South Africa FY 2007 Country Operational Plan (COP)

SOUTH AFRICA

Project Title: South Africa Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of March 2007			Notified as of June 2007			Notified as of November 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding	GAP	GHAI	New Subtotal: Field Programs Funding	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	0	1,150,000	1,150,000	0	1,150,000	1,150,000	0	1,150,000
DOL	0	0	0	0	0	0	0	0
HHS	4,818,000	123,052,972	127,870,972	4,818,000	142,075,730	146,893,730	19,693,091	166,586,821
Peace Corps	0	727,900	727,900	0	727,900	727,900	0	727,900
State	0	1,400,000	1,400,000	0	1,400,000	1,400,000	0	1,400,000
USAID	0	201,733,370	201,733,370	0	226,078,370	226,078,370	1,833,917	227,912,287
TOTAL Approved	4,818,000	328,064,242	332,882,242	4,818,000	371,432,000	376,250,000	21,527,008	397,777,008

HIV and AIDS Epidemic in South Africa:
Estimated Population: 47,432,000^*
HIV Prevalence rate: 18.8%^*
# of HIV infected: 5,500,000^*
Estimated # of OVCs: 1,200,000^*¥
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
^Prevalence is in adults only (15-49 years)
^¥Orphans aged 0-17 due to AIDS

Country Results and Projections to Achieve 2-7-10 Goals:

South Africa	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of Fiscal Year 2004*	599,900	12,200
End of Fiscal Year 2005**	548,200	93,000
End of Fiscal Year 2006***	763,200	210,300
End of Fiscal Year 2007****	991,108	265,000
End of Fiscal Year 2008****	1,359,001	380,000

^*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
^***Results. “Power of Partnerships: The President’s Emergency Plan for AIDS Relief.” Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007
^****FY 2007 Country Operational Plan targets

Program Description:

Over the past 12 years, South Africa has transformed itself into an egalitarian democracy, aggressively addressing social and economic challenges and the racial inequalities of its apartheid past. Despite a high per capita GDP ($3,480), 40% of South Africans live in poverty. In its first decade of democracy, the country’s adult HIV prevalence has risen from less than 3% to an estimated 21.5%. With 5.5 million citizens infected with HIV, South Africa has among the highest number of infected adults and children in the world. South Africa’s HIV epidemic is generalized and maturing, characterized by: (1) high levels of prevalence and asymptomatic HIV infections; (2) an infection rate that may be beginning to plateau, but is still extremely high; (3) high infection rates among sexually active young people, other vulnerable and high-risk populations (mobile populations, people in prostitution and their clients, and uniformed services), and newborns; (4) vulnerability of women and girls; and (5) important regional variations, with antenatal seroprevalence rates ranging from 15.7% to 39.1% in the nine provinces.

Though 75% of people living with HIV are asymptomatic, South Africa is witnessing increased levels of immunodeficiency and HIV-associated morbidity, frequently manifested by tuberculosis (TB), pneumonia, and wasting. The cure rate for TB is low (56.4% in 2004), and treatment default rates remain high (11.6%), which heightens concerns regarding the development of both multi-drug resistant TB (MDR-TB), and the more recently-seen extensively resistant TB (XDR-TB). AIDS-associated mortality rates are high (336,000 AIDS deaths in 2005), with large increases in HIV mortality among young adults and children. As mortality increases, so too will the number of children who have lost one or both parents, currently estimated to be 1.2 million.

Additional Funding: In June 2007, an additional $35,050,000 was allocated to significantly scale up efforts in TB/HIV, through improving TB surveillance, building TB laboratory infrastructure and capacity, and expanding private sector DOTS treatment; increase support for caregivers of PLWHA and address patient loss to follow-up between diagnosis and treatment initiation; and augment programming in counseling and testing, PMTCT, and OVC. Through the technical working group (TWG) process, $1,000,000 of the additional funds were identified to support new medical male circumcision (MC) activities in South Africa.

In fiscal year 2007, the Emergency Plan program in South Africa will provide support to public, private, and NGO sector HIV activities at the national, provincial, and local levels, through a broad-based network of prime partners and sub-partners. Emergency Plan funding will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $54,480,011 ($51,338,300 Field and $3,141,711 Central) (15.0% of prevention, care and treatment budget)

Prevention activities in South Africa include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness programs, blood and injection safety, and condoms and other prevention initiatives.

The Emergency Plan will support: (1) the expansion and strengthening of the South African PMTCT program by improving service quality, building the capacity of professional and lay health care workers, and developing effective logistic and information systems; (2) programs that create increased awareness and demand for quality PMTCT service delivery at the community level; and (3) increased integration of PMTCT with other related HIV and primary health care services.

USG agencies will support primary prevention activities, with special emphasis on abstinence and being faithful; these programs are implemented through school, community, and faith-based education programs. Through both community-based and large-scale NGO/FBO programs, the Emergency Plan will support young people to delay sexual debut and practice abstinence, faithfulness, and responsible decision-making and the avoidance of multiple concurrent partnerships.

In addition, USG agencies will assist the South African Department of Health to increase the availability and use of condoms by high-risk groups. Other prevention initiatives focus on behavior change and other communication efforts, safe medical practices and blood supply, and HIV prevention education for military personnel, women surviving on transactional sex, prison inmates and correctional officers, mobile populations, traditional healers, teachers, and trade unionists in all nine provinces of South Africa.

Principal Partners: South African Government partners include the National Departments of Health, Correctional Services, Education, and Defense. International partners include Africare, Salvation Army World Services, Population Council, EngenderHealth, Johns Hopkins University, Hope Worldwide, John Snow, Inc., Academy for Educational Development, Family Health International, University Research Corporation, Harvard School of Public Health, the Children’s AIDS Fund, Fresh Ministries, and the Elizabeth Glaser Pediatric AIDS Foundation. Local South African partners include Health Systems Trust, Human Sciences Research Council, Soul City, PATH, Kagisio, Wits Health Consortium, University of Western Cape, CompreCare, Living Hope Community Center, the Nelson Mandela School of Medicine, University of KwaZulu-Natal, Scripture Union, Youth for Christ, South Africa, and Ubuntu Education Fund.

Care: $124,573,106 ($123,480,900 Field and $1,092,206 Central) (34.2% of prevention, care and treatment budget)

Care activities in South Africa include basic palliative care and support, TB/HIV, support for orphans and vulnerable children (OVC), and counseling and testing (CT).

With 5.5 million HIV-infected individuals, the clinical and palliative care needs of patients suffering from AIDS place a severe strain on health services. Accordingly, the Emergency Plan supports programs to increase the availability and quality of palliative care services, including the provision of training, technical, and financial assistance to public sector health facilities; hospice and palliative care organizations; and NGO-, FBO-, community-based, and home-based care programs.

South Africa has one of the highest estimated TB infection rates in the world: 58% of all TB patients are also HIV-infected. With fiscal year 2007 funding, USG agencies will support implementation of best practices to maximize the integration of TB/HIV prevention, diagnosis, treatment, and management programs, and to increase the effectiveness of referral networks between TB and HIV services, especially in CT and treatment settings.

Care and support of OVC is a key component in efforts to mitigate the impact of the epidemic in South Africa, where an estimated 1.2 million children have lost at least one parent to AIDS. USG care and support of OVC will provide financial and technical assistance to OVC programs, focusing on mobilizing community- and faith-based organizations to improve the number and quality of services provided for OVC. These programs encompass the entire care and support continuum, including psychosocial and nutritional support, maximizing OVC access to South African Government benefits, and strengthening OVC support through referrals for health care, support groups, and training.

Expanding the availability, access, and quality of CT services is a critical component of the USG HIV/AIDS program in South Africa. As the majority of CT services are provided in public facilities, the Emergency Plan will continue to support National Department of Health (NDOH) efforts to expand CT sites and services. All USG CT activities are intentionally linked to clinical care and support and treatment activities, in order to ensure that individuals who test HIV positive have access to needed services. Many USG programs have mobile CT programs targeting high-risk populations, underserved communities, and men.

Principal Partners: South African Government partners include the National Departments of Health, Correctional Services, Social Development, and Defense, and the National Health Laboratory Service. International partners include Africare, CARE, Catholic Relief Services, Salvation Army World Services, Humana People to People, Population Council, EngenderHealth, Johns Hopkins University, JHPIEGO, Hope Worldwide, John Snow, Inc., Family Health International, Columbia University, Harvard University, Population Services International, and the Elizabeth Glaser Pediatric AIDS Foundation. Local South African partners include: Hospice Palliative Care Association of South Africa, Africa Center for Health and Population Studies, Wits Health Consortium, Medical Research Council, South African National Council of Child and Family Welfare, BroadReach Healthcare, Aurum Health Institute, CompreCare, Starfish, Nurturing Orphans for AIDS and Humanity, HIVCare, Living Hope Community Center, the Nelson Mandela School of Medicine, and Stellenbosch University-Desmond Tutu TB Center.

Treatment: $184,739,831 ($167,446,740 Field and $17,293,091 Central) (50.8% of prevention, care and treatment budget)

In 2003, the South African Government took the historic step of developing a comprehensive plan to implement a nationwide antiretroviral (ARV) treatment program. This plan has provided an ideal opportunity for the USG to contribute to the South African Government target of universal access to ARV services by 2009. Based upon best practices and expertise in the private and public sectors, the USG program will strengthen comprehensive care for HIV-infected people, including: scaling up existing effective programs; initiating new treatment programs; providing direct treatment services; increasing the capacity of the National and Provincial Departments of Health to develop, manage, and evaluate AIDS treatment programs (including training health workers, enhancing the quality of treatment services, and strengthening the management of ARV-related pharmaceuticals); and increasing demand for, acceptance of, and compliance with ARV treatment regimens through treatment literacy campaigns and community mobilization.

Principal Partners: South African government partners include the National Departments of Health, Correctional Services, and Defense, and the National Institute for Communicable Diseases. International partners include Africare, Catholic Relief Services, Population Council, Absolute Return for Kids (ARK), JHPIEGO, John Snow, Inc., Partnership for Supply Chain Management, Johns Hopkins University, Columbia University, Elizabeth Glaser Pediatric AIDS Foundation, Management Sciences for Health, International Training and Education Center on HIV, Xstrata and University Research Corporation. Local South African partners include Foundation for Professional Development, Africa Center for Health and Population Studies, Health Science Academy, McCord Hospital, St. Mary’s Hospital, South African Clothing and Textile Workers Union, Soul City, Wits Health Consortium, BroadReach Healthcare, Medical Research Council of South Africa, Aurum Health Institute, HIVCare, and the University of KwaZulu-Natal.

Other Costs: $33,984,060

The USG will support the NDOH in designing and implementing an integrated monitoring and evaluation (M&E) system. To facilitate the management of the Emergency Plan monitoring and reporting process, the USG has implemented a single, consolidated data warehouse center that serves as the focal point for all Emergency Plan data collected by partners. By collaborating with and assisting the South African Government and strengthening the implementing partners’ strategic information systems, the USG also will support specific, targeted evaluations, in order to improve prevention, care, and treatment programs; identify potential new interventions; and document best practices. The USG also will support South Africa’s Department of Social Development in strengthening its M&E system to identify and track OVC.

Principal Partners: South African government partners include the National Departments of Health, Correctional Services, Social Development, and Defense, the South African National Blood Service, and the National Institute for Communicable Diseases. International partners include Population Council, JHPIEGO, Academy for Educational Development, American International Health Alliance, Harvard University, University of North Carolina, and the National Alliance of State and Territorial AIDS Directors. Local South African partners include Human Sciences Research Council, Medical Research Council of South Africa, University of Pretoria, University of KwaZulu-Natal, and Wits Health Consortium.

Management and Staffing costs will support both the program and the technical assistance required to implement and manage Emergency Plan activities. USAID, HHS/CDC, Peace Corps and Department of Defense personnel, travel, management, and logistics support in-country are included in these costs.

Other Donors, Global Fund Activities, Coordination Mechanisms:

The USG is the largest bilateral donor to South Africa’s health sector. It is one of nearly 20 bilateral and multilateral donors providing technical and financial assistance in support of South Africa’s HIV and STI Strategic and Comprehensive Plans. In addition to the Global Fund, other major donors include the European Union, the United Kingdom, Belgium, the Netherlands, Australia, France, Sweden, and Germany. The Global Fund has entered into agreements for two grants from South Africa for AIDS and TB programs. These grants provide funding to expand treatment services in the Western Cape, as well as a broad package of HIV prevention, treatment, and care activities in KwaZulu-Natal. The primary HIV/AIDS coordinating body is the South African National AIDS Council (SANAC). The USG meets regularly with key officials of individual Ministries (Health, Social Development, Treasury, Defense, Education, and Correctional Services), to ensure that USG assistance complements and supports the South African Government’s plans for prevention, care, and treatment. The USG also meets with South African Government officials at the provincial level, to ensure synergy with provincial priorities and activities.

Program Contact: PEPFAR Coordinator Catherine Brokenshire-Scott

Time Frame: Fiscal year 2007 – fiscal year 2008

Approved Funding by Program Area: South Africa