“Community Action for Preventing HIV/AIDS”

“Community Action for Preventing HIV/AIDS” JFPR 9006 Cambodia, Laos and Vietnam Japanese Fund for Poverty Reduction Asian Development Bank

This is a regional project for Cambodia, Vietnam and Laos. In each country there is: • An Executing Agency (EA) • An national Implementing Agency (IA) A few provinces are selected for implementation

Lao PDR • In Laos the project is implemented by the National Committee for the control of AIDS Bureau of the Ministry of Health (NCCA-B) • The Project is implemented in three Provinces: Khammouane, Oudomxay and Savannakhet • The Executing Agency is the Primary Health Care Expansion Project

Cambodia • In Cambodia the project is implemented by the National Centre for HIV/AIDS Dermatology and STD (NCHADS) • The Project is implemented in four Provinces: Battambang, Koh Kong, Prey Veng and Svey Rieng • The Executing Agency is the Ministry of Health

Vietnam • In Vietnam the project is implemented by the AIDS Division of the Ministry of Health • The Project is implemented in five Provinces: Dong Thap, An Giang, Kien Giang, Quang Tri and Lai Cau • The Executing Agency is the National Committee for Population and family Planning

What concepts underlie this Project? • Low prevalence countries: to be cost-effective, interventions need to be targeted to high risk situations • Assumption: link between mobilityand vulnerability to HIV • Need for specificintervention strategies in each situation • Availability of in-country existing prevention packages, management structures and technical know-how.

Objectives: • to support a comprehensive set of HIV/AIDS prevention activities in situations of particular risk (“hot spots”) • to strengthen the capacity of national and local HIV authorities and selected NGOs to develop community-based prevention and care programmes.

Focus: • sites and areas that receive many transient, mobile populations or long-term migrants • large construction sites • source communities of migrants

Elements of the Community-based Programme: • behaviour change communication (BCC) • social marketing of condoms (SMC) • management of sexually transmitted infection (STI). • a capacity-building element for developing models for Care.

Duration and Budget: • Duration: 30 months; from June 2001 to 31 December 2003 • Budget: 10 million US$ ($8 million JFPR Grant, $2 million contribution from the three Governments) • Source of funding: Japan Fund for Poverty Reduction (JFPR) through ADB

Country allocations from the grant • Cambodia: $2.2 million • Lao PDR: $1.4 million • Vietnam: $3 million • Regional: $1.4 million

Allocations by category (in $'000) • 1.Revolving Credit Facilities 0 • 2.Civil Works 103 • 3.Equipment 313 • 4.Drugs and Supplies 419 • 5.Training, Workshops, Seminars 3,667 • 6.Consulting Services 2,582 • 7.Project Management 366 • 8.Other Project Inputs 0 • 9.Contingencies 550 • TOTAL 8,000

Fund flow: • Countries establish imprest accounts (usually in Ministries of Finance/Economy) with initial withdrawals (advances) from ADB of $200,000 - $400,000 • The imprest accounts are operated and audited by the EAs in accordance with ADB procedures • The IAs have sub-accounts and receive advances from the EA based on upon the work plans developed by the IAs • The IAs maintain their sub-accounts following specified procedures for the use of funds, reporting, auditing, etc • Provinces function as IAs and also have sub-accounts, operated in the same way • Statements of Expenditures (SOEs) by IAs are used to liquidate and replenish the advances.

Project activities are concentrated in six areas: • Evidence-based programming • Social marketing of condoms • STI services • IEC/BCC • Models of Care • Strengthening provincial capacity

1. Evidence-based programming: • project activities in the three provinces are based on careful and thorough assessments of risk situations; the nature and extent of risk involved, populations groups or behaviours involved, and the most effective ways to respond to them.

2. Social marketing of condoms: • The Project supports the extension of social marketing of condoms to the target populations in the three provinces

3. STI services • The project is strengthening STI services where managing STI will significantly reduce HIV transmission risk

4. IEC/BCC for Peer Education and Behaviour change: • The project supports carefully designed and targeted information, peer education and advocacy plans in each province, to ensure that all sections of society know about HIV and AIDS, know how to protect themselves, know how to live with people who have HIV or AIDS, and know how important protecting the community against HIV and AIDS is.

5. Models of comprehensive AIDS care: • The project supports the development of appropriate models of comprehensive care for PLWHA, linking testing and counseling services, institutional/clinical care, home and community care, and hospice care for terminal situations.

6. Strengthening the capacity of Provincial HIV/AIDS units: • The key to effective implementation lies in a shared responsibility between Provincial Health Departments (PHD) and the Provincial AIDS units, and central level (NCHADS, NCCA-B, AIDS Division). The central level develops overall strategy and guidelines for implementation of programme components; the provinces develop operational plans, based on these guidelines. Many other partners, such as other departments, NGOs and community organizations are also brought in for implementation.

The project is INNOVATIVE: • it makes large budgets available for implementation at provincial level • it uses established channels for fund flow • it is based on national strategies • it is relatively un-programmed: it is up to the provinces to decide exactly what they want to do • it encourages partnerships

This has BENEFITS: • Ownership: Ministries of Health clearly own the project • Flexibility: responds to real needs in real time • Efficiency: uses established channels and structures

But it also has RISKS: • strategies and plans need to be clearly established, reviewed and up-dated • planning, implementation and ACCOUNTABILITY capability must be ensured at provincial level • channels and structures must be flexible enough to cope with the innovative elements of the project

Present Status: • Technically well-established: international & local staff recruited; components based on identified operational strategies; implementation mechanisms in place; planning, monitoring and reporting systems functioning • But requires a significant and sustained increase in disbursements well above accustomed levels in ALL countries • So priority to support managerial and administrative capacity at both provincial and central level • Initial slow implementation at grass-root level will significantly accelerate in the rest of this year

Project Staff: • Regional Advisor: Peter Godwin • STI Adviser: Dr Nigel O’Farrell • BCC Adviser: Ken Swann • In-country staff (each country): • Project Implementation Officer (PIO) • Project accountant • Local consultants for BCC and STI

THE ASIAN DEVELOPMENT BANK (ADB): FIGHTING POVERTY IN ASIA • The Asian Development Bank (ADB) is working to reduce poverty in Asia; and a part of this overall development strategy has been strengthening infrastructure for primary health care, and improving the quality of health services. Reducing the spread of HIV/AIDS within the context of health care systems is particularly important. Ill-health, whether caused by HIV and AIDS or not, is an important cause of poverty; and poverty is a major reason why health services, and particularly HIV-related prevention services, are underutilized.

Thank you peter godwin Regional Adviser Phnom Penh April 2002

“Community Action for Preventing HIV/AIDS”