THE DRAFT NATIONAL STRATEGIC PLAN ON HIV and

AIDS & STI (2007-2011)

PARLIAMENTARY COMMITTEE ON HEALTH 27 FEBRUARY 2007

PURPOSE

To brief the Committee on the approach to the drafting, draft content, progress, as well as plans towards finalisation of the National Strategic Plan for HIV & AIDS and STIs; 2007-2011.

OUTLINE

Background Brief report on the assessment of National

Strategic Plan (NSP) 2000-2005 Draft NSP 2007-2011 Summary Recommendations

BACKGROUND

The DOH mandated by SANAC in May 2006 to lead a process of developing a new framework

– It was agreed that the NSP 2000-2005 is largely still relevant Embodies the multisectoral approach Statement of intent for the whole country

– All government departments and other sectors Maintain the key priority areas

– Relevant– Require a longer period to realise substantial impacts

Desktop review to be carried out

ASSESSMENT OF NSP 2000-2005

The assessment completed in September 2006 Despite its methodological limitations

– Useful Some sense of extent of implementation Important information for the development of new NSP Strengthened stakeholder involvement in the processes

Final report submitted to the department of health– Distributed to SANAC and the participating agencies

ASSESSMENT OF NSP 2000-2005

Conclusion:– Framework has fulfilled its task to a great extent

Gave direction to all stakeholders in the country-majority of programmes were formulated on the basis of the framework

Partnerships in the fight against HIV and AIDS has been broadened

– Implementation of programes tended to be vertical– Lack of a clear M &E framework and clear targets was

identified as the major gap Quantity data not reliable enough

– Overall coordination at SANAC level and with civil society another major weakness

ASSESSMENT OF NSP 2000-2005

Some recommendations– Government:

Review the approach and content of ABC message Strengthen government implementation in general Sustain existing partnerships Strengthen the implementation of cooperative agreements

among SADC Member States Strengthen coordination and M&E

ASSESSMENT OF NSP 2000-2005

Recommendations:– Civil society

Enable SANAC representatives to fulfill their mandate of coordinating the sector

Increase business sector contribution Establish an M&E Plan for all civil society sectors Consider the needs of the disabled

DRAFT NSP 2007-2011

Informed by– Previous framework – to a large degree – Findings of the NSP 2000-2005 assessment – Current status of the HIV and AIDS epidemic – Scientific developments– Current policy and legal environment– Assessment of capacities– Available interventions and resources– Inputs from the majority of critical stakeholders

DRAFT NSP 2007-2011

DOH developed the first draft and led several consultations– first draft on the 20th October

Evolved to the February 2007 version of draft 8 – Divided into 13 Sections– No fundamental deviations from the NSP 2000-2005

(NO MAJOR BREAKTHROUGH) Foreword, Executive summary, Introduction, and Process Update on Epidemiology, TB/HIV and STIs, Women, Youths,

Children<15, (prisoners, etc)– Reaching peak at about 5M estimated to be affected– Mainly young women (25-35 age-group), informal settlements (urban and

rural)– Everyone at risk!– Increasing incidence of and mortality from TB

SITUATION ANALYSIS

Surveys – DOH Annual ANC Surveillance major source of information– Cited also, MRC, STATSSA, ASSA 2003 modelling,

UNAIDS, Behavioural surveys, DHS, and HSRC work

Expert task team working on this section– Led by an actuarial scientist and an epidemiologist– Defines character, dynamics

DRAFT NSP 2007-2011

Recognition of TB as the most important opportunistic infection

– Challenges with TB control– TB/HIV coinfection– XDR-TB

Role of Sexually Transmitted infections– Gains as evidenced by decrease in syphilis– Challenges with partner management– Emergence of resistance - gonorrhoea– Importance of genital herpes in the reducing HIV acquisition

and transmission– Engaging the private sector

DRAFT NSP 2007-2011

Response analysis:– Takes a lot from the assessment report– Refers also to the NACOSA period (1992 -

1997)– Progress in many areas– Still too many challenges– Task team will make a some general risk-

assessment statement

DRAFT NSP 2007-2011

Structural organization: Developments relate to;

– Revival of the InterMinisterial Committee on AIDS– Role of the Social cluster of government – Provisions of the NHA and relevant structures

National health council NHCF

– New SANAC structure Approved by current SANAC Approved by Cabinet

– Requested to consider expanding mandate to include other important health challenges, e.g. TB Sectors working on representation

– Provincial and district level coordination structures to be informed by new SANCA Community level structures should play a meaningful role in implementation and monitoring of

programmes on the ground

DRAFT NSP 2007-2011

Guiding Principles: – Batho Pele– Comprehensive Plan– Leading role of government– Human rights climate – PLWHA, Women, Disabled, Children,

other marginalised groups - nondiscrimination– Importance of the national movement on moral regeneration

and mainstreaming of values– Social mobilisation and Meaningful community participation

PRINCIPLES

Evidence-based strategies and interventions Stigma mitigation Holistic approaches (comprehensive) Strengthening PPPs Centrality of M&E Provision of predictable and sustainable financial

resources, availability of commodities, and Harmonisation of aid

Task team also working on these

DRAFT NSP 2007-2011

GOALS OF THE NSP 2007-2011: Primary aims

– Reduce rate of new infections – Reduce impact on individuals, families, and communities

Four key priority areas – maintained from old– Prevention– Treatment care and support– M&E and research– Human and legal rights

NSP is the WHAT and the HOW MUCH (targets)– HOW is to be addressed at operational level

Work in progress by the task team

DRAFT NSP 2007-2011

Prevention: 50% reduction of rate of new infections in the NSP period

– 5 goals identified – each with targets and indicators Lead agencies identified

– Reduce vulnerability; poverty alleviation, acceleration of development, women empowerment

– Reduce sexual transmission Social mobilisation for behaviour change

– Balanced ABC message– Mutual monogamy– Men as partners– Consistent condom use– Delay in sexual debut– Gender-based violence– Substance (ab)use– Life skills education

PREVENT SEXUAL TRANSMISSION

Target high risk groups – CSW, MSM, incarcerated men, IDUs, Mobile populations, etc.

Workplace programmes Increase access to male and female condoms Target <14 – 17 for delaying sexual debut PEP for sexual assault victims Strengthen STI control and management Youth services Positive prevention

REDUCE RATE OF HIV INCIDENCE AMONG THE <5s

Essentially this is PMTCT Increase PMTCT coverage

– Increase geographic PMTCT coverage– Increase uptake– Prioritise pregnant women for ART

– Reduce transmission– Reduce maternal mortality

– Requires policy direction from the NHC Approach to testing Evidence on regimen efficacy

PREVENTION

Minimise the risk of occupational exposure– Infection control– PEP according to guidelines

Provision of safe blood for medical use and reduce the rate of transmission through IDU– Safe blood transfusion– IDU – research

TREATMENT, CARE, and SUPPORT

Provide an appropriate package of treatment, care, and support services to 80% of HIV positive people and their families by 2011

4 goals identified:– Improve screening and diagnosis through VCT and PCR

Increase coverage– Geographic access– Uptake

Expand PCR– Requires policy direction from the NHC

Approach to testing – strategies to increase uptake

TREATMENT, CARE and SUPPORT

Improve health outcomes for asymptomatic HIV positive adults and children – “positive living”

– Strengthen health system – particularly at district level STGs Commodities Training of service providers Effective links with community-based activities

– Improve health outcomes for symptomatic HIV positive adults and children

Dual TB/HIV epidemic– Active case finding both ways– Prophylaxis with Cotrimoxazole – Prophylaxis with INH – ART for TB patients

TREATMENT, CARE, and SUPPORT

Improve health outcomes for symptomatic HIV positive adults and children– Positive living– ART– Nutrition– Cotrimoxazole

TREATMENT, CARE and SUPPORT

Mitigate the impact– Build competent communities– Expand CHBC within the EPWP – Palliative care– Orphans and vulnerable children– Youths– People with disabilities– Older people– Continuum of care in health facilities

RESEARCH, MONITORING and SURVEILLANCE

Draft M&E Framework developed– Consultations underway– Task team also working on this

Scientific research– Vaccines– Microbicides– Male circumcision

Policy research– HIV screening and diagnosis– PMTCT regimens– ART guidelines– Nutrition strategies– Traditional medicines

RESEARCH, MONITORING and SURVEILLANCE

Operational research– To define models; e.g. comprehensive plan– Assess health systems responses– Define resource requirements

Regular surveillance Prevalence Incidence Youth risk behaviour Clinical and microbiological surveillance

HUMAN and LEGAL RIGHTS

Appropriate social environment– Antidiscrimination – Stigma mitigation

Monitor human rights abuses Develop an appropriate legal and policy

environment

OTHER IMPORTANT SECTIONS

Costing– Proven to be complicated– Ballpark figure being worked out– Treasury involved– More detailed study to be carried out later

Identification of requirements for effective implementation

– Policy gaps to be addressed– Gaps in the regulatory environment to be addressed– Time frames to be defined for operationalisation by different

sectors

PROCESS UNDERWAY AND FORWARD

Sector consultations ongoing – government and civil society Task team of experts appointed

– Meeting for the third time on March 1– TORs adopted– Project plan drawn– Tasks allocated– Much progress being made by the team– Final draft to NHC – 9 March 2007

National conference – 15 and 16 March 2007– Led by the DP and the MOH– Plenary and Commissions – detailed deliberation– About 500 people – wide sectoral representation

Adoption by the new SANAC Popularisation of the Plan Implementation – ALL!

SUMMARY

Largely maintains the old framework as mandated– 2 main goals – ambitious!– 4 key priority areas – some what rearranged and expanded on

Considers current situation, lessons from the previous response, policy environment and new scientific evidence

Statement of intent– What and the How Much > How

Some costing and financial commitment– Mainly from government

Comprehensive M&E Framework– With clear targets and indicators

Defines an operational plan with time frames and responsibilities

RECOMMENDATIONS

It is recommended that the portfolio committee takes note of;– The approach to the development of the NSP for

HIV & AIDS and STIs, 2007-2011– The draft content thus far– The progress made in this regard, as well as the – the plans towards finalisation of this plan.

THANK YOU!