Annual Progress Report of GFATM-HIV-SSF

Transcription

1 Kingdom of Cambodia Nation Religion King Ministry of Health Annual Progress Report of GFATM-HIV-SSF 1 st January st December 2011 National Center for HIV/AIDS, Dermatology and STD March 2012

2 Annual Progress Report of GFATM-HIV-SSF grant Contents I. Programmatic Information a) Programme Goals and Objectives b) Aggregate programmatic data for the annual reporting period 1. Impact and Outcome Indicators 2. Programmatic Indicators 3. Analysis of data quality and reporting issues 4. Conclusion II. Procurement Section 1. Expenditures 2. Updated procurement process 3. Issues and challenges III. Finance Section 2

3 Annual Progress Report GFATM-HIV-SSF grant Country: CAMBODIA Disease: HIV/AIDS Grant Number: CAM-H-NCHADS Principle-Recipient: PR-NCHADS Period: from 1st January 2011 to 31st December 2011 I. Programmatic information: a) Programme Goals and Objectives: Under the GFATM-HIV-SSF, there are 7 goals and 20 objectives. 1. Goals: 1. Goal 1: To strengthen the coordination and monitoring capacity within and across national and provincial multi-sectoral initiatives; 2. Goal 2: To scale-up illicit drug related HIV/AIDS programs as a key component to achieve Cambodia's Universal Access targets; 3. Goal 3: National scale up of HIV prevention, treatment and care for Men who have sex with Men (MSM); 4. Goal 4: To strengthen and maintain outreach and related services for Sex Workers (SWs) and expand STI services (100% Condom Use Programme) for all vulnerable groups in order to achieve universal access to HIV/AIDS services; 5. Goal 5: To reduce the impact of HIV/AIDS on Orphan Vulnerable Children (OVC) in Cambodia; and 6. Goal 6: To maintain and extend comprehensive care and treatment for People Living with HIV/AIDS (PLHA) through the Continuum of Care (CoC) framework. 7. Goal 7: To Strengthening of the national M&E system for the comprehensive and multi sectoral response to HIV 2. Main Program Objectives: 1. Strengthen coordination and capacity of multi-sectoral working groups; 2. Improve quality and accessibility of integrated services for prevention of illicit DU and HIV/AIDS transmission; 3. Develop, strengthen and improve national understanding and response to DU and HIV/AIDS; 4. Improve quality and accessibility of comprehensive detoxification, treatment and rehabilitation for DU/IDU. 5. Build national understanding of MSM issues through strategic information, enhanced advocacy and institutional capacity building. 6. Improve quality and increase coverage of targeted and comprehensive HIV prevention with MSM; 7. Improve access to quality HIV and STI treatment, care and support services and information; 8. Provide HIV/AIDS prevention and awareness messages to sex workers; 9. Improve access to health care treatment for SWs; 10. Strengthen STI services for SWs and other groups; 11. Strengthen government capacity to develop and implement policies and programs to protect, care and support OVC. 3

4 12. Strengthen capacity and community responses to protect, care and support OVC and families affected by HIV/AIDS and to ensure their increased access to essential services; 13. Improve quality and accessibility of comprehensive care for PLHA through consolidation of HFBC services in selected sites; 14. Strengthening linkages and referrals to support a linked response for prevention, care and treatment of HIV/AIDS and reproductive health including PMTCT; 15. Strengthen Strategic Information and data management systems for monitoring the Health Sector response to HIV/AIDS; 16. Provide community services to support increased access, uptake and adherence to HIV services (through CHBC, PLHA-SG and MMM activities); 17. Sustain the programme capability and effectiveness of NCHADS as a department within the Ministry of Health; 18. Strengthen the national multi-sectoral M&E system; 19. Ensure sound evidence based HIV/AIDS programming through monitoring; 20. Promote sharing of information and advocate effective use of information by all stakeholders in the national response to HIV/AIDS. b) Aggregate programmatic data for the annual reporting period: 1. Impact and Outcome Indicators: Key indicators 1. Percentage of injecting drug users aged who are HIV-infected 2. Percentage of men who have sex with men who are HIV-infected 3. Percentage of entertainment workers ( brothel based and Nonbrothel based) aged < 20 years who are HIVinfected 4. Percentage of adults and children with HIV known Baseline (year) 24.4% (2007) 4.5% (2005) 2.9% (2006) A: 87.4% C: 93.5% Intended results/ targets Actual results/ targets Data source Reason for programmatic deviation 19.5% n/a IBBSS DU/IDU IBBS will be conducted in 2012 DU/IDU is becoming a very sensitive issue, due to strong enforcement of village/commune safety policy "safe community" or "crime-free communities" that has been implemented by Ministry of Interior to ensure that there will be no drug use in communities. Based on this issue, it is expected the study on DU/IDU may be delayed until the end of 2012, in order to work closely with Ministry of Interior to improve environment to access DU/IDU for both study and services. n/a n/a IBBSS The target is set for n/a n/a IBBSS The target is set for A: 88% C: 94% A: 92.6% C: n/a NCHADS (DMU) Adults: based on 34 out of 57 adult sites (3393/3666) 4

5 to be on treatment 12 months after initiation of antiretroviral therapy 5. Number and percentage of infants born to HIV infected mothers who are infected 6. Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they injected 7. Percentage of MSM reporting the use of condom the last time they had anal sex with a male (non paid and non paying) in the past one month 8. Percentage of Entertainment workers reporting consistent condom use with every client/ sweetheart in past 3 months (2009) Data for Child did not available because only have data for 2 out of 33 pediatric sites since 29 sites do not have electronic databases since they don't have computers and are not able to clean the data. Past experiences proved that counting by hand has produced low quality data. 27% (1050) (2006) 10% % 176 HSS modeling The data is based on estimated number of HIV+ pregnant women = 1461 in 2011 multiplied by transmission probability which = 12% (172/1461) 64.7% 80% n/a IBBSS DU/IDU IBBS will be conducted in 2012 DU/IDU is becoming a very sensitive issue, due to strong enforcement of village/commune safety policy " safe community" or "crime-free communities" that has been implemented by Ministry of Interior to ensure that there will be no drug use in communities. Based on this issue, it is expected the study on DU/IDU may be delayed until the end of 2012, in order to work closely with Ministry of Interior to improve environment to access DU/IDU for both study and services. 83% n/a n/a IBBSS The target is set for (2007) clients: 94%; sweethearts: 52% (2007) n/a n/a IBBSS The target is set for

6 2. Programmatic Indicators: Key indicators 1. Number of IDU reached by needles/syringe programme Baseline (year) % of projected IDUs (old plus new but not repeated contacts) (2010) Intended results/ targets Actual results/ targets Data source NGOs reports (FHI, FI & KHANA) Reason for programmatic deviation Under achieved: 40% 0% of achievement is from GF funding; all achievement is from AUSAID HAARP program. Lack of GF contribution is due to needles and syringes still in process of procurement. Procurement is required through VPP which has denied procuring needles/syringes for PR NCHADS. PR is waiting for guidance from GF FPM on procurement possibilities for needles/syringes. FHI's achieved 0% due to fact that their SSRs still do not have an NSP license yet. FI Q4: achieved 272 against the target 183 Q3: achieved 265 against target of 179; NSP license has been renewed for 2011 with one SSR (Mith Samlanh) and the team has been implementing the program under other alternative funding (HAARP) since needles/syringes not yet procured under GF. KHANA Q4: achieved 73 against the target 589 Q3: achieved 10% of 53/506 KHANA s SSRs can only distribute needles within their drop in centers, not through outreach workers. KHANA NSP program reached no IDU under GF due to lack of procurement of needles/syringes. The 73 IDU were reached through KHANA Meanchey Drop-in Center (KMDC) under AusAID/ HAARP funding. Only SSR KMDC has been successful in receiving a NSP license from NACD. This license covers 18 Sangkat in Phnom Penh, however NACD has delayed issuing authorised ID cards for outreach workers to implement NSP in their outreach activities or in collaboration with SSRs. Due to the delay in issuing ID cards, it has only been possible to implement NSP in the KMDC DIC,

7 2. Number of DU/IDU reached by all three HIV prevention program activities at least once during quarter: (a) Outreach education (b) Condom distribution (c) Referral to STI, VCCT, OI/ART services 11,528 (cumulative) 7,531 6,164 NGOs reports (FHI, FI & KHANA) resulting in the low number of IDU reached by NSP. To address the issue of licensing, PR-NCHADS, SRs and relevant partners have consulted, prepared and submitted the Needle and Syringe Program (NSP) application package to NACD and are waiting along with the two other applicants for the review of applications by H.E. Deputy Prime Minister Ke Kimyan. There has been tacit approval by H.E. Minister of Health Eng Huot for the implementation of NSP at MMT Clinic and steps are in process to allow commencement of the provision of services. The goal is to move towards provision of NSP in public health centers. Under achieved: 82% 2 SRs underachieved because of the impact of the Village and Commune Safety Policy and the crime reduction strategies of the Cambodian Nationa Police being implemented nationwide. Only FI overchieved due to the Needle Syringe provision and medicinal medical intervention, their SSRs were able to operate their HIV prevention activities during the reporting period. - FHI achieved 71% (1985 against the target 2803) - FI achieved 123% (1547 against the target 1261) - KHANA achieved 76% (2632 against the target 3467) In quarter 3, 2011 achieved 89% of 6567 IDUs againts the target 7410 (FHI achieved 87.81% of 2450 against the target 2803; FI achieved 105% of 1309/1204 and KHANA 100% of 2808/2808). 3. Number of opioid dependent DU currently enrolled on methadone programme per period 61 (2010) NGOs reports (FHI) Over achieved: 108% FHI is SR providing oversight for this activity. The slight overachievement is due to continued MMT education at the Korsang drop-in center and assisted referrals from Korsang to the MMT Clinic at Khmer-Soviet Friendship Hospital. 4. Number of men who have sex with men reached 19,422 (Cumulative) 7,555 9,546 NGO reports In quarter 3, MMT achieved % ( 104 against the target 95) Over achieved: 126% 3 SRs achieved and overachieved, except KHANA underachieved 7

8 at least once per quarter by both these two outreach activities (a) IEC on HIV prevention (b) Condom distribution (2010) (FHI, MSC, PSI, KHANA) because one SSR (CUD) in Preah Sihanouk province was phased out due to the organizational internal conflicts and management issues. KHANA will recriut another new SSR to replace CUD. - FHI achieved 130% (2189 against the target 1680) - MSIC achieved 99.7% (1077 against the target 1080) - KHANA achieved 69% (1918 against the target 2795); - PSI achieved 218% (4362 against the target 2000) In quarter 3, 2011, achieved 128% of 8899 MSMs againts the target 6960 (FHI achieved 75 % (862 against the target 1150); KHANA 88% of 2,395 againts 2,730; MSIC: 95% of 1026 against 1080 and PSI: 231% of 4,616/2000) PR-NCHADS asked PSI to revise the taget for this indicator due to consistent overachievement, PR-NCHADS will request the GF to revise the target accordingly in updated PF. 5. Number and percent of Entertainment workers reached at least once per quarter by both these two outreach activities (a) IEC on HIV prevention (b) Condom distribution 11,953 (88%) (2010) 11,600 (89%) 9,020 (65%) NGO reports (CWPD, RHAC) Underachieved 78% Main issue is not enough condoms to reach all EW due to fact that procurement delayed by VPP. However, it also appears strategy for condom distribution by SRs is also an issue, as they are not distributing equally across sites and based on need. Achievement in Q3, 2011, achieved 67% of 7773 EWs against the target 11600, again underachieved due to lack of condoms CWPD: Q4: achieved 72.2% of 5990 against the target 6250 but only 4515 received condoms Q3: achieved 64.4% of 5787 reached, but only 4028 received condoms RHAC: Q4: achieved 4505 against the target 5550 Q3; 67% of 3745/5550. EWs in the coverage area in Q4 (13982) 8

9 6. Number of STI cases appropriately diagnosed, treated and counseled (EWs and MSMs) 28,225 EW=26,622 MSM= 1603 ( 2010) 20,600 (5,150 additional) EW=4,650 MSM=500 26,915 EW=25,01 9 MSM=189 6 NCHADS (DMU) Overachieved 131% This indicator represents national data, which is collected from all Goverment STI clinics and NGOs implementing and reporting STI services to EW and MSM in Cambodia. Q1: targets were EW=4,700; MSM=500 ; Achieved EW=5,821 MSM=382 Q2 targets were EW=4650, MSM=500; Achieved EW=5,962 MSM=406 Q3: targets were EW=4,650; MSM=500 ; Achieved EW=6,657 MSM=581 Q4 targets were EW=4650, MSM=500; Achieved EW=6,579 MSM=527 PR-NCHADS will request the GF to revise the target upwards starting January 2012 based on consistent overachievements. 7. Number and percentage of OVC whose household received at least 3 of the following types of support - health care assistance - education assistance - food/cash transfers - economic - psychosocial - other (legal/protection/shelter) 4514 (2010) 8,539 9,273 NGO reports (SCA, WVC, KHANA) Overachieved 109% - KHANA overachieved 109% (6561 against the target 6000) - SCI achieved 101% (1011 against the target 1000) - WVC achieved 97% (1701 against the target 1526) In quarter 3 we reached 103% (8765 against the target 8512); KHANA achieved 107% of 6400/6000; SCI: achieved 90% of 885/986 and WVC: achieved 97% of 1480/1526 The result was over-achieved due to mistake in calculation of the individual SR targets. (Target in KHANA s PF is 6,000 but in PR consolidated PF only 2710). The correct target in the PR PF should be 8,539. PR-NCHADS will ask GFATM to update the targets for this indicator. 8. Number of people tested for HIV and who received 348,647 (2010) 390, ,657 NCHADS (DMU) Overachieved: 103% Data compiled by NCHADS data management unit. Represents 9

10 their HIV test result (all sites) countrywide data from all VCCT sites. Results also include those partners reporting pregnant women from Linked Response sites. 9. Number of adults with advanced HIV infection currently on HAART (all sites) 10. Number of children (<15 years) with advanced HIV infection currently on HAART (all sites) 11. Number and percentage of newly registered HIV positive patients at ART/OI sites tested for TB 5,806 (2007) 4,102 (2010) 4,976 (68%) (2010) 40,500 42,034 NCHADS (DMU) 4,200 4,439 NCHADS (DMU) 90% 8,280 (78.5%) 5,596 NCHADS (DMU) Overachieved: 104% Represents countrywide data from 56 OI/ART sites, compiled by NCHADS data management unit. PR-NCHADS will ask GFATM to update the targets for this indicator Overachieved: 106% Represents countrywide data from 33 sites, compiled by NCHADS data management unit. PR-NCHADS will ask GFATM to update the targets for this indicator 87% - achieved (78.5%/90%) 78.5% of 4757/6059. Denominator=number of PLHA newly registered at OI/ART sites (estimated to be about 2,300 per quarter=9200), but actually, there are only 6059 new OI patients register at OI/ART sites: Q1: 1266/1456 Q2: 1157/1590; 2423/3046 (cumulative) Q3:1293/1651; 3716/4697 (cumulative) Q4: 1041/1362; 4757/6059(cumulative) 12. Number and percentage of health centres with HBC support teams % (2010) 437 (46%) 488 (51%) Report from (CHEC, CRS, KHANA, NCHADS, RHAC, WOMEN) Overachieved:120% 51% of HCs reached by 6 SRs: CHEC, CRS, KHANA, NCHADS, RHAC & WOMEN during this report: 488 HCs; denominator= 948HCs. - CHEC overachieved 90% (27 against the target 30) - CRS achieved 118% (130 against the target 110) - KHANA achieved 92% (144 against the target 157) - NCHADS achieved 34 HCs against the target 0 in this reporting period, because NCHADs has target only the 2 quarters (Q1&Q2), but due to the grant was signed late, therefore 10

11 NCHADS has carried budget from last reporting period to contract to NGO for implement these activities from July to Dec RHAC achieved 133% (44 against the target 33) - WOMEN achieved 100% (109 against the target 109) The target for this indicator has been calculated incorrectly and correct target should reflect CHEC target of 30 and KHANA target of 157 for total of 464. PR NCHADS will be updating the PF as of Jan 2012 for GF approval. 13. Number of PLHAs supported by HBC teams 14, 877 (2010) 14,353 16,577 Report from (CHEC, CRS, KHANA, NCHADS, RHAC, WOMEN) Note: CRS, RHAC and NCHADS has revised the target during the reprogramming, and PR-NCHADS will revise the target in updated PF for GF approval. Overachieved:115% The result was included the number of CIAs covered by HBC teams as already reported by 5 SRs, KHANA does not include the CIAs covered by HBC teams, but will do so starting from the next PUDR. - CHEC overachieved 103% (617 against the target 600) - CRS achieved 116% (3928 against the target 3388) - KHANA achieved 92% (5594 against the target 6060) - NCHADS achieved 1420 against the target 0 in this reporting period, because NCHADs has target only the 2 quarters (Q1&Q2), but due to the grant was signed late, therefore NCHADS has carried budget from last reporting period to contract to NGO for implement these activities from July to Dec RHAC achieved 117% (1540 against the target 1320) - WOMEN achieved 117% ( 3478 against the target 2985) 14. Number and % of patients on ART who kept Adult = 75.9% Children= 90.5% 80% 77.9% NCHADS (EWI Note: CRS, RHAC and NCHADS has revised the target during the reprogramming, and PR-NCHADS will revise the target in updated PF for GF approval Achieved: 97% 11

12 all appointments during the past 12 months after their ARV initiation or until the time they were classified as lost to follow up, dead, transferred out or stopped ART 15. Number and percentage of the estimated pregnant women in Cambodia tested for HIV and received their test result (all sites) 16. Number and percentage (%) of HIV-infected pregnant women who received ARVs. (2009) report) Represents sampling of 31 adults sites and 20 child sites. Random sampling of clients based on size of site. Total= 2116 Adults = 1857 or 78.6% kept all appointments Child = 259 or 73.6% kept all appointments 42% 146,453/ 348,536 (2009) 32.3% 798/ 2,475 (2009) 61% 222, % 247,106 NMCHC 56% 68.72% NCHADS & NMCHC Overachieved:111% Represents country wide data which were collected by NMCHC from PMTCT and LR sites from 841HCs and 75 RHs of 77 Ods. The denominator is estimated number of pregnant women in Cambodia in 2011: 366,080 (Total population: x crude birth rate: 2.56) (source MOH/DPHI). Overachieved:123% Total PW received ARV in year 2011 is 1004 The denominator is estimated number of HIV-infected pregnant women in 2011= 1461 (0.4%X 366,080=1464) 17. Percent of CSO staff trained in M&E curriculum who receive passing score on the training post test. 18. Number of data verification/ supervision n/a (2010) n/a (2010) n/a n/a HACC Report 5 3 NAA Report The numerator is: Number of women on ART that got pregnant during the period + Number of women on OI drugs (pre-art) that started ART prophylaxis + Number of pregnant women that know status and are HIV positive, are not on ART or ART prophylaxis, and received ART prophylaxis during delivery + Number of pregnant women that do not know their status, were tested and found to be HIV positive at the time of delivery and received ART prophylaxis during delivery. No trainings scheduled for year 1, scheduled to start in year 2 Underachieved: 60% 12

13 visits to sub-national level by NAA 19. Number and percentage of line ministries and other Government departments regularly reporting requested data to the NAA multi-sector database for monitoring the progress made in implementing NSP III n/a (2010) 5 56% 6 66% NAA Report There were 3 monitoring visits in Q3, and 3 monitoring visits in Q4. NAA has had slow impementation in 2011 due to shortage of staff. However new staff have been hired which will help to reach monitoring visit targets. Overachieved: 120% There are 6 ministries sent the requested data to NAA, these are among the target ministries. They are MoLVT, MoInt, MoND, MoSVY, MoWA, MoEYS. 13

14 3. Analysis of data quality and reporting issues: There were a number of data quality issues that were revealed during the last reporting period as a result of the following: 1. PR monitoring visits that included M&E component, in particular data verification of previous PU/DR data. PR conducted M&E monitoring visits to 11 SRs and 1 SSR between July 2011 and January The SRs visited included AHF, CHEC, FHI, FI, KHANA, MSIC, NAA, NPH, PSI, SCA, and WVC, and the SSR was MMT clinic (visited twice). Data verfication was conducted at each of these site visits. In almost all visits, some data issue was discovered, but usually a miscalculation which was easily resolved. In some cases, there were more serious data issues resulting from the SR not following definition of the indicator. This was particularly the case of MSM and OVC indicators. In these cases sometimes the data collection tools had to be modified to ensure correct data was collected. In other cases a deep discussion on the definition of the indicator was required, walking through scenarios of inclusion and exclusion factors. Where data issues were found data values were updated to reflect the definition of indicator. 2. DQA conducted in November 2011 the debrief provided to PR in November 2011 alerted PR to the issues surrounding the EW prevention indicator. This indicator has proved more problematic to resolve, particularly with regards to CWPD. PR has been working extensively with CWPD to improve their data collection tools and guide them to train their peer educators and outreach workers in data recording per indicator definition. Further CWPD was reporting EW that had only received IEC, not condoms, contrary to the definition of the indicator. PR has been able to work with CWPD to update the figure to more accurately reflect definition for this PU/DR. 3. LFA discussion of supporting documents revealed issues across number of indicators including "number of PLHIV who kept appointments" as well as some of the prevention indicators. The issues surrounding the supporting documents for these indicators have been resolved by PR working closely with SRs and verifying data they reported reflects indicator definition. d). Conclusion: Overall most performance indicators were achieved or overachieved o Much improvement has been seen since last reporting periods with most SRs achieving most of their performance indicator targets. In many cases there was much overachievement which will inform the review of performance indicators and targets during the reprogramming. In certain cases were indicators were underachieved or severely underachieved, this was mainly due to procurement issues. o It was agreed that more guidance on interpreting progress & subsequent planning to certain sub-recipients is necessary, & will be focus of second year of implementation. o Additional efforts are needed to ensure procurement process does not further delay implementation and affect coverage of people. Negative effect of procurement process on programming The procurement process through VPP remains constraining, especially for procuring small items including condom, needles/ syringes, etc. that affected to the program activities. There is no resolve for procurement of needles and syringes to date, as VPP has not agreed to procure these for PR-NCHADS. PR is waiting to hear from GF regarding decision for procurement of needles and syringes.

15 II. Procurement Section: 1. Expenditures: In year 1, the Global Fund approved budget allocated for the following procurement categories: The Global Fund disbursed fund to PR-NCHADS for Procurement of: ARV Drugs through UNICEF Reagents (HIV Test Kits) through UNCIEF CD4 Reagents & Viral Load (direct contract) Non-Health Products The Global Fund hold fund for Procurement of: Diagnostic product/rapid test (excluded HIV test kits) Pharmaceutical (OI Drugs) Consumables Health Equipment Renovation of OI/ART facilities 15

16 No Categories Total Budget for Reporting Period [USD] Actual Expenditures for Jan-Dec 2011 Current Balance Committed as of Dec Activities Carry Over Current Saving Explanation of Variance and Comments 1 Pharmaceuticals $5,275, $ 5,338, $ (81,215.03) $ (62,974.03) 1.1 ARV drugs $ 4,665, $ 4,665, Procured through UNICEF. The overspent was covering freigh, insurance, handling and buffer. During the planning process, we did not included these costs OI Drugs $ 591, $ 672, $ (81,215.03)) $ (81,215.03) 1.3 Drug and Consumable for Social Health Clinic Health Products and Commodities (excluding pharmaceuticals) $ 18,241 $ 18,241 $2,221, $ 917, $ 1,303, $ 1,303, HIV test kits and other tests $1,959, $ 917, $1,042, $ 1,042, The procurement process is delay due to procure through procurement agent. As the result of the pending to conduct the procurement from VPP on Pharmaceutical Product, Health Product and Health Equipment, This budget will be used in

17 2012. $ 261, Reagent & Consumables $ 261, $ 261, Health Products $ 64, $ 64, $ 64, Service $ 18, $ 18, $ - $ 18, As the result of the pending to conduct the procurement from VPP on Phamaceutical Prodcut, Health Product and Health Equipment, This budget will be used in The procurement process is delay due to procure through procurement agent. This budget will be used in 2012 because there are more shipment from both VPP and UNICEF under the procurement in Non-Health Products $2,819, $ 124, $ 1,953, $ 1,960, Vehicle (Pick Up) - NCHADS $ 21, $ (21,106.38) $ - $ (21,106.38) Vehicle (Pick Up) $ 25, $ (253,961.37) $ (253,961.37) Vehicle (4-WD) NCHADS $ 63, $ (63,712.49) $ (63,712.49) 17

18 Vehicle (Van) for Social Health Clinic (SHC) $ 31, $ (31,667.96) $ (31,667.96) Motorcycles $ 20, $ 23, $ (3,297.00) $ (3,297.00) 5.2 Office Equipment/Electronic Equipment/IT Software $ 516, $ 7, $508, $508, Office Furniture $ 77, $ 28, $ 49, $ 49, Office supplies/ Stationeries /Other Supplies IEC / Training / Education and Other Printing Materials $ 223,503.1 $ 114, $ 109, $ 109, $ 350, $ 223, $ 126, $ 126, Services $ 1,260,576 $ 96, $1,163, $1,163,

19 2. Procurement Progress Update: 1. Procurement of Condoms: PR-NCHADS signed confirmation on VPP s price quote (PQ-7246) on 30 June 2011 The delivery time offered by VPP is 24 weeks VPP current planned for delivery is 30 March Procurement of ARV drugs: PR-NCHADS signed the confirmation on VPP s price quote (PQ-8484) on for 2012 requirement, PR-NCHADS received planned delivery schedule on 18 January Procurement of HIV test kits, Reagents & Consumables: PR-NCHADS submit the revised forecasting to TGF on 1 December PR-NCHADS received first request from LFA on 17 January 2012 for supporting documents. PR-NCHADS received the second feedback from the GFATM on 20 February 2012 which we are working on the responses, and will response very soon. PR-NCHADS concern that we will face stock out by end of March 2012 which will affect the program implementation. 4. Updated CD4 Leasing Agreements with BD: PR-NCHADS submitted the request to renew the contract with BD for leasing of CD4 Machine and add two new machines to the TGF on 3 February The total machines will be 9 machines to support care and treatment in the country. PR-NCHADS received comments from TGF on 18 February After gone through the comments provided by TGF, PR-NCHADS will work to responses soon. 5. OI drugs: PR-NCHADS placed order with UNICEF at the end of The drugs will arrive in country soon. 3. Issues and Challenges Working with PR-CNM to finalize technical specification on IT equipment. Recruitment of International Procurement Agency which result in delay procurement of other reagents & consumables, and health equipment.

20 III. Finance Section: Budget for Reporting Period Actual Cash Outflow for Reporting Period Variance Reason for Variance Cumulative Budget through period of Progress Update Cumulative Actual Cash Outflow through period of Progress Update Variance Reason for Variance 1. Total PR cash outflow vs. budget 8,260, ,806, (6,546,554.54) 29,253, ,476, ,777, a. PR's total expenditures 3,379, ,747, (6,367,605.45) As the result of the pending approval on the Non health matrix 2011, the procurement process of the electronic equipment can't be start. Now GF approved to start the pool procurement of electronic equipment between PR-NCHADS and PR-CNM. On the other hand, the budgets of the renovation of various sites were not yet approved by GF. In other hand, some activities under "training, M&E, information system and operational 18,429, ,062, ,367, As the result of the pending approval on the Non health matrix 2011, the procurement process of the electronic equipment can't be start. Now GF approved to start the pool procurement of electronic equipment between PR-NCHADS and PR-CNM. On the other hand, the budgets of the renovation of various sites were not yet approved by GF. In other hand, some activities under "training, M&E, information system and operational

21 research" were not implemented due to delay in approval on annual budget and especially on training plan. Therefore, PR- NCHADS would like to carry over these activities to implement in research" were not implemented due to delay in approval on annual budget and especially on training plan. Therefore, PR- NCHADS would like to carry over these activities to implement in b. Disbursements to subrecipients 4,880, ,059, (178,949.09) This variance is due to direct payment for ARV drugs through VPP planned in Q was included. 10,823, ,413, ,410, This variance is due to funded kept by PR for pool procurement for Health Products and Equipments, and retained for SRs cash advance for replenishment request from SRs after liquidating the current cash advances. 21

22 Budget for Reporting Period* Actual Cash Outflow for Reporting Period Variance Reason for Variance Cumulative Budget through period of Progress Update Cumulative Actual Cash Outflow through period of Progress Update Variance Reason for Variance 2. Total pharmaceutical & health product expenditures vs. budget 54, ,378, (7,324,240.05) 8,414, ,603, (4,188,955.20) 2a. Medicines and pharmaceutical products 4, ,728, b. Health products and health equipment 50, , (6,724,685.79) (599,554.26) The over spending due to the purchase of ARV drug for 2012 with VPP in the total amount of 5,969, USD. For 2011, ARV Drugs were procured by UNICEF in the total amount of 4,695, USD and OI Drugs in total amount of 672, USD. As the result of advice from GF to conduct the procurement on Pharmaceutical Product, Health Product and Health Equipment through procurement agent, until now the procurement agent was not hired yet. Some of items were purchased through UNICEF in Q3 5,353, ,328, ,060, ,274, (5,975,314.51) 1,786, The over spending due to the purchase of ARV drug for 2012 with VPP in the total amount of 5,969, USD. For 2011, ARV Drugs were procured by UNICEF in the total amount of 4,695, USD and OI Drugs in total amount of 672, USD.\ As the result of advice from GF to conduct the procurement on Pharmaceutical Product, Health Product and Health Equipment through procurement agent, until now the procurement agent was not hired yet. Some of the procurement were conduct through

23 & Q4 but the budget set in Q1 & Q2. UNICEF. The carried budget will be used in 2012 for purchase the remaining health commodities which were not purchase in 2011 through UNICEF. As the result of the adjustment from 2010, the saving is from