective HIV prevention services free from stigma and discrimination”.

13. MISSION
Mission The strategy is to serve as a resource to stakeholders to strengthen planning, implementation, coordination, and monitoring of HIV prevention programmes to significantly reduce new infections Vision “Uganda where new HIV infections are rare, and where everyone regardless of age, gender, ethnicity or socio-economic status has uninterrupted access to high quality and effective HIV prevention services free from stigma and discrimination”.

14. GOAL
To reduce new HIV infections by 30% based on the baseline of 2009 which would result in 40% reduction of the projected number of new HIV infections in 2015, in line with the targets in the NDP
To reduce MTCT Rate reduced from 29% to less than 10% by 2015
40%
40% Reduction in new infections based on projected 2015 levels
Equivalent to 30% reduction based on 2009 estimates of new infections
IR declines from 0.74 to 0.46 /100PYs
178,930 New HIV Infections averted

15. OUTCOMES BY 2015 New HIV Infections Reduced by 30% from 2009 levels
(i.e. 40% of projected new infections in2015)
Increased coverage, and utilization of HIV prevention services
Increased adoption of safer sexual behaviors and reduced risky behaviors
A strengthened & sustainable enabling environment that mitigates underlying factors that drive the HIV epidemic
Achieving a more coordinated HIV prevention response at all levels
Strengthened information systems for HIV prevention

16. PRIORITIES FOR HIV PREVENTION
To adequately address the key drivers
Scale up priority HIV prevention services i.e. PMTCT, HCT, SMC, ART for HIV Prevention and Condom use
Reduce "unsafe sex" i.e. multiple and concurrent partnerships, early debut, cross generational , transactional and, casual sex
Make "unsafe sex" safer through condom promotion and increased male circumcision. 
Reduce gender/socio-cultural/structural constructs that facilitate sexual transmission of HIV
 Improved Coordination and M&E for HIV Prevention

17. PRIORITY POPULATION GROUPS
General Population with a strategic shift to adults, married and previously married individuals, wealthy and working adults
Residents of high prevalence / high risk locations e.g. urban residents, high HIV prevalence regions, transport corridors, boarder crossings, fish landing sites etc
Most-at-risk population groups, especially sex workers and their partners, long-distance truckers, fish-mongers, men in military service,
Vulnerable population groups e.g. victims of rape and sexual violence, non-infected partners of individuals in HIV sero-discordant relationships, widows, etc
PLHIV

18. MINIMUM PACKAGE OF SERVICES FOR GENERAL POPULATION
Core Components:
PMTCT
Male circumcision
HIV counseling and testing
Antiretroviral Therapy
Condom promotion
BCC integrated into existing structures (religious institutions, work places, school, etc) focusing on multiple partnerships etc
Complimentary Components:
IEC Messages and social norms reinforced through mass media
STI screening and treatment
Blood Transfusion Safety and Infection Control
Supporting policy and advocacy

19. MINIMUM PACKAGE OF SERVICES FOR MARPs
Community-based peer education and outreach
Risk reduction counseling (peer, outreach or in clinic settings)
Condom promotion and distribution
HIV counseling and testing
STI screening and treatment
Family planning and SRH services
Post Exposure Prophylaxis
HIV care and treatment
Access to health/social services
Structural issues (community mobilization initiatives and policy level initiatives, including those which address stigma and discrimination)

20. IMPLEMENTATION STRATEGY
Combination HIV Prevention
Referral linkages, Integration of services, Health Systems Strengthening
Realignment of funding priorities
Increased domestic and external resources, Fund HIV Prevention as a key and cross-cutting component of the NDP
Improved Coordination
Multisectoral response, Health sector, Line Ministries, LGs
Monitoring and Evaluation
Results-based, Strengthening of M&E systems, Alignment of M&E systems, Improved reporting and surveillance, systems
Impact evaluation, Resource tracking, Improved information management and sharing

21.  
INTRODUCTION TO RFA

22. INTRODUCTION TO RFA
HIV/AIDS epidemic in Uganda , goal and purpose
 The HIV Prevention Strategy
Combination HIV Prevention with emphasis on behavioural and structural interventions
The community engagement concept
Eligible CSOs CBOs; cultural/religious institutions; NGOs; networks and NNGOs.
principal recipients must have district presence of 3 years
consortiums.
6 focus districts
 UGX 26 billion in a period of 36 months.

23. OBJECTIVES OF THE RFA
The objectives for this RFA mirror those stipulated in the National Prevention Strategy. These include:
To empower individuals and communities to effectively demand for quality HIV/AIDS services and to demand for inclusive delivery of these services.
To increase adoption of safer sexual behaviors/practices
To create a sustainable enabling environment that mitigates the underlying socio-cultural, gender based and other structural drivers of the HIV epidemic
To achieve a well coordinated HIV prevention response

24. EXPECTED OUTCOMES OF THE RFA
Higher Level Outcomes
Increased demand for and utilization of HIV prevention and care services in the targeted districts
Increased adoption of safer sexual behaviors /practices and reduced risky behavior among targeted men and women
Improved community perception of the benefits of sustained behavior change.
Well coordinated HIV prevention efforts at national, district and community level.

25. EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes
Increased proportion of adults who have ever received HCT and know at least two benefits of testing.
Increased proportion of infected mothers and the exposed infants accessing a minimum package of PMTCT
Reduced recent multiple concurrent partners among men and women in the targeted communities
Increased average age for marriage or sexual debut for individuals especially youth in the targeted communities
Increased proportion of risky sexual acts/encounters that are consistently protected by condoms

26. EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes (cont..)
Increased percentage of women who make decisions about their sexual and reproductive health rights independently or jointly with their partners
Reduction of percentage of women who experience sexual violence
Improved involvement of men in community based HIV prevention interventions
Functional referral mechanisms/systems among the community and facility HIV/AIDS services

27. THE 4 KNOWS Know Your Epidemic Know Your Context Know Your Response
Analysis of data on prevalence and incidence to prioritize populations and geographic areas that are most at risk for HIV.
Know Your Context
Data to contextualize the epidemic. Ensure cultural relevance.
Know Your Response
Tracking the epidemiological alignment, scope, coverage and effectiveness of prevention efforts.
Know Your Costs
Knowing what is spent, and what the output for investment is; prioritizing interventions based on cost-effectiveness.

28. COMBINATION HIV PREVENTION 
COMBINATION HIV PREVENTION

29. COMBINATION HIV PREVENTION
The National HIV Prevention Strategy for Uganda calls for a strategic shift towards Combination HIV Prevention Definition (UNAIDS ) “The strategic, simultaneous use of different classes of prevention activities (biomedical, behavioral, social/ structural) that operates on multiple levels (individual, community, societal), to respond to the specific needs of particular audiences and modes of HIV transmission, and to make efficient use of resources through prioritizing, partnership, and engagement of affected communities.”

30. BIOMEDICAL ART treatment for eligible patients and PreP
Safe Male Circumcision
PMTCT
Home-based HIV Testing
HIV Testing (routine/opt-out) linked to ART and behavioral change programs TLC
Family planning
STI-screening and treatment of MARPs & PLHIV
Safe syringes

31. BEHAVIORAL Condom Use Promotion Programs
Peer education HIV prevention programs addressing condom use, concurrency, age-mixing and transactional sex targeting high risk groups
Couple counseling
Disclosure promotion programs
Delay sexual onset
Adherence to ART support programs
Positives Counseling Programs
Positive Health Dignity and Prevention (PHDP)
Abstinence and Faithfulness programs

32. SOCIAL/STRUCTURAL
Micro credit programs to support women’s economic situation
Creating Demand for HIV Prevention Services Programs
GBV prevention programs
Conditional Cash Transfers
Women Empowerment Programs
PLHIV programs addressing stigma
Addressing widow inheritance
Human Rights and Empowerment Interventions for Sex Workers, IDU’s
Easing access to care for Sex Workers, IDU’s

33. BENEFITS OF THE RIGHT COMBINATION
Several HIV interventions have a proven, but partial efficacy
In combination a synergy effect can occur between different interventions, which increases the effectiveness of all of the interventions when delivered together.
According to the local epidemiology we will have a tailor made HIV prevention program for the area
The tailor made approach adds effectiveness, high risk individuals and groups are targeted first to avert most new HIV infections
Tailor made combined intervention taking place at the same time in the same place to a defined standard are know to be more effective.
Efficacy is what’s shown in Randomized Clinical Trials. It’s the result you get while implementing an intervention. As you all know there’s no one solution that works everywhere and for everyone.

34.  
COMMUNITY ENGAGEMENT

35. COMMUNITY ENGAGEMENT DEFINITION
Community engagement is the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.(adapted from Fawcett et al, 1995)
Different levels at which one engages with people:-
* Inform
* Consult
* Involve
* Collaborate
* Empower
N.B: Different situations require the use of different levels of engagement

36. COMMUNITY ENGAGEMENT PRINCIPLES
Empowering the people to make decisions, raise question & problems and be part of the solution
The rules of engagement between the target beneficiaries and the supporting agency need to be clarified
Should be participatory (need awareness before this can be acted upon)
Should include both men and women
Focus on the power dynamics (women empowerment)
Community ownership
Accountability

37. BENEFITS OF COMMUNITY ENGAGEMENT
of engaging the community:-
the development of sustained, community-focused and led interventions
Use of explicit methodologies that engage people in discussion and collective action on the factors that influence risk and vulnerability to HIV in their particular communities.
The development and/or strengthening of strategic partnerships and coalitions that help mobilize resources and influence systems, change relationships and serve as catalysts for changing policies, programs and practices.

38. Innovative interventions in the following:-
AREA OF FOCUS AND SUGGESTED INTERVENTIONS
Innovative interventions in the following:-
Communication for social and individual behavior change
Gender norms and harmful social cultural practices
 Coordination, collaboration, strategic partnerships networks and referrals
Cross cutting issues
Engage with district and any other relevant
Capacity building interventions for communities and selected duty bearers.

39. NOTES
Consortiums -leverage resources and avoid duplication of efforts.
Procurement restrictions
Niche/comparative advantage
Coverage of target populations

40.   Building Strategic Partnerships, Linkages and Referrals
– The role of the various stakeholders in the district

41. Strategies for strengthening partnership, linkages & referrals
Establishing terms and conditions of partnership
Ensuring clarity of roles of all partners
Ensuring regular meetings of the partners
Ensuring transparency and accountability in the partnerships
Strengthening forums for partnership development
Strengthening the capacity of service providers to manage referrals

42. OVERVIEW OF THE M&E SECTION 
OVERVIEW OF THE M&E SECTION

43. OVERVIEW OF THE M&E SECTION
The M&E section has three main components;
The M&E Matrix
The M&E Narrative
3. The M&E Resources
4. The CSF M&E System

44. THE M&E MATRIX
Builds on the log frame and provides the following details:
Overall Objective – what your project intends to contribute to.
Outcome-desired change/ result that your project aims to achieve
Outputs - immediate results of project activities
Performance indicators (within prevention strategy framework) and respective baselines and targets
Means of Verification (MOV) - Data sources
Frequency of data collection for each indicator
7. Responsible person /entity for data collection for each indicator
8. Frequency of data analysis and use for each indicator
9. Responsible person /entity for data analysis for each indicator

45. THE NARRATIVE SECTION
Explain precisely the how, what, who, when and where regarding;
Data collection
Data storage
Data analysis, reporting and utilization
Other monitoring processes
Data quality assurance
M&E capacity building
Monitoring external, uncontrollable factors

46. M&E RESOURCES
Provide a sufficient M&E budget (10 – 15% of the total project budget) cater for:-
Full-time M&E personnel to carry out M&E functions
Equipment for data capture, storage, processing and reporting e.g. computers, internet
Short-term M&E resources e.g. consultants, data entrants
M&E activities including data collection, analysis, storage, reporting, review meetings, trainings, assessments, tools production, field monitoring visits and the like.

47. The CSF M&E System
Data collection tools: CSF has standardized data collection tools fro capturing HCT, HIV prevention, PMTCT, that are used by all the sub grantees. The sub grantees will therefore be required to adopt the available data collection tools.
Reporting formats: CSF has standardized reporting formats for quarterly, semi annual and annual reports. All sub grantees are supposed to abide by the reporting timelines
An online database: CSF has an online database for capturing sub grantee data and all are required to enter their data in this database.
Indicators: CSF has standardized indicators that all sub grantees are required report against.

48. TARGET AND DENOMINATOR TABLE
CATEGORY (CSW, PHA, Fisher folk etc)
District
Female
Male
Total
Sub county
Parish
Age (Years)
Target
Denominator
10-14
15-24
≥25

49. EXPECTED OUTCOMES OF THE RFA
Higher Level Outcomes
Increased demand for and utilization of HIV prevention and care services in the targeted districts
Increased adoption of safer sexual behaviors /practices and reduced risky behavior among targeted men and women
Improved community perception of the benefits of sustained behavior change.
Well coordinated HIV prevention efforts at national, district and community level.

50. EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes
Increased proportion of adults who have ever received HCT and know at least two benefits of testing.
Increased proportion of infected mothers and the exposed infants accessing a minimum package of PMTCT
Reduced recent multiple concurrent partners among men and women in the targeted communities
Increased average age for marriage or sexual debut for individuals especially youth in the targeted communities
Increased proportion of risky sexual acts/encounters that are consistently protected by condoms

51. EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes (cont..)
Increased percentage of women who make decisions about their sexual and reproductive health rights independently or jointly with their partners
Reduction of percentage of women who experience sexual violence
Improved involvement of men in community based HIV prevention interventions
Functional referral mechanisms/systems among the community and facility HIV/AIDS services

52. THANK YOU