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Community Engagement Strengthening for the Philippine HIV Response (CES4PHR) Project – Part 1 TERMINAL REPORT (01 September 2009 - 31 August 2010)

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Page 1: External Validation Panel ReportbHxM1l-S8CPA…  · Web viewCommunity engagement, however, should not be mistaken as taking the role of Government in leading the country’s response

Community Engagement Strengthening for the Philippine HIV Response (CES4PHR) Project – Part 1

TERMINAL REPORT

(01 September 2009 - 31 August 2010)

(A joint initiative of the Philippine NGO Support Program, Inc. and the Philippine National AIDS Council with support from the International HIV/AIDS Alliance)

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Table of Contents

Title Page

Table of Contents 1

Introduction 2

A The Project 3

A.1 Background and Rationale 3

A.2 Objectives and Expected Outcomes 4

B Project Results

B.1 Actual vs Planned Activities 4

B.2 Actual vs Planned Outcomes 6

C Lessons Learned 6

E Future Plan 7

Annexes

1 Planned and actual activities and results. 8

2 Synthesis of the planning session outputs. 10

3 Roundtable design and output. 11

4 Proceedings of the Validation Forum and Planning Workshop

5 CES4PHR Part 2 WorkPlan

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Introduction

The concept of community engagement takes its roots in the collective and collaborative actions that communities have always taken, and in the response they have shaped through the years to promote, protect and support their members. Community engagement is referred to variously as “community participation”, “community involvement” or “community competence”. In the HIV sector, it is synonymous with GIPA or MIPA -- both are aimed at discovering and harnessing the inherent human capacities of individuals and communities towards a national HIV response that are truly community-owned and community-sustained.

Deepening our thoughts of what “engagement” is and how it differs from merely participation and involvement, we have found it useful to see them as separate and distinct; and see involvement and participation as steps on the way to engagement1 such that:

Involvement… is about involvement in community activities in a variety of different ways. Community involvement often starts with agenda and programmes that originate outside the community.

Participation… is about people being active partners in the regeneration of communities – contributing and sharing in the decisions that affect their lives. Participation should enable people to have a degree of power and control in the processes with which they are involved.

Engagement… is about continuous dialogue among various stakeholders – the development and maintenance of relationships between communities and organizations where decisions are shared and based on mutual and growing understanding towards a common cause or aspiration or goal.

With this in mind, the aim of community engagement in the context of the country’s response to HIV is to develop the inherent capacities of individuals and communities who are affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being, in this case HIV. The core principle is that everyone has the capacity to learn and respond through the process of actually doing and “learning through participation” and continuously engaged. When we are open to learning in this manner, change and action are seen in individuals, families, communities and organizations, and response expands from one sphere of influence to the other.

“Community engagement is defined as the process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being”2. Civil society and PLHIV groups have long been advocating for greater involvement and, in general, government and private entities implementing HIV programs have responded to this call in various ways. In view of the findings and recommendations made in the AMTP Mid-term Assessment Report, it is time to assess the level of engagement of key population groups (particularly MSM, PWID, and PIP) as well as CBOs and NGOs working with them in the frontlines. The results of the study will inform stakeholders in developing, implementing and sustaining appropriate initiatives to strengthen community engagement.

1 http://changesuk.net/themes/community-engagement/2 Principles of Community Engagement. Center for Disease Control and Prevention, USA, 1997.

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Approaches have long been in place and are evolving. These are captured in the Alma Ata declaration of 19783 as well as the World Health Organization on the social determinants of health4. These laid the foundations for much of the work that has been done, highlighting the role of communities in increasing the reach and impact of health systems, for example in TB, malaria and HIV care and prevention. It has become increasingly clear that community engagement for health and social welfare has unique advantages in its ability to make things happen through people’s own culture, resources, peer-sanctioned behaviors, and shared interests.

Community engagement, however, should not be mistaken as taking the role of Government in leading the country’s response to HIV and AIDS. It should instead emphasize common purpose and collaboration among stakeholders where communities are the rights-bearers and the government as duty-bearer.

Given the evolving nature of the country’s HIV epidemic where spikes in infections were observed in recent months, the Philippine National AIDS Council (PNAC) and the Philippine NGO Support Program, Inc. (PHANSuP) saw the need to enhance community engagement to “bring out unheard voices” in the areas of policy advocacy, strategic information and knowledge management and service delivery as an approach towards a more effective, efficient and sustainable response.

A. The Project A.1 Background and Rationale

The HIV&AIDS response in the Philippines is facing its most serious challenge to date. Data from the National HIV&AIDS Registry show a steep increase in the number of cases starting in 2006. In 2008, the number of new cases discovered topped 528, almost a threefold increase over the annual average of new cases of the previous 5 years. Latest records show that for May 2009 there were 85 new cases, which is 143% increase on the number of cases reported in the same period last year. The UNDP declared that “all the main ingredients for an epidemic are present in the country”5.

The national response is guided by the AIDS Medium Term Plan (AMTP) approved by the Philippine National AIDS Council (PNAC). The midterm assessment of the 4th AMTP was done in November 2008. The report6 emphasized, among others, that “partnerships are critical to the success of the program” and that “some types of partnerships have either not taken off or not blossomed in the last few years…”. In terms of strategic knowledge management, the report recommended that:

“Partnership and agreement with development partners is necessary and should be geared towards sharing information with PNAC…The PNAC Secretariat must … be positioned to serve as a repository for all program related information of the country. This can be done online, so that LGUs and other partners can access critical information, either related to the epidemic or to programmatic response. All the guidelines and studies (those without confidential information) should also be readily available on this online platform. Once a year the PNAC Secretariat should host learning

3 Declaration of Alma Ata – International conference on primary health care 1978 http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf

4 WHO – social determinants of health http://www.who.int/hia/evidence/doh/en/index.html5 UN Says RP Falling Behind in AIDS Fight. The Philippine Star, p13, 24 July 2009 issue.6 Mid-term Review Report on AMTP IV, pp 38-39. Swasti Health Resource Center, December 2008.

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seminars, where the LGUs, government and non government agencies can share their experiences and learn from each other.”

The International HIV/AIDS Alliance (IHAA or Alliance) has been in the forefront of “supporting community action on AIDS in developing countries” since 1993. It aims to scale up quality responses, strengthen civil society, and improve HIV policies. The Alliance visited the Philippines in June 2009 to identify ways on how it can help strengthen the national response through its linking organization, the Philippine NGO Support Program, Inc. (PHANSuP). The Alliance and PHANSuP conducted courtesy and consultative meetings with DOH, UNAIDS, USAID, UNDP, UNFPA, ILO, EU, and AusAID.

Additionally, PHANSuP, under its +Lifeguide Project supported by GlaxoSmithKline Positive Action, has started working with Pinoy Plus, PAFPI, BABAE+ and RAF to identify concrete measures to actively engage the positive community and the groups working with them in addressing some of the gaps in the current response specifically in the area of sharing information relevant to the needs of PLHIV. These consultations highlighted the imperative of developing a strategy to strengthen the meaningful engagement of various stakeholders, particularly those at the grassroots level, in support of a harmonized, effective, and sustainable national response.

A.2 Objective and Expected Outcomes

The Community Engagement for Philippine HIV and AIDS Response (CES4PHR) Project aims to contribute to the strengthening to the meaningful engagement of the key community groups in the country’s response to the HIV and AIDS epidemic.

Specifically, it intends to develop an effective platform for engaging PLHIV and MARP groups as well as civil society organizations working on HIV and AIDS in the area of policy advocacy, strategic information sharing and knowledge management, and service delivery. Within 12 months, the Project is expected to accomplish: (1) a baseline research paper that indicates the country’s gain and opportunities in meaningfully engaging various community and civil society stakeholders in specific thematic areas, the weaknesses and gaps that should be addressed and the key actions to move forward; (2) a functional system facilitating exchange of strategic information; and (3) a core group of key HIV and AIDS stakeholders representing various sectors actively interacting and or collaborating with each other.

B. Project Results

B.1 Actual vs Planned Activities

Annex 1 shows the detailed planned activities and results versus the actual activities and results.

The Project was designed to be implemented in 2 phases. Phase 1 consisted of key activities intended to identify gains and needs and to generate a consensus on follow-through actions to be undertaken under Phase 2.

Under Phase 1, two (2) key activities were planned: the forging of a formal partnership with the Philippine National AIDS Council; and the conduct of an assessment study to determine the status of community engagement in the country, identify issues as well as opportunities, and pinpoint key priorities or imperatives that must be acted upon to enhance the engagement of community-based groups.

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The above 2 key activities were successfully completed. The PNAC Executive Committee fully “endorsed” the Project to the PNAC Assembly as a joint PNAC-PHANSuP initiative. However, as the PNAC Assembly has not met since then, the PNAC Secretariat and PHANSuP deemed that the “endorsement” by the Executive Committee was already sufficient to legitimize the joint initiative. The forging of a formal partnership with PNAC was necessary given the need to harmonize efforts towards and effective response to the HIV epidemic.

The research activity entitled “Assessment of the Engagement of Community-based Groups (CBGs) in the Philippine HIV Response” was likewise completed. The research aimed to determine the status, challenges and opportunities, and strategic imperatives in engaging key population groups and frontline CSOs in the Philippine HIV response in the areas of policy advocacy, knowledge management and strategic information sharing, and network and partnership building. It covered 67 HIV-related groups and organizations, 36 (54%) of which are considered CBGs representing men-having-sex-with-men (MSM), people in prostitution (PIP) and people who inject drugs (PWID).

The assessment revealed, among others, the following:

CBGs tend to consider themselves in the lower levels of the GIPA/MIPA engagement ladder as “target audience”, “contributors”, and “speakers” due to their “still needing assistance from other groups”. Support Groups such as NGOs, however, reported being in the higher levels as “decision makers” and “experts”.

CBGs identified the following areas for capacity building: a) under policy advocacy: policy formulation and lobbying; b) under knowledge management: information processing and information utilization; and c) under service delivery: monitoring and evaluation, and sustainability.

Majority (92%) of the 67 respondents expressed the need to set-up a country-level electronic website or portal for strategic information sharing and knowledge management in the context of community engagement. They recommended that such portal should feature: an updated information on HIV and AIDS, a directory of organization and their services, website hosting and marketing of project proposals, community online forum and social networking.

The results of the assessment were presented in a one-day validation and planning workshop held at the Department of Health (DOH) Office of the Secretary (OSec) conference facility. The workshop participants provided comments/inputs on/to the research paper. They also identified outcomes that may be pursued to promote community engagement as follow:

1) CBGs instrumental in the revision and full implementation of pertinent provisions of RA 8504 (e.g., formation of HACTs, monitoring of human rights violations, etc);

2) CBGs sharing experiences and transforming these into useful knowledge; and3) CBGs driving the increased uptake of services.

To realize these outcomes, the participants identified several activities to be pursued under the national HIV response (Annex 2).

Another key activity undertaken, which was unplanned under Phase 1, is the forum entitled “2010 and Beyond: Responding to the HIV Challenge – a Roundtable Forum to Craft the Philippine HIV Management Agenda” held on 12 February 2010. This special activity was triggered by the controversy generated by the DOH Secretary’s admission that, indeed, there was an alarming increase in the number of HIV infections especially among “call center employees”. (Such concern was, incidentally, the focus of the unsuccessful Round 9 proposal to GFATM.) The roundtable forum identified specific issues with corresponding recommendations to address these. These issues were grouped under policy and governance,

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service delivery, and financing and sustainability (Annex 3). The output was circulated to stakeholders prior to the HIV Summit convened by the DOH in April 2010.

Under Phase 2, the development of an e-portal and an MSM-focused pilot project was planned subject to the results of Phase 1. However, due to the delays encountered, these were deferred for implementation.

B.2 Actual vs Planned Outcomes

Within 12 months, the Project is expected to accomplish: (1) a baseline research paper that indicates the country’s gain and opportunities in meaningfully engaging various community and civil society stakeholders in specific thematic areas, the weaknesses and gaps that should be addressed and the key actions to move forward; (2) a functional system facilitating exchange of strategic information; and (3) a core group of key HIV and AIDS stakeholders representing various sectors actively interacting and or collaborating with each other.

Of the 3 outcomes listed above, only the baseline research paper was fully achieved. However, the following related outcomes were also noted:

The formal PNAC-PHANSuP tie-up resulted in:

a) The openness and interest of most organizations and groups involved in the country’s HIV response to join and participate in project activities;

b) The recognition of the need to review current community engagement arrangements and identify measures to improve these; and

c) The sharing of resources with DOH/PNAC Secretariat thereby augmenting what is available in each partner.

The Project’s research findings and forum outputs are now being used to inform the ongoing preparation of the 5th AIDS Medium-term Plan (AMTP) for 2011-2015.

A Facebook account (http://www.facebook.com/#!/pages/Community-Engagement-Strengthening-for-the-Philippine-HIV-Response/148949575144513 ) was also created to serve as a venue for information exchange pending the development of the e-portal. A comprehensive list of CBGs and NGOs involved in the HIV response was also prepared and will be published as a directory.

The core group envisaged to be formed is yet to be realized. Nevertheless, potential members were already identified through the assessment/research conducted.

C. Lessons Learned

PHANSuP is committed to observe the principles of community engagement throughout the entire project cycle from design to evaluation. As such, the project may be considered as an initiative to demonstrate genuine engagement of relevant stakeholders in the area of ‘community engagement strengthening’. To date, the following lessons may be drawn from “walking the talk” in community engagement:

1. On project partnership building, it is important to engage the prospective partner even at the early stage of designing the project. Though PHANSuP has consulted a number of key stakeholders while designing the project, it had not directly consulted the PNAC Executive Committee thereby making it difficult to get budgetary support or counterpart once the Project has taken off. The PNAC Secretariat, however, was able

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to assist in mobilizing community and government stakeholders in specific Project activities.

2. On project scheduling, it is important to give ample lead time or allowance for consultations and protocols. For instance, getting the formal ‘endorsement’ of the PNAC Executive Committee took longer than expected. This same issue surfaced in the application for research ethical clearance from DOH as well as in getting the consent of some NGOs to involve the CBGs they were assisting as respondents in the survey.

3. On project communications, it is important for all stakeholders involved in project oversight, management and implementation to have a common understanding and appreciation of basic concepts, principles, terminologies and processes. This communication difficulty arising from conceptual and technical issues was highlighted during the research activity -- from instrument design, to review/clearance, to pre-testing, and to actual use even during data collation and analysis.

4. On project design, it is important to allow for some surprises consistent with the concept of ‘emergence’ as not everything can be planned for. Emergence is defined as: "the arising of novel and coherent structures, patterns and properties during the process of self-organization in complex systems”.7 A good example is the conduct of the roundtable forum that was pursued as a result of the controversy arising from the government’s formal admission of a worsening HIV epidemic in the country. Though the activity delayed some of the planned activities, it provided a venue for the Project to make a contribution at a crucial moment. The output of the forum was circulated to a number of key stakeholders who attended the HIV Summit convened by the government in April 2010.

D. Future Plan

Part 2 of the CES4PHR Project will focus mainly on the remaining target outcomes, i.e., development of the web-based community engagement portal and the formation and strengthening of a core group of community engagement fellows. A separate budget proposal will be submitted to the Alliance.

Prepared by:

John Piermont V. MontillaProject Officer

Approved by:

Roberto A. O. NebridaExecutive Director7 http://en.wikipedia.org/wiki/Emergence

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Annex 1. Planned and Actual Activities and Results.

Item Planned Activity/Results Actual Activity/Results RemarksPhase 1:

1 Signing of a project collaboration agreement with DOH-PNAC Secretariat. (Month 1)

Expected Output: Memorandum of Agreement

The CES4PHR Project was presented to the PNAC Executive Committee, which “endorsed” the project for implementation in coordination with PNAC. (Month 3)Actual Output:Official recognition of the Project as a joint initiative sans a MOA.

The PNAC Assembly seldom meets and it was deemed that the Execom endorsement was already sufficient to make the partnership official. This official recognition was important given the need to align the Project activities with the PNAC goal and strategies.

2 Conduct research to identify needs and recommendations of key stakeholder groups on how best to support and be meaningfully engaged in the national response along specific thematic areas. (Months 1-4)

Expected Output:Research report highlighting the needs of and recommendations by key stakeholders in the area of community engagement.

A research entitled “Assessment of the Engagement of Community-based Groups (CBGs) in the Philippine HIV Response” was conducted. (Months 7-12)

Actual Output:The research activity generated 2 documents: the research report and a directory of community-based groups as well as support organizations in the HIV sector.

The research covered 67 HIV-related groups and organizations, of which 36 (54%) are community-based.

This activity was delayed for 3 reasons:1) a special activity was done in view of the controversy generated by the DOH Secretary’s admission that, indeed, there was an alarming increase in the number of HIV infections especially among “call center employees”.2) processing of research clearances from the PNAC scientific committee and the DOH Review and Ethics Committee.3) difficulty in locating community-based groups as there was no directory available.

3 Share research results with all key stakeholders: PLHIV community, civil society (NGOs/CBOs), PNAC membership, multi/bilateral agencies, faith-based groups, LGUs, etc. (Month 5)

Expected Output:Recommendations to improve the research report.

A validation and planning workshop was done at the DOH OSec Conference Room (Month 13). Actual output:The participants provided comments/inputs on/to the research paper. They also identified outcomes and activities that may be pursued to promote community engagement.

There was a slight delay in the conduct of this workshop due to conflict in schedules. The expense was accrued for Month 12.

4 Assist stakeholders to identify key actions to implement recommendations. (Month 5)Expected Output:List of recommendations

Done. Merged with item 3 above.

Items 3 and 4 were combined into one workshop to save on the budget.

5 Get formal commitment from all stakeholders (e.g., PNAC resolution, collaboration agreement with CSOs/etc) to implement a specific action/s in line with the capability of PHANSuP and its partners.

Pending. Will be done for Part 2 of the Project.

Phase 2 This Phase was not pursued due to the delays encountered above.

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6 Development of e-Portal7 Piloting of MSM BCC Intervention

Annex 2. Synthesis of the planning session output.

Item Desired CommunityEngagement Outcome

Planned Activities to Enhance Community Engagement

1 On Policy Advocacy:

CBGs instrumental in the revision and full implementation of pertinent provisions of RA 8504 (e.g., formation of HACTs, monitoring of human rights violations, etc).

1.1 allow and encourage CBOs to sit and actively participate in local and national policy bodies such as LACs, PNAC, CCM, etc).

1.2 inventory, list, review, monitor and evaluate (and amend if necessary) existing policies at the local and national levels (especially those dealing on discrimination).

1.3 develop the capacities of CBGs on policy development and implementation.

2 On Strategic Information and Knowledge Management:

CBGs sharing experiences and transforming these into useful knowledge.

2.1 train CBGs on knowledge management based on the results of a TNA (to confirm initial findings of the research).

2.2 develop learning modules and BCC materials that are tailored to the needs of key populations.

2.3 establish a core group that will facilitate the generation, sharing, dissemination and use of community-generated knowledge.

3 On Service Delivery

CBGs driving the increased uptake of services.

3.1 intensify resource mobilization for the delivery of a package of services to specific target populations.

3.2 intensify campaign for VCT and ART.

3.3 train CBGs to deliver services, do BCC and conduct monitoring and evaluation.

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Annex 3. Roundtable design and output.

2010 & Beyond: Responding to the HIV Challenge(A Roundtable Forum to Craft the Philippine HIV Management Agenda)

Asian Institute of Management (AIM) Conference Center12 February 2010

A joint initiative of the Philippine National AIDS Council (PNAC) and the Philippine NGO Support Program, Inc. (PHANSuP) under the Community Engagement

Strengthening for the Philippine HIV Response (CES4PHR) Project

with funding support from the International HIV/AIDS Alliance

A. Background

The National Epidemiology Center (NEC) of the Department of Health (DOH) has released a report during the 2009 IHBSS Dissemination Forum (dubbed “this is it!”) citing the sharp increase in the number of HIV cases in the Philippines from “1 new case every 3 days” in 2000 to “2 new cases a day” in 20098. Media reports over the past few weeks, quoting government’s health officials, have also highlighted that urban young professionals, especially those working in the call center industry (one of the key drivers of the economy) are particularly vulnerable – raising a lot of concerns from the public9.

If indeed “this is it!” then “what to do now?”. With the anticipated change of administration after the May 2010 national elections, what specific HIV response agenda can be offered to our new national and local leaders to manage the alarming HIV situation in our country?

B. Objective

The forum aims to identify key, specific recommendations to effectively and efficiently manage the country’s HIV epidemic. It brings together experts and stakeholders to specifically:

a) identify key gains, issues and opportunities in the current HIV response; and

b) recommend concrete actions at the policy and operational levels to enhance and sustain the country’s response.

8 Presentation of Dr Eric Tayag of NEC during the 2009 Integrated HIV Behavioral and Serological Surveillance (IHBSS) on 10-11 December 2009 at The Heritage Hotel, Manila.9 http://www.abs-cbnnews.com/feedback/01/29/10/re-hiv-among-call-center-agents-news-feeds-tv-patrol

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C. Participants

The Forum was attended by leaders and key personalities from PLHIV groups, MSM groups, civil society, government, academe, and multi/bilateral agencies such as UNAIDS, USAID, EU, etc. Dr Nemesio Gaco, DOH Assistant Secretary, was the keynote speaker.

D. Forum Output: Key Issues and Recommendations

ITEM AREA OF CONCERN / SPECIFIC ISSUE RECOMMENDATION/S

1 Policy and Governance (see also item 3.3 below)

1.1 PNAC not functioning and not adequately funded.

Review the role, structure and operations of PNAC and its relationship among its members and with other mechanisms such as the CCM of the Global Fund. PNAC should ensure harmonization and integration of interventions.

1.2HIV&AIDS separated from discussions and advocacies related to reproductive health.

See recommendation above.

1.3Sexuality issues are not openly discussed (i.e., taboo) thereby making people mis/uninformed.

Promulgate a policy (i.e., pass the RH bill) that will ensure open and clear sexuality education starting at elementary level, as well as to ensure availability of resources and services.

1.4Project-driven interventions and over-dependence on GFATM projects.

Adopt a long-term programming approach based on the country’s strategic plan to address the HIV epidemic.

1.5Conflicting policies and regulations (e.g., anti vagrancy law, drug control law, etc.)

1.6 Unreliable/unrealistic data. 2 Service Delivery

2.1Fear of stigma and discrimination that prevents people from accessing services (e.g., testing).

Enhance education campaign towards acceptance; advocate for the rights of PLHIVs.Develop a network of educators among PLHIVs.

2.2 Limited package of SRH services for PLHIVs especially women.

Make a comprehensive list of WLHIVs in need of SRH services; implement full Philhealth package for PLHIVs.Integrate prevention, treatment, care and support services.

2.3 Turn-over of medical personnel hampering the delivery of services.

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2.4 High cost of treatment and other services.

2.5 Steep increase of infections among young people.

Come up with a response that will not stigmatize call center workers. This may be done by packaging such program as intended for yuppies or young urban professionals to make it more general.

3 Financing and Sustainability

3.1 Non-harmonized financing as a result of lack of donor coordination.

Create a centrally-coordinated resource mobilization and project implementation mechanism.

3.2

Unclear sustainability of services (e.g., the provision of free ARVs) as these are mainly dependent on project funding.

Intervention should be properly designed to make it sustainable even after project life.

3.3 Lack of government appropriation for HIV interventions.

Increase the budget of the PNAC Secretariat, which should also enter into a MOA with other entities (government and private) to generate additional resources.Pass the new law providing explicit HIV budget for each relevant agency (HB 1389).

3.4 Lack of sustainability in engaging PLHIVs in the response.

PLHIVs should be considered for full-time employment in the country’s HIV projects consistent with MIPA.Provide livelihood opportunities.

4 Others

4.1 Lack of HIV education in all academic levels.

Advocate for the inclusion of HIV education through DepEd, TESDA and CHED. Take a look at the CBCP module, if any.Develop standard protocols and teaching aids for all levels.

4.2

Lack of mechanisms to reach out to workers in informal sectors. Also, difficulty of sustaining HIV in the workplace programs even in the formal sector.

Engage NGOs and LGUs to implement HIV interventions.LGUs to promulgate HIV education policy for tricycle/jeep drivers, vendors and sex workers.Enhance the role of DOLE (i.e., give more ‘teeth’).

4.3 Lack of uniform response to all controversial issues.

Develop a standard information to respond to specific issues with PNAC as THE spokesperson.

4.4 Lack of mechanism to orient newly-elected officials on HIV concerns

For DILG-ILGA: develop a seminar module to orient newly-elected officials and piggyback this into the training on executive-legislative agenda.

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