1. Demanding a high impact HIV response: civil society advocacy and the President’s Emergency Plan for Aids Relief (PEPFAR)
Dorothy Namutamba
International Community Of Women Living with HIV Eastern Africa

2. Background
The International Community of Women living with HIV Eastern Africa (ICWEA) is a registered regional advocacy network and membership based organisation
Founded in 2005 to give visibility to women living with HIV.
ICWEA believes that gender inequalities and limited access to sexual & reproductive health & rights for women is at the heart of the HIV epidemic.
Our advocacy is based on evidence of our daily lived experiences and we use participatory processes to addresses the priorities of women living with HIV, including young women.

3. Introduction
The PEPFAR programme provides treatment, prevention and care for PLHIV in high burden countries including Uganda where it is the largest donor.
Engagement of civil society in the development and implementation of PEPFAR’s plans is therefore critical to ensuring that PEPFAR’s priorities reflect real lived experience and that the plans emphasize the priorities of communities most affected.
The 2015 PEPFAR programme provided for structured CSO engagement as opposed to the past where it was ad hoc
In Uganda, the International Community of Women Living with HIV Eastern Africa (ICWEA) coordinates and convenes CSOs in a coalition focused on analysis and advocacy on PEPFAR and other major actors in AIDS response
This coalition has engaged in a series of high impact advocacy efforts
With support from AVAC and Health GAP!
PEPFAR was also supporting health system strengthening including ensuring that health facilities providing HIV services had sufficient and qualified manpower.

4. Engagement with the PEPFAR team that is informed by evidence;
ICWEA convened four quarterly meetings of CSOs and with PEPFAR country team to discuss activist priorities including:
Accelerating treatment scale up
Improving the quality of treatment and Option B+ programming, focusing on community engagement
The withdraw of PEPFAR programs from 10 Districts,
The DREAMS initiative,
Key population programming and
Leveraging the quarterly review process.
The quarterly review process is now getting structured and the PEPFAR country team has committed to sharing dashboard data every end of quarter.
ICWEA was part of a team of CSOs that went to Windhoek, Namibia in June and to Johannesburg May 2016 to participate in the regional COP review meeting
The team reviewed the contents of the COPs and provided feedback.

5. Engagement with the PEPFAR team that is informed by evidence
CSOs sought support and training in data interpretation and are now able to analyze PEPFAR data
CSOs also analyzed and discussed the quarter dashboard data that was provided by the PEPFAR country team.
CSOs provided feedback on a number of issues including:
The low numbers of people and children on treatment,
delayed roll out of viral load monitoring programmes,
insufficient communication and engagement of CSOs on the DREAMS initiative
and the need to give CSOs sufficient time to review the quarterly data.

6. Monitor the implementation of PEPFAR programs in selected districts
Aimed at checking in on the quality of programs, human rights protections and ensuring that service delivery reflects the needs and priorities of affected communities.
Based on the HIV burden statistics, PEPFAR has transitioned out of some districts and left HIV and AIDS services provision to either the Government of Uganda or other non- PEPFAR funded implementing partners.
ICWEA visited 2 districts that had been affected by the transition process : to assess the impact of PEPFAR withdrawal from selected districts of Uganda.
Convened meetings with PLHIV, health care providers, opinion leaders and implementing partners to discuss the transition process.
PEPFAR support was through the established government health system but did not 100% follow government guidelines and policies in all aspects
All the findings were shared during the PEPFAR – CSO quarterly review process in January 2016.
The transition means that the government of Uganda is solely responsible for provision of HIV and AIDS services in those districts; though any other non-PEPFAR partner can support HIV services provision
Find out on several issues that included
the support being provided to patients during the process and any other issues and challenges.
. A case in point is that all health workers recruited and supported by PEPFAR were not following government procedures implying that adapting them in the government health structure might be difficulty. PEPFAR was supporting a big number of positions that are not in the government structure and therefore they can’t be absorbed using the current structure; implying that that will affect service delivery directly
There is no formal roadmap showing the rationalization and transition of PEPFAR support in Uganda and therefore it is premature to conclude that PEPFAR has transitioned out of some districts

7. Outcomes The quarterly review process is now getting structured
The PEPFAR country team has committed to sharing dashboard data every end of quarter and seeking CSO feedback on the same.
CSO-PEPFAR meetings provide for a to discuss other issues of concern to the health sector, including ARV stock outs, delayed implementation of the AIDS indicator survey and the proposed NGO Bill
CSO agreed to integrate field visits to the quarterly review process.
Quarterly field assessments have enabled CSOs to provide feedback informed by evidence to the PEPFAR country teams and push for relevant corrective measures
The process is empowering and creates a sense of ownership to people with HIV and their communities, especially women and young women living with HIV who gather thesedata.

8. Challenges:
The quarterly dashboard data is a lot and requires time and skills to analyze.
Limited time to review the data. This issue was raised to the country team with a request to provide ample time to CSOs to understand, analyze and discuss the data before providing feedback
Delayed feedback on issues raised by CSOs to the country team. CSOs have raised the issue with the country team and requested that accurate feedback be provided quickly on issues they raise.
Limited knowledge among beneficiaries, health workers and district officials on PEPFAR funding/programming and transition at district level.

9. Conclusion
ICWEA convened advocacy helped generate substantial changes to the priorities and budgets and targets of the Uganda PEPFAR COP
Monitoring and implementation is the next challenge!
ICWEA with national and global partners has developed a PEPFAR COP engagement strategy, complementing Global Fund, to generate strong and effective advocacy in order to improve accountability of donors and address bottlenecks obstructing efforts to end AIDS in Uganda.

10. Acknowledgment Health GAP AVAC
Civil Society Organization who are members the Coalition in Uganda
Uganda PEPFAR country team