Transcript The President’s Emergency Plan for AIDS Relief in South Africa

SAG-USG Joint 5-Year Partnership Framework
(PF) and Partnership Framework
Implementation Plan (PFIP)
2012/13 – 2016/17
KwaZulu Natal SAG PEPFAR All Partners’
Meeting
28 November 2011
Key Questions for PEPFAR
• Where were we?
• Where are we?
• What has changed?
• Where are we going?
Where were we?
South Africa
• Scale of SA HIV epidemic huge
• Consequences of SA HIV epidemic
staggering (morbidity, mortality, orphans,
stigma)
• AIDS Denialism slowed effective response
• Tools to respond limited: ART, palliative
care, VCT, AB(C)
PEPFAR
PEPFAR started as an Emergency Plan
Put as many people on ART as quickly as possible
Rapidly scale-up of programs
Rapid and substantial increase in funding 2004 – 08
Principles of the South Africa PEPFAR Program
Core Principle
Interagency Cooperation in a single program
1. Partner with South African Government
2. Support the South African National Strategic Plan
3. Fewer partners, but work with more indigenous
organizations
4. Build on demonstrated success
5. Develop local capacity
6. Plan for sustainability
South African Government Partnerships
• Supporting the South African Government is a
Core Principle of PEPFAR in South Africa
– Department of Health
– Department of Correctional Services
– South African National Defence Force
(including Military Health Services)
– Department of Social Development
– Department of Education
– Provincial Departments of Health
PEPFAR Operations in SA
U.S. President's Emergency Plan for AIDS Relief:
Office of the Global AIDS
Coordinator (OGAC),
Washington DC
Office of International Health,
PEPFAR Secretariat, South
Africa
Coordination, Collaboration, Support of PEPFAR Implementing
Agencies
U.S. Agency
for
International
Development
(USAID)
Centers for
Disease
Control and
Prevention
(CDC)
Peace Corps
Ambassador’s
Community
Grants
Program
U.S.
Department
of Defense
South Africa PEPFAR Funding
7.00
Rand Amount (in
billions)
6.00
5.00
Dollar Amount (in
100 millions)
4.00
3.00
Dollar Amount for
ARVs (in 100
millions)
2.00
1.00
-
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
USAID and CDC PEPFAR PROGRAM
148 prime implementing partners (contractors
and grantees)
and
more than 650 sub-partners
working throughout
the nine provinces
Unintended Consequences
• Weak coordination of scale-up
• Duplication and gaps in coverage
• Duplication/innovation – HMIS systems,
training curricula, training, …
• Systems Parallel to SAG response created
• SAG Ownership of PEPFAR not enough,
although aligned
• Decision-making processes not shared
What has Changed?
• Huge achievements in South Africa
• Political mandate to strengthen the
National HIV Response
• Vibrant visionary leadership in health
• Roll out of new strategies to increase
access and control HIV
• Expanding portfolio of prevention
interventions
Achievements
• About 1.7 million South African on ART
• Mother-to-Child- Transmission decreased
to 3.5%
• HIV Incidence decreased 25% between
2001 and 2009
PEPFAR Reauthorization
• Moving from Emergency to Sustainability
o Strengthen SA leadership in PEPFAR SA program
activities
o Transition progressively PEPFAR operations from
direct service delivery to technical assistance and
capacity building
o Expand prevention
• Partnership Framework (PF) and PFIP
o Sets new course for change
o Change in doing business
What is the PF?
The PF is a 5-year joint strategic framework for
cooperation between the US and SA governments,
and other partners to combat HIV/AIDS and TB in
South Africa.
Key themes in the PF?
 Efficiency
 Sustainability
Framework Stages
Stage 1: Partnership
Framework (PF)
Stage 2: Partnership
Framework Implementation
Plan (PFIP)
1. Establish collaborative
relationship
2. Negotiate overarching 5-year
Develop an Implementation Plan that
goals of PF and commitments
Includes specific strategies to
of each party
achieve 5 year Goals and Objectives
3. Synthesize agreements into a
concise signed document
PF signed December 14, 2010
in the PF
Focus of the PF
Purpose
To improve the effectiveness, efficiency and
sustainability of the South African national HIV and
TB response.
Guiding Principles
o
o
o
o
o
o
o
o
South African Leadership
Alignment
Sustainability
Innovation & Responsiveness
Mutual Accountability
Multi-Sectoral Engagement & Participation
Gender Sensitivity
Financial Commitments & Transparency
PF Goals
The goals of the PF are based on SA priorities:
o Prevent new HIV & TB infections
o Increase life expectancy and improve the
quality of life for people living with and
affected by HIV & TB
o Strengthen the effectiveness of the HIV &
TB response
Goal 1 Objectives
Prevent new HIV & TB infections
o Expand biomedical
and behavioral
prevention interventions that address the
various drivers of the epidemics
o Reduce vulnerability to HIV & TB infection,
especially focusing on the needs of infants,
girls and women
o Increase the number of persons who know
their HIV & TB status and link them to
appropriate services
Goal 2 Objectives
Increase life expectancy and improve the quality of
life for people living with and affected by HIV & TB
o Expand integrated
support services
treatment,
care,
and
o Decrease infant, child, and maternal mortality
due to HIV&AIDS and TB
o Mitigate the impact of HIV & AIDS and TB on
individuals , families and communities,
especially OVC
Goal 3 Objectives
Strengthen the effectiveness of the HIV & TB
response
o Strengthen and improve access to institutions
and services, especially primary institutions
o Strengthen the use of quality epidemiological
and program information to inform planning,
policy and decision making
o Improve planning and management of human
resources to meet the changing needs of the
epidemic
o Improve health care and prevention financing
Governance & Management Structure
High-level Steering Committee
o Strategic direction
o Governance
Management-level Committee
o Management
o Coordination
Key Elements
o Joint oversight of PF and its implementation
o Annual evaluation and review
o Annual adjustments as needed
Where do we need to go?
PFIP Development
Treatment and Care to transition to the
SAG
• Integrate with the NSP 2012 - 2016
• Adopt and follow SAG priorities
• Integrate with the PHC and District Health
System model
• Work with SAG to determine how NGOs
can best contribute to this plan
Where are we going?
PFIP Development
• Limit the amount of overlap to be efficient
and effective
• Drive down the cost of service
• While strengthening the overall health
system
• Prevention is the key to sustainability
• At all times ensure that care and treatment
of patients is ensured
PFIP Development
• Bilateral PF Steering Committee includes
Office of Deputy President, NDOH, DSD,
DOE, DPSA and Treasury
• Align with the National Strategic Plan for
HIV & Aids, STIs and TB (2012-2016)
• Work with provinces and districts
• Consultations
PFIP Development
• Provincial Consultations
– Input on provincial and district needs early
– Discussion of proposed PFIP
– Discuss how NGOs can best contribute to this
plan in provinces and districts
• PFIP will address national program with
room for provincial and district “tailoring” of
activities/effort
Transition, Technical Assistance,
and Capacity Building
• Progressively transition delivery of
services to SA DOH staff
• “Transfer” staff from PEPFAR NGOs to
DOH
• Train new health care workers
• Train existing DOH staff to enhance skills
• Provide technical expertise for a period of
time to transfer skills, build a system, etc.
Partnership
• Change is difficult
• Partnership and teamwork make things
happen
• Together we have a chance to really make
a difference
Thank You