Zambia FY 2007 Country Operational Plan (COP)

ZAMBIA

Project Title: Zambia 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
GAP	GHAI	Subtotal: Field Programs Funding	GAP	GHAI	New Subtotal: Field Programs Funding	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
0	4,780,080	4,780,080	0	5,563,929	5,563,929	0	5,563,929
0	0	0	0	0	0	0	0
2,914,000	41,635,500	44,549,500	2,914,000	55,955,500	58,869,500	24,320,022	83,189,522
0	2,100,000	2,100,000	0	2,100,000	2,100,000	0	2,100,000
0	1,575,000	1,575,000	0	1,285,000	1,285,000	0	1,285,000
0	92,137,618	92,137,618	0	116,992,618	116,992,618	6,881,711	123,874,329
2,914,000	142,228,198	145,142,198	2,914,000	181,897,047	184,811,047	31,201,733	216,012,780

HIV/AIDS Epidemic in Zambia:
Estimated Population: 11,668,000^*
HIV Prevalence rate: 15.6%^*
# of HIV infected: 1,100,000^*
Estimated # of OVCs: 710,000^*¥
*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

Zambia	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of Fiscal Year 2004*	300,300	13,600
End of Fiscal Year 2005**	321,300	36,000
End of Fiscal Year 2006***	467,700	71,500
End of Fiscal Year 2007****	438,581	109,050
End of Fiscal Year 2008****	600,000	120,000

^* 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

Zambia is facing its most critical health, development, and humanitarian crisis to date. An estimated 15.6% of the adult population is infected with HIV, of which 920,000 Zambian adults and children live with HIV/AIDS in a total population of 10.5 million people. About one in every six adult Zambians is HIV positive. Women represent over half of those infected with HIV in Zambia. Despite a plateau in the growth of the HIV infection rate, the repercussions of the HIV/AIDS epidemic continue to loom over the nation, with the loss of 89,000 persons from AIDS every year, leaving behind an estimated 630,000 AIDS orphans. Zambia’s HIV/AIDS epidemic primarily is transmitted through heterosexual contact and from mother to child. There are also clearly identifiable high risk groups that warrant special attention: HIV discordant couples; people in prostitution and their clients and partners; long distance truck drivers; bus drivers; fish camp traders; migrant workers; prisoners; refugees; and uniformed personnel, including members of the military and police forces.

HIV sero-discordant couples are estimated to make up 21% of all married couples. 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 (STIs). Orphans and vulnerable children (OVC) are particularly at risk for property grabbing, homelessness, sexual exploitation, violence, abuse, and a life of abject poverty. Youth are another high risk group, with a high proportion of females aged 15-24 years nearly twice as likely to be HIV positive as males in the same age group. It is estimated that over 50% of TB/HIV cases are co-infected.

Additional Funding: In June 2007, an additional $25,248,849 was allocated to expand services for PMTCT, opt-out counseling and testing, palliative care, and HIV/TB, and to increase coverage in rural areas. Additional funding will also provide opportunities for more integrated services, including comprehensive OVC care, integrated counseling and testing with STI services, and strengthened PMTCT and Maternal and Child Health service delivery. Through the technical working group (TWG) process, $3,000,000 of the additional funds were identified to support new medical male circumcision (MC) activities in Zambia.

PEPFAR funding for fiscal year 2007 will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $45,147,479 ($38,497,183 Field and $6,650,296 Central) (23.8% 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.

In fiscal year 2007, 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 high quality PMTCT services, including in areas that serve military personnel.

The USG will intensify prevention efforts with messages targeting youth, military, uniformed services, prisoners, and refugees. Blood and injection safety practices will be strengthened to prevent HIV transmission. The USG will continue Post Exposure Prophylaxis protocols and guidelines in all antiretroviral therapy (ART) sites. These activities will train individuals to promote a comprehensive ABC approach (abstain, be faithful, and correct and consistent use of condoms), targeting high-risk populations. Support will result in behavior change interventions and the establishment of condom outlets at targeted sites, reaching high risk groups such as HIV discordant couples, people in prostitution, police, military, refugees, victims of sexual violence, and prisoners.

Principal partners include: Tulane University, International Executive Service Corps, Children AIDS Fund, Churches Health Association of Zambia, Ministry of Health, United Nations Children’s Fund, Copperbelt University, JHPIEGO, Academy for Educational 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, U.S. Peace Corps, National Arts Council of Zambia, University of Zambia, Pact Inc., Zambia National Blood Transfusion Service, Chemonics International, and the United Nations High Commissioner for Refugees.

Care: $61,367,596 ($59,936,181 Field and $4,431,415 Central) (32.3% of prevention, care, and treatment budget)

Care activities in Zambia include counseling and testing (CT), provision of basic health care and support, focused efforts on delivery of integrated TB/HIV services, and expanded programs supporting OVC.

A primary emphasis of the USG in fiscal year 2007 will be to improve the quality of CT services. In fiscal year 2007, the USG will place high priority on effective networks and referral linkages to other care and treatment services. Palliative care activities will reach HIV-positive individuals at service delivery sites by providing nursing/medical care, treatment of opportunistic infections, 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 tuberculosis (TB) and HIV co-infection, the USG will continue to enhance the linkage between TB and HIV services. OVC will receive improved access to educational opportunities, provision of food and shelter, psychosocial support, health care, livelihood training, access to microfinance, and training for caregivers.

Principal partners include: University Teaching Hospital (Lusaka), Tulane University, Cooperative League of the USA, American Institutes of Research, CARE International, Christian Aid, Development Aid from People to People Zambia, HOPE Worldwide Zambia, Opportunity International, Educational Development Center, World Concern Development Organization, Partnership for Supply Chain Management, International Executive Service Corps, United Nations High Commissioner for Refugees, 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, Johns Hopkins University, Churches Health Association of Zambia, and JHPIEGO.

Treatment: $83,535,179 ($63,415,157 Field and $20,120,022 Central) (44.0% of prevention, care, and treatment budget)

As of September 2006, the number of sites providing ART has grown to over 300 government and religious mission health facilities. At the end of March 2006, 65,000 persons were receiving ART in the public sector. The USG will continue to collaborate with the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) to coordinate the purchase of antiretroviral drugs (ARVs) for the public sector. Through this collaboration, the Global Fund will purchase appropriate, approved first line regimens (comprised of generic ARVs), while the USG will procure second line ARVs, pediatric formulations, and one first line drug.

In fiscal year 2007, the USG will continue to provide comprehensive ART services, including public and private sector hospitals, clinic sites, and provincial and district public sector facilities. In addition to ART procurement, the USG will support comprehensive care and treatment services for infants and children; health care provider training on provision of quality ART services; strengthened effective service delivery networks and linkages; strengthened laboratory, logistics, and health information management systems; and implementation of ART adherence activities. Zambia’s human capacity crisis will be addressed by supporting the MoH in human resource planning and management, hiring, and seconding key technical staff to provide HIV/AIDS services.

Principal partners: Partnership for Supply Chain Management, Columbia Mailman School of Public Health, Abt Associates, Comforce Technical Services Global, American Society for Microbiology, Tulane University, Ministry of Health, Elizabeth Glaser Pediatric AIDS Foundation, Family Health International, World Vision International, JHPIEGO, University Teaching Hospital (Lusaka), Catholic Relief Services, American International Health Alliance, University of Nebraska (Lincoln), Tropical Diseases Research Centre, Chest Diseases Laboratory, and the Regional Procurement Support Office.

Other Costs: $25,962,526

PEPFAR funding will support strategic information, policy analysis and systems strengthening, and management and staffing. Fiscal year 2007 funds will strengthen local health management information systems, expand use of quality program data for policy development and program management, upgrade quality assurance procedures, provide essential training and support, provide technical assistance in developing sustainable Monitoring and Evaluation systems and information and communication technology.

Principal Partners include: Elizabeth Glaser Pediatric AIDS Foundation, JHPIEGO, Catholic Relief Services, Ministry of Health, National Association of State and Territorial AIDS Directors, National HIV/AIDS/TB/STI Council, Central Statistics Office, Tropical Diseases Research Centre, Comforce Technical Services Global, Macro International, University of North Carolina Chapel Hill, and John Snow Research and Training.

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. 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.

Principal Partners include: National Association of State and Territorial AIDS Directors, University of Zambia, Vanderbilt Institute for Global Health, JHPIEGO, Project Concern International, Partnership for Supply Chain Management, John Snow Research and Training, Abt Associates, National HIV/AIDS/STI/TB Council

Management and staffing funds will support the in-country personnel needed for USAID, HHS, State Department, Department of Defense, and the Peace Corps. Funding will support program monitoring and accountability, ensure USG policy and technical leadership within the Zambia national response, and cover compensation, logistics, and office and administrative costs.

Other Donors, Global Fund Activities, Coordination Mechanisms

To date, the Global Fund has provided a total of $477.906 million to Zambia in Round One and Round Four funding, of which $346.455 million is for HIV/AIDS activities. 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. In August 2006, Zambia submitted a proposal for Round Six. Other major donors working in the HIV/AIDS sector are the World Bank (whose Multi-Country HIV/AIDS Program is scheduled to close at the end of 2007) and UNICEF, as well as the British Department for International Development (DFID), which supports PMTCT, workplace prevention and treatment programs, condoms, and sexually transmitted infection drug procurement.

The USG shares the donor seat on the Global Fund Country Coordinating Mechanism and participates in the various national sector coordinating committees, national technical HIV/AIDS working groups, the UNAIDS Expanded Theme Group, and the GRZ Partnership Forum. The USG and DFID serve as the co-chairs the UNAIDS Cooperating Partners on HIV/AIDS Group.

Program Contact: PEPFAR Coordinator, Cristina Garces

Time Frame: Fiscal year 2007 – fiscal year 2008

Approved Funding by Program Area: Zambia