Botswana FY 2007 Country Operational Plan (COP)

BOTSWANA

Project Title: Botswana FY 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	770,000	770,000	0	770,000	770,000	0	770,000
DOL	0	200,000	200,000	0	200,000	200,000	0	200,000
HHS	7,547,000	43,852,576	51,399,576	7,547,000	46,620,847	54,167,847	3,486,962	57,654,809
Peace Corps	0	600,000	600,000	0	800,000	800,000	0	800,000
State	0	2,200,000	2,200,000	0	4,035,227	4,035,227	700,000	4,735,227
USAID	0	8,179,426	8,179,426	0	11,626,926	11,626,926	427,165	12,054,091
TOTAL Approved	7,547,000	55,802,002	63,349,002	7,547,000	64,053,000	71,600,000	4,614,127	76,214,127

HIV/AIDS Epidemic in Botswana:
Estimated Population: 1,765,000^*
HIV Prevalence rate: 24.1%^*Ö
# of HIV infected: 270,000^*
Estimated # of OVCs: 120,000<sup>*¥

*</sup>Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
^ÖPrevalence is in adults only (15-49 years)
^¥Orphans aged 0-17 due to AIDS

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

Botswana	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of Fiscal Year 2004*	52,800	32,900
End of Fiscal Year 2005**	69,800	37,300
End of Fiscal Year 2006***	149,300	67,500
End of Fiscal Year 2007****	216,389	73,731
End of Fiscal Year 2008****	238,028	81,603

^*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

Botswana is experiencing one of the most severe HIV/AIDS epidemics in the world, with the second-highest HIV-prevalence in Sub-Saharan Africa. The Botswana National AIDS Coordinating Agency (NACA) estimates that 25.2 % (about 272,000) of adults 15-49 years of age are infected with HIV. According to the Botswana 2005 HIV Sentinel Surveillance data, the HIV infection rate among pregnant women aged 15-49 years was 33.4%. A 2004 household survey (BAIS II) confirmed high infection rates in men (20%) and women (29.4%) aged 15-49. 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 the growing problem of orphans and vulnerable children (OVC); UNAIDS estimates that at the end of 2003, there were 120,000 children who had been orphaned due to HIV/AIDS.

Additional Funding: In June 2007, an additional $5,500,000 was allocated to significantly strengthen TB/HIV, pediatric AIDS and counseling and testing efforts and for facility renovation of USG office space.

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

Prevention: $15,738,834 ($14,171,026 Field and $1,567,808 Central) (24.9% of prevention, care, and treatment budget)

Prevention activities in Botswana include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness (AB) programs, blood and injection safety, and other behavioral prevention initiatives. Previous USG-supported PMTCT activities have helped the GOB to establish and strengthen PMTCT services in all public facilities through the Maternal Child Health/Family Planning system, which now serves over 95% of all pregnant women. In fiscal year 2007, the USG will continue to strengthen the scope, quality, and sustainability of PMTCT services. This support will improve technical and human resource capacity-building at both national and district levels, provide for technical and managerial training for PMTCT staff, and build the capacity of faith-based, community-based, and non-governmental organizations (FBOs, CBOs, and NGOs) to deliver high-quality, sustainable PMTCT services, including expansion of psychosocial support and peer counseling services to HIV-positive women and their families. The USG will also pursue 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 for both mothers and their HIV-infected infants and children.

The GOB takes the lead on national AB activities, which include abstinence curricula in schools and related programs for youth. With fiscal year 2007 funds, the USG will continue to provide strong support for these efforts, including the scale-up and monitoring of the in-school Life Skills programs for youth and outreach activities for the nationwide, media-based behavior change communication program, Makgabaneng. New programs will target youth/parent communication and will provide training for government health and social professionals engaged in HIV programs that address gender issues.

In order to strengthen systems for blood collection, testing, storage and handling—as well as systems for safe injection—the USG provides financial and technical support to strengthen medical transmission policies and systems, strengthen human capacity, and provide essential supplies and equipment for these important activities.

Additional fiscal year 2007 prevention activities include:

• continuing support to the radio serial-drama Makgabaneng to provide non-AB prevention messages;
• promoting sensitization to the role that alcohol plays in HIV infection, non-adherence and ARV treatment;
• maintaining a national HIV/AIDS hotline;
• assisting border communities in accessing HIV/AIDS services; and,
• continuing military-to-military prevention activities.

Fiscal year 2007 funding will also support new prevention activities, such as:

• conducting a rapid assessment of HIV prevention needs of men who have sex with men (MSM);
• funding and strengthening civil society groups that target people in prostitution and/or MSM;
• assessing the prevalence of male circumcision and attitudes toward the development of services to provide this procedure; and,
• strengthening prevention interventions in clinical settings for persons living with HIV/AIDS (PLWHA).

All prevention activities will establish linkages to treatment and care programs.

Principal Partners: Blossom, BDF, Botswana Network of People Living with HIV/AIDS (BONEPWA), Family Health International (FHI), Hope Worldwide, John Snow Incorporated, International Training and Education Center (I-TECH), Pact or its replacement Makgabaneng, MOH, MOE, Ministry of Labor and Home Affairs (MOLHA), Ministry of Local Government (MOLG), Partnership for Supply Chain Management (PFSCM), Pathfinder International, Population Services International (PSI), Safe Blood For Africa, United Nations Children’s Fund (UNICEF), University of Medicine and Dentistry of New Jersey, and Youth Health Organization (YOHO).

Care: $21,971,891 ($21,712,534 Field and $259,357 Central) (34.7% of prevention, care and treatment budget)

To address the palliative care needs of PLWHA, the USG will use fiscal year 2007 funds to continue providing leadership, guidance, and coordination in the provision of palliative care services. Support to maintain the scale-up of palliative care services will be ongoing, through the dissemination of palliative care guidelines (including guidelines on the management of opportunistic infections) in trainings and conference venues. Technical assistance providers will continue training for public and private health care providers to deliver high quality palliative care services in both household and clinical settings. New activities include an assessment to determine gaps in services for PLWHA, expansion of local efforts to provide palliative care in underserved regions, and scale-up of pediatric palliative care in the north of the country. All palliative care efforts will endeavor to establish linkages between those receiving services and their families and other appropriate prevention, care, and treatment services.

Between 60% and 80% of tuberculosis (TB) patients in Botswana are HIV-infected; the leading cause of death among adult PLWHA is TB. In fiscal year 2007, the USG will continue training efforts to strengthen referrals and services for co-infected HIV/TB patients, including the integration of HIV testing in adult and pediatric TB patients and referral to other appropriate prevention, care, and treatment services. New activities for fiscal year 2007 include strengthening TB/HIV laboratory capacity and implementing a model demonstration-program for TB/HIV care and treatment.

In Botswana, HIV counseling and testing (CT) is a key component of care interventions. The USG initiated voluntary counseling and testing (VCT) services in 2000 and supported the creation of a testing network of 16 centers, 11 satellites, and 4 mobile caravans located throughout the country. Fiscal year 2007 funds will maintain support for providing free, anonymous VCT with same-day results, as well as conducting social marketing activities and community mobilization to increase the demand for VCT. In addition, the USG will foster links between VCT and palliative care and treatment services with funding for expanded on-site services, such as CD4 counts and follow-up counseling, and intensified referrals to other services. The USG will continue supporting routine HIV testing through the national health care system, VCT for military personnel, and home-based VCT. A special effort will be made to ensure that CT programs forge effective links with treatment services.

OVC 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. With fiscal year 2007 support, the OVC unit at the Ministry of Local Government, Department of Social Services will receive support to disseminate and diffuse national guidelines and frameworks for improving the quality and type of services provided to OVC, through workshops targeted to different audiences. It also will continue providing services to at-risk children and families. Support will be continued for the Circles of Support program, which addresses the psycho-social support needs of children by linking them to a network of multi-sectoral support. Fiscal year 2007 funds will also expand assistance to OVC 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. USG support in fiscal year 2007 will strengthen linkages to treatment and prevention through training for pediatricians and dieticians, as well as for parents/guardians, health care workers, and CBO staff. The Peace Corps will also place Peace Corps Volunteers with local FBOs, CBOs, and NGOs that are mobilizing community responses to OVC and other aspects of the HIV/AIDS epidemic. Fiscal year 2007 funding for the Ambassador’s HIV/AIDS Initiative will continue to strengthen the capacity of FBOs, CBOs, and NGOs to provide holistic services for children affected by the epidemic.

Principal Partners: Academy of Educational Development (AED), American International Health Association, Botswana Christian AIDS Intervention Program, BDF, Catholic Relief Services, Hope Worldwide, Humana People-to-People, I-TECH, MOE, MOH, MLG, Nurses Association of Botswana, Tebelopele, and UNICEF.

Treatment: $25,532,018 ($22,745,056 Field and $2,786,962 Central) (40.4% of prevention, care and treatment budget)

Since January 2002, Botswana has been providing free antiretroviral treatment (ART) to PLWHA. The nationally-funded program has grown to 32 treatment sites, with 56,162 patients on treatment as of June 2006. Pregnant women are routinely referred to the ARV program; there are no dedicated PMTCT-plus sites in Botswana. With fiscal year 2007 funds, the USG will continue to support ensuring a safe and secure supply of ART by procuring antiretroviral (ARV) drugs and providing training on supply chain management, quality assurance, good manufacturing practices, inspections and pharmaco-vigilance. Special provision will be made again for the purchase of pediatric ARV drugs. The USG also will work to make more effective the referral systems for women in the PMTCT program and their HIV-infected infants. In addition, coordination of inpatient and outpatient treatment and care for older HIV-infected children will be a focus of pediatric treatment efforts.

The USG will improve HIV/AIDS services for children and adults by training clinicians in adult and pediatric HIV care. Security at both the Central Medical Stores and local clinic pharmacies will be strengthened to prevent disruption of the ART supply chain. Continuing medical education will be maintained for private practitioners, harmonizing their training with the national training curriculum. Also with fiscal year 2007 funding, pediatric programs will continue to be strengthened with support for HIV/AIDS pediatricians and the implementation of early infant diagnosis. Treatment services for military personnel will be ongoing. All treatment service programs will seek effective mechanisms for referring patients to appropriate prevention and care programs.

To strengthen the laboratory infrastructure in Botswana, the USG will 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. Support to military laboratory services also will be ongoing.

Principal partners: Associated Funds Administrators/Botswana, Baylor University, BDF, Harvard School of Public Health, I-TECH, MOH, MOLG, PFSCM and United Nations High Commission for Refugees.

Other Costs: $12,971,384

Strategic information is crucial to measuring the progress made in reaching the 2-7-10 goals of the Emergency Plan. Fiscal year 2007 funding will provide support to enhance the Botswana HIV/AIDS Response Information Management System (BHRIMS), which generates information on the national HIV/AIDS response, as well as support for 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 at the national level will continue to be strengthened. A key objective of all strategic information activities will be to integrate data collection across prevention, care, and treatment.

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 in fiscal year 2007 will focus on building sustainable national capacity 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; and
• engaging the private sector in AIDS-in-the-workplace activities.

Furthermore, the USG will support ongoing activities to strengthen indigenous FBOs, CBOs, and NGOs. New fiscal year 2007 activities include the promotion of health worker wellness to increase staff motivation, productivity and retention, and support to NACA to strengthen their role in donor and partner coordination.

Principal Partners: American International Health Alliance, Botswana Business Coalition on AIDS, Botswana Network for Ethics, Law and HIV/AIDS (BONELA), Institute of Development Management, I-TECH, International Labor Organization, MOE, Ministry of Finance Planning and Development, MOH, MOLG, NACA, National Alliance of State and Territorial AIDS Directors (NASTAD), and University of Medicine and Dentistry of New Jersey.

Management and staffing activities will ensure effective implementation of the Emergency Plan, including the technical assistance required to execute and manage Emergency Plan activities.

Other Donors, Global Fund Activities, Coordination Mechanisms:

Because Botswana is a middle-income country, the GOB bears the largest burden of the cost for HIV/AIDS intervention. There are relatively few bilateral or multilateral donors assisting the GOB in their response. 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. Coordination of support is accomplished through the Development Partner Forum and the GFATM Country Coordinating Mechanism, which both are chaired by the Ministry of Finance and Development Planning. Additional nominal 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 coordinating across other Ministries.

Program Contact: Deputy Chief of Mission, Phillip Drouin and Emergency Plan Coordinator, Jim Allman

Time Frame: Fiscal year 2007 – fiscal year 2008

Approved Funding By Program Area: Botswana