Haiti FY 2007 Country Operational Plan (COP)

HAITI

Project Title: Haiti 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	0	0	0	0	0	0	0
DOL	0	600,000	600,000	0	350,000	350,000	0	350,000
HHS	1,000,000	36,391,076	37,391,076	1,000,000	43,634,000	44,634,000	3,102,679	47,736,679
Peace Corps	0	0	0	0	0	0	0	0
State	0	0	0	0	0	0	0	0
USAID	0	30,176,000	30,176,000	0	33,301,000	33,301,000	3,302,053	36,603,053
TOTAL Approved	1,000,000	67,167,076	68,167,076	1,000,000	77,285,000	78,285,000	6,404,732	84,689,732

HIV/AIDS Epidemic in Haiti:
Estimated Population: 8,528,000^*
HIV Prevalence rate: 3.8%^*§
# of HIV infected: 190,000^*
Estimated # of OVCs: no UNAIDS estimate
^*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
^§Prevalence is in adults only (15-49 years)

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

Haiti	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of Fiscal Year 2004*	30,100	2,800
End of Fiscal Year 2005**	57,100	4,300
End of Fiscal Year 2006***	77,200	8,000
End of Fiscal Year 2007****	125,000	15,000
End of Fiscal Year 2008****	150,000	20,000

^*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
^****Fiscal year 2007 Country Operational Plan targets

Program Description:

An estimated 3.8% of the Haitian population is infected with HIV (53% of adult women and 47% of adult males); 180,000 Haitian adults aged 15 and older and 10,000 Haitian children aged 0 to 14 are living with HIV/AIDS, in a total population of 8.5 million people (UNAIDS 2006.) The repercussions of an epidemic that started in Haiti in 1980-1981 continue to be felt throughout the nation, with 16,000 individuals having died from AIDS in 2005 (UNAIDS, 2006). Haiti has by far the highest incidence of tuberculosis (TB) in Latin America and the Caribbean (LAC) region, with a rate of 306 cases per 100,000; an estimated 20% of these TB patients are infected with HIV.

Although the Haitian AIDS epidemic is mostly transmitted through heterosexual contact and from mother to child, there are clearly identifiable high-risk groups that warrant special attention: people in prostitution and their clients and partners; migrant workers in the agricultural, fishing, and construction sectors, factory workers in duty-free zones, truck and bus drivers and other men who work away from home for long periods; uniformed personnel, including members of the police force, border, and customs agencies; and HIV-discordant couples. Orphans and vulnerable children (OVC) are particularly vulnerable to property-grabbing, homelessness, sexual exploitation, violence, abuse, and a life of abject poverty. OVC who become “restaveks,” a Haitian custom of placing a child who cannot be cared for as a house servant with another, often wealthier, family, are much more vulnerable to sexual and physical abuse. Youth are another high-risk group – 3.1% of females aged 15-24 years and 1.1% of males in the same age group are HIV-positive, resulting from an early age of sexual debut (mean age of 13 years for boys and 15 years for girls (DHS 2005; CERA/FHI, 2000) and multiple sex partners, often through transactional sex as a means to pay for school or to support other family members. Condom use is low among both youth and adults. Only 20% of Haitian males aged 15-24 and 24.2% of males aged 25-49 reported using condoms in their last sexual encounter with a non-regular partner (2005 DHS).

Of the 38,000 Haitians eligible for antiretroviral therapy (ART), approximately 8,000 were receiving it as of September 2006 through support from the Emergency Plan and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (Global Fund). There are sufficient drugs and laboratory commodities for screening and follow-up testing for twice this number; with significant Emergency Plan and Global Fund support, Haiti’s National AIDS Program can offer all HIV/AIDS services free of charge. Consequently, neither drug availability nor service fees present a barrier to PLWHA. The principal barriers to expanding high quality ART services to more eligible people are underdeveloped laboratory and clinical infrastructure, inadequate human resources, weak administrative and managerial systems, and poor roads and transportation systems.

Additional Funding: In June 2007, an additional $10,117,924 was allocated to expand activities in palliative care, HIV/TB, OVC, counseling and testing, PMTCT, and treatment services.

In fiscal year 2007, Emergency Plan funding will focus on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $13,121,983 ($8,234,000 Field and $4,887,983 Central) (17.5% of prevention, care and treatment budget)

Prevention activities in Haiti include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness programs, other behavioral prevention interventions, including those that focus on high-risk populations, and blood and injection safety programs. In fiscal year 2007, the USG will strengthen the scope, quality and sustainability of PMTCT services. The Emergency Plan will continue to support technical capacity-building and technical and managerial training for PMTCT staff; it also will build the capacity of faith-based organizations (FBOs), community-based organizations (CBOs), and other non-governmental organizations (NGOs) to deliver high-quality, sustainable PMTCT services nationwide. Post-natal PMTCT interventions will be linked with OVC programs to support children under five, in order to maximize HIV-free child survival for all children born to HIV-positive women. Finally, the USG will support community mobilization and health education activities to increase awareness and demand for PMTCT services.

The USG will continue to support high-quality behavior change programs, including life skills programs for in-school and out-of-school youth and faithfulness messages for married couples, particularly husbands who travel from home for work reasons. In fiscal year 2007, the USG will strengthen its ongoing activities, including training and monitoring of youth peer educators in after-school clubs, church youth groups, and church couples’ groups regarding ways to deliver messages about abstinence and being faithful. The Emergency Plan also will train community health agents to inform, educate and mobilize communities around HIV/AIDS prevention. Prevention activities will provide strong linkages to HIV/AIDS care and support services.

Efforts to reduce new infections among high-risk or high-transmitter groups (such as people in prostitution, migrant workers and mobile populations, and high school and university students), including the USG-supported national behavior change communication program and condom social marketing, will be expanded and targeted to locales where high-risk activities take place (brothels, duty-free factory zones, agricultural plantations, and university campuses). A special emphasis will be placed on these activities in key border towns with a high volume of movement between Haiti and the Dominican Republic. Counseling and Testing (CT) and Sexually Transmitted Infection (STI) services are available at a number of prevention and outreach centers, to help ensure that those who test HIV-positive receive care and support services.

Finally, in order to strengthen systems for blood collection, testing, storage, and handling, the USG will provide support to strengthen GOH policies, systems, and human capacity and provide essential supplies and equipment for blood.

Principal Partners: Academy for Educational Development (AED), American Red Cross, Educational Development Center (EDC), Family Health International (FHI), Food for the Hungry, Foundation for Reproductive and Family Health (FOSREF), International Training and Education Center (I-TECH), JHPIEGO, John Snow Incorporated (JSI), Haitian Ministry of Health (MOH), Johns Hopkins University’s Health Communication Programs (JHU/HCP), Plan International, Promoteurs Objectif Zerosida (POZ), Population Services International (PSI), Regional Procurement Services Organization/Ft. Lauderdale (RPSO/Ft. Lauderdale), World Concern, World Health Organization/Pan American Health Organization (WHO/PAHO), World Relief, and World Vision.

Care: $27,859,454 ($26,645,384 Field and $1,214,070 Central) (37.1% of prevention, care and treatment budget)

Care activities in Haiti include counseling and testing (CT), basic palliative care, support to integrate TB and HIV programs, and support for OVC. The CT strategy for fiscal year 2007 will include training of counselors, with an emphasis on specialized counseling for pregnant women and high-risk populations (HIV-discordant couples, people in prostitution and partners, uniformed servicemen, and TB and STI patients); it also will include the application of an HIV counseling curriculum developed for pre-service training of nurses, psychologists, and social workers. The “opt-out” strategy for HIV testing will be implemented for all pregnant women in CT sites; those who test positive will be referred to PMTCT services. Additionally, the USG plans to initiate new CT sites in fiscal year 2007.

Palliative care activities will be comprised of a package of care services and community support to HIV-positive individuals and their families, targeted to meet the needs of asymptomatic, symptomatic, and chronically ill/end-of-life populations. HIV/AIDS care and treatment centers are considered to be the key catalysts for care, and as such they will be the focus of enrollment and care for all HIV-positive individuals. An emphasis will be placed on providing high-quality clinical care for HIV/AIDS patients, specifically the management of opportunistic infections and nutritional assessment, and counseling and support for both adult and pediatric patients, following national and World Health Organization (WHO) guidelines for integrated management of adult illness (IMAI) and integrated management of childhood illness (IMCI). Clinical palliative care services for HIV-positive children will be incorporated into selected sites. These sites will be supported through human capacity strengthening; technical assistance; quality assurance; provision of palliative care drugs and supplies; and laboratory tests, supplies, and equipment. The USG also will initiate new palliative care sites.

At the community level, the Emergency Plan will support palliative care activities linked to the HIV/AIDS prevention, care, and treatment centers. This support will include strengthening CBOs and FBOs to promote “positive living” and provide psychosocial, spiritual, nutritional, and other support to individuals and families affected by HIV/AIDS. The USG will continue to leverage use of the World Food Program (WFP)’s food assistance program in Haiti, with distribution of food to targeted individuals and families living with HIV/AIDS. USG partners will complement this food aid with assistance to individuals and families, following dietary assessments and the identification of ways to address continued nutritional and food deficits. The support groups that have been organized throughout the country for persons living with HIV/AIDS (PLWHA) play an important role in providing palliative care, education, and support for treatment adherence at both the clinic and community levels. Stigma reduction will be addressed through information, education, and communication materials and other efforts targeting health care providers, caregivers, and communities surrounding HIV/AIDS care and treatment sites. Care and treatment sites located in towns along the Haiti/Dominican Republic border will work closely with sister hospitals in the Dominican Republic to ensure effective referral systems and cooperation in palliative care services. Cross-border collaboration also will take place between the CBOs that provide home and community-based palliative care and support.

In fiscal year 2007, the USG will continue its work to integrate Haiti’s TB and HIV/AIDS programs. The strategy for TB/HIV integration includes provider-initiated clinical and diagnostic HIV counseling and testing for all persons with TB as part of standard TB care; screening of all HIV-infected persons for active TB disease as part of the routine clinical care of HIV-positive persons at palliative care sites; and establishment of a strong patient referral system between TB clinics and HIV/AIDS care and treatment centers for HIV-infected persons.

In fiscal year 2007, the USG will support FBOs and NGOs in working with OVC throughout the country to provide a basic package of care and support. The package will include potable water, immunization, access to health care and psychosocial support, provision of school fees and supplies, dietary assessment and nutritional support, HIV prevention and life skill programs, and assistance with income generating activities for foster families and care-givers. The Emergency Plan will continue to leverage use of P.L. 480 Title II resources to provide food assistance to OVC in USG-supported health networks. Priority will be given to providing basic child survival interventions for under-five OVC. Fiscal year 2007 funds will address the vulnerability to HIV/AIDS of the increasing number of abandoned and homeless children on the streets of Port-au-Prince and other major cities. The USG will support advocacy and policy/legal changes on such OVC issues as inheritance rights, guardianship responsibilities, permission/authority for HIV testing of orphans when parents have died of AIDS, privacy rights, and protection from stigma and discrimination at school. The USG also supports and participates in a fledgling National Forum on OVC and HIV/AIDS.

Principal Partners: CARE, Catholic Relief Services (CRS), Family Health International (FHI), Foundation for Reproductive and Family Health (FOSREF), Group Haitien d’Etude du Sindrome de Karposi et Autres Infections Opportunistes (GHESKIO), Partners in Health/Zanmi Lasante (PIH/ZL), Plan International, World Concern and World Vision.

Treatment: $34,081,295 ($33,778,616 Field and $302,679 Central) (45.4% of prevention, care and treatment budgets)

Treatment activities in Haiti include the provision of ARV drugs and services, as well as laboratory support. A national scale-up of the provision of free ARV treatment services began in 2003 with a Global Fund grant and has continued with joint Global Fund/USG support since 2004. With fiscal year 2007 funds, the USG and Global Fund will work to ensure a safe and secure supply of ARV drugs in Haiti by procuring and distributing ARV drugs, installing a security system at a new central warehouse tied to the MOH commodities warehouse, and training warehouse and site staff on supply chain and stock management and quality assurance. The Emergency Plan will improve AIDS treatment for children and adults, working with local and international technical assistance partners to develop guidelines, policies, and curricula; conduct pre-service and in-service trainings of clinicians; and supervise service delivery sites for quality assurance, quality control (QA/QC), and continuous quality improvement. Fiscal year 2007 funding will expand the number of adult treatment sites as well as those providing pediatric diagnostic and treatment services.

The USG will continue to strengthen the national laboratory infrastructure in fiscal year 2007. Emergency Plan funding will help ensure that laboratories have increased space, improved QA/QC systems and processes, well-maintained laboratory equipment, a continuous supply of reagents, and an improved standard of practice among laboratory staff. Support also will be provided to upgrade laboratory capacity in pediatric diagnostic procedures at both the central and peripheral levels of the national laboratory system.

Principal partners: Centers for Disease Control (CDC), Catholic Relief Services (CRS), Group Haitien d’Etude du Sindrome de Karposi et Autres Infections Opportunistes (GHESKIO), Ministry of Health (MOH), Partners in Health/Zanmi Lasante (PIH/ZL), Partners for Supply Chain Management (PFSCM), and University of Maryland.

Other costs: $9,627,000

The USG will continue to monitor and evaluate the progress of Haiti’s national response to HIV/AIDS and Emergency Plan and Global Fund achievements. These efforts will be directed at developing and implementing routine information management systems for reporting on both programs and patients at the facility and non-facility level, as well as ensuring the continuation of HIV/AIDS surveillance (biological and behavioral) via population-based surveys. Additionally, the USG will support targeted evaluations and policy-related data analyses, which are essential for an effective response to the HIV/AIDS epidemic.

Principal Partners: Family Health International (FHI), Group Haitien d’Etude du Sindrome de Karposi et Autres Infections Opportunistes (GHESKIO), John Snow Incorporated/Measure Project (JSI/Measure), Ministry of Health (MOH), National Association of State and Territorial AIDS Directors (NASTAD), The Futures Group/Health Policy Initiative (TFG/HPI) and Tulane University.

The USG will collaborate with the MOH, Pan American Health Organization (PAHO), and other donors to develop a national human capacity assessment focused on HIV/AIDS health care providers. Findings will inform the process of prioritizing the uses of USG resources for training and system strengthening. USG-supported initiatives in fiscal year 2007 will expand the number of nurses, psychologists, and social workers specializing in HIV/AIDS treatment and care, through pre-service training; in addition, a degree program for medical technicians will be developed at a Haitian university. Fiscal year 2007 resources will support the revitalization of the National AIDS Council to improve its technical, programmatic, and administrative management of the increasing levels of funding being mobilized by Haiti’s national HIV/AIDS response.

Principal Partners: Haitian Ministry of Health, American Council on Education and The Futures Group/Health Policy Initiative.

Management and staffing funds will support the in-country personnel needs for HHS/CDC and USAID. Funds will ensure program monitoring and accountability, ensure USG policy and technical leadership within the Haiti national response, and cover compensation, logistics, office, and administrative costs.

Other Donors, Global Fund Activities, Coordination Mechanisms:

The USG is the largest bilateral donor to Haiti’s health sector. The other major donor in the health sector is the Global Fund, which has awarded Haiti two five-year AIDS grants ($65 million in Round 1 and $50 million in Round 5), and grants for malaria ($7.5 million) and tuberculosis ($6.5 million) in Round 3. Other donors who contribute to the fight against AIDS include the European Union, France, Canada, Brazil, and UN agencies, including UNICEF, UNFPA and WHO/PAHO. The USG meets regularly with the principal recipient of the Global Fund in order to carry out joint planning and review of implementing partners/sub-recipients’ activities, to preclude any duplication of funding and/or reporting of results. The National AIDS Council has the mandate to be Haiti’s primary HIV/AIDS coordinating body; however, during the past three years of political unrest and transitional government, the National AIDS Council has not been able to function. The new Minister of Health has identified as one of his priorities the revitalization of this national coordinating body, and the USG will support this effort in fiscal year 2007. During this three-year period, the Country Coordinating Mechanism (CCM) of the Global Fund has provided a national forum for information sharing and participation in AIDS programming and planning by other non-health Ministries, as well as by civil society groups and associations of PLWHA. The USG is a voting member of the CCM and participates fully in all meetings, discussions, and decisions. Additionally, the Emergency Plan meets regularly with key officials of individual Ministries (Health, Education, Women’s Affairs, Sports and Youth, and Social Welfare) to ensure that USG support complements and supports the overall Haitian plan for HIV/AIDS prevention, care, and treatment.

Program Contact: Emergency Plan Country Coordinator, Judith Timyan

Time Frame: Fiscal year 2007 – fiscal year FY 2008

Approved Funding by Program Area: Haiti