Nassau, The Bahamas 18 November 2011 ENHANCING COUNTRY OWNERSHIP: AN ANALYTICAL REVIEW OF COUNTRY HIV PROGRAMMES Dr. Morris Edwards: Head, Strategy and Resourcing Division, PCU Dr. Ingrid Cox Pierre: Strategy and Resourcing Officer, Care, Treatment and Support

Nassau, The Bahamas 18 November 2011 Focus of Presentation  Role of the PANCAP Coordinating unit in achievement of the goals of Caribbean Regional Strategic Framework (CRSF) 2008 – 2012  Analysis of country needs for achieving these goals.  Challenges encountered in the process

Nassau, The Bahamas 18 November 2011 Background Vision of the Caribbean Regional Strategic Framework (CRSF) “Substantially reduce the spread and impact of HIV in the Caribbean through sustainable systems of universal access to HIV prevention, treatment, care, and support”.

Nassau, The Bahamas 18 November 2011 Assigned roles PANCAP Coordinating Unit (PCU)  Coordination of regional response  Resource mobilization  Advocacy

Nassau, The Bahamas 18 November 2011 PANCAP 10 th AGM identified critical areas for emphasis to achieve the goals of the CRSF.  Reduction of new HIV infections by 50%.  Elimination of mother to child transmission of HIV.  Increased access to treatment by 80%.  Accelerate the agenda to achieve human rights for PLHIV including the elimination of travel restrictions for PLHIV.  Elimination of travel restrictions for PLHIV.

Nassau, The Bahamas 18 November 2011 For the PCU to effectively perform its role, it must be able to collect information at country level and from partners on:  Ongoing initiatives  Available resources  Gaps in implementation of national strategies

Nassau, The Bahamas 18 November 2011 Activities conducted by PCU to support its functions  Development of the PANCAP Biennial Operational Plan (PBOP)  Country assessments to ascertain implementation gaps in their NSP  Convening a Partners meeting and development of an implementation matrix of ongoing activities in countries by partners

Nassau, The Bahamas 18 November 2011 Activities conducted by PCU to support its functions……..  Establishment of a lab partners working group  Review of financial resources available at country level for implementation of NSP and their contribution to the achievement of the Tenth AGM targets.

Nassau, The Bahamas 18 November 2011 Resource mobilization by PCU  Estimated (under estimate) US$58 M required for implementation of the CRSF.  The PCU has mobilized approximately US$47 M of this estimate  However priority areas of prevention and treatment and care have secured resources in excess of that budgeted for by the CRSF

Nassau, The Bahamas 18 November 2011 PRIORITY AREA CRSF ESTIMATED NEEDS (US$) FUNDING SECURED (CRSF) FUNDING GAP (CRSF) PA16,337,3002,951,1893,386,111 PA29,156,900912,2088,244,692 PA311,287,60025,573,778-14,286,178 PA42,000,0003,467,415-1,467,415 PA59,208,0504,126,8585,081,192 PA67,730,0004,250,2033,479,797 Coordinating & Monitoring Bodies8,027,3606,343,3441,684,016 IEC Strategy supporting CRSF2,000,000 Contingency (5%)2,787,360 Total58,534,57047,624,99510,909,575 Source: Progress Report and Financial Analysis of Implementation of the CRSF for 17th Executive Board Meeting COMPARATIVE ANALYSIS OF FINANCIAL SUPPORT TO THE CRSF

Nassau, The Bahamas 18 November 2011 Inadequacy of resource mobilization efforts Although secured funds are in excess of that budgeted for in these two areas, regional reports have identified that:  Some areas in prevention, especially interventions with MARPS (other than MSM and CSWs) and PMTCT are critical areas or gaps in the response.  The area of treatment and care is inadequately supplied as many countries are below the required coverage for persons who require ARVs

Nassau, The Bahamas 18 November 2011 Inadequacy of resource mobilization…….  This emphasizes the importance of information to guide the resource mobilization process and focus efforts where needed

Nassau, The Bahamas 18 November 2011 Country Analysis Methodology 1. Available country NSPs were evaluated for alignment with the CRSF 2. Country assessments were conducted from 2010 to 2011 looking at gaps in implementation of country NSPs or implementation plans The reports were presented at prior meetings and to the PACC

Nassau, The Bahamas 18 November 2011 Country Analysis Methodology….. 3.A financial review of allocated resources at country level in relation to the tenth AGM targets  Template designed to collect information on areas of focus under the individual 10th AGM targets noting:  Area of strategic focus  Source of funding (whether govt. or donor)  Specific area funded e.g prevention programmes for MARPS  Budget allocated  Timeframe of support  Identified gaps in the response and associated funding

Nassau, The Bahamas 18 November 2011 Results 9 countries responded:  Antigua and Barbuda  Dominica  Jamaica  Suriname  Belize  St. Kitts and Nevis  Montserrat  Tortola  Trinidad and Tobago

Nassau, The Bahamas 18 November 2011 Results…..  Countries are at different stages in reaching the 2015 targets.  Main issue is sustainable funding, especially of commodities such as ARVs.  Funding in most of the reporting countries is still largely supported by donor agencies.

Nassau, The Bahamas 18 November 2011 Results…..  The areas highlighted as deficient in the funding of the CRSF correspond closely to those that are being reported in countries.  There is the need to include stigma and discrimination in the area of human rights  There is a need for targeted prevention interventions especially for groups such as youth, with critical focus on minors because of early sexual debut.

Nassau, The Bahamas 18 November 2011 Prevention Targets

Nassau, The Bahamas 18 November 2011 Prevention Target Gaps ABBzeDomJamMonSurTorSKNTT Strategic information related to prevention efforts especially MARPs XXXXXXX Models for development of prevention strategies especially in MARPs XXXXX Support to HFLE programme for sustainability and technical assistance (TA) for expansion of education sector response XXXX Expansion of STI services and integration into existing services e.g PHC XXXX

Nassau, The Bahamas 18 November 2011 Prevention Target Gaps ABBzeDomJamMonSurTorSKNTT BCC especially with reference to a communication strategy for the target groups and programme planning XX Support for expansion of testing sites including test kits and training of providers XXX Programmes for drug users and interventions for incarcerated youth and inmates. XXXX

Nassau, The Bahamas 18 November 2011 Prevention Target Gaps ABBzeDomJamMonSurTorSKNTT Prevention interventions in youth such as SRH interventions for parents, support for adolescent PLHIV, comprehensive programmes to respond to sexually active minors in the school setting XX Development of gender based interventions XXX Prevention in positives XXX

Nassau, The Bahamas 18 November 2011 Prevention Target Gaps ABBzeDomJamMonSurTorSKNTT Strengthening the NGO,CBO and CSO contribution to the prevention response X Strengthening universal access to social support services for PLHIVs X Legislation and policies related to testing of minors. X

Nassau, The Bahamas 18 November 2011 Elimination Target

Nassau, The Bahamas 18 November 2011 Elimination target Many countries did not outline deficiency in funding in this area however regional data available shows that the coverage is not optimal

Nassau, The Bahamas 18 November 2011 Elimination Target GapsABBzeDo m JamMonSurTorSK NT Drugs for PMTCTXXXX Financial resources for procurement of testing supplies, testing at least twice during pregnancy and partner testing XX Programmes to improve adherence to PMTCT drugs by Positive mothers X Follow up of exposed infantsX Integration into MCH programmes X SurveillanceXX Elimination Target Gaps ABBzeDomJamMonSurTorSKNTT Drugs for PMTCT XXXX Financial resources for procurement of testing supplies, testing at least twice during pregnancy and partner testing XX Programmes to improve adherence to PMTCT drugs by Positive mothers X Follow up of exposed infants X Integration into MCH programmes X Surveillance XX

Nassau, The Bahamas 18 November 2011 Treatment and Care Target

Nassau, The Bahamas 18 November 2011 Treatment & Care Target Gaps ABBzeDomJamMonSurTorSKNTT Diagnosis and treatment of Opportunistic infections (OI). XXX Strategies including policies for integration of HIV/STI care into existing services X Sustainability of treatment XXXXXXXX Laboratory tests for monitoring ARV treatment XXXXX Research on drug resistance XX

Nassau, The Bahamas 18 November 2011 Treatment & Care Target Gaps ABBzeDomJamMonSurTorSKNTT Social support programmes for adolescent, orphans and children living with HIV XX Capacity building in forecasting for procurement of ARV drugs to prevent stock outs X Capacity building in laboratory surveillance, internal quality control documentation and implementation, external quality assurance XXX

Nassau, The Bahamas 18 November 2011 Human Rights Target

Nassau, The Bahamas 18 November 2011 Human Rights Target Gaps ABBzeDomJamMonSurTorSKNTT Funding for expansion of initiatives: development of polices and legislation as well as advocacy XXXXXXX Development of a framework and policies to encourage support and empowerment of PLHIVs X Capacity building for monitoring and advocacy of the policy and legislative arena X Training of CSOs, NGOs etc and other partners within the multi-sectoral response in advocacy XX

Nassau, The Bahamas 18 November 2011 Human Rights Target Gaps ABBzeDomJamMonSurTorSKNTT Capacity building for redress mechanisms XX Sensitization of health care workers X Development of sector wide change agents X Gender agenda with focus on gender violence related to women and sexual orientation XX

Nassau, The Bahamas 18 November 2011 Human Rights Target Gaps ABBzeDomJamMonSurTorSKNTT Removal of punitive laws related to same sex relationshipsX Research related to S&DX Advocacy to include developed policies in the legislative agenda X Capacity building of administrative and financial abilities is essential to improve the effectiveness of their advocacy agenda. X M&E reporting and management capacity of CSOs X

Nassau, The Bahamas 18 November 2011 Challenges

Nassau, The Bahamas 18 November 2011 Challenges Main challenges encountered in gathering the data were:  Regional level:  Difficulty in getting the required data from regional partners and donor agencies.  National level  Poor response from member countries possibly due to: – Competing interests: Harmonization of donor efforts at country level is needed – Unavailability of data or information needed at country level

Nassau, The Bahamas 18 November 2011 THE MEETING is invited to: (i)Advise on mechanisms to overcome the challenges with information sharing; and (ii) Agree on the strategic objectives, regional public goods and services and activities to be included in the Biennial Operational Plan,