National Framework for GFATM Round 7 proposal Dr Rajendra Pant MBBS,MCPS,MPH Deputy Director National Center for AIDS and STD Control Kathmandu Nepal

CCM Decides and form PSC PSC decides the process and form ETSC and writing team TRP comments analysis of 6 th Round Collection of data Performance assessment of 2 nd round Call for PR(s) (May 10th) Develop NF and TOR for PR selection In consultation with stakeholders (May 3rd) CCM consensus on National Proposal Framework and TOR for the selection of PRs (May 9th) Drafting proposal by writing team, selected PRs with TA from ETSC (May 10 – June 5) Peer Review (International TA) June 1 st – 2 nd wk Final Draft Including consolidation (June 3 rd wk) CCM Endorsement (June 4 th week) Submission to the Fund (July 31 st ) 13-Step Country Proposal Development Process Gap analysis Selection of PR (s) (May 25th)

Preparation process 1. Regional workshop by WHO/GFATM (March 2 nd week) - capacity building, setting up environment 2. Technical Subcommittee (TSC) Meeting (April 18 th ) – Selection of Proposal writing team and mandated to initiate the process 3. Extended TSC (25 and 26 April) – preparation of National Framework 4. National Validation Workshop (3 rd May)

MDG Goal: Halt and begin to reverse the increasing trend of HIV by 2015 Results Strategic info, M and E Goal:

Risk and needs Assessment Risk behaviors/Factors Unsafe Sexual practices (Mobility, MSMs, Multiple sex partners) Unsafe Sexual practices (Mobility, MSMs, Multiple sex partners) Drug Injecting behaviors Drug Injecting behaviors Parent to child transmission Parent to child transmissionSizePrevalence Disease Burden Programme coverage and gaps

Where it happens  Mobility – Far west and other districts  Injecting behaviors – Urban areas  Unsafe sexual practices- Urban and Rural  Mother to Child – all over

NEEDS:  Treatment ARV ARV OI,STI OI,STI TB/HIV TB/HIV  Care and support Psychosocial Psychosocial Economic and social Economic and social Impact mitigating Impact mitigating

Existing coverage Based on UNGASS report 2006

Total % of Total cases Population at higher risk IDU6, MSM2, Sex workers 1, Clients of sex workers 13, Seasonal labour migrant 32, Sub-total79.8 Population at lower-risk Urban female low risk Population 1, Rural female low risk population 12, Sub-total20.2 Total70, Estimation of HIV Cases by Risk Group- What does it mean to national HIV/AIDS programs

National Action Plan ( )

NAP – Resource gap

Goal Obj 1: SDA 1.1 SDA 1. 2 Activity Obj 2: SDA 2.1 SDA 2.2 Obj 3: SDA 3.1 SDA 3.2

National Framework  Goal: Reduce HIV related morbidity and vulnerability through comprehensive and expanded services focused on infected and most at risk groups (Needs further fine tuning) OR  To achieve universal access through comprehensive and expanded intervention services for the infected and most at risk groups.

 Objective 1: Increase prevention services for MARPs and vulnerable population  Objective 2: Reduction of risk and vulnerability of mobile populations and their spouse in the place of origin and destinations  Objective 3: Expansion and scaling up of comprehensive diagnostic, treatment and care services  Objective 4: Reduce the vulnerability and mitigate the impact on infected and affected  Objective 5: Strengthen National AIDS programme Objectives

Objective 1: Increase prevention services for MARPs and vulnerable population

Objective 2: Reduction of risk and vulnerability of mobile populations and their spouse in the place of origin and destinations

Objective 3: Expansion and scaling up of comprehensive diagnostic, treatment and care services

Objective 4: Reduce the vulnerability and mitigate the impact on infected and affected  SDA 4.1OVCs SDA 4.1OVCs SDA 4.1OVCs  SDA 4.2Care and support SDA 4.2Care and support SDA 4.2Care and support  SDA 4.3Stigma reduction SDA 4.3Stigma reduction SDA 4.3Stigma reduction

Objective 5: Strengthen National AIDS programme  SDA 5.1Strategic Information system and operational research SDA 5.1Strategic Information system and operational research SDA 5.1Strategic Information system and operational research  SDA 5.2Policy advocacy SDA 5.2Policy advocacy SDA 5.2Policy advocacy  SDA 5.3Strengthening civil society and institutional capacity building SDA 5.3Strengthening civil society and institutional capacity building SDA 5.3Strengthening civil society and institutional capacity building  SDA 5.4Technical Assistance SDA 5.4Technical Assistance SDA 5.4Technical Assistance

Experience/Lessons learned:  Low absorption capacity of PR - Multiple PR needed for performance based programming  Comprehensive programs/packaging for better and cost effective programming  Mobilizing Local partners is crucial  Community to services rather than service centres to community for wider coverage.  Regular monitoring and support needed for the Quality programming  Capacity building of partners to be considered from the very begining  Strong coordination and collaboration between PRs needed  CCM to be functional to provide policy guidance, enhancing coordination/ collaboration and M and E of performance based programming  Local level ownership and decentralized programming to be promoted  Need of uniform rules and procedures for GFATM grant.

Current status of Proposal writing  (National Proposal Frame work has been drafted and consulted with the stakeholders)  Proposal Steering Committee (PSC) formed by CCM meeting held on 1st March 07  Regional workshop by WHO/GFATM (March 2nd week) - capacity building, setting up environment

Cont…  Technical Subcommittee (TSC) Meeting (April 18th) – Selection of Proposal writing team and mandated to initiate the process  Extended TSC Meetings (25 and 26 April) – preparation of National Framework  National Validation Workshop (3rd May 2007) to validate Frameowrk of the proposal for 7th round  PSC meeting held on May 4th in the chairmanship of Acting Secretary, MoHP  Task group meeting including writing team met on 6th May to discuss about the selection procedures and criteria for PR/s

Challenges Or limitations in integrating HSS into disease components  1. Strong links to reducing spread and impact of target diseases  2. Strong health system analyses  3. Realistic indicators of HSS  4. Realistic pace of activities  5. Proposal coherence  10. Added value for regional proposals

Expectations from attending this workshop  Mobilization of HRs, Capacity building  Ways to improve disease specific surveillance system and linkages of the systems: data management/ impact assessments/analysis and use of data  Standardized and Quality assured laboratory networks for microscopy, culture and drug susceptibility testing for the diseases.

Cont…  Improving HSS for Strategic information (Surveillance, treatment outcomes, drug resistance, monitoring universal access, reviews and operational research)  Strengthening of Health Systems  (planning, management, procurement, logistics, laboratory, human resource and financing)

Estimated HIV infections - Kathmandu Valley Population groups Average PLWHA N % of total PLHA IDU2, MSM Female Sex workers Clients of sex workers 5, Seasonal labour migrant 1, Urban female Rural female Total12,