ANNUAL PROGRESS REPORT 2014/15 PROVINCIAL STRATEGIC PLAN

Transcription

1 MARCH 2016 ANNUAL PROGRESS REPORT 2014/15 PROVINCIAL STRATEGIC PLAN KZN PROVINCAL AIDS COUNCIL

2 ACRONYMS AND ABBREVIATIONS ART ANTIRETROVIRAL THERAPHY DAC DISTRICT AIDS COUNCIL DHIS DISTRICT HEALTH INFORMATION SYSTEM HAST HIV AND AIDS, STI AND TB HCT HIV COUNSELLING AND TESTING HPV - HUMAN PAPILLOMA VIRUS HTA HIGH TRANSMISSION AREAS KZN- KWAZULU-NATAL LAC LOCAL AIDS COUNCIL LGBT LISBIANS GAYS BISEXUAL TRANSAXUAL LMIS LOGISTIC MANAGEMENT INFORMATION SYSTEM NHI NATIONAL HEALTH INSUARANCE NIMART NURSE INITIATED AND MANAGED ANTI-RETROVARAL TREATMENT OSS OPERATION SUKUMA SAKHE PCR- POLYMERASE CHAIN REACTION PGDS - PROVINCIAL GROWTH AND DEVELOPMENT STRATEGY PLHIV PEOPLE LIVING WITH HIV PMTCT PREVENTION OF MOTHER TO CHILD TRANSMISSION PSP PROVINCIAL STRATEGIC PLAN SCM- SUPPLY CHAIN MANAGEMENT TIVET - TECHNICAL AND VOCATIONAL EDUCATION AND TRAINING P a g e 1 20

3 TABLE OF CONTENTS BACKGROUND TO PSP ASSESSING PROGRESS MADE ON PSP/NSP GOALS...6 ASSESSING PROGRESS MADE ON THE SOs...9 MONITORING AND EVALUATION..18 ON CONCLUSION..20 P a g e 2 20

4 BACKGROUND TO KZN PSP The KwaZulu-Natal Provincial HIV and AIDS, STI and TB (HAST) Plan sets out the broad strategic directions that will guide the HAST response over the next five years. Development of the plan was borne out of a series of consultations with stakeholders and results of a review of the previous plan, the KwaZulu-Natal (KZN) Provincial Strategic Plan (PSP) The response to HIV and AIDS, STIs and TB is linked to the wider development efforts at international, national and provincial level. It therefore cannot be implemented in isolation. For this reason, the KZNPSP was developed in the context of a number of global, national and provincial developmental commitments. It is aligned to and consistent with the NSP , the KZN Provincial Growth and Development Strategy (PGDS) and the South African Mid-term Strategic Framework This report gives details of the status of the implementation of the PSP during the period of 2014/15. PSP goal The goal of KZNPSP is to provide strategic guidance to the provincial HAST response and act as framework within which various initiatives will be implemented by diverse stakeholders in the province. It forms the basis for measuring progress in the provincial response. Secondly, the plan will serve as an advocacy and resources mobilisation tool for the HAST response. PSP objectives The report is based on the provincial multi-sectoral strategic plan for HAST broad strategic objectives as follows; Strategic Objective 1: Addressing Social and Structural Drivers of HIV & AIDS, STIs and TB Prevention Strategic Objective 2: Prevention of New HIV & AIDS, STI and TB Infections Strategic Objective 3: Sustaining Health and Wellness Strategic Objective 4: Coordination and Monitoring and Evaluation P a g e 3 20

5 Strategic Objective 1: Addressing Social and Structural Drivers of HAST Prevention, Care and Impact. Strategic objective 1 focuses on reducing vulnerability to HIV, STI and TB due to poverty, socio-cultural norms and gender imbalance by The sub- objectives for this objective are as follows: reducing poverty, unemployment and gender inequality and promoting positive socio-cultural norms and values. The expected results of strategic objective 1 are as follows: a reduced poverty level, reduced unemployment and gender inequality levels; favourable socio-economic and cultural environment. Strategic Objective 2: Prevention of new HAST Infections The following sub-objectives were included for HIV, STI and TB prevention: To reduce new HIV infections to less than 1.2% by 2016 To reduce new smear positive TB infection to less than 200 per 100,000 population by 2016 To reduce STI incidence to less than 0.5% by 2016 To achieve these sub-objectives; the PSP proposed the implementation of the following interventions as a way of combating the epidemic: Behaviour Change Communication; Prevention of Mother to Child Transmission, Male Medical Circumcision, Sexually Transmitted Infections Treatment, HIV and TB Screening, Condoms distribution and use, Treatment of TB, HIV transmission through blood and blood products, HIV transmission from occupational exposure, sexual violence and discordance. The expected results under strategic objective 2 are as follows; Reduced HIV Incidence in the general population to less than 1.2% by 2016; Zero HIV Transmission to infants by 2016; P a g e 4 20

6 Reduced HIV prevalence for age group years to less than 10% by 2016; Reduced TB infection to less than 200 new smear positive TB per 100,000 population by 2016; Reduced STI incidence to less than 0.5% by 2016 Strategic Objective 3: Sustaining Health and Wellness The sub-objective for strategic objective 3 is to reduce mortality, sustain wellness and improve the quality of life of at least 80% of those infected and affected and 70% of those on treatment to be still on treatment by To achieve this sub-objective, the PSP proposed the following interventions to reduce the impact of the epidemic: Increased access to treatment and support, adherence (to treatment) and optimum health for PLHIV Increased access treatment (TB) and services that are responsive Increased access to support for the affected Increased quality care for OVC. The expected results under strategic objective 3 are as follows: A reduction in TB associated mortality by 80% by 2016 An improved quality of life of HIV and TB infected individuals and their families by Strategic Objective 4: Ensuring Protection of Human Rights and Improving Access to Justice The sub-objective for strategic objective 4 is to reduce vulnerability to HIV, STIs and TB by creating a supportive policy, human rights and regulatory environment and; promoting desirable social norms in the province by To achieve this sub- objective, the PSP proposed the following interventions to reduce the burden of the epidemic: Strengthening leadership to speak out against, stigma, discrimination Adherence to existing legislation and policy on human rights and promotion of access to justice Capacity building on policies and legislation relating to HIV and AIDS and TB Greater involvement of PLHIV and LGBT. P a g e 5 20

7 The expected result is that the rights of those infected and affected be upheld by a supportive policy, human rights and regulatory environment. Strategic Objective 5: Coordination, Monitoring and Evaluation The sub-objective for strategic objective 5 is to have a well-coordinated provincial response to HIV and AIDS, STI and TB that is informed by an effective M and E system by The interventions earmarked to achieve this sub-objective are as follows: Strengthening coordination and management Strengthening Monitoring and Evaluation system at all levels Strengthening the research component of the response. The expected result of implementing interventions under strategic objective 5 is the development of an effective coordination and Monitoring mechanism which leads to the achievement of targets. P a g e 6 20

8 ASSESSING PROGRESS MADE PSP/NSP GOALS PSP Major Achievements KwaZulu-Natal has the highest burden of disease associated with underdevelopment and poverty in the country, which includes HIV, AIDS, STIs and TB. The Provincial achievement will be outlined as per each KZNPSP objectives below. Increasing access to quality of care and support to at least 90% of the OVC by 2016: During the period under review, 43% of the estimated number of Orphans and Vulnerable Children (OVC) in the province were registered. Harry Gwala (146%), Amajuba (75%) and umgungundlovu (69%) recording the highest registrations. Zululand (15%) and umkhanyakude (17%) had the lowest registration of OVCs. The other three districts namely UGu, umzinyathi and uthukela are showing consistent increase in registration. Reducing the risk of mother to child transmission to less than 1% by 2016 KZN Province needs to scale up the access to early diagnosis of HIV in babies born to HIV infected mothers in order to reduce the rate of mother-to-child transmission. The province committed to ensuring that all mothers get tested early to inform timely interventions. During the reporting period; Polymerase Chain Reaction (PCR) positivity rate was 1.3%., There was a significant improvement on mother to child transmission positivity rate over the years from 4% (2011/12), 1.6% in 2013/14 to 1.3% in 2014/15. With regard to infant HIV antibody test at around 18 months positivity rate was 1.1% whereas the previous year was 1.7%. Ensuring that 100% of men and women aged know their HIV status and receive TB screening by 2016 The province has reached 100% (106%) HIV testing coverage with most districts (9/11) showing an increase in numbers tested between quarter 3 and quarter 4 of Nine out of eleven districts in the province were on the upward trend in terms of HIV testing during quarters 3 and 4 of The province tested P a g e 7 20

9 clients aged years in The number of clients who were tested in 2014 is higher than the number of clients who were tested in 2013/2014 ( The HIV prevalence rate amongst clients aged years showed a slight decrease from 13.7% in 2013 to 13% in Ensuring that 100% of men and women aged have access to condoms by 2016 The province achieved 95% of the distribution targets for Male condoms and above 100% (137%) for female condoms. Ensuring that at least 90% of HIV infected people have access to treatment and support, remain adherent to treatment and maintain optimum health by 2016 The Province initiated new clients on ART and exceeded the annual target by 19%. As of the last quarter of 2014/15 the province had almost reached 1 million patients enrolled into HIV care and on treatment. Gaps and challenges Decreasing behaviours that put men and women aged years at Risk of HAST through implementation of focussed programmes by 2016: The number of learner pregnancy doubled in 2014 to 8359 as compared to in 2013 Scaling up male medical circumcision services to 80% of males aged years: All the districts did not achieve the set target for 2014 in terms of scaling up male medical circumcision services. The provincial performance was 28% below the set target. Strengthening coordination and management for an effective provincial response by 2016, strengthening monitoring & evaluation systems at all levels and ensuring that at least 90% of the sectors report to coordination structures by 2016: P a g e 8 20

10 There was poor coordination between Local Aids Council (LAC) reporting and District Aids councils (DACs) with just about 40 % of LACs reporting to DAC and generally Ward AIDS Committees not reporting to LACs. Reducing the risk of HIV transmission from occupational exposure, sexual violence and discordance to less than 1% by 2016: There were uncoordinated efforts in the fight against sexual violence and the reporting thereof which makes it difficult to track performance. Recommendations There is a need to scale up prevention efforts to ensure success in HIV and AIDS responses in the province. The combined prevention efforts need to be brought to scale and at a faster pace. There should be re-focusing of efforts and investments in prevention, while continuing to provide equitable treatment, care and support services for those in need. Proven emerging prevention interventions should be embraced and scaled up based on national policies and guidelines. New prevention technologies such as male medical circumcision (MMC) should be rapidly scaled up. Impact Indicators: NSP/PSP, 2013/ /15 Indicator FY 2014/15 Status HIV prevalence among women and men aged % HIV prevalence in key populations 30.1% 1 HIV Incidence 1.3.% i HIV mortality 7.3% MTCT (around 6 weeks) rate 1.3% 2 Patients alive and on treatment Prevalence for 25 years and older in 2012 source: South African National HIV Prevalence, incidence and behaviour survey Source DOH Annual Report 3 Source: DHIS 2014/15 P a g e 9 20

11 ASSESSING PROGRESS TOWARDS ACHIEVING PSP STRATEGIC OBJECTIVES Strategic Objective 1: Social and Structural Drivers of HIV, STIS and TB Prevention, Care and Impact The province took huge strides in promoting collaborative HIV/TB management at facility level. The Province evised PMTCT guidelines and the new TB guidelines were implemented during the period under review. There were strong partnerships between Public-private institutions of higher learning such as, Higher Education HIV AIDS (HEAIDS) program, Public Rail Association of South Africa (PRASA) which allowed for health services targeting the youth in and out of school. There were 124 functional High Transmission Area (HTA) intervention sites and UMgungundlovu district had the highest number with 58 HTA sites during the current reporting period. These sites included prisons, tertiary institutions, truck stops, sex workers hotspots/ brothels, MSM clinics, farms and taxi ranks. Targeting these areas with prevention messaging and services was a means to cub HIV incidence as these are some of the major drivers of the epidemic in the Province. Strategic Objective 1 Social and Structural Drivers of HIV, STIS and TB Prevention, Care and Impact Indicator Baseline Target 2016 FY 2014/15 Status Comment progress towards target % government departments and sectors with operational plans with HIV, TB and related gender and rights based dimension integrated % municipalities with at least one informal settlement where targeted comprehensive HIV, STI and TB services are implemented 80% 100% 80% 100% 100% Operation Sukhuma Sakhe reaches wards with comprehensive services Delivery rates for women under 18-NIDS Number of women and children reporting gender-based violence (GBV) to the police in the last year (Total sexual crimes from Crime Research and Statistics SAPS) Data from SAPS is not disaggregated to fulfil this indicator The Provincial Flagship Programme, Operation Sukuma Sakhe (OSS) served as the primary vehicle for rendering integrated community-based services. This ensured integrated services to address the social determinants of health including (but not P a g e 10 20

12 exclusive to) poverty eradication, provision of sanitation, water, electricity and waste removal are provided to communities holistically. P a g e 11 20

13 Updates on key policy issues The National Health Insurance pilot commenced in April 2012 in three pilot districts namely: UMgungundlovu and UMzinyathi Districts (National sites) and Amajuba District (Provincial site). In these three pilot sites there was a notable improvement in efficiency in the delivery of quality health care services which led to patients having access to affordable, healthcare services regardless of their economic status. The implementation of the policy on TB screening that all PHC attendees in all facilities should be symptomatically screened for TB has improved case finding in the Province. The TB case finding rate improved through the implementation of the TB screening policy which encourages TB symptom screening. Major Achievements The Province made a ground breaking initiative of taking health services to identified places such as Kwa-Mashu Township in ethekwini district where the district was identified as one of the poorly performing districts in key health indicators including condom distribution, male medical circumcision and STI cases. These indicators were worse for specific target groups mainly older males and youth in and out of schools. This initiative was handed over to ethekwini district to continue taking services to people. P a g e 12 20

14 A number of behaviour change activities were carried out including the Isibaya Samadoda in Kraal Water in ethekwini district and the concept was replicated in all the districts in the province; to promote MMC and intensify behaviour change with the assistance of Men s Forum and Amakhosi (Traditional Leaders). The Department of Basic Education employed learner support agents in schools to provide additional support to the Life Orientation Educators in terms of care and support and behaviour change peer education programmes. The learner agents effectively addressed the structural drivers of new HIV infections by driving youth friendly curricular programmes. In addition, the learner agents made a difference in improving learners retention and academic performance as well as fostering education to prevent risky behaviours. Gaps and Challenges The process of capturing household data which will inform community interventions such as social determinants of health and intensified community outreach to address issues of poverty and deprivation is taking too long. HTA coverage is still a challenge for Men who have Sex with Men interventions in the Province. Strategic Objective 2: Preventing new HIV, TB and STI infection The province established a strong working relationship with secondary condom distribution sites in TVETs, traditional courts and municipal offices. This yielded positive results in improving condom distribution and a study to determine if there is a relative increase in condom use is yet to be done after the current reporting period. Implementing the policy of screening all PHC attendees for TB improved the TB case finding as well as early diagnosis as well as linkages to HIV and TB care if one is coinfected; leading to a reduction in TB/HIV co-morbidity and mortality. P a g e 13 20

15 Updates on key policy issues The Human Papilloma Virus (HPV) Vaccine campaign was introduced in March 2014 targeting Grade 4 female learners. The aim of the HPV vaccine campaign was to reduce the incidence of cervical cancer. Preparation for implementation commenced in March 2014 with the intention of rolling out the campaign during the first quarter of 2014/15. It should be noted that the campaign was successfully implemented in the selected schools. The Province adopted the revised National Contraceptive Policy and Guidelines in February The adopted policy makes provision for the long-acting, easy to use implant as a contraceptive method effective for three years. It is anticipated that the implementation of this policy will contribute towards the reduction of teenage, learner unwanted pregnancies. Implementation of the policy on TB screening of all PHC attendees in all facilities assisted to improve TB case findings. The table below indicates performance for 2014/15 in HIV testing, HIV prevalence, TB screening and condom distribution. The province tested people aged between years in 2014/2015; which was an increase of more than people as compared to 2013/2014 where HIV testing on clients years was The HIV prevalence rate amongst clients aged years showed a slight decrease from 13.7% in 2013 to 13% in P a g e 14 20

16 Strategic Objective 2: Preventing new HIV, TB and STI infection Indicator Baseline Target 2016/17 FY 2014/15 Achieved Comment progress towards target Number (and percentage) of men and Achievements can be attributed to the drive to hold hold women counselled and tested for the Hlola Manje campaigns and the constant Nerve HIV: centre meetings to track progress with HCT as well as i. HIV test client years ii. HIV prevalence amongst client tested ongoing provision of HCT service at high yield venues including Taxi Ranks. 49 years rate (%) 13.7% 13.0% Number and percentage of people Intensified TB screening will be continued in all facilities, screened for TB: schools and HTAs through kick TB project. Client screened for TB TB symptom 5 years and older screened rate / / / % 35% 14.9% Number of newly diagnosed HIV positive % The target has since been revised to 70 % of HIV people started on IPT for latent TB infection ( ) 65.4 % positive clients Male condom distribution ,371, New marketing approaches are being explored to promote condom use including the development of condoms with multiple attractive colours District condom distribution plans are being developed and LMIS trainings schedules are finalised for all districts. Female condom distribution District condom distribution plans are being developed and LMIS trainings schedules are finalised for all districts. Number of men medically circumcised cum actual Ongoing partnership with HEAIDS in activations planned not cum. cum( ) for 2015/16 to promote VMMC uptake Source: NDoH There is a commitment to have clinics in some TVET s at DIP least once a week and in some once every month. Targets There are ongoing negotiations between the province and the Nazreth Baptist Church in scaling MMC uptake within the traditional settings. Number of people reached by prevention communication at least twice a year N/A No data No data No data No data P a g e 15 20

17 Major Achievements There was a strong focus on prevention of new infections and improving the management of patients living with HIV. A total of people between years were tested for HIV. The number of medical male circumcisions increased by 47% between 2013/14 and 2014/15 ( to ). Extensive consultation and engagement with all stakeholders continued in 2014/15 to finalise the Provincial long term plan to increase MMC performance. Targets for the Mother to Child Transmission (MTCT) programme were reached in the Province. The number of babies that tested positive for HIV at 6 weeks decreased from (2013/14) to in 2014/15, and the number of HIV exposed babies that received Nevirapine within 72 hours of birth increased from to between 2013/14 and 2014/15. Partnerships with secondary condom distribution stakeholders in the community assisted the province increasing the number of condoms distributed. Although the province has not met the MMC targets, there were huge strides to reach these ambitious targets using different methods such as the collaborations with TVET colleges which led to 162 males circumcised in TVET colleges in 2014/15. There were ongoing negotiations between the province and the Nazreth Baptist Church in scaling MMC uptake within the traditional settings; during the period under review. The province introduced a mobile unit which was roving in all districts and managed to circumcise males in all the districts. Provision of HCT service as an outreach service at Taxi Rank yielded positive results towards reaching the HCT targets. P a g e 16 20

18 Gaps and Challenges The target for IPT at 100 % was not achievable due to the fact that not all HIV positive clients are eligible for IPT. Male condom targets were not reached during the reporting year 2014/15 as the province did not have a contract with service providers to distribute condoms in the districts. This resulted in a shortage of condoms in non medical sites especially at community level. This challenge was mainly due to Supply Chain Management processes and contractual management with identified service providers. Recommendations There is a need to strengthen private partnerships with organisations such as NETCARE and private General Practitioners to increase the number of MMC done privately. Strategic Objective 3: Sustaining Health and Wellness KZN has one of the largest ART programme in the country. All fixed clinics have HAST services and the anti-retroviral therapy (ART) programme matured over the years and was integrated into other primary health care programmes. Updates on key policy issues Implementation of the new HIV/AIDS Guidelines for Management of HIV positive people; in terms of the changes in the treatment regimens led to an increase in the number of people eligible for ART, initiated on ART and Total Remaining in HIV Care (TROA). P a g e 17 20

19 Strategic Objective 3: Sustaining Health and Wellness Indicator Baseline Targets FY 2014/15 achieved Proportion (%) of people per year becoming eligible who receive ART: Comment progress towards targets. i).hiv positive adult (15 years and older) patients eligible for ART starting ART rate (%) Above 100% Ongoing NIMART Mentorship ii) HIV positive children under 15 years eligible for ART starting ART rate (%) Strengthen capacity of nurses to comprehensively manage children on ART Patients alive and on treatment MTCT rate : 6 weeks and 18-months): Targets for MTCT reached i) Infant 1st PCR test positive around 6 weeks rate (%) 1.6% < 1.4% 1.3% ii) Infant rapid HIV test around 18 months positive rate (%) 1.7% <1.4% 1.1% NDoH Target P a g e 18 20

20 Major Achievements The province managed to scale up ART services such that all eligible people who qualified for treatment were initiated. This was achieved through NIMART and the use of outreach service points like mobile clinics and HTA. The number of patients on antiretroviral treatment increased by 13% from to over the last two years; prior to the current reporting period. The increase can be attributed to the mentorship support which was provided to facilities that were not initiating ART especially on paediatrics. There was an increase in the number of facilities signed off on Tier.Net; which is a patient management system that allows for longitudinal follow up of ART patients cohort reporting. There was improved interaction with the Department of Home Affairs at facility level for verification of clients who died on treatment. Gaps and Challenges Double counting of people who are eligible for treatment and those initiating treatment still remain a challenge. Internal and external migration affected initiation of children. Mothers who delivered at a different area and moved to stay at another area usually between delivery and 3 months post-delivery, were affected by both internal and external migration. There were challenges with children who tested positive at an older age especially after the age of 5years. Most of these children were not cared for by their biological parents and guardians were often reluctant to start them on treatment. Strategic Objective 4: Ensuring protection of human rights and improving access to justice Access to healthcare services is a fundamental right enshrined in the South African constitution. Ensuring access to healthcare services requires that interventions be planned and implemented in a manner that addresses the specific needs and barriers to access health services by key populations. Furthermore, inadequate human rights protection and access to justice contribute to vulnerability to HIV, STI and TB infections. Inadequate human rights protection includes stigma and P a g e 19 20

21 discrimination, gender inequality, gender violence and other forms of discrimination. This priority area deals with vulnerabilities due to factors that are influenced by human rights, policies, legal environment and social norms. In the KZN province, this strategic objective was implemented by the Department of Justice and civil society groups such as the organisations for People Living with HIV. Thuthuzela Care Centres took the lead in strengthening the management of victims of sexual assault and fast tracking the finalisation of cases on sexual offences. Furthermore, plans were put in place to implement some of the propositions which came out of the National Stigma Index which was conducted during the period under review. MONITORING AND EVALUATION The Provincial AIDS Council established M&E unit which was tasked to co-ordinated reporting on the multi-sectoral response; during the period under review. The M&E team collected data from departments and sectors using existing secondary data platforms, analysed data and reported to the AIDS council on progress made against core PSP indicators. The M&E unit is also tasked to give capacity to sectors in terms on reporting, monitoring and evaluation. The unit was also tasked to identify key evaluation areas on the multi-sectoral response and lead such activities. Changes in data collection systems allowed the province to embark on a process of data cleaning, such that all facilities which were using an electronic system were able to account for clients on treatment during the current reporting period. This resulted in stagnation of total clients remaining on treatment as all inactive clients were removed from the system using prescribed procedures and processes. There was a functional provincial multi-sectoral nerve centre which met every quarter during the period under review. The purpose of the multi-sectoral nerve centre was to ensure that there was a coordinated monitoring and evaluation of the multisectoral programs to track performance against targets and enhance accountability throughout the current reporting period. The data collection process assumed a bottom-up approach starting from the ward level to the facility level, which used paper- based system; through to the sub-district level which used an electronic system; then to the district level and finally to the provincial level which used the P a g e 20 20

22 District Health Information System. Data collection and validation was managed through Provincial Data Management Protocol. At the provincial level data was presented to the nerve centre for review and analysis by indicator. Data was reported at district level for decision making on how to improve performance. Major Achievements Training and monitoring of District AIDS Councils was conducted in all the 11 districts. In addition, support visits were conducted by the provincial M&E unit during scheduled DAC meetings. A consistent improvement in the completeness and quality of data and interpretation and use of information at decentralised level was noted during the current reporting period. There was a functional provincial multi-sectoral nerve centre which held quarterly meetings with the aim of tracking performance against targets and ensuring accountability. Routine monitoring and consistent provision of feedback to local levels on data that was received every quarter showed improvement on the quality and completeness of data during the current reporting period. Gaps and Challenges The volume of data collected manually increases the probability of error. The vast number of data elements being collected at Provincial level increase staff workload significantly which impacts negatively on other support functions. High workload, lack of Data Capturers at facility or ward level, impacts on data completeness and quality. Community-based data is still inadequate to inform evidence-based planning and decision-making. The current information system does not make adequate provision for inclusion of community-based data. Assumptions with regards to impact of P a g e 21 20

23 improved community-based interventions at ward level cannot be proven which influences the allocation of resources and scale up of programmes. Some departments have M&E units that either do not assist with monitoring the multisectoral response. Shortage of human resources negatively impacts the process of data collection at the provincial level. Municipalities do not have dedicated M&E personnel at both district and ward level. External service providers such as NHLS, GEMS were at times using indicators (e.g. HCT testing, viral loads and CD4 done) that were not aligned to the reporting requirements which made it difficult to consolidate data received from these external stakeholders. Recommendations The validation of data collection needs to be prioritised during 2015/16. There is a need to ensure data quality at local levels by strengthening the district and local nerve centres where data will be interrogated to identify and address data quality issues. Planning and M&E need to be synchronised so that strategic and operational plans are supported seamlessly by a practical M&E system. In this way the multi-sectoral plans, monitoring framework and tools will be well aligned to the stakeholder activities. Capacity and capability for M&E systems within the Province should be built to ensure that data is collected, analysed and transformed into useable reports on a timely and regular basis KZN will work to strengthen the reporting, monitoring and evaluation of activities under this strategic objective and ensure they are optimally covered. P a g e 22 20

24 CONCLUSION The report provided information on the status of implementation of the multi-sectoral response in 2014/2015. As the province moves into the last year of implementing KZN PSP , efforts to support improvement of data collection and reporting should continue. Preparing and sending district specific feedback reports, hosting of DAC/LAC secretariat meetings and DAC meeting feedback sessions are all part of this support. This support further reinforces the provincial emphasis of empowering districts and lower level structures in the monitoring of the response and use of data at the lower levels. Data quality and compliance to the policy and SOP s will be strictly monitored. OVERALL RECOMMENDATIONS There is a need to ensure that all departments align their operational plans and department indicators with the PSP strategic objectives and PSP indicators. The PSP should be widely distributed to all stakeholders. The review of the PSP should be on an annual basis based on the gaps and challenges noted in the annual progress reports. FAST TRACKING PROGRESS PLAN /16 Scale up interventions to curb the impact of social and structural drivers of the epidemics by implementing collaborative activities between government and civil society; Strengthen the implementation of VMMC activities through establishing public and private partnerships to allow for referrals, linkages and reporting; Establish systems to allow for reporting on non-government related activities especially in SO4; Improve the condom distribution supply chain management to ensure condoms are readily available to meet demand as created through the various condom marketing strategies. P a g e 23 20

25 i UNAIDS Spectrum 2013 P a g e 24 20