1. Overview of ESTHER model: Status and perspectives Dr Gilles Raguin Director www.esther.fr IAS, july 2012

2. FRENCH HOSPITALS Ministry of Health in Partner countries Capacity building Training Lab support PSM M and E Psycho -social support HOSPITALS AND CBOS IN PARTNER COUNTRIES PARTNERSHIPS ESTHER is a public operator IAS, july 2012

3. 19 partner countries 15 in Africa Bénin Burkina Faso Burundi Cameroun Côte d’Ivoire Gabon Ghana Libéria Maroc Mali Niger RCA Sénégal Tchad Togo 3 in Asia Cambodge Laos Vietnam 1 in the Carribean : Haïti IAS, july 2012

4. 173 sites supported by ESTHER in 2011 IAS, july 2012

5. RESULTS 2011 (1): 158.000 PVVIH on ART IAS, july 2012

6. RESULTS 2010 (2) for 113 367 pts (2011 results pending) Nb sites assesses Nb sites withdata Nb patients On ART Nb persons with PSS Treatment Sites 121100113 36774 500 (66%)35 831 N and % of LTFU at M12 43%11% 143 sites in 17 countries assessed Response rate: 79% IAS, july 2012

7. RESULTS (3) IndicatorsAvailabilityNumber (%)% Range N patients94%113 367NA N and % children < 2 yrs on ART 23% (19/82 sites)803 (34%)8% – 100% N and % neonates w DNA PCR < 3 months 29% 786 (84%)11% – 100% N and % pregnant women w complete PMTCT 63% ( 54/86 sites)1 784 (58%) 8% – 100% IAS, july 2012

8. Training: a priority in order to mitigate the Health Human resources crisis En 2011, 4400 health providers trained IAS, july 2012

9. Psychosocial support: a know how and a priority for ESTHER 855 counselors and community health workers trained 132 partner CBOs IAS, july 2012

10. Main mode of intervention: hospital partnerships 46 french hospitals involved 2011 : French caribean hospitals IAS, july 2012

11. Types of expertise mobilized Doctors (77%) Nurses, midwives and labtechs (15%) IAS, july 2012

12. Hospital Twinnings in 2012: limits and perspectives Capacities limited by financial crisis and health reforms New modes of intervention linked to external funding (UNITAID/AFD/GF) w specific TORs (52%) New strategies and objectives: Health system strengthening, MCH (MDGs 4 and 5), patient safety, more operational research IAS, july 2012

13. FOCUS 1 : Mother and child 2010 12 000 pregnant women with PMTCT 4 000 neonates with early infant diagnosis 35 reference maternities in 12 countries

14. FOCUS 2 : Laboratory strengthening In 2010, 88 laboratories supported by ESTHER In 17 countries -Imrprove access to innovative technologies for VLT: OPPERA project (UNITAID) -Strengthen lab networks ? IAS, july 2012

15. FOCUS 3 : Key populations Prisoners in Côte d’Ivoire IDUs in Dakar MSM in CAR -Discrimination still major - MSM and IDUs in Africa: the hidden epidemic ? IAS, july 2012

16. Conclusion Hospital partnerships is the backbone of ESTHER programs (solidarity and expertise) However, evolutions are ongoing to adapt to new constraints and new fundings Strategy 2012-2014 – 1/ Move from a site approach to a national approach, aligned on national strategies and a bilateral-multiteral approach – 2/ Move from a vertical, disease based approach, to a more transversal approach: health system strenthening IAS, july 2012

17. aknowledgements To the 28 ESTHER staff members at the headquarters and 73 local staff in countries To all hospital and CBOs partners in french hospitals and partner countries To the technical and financial partners IAS, july 2012