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2 2 1. INTRODUCTION BACKGROUND In 2002 the Government of Lesotho submitted a proposal to the Global Fund to support the implementation HIV/AIDS and Tuberculosis programme activities. Approval was granted in February 2003 to the tune of US34, 321,000 for a period of five years. In October 2003, the Global Fund and Government of Lesotho signed an agreement to support the program with USD10, 557,000 for HIV/AIDS and USD 2,000,000, for TB for the next two years beginning January The main focus of the proposal was to fight the worsening HIV/AIDS as well as TB infections facing the Country. The UNAIDS estimated prevalence at 31% (2002) of the adult population infected. The overall goal of the HIV/AIDS component was to reduce the prevalence of HIV by 6% by 2007, from 31% to 25%, by intensifying prevention among youth (10-25); strengthening community capacity; mitigating the impact of AIDS among PLWAS and OVCs. The proposal also included a component to introduce ARVs and strengthen the National management structures in the delivery of HIV/AIDS services. The beneficiaries of the Global Fund supported HIV/AIDS program primarily included the youth (through prevention), PLWAs (through treatment, care and support) and OVCs (impact mitigation). Secondary beneficiaries were communities though reduced burden of HIV/AIDS morbidity and mortality. GOVERNING STRUCTURES MONITORING AND EVALUATION The monitoring and Evaluation Plan was developed and approved towards the end of year. The purpose of M&E Plan was to document how the Ministry of Finance and Development Planning (MFDP), as Principal Recipient of GFATM grant funding, would monitor, evaluate and report on progress made in terms of the GFATM activities defined in the Lesotho s HIV/AIDS proposal to GFATM. These monitoring, evaluation, reporting and data management procedures would not only provide information for programme implementation, but also form the basis for continued disbursements, as per the performance-based disbursement system. STRUCTURE OF THE REPORT The report is divided into 4 parts. The first part introduces the background of the proposal and structures that rule the whole process of implementation. The second part deals with the interventions proposed in the Proposal, objectives and activities to be implemented. These are followed by the progress achieved. The third part relates the challenges which impacted negatively on the implementation, and slowed the performance. The Fourth part concludes the document and gives the recommendation for the second year of performance. The last relates to the budget as expended during the first year of the implementation.

3 3 2. INTERVENTIONS The HIV and AIDS component of the proposal was divided into four components of Prevention, Care and treatment, Mitigation, and Governance. 2.1 PREVENTION COMPONENT The objectives as stated in the proposal were to expand and strengthen life skills education in schools and HIV/AIDS peer education training with specific focus on girls; to expand access of condoms for sexually active youth by installing condom dispensing machines in 70% of all youth friendly corners in the existing health service areas by 2007; and to reduce the proportion of infants infected by 20% by establishing PMTCT programmes in the 18 health service areas by the end of In order to achieve these objectives in the first year the activities which were planned included to establish 4 Youth Resource Centres in all ten districts; increase 3 Adolescent Health corners in 3 districts; develop and disseminate Policy on Adolescent Health; develop M&E system; provide 2,000,000 Condoms throughout the Country; conduct Community Empowerment activities youth; integrate Voluntary Counselling and Testing (VCT) services into Adolescent and youth centres; scale up PMTCT programme in all Health Service Areas; institutionalize HIV/AIDS Curriculum in all schools including tertiary institutions; design and erect IEC billboards promoting PMTCT and VCT at the community level and conduct advocacy activities for Community leaders. PROGRESS STATUS : YOUTH RESOURCE CENTRES The Ministry of Youth, Gender, Sports and Recreation (MGYSR) identified sites for the establishment of the Youth Resource Centres in Leribe, Maseru (Semonkong), Thaba-Tseka and Mohale s hoek in April, In June the Private firm which was identified and engaged by the Ministry of Public Works and Transport completed Architectural Plans for the youth resource centres. It was found that the plans drawn did not meet the objective requirements. The Plans had to be redone in order to meet the requirements. The original plan to build 4 YRCs was changed to 2 due to the exchange rate fluctuations (vis Rand/US Dollar). The commencement of the activity was delayed further by the temporary halt in the disbursements of funds while the m&e and PSM plans were being developed INCREASE 3 ADOLESCENT HEALTH CORNERS IN 3 DISTRICTS. Staff to operate the Adolescent Health Corners in the 3 HSAs, including Mamohau, Berea and Tebellong, were selected and appointed by the MOHSW in the first quarter of During the second quarter of the year, the Adolescent Programme Manager conducted sensitization workshops on Adolescent health and reproduction health issues in the three H.S.As. The purpose of the workshops was to create awareness to the community about HIV and AIDS; solicit the support and assistance of the communities in the prevention of Reproductive Health problems including HIV and AIDS; and create awareness about the selected sites for adolescent friendly reproductive health services which were to provide the PMTCT and the VCT service.

4 4 At the end of the year, ADCs were able to reached 17,310 adolescents, 996 adolescents were counselled on HIV/AIDS, while 741 were tested for HIV/AIDS, and 195 were found to be positive. The procurement of equipment for the three identified Adolescent Health Corners in Mamohau, Berea, and Tebellong was not achieved by the end of the year due to limited funds. The tendering process to procure equipment for Adolescent corners was completed towards the end of September 2004, but the evaluation of tenders was to be put on hold due to non availability of funds during third and fourth quarter of implementation. As funds was made available only at the end of the year, evaluation of suppliers was scheduled to be completed during the month of January DEVELOP AND DISSEMINATE ADOLESCENT HEALTH POLICY The Adolescent Health Policy is completed and has been translated into Sesotho and is ready for presentation to cabinet. This policy is aimed at addressing adolescent health in general, with regards to sexual and reproductive health, mental aspects, substance abuse, injuries from accidents and emotional consequences. Thus the policy will enhance provision of adolescent reproductive health programs and limit imposition of restrictions by administrators and service providers based in their own personal beliefs that may prohibit youth from gaining access to essential information and services There has been some impressive success in establishment of the adolescent health corners within the country. Adolescent health corners have been set up in Mamohau, Tebellong and Berea. The plans are underway to provide targeted training to all nurses on provision of adolescent health service As a means of extending provision of adolescent health service provision, 34 CHWs were trained in adolescent health issues including PMTCT. In addition 53 Peer Educators have been trained in Adolescent Sexual and Reproductive Rights, while the other 82 have been sensitized on the subject. This was coupled with distribution of 70,000 pamphlets on behavioural change communication. The procurement of equipment related to this aspect was put on hold due to delays in disbursement of funds from the GOL PROCUREMENT OF 2,000,000 CONDOMS AND 200 CONDOM DISPENSERS. The procured condoms were to be placed in the youth resource centres as well as the adolescent health centres throughout the country. Condom vending machines were to be installed within youth friendly corners to support access and availability. The procurement of Condoms under the Global Fund support did not take place during the fourth quarter as was expected because the disbursement request was put on hold. The reasons for this was fact that procurement supply management plan was only completed and approved in by end of October, At the same time condoms have been procured using other means and 1,500,000 male condoms and 10,000 female condoms were distributed to various organizations through out the country PROMOTING PMTCT AND VCT AT THE COMMUNITY LEVEL. Bonang Graphics and Art designers were selected to design and erect billboards to promote PMTCT and VCT at the Community level in August, Towards the end of quarter 4 billboards were erected countrywide.

5 5 The Prevention of Mother to Child Transmission (PMTCT) Strategy has also been recently adopted for reducing infant and child morbidity and mortality from HIV/AIDS. The program target was to counsel 14,000 women on HIV/AIDS and PMTCT. In achieving this target the PMTCT program, which was initially piloted in the 8 HSAs of Mafeteng, Quthing, Queen Elizabeth II, Mokhotlong, Seboche, Scott, Maluti and Roma (St. Josephs) was rolled out to additional 6 HSAs in 2004, but Berea and Mantśonyane have not yet been reached. To strengthen capacity for implementation in PMTCT programme, 140 health personnel from the 14 areas comprising of registered nurses, nursing assistants and pharmacists were trained in PMTCT during the year. To further strengthen the program, 20 PMTCT trainers received training in psychosocial support of the infected women. This training is another positive step towards assisting HIV positive mothers to cope better with the situation. Furthermore training for 120 health workers from other areas did not take place because the third quarter Global Fund support disbursement had been put on hold. Assessment of program implementation by Linkage Consultants in the pilot HSAs has indicated success in QE II, Maluti and Scott, Mokhotlong, Seboche and Quthing. Implementation is low for St. Josephs HSA while the Leribe program failed to take off due to the reported lack of space. Leribe has however been followed up and it is sorting itself to effect this program. An increasing number of pregnant women are volunteering to undertake the HIV test as well as taking nevirapine to protect their unborn babies from being infected. A total of 12,528 women have been counselled and trained since the inception of the programme. Out of these, a total of 5,821 women were tested for HIV and 1,556 were found positive. 758 were provided with a full course of ARV prophylaxis Table: 1 PMTCT Service Provision in the HSAs in 2004 Years Number of Women Nevirapine Counselled Tested HIV Positive Received Uptake and trained Nevirapine ,664 1, % Baseline ,864 4,620 1, % Total 12,528 5,821 1, % CONDUCT COMMUNITY EMPOWERMENT ACTIVITIES YOUTH The Family Health Division, of the Ministry of Health and Social Welfare, conducted peer educators training in the Southern region of the country. The trainings started in Qacha s nek from April, 2004, and were completed in Mafeteng July, The target was to train 20 peer educators per district, in all ten districts, making a total of 200 in the country. The country is demarcated into three regions as follows: Southern (comprising 4 districts), Central (2 districts) and Northern (4). In all, 83 peer educators were trained in the southern region of Lesotho as follows: Qacha s nek - 18; Mohales hoek 15; Quthing - 20, and Mafeteng The trained peer educators in Qacha s nek are already active and implementing activities in the respective communities. During the third quarter, the World Vision Lesotho was provided with funds to conduct Peer education trainings in the Northern Region of the Country. The set target was to train additional 120 teachers on peer education. Because of shortage of funds however, World Vision only managed to train 15 teachers in peer education and life skills. The teachers also trained further 585 pupils on peer education and life skills by the end of the year. Intensive trainings are to be conducted during the first quarter of year 2005 when funds could be accessed.

6 CONDUCT ADVOCACY ACTIVITIES FOR COMMUNITY LEADERS. A workshop for community leaders was conducted to advocate the issues of breast-feeding and the PMTCT in the Quthing district at St. Matthews clinic. The other purpose of the workshop was to build capacity among the community leaders to enable them to support HIV positive mothers in making appropriate decisions on infant and young children feeding options. 70 community leaders were trained including 10 area chiefs, 15 church leaders and 45 community health works. Further MoHSW initiated the process to engage NGOs to promote PMTCT and VCT activities in respective communities using Global Fund resources INSTITUTIONALIZE HIV/AIDS CURRICULUM IN ALL SCHOOLS INCLUDING TERTIARY INSTITUTIONS The Ministry of Education and Training initiated the process of identifying a consultant to integrate HIV/AIDS in the school curriculum. The activity was put on hold because funds were not available to pay the Consultant. The decision was made to revisit the activity during the first quarter of MITIGATION COMPONENT The strategies under this component included advocating for the rights of orphans and other vulnerable children (OVCs) as well as those living with AIDS, enrolling OVCs in schools, and involvement of caregivers in support and care for the OVCs as well as the chronically ill. The objectives included scale up of the provision of basic package of care, support and protection to 60% of OVCs by 2007 and to increase general awareness on the human rights of persons living with HIV/AIDS (PLWHAs) including affected people in Lesotho by 40% by The activities to be implemented included mobilisation and sensitisation of Communities on OVC situation and problems; conducting awareness on the human rights of the PLWHAs and AIDSaffected people in Lesotho by 40% by 2007; Identification and training of care givers and volunteers throughout the country; Guaranteeing primary education for Orphans and Vulnerable Children; Provision of food baskets to OVCs and chronically ill;. Reduction of stigma and discrimination of the PLWHAs. Every year, the Ministry of Education and the department of Social Welfare, in the Ministry of Health and Social Welfare, register children throughout the country who cannot afford to pay for their education. However, this only covers those who come for help or referred by relatives, community or grandparents. Using Global Fund support, the OVCs that pass their secondary level are now being assisted to complete their high school. This is has been seen as a significant achievement and thus made a direct impact on the children whose future lives otherwise would have been bleak. PROGRESS : COMMUNITIES MOBILIZED / SENSITIZED ABOUT OVC PROBLEMS The Social Welfare has been mandated to coordinate the OVC issues, and this has seen the department taking the lead in the advocacy and sensitization of the public on the OVC rights. This was done through conducting of 30 radio talk episodes using local radio stations (i.e. Mo-Afrika and Catholic radio). The activity was conducted during the first and second quarters of the year. The activity had to stop during the third quarter as funds were not available to pay the radio stations.

7 INCREASE GENERAL AWARENESS ON THE HUMAN RIGHTS OF THE PLWHAS AND AIDS-AFFECTED AFFECTED PEOPLE IN LESOTHO BY 40% BY 2007 Workshops were conducted by the NGOs country-wide to increase awareness on the human rights of the PLWHAs and AIDS affected people in Lesotho. 169 community leaders and government officials were trained and sensitized in various districts of Lesotho, including as Thaba-tseka, Quthing, Mohaleshoek, Mafeteng, Maseru and Berea. Specifically 47 Government officials, 58 chiefs, 30 church leaders, 12 traditional healers, 3 Teachers, and 14 support groups were trained in Human Rights for PLWHAs. The trained leaders have identified the problem of stigma and discrimination against people living with AIDS in their areas and have begun to create awareness among the communities. Some chiefs also indicated that they were encouraging the people to test to know their status. The department of police and prisons have very active support groups that were formed with the purpose of creating awareness and providing lay counselling among the police and the prisoners. Training on Human Rights by category and district Districts Organization Total DS Govt Dept Chiefs Church Reps Trad. Healers Teachers/ NGOs Support Groups Mokhotlong Botha-Bothe/ Leribe Maseru Berea Mafeteng Mohale shoek Quthing Qacha snek Thaba-Tseka TOTAL Source : World Vision Progress Report (2004) IDENTIFY AND TRAIN CARE GIVERS AND VOLUNTEERS THROUGHOUT THE COUNTRY World Vision Lesotho managed to train 658 Volunteers in home - based care and support in all the districts except the district of Thaba-Tseka and Qachas nek due to shortage of funds to continue with trainings. Issues that relate to care of sick people were addressed; basic facts about HIV and AIDS, counselling, nursing care, nutrition, cleanliness, demonstration on use of care kits, production of vegetables and many more. The groups ranged from 40 to 90 in number. Where the numbers were high, the groups were broken down into manageable sizes.. The table below shows the number of care-givers trained per district.

8 8 CARE GIVERS BY DISTRICT District 3 4th Quarter Quarter TOTAL Botha-Bothe Bothe Leribe Berea Maseru Mafeteng Mohaleshoek Quthing Mokhotlong Qacha snek - 0 Thaba-Tseka Tseka - 0 TOTAL The trained Caregivers or volunteers provided support and care to 314 patients. The active volunteers came from the districts of Berea, Botha-Bothe, Matsieng, and Mafeteng. The Caregivers were to have provided with Home based Care Kits as support so as to be able to extend support to the patients. The home based care kits were not procured due to funds not made available during the last two quarters. This activity was postponed to be done during the first quarter of the second year. Those who managed to support and took care of patients raised their own funds to procure the supporting materials. PROCURE AND DISTRIBUTE FOOD BASKETS: The malnutrition crisis in most parts of the country affected about 44% of children under five years old. The aimed at supporting NGOs/CBOs/FBOs in the provision of food baskets to affected OVC. However due to limited funds and the need for programme sustainability, the activity was reprogrammed to extend other types of support to OVCs (ie. Income Generation Activities and Psycho-social support activities). Hence a request was put forward to the Global Fund in July, 2004 by the CCM to reprogramme the activity to implement Income Generating Activities (IGA). To-date, 37 Community Based Organizations in the form of support groups, youth groups and children s institutions in Maseru, Leribe, Botha-Bothe, Mafeteng and Quthing districts were trained in small business management and life skills so that they could be able to provide support to OVCs. Some of the IGAs already underway include rearing of chickens (broilers and layers) and/or pigs, producing vegetables and catering. Initial capital to start the enterprises will be given to the groups when funds are available. 2,071 OVC have so far been registered under the CBOs and the institutions committed to provide support. ORPHANS REGISTERED FOR IGA SUPPORT AREA NAME OF DISTRICT NGO/GROUP Botha-Bothe Bothe Manamela DATF office Maloseng Mopeli (Moreneng) Manamela S Group Re-Tla-Hlola PLW Maloseng S Group Likila Comm Assoc Maseru Nazareth Nazareth Clinic Naz Youth Dev Youth For Christ Selibeng Child Wel NUMBER OF CHILDREN

9 9 Matsieng Matsieng S Group Ha Paanya Moruthane Sekamaneng Mazenod Moruthane S Group Sisters of Charity Child Counseling Unit Lesotho Save the Children Mohalalitoe Mafeteng Mafeteng Lesotho Ref Church Motse-Mocha Matsaneng Quthing Moseneke Tosing Mokanametsong Koali Mamalitsane Ikaheng Moseneke Ithateleng Tosing Matsoho-Hlatsoana Raohang Basotho Tsohang Basotho Mokanametsong SG Ikaheng-Ka-Lerato Ikaheng Youth club Thaba-Tseka Tseka Paray Paray Primary 74 TOTAL GUARANTEE PRIMARY EDUCATION FOR ORPHANS AND VULNERABLE CHILDREN; PROVIDE FOOD BASKETS TO THE OVCs AND THE VERY SICK Initially, the primary level OVC were to be provided with the school fees. After consultations with the Ministry of Education and Training on the payment of OVC fees, the decision was then made that the OVCs who had completed their lower secondary level had a greater need for financial support to facilitate their progression to higher education. As the funds were not adequate to cover the OVCs, it was further agreed that criteria had to be set to identify those who were most needy. Hence priority was extended to double orphans and the desperately vulnerable children. Funds allowing however, other less desperate OVC, were to be considered. District AIDS Coordinators and District Education Officers were involved in the identification and registration of the OVC. Schools were required to take in the OVC that were not enrolled in their schools. Initially, the Primary level OVC were to be provided with all necessities such as fees and uniform to be able to attend school. It should be noted that the reason for reprogramming from primary to higher education, was that the Government of Lesotho had initiated free education for the primary pupils. As a result a substantial number of OVCs were eventually enrolled and registered in primary schools. The table below depicts the situation. Lower Higher Primary Orphans District Name Lower Higher Totals Butha-Buthe Leribe Berea Maseru Mafeteng Mohales Hoek Quthing Qacha's Nek

10 10 Thaba-Tseka Mokhotlong Totals Source : Report from MOE A criteria was agreed upon by the Ministry of Education and other stakeholders that the OVC to be supported should be those doing Form D and E. Priority was given to the double orphans. A total of 1,336 Orphans and Vulnerable Children (OVC) were registered and enrolled to be supported with fees at a higher level, to do Form D and E. Out of those, 1 OVC died during the schooling period, while 154 did not exist. High Schools Orphans District # of Schools # of OVC Butha-Buthe Leribe Berea 8 50 Maseru Mafeteng Mohales Hoek Quthing Qacha's Nek 9 47 Thaba-Tseka 2 17 Mokhotlong 3 77 Totals Source: World Vision Verification Report. November CARE AND TREATMENT COMPONENT Introduction As outlined in the approved proposal, comprehensive clinical care and support for people living with HIV/AIDS (PLWHAs) has been regarded as critical to the improvement of their quality of life. It is stated that PLWHAs must have access to the treatment of opportunistic infections coupled with psychosocial counselling and palliative care, and the services should be made available both in the homes and communities as well as in the health facilities providing a continuum of care. For the services to be efficient, the health facilities will have to establish and enhance referral systems down to the communality level, as well as strengthen service provision and coordination. The complete package of services includes the provision of adequate diagnostic facilities, adequate medicines for the treatment of opportunistic infections, the strengthening of referral mechanisms between the health centres and communities, the provision of home based care kits and training for both community care givers and health facility personnel and the counsellors.

11 11 Major Objectives to be achieved for this component included to provide Continuum of Care services to 80% of PLHWAs in Lesotho by 2007 (Botha-Bothe, Mafeteng, Maluti, Machabeng, Mohale s hoek, Maseru H.S.A in year one, and three additional H.S.As in year two. Three additional H.S.As will be identified in year one); to provide Antiretroviral ARV Therapy to 50% of the PLHWAs by 2007 and to establish Voluntary Counselling and Testing (VCT) services in all the 10 Districts by The activities which were planned during the year were: development of policy guidelines and protocols; identification and development of training and Capacity building programme for laboratory and non - laboratory personnel; Training and recruitment of counselors; establishment of VCT and the ARV programmes; training of Professional Health personnel on HIV diagnosis and management of the ARVs; Procurement of reagents and Laboratory supplies; and Monitoring for Quality assurance. PROGRESS: DEVELOPMENT OF POLICY GUIDELINES ES AND PROTOCOLS The manuals and guidelines for VCT and ARV treatment were developed and completed during the second quarter of the year. ARV registers, supervisory checklists and reporting forms were developed but printing and dissemination of those documents to the H.S.As did not take place due to delays in receiving the Global Fund money IDENTIFY AND DEVELOP TRAINING AND CAPACITY BUILDING PROGRAMME FOR LABORATORY AND NON - LABORATORY PERSONNEL From the 21 June, 2004 to the 16 July 2004, 56 laboratory technicians were trained on HIV and AIDS testing. The main objective of the workshop was to improve the knowledge and strengthen laboratory personnel capacity on HIV and AIDS care and support for those infected and affected. All HSAs were invited to participate, but only 13 HSAs participated, those without representatives were from Quthing, Mokhotlong, St. Joseph s, Seboche and Paray PROCUREMENT OF REAGENTS AND LABORATORY SUPPLIES Home - based care kits, reagents and ARV drugs were not procured because of unavailability of funds during this quarter ESTABLISH THE VCT AND THE ARV PROGRAMMES As part of the preparations for the national ARV programme roll-out, a needs assessment was conducted in all the districts excluding Thaba-Tseka. It was found out that in some districts there was a shortage of staff, equipment and space to start the program. But Leribe, QE-II, Mafeteng, and Mohale s Hoek had structures that needed to be rehabilitated. It was decided that the ARV programmes should be established within the HSAs as well as within the VCT sites. Four ART Clinics were established in the four H.S.As of Leribe, Mafeteng, Mohale s hoek, and QEII. A total of 858 patients have been put on ARV treatment since May These include 611 patients from Senkatana Clinic (non-global Fund support), 102 from Leribe (Tsepong Clinic), 117 from Mafeteng Clinic, 10 from QEII Clinic, 1 from Mokhotlong Clinic and 5 from Quthing Clinic. The ARV drugs currently being used were procured using the Lesotho Government funds. However funds from the Global Fund were only made available during the end of quarter four. Procurement of ARVs is planned in the first quarter of VCT sites were also established in the above mentioned HSAs. At the same time additional VCT sites in the remaining 5 Government HSAs (excluding Thaba-Tseka) have been opened and staffed with Counsellors whose salaries are being paid using Global Fund resources.

12 12 A total of 69 counsellors (including 10 professional, 24 basic and 35 community counsellors) were trained in VCT skills and deployed in all ten HSAs. Hence a significant number of clients have been counselled countrywide in all HSAs. Since July 2004, a total of 18,362 have been counselled in the 10 Government HSAs, in the PSI sites and in respective line Ministries. Out of these, 17,956 were tested for HIV and 7,632 were found to be positive. Since July 2004, VCT services have been availed to a large number of Basotho countrywide. The statistics presented below reflect the response noted since the placement of the counsellors. VCT Results of the 4 Districts Piloting ART Program Districts Leribe Maseru Mafete Clients Pre-test counselled ng Mohale s Hoek Total Clients test ed Clients Post-test counselled No. of female clients counselled No. of male clients counselled No. HIV positive No. HIV negative No. of clients who declined testing No. of clients referred 57 Source : Directorate HIV/AIDS/STI 2004 Report This is the data from the 4 established VCT sites. Below is the additional data from the rest of the HSAs where Counsellors have been deployed. VCT Results of districts not piloting ART Program Clients Pre-tested Districts Qacha s Berea Butha- Mokhotlon Quthing Total Nek Buthe g Clients tested Clients Post-tested No. of female clients counselled No. of male clients counselled No. HIV positive No. HIV negative No. of clients who declined testing No. of clients referred No of clients referred for PMTCT Source : Directorate HIV/AIDS/STI

13 13 The results above indicated that a significant number of Basotho were using the HTC facilities provided. The statistics from all districts depicted a steady increase in the people who voluntarily approached the VCT sites for testing. This could be attributed to the fact that the efforts have been made by the counsellors to sensitize the community about HTC services. TRAIN PROFESSIONAL HEALTH PERSONNEL ON HIV DIAGNOSIS AND MANAGEMENT OF THE ARVS 241 health professionals including doctors, nurses, pharmacists, laboratory technicians and laboratory technologists were trained in management and diagnosis of HIV/AIDS treatment. Health staff was drawn from all the districts except Quthing, Scott and Thaba tseka. 2.4 GOVERNANCE COMPONENT INTRODUCTION: The area of focus for this component was the enhancement and strengthening of LAPCA s/nas coordination mandate of all HIV/AIDS implementing structures at all levels. This included capacity building for LAPCA/NAS, as the central coordinating authority to ensure adequate coordination, development of policy and legal framework as well as guidelines for implementing agencies. Capacity building was to include technical assistance in issues related to Monitoring and Evaluation, training in different areas, and training of trainers program. There was also a need for staffing, equipment, infrastructure, and ability to provide technical support and overall institutional leadership and management for all participating agencies. These include PLHWAs, District AIDS Taskforces (DATFs), Community Based Organizations (CBOs), GOL ministries, NGOs and private sector. Civil Society, on the other hand, was to be strengthened in terms of their Umbrella bodies to enhance their ability to liaise with their membership involved in implementing HIV/AIDS activities at the community level. The strengthening of supervision at all levels will require transport. The objectives under this component which were to be achieved included to operationalise and strengthen LAPCA`s Coordination Mandate in the implementation of the National HIV/AIDS Strategic Plan by 100% by 2005; to establish and/or strengthen HIV/AIDS Coordination Units in all Public Sectors, and at least 80% Private and NGO Sectors at the Central level by 2007; and to strengthen the Capacity of the District HIV/AIDS Coordination Mechanism in all the sectors in and outside Government by The planned activities for the first year included: Procure equipment and vehicles; Renovate and furnish10 Offices for District secretaries; Train personnel on monitoring and evaluation; Develop communication strategy; Train DACs and DATF to develop comprehensive work-plans that integrate issues of prevention, mitigation and care and support; Assist Coordinating Units to develop strategic plans; Strengthen the umbrella body of NGOs to coordinate an implementation of HIV and AIDS activities at the community level; and Strengthen a network of PLWA groups to be more effective in coordination of PLWA. PROGRESS : PROCURE EQUIPMENT AND VEHICLES For the purpose of Coordination of the Global Fund activities, a motor vehicle was procured. A further three vehicles were procured, 2 for Continuum of Care activities within the Ministry of Health to monitor VCT and ART activities at the district level, while 1 vehicle was purchased for Lesotho Council of NGOs in order to coordinate NGOs activities. The 10 DACs offices were provided with desks and chairs, computers and printers which were procured for Coordinators as a means to strengthen the coordination at the District level. These

14 14 were the officers who were employed during the 2003 through the assistance of Development of Ireland and the Government of Lesotho to strengthen and monitor as well as coordinate HIV/AIDS activities at the district level. Additional Computers were procured for the Monitoring and Evaluation Expert and his counterpart, Communication Expert and Counterpart and the Coordination unit. The items were procured during the first quarter of the first year RENOVATE AND FURNISH 10 OFFICES FOR DISTRICT SECRETARIES The Ministry of Public Works and Transport conducted the needs survey of the District Secretaries Offices to investigate whether there was a possibility to house the DACs within the DS Offices, and this was followed by designing of the architectural plans and quantity estimates of materials to be used in the ten Districts. The Plans were completed during the third quarter of the year. The work to renovate / and construct were necessary was to be put on hold due to funds not being available during the third and fourth quarter of the year TRAIN PERSONNEL ON MONITORING AND EVALUATION A Monitoring and Evaluation Expert was hired during the last quarter of year, in November This expert was to work with the LAPCA/NAS to assist in the development of the National HIV/AIDS Monitoring and Evaluation Plan, establish the LAPCA/NAs M&E System, and pilot the system to ensure that it was working. The position of the Monitoring and Evaluation counterpart was also advertised and selected processes initiated. Due to the transformation which was carried out at LAPCA/NAS, the hiring of the counterpart was postponed until that time when the Chief Executive for NAS was in place. The training would then be on the job- training done by the M&E Expert when the counterpart is in place DEVELOP COMMUNICATION STRATEGY Although advertisement for the Position of the Communication Expert for the LPACA/NAS was made during the first quarter of implementation of the project, processing of the recruitment and that of a counterpart was put on hold until when the Chief Executive for LAPCA/NAS was in place. The process to develop the Communication strategy could therefore not go ahead without this expertise ASSIST COORDINATING UNITS TO DEVELOP STRATEGIC PLANS The Foundation for Hope Development conducted a two - week workshop for Coordinating Units to train them on Strategic Planning and for the development of the HIV and AIDS Strategic Plans for their individual sectors. A comprehensive HIV/AIDS Strategic Plan for all sectors is now available TRAIN DACS AND DATF TO DEVELOP COMPREHENSIVE WORK-PLANS THAT INTEGRATE ISSUES OF PREVENTION, MITIGATION AND CARE AND SUPPORT This activity was supposed to have been conducted during the third and fourth quarter of year. A local organisational development consulting firm, IDM Lesotho, was identified and contracted to train the DACs and DATFs during the fourth quarter. Because of shortage of funds, the training was put on hold and postponed to first quarter of The purpose of the training was to assist the DATFs to acquire skills in strategic planning, report and proposal writing, which would be followed by the development of the individual strategic plans, action plans and detailed costing of those plans.

15 STRENGTHEN THE UMBRELLA BODY OF NGOS TO COORDINATE AND IMPLEMENTATION OF HIV AND AIDS ACTIVITIES AT THE COMMUNITY LEVEL. The Lesotho Council of NGOs (LCN) has been strengthened to coordinate HIV/AIDS activities by engaging a HIV/AIDS Coordinator, for a period of two years. The office was also provided with a 4x4 Toyota Vehicle as well as office equipment for the Coordinator. The Coordinator started work since the month of September, STRENGTHEN A NETWORK OF PLWHA GROUPS TO BE MORE EFFECTIVE IN COORDINATION OF PLWA. A Constitution for the Associations of PLWHAS was developed and completed during the third quarter. This was work initiated by the Consultant supported by DCI funds during the year 2002/2003. This was followed by the establishment of a Network of PLWHAS. The draft document to establish the network is available. A task team was established to follow up activities which would ensure that all Associations of PLWHAS in the country were aware of the Network activities. The proposed name of the Network is (LENEPWA) Lesotho Network of People Living with AIDS. 3. KEY CHALLENGESS The major challenges during the first year of the implementation of the Global Fund support included: The strengthening of the Rand against the dollar, which resulted in the provision of funds being reduced by more than 60% from the original amount allocated. This has resulted in the targets set not being met fully as funds were limited. The unfortunate situation where the Monitoring and Evaluation Expert who was engaged to assist in the development of the Monitoring and Evaluation Plan not able to finish the work in time due to family problems. The second M&E Consultant was engaged during the third quarter to start the process afresh, managed to finish the M&E Plan by beginning of the fourth quarter. At the same time the Procurement Supply Management Plan was also delayed, and only saw the approval by the LFA in the last quarter of the year. Because of these two documents, funds were not released and not made accessible for the whole two quarters of the year. This means the major activities were delayed by a period of six months. The Transformation of LAPCA saw some of the activities being put on hold as they were dependent on the approval and consent of the new Chief Executive Officer especially that it is a Sub- Recipient for HIV/AIDS component. Some documents such as policies had been delayed in being finalized as they were still awaiting the Cabinet Approval. This has seen documents not being disseminated to stakeholders and being finalized. The tender board procedures had also delayed some activities such as procurement of medical and furniture as it takes between four to six months to get final approval on the whole process to get supplies in place. Limited number of professional health staff for training has resulted in some of the targets not being met.

16 16 4. CONCLUSION AND RECOMMENDATION MMENDATIONS Little progress was made, towards the attainment of targets, due to many factors and challenges that were encountered during The Major challenge was the issue of funds being put on hold with the recommendations made by the Local Fund Agent to the Global Fund. This was as a result of the lack of an m&e and PSM plan in the country. The set targets, on the other hand, were too high. The exchange rate fluctuations further exacerbated the situation especially that budget was based on the US dollar. By the time of proposal approval, the rand had strengthened, and the funds available were reduced by more than 60%. Furthermore, the delay by the Global Fund to release funds for the second disbursement by more than two months contributed in the lost implementation time for about six months. On the other hand, improvement in of voluntary testing and counselling strategies has led to increased uptake of ART services, while at the same more people have benefited from quality related support services. GOL has committed at the highest level by supporting ART and other related initiatives by making funds available and public statements accordingly. A nationwide roll-out of PMTCT was planned and partially accomplished in 2004, while the rest of the country will be covered before the end of Recommendations 1. Commitment toward implementation of the Global Fund implementation is needed especially from all level of sectors to ensure compliance of the contract agreement. 2. Concerted effort towards monitoring and supervision of the grant needs to be provided by the Lesotho CCM to ensure that implementation goes according to the schedule. 3. The Lesotho CCM should facilitate the additional resources especially to ensure larger scale roll out of ART programme, however the country needs to overcome the shortage of funds to ensure that more patients being placed on ARV treatment.


18 18 ITEM Q1 Q2 Q3 Q4 Total Year One Total Year Two CARE AND SUPPORT PROCUREMENT 114,461 RECRUITMENT 30, , , TRAINING 9, M&E 1, ADMINISTRATION 70, Sub-total 145, , , , MITIGATION PROCUREMENT RECRUITMENT 72,000 TRAINING 562,925 2, M&E ADMINISTRATION Sub-total 562,925 74, , PREVENTION PROCUREMENT RECRUITMENT TRAINING 14,194 35, , M&E 810 ADMINISTRATION Sub-total 15,004 35, , , GOVERNANCE PROCUREMENT 146,391 RECRUITMENT 12,727 21, TRAINING 6,276 6, M&E 510 ADMINISTRATION 7, ,207 10, , Sub-total 7, ,111 38, , , Grand Total Expenditure 7, , , , ,369, New receipts as at 22 December, 2004 US $ 3,148,252 3,148,252 Balance brought forward December, 31, 2004 US$3,246,798.20

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