Zambia FY 2006 Country Operational Plan (COP)

ZAMBIA

Project Title: Zambia 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	0	6,065,000	6,065,000	0	0	6,065,000	0	6,065,000
DOL	0	0	0	0	0	0	0	0
HHS	2,914,000	33,861,000	36,775,000	-600,000	0	36,175,000	22,296,462	58,471,462
Peace Corps	0	1,700,000	1,700,000	0	0	1,700,000	0	1,700,000
State	0	1,322,546	1,322,546	0	0	1,322,546	0	1,322,546
USAID	0	73,051,454	73,051,454	600,000	0	73,51,454	7,811,691	81,463,145
TOTAL Approved	2,914,000	116,000,000	118,914,000	0	0	118,914,000	30,108,153	149,022,153

HIV/AIDS Epidemic in Zambia:

Adult HIV Prevalence Rate: 17.0% [15.9-18.1%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 1.1 million [1,100,000-1,200,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 710,000 [630,000-830,000] (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:

Zambia is facing its most critical health, development and humanitarian crisis to date. An estimated 17.0% [15.9-18.1%] of the adult population is infected with HIV (18% of adult women and 13% of adult males); 1.1 million Zambian adults and children are living with HIV/AIDS in a total population of 10.5 million people; about one in every six Zambians is HIV positive. In urban areas almost one in four adults is infected (23.1% HIV prevalence); a staggering one-third of the population in border towns has HIV/AIDS; and in rural areas the rate is 10.8%. The infection rate among pregnant women attending selected antenatal clinics is 19%. Antenatal surveillance trends since 1994 indicate that the epidemic has remained at fairly consistent levels at these same 22 clinics over the last decade. Despite this plateau in the growth of the HIV infection rate, the repercussions of the HIV/AIDS epidemic continue to loom over the nation. Zambia’s HIV/AIDS epidemic is mostly transmitted through heterosexual contact and from mother-to-child. However, there are also clearly identifiable high risk groups that warrant special attention: discordant couples; commercial sex workers and their clients and partners; long distance truck drivers; bus drivers; fish camp traders; migrant workers; prisoners; refugees; and uniformed personnel including military and police forces.

HIV sero-discordant couples are estimated to make up 15-20% of all married couples. Couples are a major source of the incident cases. The strong relationships between gender inequality, alcohol and substance abuse, high risk sexual behavior and sexual violence fuel the transmission of HIV. There is a high relative risk of HIV co-infection for those diagnosed with sexually transmitted infections (STI). Orphans and Vulnerable Children (OVC) are particularly at risk to property grabbing, homelessness, sexual exploitation, violence, abuse, and a life of abject poverty. Youth (particularly girls) are another high risk group, with 11.2% of females aged 15-24 years and 3.0% of males in the same age group being HIV positive, which highlights the effect of older men having sex with younger women as a factor contributing to the high prevalence. It is estimated that over 50% of tuberculosis (TB) cases are co-infected with HIV.

In July 2005, a change in Government of the Republic of Zambia (GRZ) policy made provision of antiretroviral (ART) services free for all Zambians through public health care facilities. As a result of this decision, ART – including free antiretrovirals (ARV) and associated laboratory testing – is now available to a significantly larger proportion of Zambians. However, there are many challenges associated with this significant policy change, as the public health care system is already at its limits of providing high-quality health care, such as HIV counseling and testing services – the entry point to ART services. The ripple effects of this policy change will be felt at all levels of the public health care system, from HIV counseling and testing services to community home-based care programs. A particular challenge that the USG Zambia team faces is not being able to scale-up prevention, care, and treatment programs as originally planned due to the limited projected increase in FY 2006 funding.

Emergency Plan funding will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $25,645,997 as of August 2006 ($20,387,000 Field and $5,258,997 Central) (19.6% of prevention, care, and treatment budget)

Prevention activities in Zambia include increasing access to quality prevention of mother-to-child transmission (PMTCT) services; promoting healthy behavior for youth through abstinence and faithfulness programs; encouraging fidelity among adults; improving blood and injection safety practices in health facilities; and providing services, condoms, and behavior change interventions targeted at high risk populations to reduce HIV transmission.

The USG will continue to improve the quality of existing PMTCT programs, fully integrate PMTCT with other maternal and child health services, and increase access to quality PMTCT service by establishing new PMTCT sites across the country, including areas that serve military personnel. With FY 2006 funds, the USG will provide support to 304 PMTCT sites in all nine provinces.

With FY 2006 funding, the USG plans to reach 194,500 youth with abstinence messages, and 1,476,300 youth and adults with messages promoting abstinence and encouraging fidelity by supporting performing groups, programs targeting youth, public and private workplace programs, community mobilization and behavior change communication.

With FY 2006 funds, blood and injection safety practices will be strengthened to prevent HIV transmission, and will include training over 520 Ministry of Health (MOH) and Zambia Defense Force (ZDF) medical service personnel and continuing Post Exposure Prophylaxis protocols and guidelines in all ART sites. Other prevention activities will train 962 individuals to promote a comprehensive ABC (Abstinence, Be Faithful, and Correct, Consistent Use of Condoms) approach targeting high-risk populations. Support will result in 656 condom outlets and behavior change interventions at border, transit corridors, truck stops, urban centers, bars, nightclubs, and fishing communities. These interventions will target 4,355,000 high-risk individuals such as discordant couples, commercial sex workers, police, military, refugees, victims of sexual violence, and prisoners to reduce HIV transmission. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: MOH, Boston University, JHPIEGO, Academy for Education Development, Elizabeth Glaser Pediatric AIDS Foundation, CARE International, Family Health International, American Institutes for Research, Population Services International, Johns Hopkins University, International Youth Foundation, Cooperative League of the USA, Development Alternatives, Inc, World Vision International, John Snow Research and Training Institute, Project Concern International, US Peace Corps, National Arts Council of Zambia, University of Zambia, Pact Inc, Zambia National Blood Transfusion Service, and the United Nations High Commissioner for Refugees.

Care: $39,906,213 as of August 2006 ($35,177,079 Field and $4,729,134 Central) (30.5% of prevention, care, and treatment budget)

Care activities in Zambia include counseling and testing (CT), basic palliative care, focused efforts on delivery of integrated TB/HIV services, and expansion of the breadth and depth of programs supporting OVC.

Because only nine percent of adults have ever been tested in Zambia, a primary emphasis of the USG will be to use FY 2006 funds to increase access to and improve the quality of CT services, including mobile CT that reaches underserved populations. The USG will support 279 CT sites in all nine provinces to reach 335,917 people with CT services, will strengthen MoH logistics and forecasting for HIV test kits, and will procure HIV test kits for the public sector. The USG will continue to strengthen the capacity of Faith Based Organizations (FBO), the public sector, the military, and workplace programs to deliver quality Palliative Care/Basic Health Services through home-based, hospice, clinical and hospital care. Utilizing FY 2006 funding, the USG will establish effective networks and referral linkages to other care and treatment services. Twinning activities will enable South-to-South Palliative Care technical support to local and regional palliative care institutions. Palliative care activities will reach 111,692 HIV-positive individuals in 262 service delivery sites with nursing/medical care, treatment of opportunistic infections (OIs), pain relief, nutritional supplements, psycho-social support, referral to ART and ART adherence programs, pediatric and family support, and training of caregivers and service providers. To address the high proportion of TB and HIV co-infection, the USG will continue to enhance the linkage between TB and HIV services. An estimated 432,529 OVC will also receive improved access to educational opportunities, provision of food and shelter, psychosocial support, health care, livelihood training, access to microfinance, and 18,564 caregivers will receive training.

In May 2006, an additional $400,000 was allocated to care activities. These funds will be used to provide training to 30 new local organizations and 150 caregivers. Also an additional 5,625 OVC, including 2250 malnourished OVC, will be served by this additional funding. In August 2006, there was no change in the amount of funding allocated for care.

Principal Partners: MOH, Project Concern International, World Vision International, John Snow Research and Training Institute, Catholic Relief Services, American International Health Alliance, Family Health International, Population Services International, John Snow Inc., Johns Hopkins University, Churches Health Association of Zambia, and JHPIEGO.

Treatment: $65,199,806 as of August 2006 ($45,079,784 Field and $20,120,022 Central) (49.9% of prevention, care, and treatment budget).

As of September 2005, the number of sites providing ART has grown to 80 government and religious mission health facilities. An estimated 36,000 persons currently receive ART (public and private sector). With FY 2006 funds; 71,000 individuals will be receiving ART. In 2005, the USG and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) combined efforts and coordinated the purchase of ARV for the public sector. Through this collaboration, the GFATM will be purchasing appropriate, approved first line regimens (comprised of generic ARV) while the USG will procure second line ARV, pediatric formulations, and one first line drug. The Clinton Foundation will procure ARV drug formulations for 1,000 HIV-infected Zambian children in FY 2006. The USG, plus GRZ and private contributions to ARV combined, will result in 95,423 people on ART by September 30, 2007 (exceeding USG’s projected target for ART).

Increasing demand for ART will be supported through procuring ARV for the public sector, training health care providers in provision of quality ART services, creating effective service delivery networks and linkages, strengthening laboratory, logistics, and health information management systems, and implementing ART adherence activities. Zambia’s human capacity crisis will be addressed by supporting the GRZ’s established rural retention scheme, which places physicians and other health workers in underserved areas. The USG will support a new GRZ retention scheme to keep tutors at the country’s nursing schools and support the MOH in sector human resource planning and management, hiring, and seconding key technical staff to provide HIV/AIDS services.

Approximately 1,250 HIV-infected children are currently receiving ART in public sector facilities in Zambia. An important goal is to increase the number of infants and children receiving comprehensive care and treatment for HIV/AIDS. In FY 2006, the USG is increasing the ARV procurement and ARV logistical support for the public sector. The USG will establish new ART sites in eight military hospitals, and will support 99 service delivery sites including public and private sector hospitals, clinic sites, and Mission hospitals, provincial and district public sector facilities, and private workplace clinical facilities. The USG will directly enable 71,000 individuals to receive ART, including 35,352 new clients. Centrally funded treatment activities are expected to complement these efforts.

In May 2006, an additional $6,891,000 was allocated for treatment activities. Of the additional funding, $1.3 million will be used to purchase ARVs to put an additional 9600 people on treatment, $600,000 will be used to strengthen laboratory services through procurement of critical commodities and supplies, and the remaining $6.2 million will support the Republic of Zambia’s national ART scale-up plan. 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: MOH, Abt Associates, John Snow Inc., Elizabeth Glaser Pediatric AIDS Foundation, Family Health International, Johns Hopkins University, World Vision International, JHPIEGO, Columbia University, University Teaching Hospital (Lusaka), Catholic Relief Services, American International Health Alliance, University of Nebraska, Tropical Diseases Research Centre, Chest Diseases Laboratory, Oak Ridge Institute of Science and Education, Regional Procurement Support Office, and Crown Agents.

Other: $18,270,137 as of August 2006

Emergency Plan funding will support strategic information, policy analysis and systems strengthening, and management and staffing. FY 2006 funds will strengthen local health management information systems, expand use of quality program data for policy development and program management, and improve national coordination in HIV/AIDS monitoring and evaluation activities. The USG will support the Demographic and Health Survey (DHS+), an electronic patient record (smartcard) to ensure continuity of care, the national M&E system, a verbal autopsy study, and preparation for the second national HIV prevalence study. Policy and advocacy efforts will be expanded to reduce stigma and discrimination within communities and in the workplace, encourage strong national and local leadership among traditional, religious, and political leaders, and increase financial and human resources for HIV prevention, care and treatment services. The USG will work closely with Zambian leaders to inspire a national movement in the fight against AIDS that helps to eliminate stigma associated with HIV/AIDS. Sub-grants and technical support will be provided to HIV-positive people’s networks and to community and national leaders for HIV/AIDS prevention, care, and treatment advocacy. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners: Abt Associates, University of North Carolina – Chapel Hill, John Snow Research and Training Institute, Macro International, Elizabeth Glaser Pediatric AIDS Foundation, JHPIEGO, Catholic Relief Services, MOH, National Association of State and Territorial AIDS Directors, National AIDS Council, Central Statistics Office, Tropical Diseases Research Centre, Project Concern International, Pact Inc., National Department of Social Development (University of Zambia), and the American International Health Alliance.

Other Donors, Global Fund Activities, Coordination Mechanisms:

To date, the GFATM has provided $74.8 million to Zambia in Round One and Round Four funding. Nearly half of the funds go through the MOH for public sector services, including $10.4 million of Round Four monies that will be used for ARV procurement. Other major donors supporting HIV/AIDS efforts are the World Bank, providing $42 million over five years, and UNICEF which is providing $4 million to improve services for OVC, and the British DFID, which is providing $9 million in 2005 to support PMTCT, workplace prevention and treatment programs, condoms and STI drug procurement. A number of health sector donors contribute to pooled funding arrangements under the MOH that support the operation of health services. Donor coordination takes place in a variety of forums. For example, the USG shares the donor seat on the GFATM Country Coordinating Mechanism and participates in the various national sector coordinating committees, national technical HIV/AIDS working groups, and the UNAIDS Expanded Theme Group.

Program Contact: Ambassador Carmen M. Martinez and Emergency Plan Interagency Coordinator, Cristina Garces

Time Frame: FY 2006 - FY 2007

Approved Funding by Program Area: Zambia

August 2006 Operational Plan Main Page