the national aids secretariat (nas)...ccf christian children fund ccsi community and civil society...

Only you can stop AIDS

GOVERNMENT OF SIERRA LEONE

REPORT OF THE

INSTITUTIONAL REVIEW

OF

THE NATIONAL AIDS SECRETARIAT

(NAS)

FEBRUARY 2009

National HIV/AIDS Secretariat

NAS Institutional Review Report 2009

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ContentsList of tables....................................................................................................................... iiiList of figures..................................................................................................................... iiiAbbreviations..................................................................................................................... ivAcknowledgements............................................................................................................ viExecutive summary........................................................................................................... vii

1.1 Background ........................................................................................................ vii1.2 Objectives........................................................................................................... vii1.3 Review steps and process................................................................................... vii1.4 Meaning of coordination ................................................................................... viii1.5 NAC’s mandate and composition ..................................................................... viii1.6 NAS’s functions and structure .......................................................................... viii1.7 Findings............................................................................................................... ix

1.7.1 Institutional ................................................................................................ ix1.7.2 Administrative............................................................................................. x1.7.3 Communication and information with the public ....................................... x1.7.4 Technical support........................................................................................ x1.7.5 Monitoring and evaluation.......................................................................... x1.7.6 Decentralization .......................................................................................... x

1.8 Recommendations ............................................................................................... xi1.8.1 Political support ......................................................................................... xi1.8.2 Legality and composition of NAC............................................................. xi1.8.3 Technical capacity ..................................................................................... xi1.8.4 Public relations........................................................................................... xi1.8.5 Mapping .................................................................................................... xii

2 Introduction................................................................................................................. 12.1 Background .......................................................................................................... 12.2 Rationale............................................................................................................... 12.3 Objectives............................................................................................................. 12.4 Activities .............................................................................................................. 22.5 Review deliverables ............................................................................................. 22.6 Review steps......................................................................................................... 22.7 Review process..................................................................................................... 2

3 National response to the epidemic .............................................................................. 33.1 Challenges to the national response ..................................................................... 3

4 Areas of response........................................................................................................ 54.1 Prevention............................................................................................................. 54.2 Treatment ............................................................................................................. 54.3 Care ...................................................................................................................... 54.4 Support ................................................................................................................. 64.5 Impact mitigation ................................................................................................. 64.6 Monitoring, surveillance and research ................................................................. 6

5 Sectors involved in the response................................................................................. 75.1 Public sector ......................................................................................................... 7


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5.2 Private................................................................................................................... 75.3 Civil society.......................................................................................................... 75.4 Informal sector ..................................................................................................... 75.5 International development partners...................................................................... 8

5.5.1 Multilateral organizations ........................................................................... 85.5.2 Bilateral organizations ................................................................................ 8

6 Meaning of coordination of the sectors ...................................................................... 97 The mandates of NAC and NAS............................................................................... 10

7.1 NAS’s functions ................................................................................................. 108 NAC composition ..................................................................................................... 129 NAS’s structure......................................................................................................... 13

9.1 Office of the Executive Director ........................................................................ 139.1.1 Directorate for Coordination..................................................................... 149.1.2 Directorate for management ..................................................................... 14

10 Technical and other support groups.......................................................................... 1510.1 Partnership forum ........................................................................................... 1510.2 Parliamentary Committee on HIV/AIDS ....................................................... 1510.3 Donor Partners Consultative Group on AIDS ................................................ 1610.4 Expanded Technical Working Group ............................................................. 1610.5 IEC/BCC Steering Force ................................................................................ 1710.6 M&E Technical Working Group.................................................................... 1710.7 Treatment Technical Working Group............................................................. 1810.8 Laboratory Technical Working Group ........................................................... 19

11 Review findings ........................................................................................................ 2011.1 Results from local and international NGOs.................................................... 2011.2 Results from district-level contributions ........................................................ 2211.3 SWOC results ................................................................................................. 23

11.3.1 Strengths – (to be maintained) .................................................................. 2411.3.2 Weaknesses – (to be addressed)................................................................ 2411.3.3 Opportunities – (to be used)...................................................................... 2411.3.4 Challenges (Threats) – (to be overcome).................................................. 25

12 Summary and recommendations............................................................................... 2612.1 Summary......................................................................................................... 26

12.1.1 Institutional ............................................................................................... 2612.1.2 Administrative........................................................................................... 2612.1.3 Communication and information with the public ..................................... 2612.1.4 Technical support...................................................................................... 2712.1.5 Monitoring and evaluation........................................................................ 2712.1.6 Decentralization ........................................................................................ 27

12.2 Recommendations .......................................................................................... 2712.2.1 Political support ........................................................................................ 2712.2.2 Legality and composition of NAC............................................................ 2712.2.3 Technical capacity .................................................................................... 2812.2.4 Public relations.......................................................................................... 2812.2.5 Mapping .................................................................................................... 29

13 Annexes..................................................................................................................... 30


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13.1 Annex 1: List of stakeholders met.................................................................. 3013.1.1 Individual interviews ................................................................................ 3013.1.2 Written submissions.................................................................................. 3113.1.3 Group discussions ..................................................................................... 32

13.2 Annex 2: Information gathering questions ..................................................... 3413.2.1 To national and international partners ...................................................... 3413.2.2 To district level ......................................................................................... 35

13.3 Annex 3: Members of NAC............................................................................ 3613.4 Annex 4: Proposed NAS linkages, communication and organogram ............ 37

14 References................................................................................................................. 39

List of tables

Table 8-1: NAC membership composition....................................................................... 12Table 11-1: Summary of the views of from local and international NGOs...................... 21Table 11-2: Views of district-level respondents ............................................................... 22

List of figures

Figure 11-1: Current structure of NAS ............................................................................. 20Figure 13-1: NAS linkages and communication............................................................... 37Figure 13-2: Proposed NAS Organogram......................................................................... 38


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Abbreviations

AIDS Acquired Immune Deficiency SyndromeARG AIDS Response GroupART Antiretroviral TherapyARV AntiretroviralBCC Behaviour Change CommunicationBSS Blood Safety ServicesCAC Chieftain HIV/AIDS CommitteeCCF Christian Children FundCCSI Community and Civil Society InitiativeCHAT Country Harmonization and Alignment ToolCRIS Country Response Information SystemCRS Catholic Relief ServicesDAAG Disability Awareness Action GroupDAC District HIV/AIDS CommitteeDHMT District Health Management TeamGF The Global FundGLCS Grace Land Counselling ServicesGOAL An Irish international human development organizationHIV Human Immunodeficiency VirusIEC Information, Education and CommunicationINCLUDE Initiatives for Changing Lives for Ultimate Disability EmpowermentJPR Joint Programme ReviewM&E Monitoring and EvaluationMDA Ministries, Departments and AgenciesMoHS Ministry of Health and SanitationMoLG Ministry of Local Government (Ministry of Internal Affairs, Local Government and

Rural Development)MoEYS Ministry of Education, Youth and SportsMSSL Marie Stopes Society Sierra LeoneNAC National HIV/AIDS CouncilNACP National AIDS Control ProgrammeNAS National AIDS SecretariatNETHIPS Network of HIV PositivesNIDA National Islamic Development AssociationNMJD Network Movement for Justice and DevelopmentNSP National Strategic PlanPADI Pan African Development InitiativesSHARP Sierra Leone HIV/AIDS Response ProjectSL Sierra LeoneSLANGO Sierra Leone Association of Non-governmental OrganizationsSLCC Sierra Leone Chamber of CommerceSPW-SL Students Partnership Worldwide, Sierra LeoneSSL Statistics Sierra LeoneSTI Sexually Transmitted InfectionsSWAASL Society for Women Against AIDS in Africa, Sierra LeoneSWOC Strength, Weakness, Opportunity and ChallengeToR Terms of referenceUN United Nations


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UNAIDS Joint United Nations Program on HIV and AIDSUNDP United Nations Development ProgrammeUNICEF United Nations Children FundUNIFEM United Nations Development Fund for WomenVCCT Voluntary Confidential Counselling and Testing (for HIV)WFP World Food ProgrammeWHO World Health OrganizationWR WHO RepresentativeYWDO Youth Welfare and Development Organizations


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Acknowledgements

The Review Team would like to thank all the people who contributed views on how themultisectoral coordination of the national response could be improved either throughface-to-face interviews or written submissions. The Review Team also acknowledgeswith appreciation the unreserved support they received from Dr Brima Kargbo, DirectorNAS, Ms Mulunesh Tennagashaw, UCC and their staff especially Mr Abdul RahmanSessay, Mr Abu Bakar Koroma Ms Margaret Nemahun and Mr Bockari Samba.

This Review would not have been possible if the government and various bilateral andinternational organizations, especially UNAIDS, had not committed funds for the work.The Review was supported by: NAS, UNAIDS and UNDP.


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Executive summary

1.1 Background

The National HIV/AIDS Council (NAC) is mandated to coordinate the national response to theHIV and AIDS epidemic through its secretariat: the National HIV/AIDS Secretariat (NAS).

To effectively carry out this responsibility, the secretariat should be well positioned in terms of itsmandate, leadership and institutional orientation, human and financial capabilities. A JointProgramme Review (JPR) of the NSP 2006-2010 conducted in May 2008 recommended for aninstitutional review of NAS because of the changing dynamics of the national response to HIVand AIDS.

1.2 Objectives

The objective of the review was to identify strategies and environment that would enable NACand NAS satisfy their mandates. The mandates of NAC being setting the national policy onHIV/AIDS and oversee the multisectoral coordination of the national response. NAS’smandate is to assist NAC fulfil its mandate by providing coordination and administrativesupport without involvement in implementation of HIV/AIDS activities.

1.3 Review steps and process

The review followed the following steps in order to come up with a structure for NAS that wouldsatisfy the national requirements for comprehensive multisectoral coordination. The review teamexamined, first, the national response followed by elaborating the areas of response and thesectors involved in the response. The review then defined coordination in the context of thenational response to the epidemic. Views were then collected from a cross-section of stakeholderson the multisectoral coordination including NAC and NAS. The roles and functions of NAC andNAS and NAC’s composition were examined followed finally by elaborating a structure for NASinformed by all the compiled evidence.

The main purpose of review process was to invite dialogue about the strengths and weaknesses ofNAC and NAS, leading to positive action for change. The process placed less emphasis on theability to generalize from a large amount of data than on promoting information sharing forchange. The review was fully participatory involving stakeholders form all sectors. Views weresolicited from a wide range of people. There were ‘one-to-one’ interviews with sectoral policyleaders, group discussions with technical working groups and NGOs and written submissionsfrom umbrella groups, district managers, organizations and individuals. The face-to-faceinterviews with ministers and heads of agencies involved in HIV/AIDS national responseafforded the review with a wide range of views on how the national response is being coordinatedand managed. Annex 1 gives the list of the people interviewed. Discussion questions wereadapted from UNAID’s Country Harmonization and Alignment Tool (CHAT) as shown in Annex2.


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1.4 Meaning of coordination

Coordination can be defined as a process of making different people or things work together for agoal or effect. It can also be defined as a resulting state (a ‘product’) of working together;cooperation; synchronization.

Coordination should not be seen as control. Coordination in the context of the national responseto the epidemic should be seen as leadership of the response and providing an environment inwhich the different players can maximise their inputs for the good of the country workingtogether in cooperation and synchronized manner

1.5 NAC’s mandate and composition

The overall mandate for NAC is to set the national policy on HIV/AIDS and oversee themultisectoral coordination of the national response.

NAC is currently made up of 29 members and the Chairman who is the President of Sierra Leone.Just over a quarter of the members (27.5%) are government ministers, 21% are special interestgroups. UN agencies, bilateral agencies and regional organizations make up 24% of themembership. The remaining 27.5% of the membership is made up of security services (2members), a foreign country, legislature (2 members), one professional body and NGOs (2members).

NAC’s main role is to set the national policy on HIV/AIDS as part of its coordination of thenational response in all sectors in the country. NAC composition should, therefore, be guided byits mandate which is policy formulation. Technical matters and inter-sectoral linkages related tothe implementation of the policy are undertaken by the Council’s secretariat (NAS). Membershipof NAC should, therefore, be of people legally entitled to make national policy for the Republicof Sierra Leone. The Council should not be overly too large to convene and manage but it shouldbe made up of people who can collectively cover the national needs for effective response to theepidemic in all aspect of human society. The Council should have powers to invite anyone to itsmeetings as an observer or to provide information about a specific topic under the considerationof the Council.

NAS as the executing body of national policy should provide sufficient fora for encompassing all,national and international, partners (including financing agencies) to contribute to theinterpretation and implementation of the national policy, preparation of the strategic plan and itsimplementation.

1.6 NAS’s functions and structure

NAS’s mandate is to assist NAC in fulfilling its mandate by interpreting the national HIV/AIDSpolicy, preparing the national strategic plan and overseeing its implementation throughcoordination and administrative support without involvement in implementation of HIV/AIDSactivities. The coordination includes flow of human, material and financial resources destined forHIV/AIDS activities. It also includes the messages designed for preventive or informationpurposes. NAS executes its coordination of all sectors in Sierra Leone through the establishmentof an environment in which all stakeholders can carry out their activities in a synchronized andcooperative manner. The environment has to be more of leadership and guidance of thestakeholders to the national policies but not of control. NAS has also the responsibility to manageand coordinate resources placed under the direct authority of NAC.


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The Sierra Leone HIV/AIDS response operates on the “Three Ones” guiding principles to ensureall partners in the country join forces to achieve the goal of universal access for prevention,treatment, care and support. In order to ensure NAC fulfils its mandate, a national AIDSsecretariat (NAS) was set up to support the council. For NAS to effectively execute NAC’scoordinating mandate, the secretariat’s head should be at a rank not below senior ministeriallevel. (The level of ‘senior minister’ is suggested without any political implication but merely toreflect the level of seniority required by the head of the multisectoral coordinating body to be ableto perform his/her duties.) The proposed structure for NAS highlights its coordinating role forthe multi-sectoral national response and the management role for the NAS office.

Two ‘arms’ of NAS are proposed: the coordination and management arms both under the officeof an executive director. The coordination arm reflects the “Three Ones” principle by having aprogramme coordination branch, a policy, strategy and planning coordination branch and amonitoring, evaluation and research branch.

The management arm is responsible for the running of NAS office and management of financialresources for HIV/AIDS activities under NAS’s control. It includes: finance management,operations management and procurement management. It also provides administrative andfinancial management support to NAC/NAS. It participates in costing of the national frameworks,manage the budget of NAS and partners, and conduct timely procurement of goods and services.It provides financial statements and reports and builds capacity of NAS, as well as supportservices for its effective functioning

1.7 Findings

A number of important insights in the working of NAC and NAS have come out of the reviewexercise from a fairly comprehensive cross section of stakeholders. A number of strong points,weaknesses, opportunities and challenges have been identified and form the basis of therecommendations.

1.7.1 Institutional

Institutionally, the national response has very strong foundations to build the coordinatinginstitutions. The demonstrated political support from the highest level was noted by all the peoplethe review team interviewed. NAS was also said to have “a more positive image” since theadministrative changes were made. There is also an environment of good relationship andgoodwill between NAC/NAS and development partners. The review noted the strong moral andtechnical support NAS receives from UNAIDS including the nearly completed mapping ofimplementing and funding agencies and the activities implemented all over the country.

Some of the weaknesses and challenges stem from the historical circumstances under which NACand NAS were established as part of a World Bank-funded project and later on took on theadditional responsibilities of being principal recipients of the Global Fund funds. NAC and NASwere also created by Cabinet decision not by Act of Parliament which would have given them alegal status as a state institution with financial allocation in the annual budget with its own budgetvote. Such legal instrument would spell out the functions, composition of the people serving inNAS and their .status.

The multisectoral coordinating body is not a transient organization with a lifetime of a project.This body is likely to be an essential part of the national response to the HIV/AIDS epidemic for


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some years to come. Even if HIV/AIDS were to be eradicated it would remain as a provenapproach to coordinating multisectoral issues. NAS’s dependence on project funding withminimal government allocations cannot provide for its long-term sustainability. This body canonly be sustained by government providing core funding for its operations.

1.7.2 Administrative

NAS staff members do not see themselves as public servants because they have all alongdepended on non-government funding. Government does not treat them as civil servants either.The government pays social security for all civil servants but not for NAS employees who maketheir contribution all the same.

1.7.3 Communication and information with the public

The review noted that the public is not clear about what NAC is doing as well as NAS’scoordinating role, involvement in implementing activities and its relationship with ARG-MoHS.A number of people interviewed (development partners, policy makers and heads of civil societyorganizations) could not categorically correctly state what NAS does and its link with the AIDSResponse Group (ARG). The physical location of ARG and having been supervised by thecurrent Director NAS then as Team Leader of ARG continue to be the source of misconceptionthat the Response Group was under NAS.

A number of stakeholders look at NAS as a funding agency and complain that it does not allocatefunds to strategic implementing partners. NAS is not effectively informing the public thedifference between its mandatory role of coordination and the special responsibility as a principalrecipient of the Global Fund funds.

1.7.4 Technical support

The review noted that there were no functioning technical working groups for key response areasof treatment and laboratory support. NAS lacks, therefore, the technical guidance and support itwould require for effective coordination in those areas.

1.7.5 Monitoring and evaluation

Major functional weaknesses noted by the review and also identified by the Joint ProgrammeReview in May 2008 were the level of qualification of the M&E staff and lack of monitoring staffin the districts. These weaknesses are believed to impact the effective alignment of partners’M&E to the national framework.

1.7.6 Decentralization

Discussions with the ministry of local government highlighted the existing institutionalchallenges NAS faces especially in communicating with sectoral partners and missedopportunities of links with the grassroots through existing decentralized administrative structures.DACs and CACs are not fully functional in all districts thereby limiting the involvement of themultisectoral coordination process in the decentralization exercise.


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1.8 Recommendations

The following recommendations are made:

1.8.1 Political support

i. The current visibly high level of political support for the national response should bemaintained and encouraged within all MDAs

1.8.2 Legality and composition of NAC

i. The Office of the President should urgently move to have NAC and NAS establishedby law according to legal provisions of the Republic of Sierra Leone.

ii. The Act of Parliament establishing NAC and NAS should clearly spell out NAC’smembership reflecting the Council’s mandate of making national policy.

iii. The Act of Parliament establishing NAC and NAS should outline theirdecentralization and roles and functions of DACs and CACs and their linkages to thedistrict councils and district health medical teams.

iv. The Act of Parliament establishing NAC and NAS should ensure that leadership ofNAS is legally established at such a level within the administrative system such thathe head of NAS can exercise his/her role of coordination of sectors with dueauthority and with minimal political interference.

1.8.3 Technical capacity

i. NAC should establish mechanisms to oversee NAS’s activities through OversightCommittees (authorized to co-opt technically qualified professionals) through whichNAS would provide technical guidance to NAC.

ii. NAS should establish technical working groups or steering committees for allprogramme areas

iii. NAS and ARG should work out the terms of reference and composition of theLaboratory Technical Working Group

iv. NAS should decentralize M&E services to district level with qualified staffv. NAS, in collaboration with development partners should provide long term training

for all M&E staff, at national and district level, in data collection, computer skills,data analysis and skills in survey methodologies and to ensure that training is beingtranslated into performance.

1.8.4 Public relations

i. NAS establishes an active public relations entity (not necessarily by recruiting newpeople) to engage the public media in “marketing” the multi-sectoral nationalresponse

ii. Ways be found to physically separate NAS and ARGiii. The government should rename ARG what it used to be called: National AIDS

Control Programme (NACP) within the MoHS


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1.8.5 Mapping

i. NAS should press for the completion of the comprehensive mapping ofimplementing and funding agencies and the activities implemented all over thecountry

ii. NAS should establish a mechanism of regular updating the informationiii. The information is shared with all stakeholders to guide them in coordinating their

activities among themselves.


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2 Introduction

2.1 Background

The National HIV/AIDS Council (NAC) is mandated to coordinate the national response to theHIV and AIDS epidemic through its secretariat: the National HIV/AIDS Secretariat (NAS).

To effectively carry out this responsibility, the secretariat should be well positioned in terms of itsmandate, leadership and institutional orientation, human and financial capabilities. A JointProgramme Review (JPR) of the NSP 2006-2010 conducted in May 2008 recommended for aninstitutional review of NAS because of the changing dynamics of the national response to HIVand AIDS.

2.2 Rationale

The active involvement of national partners in all stages of the planning process (design,planning, costing and assessment) is partially determined by the type of consultation strategy used(ranging from passive to empowering) and by the degree of commitment of the government toinclusive and transparent public management practices. A major challenge is the need tostrengthen public administration and coordination capacities.

An effective national AIDS response actively involves all key national and international partnerswith a special emphasis on including civil society organizations that represent affected groups.Strong, multi-stakeholder involvement in NAC is an essential aspect of such an inclusiveapproach.

2.3 Objectives

The objective of the review was to identify strategies and environment that would enable NACand NAS satisfy their mandates1 by:

i. Enhancing the strategic and functional role of NAS in coordinating the multi-sectoralresponse within the framework of the principles of the ‘Three Ones’2;

ii. Guiding the overall process of key sectoral and thematic interventions proposed by the NSP;iii. Strengthening a platform for improved coordination, advocacy, partnership and resource

mobilisation; andiv. Aligning the overall joint UN vision to the strategic role of NAS in responding to HIV and

AIDS

1 NAC’s mandate is to set the national policy on HIV/AIDS and oversee the multisectoral coordination ofthe national response

NAS’s mandate is to assist NAC in fulfilling its mandate by providing coordination and administrativesupport without involvement in implementation of HIV/AIDS activities. NAS’s principalresponsibilities consist of support for the work of NAC with regard to policy interpretation andimplementation, preparation of the national strategic plan and plan of action, strategic planning,programme monitoring and evaluation, as well as the management and coordination of resources placedunder the direct authority of NAC.

2 One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of allpartners. One National AIDS Coordinating Authority, with a broad-based multisectoral mandate. Oneagreed country-level Monitoring and Evaluation System.



2.4 Activities

i. Undertake a joint institutional review of the National AIDS Secretariatii. Propose a new structural orientation for NAS aligned by key sectoral or thematic areasiii. Propose linkages to guide NAS in its multisectoral coordination.

2.5 Review deliverables

The review’s outputs are:1. The final review report including

An organogram of NAS with specific roles and responsibilities; ToR of

NAC NAS Donor partners consultative group on AIDS The Parliamentary Committee Expanded Technical Working Group The M&E Technical Working Group Other relevant groups as identified by the mapping of co-ordinating bodies

2.6 Review steps

In order to come up with a new structure for NAS, the team reviewed in sequence:1. The national response, then2. Areas of response, then3. The sectors involved in the response, then4. The meaning of coordination of the sectors, then5. The views of a cross-section of stakeholders, then6. The mandates (roles and functions) for NAC and NAS then7. NAC composition, and finally8. NAS’s structure

2.7 Review process

The main purpose of review process was to invite dialogue about the strengths and weaknesses ofNAC and NAS, leading to positive action for change. The process placed less emphasis on theability to generalize from a large amount of data than on promoting information sharing forchange. The review was fully participatory involving stakeholders from all sectors. Views weresolicited from a wide range of people. There were ‘one-to-one’ interviews with sectoral policyleaders, group discussions with technical working groups and NGOs and written submissionsfrom umbrella groups, district managers, organizations and individuals. The face-to-faceinterviews with ministers and heads of agencies involved in HIV/AIDS national responseafforded the review with a wide range of views on how the national response is being coordinatedand managed. Annex 1 gives the list of the people interviewed. Discussion questions wereadapted from UNAID’s Country Harmonization and Alignment Tool (CHAT) as shown in Annex2.



3 National response to the epidemic3

The first step taken by the government in responding to the discovery of HIV in Sierra Leone wasthe formation of a National AIDS Committee in 1986. This Committee was transformed into theNational AIDS Control Programme (NACP) in 1988 to strengthen the HIV/AIDS preventionactivities. The main focus then was raising people’s awareness of HIV/AIDS but preventive andcontrol activities were not given high priority, mainly because of the internal conflict, inadequateresources and low political commitment and advocacy. The situation however changed in 2001when the Government recognized that HIV/AIDS was a developmental problem.

In 2001, the Government of Sierra Leone appointed a Cabinet Sub-Committee on HIV/AIDSunder the leadership of the Minister of Information and Broadcasting. The Cabinet Sub-Committee collaborated with several development partners such as the UN Theme Group onHIV/AIDS, the World Bank and the US Government to establish structures that would strengthenthe national response to HIV/AIDS. Through this collaborative partnership, mostly with theexpanded UN Theme Group on HIV/AIDS, a National Policy was drafted in 2001. Governmentalso collaborated with the US Centre for Disease Control and Prevention (CDC) to conduct anational HIV Sero-Prevalence and Behavioural Survey in 2002 which provided a relatively clearstatus of the HIV/AIDS situation in the country.

There was renewed interest and awareness leading to heightened activities to respond to theHIV/AIDS epidemic. A four-year project: Sierra Leone HIV/AIDS Response Project (SHARP)was formulated with World Bank funding in 2002. The project had a conditionality of amultisectoral coordination of all the activities that were covered by the funding. This resulted inthe establishment of the National AIDS Council (NAC) as the highest strategic body in thenational response. Its Secretariat (NAS) coordinates the implementation of the policies agreedupon by the NAC by involving key Ministries, local councils, the private sector, and civil societyin the design, planning, implementation, monitoring and evaluation of programmes. Plans for thedecentralization of the coordination required the establishment of District AIDS Committees(DAC) as extensions of NAC to district level districts to enhance the coordination of HIV/AIDSactivities.

The Ministry of Health and Sanitation (MoHS) established, in October 2002, the AIDS ResponseGroup (ARG) as the health sector’s technical arm with four major areas of focus: surveillance,prevention, care and capacity building. Combating HIV/AIDS is also considered a major steptowards poverty reduction.

3.1 Challenges to the national response

A mid-term review of the National Strategic Plan (NSP) identified a number of challenges to thenational response. Among them ware:

i. The changed circumstances under which NAC and NAS were established. The World Bankproject had ended and NAS was currently looking after the Global Fund funds.

3 Adapted from Report of the Joint Review of National Response to HIV and AIDS, May 2008



ii. The current relatively low prevalence of HIV/AIDS leading to the challenge to haveaudible calls and visible actions that can galvanize the residents of Sierra Leone to realizethat the country is threatened by a new war, a war that could be more devastating than theten-year war.

iii. Different interpretation of coordination by different people. Some see it as managementothers as control etc. Lack of clarity on what coordination is within the framework of thenational response and the “Three Ones” principle is a major challenge to NAS’sperformance. There is, therefore, a need for an unequivocal national definition ofcoordination of HIV/AIDS national response by NAS.

The review noted that:

i. There should be a clear differentiation between NAS’s monitoring of programmes whoseactivities are funded through NAS and NAS’s statutory role to coordinate the nationalresponse irrespective of the source of funds.

ii. Existing gaps in NAS’s coordination of HIV/AIDS-related activities by someimplementing organizations or funding that NAS does not know of undermine the nationaleffort. These gaps lead to duplication of activities, competition for “tuff” and waste oflimited resources.

iii. The multisectoral response has not fully caught up with the administrative decentralization.Although DACs have been formally established they need to be fully functional and CACsformed to take the NAC’s statutory activities to the lowest administrative level.



4 Areas of response

Sierra Leone’s response to the epidemic covers all areas albeit with varying levels of depth andextent. The review addressed areas of response which NAS has to coordinate across all sectorsbut not the specific methods used which are more closely related with the implementation of theinterventions. For example IEC and BCC which cut across a number of response areas amongdifferent sectors. Treatment, care and support are addressed separately not because they aremutually exclusive but merely to highlight the importance of each. These three areas are closelyrelated at implementation level.

4.1 Prevention

In the absence of a cure for AIDS priority has been given to prevention using the followingstrategies against the spread of HIV:(i) Promoting safer sex and healthy sexual behaviour;(ii) Preventing the spread of STIs,(iii) Improving the management of STIs;(iv) Prevention of mother-to-child transmission (PMTCT);(v) Promoting voluntary confidential counselling and testing (VCCT);(vi) Promoting safe blood supply;(vii) Proper medical waste management; and(viii) Preventing accidental exposure especially by care providers

4.2 Treatment

The availability of affordable antiretroviral drugs has added a new dimension to the nationalresponse to the epidemic and the people’s attitudes. Although the available drugs do not cure HIVinfection or AIDS they have reduced the disease from a killer to a chronic disease. Treatmentprovided by public and private sectors with, so far, free drugs require close monitoring andcoordination to ensure that services are offered strictly according to national and internationalstandards to maximize national benefit and avoid development of resistant strains of the virus.Treatment response includes treatment for tuberculosis, sexually transmitted infections (STI) andother opportunistic infections. Coordination of the national treatment response must, therefore, bemindful of the multiplicity of implementing partners and the need for adherence to strictguidelines.

4.3 Care

Care and support to PLHIVs are some of the most important components in the fight against theHIV/AIDS epidemic in many countries because of its toll on the mental and psychological wellbeing of the people with the virus. At the moment there is no cure for HIV/AIDS but there areoptions for care. To be able to successfully cope with HIV and AIDS, people living with the virusmust have access to a range of treatment, care and support services. Sierra Leone identifies aspriority areas of care of PLHIVs, families and communities:

(i) Provision of adequate care to all individuals, families and communities.(ii) Development and implementation of a programme for care for orphans and vulnerable

children.



These priority areas cover palliative and hospice care and social care for the affected individualsand communities.

4.4 Support

Support, for people and communities affected by HIV/AIDS, is frequently taken together withtreatment and care. It is considered as an area of response on its own for purposes of theinstitutional review not because it should be implemented in isolation. Support includes material(food, medication, shelter etc.), psychological (counselling etc.) and development (educationetc.).

4.5 Impact mitigation

HIV/AIDS unlike many other diseases impacts society in a multiplicity of ways which thecountry is addressing. The physical response against the impact of the epidemic attracts manysmall scale implementers in all sectors requiring a much greater level of coordination than may becalled for other areas of response.

Impact mitigation activities include: Support for orphans and vulnerable children (OVC) Addressing issues peculiar to vulnerable groups e.g. women, the disabled, commercial sex

workers, Uniformed Services Personnel, etc. Education and provision of nutritional needs for people on ART Schemes to reduce the economic impact due to loss earnings directly and indirectly and loss

of productivity Establishing specific projects for young people Fighting stigma

4.6 Monitoring, surveillance and research

The national response must be informed by reliable accurate information on the inputs of thevarious stakeholders and the outputs and outcomes of their inputs. The effective implementationof activities, irrespective of the implementing organization, depends largely on existence of anational monitoring and evaluation framework which contributes towards the provision ofstrategic information for tracking of the epidemic and to enhance informed decision-making at alllevels of implementation. Within the framework of the “Three Ones” the coordinating body of thenational response needs to coordinate the monitoring systems that exist among the variousimplementing groups.

Surveillance is a crucial area in tracking the epidemic. Periodic HIV surveys must be closelymonitored and sources of routine reports of the new infections and AIDS cases must be properlycoordinated to ensure that the information provided is reliable.

Research, especially operational research, needs more concerted promotion and coordination withfora for sharing research results and feeding them into the improvement of the national response.



5 Sectors involved in the response

The coordination of the national response involves providing leadership and guidance to sectorsinvolved in the response. It was, therefore, imperative for the team to identify the sectors involvedin the national response. The following examples of sectoral compositions are not necessarilycomprehensive, they are merely indicative of the type of organizations belonging to the sector.

5.1 Public sector

Government ministries Parastatal organizations

o Port Authorityo Road Transport Authorityo Airports Authority

Primary and secondary schools Technical, Vocational schools Colleges and universities Uniformed Services Etc.

5.2 Private

Private-for-profito Bankso Mining industrieso Communication industrieso Transport industrieso Commercial enterprises

Private-for-non profito Faith based organizations (FBOs)o Non-government organizations (NGOs)o Community-based Organizations (CBOs)o Youth Networks

Etc.

5.3 Civil society

Action groupso Women’s action groupso Youth groups

Traditional leaders (Council of Chiefs) Etc.

5.4 Informal sector

Roadside traders (petty traders) Market Women Association Etc.



5.5 International development partners

5.5.1 Multilateral organizations

African Development Bank UN Organizations World Bank The Global Fund Etc.

5.5.2 Bilateral organizations

DIfD Irish Aid USAID Etc.



6 Meaning of coordination of the sectors

The Joint Review of National Response to HIV and AIDS in May 2008 noted that differentpeople interpret coordination differently. Some see it as management others as control etc. TheReview observed that lack of clarity on the meaning of coordination, within the framework of thenational response and the “Three Ones” principle, was a major challenge to NAS’s performanceand that there was, therefore, a need for an unequivocal national definition of coordination ofHIV/AIDS national response by NAS.

Coordination can be defined as a process of making different people or things work together for agoal or effect. It can also be defined as a resulting state (a ‘product’) of working together;cooperation; synchronization.

Coordination should not be seen as control. Coordination in the context of the national responseto the epidemic should be seen as leadership of the response and providing an environment inwhich the different players can maximise their inputs for the good of the country workingtogether in cooperation and synchronized manner

NAS is the “implementing arm of NAC” executing NAC’s duties of coordinating, monitoring,evaluating and managing funds for HIV/AIDS activities in the country as stated in NAC’s termsof reference in 2002. There should, however, be a clear differentiation between NAS’smonitoring of programmes whose activities are funded through NAS and NAS’s statutory role tocoordinate the national response irrespective of the source of funds.

.



7 The mandates of NAC and NAS

The overall mandate for NAC is to set the national policy on HIV/AIDS and oversee themultisectoral coordination of the national response.

NAS’s mandate is to assist NAC fulfill its mandate by interpreting the national HIV/AIDS policy,preparing the national strategic plan and overseeing its implementation through coordination andadministrative support without involvement in implementation of HIV/AIDS activities. Thecoordination includes flow of human, material and financial resources into the country destinedfor HIV/AIDS activities. It also includes the messages designed for preventive or informationpurposes. NAS executes its coordination of all sectors in Sierra Leone through the establishmentof an environment in which all stakeholders4 can carry out their activities in a synchronized andcooperative manner. The environment has to be more of leadership and guidance of thestakeholders to the national policies but not of control. NAS has also the responsibility to manageand coordinate resources placed under the direct authority of NAC.

7.1 NAS’s functions

NAS’S specific functions are to:

(a) Interpret and implement the overall policy and establish programmed priorities for the

control of the HIV/AIDS epidemic and management of its consequences throughout the

country

(b) Map and maintain an inventory of all stakeholders and the areas of their activities and level

of coverage

(c) Guide stakeholders in proper planning of their activities according to the national strategic

plan and sectoral leaders in intra-sectoral coordination of all HIV/AIDS control policies

and programmes within sectors.

(d) Identify obstacles to the implementation of HIV/AIDS control programmes and activities

and provide guidance in how the obstacles can be overcome.

(e) Provide leadership in the mobilization of resources5 for the HIV/AIDS control

programmes and activities.

(f) Facilitate the building of local capacity in critical areas of the national response by

(i) identifying gaps and bringing them to the notice of the appropriate sector,

(ii) mobilizing resources for bridging the gap and

(iii) enabling the appropriate sector to correct the gap

(g) Establish and maintain information sharing mechanism with stakeholders on the inflow of

resources for the HIV/AIDS control programmes and ongoing and planned activities in the

country.

(h) Establish and maintain information sharing mechanism with stakeholders in the use of the

resources for the HIV/AIDS control.

4 The term ‘stakeholders’ is used here to mean individuals, groups of individuals, organizations,government ministries, departments and agencies, companies etc. involved, in one form or another, inHIV/AIDS-related activity.

5 ‘Resources’ in this context covers: human, financial, technical assistance (e.g. laboratory management),technical cooperation (e.g. “twinning” of programmes, scientific linkages (e.g. international conferencesetc.)



(i) Act as a clearing house of proposals soliciting for funding from any source, internal and

external, to ensure that such proposals conform to national activity-specific guidelines and

in line with the Development Aid Coordinating Office guidelines.

(j) Collect, analyze and disseminate information on HIV/AIDS epidemic and its

consequences.

(k) Identify gaps in activities and geographic and population coverage related to the control of

the HIV/AIDS epidemic in Sierra Leone based on the mapping of stakeholders and their

activities, in particular regarding:

(i) Infrastructure

(ii) Health care and counselling of HIV/AIDS patients;

(iii) The welfare of bereaved orphans, and people infected or affected by HIV/AIDS;

(iv) The provision of medical supplies and equipment;

(v) The handling of socio-economic, cultural and legal issues related to the HIV/AIDS

epidemic; and

(vi) Biomedical research and surveillance into the HIV/AIDS epidemic and methods of

its prevention and control.

(l) Perform such other functions relating to the prevention and control of the HIV/AIDS

epidemic in Sierra Leone, as may be dictated by national circumstances.



8 NAC composition

NAC is currently made up of 29 members and the Chairman who is the President of Sierra Leone.The composition is as follows:

Table 8-1: NAC membership composition

The President, Chairman 1Ministers 8Security services 2UN agencies 4Bilateral agencies 2Foreign country 1Regional organization 1Legislature 2Professional bodies 1NGOs 2Special interest groups 6Total 30

The full membership list is shown in Annex 3.

NAC’s main role is to set the national policy on HIV/AIDS as part of its coordination of thenational response in all sectors in the country. NAC composition should be guided by its mandatewhich is policy formulation. Technical matters and inter-sectoral linkages related to theimplementation of the policy are undertaken by the Council’s secretariat (NAS). Membership ofNAC should, therefore, be of people legally entitled to make national policy for the Republic ofSierra Leone. The Council should not be overly too large to convene and manage. It should bemade up of people who can collectively cover the national needs and approaches for effectiveresponse to the epidemic in all aspects of human society. The Council should have powers toinvite anyone to its meetings as an observer or as a source of information about a specific topicthe Council may be deliberating.

NAS as the executing body of national policy should provide sufficient fora for encompassing allpartners, national and international, (including financing agencies) to contribute to theinterpretation and implementation of the national policy, preparation of the strategic plan and itsimplementation.



9 NAS’s structure

The Sierra Leone HIV/AIDS response operates on the “Three Ones” guiding principles to ensureall partners in the country join forces to achieve the goal of universal access for prevention,treatment, care and support. These principles are based on the premise of one national HIV/AIDScoordination council (NAC) with a broad multi-sectoral mandate, one national HIV/AIDSstrategic plan framework and one national monitoring and evaluation framework. In order toensure NAC fulfils its mandate, a national AIDS secretariat (NAS) was set up to support thecouncil. For NAS to effectively execute NAC’s coordinating mandate, the secretariat’s headshould be at a rank not below senior ministerial level. (The level of ‘senior minister’ is suggestedwithout any political implication but merely to reflect the level of seniority required by the headof the multisectoral coordinating body to be able to perform his/her duties.) The proposedstructure for NAS highlights its coordinating role for the multi-sectoral national response and themanagement role for the NAS office. Annex 4 gives the proposed NAS linkages, communicationand organogram.

Figure 13-1 in Annex 4 shows NAS linkages through which coordination, as defined in thisreport, is supposed to be done. Figure 13-1 does not show individual partners. Agencies andorganizations financing the national response in whatever form are coordinated through theDonor Partners Consultative Group. Implementing partners must all be involved in at least one ofthe areas of response outlined in Section 4. NAS provides guidance and leadership to theimplementing partners through the technical environment of the technical working groups andsteering committees elaborated in Section 10. Any other formal interaction of NAS withimplementing partners is through the Partnership Forum.

The Extended TWG brings together all the technical working groups and steering groups thatNAS establishes to provide the technical environment for smooth operations of the implementingpartners.

Apart from the coordination linkages of the various partners to NAS, Figure 13-1 shows essentiallinkages among the coordination fora. For example the Partnership Forum should have links withthe coordination of thematic activities structure because that is the structure within whichimplementing partners are operating at the district level. The treatment and laboratory technicalworking groups must have direct links while the laboratory technical working group must belinked with the National Reference Laboratory. The Parliamentary Committee has links withMDAs, districts and chiefdoms.

Figure 13-2 shows functionally the proposed major components of NAS without making anyinference on the number of people handling the functions.

9.1 Office of the Executive Director

This is the top head of NAS accountable for all NAS’s functions and responsibilities and placedwithin the President’s Office. This office links with the Ministry of Finance and developmentpartners for information on financial inflows in the country for HIV/AIDS that are not in NAS’scontrol.



9.1.1 Directorate for Coordination

This directorate is responsible for multi-sectoral coordination of HIV/AIDS national response asoutlined in NAS’s mandate. The coordination is organized along the three pillars of the “ThreeOnes” principle.

9.1.1.1 Programmes Coordination

Programme coordination facilitates the development of programmes in all priority areas of thenational HIV/AIDS response with special focus on the thematic areas of prevention, treatment,care and support, impact mitigation and IEC/BCC.

9.1.1.2 Policy, Strategy and Planning Coordination

Policy, strategy and planning coordination ensures that the right policy environment exist formulti-sectoral cooperation. It provides innovative technical and political guidance to improvepolicy dialogue and enhance problem resolution. It facilitates the planning process for bothnational strategic framework and annual action plan. It ensures the participation of all partners inall stages of planning and mainstreaming of HIV/AIDS in all line ministries making sure thatAIDS is aligned with the wider government development agenda and budgeting cycles.

9.1.1.3 Monitoring, Evaluation and Research Coordination

Monitoring, evaluation and research coordination promotes a coherent and coordinated nationalHIV/AIDS monitoring and evaluation framework that links data from several sources and levelsto the overall results framework for the national HIV/AIDS response. It monitors the programmeand service delivery activities at all levels; makes sure there is true integration and properalignment of partners’ data collection with the national framework.

It facilitates operations research, surveillance and prevalence studies of the epidemic andundertakes regular mapping exercise to ensure total inclusiveness

9.1.2 Directorate for management

Directorate for management is responsible for the running of NAS office and management offinancial resources for HIV/AIDS activities under NAS’s control. It includes: Financemanagement, Operations management and Procurement management.

The directorate provides administrative and financial management support to NAC/NAS. Itparticipates in costing of the national frameworks, manage the budget of NAS and partners, andconduct timely procurement of goods and services. It provides financial statements and reportsand builds capacity of NAS, as well as support services for its effective functioning.



10 Technical and other support groups

NAS’s mandate is to coordinate the multisectoral national response to the HIV/AIDS epidemicunder an environment in which all stakeholders can carry out their activities in a synchronizedand cooperative manner. The environment has to be more of leadership and guidance of thestakeholders to the interpretation and implementation of the national policy, preparation of thestrategic plan and its implementation. NAS has to draw on the technical expertise of stakeholdersthrough well constituted technical working group and advisory groups of development partnersand policy makers.

10.1 Partnership forum

The HIV/AIDS partnership forum was established in 2008 as a strategic and dynamic mechanismthat aims at mobilizing institutions and resources for scaling up the national response, minimizewasteful duplication, and maximize potentials for synergies, harmonization, learning and peersupport. Membership covers all conceivable partners in the fight against HIV/AIDS. The forum issupposed to meet once every year.

The partnership forum goal is to enable NAS employ a broad-based approach to the nationalresponse in partnership with all stakeholders to reverse the trend of the epidemic in the country.

The specific objectives are to:i. Review the trend of the epidemic and the national responseii. Make recommendations for improved implementation of the NSPiii. Note emerging policy and programme issues and challenges, and propose priority

areasiv. Support HIV/AIDS coordination at the national, district and chiefdom levelsv. Support resource mobilization strategies for the implementation of the national

strategic plan

Composition Heads of organization and social groupings involved in HIV/AIDS responseLinks NAC through NAS and districtsMeetings Three times a yearReporting NAC

10.2 Parliamentary Committee on HIV/AIDS

The Parliamentary Committee on HIV/AIDS is an oversight committee that monitors theinvolvement of government ministries, departments and agencies (MDA) in the nationalHIV/AIDS response on behalf of parliament.

The functions of the Committee are to:i. Liaise with senior leadership of MDAs to obtain current and up-to-date sectoral

policy, strategic, programming and budgetary information on the sectoral response toHIV/AIDS and share it with parliament and NAC

ii. Promote transparency and accountability in the institutional practices of nationalstakeholders and towards sub-sectors and beneficiaries for the national HIV/AIDSresponse at the community level

iii. Participate in the planning process for the strategic framework and annual planformulation



iv. Seek information, on behalf of parliament for oversight, regarding key programmingdirections or specialized budgetary allocations received by the civil society frominternational sources that may have implications for the national HIV/AIDS response

v. Advocate for additional budgetary allocation or increase for MDAs

Composition Members of parliament chosen through appropriate parliamentary proceduresLinks Ministries, districts councils and chiefdom councilsMeetings As decided by parliamentary authoritiesReporting Parliament and NAC through NAS

10.3 Donor Partners Consultative Group on AIDS

The Donor Partners’ Consultative Group (DPCG) on AIDS is made up of organizations providingfunding to Sierra Leone for HIV/AIDS activities either through government or directly toimplementing agencies. The DPCG was established to harmonize external financial support andmaximize the benefits to the national response. The Group is chaired by the NAS Director.

Composition UN Agencies, heads of bilateral funding agencies, development banks,Ambassadors and High Commissioners of countries supporting the nationalresponse.

Links PrincipalsMeetings Quarterly chaired by NAS and co-chaired by Chair of UN Theme Group on

AIDSReporting NAC through NAS and their principals according to their reporting lines

10.4 Expanded Technical Working Group

The Expanded Technical Working Group (ETWG) brings together technically qualified peoplefrom all sectors involved in HIV/AIDS activities: public, private-for-profit, private-not-for-profitand civil society. This was originally a technical working group of UN organizations only but wasexpanded to include other stakeholders. Members represent technical disciplines of the thematicareas in their respective sectors. The Group is chaired by NAS.

The functions of the Expanded Technical Working Group are to:

i. Guide and support the technical working groups of the various thematic areas in thedevelopment and implementation of the national strategic plan.

ii. Support the mobilization of technical and financial resources for implementation ofthe National HIV/AIDS Framework

iii. Provide technical guidance in the planning of and execution of monitoring andsurveillance surveys

iv. Provide guidance in the development of a capacity building plans for all thematicareas

v. Provide a forum for coherent and unified links at the technical level among thematicareas and stakeholders

Composition Technically qualified people from the thematic areas of prevention, treatment,care, support, impact mitigation, monitoring, surveillance and research

Links TWG of the thematic areas



Meetings Quarterly chaired by NASReporting NAC through Directorate for Coordination

10.5 IEC/BCC Steering Force

The IEC/BCC Steering Committee serves as a forum to exchange information on ongoing andplanned IEC/BCC activities, materials and messages; to identify potential gaps and overlaps inIEC materials and messages; to discuss ways to address these gaps and overlaps where they doexist. The Steering Committee is made up of communication specialists with technical skills andexperience from key partner organizations and programmes. The total membership at anyoneterm shall not exceed 15 people.

The functions of the Steering Committee are to:

i. To guide and support the planning and monitoring processes in relation toHIV/AIDS IEC/BCC activities by all stakeholders at national and district levels;

ii. To guide and support the preparation of the National HIV/AIDS CommunicationStrategy

iii. To guide and support the preparation of the National Communication Work Plan forNAS and partners

iv. Review all HIV/AIDS IEC/BCC materials prepared by partners and providetechnical advice before production and dissemination.

v. To guide the development of a national HIV/AIDS research agenda communicationand behaviour change and monitor its implementation;

vi. Provide technical guidance to implementers of HIV/AIDS communication andbehavioural programmes;

vii. To guide the development of a capacity building plan for communication personnelviii. Support the development or review of national IEC/BCC protocols and guidelines to

ensure they are aligned to the National HIV/AIDS Communication Strategy;

Composition A maximum of 15 communication specialists with technical skills andexperience from key partner organizations and programmes

Links Sectoral IEC/BCC units and systemsMeetings Monthly convened by NASReporting Reports to NAS through the Directorate for Coordination

10.6 M&E Technical Working Group

The purpose of the National HIV/AIDS Monitoring and Evaluation (M&E) TWG is to provideoverall technical guidance and leadership in the implementation of the National HIV/AIDSMonitoring and Evaluation framework and the M&E provisions in the national HIV/AIDSStrategic Plan. The TWG will ensure that the implementation of the M&E framework meets theexpectations for the multisectoral monitoring including the harmonization of the stakeholders’monitoring systems. The TWG will be constituted by technically qualified people in themonitoring and evaluation field drawn from a wide spectrum of stakeholders. Members do notrepresent views of their organizations but views based on their competence in monitoring andevaluation. The TWG will not take directives from NAS but will instead serve as thestakeholders’ forum which will ensure that the NAS plays its pivotal role in the execution of theM&E framework.



The functions of the TWG are:

i. To guide and support the development of the National HIV/AIDS Monitoring andEvaluation Framework and its review and revision whenever necessary

ii. To guide the coordination, implementation and monitoring of the M&E Frameworkactivities

iii. To guide the planning of major National M&E activities for data collection such asbiological, behavioural, workplace and quality of service surveys, resource tracking,stakeholder mapping and annual and mid-term reviews of major programmes.

iv. To guide the development of a national HIV/AIDS research agenda and monitor itsimplementation

v. To guide the development of a capacity building plan for HIV/AIDS Monitoring andEvaluation in all sectors and thematic areas of the response and at all programmelevels in the country

vi. Support the preparation of reports in fulfilment of national and internationalrequirements

vii. Support the integration and alignment of all partners’ monitoring systems with thenational M&E framework and ensure data collected on relevant indicators areforwarded at regular intervals for national level compilation and analysis

viii. Support the mobilization of technical and financial resources for implementation ofthe M&E activities according to the National HIV/AIDS M&E Framework

ix. Develop guidelines to facilitate the identification, transfer, adoption and scaling upof best practices that would enhance the effectiveness of the HIV/AIDS nationalresponse interventions

x. Provide a coherent and unified performance measurement system that links datafrom many different sources and levels to the overall results framework for thenational HIV/AIDS response

xi. Develop action and work plans to guide the work of the TWG and serve as basis forresource mobilization to support TWG’s work programme.

xii. Any other M&E related activities that may be requested by the NAS andstakeholders.

The TWG is expected to report to NAS through the Directorate for Coordination every quarterand the report should be circulated to all members

Composition Technically qualified people drawn from a wide spectrum of stakeholdersLinks Sectoral M&E at national level with sectoral M&E linking their sectoral

implementing partners at all levels. SSLMeetings Every three months timed to be able to prepare the reports NAS has to submit to

NAC meetingsReporting Reports to NAS through the Directorate for Coordination

10.7 Treatment Technical Working Group

The Treatment Steering Committee serves as a forum to exchange information on treatment ofAIDS patients with ARV drugs and management of opportunistic infections including TB. TheSteering Committee supports NAS in identifying potential gaps service delivery infrastructure,human resources, delivery of drugs and supplies and availability of the services all over thecountry. The Steering Committee is made up of professionally qualified people in ART delivery,



TB treatment, STI treatment and management drawn from a wide spectrum of stakeholders, in thepublic and private sectors, delivering treatment services for HIV/AIDS.

The functions of the Treatment Technical Working Group are to:

i. Guide and support the planning and monitoring processes of treatment services withARVs and for opportunistic infections including TB

ii. Guide and support the preparation of the national HIV/AIDS treatment strategyiii. Guide and support the preparation of the treatment work plans for stakeholdersiv. Review all treatment protocols prepared by partners and provide technical advice

before accreditationv. Guide the development of a national HIV/AIDS treatment research agenda and

monitor its implementationvi. Provide technical guidance to implementers of HIV/AIDS treatment programmesvii. Guide the development of a capacity building plan for stakeholders providing

treatmentviii. Support the development or review of national HIV/AIDS treatment protocols and

guidelines to ensure they conform to national and international standards.

Composition Professionally qualified people in ART delivery, TB treatment, STI treatmentand management drawn from a wide spectrum of stakeholders deliveringtreatment services for HIV/AIDS.

Links ARG MoHS, National Reference Laboratory through the Laboratory TWGMeetings Every three months timed to be able to prepare the reports NAS has to submit to

NAC meetingsReporting Reports to the Directorate for Coordination through ARG

10.8 Laboratory Technical Working Group

The Laboratory Technical Working Group is to provide overall technical guidance andleadership in the laboratory support for national HIV/AIDS response especially in connectionwith ART. The TWG would be responsible for the preparation of a comprehensive nationallaboratory strategy for HIV/AIDS activities. The TWG would provide guidance on laboratoryissues including:

i. National quality assuranceii. Training of laboratory technologists and techniciansiii. Regulatory requirements for accreditation of laboratories, certification of technicians

and quality of test kitsiv. Supply and distribution of laboratory reagents and medical equipment

Composition (To be completed by NAS and ARG)Links ARG MoHS, Treatment TWGMeetings Every three months timed to be able to prepare the reports NAS has to submit to

NAC meetingsReporting Reports to the Directorate for Coordination through ARG



11 Review findings

An institutional review of NAS had to listen to the views of the stakeholders who make up NAS’sconstituency in the multi-sectoral coordination of the national response. The review processinvited dialogue about the strengths and weaknesses of NAC and NAS and solicited forsuggestions on how positive changes could be achieved. The process placed less emphasis on theability to generalize from a large amount of data than on promoting information sharing forchange. There were ‘one-to-one’ interviews with sectoral policy leaders, group discussions withtechnical working groups and NGOs and written submissions from umbrella groups, districtmanagers, organizations and individuals.

Figure 11-1 shows the current structure of NAS with six functional areas reporting to a deputydirector who reports to the director. Based on the current levels of staffing in NAS most of theseorganization areas are each staffed by one person. The chart does not differentiate between thecoordinating and NAS management roles

11.1 Results from local and international NGOs

Table 11-1 gives a summary of the views of from local and international NGOs implementingHIV/AIDS activities.

Director

Deputy Director

CapacityDevelopment

CCSI Administrationand Finance

Procurement Finance

IEC/BCC LineMinistry

M&E

ProgrammeOfficers

InformationCentre

Figure 11-1: Current structure of NAS



Table 11-1: Summary of the views of from local and international NGOs

Issue ViewA. Extent of representation of national

partners in NAC or NAS A few international organizations are members of

NAC either as representatives of bilateral fundingcountries or representatives of groups of organizationsor as major players in HIV/AIDS national and globalresponse. All international NGOs have someinteraction with NAS especially if they receive fundsfrom NAS.

B. Extent of openness and transparencyamong national partners and NAS andNAS’s involvement in the nationalpartners’ plans

There is information flow through meetings but notalways timely and accurate

NAS is involved in the work plans of NGOs that aresub-recipients of funds from NAS

C. Monitoring and evaluation More stakeholders should be involved. Governmentcannot do the monitoring all alone.

The involvement of MoHS is limited, let alone otherline ministries such as MoEYS which has significantroles to play in HIV programming.

M&E Technical Working Group could be improvedD. Long-term sustainability of NAC and

NAS Integration of HIV/AIDS response into other health

care service provision mechanisms in Sierra Leone. Effective resource mobilization for example through

special taxation for HIV and AIDS related activities Research to better inform policy Capacity building at NAS level and a diversified

membership combined with a strong political will atNAC level



Issue ViewE. Opinion on how NAC and NAS can be

improved and key issues that should beaddressed

Better coordination and communication Government must demonstrate commitment through

budgetary allocation to HIV/AIDS activities A comprehensive decentralization of the national

response All Government agencies should adopt the HIV and

AIDS workplace policy and mainstream HIV andAIDS into their core activities

The national HIV/AIDS strategic plan should beshared with all partners

NAC and NAS should be established by lawaccording to legal provisions of the Republic of SierraLeone

NAC needs to receive more technical guidance fromNAS to enable it be better informed to provide policyguidance to the country

Improved functionality of the NAC throughestablishment of technical working groups

Capacity Building of NAS staff More commitment on the part of NAC members

especially politicians and multi-nationalrepresentatives

Adequate funding and decentralization of theactivities of NAC and NAS

More involvement of the private sector (hospitals,clinics etc) in treatment and care of AIDS patients.

Improve the coordination between NAS and otheragencies.

Maintaining the current political will at the highestlevel

11.2 Results from district-level contributions

Table 11-2 gives a summary of the views of the district-level respondents. Fourteen respondentspeople from 6 districts submitted written responses to a set of questions specially prepared toelicit views related to district-level coordination activities.

Table 11-2: Views of district-level respondentsIssue Views

A. District perception of NAS and itsinvolvement in the district HIV/AIDSactivities

All district level contributions indicated thatNAS was involved in the districts especiallywith sensitization activities. While somerespondents saw NAS as performing acoordinating role, others thought it wasimplementing projects.

B. Extent of openness and transparencyamong district partners and NAS

The main message from district levelrespondents was that information flow waslimited and not always transparent.



C. District plans and the NSP The NSP is not widely publicised hence not alldistrict plans are based on the NSP.

D. Monitoring and evaluation from thedistrict’s view point

Districts should be involved more in thenational monitoring of the response. This couldbe done with the establishment of DACs andCACs with clear definition of their roles andempowering them to perform their duties. NASshould work more with district level partnersincluding local councils and chiefs withimproved coordination and partnership throughthe MoLG

E. Opinion on how NAC and NAS canbe improved and issues that should beaddressed

Monitor correct use of funds Allocation of funds to strategic implementing

partners NAC and NAS should be liaising with the

district HIV/AIDS personnel to be informed ofconstraints, successes and failures

Districts to be involved in planning Strengthen coordination, collaboration and

communication Leadership of DAC is not clear whether it

should be the Council or the DHMT Reconstitute NAS or strengthen its capacity to

enhance technical expertise Involve women and the youth groups Regular monitoring and evaluation with follow-

up at all levels and prompt and swiftinformation flow in all directions

11.3 SWOC results

Although the review’s terms of reference go beyond merely proposing a structure for NAS, thereview process adopted aimed at finally coming up with a structure that would be informed byNAS’s mandate and information from stakeholders on how they viewed the performance of thecurrent set-up. The interviews asked for perceived NAS’s strengths, weaknesses, opportunitiesand challenges.

These SWOC results and those gleaned out of the written submissions and group discussionsincluded a number of strengths that should not be lost in any changes or reorganization of NAS.A longer list of weaknesses have been identified which have to be addressed seriously. There arealso a number of opportunities that NAS can use in its work. A number of challenges wereidentified which have to be overcome.

The strengths, weaknesses, opportunities and challenges were mentioned by the peopleinterviewed either face-to-face or in groups or submitted in writing.



11.3.1 Strengths – (to be maintained)

Institutional strengthsi. NAC and NAS are well placed in the President’s Office to coordinate the multi-

sectoral response.ii. Positive image of the current NAS leadershipiii. Good relationship and goodwill with development partners

Staff strengthsiv. Good relationship among NAS’s top managersv. Staff commitment to their work and working as a team and doing as much as

possible with the available resourcesvi. Ability to delegate (share) responsibilities

11.3.2 Weaknesses – (to be addressed)

Institutional weaknessesi. Lack of legal instruments establishing NAC and NASii. NAC’s composition does not reflect the Council’s mandateiii. NAC lacks oversight capacity to oversee NAS’s activities.iv. Lack of Steering Committees for all programme areas coordinated by NASv. Lack of a public relations entity in NAS to “market” the multi-sectoral national

response leading to ineffective communication with the public mediavi. Apparent exclusion of some MDAs in NAS’s workvii. Low-level NAC and NAS decentralization resulting in weak district-level

coordinationviii. Lack of a resource mobilization entity within NAS

Implementation weaknessesix. Absence of comprehensive mapping of implementing and funding agencies and the

activities implemented all over the countryx. Technical Working Groups not being made up fully by technically qualified peoplexi. Lack of a capacity building plan for the national response

Functional weaknessxii. Available M&E personnel are not adequately qualified and all are deployed at HQ at

the expense of the districts and chiefdoms thereby preventing the effective alignmentof partners’ M&Es to the national framework.

11.3.3 Opportunities – (to be used)

Institutional opportunitiesi. Political will and support given by the governmentii. Recent administrative changes in NAS offer an opportunity for a more focused

approach in the coordination of the national response and to make up for any losttime.

iii. MoLG grassroots administrative network for reaching the people within theircommunities

iv. Recent reconstitution of the Partnership Forum will provide the necessary interfacebetween partners and NAS



Financial opportunitiesv. Development partners are keen to support national response activities according to

their respective mandates for example through the Global Fund

Operational opportunitiesvi. Existence of M&E systems within various sectors is an opportunity for strengthening

the national M&E system

11.3.4 Challenges (Threats) – (to be overcome)

Financial challengei. NAC and NAS’s dependence on project funding with the minimal government

allocation cannot provide long-term sustainability of the NAC and its secretariat.

Institutional challengesii. Reduction of NAS’s staffing levels is likely to compromise its ability to effectively

carry out its statutory activitiesiii. Uncoordinated funding sources with different channelling routesiv. Limited “presence” of NAS in the districts in terms of low functionality of DACs

and CACsv. Reporting on HIV/AIDS by partners is driven by financing agenciesvi. NAS staff members do not see themselves as public servants because they have all

along depended on non-government funding.vii. Outsourcing procurement services and financial management

Functional challengesviii. The public is not clear about what NAC is doing and NAS’s coordinating role and

involvement in implementing activities and its relationship with ARG-MoHSix. The low technical capability of the staff especially in M&E

Implementation challengex. There is a gap in mapping of participating partners in the response

Information challengexi. Some stakeholders involved in ART feel “left out” of the “recognized national

response” as NAS advertises ART being available from “government” healthfacilities only

Physical challengexii. Lack of government ownership of the physical structures of NAS offices



12 Summary and recommendations

12.1 Summary

A number of important insights in the working of NAC and NAS have come out of the reviewexercise from a fairly comprehensive cross section of stakeholders. A number of strong points,weaknesses, opportunities and challenges have been identified and form the basis of therecommendations.

12.1.1 Institutional

Institutionally, the national response has very strong foundations to build the coordinatinginstitutions. The demonstrated political support from the highest level was noted by all the peoplethe review team interviewed. NAS was also said to have “a more positive image” since theadministrative changes were made. There is also an environment of good relationship andgoodwill between NAC/NAS and development partners. The review noted the strong moral andtechnical support NAS receives from UNAIDS including the nearly completed mapping ofimplementing and funding agencies and the activities implemented all over the country.

Some of the weaknesses and challenges stem from the historical circumstances under which NACand NAS were established as part of a World Bank-funded project and later on took on theadditional responsibilities of being principal recipients of the Global Fund funds. NAC and NASwere also created by Cabinet decision not by Act of Parliament which would have given them alegal status as a state institution with financial allocation in the annual budget with its own budgetvote. Such legal instrument would spell out the functions, composition of the people serving inNAS and their status.

The multisectoral coordinating body is not a transient organization with a lifetime of a project.This body is likely to be an essential part of the national response to the HIV/AIDS epidemic forsome years to come. Even if HIV/AIDS were to be eradicated it would remain as a provenapproach to coordinating multisectoral issues. NAS’s dependence on project funding withminimal government allocations cannot provide for its long-term sustainability. This body canonly be sustained by government providing core funding for its operations.

12.1.2 Administrative

NAS staff members do not see themselves as public servants because they have all alongdepended on non-government funding. Government does not treat them as civil servants either.The government pays social security for all civil servants but not for NAS employees who maketheir contribution all the same.

12.1.3 Communication and information with the public

The review noted that the public is not clear about what NAC is doing as well as NAS’scoordinating role, involvement in implementing activities and its relationship with ARG-MoHS.A number of people interviewed (development partners, policy makers and heads of civil societyorganizations) could not categorically correctly state what NAS does and its link with the AIDSResponse Group (ARG). There is continuing belief by people from all levels of stakeholders that



ARG is in NAS or that NAS is part of the Ministry of Health and Sanitation. The physicallocation of ARG and having been supervised by current Diretor of NAS then as Team Leader ofARG continue to be the source of misconception that the Response Group was under NAS. TheJoint Programme Review in May 2008 recommended that the clarification of the relationshipbetween NAS and ARG should be publicised to all stakeholders and the people working in ARG.

A number of stakeholders look at NAS as a funding agency and complain that it does not allocatefunds to strategic implementing partners. NAS is not effectively informing the public thedifference between its mandatory role of coordination and the special responsibility as a principalrecipient of the Global Fund funds.

12.1.4 Technical support

The review noted that there were no functioning technical working groups for key response areasof treatment and laboratory support. NAS lacks, therefore, the technical guidance and support itwould require for effective coordination in those areas.

12.1.5 Monitoring and evaluation

Major functional weaknesses noted by the review and also identified by the Joint ProgrammeReview in May 2008 were the level of qualification of the M&E staff and lack of monitoring staffin the districts. These weaknesses are believed to impact the effective alignment of partners’M&E to the national framework.

12.1.6 Decentralization

Discussions with the ministry of local government highlighted the existing institutionalchallenges NAS faces especially in communicating with sectoral partners and missedopportunities of links with the grassroots through existing decentralized administrative structures.DACs and CACs are not fully functional in all districts thereby limiting the involvement of themultisectoral coordination process in the decentralization exercise.

12.2 Recommendations

12.2.1 Political support

It has been shown that countries with demonstrated political support to their HIV/AIDS responsehave been more successful in fighting the spread of HIV and in mitigating its impact. Thepolitical support has to be consistent, pervasive and persistent. It is, therefore, recommended that:

ii. The current visibly high level of political support for the national response should bemaintained and encouraged within all MDAs

12.2.2 Legality and composition of NAC

NAC and NAS were established by Cabinet decision, not by Act of Parliament, in response tointernational suggestions during the preparation for World Bank funding for HIV/AIDS project.NAC and NAS do not have a legal standing in government structures enabling them to be



included in the government budget under their own vote or negotiate for funding directly. Thestaffing, roles, functions, responsibilities, liabilities and hierarchal links are not defined. Legalregularization of NAC and NAS requires very urgent attention. It is recommended that:

v. The Office of the President should urgently move to have NAC and NAS establishedby law according to legal provisions of the Republic of Sierra Leone.

vi. The Act of Parliament establishing NAC and NAS should clearly spell out NAC’smembership reflecting the Council’s mandate of making national policy.

vii. The Act of Parliament establishing NAC and NAS should outline their district leveldecentralization and the roles and functions of DACs and CACs

viii. The Act of Parliament establishing NAC and NAS should ensure that leadership ofNAS is legally established at such a level within the administrative system such thatthe head of NAS can exercise his/her role of coordination of sectors with dueauthority and with minimal political interference.

12.2.3 Technical capacity

The current NAC composition and its mode of work do not lend themselves to monitoring NAS’swork. NAC as a policy making body needs to receive more technical guidance from NAS toenable it be better informed to provide policy guidance to the country and NAS in turn must havestrong technical guidance from among the stakeholders. M&E technical weakness impacts themonitoring of the national response and effective alignment of sectoral M&E to the nationalframework. It is, therefore, recommended that:

vi. NAC should establish mechanisms to oversee NAS’s activities through OversightCommittees (authorized to co-opt technically qualified professionals) through whichNAS would also provide technical guidance to NAC.

vii. NAS should establish technical working groups or steering committees for allprogramme areas

viii. NAS and ARG should work out the terms of reference and composition of theLaboratory Technical Working Group

ix. NAS should decentralize M&E services to district level with qualified staffx. NAS, in collaboration with development partners should provide long term training

for all M&E staff, at national and district level, in data collection, computer skills,data analysis and skills in survey methodologies and to ensure that training is beingtranslated into performance.

12.2.4 Public relations

There is widespread misinformation on the role of NAS and its relationship with the ministry ofhealth and sanitation even among policy makers and development partners. There is continuingbelief by people from all levels of stakeholders that ARG is in NAS or that NAS is part of theministry of health and sanitation. The physical location of ARG and having been supervised bythe current Director of NAS as then Team Leader of ARG continue to be the source of THEmisconception. It is recommended that:

iv. NAS establishes an active public relations entity (not necessarily by recruiting newpeople) to engage the public media in “marketing” the multi-sectoral nationalresponse

v. The government finds ways to physically separate NAS and ARG



vi. The government should rename ARG what it used to be called: National AIDSControl Programme (NACP) within the MoHS

12.2.5 Mapping

NAS’s raison d’être is to coordinate all stakeholders involved in the national response to theHIV/AIDS epidemic. NAS has, therefore, to know the stakeholders involved in HIV/AIDSactivities, their geographical areas of operation and the type of activities they are doing. An up-to-date map of these elements is absolutely necessary. While UNAIDS is supporting the productionof the map, it is recommended that:

iv. NAS should press for the completion of the comprehensive mapping ofimplementing and funding agencies and the activities implemented all over thecountry

v. NAS should establish a mechanism of regularly updating the mapped informationvi. The information from the mapping exercise is shared with all stakeholders to guide

them in coordinating their activities among themselves.



13 Annexes

13.1 Annex 1: List of stakeholders met

13.1.1 Individual interviews

These are the people the Review Team interviewed during the course of information gathering.

13.1.1.1 UN Agencies

Agency Name DesignationUNAIDS Ms Mulunesh Tennagashaw UCC

Mr Bockari Samba UNAIDS Programme OfficerUNIFEM Ms Eunice Njovana Representative

Ms Maryrose KargboUNHCR Mr Valentin Tapsoba Representative

Ms Inatosma Coomber Associate Community Services OfficerUNICEF Mr Geert Cappelaere Representative

Dr Rumishael Shoo Chief, Child Survival and DevelopmentWFP Ms Jyati Rajkundlia Senior Programme Officer

Ms Zainab Mansaray HIV/AID Focal PointWHO Dr Wondimagegnehu Alemu WR

Dr Louisa Ganda WHO, HIV Focal PersonWorld Bank Mr Engilbert Gudmundsoon Country Manager

13.1.1.2 Government Agencies

MDA Name DesignationOffice of thePresident

Mr Osho Coker Secretary to the President

MoHS Dr Soccoh Kabia MinisterDr. Momodu Sesay Manager ARG

MoLG Ambassador Dauda Sulaiman Kamara MinisterHon. Hadiru I. Kaloko Deputy MinisterMr. L. B. Koroma Permanent SecretaryMr Rayomond K.M. Bindi Deputy SecretaryMr. J.P. Lebbie Director of Local GovernmentMr Suramani M. Kamara Deputy Director of Local

GovernmentMr Michael A. Sandi Deputy Rural OfficerMs Alice Kandi Rural Development officerMs Marina E. Doherty Executive OfficerMr J. Macauly Press Officer

NAS Dr Brima Kargbo Director, NASMoF Mr David Carew Minister



13.1.1.3 Civil societies and local and international nongovernmental organisations

Name OrganizationMs Marie Benjamin SWAASLMs Graine Oneill Irish AidMs Joanna Reid DfIDMr Dominic Lamin Chairman, CCM

13.1.2 Written submissions

The following district level partners, organizations and one private practitioner submitted writtencontributions in response to the questions shown in Annex 2 (section 13.2.2)

13.1.2.1 District level

Bombali DistrictAction Aid ProgrammeOfficerAlimany P. Kamara

Fallah Kamanda

Annonymous

Santigil Sesay

Musa Sesey CCF - SLMohamed Conteh

Tonkolili DistrictFredrick Yamba M&E OfficerBCC Field Officer CAREKailahum DistrictEdward Bockarie

Kailahum DistrictRADA -SL

Kailahum DistrictHIV/AIDS Counsellor Bo Government HospitalPaul F. Lahai NMJDKenema DistrictAnnonymous



13.1.2.2 Organizations

Organization TypeCatholic Relief Services (CRS) Faith-based NGOCARE International NGOGOAL SL International NGOIOM International OrganizationLan Harris Private practitioner and university professorNETHIPS Network of people living with HIVPlan International SL International NGOUNDP International

13.1.3 Group discussions

Most of the people gave their views during group discussions.

13.1.3.1 NAS

Name Department ResponsibilityDr Abdul Rahman Sessay Management Deputy Director, NASMr. Kemoh S. Mansaray GF Programme OfficerMr. Salifu Mansaray CCSI Programme OfficerMrs. Joyce W. Abu Business Coalition CoordinatorMrs. Dilys Thompson Capacity Development SpecialistMrs. Martha S. Kamara Documentation Centre Documentation OfficerMr. Thomas B. Owusu Finance and Administration Financial SpecialistMr. Marxin S. Kanu Finance and Administration CoordinatorMr. Ayorinde Gilpin-Jackson Finance and Administration Financial SpecialistMr. Donald Charles Finance and Administration AccountantMr. Abu B.B. Koroma IEC/BCC CoordinatorMr. Ibrahim R. Kamara Information and Technology TechnicianMaj. Phillip M. Bangura Logistics CoordinatorMr. John B. Baimba Monitoring and Evaluation M&E OfficerDr. Saidou Hangadoumbo Monitoring and Evaluation ConsultantMr. Victor S. Kamara Monitoring and Evaluation Senior M&E OfficerMr. Valentine Younge Procurement Procurement SpecialistMr. Joe-Max Tucker Procurement Procurement Officer

13.1.3.2 NAS M&E and Members of the M&E Technical Working Group

Name Designation Institution

Ms Maybelle A. Gamanga* Asst. Director, HIV/AIDS Focal Point MoEYS

Mr Edmund Makiu* HIV/AIDS Specialist UNICEF

Ms Umu N. Nabieu M & E Officer

Dr. Saidou Hangadoumbo* M & E International Consultant NAS

Mr Joseph C. Kobba Programme Officer NAS

Mr Kemoh S. Mansaray Programme Officer NAS

Mr John B. Baimba M & E Officer NAS



Mr Mohamed Turay* CRIS Manager, UNAIDS

Mr Gbogboto B. Musa Senior Statistician* Members of the TWG

13.1.3.3 IEC/BCC Steering Committee

Name OrganizationMr. Abu B.B. Koroma IEC/BCCMrs. Martha S. Kamara Documentation CentreMr. Mustapha Kemokai Pampana CommunicationsMs Aminata Kobie WHOMr. Edmund Makiu UNICEFMr. Frederick Bobor James UNICEFMr. Alimamy Sesay NASMr Salieu Jalloh UNICEFMr. James M. Fofanah SPW-SLMr. Mohamed K. Sandi NASMs Salamatu Barley UNAIDSDr. Marcel Mbaya Lumbala UNHCR

13.1.3.4 SLANGO

Name OrganizationMr Richard Kamara PADMr Brima M. Kabba GOALMr Festus Marlow GOALMr Foday Turay MSSLMs Memuna Jalloh MSSLMr Hudson Tucker Dignity AssociationMr Ibrahim Kamara YWDOMr Brima Frank Bameh NIDAMs Kadijatu Koroma CARE - Sierra LeoneMr Sahr Morehendeh GLCSMr Musa Sesay CCF - Sierra LeoneMr Alhaji S. Mansaray CAUSE CanadaMs Melrose Colliy INCLUDEMr Charlie Walker Christian AidMs Emma Turay DAAGMs Aminata B. Jalloj CRS - Sierra Leone

13.1.3.5 Private Organisations

Name OrganizationMr Christopher Forster SLCC, Picton ServicesDr O.J. Mbonu Sierra Leone Breweries Ltd.Ms Ayodele Wale-Williams Del Wale AgenciesMrs Alice M. Onomake Reliance Insurance Trust

Corporation (SL) Ltd.



13.2 Annex 2: Information gathering questions

13.2.1 To national and international partners

Issue QuestionA. Extent of representation of national

partners in the national AIDScoordinating authority or equivalentbody

Is your organization represented in NAS’sactivities at the national or sub nationallevels?

Did your organization participate in thedesign or assessment of the administrativeprocedures for the national AIDSresponse?

B. Extent of openness and transparencyamong national partners and with thenational AIDS coordinating authority

Is there an accurate and timely informationflow between NAS and your organization?

Is there transparency regarding sharing ofbudgetary and programming informationbetween NAS and your organization?

C. Extent of NAS’s involvement in thenational partners’ plans

Does your organization have its AIDSprogramming plan reviewed and validatedby NAS?

D. M&E from NAS’ view point What can NAS do to strengthen thenational monitoring and evaluationframework or system?

E. M&E from public sector’s view point Do you think that government agencies ordepartments have been adequatelyinvolved in the national monitoring andevaluation system?

What improvements could be made (ateither the national or sub national levels)?

F. Long-term sustainability of NAC andNAS

What is being done to assure long-termsustainability of the systems and processesfor the national AIDS response?

G. International organizations’ support toNAS

How is your organization supportingcapacity-building for NAS?

How is your organization helping toenhance leadership, ownership and controlover the national response?

H. Opinion on how NAC and NAS can beimproved

What, in your opinion, are the main issuesthat need to be addressed to help ensure amore effective NAC and NAS?



13.2.2 To district level

Issue QuestionA. NAS’s perception in the district What is NAS’s involvement in the national

response to HIV/AIDS epidemic in thedistrict?

B. Extent of openness and transparencyamong district partners and NAS

Is there an accurate and timely informationflow between NAS and the district?

Is there transparency regarding sharing ofbudgetary and programming informationbetween NAS and the district?

C. Extent of NAS’s involvement in thenational partners’ plans

Are there district HIV/AIDS response plans?

If “yes”, are the plans based on the NSP?

Were the plans reviewed by NAS?

D. M&E from the district’s view point Do you think that districts have beenadequately involved in the national NASmonitoring and evaluation system?

What improvements could be made (at eitherthe national or district levels)?

E. Opinion on how NAC and NAS canbe improved

What, in your opinion, are the main issuesthat need to be addressed to help ensure amore effective NAC and NAS?



13.3 Annex 3: Members of NAC

1. His Excellency, The President Chairman

2. The Minister of Finance Development & Economic Planning Member

3. The Minister of Health & Sanitation Member

4. The Minister of Information & Broadcasting Member

5. The Minister of Education, Youth & Sports Member

6. The Minister of Agriculture, Food Security & Forestry Member

7. The Minister of Transport & Aviation Member

8. The Minister of Social Welfare, Gender & Children’s Affairs Member

9. The Minister of Defence Member

10. Chief of Defence Staff, Sierra Leone Army Member

11. The Inspector General, Sierra Leone Police Member

12. The Chair of Parliamentary Committee on HIV/AIDS Member

13. The Chair of Parliamentary Committee on Health Member

14. The Country Coordinator UNAIDS Member

15. The Chair, UN Theme Group on HIV/AIDS Member

16. The Resident Representative, World Health Organisation Member

17. The Resident Representative, UNICEF Member

18. The Head of European Commission Member

19. The President, Sierra Leone Medical & Dental Association Member

20. The Coordinator, SLANGO Member

21. The Chair, International Non-Governmental Organisations Forum Member

22. The Country Representative, DFID Member

23. The Country Director, Irish AID Member

24. The Ambassador of the United States Member

25. The President, Inter-Religious Council of Sierra Leone Member

26. The President, Women’s Forum Member

27. The President, Sierra Leone Chamber of Commerce Member

28. The President, National Union of Sierra Leone Students Member

29. The President, Network of HIV Positives in Sierra Leone (NETHIPS) Member

30. The Chair, Business Coalition Against AIDS in Sierra (BCAASL) Member



13.4 Annex 4: Proposed NAS linkages, communication and organogram

Figure 13-1: NAS linkages and communication

IMC: Impact mitigation coordinationPr.C: Prevention coordinationTr C Treatment coordinationCSC Care and support coordinationLab. Laboratory coordinationTWG Technical Working GroupsIEC/BCC Information Education

Communication/Behaviour Change

Linkage Line

Reporting Line

NAC

NAS

Partnership Forum

Donor PartnersConsultative

group

Directorate of CoordinationNACP

Thematic Activities Implementation by all Partnersand sectors

MDAS

Parliamentary Committee

Parliament

Principals

IMC Pr. C CSC IEC/BCC

Tr. C &Lab.

TWGs

NationalReferenceLaboratory

Coordination of Thematic Activities



Pr. C Tr C CSC IEC/BCCCoordination

IMC

District Level Programme Coordination

IMC: Impact mitigation coordinationPr.C: Prevention coordinationTr C Treatment coordinationCSC Care and support coordinationCRIS Country Response Information System-.-.-.-. Information lines

Directorate forManagement

FinanceManagement

ProcurementManagement

Accounts Procurement

Information andTechnology

Transport OfficeManagement

Operations Management

Finances under NASmanagementExternal financing

partners

Ministry of Finance

Office of the ExecutiveDirector

Directorate forCoordination

Program Coordination Policy Strategy PlanCoordination

M&E and ResearchCoordination

ResearchCoordination

District M&ECoordination

MappingCoordination

CRISCoordination

Information Centre

Office Assistant

Figure 13-2: Proposed NAS Organogram



14 References

1. GSL. Terms of reference for the National HIV/AIDS Council (NAC) and the National HIV/AIDS

Secretariat (NAS). Ministry of Development and Economic Planning, January 2002.

2. GSL. Terms of reference for staffing and positions within the National HIV/AIDS Secretariat.

Ministry of Development and Economic Planning, December 2001.

3. GSL. Report of the Joint Review of National Response to HIV and AIDS. May 2008

4. GSL. Sierra Leone HIV and AIDS Operational Plan (2009-2010). May 2008

5. R.C. Sessay. Diagnostics study of national response to HIV/AIDS 1987-2007. (Draft)

6. GSL. Memorandum of Understanding between National HIV/AIDS Secretariat (NAS) and Local

Councils on the establishment of the District HIV/AIDS Committees (DAC) within the Local

Councils.

7. NAS. Concept paper on the Re-activation of District AIDS committees (DACs). October 2008

8. NAS. Concept note for a three-year transition strategy for the National HIV/AIDS Secretariat

2008-2010. May 2007

9. World Bank. Sierra Leone HIV/AIDS Response Project. Project Appraisal Document. Africa

Regional Office, AFTH2. February 2002.

10. Dr. Ernest Bai Koroma. The Agenda for Change. My Government’s Policies for Sierra Leone’s

Poverty Reduction Strategy. 1 December, 2008.

11. United Nations Country Team. Supporting Sierra Leone. A Joint Vision of the United Nations’

Family. December, 2008.

12. NAC. Minutes of meeting held at state House Freetown on 17th April 2008

13. NAC. Minutes of the Second National AIDS Council (NAC) Meeting on 11th November 2008 at

the State House.

14. Government of Sierra Leone. National HIV/AIDS Policy. Revised August 2007

15. Republic of Sierra Leone. HIV/AIDS Response Project (SHARP) NAS Administrative manual

(PAM). May 2002.

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