THE DRAFT NATIONAL STRATEGIC PLAN ON HIV and AIDS & STI (2007-2011)

1. THE DRAFT NATIONAL STRATEGIC PLAN ON HIV and AIDS & STI (2007-2011) PARLIAMENTARY COMMITTEE ON HEALTH 27 FEBRUARY 2007

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

3. OUTLINE • Background • Brief report on the assessment of National Strategic Plan (NSP) 2000-2005 • Draft NSP 2007-2011 • Summary • Recommendations

4. BACKGROUND • The DOH mandated by SANAC in May 2006 to lead a process of developing a new framework • It was agreed that the NSP 2000-2005 is largely still relevant • Embodies the multisectoral approach • Statement of intent for the whole country • All government departments and other sectors • Maintain the key priority areas • Relevant • Require a longer period to realise substantial impacts • Desktop review to be carried out

5. ASSESSMENT OF NSP 2000-2005 • The assessment completed in September 2006 • Despite its methodological limitations • Useful • Some sense of extent of implementation • Important information for the development of new NSP • Strengthened stakeholder involvement in the processes • Final report submitted to the department of health • Distributed to SANAC and the participating agencies

6. ASSESSMENT OF NSP 2000-2005 • Conclusion: • Framework has fulfilled its task to a great extent • Gave direction to all stakeholders in the country -majority of programmes were formulated on the basis of the framework • Partnerships in the fight against HIV and AIDS has been broadened • Implementation of programes tended to be vertical • Lack of a clear M &E framework and clear targets was identified as the major gap • Quantity data not reliable enough • Overall coordination at SANAC level and with civil society another major weakness

7. ASSESSMENT OF NSP 2000-2005 • Some recommendations • Government: • Review the approach and content of ABC message • Strengthen government implementation in general • Sustain existing partnerships • Strengthen the implementation of cooperative agreements among SADC Member States • Strengthen coordination and M&E

8. ASSESSMENT OF NSP 2000-2005 • Recommendations: • Civil society • Enable SANAC representatives to fulfill their mandate of coordinating the sector • Increase business sector contribution • Establish an M&E Plan for all civil society sectors • Consider the needs of the disabled

9. DRAFT NSP 2007-2011 • Informed by • Previous framework – to a large degree • Findings of the NSP 2000-2005 assessment • Current status of the HIV and AIDS epidemic • Scientific developments • Current policy and legal environment • Assessment of capacities • Available interventions and resources • Inputs from the majority of critical stakeholders

10. DRAFT NSP 2007-2011 • DOH developed the first draft and led several consultations • first draft on the 20th October • Evolved to the February 2007 version of draft 8 • Divided into 13 Sections • No fundamental deviations from the NSP 2000-2005 • (NO MAJOR BREAKTHROUGH) • Foreword, Executive summary, Introduction, and Process • Update on Epidemiology, TB/HIV and STIs, Women, Youths, Children<15, (prisoners, etc) • Reaching peak at about 5M estimated to be affected • Mainly young women (25-35 age-group), informal settlements (urban and rural) • Everyone at risk! • Increasing incidence of and mortality from TB

11. SITUATION ANALYSIS • Surveys – DOH Annual ANC Surveillance major source of information • Cited also, MRC, STATSSA, ASSA 2003 modelling, UNAIDS, Behavioural surveys, DHS, and HSRC work • Expert task team working on this section • Led by an actuarial scientist and an epidemiologist • Defines character, dynamics

12. DRAFT NSP 2007-2011 • Recognition of TB as the most important opportunistic infection • Challenges with TB control • TB/HIV coinfection • XDR-TB • Role of Sexually Transmitted infections • Gains as evidenced by decrease in syphilis • Challenges with partner management • Emergence of resistance - gonorrhoea • Importance of genital herpes in the reducing HIV acquisition and transmission • Engaging the private sector

13. DRAFT NSP 2007-2011 • Response analysis: • Takes a lot from the assessment report • Refers also to the NACOSA period (1992 -1997) • Progress in many areas • Still too many challenges • Task team will make a some general risk-assessment statement

14. DRAFT NSP 2007-2011 • Structural organization: • Developments relate to; • Revival of the InterMinisterial Committee on AIDS • Role of the Social cluster of government • Provisions of the NHA and relevant structures • National health council • NHCF • New SANAC structure • Approved by current SANAC • Approved by Cabinet • Requested to consider expanding mandate to include other important health challenges, e.g. TB • Sectors working on representation • Provincial and district level coordination structures to be informed by new SANCA • Community level structures should play a meaningful role in implementation and monitoring of programmes on the ground

15. DRAFT NSP 2007-2011 Guiding Principles: • Batho Pele • Comprehensive Plan • Leading role of government • Human rights climate – PLWHA, Women, Disabled, Children, other marginalised groups - nondiscrimination • Importance of the national movement on moral regeneration and mainstreaming of values • Social mobilisation and Meaningful community participation

16. PRINCIPLES • Evidence-based strategies and interventions • Stigma mitigation • Holistic approaches (comprehensive) • Strengthening PPPs • Centrality of M&E • Provision of predictable and sustainable financial resources, availability of commodities, and Harmonisation of aid • Task team also working on these

17. DRAFT NSP 2007-2011 GOALS OF THE NSP 2007-2011: • Primary aims • Reduce rate of new infections • Reduce impact on individuals, families, and communities • Four key priority areas – maintained from old • Prevention • Treatment care and support • M&E and research • Human and legal rights • NSP is the WHAT and the HOW MUCH (targets) • HOW is to be addressed at operational level • Work in progress by the task team

18. DRAFT NSP 2007-2011 • Prevention: 50% reduction of rate of new infections in the NSP period • 5 goals identified – each with targets and indicators • Lead agencies identified • Reduce vulnerability; poverty alleviation, acceleration of development, women empowerment • Reduce sexual transmission • Social mobilisation for behaviour change • Balanced ABC message • Mutual monogamy • Men as partners • Consistent condom use • Delay in sexual debut • Gender-based violence • Substance (ab)use • Life skills education

19. PREVENT SEXUAL TRANSMISSION • Target high risk groups – CSW, MSM, incarcerated men, IDUs, Mobile populations, etc. • Workplace programmes • Increase access to male and female condoms • Target <14 – 17 for delaying sexual debut • PEP for sexual assault victims • Strengthen STI control and management • Youth services • Positive prevention

20. REDUCE RATE OF HIV INCIDENCE AMONG THE <5s • Essentially this is PMTCT • Increase PMTCT coverage • Increase geographic PMTCT coverage • Increase uptake • Prioritise pregnant women for ART • Reduce transmission • Reduce maternal mortality • Requires policy direction from the NHC • Approach to testing • Evidence on regimen efficacy

21. PREVENTION • Minimise the risk of occupational exposure • Infection control • PEP according to guidelines • Provision of safe blood for medical use and reduce the rate of transmission through IDU • Safe blood transfusion • IDU – research

22. TREATMENT, CARE, and SUPPORT • Provide an appropriate package of treatment, care, and support services to 80% of HIV positive people and their families by 2011 • 4 goals identified: • Improve screening and diagnosis through VCT and PCR • Increase coverage • Geographic access • Uptake • Expand PCR • Requires policy direction from the NHC • Approach to testing – strategies to increase uptake

23. TREATMENT, CARE and SUPPORT • Improve health outcomes for asymptomatic HIV positive adults and children – “positive living” • Strengthen health system – particularly at district level • STGs • Commodities • Training of service providers • Effective links with community-based activities • Improve health outcomes for symptomatic HIV positive adults and children • Dual TB/HIV epidemic • Active case finding both ways • Prophylaxis with Cotrimoxazole • Prophylaxis with INH • ART for TB patients

24. TREATMENT, CARE, and SUPPORT • Improve health outcomes for symptomatic HIV positive adults and children • Positive living • ART • Nutrition • Cotrimoxazole

25. TREATMENT, CARE and SUPPORT • Mitigate the impact • Build competent communities • Expand CHBC within the EPWP • Palliative care • Orphans and vulnerable children • Youths • People with disabilities • Older people • Continuum of care in health facilities

26. RESEARCH, MONITORING and SURVEILLANCE • Draft M&E Framework developed • Consultations underway • Task team also working on this • Scientific research • Vaccines • Microbicides • Male circumcision • Policy research • HIV screening and diagnosis • PMTCT regimens • ART guidelines • Nutrition strategies • Traditional medicines

27. RESEARCH, MONITORING and SURVEILLANCE • Operational research • To define models; e.g. comprehensive plan • Assess health systems responses • Define resource requirements • Regular surveillance • Prevalence • Incidence • Youth risk behaviour • Clinical and microbiological surveillance

28. HUMAN and LEGAL RIGHTS • Appropriate social environment • Antidiscrimination • Stigma mitigation • Monitor human rights abuses • Develop an appropriate legal and policy environment

29. OTHER IMPORTANT SECTIONS • Costing • Proven to be complicated • Ballpark figure being worked out • Treasury involved • More detailed study to be carried out later • Identification of requirements for effective implementation • Policy gaps to be addressed • Gaps in the regulatory environment to be addressed • Time frames to be defined for operationalisation by different sectors

30. PROCESS UNDERWAY AND FORWARD • Sector consultations ongoing – government and civil society • Task team of experts appointed • Meeting for the third time on March 1 • TORs adopted • Project plan drawn • Tasks allocated • Much progress being made by the team • Final draft to NHC – 9 March 2007 • National conference – 15 and 16 March 2007 • Led by the DP and the MOH • Plenary and Commissions – detailed deliberation • About 500 people – wide sectoral representation • Adoption by the new SANAC • Popularisation of the Plan • Implementation – ALL!

31. SUMMARY • Largely maintains the old framework as mandated • 2 main goals – ambitious! • 4 key priority areas – some what rearranged and expanded on • Considers current situation, lessons from the previous response, policy environment and new scientific evidence • Statement of intent • What and the How Much > How • Some costing and financial commitment • Mainly from government • Comprehensive M&E Framework • With clear targets and indicators • Defines an operational plan with time frames and responsibilities

32. RECOMMENDATIONS • It is recommended that the portfolio committee takes note of; • The approach to the development of the NSP for HIV & AIDS and STIs, 2007-2011 • The draft content thus far • The progress made in this regard, as well as the • the plans towards finalisation of this plan. • THANK YOU!