Dr. Mean Chhi Vun NCHADS Director

Transcription

1 Dr. Mean Chhi Vun NCHADS Director The Second Phnom Penh Symposium on HIV Prevention, Care and Treatment Phnom Penh Hotel, Phnom Penh, Cambodia 15-16, December 2008

2 Outline Background Key success factors Some examples Challenges

3 Background Total Pop. ~ 13 million (MMR: 472/100,000, IMR: 95/1000) Female adult literacy rate: 57% Per capita GDP:339 (NSDP 2006) First HIV detected in 1991 and first AIDS case diagnosed in 1993 Main route of HIV transmission is heterosexual In 2006, estimated HIV prevalence among adult and children: 70,000 (0.9%) where 33,000 PLHA eligible for ART 3

4 Results: 10 years of collaborative effort 97% Cambodians aware of HIV Condom use in high risk sex - 97% VCT site is increasing from 12 in 2002 to ,000 people counselled, tested and return for the test result

5 HIV Prevalence among adult pop Urban Rural Total

6 Percent ART coverage among PLHA eligible for ART 71% 69% 65% Total Population (Adult and children) Adult Children

7 How Do We Get There? Two key factors in success: Ownership Partnership

8 Ownership (1) Clear Vision and Strategy Government-led: - HIV Prevention: stabilizing HIV epidemic within 10 years 100% CUP at brothel based implemented country wide - Care and treatment: increasing the access to high quality of care and ART to all those who are needed CoC integrated into HCS and implemented at OD. Strong program management: NCHADS - planning, resource allocation, SOPs, functioning M&E component

9 Ownership (2) Effective institutional structure: NCHADS is within MoH, based on Functional Task Analysis Decentralized implementation through health care system to provinces and Operational Districts Evidence-based programming (sentinel surveillance system since 1994 and BSS since 1997)

10 Partnership Working together with all partners: Clear and shared vision Common policy and strategies, guidelines Common M&E Explicit coordination mechanisms Explicit mutual benefit NCHADS plays the leading role to coordinate all relevant strategic activities through coordinating mechanisms: Steering Committees, Technical Working Groups (TWG), Sub-TWGs, partnership mechanisms

11 Examples

12 Coordinating Mechanisms, example Steering Committee On CoC TWG on VCCT TWG on FBC TWG on HCBC 1- Sub TWG on Lab 2- Sub TWG on QA TWGs & Sub TWGs led by NCHADS Technical Unit All relevant stakeholders are involving in policy, strategy and guidelines formulation and updating, program implementation and monitoring as well.

13 Example: Memorandum of Understanding (MoU) and Letter of Agreement (LoA) MoUs between MoH and all stakeholders: - Project details: Objectives, Strategic Interventions and Funding - Regular Monitoring: Quarterly Reports - Transparent and shared LoA between NCHADS and partners: - Project details: Objectives, Activities, Implementation Area (where) and Funding - Shared with PHD and OD - Regular Monitoring: Quarterly Meeting and Reporting - In 2007, 35 stakeholders and partners signed LoA with NCHADS For further detail information, please go to

14 How to manage resources: before 2002 (1) - More than 50 partners supported the HIV/AIDS response - No system for resource allocation - Duplication or gaps of resources to support activities - No information about funding (sources or expenditure) available for the national program

15 How to manage resources: before 2002 (2) INGOs LNGOs NCHADS Care Bilateral Donors NB Social Support Prevention ADB UN WB

16 How to manage resources effectively: SWiM (1) 1- Managing funds through NCHADS (10 funding sources): - SoPs: budget disbursement, ceilings, authority levels, procurement, monitoring and reporting (use for all funding sources) 2- Managing funds by stakeholders (eg. USAID through their NGOs partners) - LoA with NCHADS/PHD/OD - Agreement on coverage area and activities - Follow national policy, guideline and strategic activities For a sample of SoP, please go to

17 How to manage resources effectively: SWiM (2) Private Roche/UNSW Academic NGOs USAID/NGOs GFATM DFID CDC-GAP EU NCHADS (SOP) NB WB ADB LOA PHD/OD NGOs JICA ANRS Esther, etc HIV/AIDS Response

18 HIV/AIDS Funds Managed by NCHADS No. Source Title Start date End date Amount (millions) 1 ADB-CDC/GMS Regional Communicable Diseases Control Project for the GMS 2 CDC-GAP "Expansion of HIV/AIDS/STD Prevention in Cambodia" 3 DFID "Strengthening Cambodia's Response to HIV/AIDS" 4 EU "Increasing the Relevance and Effectiveness of HIV/AIDS Prevention and Care among Youth through a Cambodia-Thailand Partnership" July 2006 December 2009 $0.56 August 2002 July 2008 $6.00 July 2003 June 2008 $6.50 July 2004 June 2007 $ University of New South Wales/Roche "Cambodia Treatment Access Project" October 2003 September 2007 $ World Bank Grant TF H016 KH February 2003 January 2007 $ Clinton Foundation CF HIV/AIDS Initiative $ WHO "Development of a Data Management system for M&E for NCHADS" $ AHF AIDS Healthcare Foundation $ GFATM Round 1 August 2003 August 2006 $ GFATM Round 2 December 2003 December 2007 $ GFATM Round 4 September 2005 August 2009 $ GFATM Round 5* $3.24 Total $46.71

19 HIV funds from partners in provinces

20 Expenditures by source, NCHADS Program: DFID, $4,718,560, 25% EUROPAID, $1,074,562, 6% US CDC, $4,883,722, 27% CIPRA, $25,084, 0% CTAP, $20,539, 0% AusAID, $41,996, 0% CHAI, $154,497, 1% GFATM, $3,994,974, 21% NATIONAL BUDGET, $411,198, 2% ADB /JFPR REG 9006, $2,589,656, 14% WB - TF H016KH, $812,271, 4%

21 Challenges: implementation Work load of existing health staff at NCHADS, PHD/OD Creating conflict of interest and benefit (competition for resources) Limited capacity for management including finance and budgeting, reporting Harmonization among partners needs strengthening

22 Challenges: management Managing partnerships: negotiation and compromise Strengthening ownership: building confidence and capability among staff Governance: doing the right things in a less favorable environment Management: doing things right

23 Challenges: political will Understanding of the issues? Vertical vs integrated programming? New problem, so highlights need for new approaches Acceptance of change? Benefits: personal and institutional?

24 Thank you