Botswana FY 2006 Country Operational Plan (COP)

BOTSWANA

Project Title: Botswana FY 2006 Country Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of May 2006			Current Notification August 2006			Current Notification August 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding by Account	GHAI	GAP	New Subtotal: Field Programs Funding by Account	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	-	600,000	600,000	-	-	600,000	-	600,000
DOL	-	-	-	-	-	-	-	-
HHS	7,547,000	34,185,174	41,732,174	-	-	41,732,174	5,991,441	47,723,615
Peace Corps	-	580,000	580,000	-	-	580,000	-	580,000
State	-	200,000	200,000	-	-	200,000	-	200,000
USAID	-	5,434,826	5,434,826	-	-	5,434,826	386,585	5,821,411
TOTAL Approved	7,547,000	41,000,000	48,547,000	-	-	48,547,000	6,378,026	54,925,026

HIV/AIDS Epidemic in Botswana:

Adult HIV Prevalence Rate: 24.1% [23.0-32.0%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 270,000 [260,000-350,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 120,000 [110,000-150,000] (UNAIDS 2006)

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

Botswana is experiencing one of the most severe HIV/AIDS epidemics in the world, with the second-highest HIV-prevalence in Sub-Saharan Africa: UNAIDS estimates that 24.1% [23.0-32.0%] (about 270,000) of adults 15-49 years of age are infected with HIV. In two Eastern districts, the prevalence among pregnant women aged 25-29 years is more than 70%. Even in districts with the lowest prevalence, almost one in four adults aged 15-49 is infected with HIV (National AIDS Coordinating Agency (NACA), Botswana Second Generation HIV/AIDS Surveillance, 2003). With so many young adults infected with HIV, the epidemic is not only a severe health crisis but also a threat to the future development and vitality of Botswana as a nation. There is also a growing problem of orphans and vulnerable children (OVC); UNAIDS estimates that at the end of 2003, there were 120,000 children who have been orphaned due to HIV/AIDS. Given the overall HIV prevalence rate of 37.4% for pregnant women, the number of orphans could increase to 159,000-214,000 by 2010.

The Government of Botswana (GOB) has made impressive strides in combating the disease. It is the intention of the President’s Emergency Plan in Botswana to strengthen and expand these advances and to more effectively engage civil society in HIV/AIDS intervention efforts to achieve the 2-7-10 targets in the following programmatic areas:

Prevention: $15,187,416 as of August 2006 ($11,206,745 Field and $3,980,671 Central) (32.3% of prevention, care, and treatment budget)

Prevention activities in Botswana include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness programs, blood and injection safety, and other behavioral prevention initiatives. Using FY 2006 funds, PMTCT activities build upon work completed under the President’s Initiative for PMTCT and the first two years of the President’s Emergency Plan. These USG activities have helped the GOB to establish PMTCT services in all public facilities through the Maternal Child Health/Family Planning system, which now serves over 95% of all pregnant women. The USG will partner with GOB to strengthen the scope, quality and sustainability of PMTCT services. The Emergency Plan will continue to support technical capacity-building in the Ministry of Health (MOH) and in district health centers, support technical and managerial training for PMTCT staff, and build the capacity of faith-based, community-based, and non- governmental organizations (FBO, CBO, and NGO) to deliver high-quality, sustainable PMTCT services, including expansion of psychosocial support and peer counseling services to HIV-positive women and their families. Finally, the USG will support community mobilization and information and education (IEC) activities to increase awareness of and demand for PMTCT services. Every effort will be made to link PMTCT services to treatment programs.

The GOB takes the lead on national abstinence and be faithful (AB) activities, which include abstinence curricula in schools and related programs for youth. With FY 2006 funds, the USG will continue to provide strong support for these efforts, including support for monitoring the implementation of the life skills programs for school youth developed by the Ministry of Education (MOE), as well as continued support for a successful nationwide media-based behavior change communication program, the Makgabaneng radio serial-drama. A small-grants program will fund local organizations that target youth, delayed sexual debut, and faithfulness, and will provide training for these organizations in organizational management issues. The USG will strengthen other ongoing activities, including training youth groups, schools and faith-based organizations in effective prevention efforts and in developing ways to reach youth and deliver messages about abstinence. New programs will further target youth/parent communication and will provide project coordination, strategic planning, advocacy and policy development, and technical skills training for government health and social professionals engaged in gender-HIV programs. In order to strengthen systems for blood collection, testing, storage and handling -- as well as systems for safe injection -- the USG is providing financial and technical support to strengthen GOB policies and systems, strengthen human capacity and provide essential supplies and equipment for these important activities. Both sectors are supported through FY 2006 central program funding.

In order to strengthen systems for blood collection, testing, storage and handling -- as well as systems for safe injection -- the USG is providing financial and technical support to strengthen GOB policies and systems, strengthen human capacity and provide essential supplies and equipment for these important activities. Both sectors are supported through FY 2006 central program funding.

Additional prevention activities that will continue with FY 2006 funding include support of episodes of Makgabaneng that deal with non-AB prevention messages, working with Botswana’s largest alcohol distributor to promote sensitization to the role that alcohol plays in HIV infection, non-adherence and ARV treatment; support of a national HIV/AIDS hotline; working to strengthen the capacity to provide HIV/AIDS services to those with sexually transmitted infections (STIs); and assistance to border communities. The Department of Defense (DOD) will support prevention activities within the Botswana Defense Force.

All prevention activities will undertake to establish linkages to treatment and care programs. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: AXIOM, Botswana Defense Force, Nesswana, Hope Worldwide, Humana People-to-People, John Snow Incorporated, International Training and Education Center (I-TECH), MOH, MOE, Ministry of Labor and Home Affairs (MOLHA), Ministry of Local Government (MOLG), National AIDS Coordinating Agency (NACA), Pact, Pathfinder, Population Services International (PSI), Safe Blood For Africa, United Nations Children’s Fund (UNICEF), University of Medicine and Dentistry of New Jersey, University of Washington, Youth Health Organization (YOHO). The USG will also work with numerous other local FBO, CBO, and NGO partners.

Care: $15,236,466 as of August 2006 ($15,039,112 Field and $197,354 Central) (32.5% of prevention, care and treatment budget)

To address the palliative care needs of people living with HIV/AIDS (PLWHA), the USG will use FY 2006 funds to work with the MOH to further develop palliative care training modules, conduct training of trainers in all districts, and scale up training for public and private health care providers to deliver high quality palliative care services, including management of opportunistic infections. A small grants program will fund local organizations that offer palliative care, and will provide training for these organizations in organizational management issues. A new program will link care for people who are HIV positive with prevention. All palliative care efforts will endeavor to establish linkages between those receiving services (and their families) and other appropriate prevention, care and treatment services.

Approximately 60% of Tuberculosis (TB) patients in Botswana are HIV-infected; the leading cause of death among adult PLWHA is TB. The USG will expand its support of on-going training through the MOH to strengthen referrals and services for co-infected HIV/TB patients, including the integration of HIV testing among TB patients and referral to other appropriate prevention, care and treatment services.

In Botswana, HIV counseling and testing (CT) is a key component of care interventions. In 2000, the USG initiated voluntary counseling and testing (VCT) services through the Tebelopele program, now an independent NGO with a network of 16 centers, 11 satellites, and four mobile caravans located throughout the country. FY 2006 funds will continue to support Tebelopele in providing free, anonymous VCT with same day results to an estimated 100,000 clients, as well as conducting social marketing activities and community mobilization to increase the demand for VCT. Support of routine HIV testing through the MOH AIDS/STI unit will continue. The USG will also support a new innovative pilot of home-based voluntary counseling and testing, scaling up training for HIV counselors from government and FBO, CBO, and NGO (especially in rural areas), and monitoring and evaluation. The DOD will support testing activities within the Botswana Defense Force. A special effort will be made to ensure that CT programs forge effective links with treatment services.

Orphans and vulnerable children activities will include technical and financial support for community mobilization, policy development, strengthening of management and referral structures, addressing the educational and health needs of children affected by HIV/AIDS, service delivery, and advocacy. FY 2006 funding for the Ambassador’s HIV/AIDS Initiative will continue to strengthen the capacity of 20 FBO, CBO, and NGO to provide holistic services for children affected by the epidemic. Two additional programs will provide small-grants and directly support capacity building for FBO, CBO, and NGO that provide OVC services. With USG FY 2006 support, rehabilitation units for malnourished children infected with HIV/AIDS at two referral hospitals will expand their services to include training for pediatricians and dieticians, as well as scaling up training for parents/guardians, health care workers, and CBO. The USG will also place an additional 11 Peace Corps Volunteers with local FBO, CBO, and NGO who are striving to mobilize and implement community responses to OVC and other aspects of the HIV/AIDS epidemic. The OVC unit at the Ministry of Local Government Department of Social Services will receive support to enhance its effectiveness and provide proactive services to at-risk children and families, and the Ministry of Education will receive support to scale up a program called Circles of Support, which addresses the psycho-social support needs of children by linking them to a network of multi-sectoral support. Hope Worldwide will continue their assistance to OVC while a new partner, Catholic Relief Services, will provide OVC support in the hard-hit northeastern region of the country. A key component of all OVC programs is to refer children and their families to other appropriate prevention, care and treatment services.

In the May 2006 notification an additional $385,946 was allocated for care activities. The additional funds will expand efforts to train community caregivers and service providers that work with children affected by HIV/AIDS. An additional 1,200 individuals will be trained to provide psychosocial support for OVCs. In August 2006, there was no change in the amount of funding allocated for care.

Additionally, the funding mechanism for an OVC activity was reevaluated and changed to streamline funding between agencies. This change is reflected in the Budget Summary table.

Principal Partners: Academy of Educational Development (AED), Botswana Defense Force, Catholic Relief Services, MOE, Hope Worldwide, Humana People-to-People, Futures Group International, MOH, Ministry of Local Government, Pact, Peace Corps, Tebelopele, University of Pennsylvania, and UNICEF. The USG will also work with numerous other local FBO, CBO, and NGO partners.

Treatment: $16,527,464 as of August 2006 ($14,327,463 Field and $2,200,001 Central) (35.2% of prevention, care and treatment budget)

Since January 2002, Botswana has been providing free antiretroviral (ARV) treatment to PLWHA. This program has grown to 32 treatment sites with 43,231 patients on treatment as of July 2005. Pregnant women are routinely referred to the ARV program, thus there are no dedicated PMTCT-plus sites in Botswana. With FY 2006 funds, the USG will continue to work with the MOH to ensure a safe and secure supply of ARV by procuring the drugs, continuing to train Central Medical Stores (CMS) staff on supply chain management and quality assurance, training Drug Regulatory Unit staff in good manufacturing practices, inspections and pharmaco-vigilance, and laying the foundation for the introduction of generic drugs. Special provision will be made for the purchase of pediatric ARV.

The USG will improve HIV/AIDS services for children and adults, working with international technical assistance partners focusing on training clinicians in adult and pediatric HIV care. Security at CMS will be strengthened, as will security at local clinic pharmacies to ensure no disruption of the ART supply chain. Continuing medical education will be provided to private practitioners, harmonizing their training with the national training curriculum. Also with FY 2006 funding, new programs to provide HIV/AIDS pediatricians and undertake early infant diagnosis will be established. The DOD will support treatment services within the Botswana Defense Force. Treatment services will also be provided by Harvard School of Public Health through central program funding. All treatment service programs will seek effective mechanisms to refer patients to appropriate prevention and care programs.

To strengthen the laboratory infrastructure in Botswana, the USG will work with the MOH to ensure that laboratories have increased space, improved techniques and quality assurance, well-maintained laboratory equipment, a continuous supply of reagents and an improved standard of practice among laboratory staff. The DOD will also support laboratory services within the Botswana Defense Force.

In the May 2006 notification $1,064,054 was allocated for treatment activities. The additional funds will expand efforts to renovate health clinics throughout the country for the national ART program. An additional 85 clinics will be renovated for a total of 98 clinics in FY 2006, and an additional 12,750 patients will be able to receive ARVs. In August 2006, there was no change in the amount of funding allocated for treatment. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: Associated Funds Administrators/Botswana, Association of Public Health Laboratories (APHL), Baylor University, Botswana Defense Force, Harvard School of Public Health, I-TECH, Ministry of Local Government, MOH, and University of Pennsylvania, and the Botswana Defense Force.

Other Costs: $7,973,680 as of August 2006

Strategic information is crucial to measuring the progress made in reaching the 2-7-10 goals of the Emergency Plan. The USG will continue with FY 2006 funding to provide support for enhancing the Botswana HIV/AIDS Response Information Management System (BHRIMS), which will generate information on the national HIV/AIDS response, as well as support the improvement and expansion of the Integrated Patient Management System (IPMS), which provides comprehensive information on HIV treatment and care from major hospitals and their satellite clinics. Monitoring and evaluation capabilities of the newly formed Department of AIDS Prevention and Care in MOH will be strengthened, as will those of the AIDS Coordinating Unit in the Ministry of Local Government and the AIDS Resource Unit at NACA. Additional, targeted strategic information activities will enhance the human resource and technical capacities for monitoring and evaluation. A key objective of all strategic information activities will be to integrate the collection of data across the prevention, care and treatment spectrum.

An important objective of policy analysis and system strengthening activities will be the integration of prevention, care and treatment programs. Policy analysis and system strengthening activities using FY 2006 funds will focus on building sustainable national capacity to address the HIV/AIDS epidemic in Botswana by developing and implementing an Integrated Service Delivery Plan, supporting management training across numerous programs, providing technical assistance to improve the capacity of HIV/AIDS program managers, strengthening districts to engage in a community planning process for HIV/AIDS response, as well as engaging the private sector in AIDS-in-the-workplace activities. Furthermore, the USG will continue to work to strengthen indigenous FBO, CBO, and NGO via a central HIV/AIDS umbrella organization in Botswana that will become a leading partner in the HIV/AIDS fight locally. A new project will enable the United Nations High Commissioner for Human Rights (UNHCR) to bring prevention, care and treatment services to Dukwe Refugee Camp and surrounding villages. The costs of the Health and Human Services (HHS)/Center for Disease Control and Prevention (CDC) Director’s office and information technology are funded in this section.

Principal Partners: Botswana Network for Ethics, Law and HIV/AIDS (BONELA), Chervil (Pty) Ltd, Institute of Development Management, Ministry of Local Government, MOH, Ministry of Local Government, NACA, National Alliance of State and Territorial AIDS Directors (NASTAD), Pact, United Nations Development Program (UNDP), and UNHCR.

Management and staffing activities will ensure effective implementation of the Emergency Plan, including the technical assistance required to execute and manage Emergency Plan activities. Personnel, travel, management, and logistics support in country, and ICASS and capital security costs, will be included in this section. A new activity will be the hiring of a State Department President’s Emergency Plan for AIDS Relief (PEPFAR) Coordinator as recommended by the State Department Office of the Inspector General.

In the May 2006 notification $50,000 was allocated for management and staffing activities. The additional funds are needed to adequately support the new Emergency Plan Coordinator. In August 2006, there was no change in the amount of funding allocated for other costs.

Additionally, funding mechanisms for two activities were reviewed and changed to streamline funding between agencies; these changes are reflected in the Budget Summary table above.

Other Donors, Global Fund Activities, Coordination Mechanisms:

As a middle-income country, Botswana bears the bulk of the cost for HIV/AIDS intervention. There are relatively few donors. However, significant additional funds and assistance are provided by the African Comprehensive HIV/AIDS Partnership (ACHAP--funded by the Bill and Melinda Gates Foundation and the Merck Foundation), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and UN agencies. Bristol-Myers Squibb, the European Union, China, Cuba, Germany, Japan, Norway, Sweden, and the United Kingdom provide other support. Donor coordination is accomplished through the Development Partner Forum and the GFATM Country Coordinating Mechanism (CCM), both chaired by the Ministry of Finance and Development Planning. Additional coordination occurs through the NACA-chaired National HIV/AIDS Partnership Forum, and by various sector-specific groups at the technical level working in NACA and the line Ministries. The USG Emergency Plan (EP) Steering Committee (which approves annual EP Country Operational Plans and recommends them to the CCM) and the use of multi-agency technical working groups to plan the COPs ensure ongoing close coordination with the Government of Botswana and other partners.

Program Contact: Deputy Chief of Mission, Lois Aroian and Regional Environmental and Health Officer, Theodore Pierce

Time Frame: FY 2006 – FY 2007

Approved Funding By Program Area: Botswana