Presentation on theme: "Pre-bidders workshops ; 12th October 2011"— Presentation transcript:
1 Pre-bidders workshops ; 12th October 2011 CIVIL SOCIETY FUNDStrengthening civil society for improved HIV/AIDS and OVC service delivery in UgandaRFA # : Reduction Of New HIV Infections Through Enhanced Community Engagement In Combination HIV PreventionPre-bidders workshops ; 12th October 2011
2 WORKSHOP OBJECTIVESOrient potential applicants on the RFA requirementsShare 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/proposalsImproved 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 yearsAlthough various HIV Prevention Interventions have piloted / implemented for 25 yrs, Uganda still has a run away epidemicOver 124,000 new HIV Infections in 2009New Infections exceeding AIDS deaths by about X2New Infections exceed annual ART enrolment by X3HIV 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 PrevalenceSex Workers, Partners of Sex workers, Individuals with history of same sex. Fishing communitiesAverage HIV PrevalenceAntenatal women, Boda boda cyclists, Plantation workersRelatively low HIV PrevalenceUniversity StudentsMajority of new infections sexually transmitted37% multiple partnershipsHIV discordant monogamousSex work and networksMajority of sexual transmission among individuals over 25 yearsMTCT about 20-25% infectionsNegligible blood borne infections
8 SOCIAL/STRUCTURAL DRIVERS OF HIV Socio-cultural driversHarmful cultural beliefs/practices e.g. polygamy, widow inheritance, courtship rape, rites of passage,Gender NormsSGBV, multiple partnerships among men, Permissiveness among women, Masculinity among menSocio-EconomicPoverty/wealth, Dependency , mobilityHuman rights violations especially for women/girlsaccess to justice- weak enforcement of existing lawsInequities in access to health servicesStigma 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, etcLow coverage of male circumcisionSocio-cultural and gender norms often neglectedCoverage of key HIV prevention services still sub-optimal to make public health impactOver 60% of adults never tested for HIVOver 40% of antenatal mothers no access to PMTCTAlmost three-quarters of adult men not circumcisedOver half of risky sex not protected with condomsQuality of HIV prevention services not optimal
10 CONSIDERATIONS IN THE NEW STRATEGY Aligning HIV prevention efforts to drivers of the HIV/AIDS epidemicTarget population groups with the highest risk of new infectionsCentral theme of the new strategy is Combination HIV prevention approaches using proven interventionsMinimum HIV prevention packages for the general population and specific groups brought to critical coverageAlignment to NDP NSP, HSSIP – i.e. the strategy to implement the HIV prevention component in these frameworks / strategic plans
12 MISSION & VISIONMission 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 MISSIONMission 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 GOALTo 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 NDPTo reduce MTCT Rate reduced from 29% to less than 10% by 201540%40% Reduction in new infections based on projected 2015 levelsEquivalent to 30% reduction based on 2009 estimates of new infectionsIR declines from 0.74 to 0.46 /100PYs178,930 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 servicesIncreased adoption of safer sexual behaviors and reduced risky behaviorsA strengthened & sustainable enabling environment that mitigates underlying factors that drive the HIV epidemicAchieving a more coordinated HIV prevention response at all levelsStrengthened information systems for HIV prevention
16 PRIORITIES FOR HIV PREVENTION To adequately address the key driversScale up priority HIV prevention services i.e. PMTCT, HCT, SMC, ART for HIV Prevention and Condom useReduce "unsafe sex" i.e. multiple and concurrent partnerships, early debut, cross generational , transactional and, casual sexMake "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 adultsResidents of high prevalence / high risk locations e.g. urban residents, high HIV prevalence regions, transport corridors, boarder crossings, fish landing sites etcMost-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, etcPLHIV
18 MINIMUM PACKAGE OF SERVICES FOR GENERAL POPULATION Core Components:PMTCTMale circumcisionHIV counseling and testingAntiretroviral TherapyCondom promotionBCC integrated into existing structures (religious institutions, work places, school, etc) focusing on multiple partnerships etcComplimentary Components:IEC Messages and social norms reinforced through mass mediaSTI screening and treatmentBlood Transfusion Safety and Infection ControlSupporting policy and advocacy
19 MINIMUM PACKAGE OF SERVICES FOR MARPs Community-based peer education and outreachRisk reduction counseling (peer, outreach or in clinic settings)Condom promotion and distributionHIV counseling and testingSTI screening and treatmentFamily planning and SRH servicesPost Exposure ProphylaxisHIV care and treatmentAccess to health/social servicesStructural issues (community mobilization initiatives and policy level initiatives, including those which address stigma and discrimination)
20 IMPLEMENTATION STRATEGY Combination HIV PreventionReferral linkages, Integration of services, Health Systems StrengtheningRealignment of funding prioritiesIncreased domestic and external resources, Fund HIV Prevention as a key and cross-cutting component of the NDPImproved CoordinationMultisectoral response, Health sector, Line Ministries, LGsMonitoring and EvaluationResults-based, Strengthening of M&E systems, Alignment of M&E systems, Improved reporting and surveillance, systemsImpact evaluation, Resource tracking, Improved information management and sharing
22 INTRODUCTION TO RFAHIV/AIDS epidemic in Uganda , goal and purpose The HIV Prevention StrategyCombination HIV Prevention with emphasis on behavioural and structural interventionsThe community engagement conceptEligible CSOs CBOs; cultural/religious institutions; NGOs; networks and NNGOs.principal recipients must have district presence of 3 yearsconsortiums.6 focus districts UGX 26 billion in a period of 36 months.
23 OBJECTIVES OF THE RFAThe 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/practicesTo create a sustainable enabling environment that mitigates the underlying socio-cultural, gender based and other structural drivers of the HIV epidemicTo achieve a well coordinated HIV prevention response
24 EXPECTED OUTCOMES OF THE RFA Higher Level OutcomesIncreased demand for and utilization of HIV prevention and care services in the targeted districtsIncreased adoption of safer sexual behaviors /practices and reduced risky behavior among targeted men and womenImproved 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 OutcomesIncreased 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 PMTCTReduced recent multiple concurrent partners among men and women in the targeted communitiesIncreased average age for marriage or sexual debut for individuals especially youth in the targeted communitiesIncreased 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 partnersReduction of percentage of women who experience sexual violenceImproved involvement of men in community based HIV prevention interventionsFunctional 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 ContextData to contextualize the epidemic. Ensure cultural relevance.Know Your ResponseTracking the epidemiological alignment, scope, coverage and effectiveness of prevention efforts.Know Your CostsKnowing 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 CircumcisionPMTCTHome-based HIV TestingHIV Testing (routine/opt-out) linked to ART and behavioral change programs TLCFamily planningSTI-screening and treatment of MARPs & PLHIVSafe syringes
31 BEHAVIORAL Condom Use Promotion Programs Peer education HIV prevention programs addressing condom use, concurrency, age-mixing and transactional sex targeting high risk groupsCouple counselingDisclosure promotion programsDelay sexual onsetAdherence to ART support programsPositives Counseling ProgramsPositive Health Dignity and Prevention (PHDP)Abstinence and Faithfulness programs
32 SOCIAL/STRUCTURALMicro credit programs to support women’s economic situationCreating Demand for HIV Prevention Services ProgramsGBV prevention programsConditional Cash TransfersWomen Empowerment ProgramsPLHIV programs addressing stigmaAddressing widow inheritanceHuman Rights and Empowerment Interventions for Sex Workers, IDU’sEasing access to care for Sex Workers, IDU’s
33 BENEFITS OF THE RIGHT COMBINATION Several HIV interventions have a proven, but partial efficacyIn 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 areaThe tailor made approach adds effectiveness, high risk individuals and groups are targeted first to avert most new HIV infectionsTailor 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.
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* EmpowerN.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 solutionThe rules of engagement between the target beneficiaries and the supporting agency need to be clarifiedShould be participatory (need awareness before this can be acted upon)Should include both men and womenFocus on the power dynamics (women empowerment)Community ownershipAccountability
37 BENEFITS OF COMMUNITY ENGAGEMENT of engaging the community:-the development of sustained, community-focused and led interventionsUse 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 INTERVENTIONSInnovative interventions in the following:-Communication for social and individual behavior changeGender norms and harmful social cultural practices Coordination, collaboration, strategic partnerships networks and referralsCross cutting issuesEngage with district and any other relevantCapacity building interventions for communities and selected duty bearers.
39 NOTESConsortiums -leverage resources and avoid duplication of efforts.Procurement restrictionsNiche/comparative advantageCoverage 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 partnershipEnsuring clarity of roles of all partnersEnsuring regular meetings of the partnersEnsuring transparency and accountability in the partnershipsStrengthening forums for partnership developmentStrengthening 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 MatrixThe M&E Narrative3. The M&E Resources4. The CSF M&E System
44 THE M&E MATRIXBuilds 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 achieveOutputs - immediate results of project activitiesPerformance indicators (within prevention strategy framework) and respective baselines and targetsMeans of Verification (MOV) - Data sourcesFrequency of data collection for each indicator7. Responsible person /entity for data collection for each indicator8. Frequency of data analysis and use for each indicator9. Responsible person /entity for data analysis for each indicator
45 THE NARRATIVE SECTIONExplain precisely the how, what, who, when and where regarding;Data collectionData storageData analysis, reporting and utilizationOther monitoring processesData quality assuranceM&E capacity buildingMonitoring external, uncontrollable factors
46 M&E RESOURCESProvide a sufficient M&E budget (10 – 15% of the total project budget) cater for:-Full-time M&E personnel to carry out M&E functionsEquipment for data capture, storage, processing and reporting e.g. computers, internetShort-term M&E resources e.g. consultants, data entrantsM&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 SystemData 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 timelinesAn 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)DistrictFemaleMaleTotalSub countyParishAge (Years)TargetDenominator10-1415-24≥25
49 EXPECTED OUTCOMES OF THE RFA Higher Level OutcomesIncreased demand for and utilization of HIV prevention and care services in the targeted districtsIncreased adoption of safer sexual behaviors /practices and reduced risky behavior among targeted men and womenImproved 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 OutcomesIncreased 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 PMTCTReduced recent multiple concurrent partners among men and women in the targeted communitiesIncreased average age for marriage or sexual debut for individuals especially youth in the targeted communitiesIncreased 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 partnersReduction of percentage of women who experience sexual violenceImproved involvement of men in community based HIV prevention interventionsFunctional referral mechanisms/systems among the community and facility HIV/AIDS services