BAPHALALI SWAZILAND RED CROSS SOCIETY

Baphalali Swaziland Red Cross Society: Integrated HIV and AIDS Programme 2006-2010 BAPHALALI SWAZILAND RED CROSS SOCIETY INTEGRATED HIV and AIDS PROGRAMME 2006-2010 November 2006 1

Executive Summary Swaziland has adopted a multi-sectoral approach Expanding care, treatment, and support; to HIV and AIDS, which involves various Reducing stigma and discrimination. stakeholders including the Baphalali Swaziland Red Cross Society (BSRCS). The National The purpose of this programme is to reduce Society is currently running an integrated HIV vulnerability to HIV and its impact in Swaziland and AIDS programme, focusing on HIV through achieving the above three outputs. In prevention, care and support for people living order to achieve these three outputs, MRCS with HIV (PLHIV), raising treatment literacy on capacity will be strengthened to enable more antiretroviral therapy (ART), support to OVC effective, expanded, direct outreach to served including addressing the humanitarian crises communities. such as food insecurity. By Mid June 2005, The new programme will target 200,000 youth BSRCS was providing home based care (HBC) throughout the country (in all its 59 branches), services to 3,500 PLHIV, material support, 300,000 women and men from the general adult educational assistance to 6,000 orphans and population, 22,000 PLHIV, 30,000 OVC in other vulnerable children (OVC) and facilitating Sigombeni, Mahwalala and Silele and 5,000 the operations of five support groups of PLHIV. Correctional Services Community (Staff, their The National Society has integrated HIV and families and inmates) from 14 correctional AIDS into food security, water and sanitation services and other mobile populations. The and its other core programmes. National Society will advocate for greater In recognition of the huge problem that the involvement of PLHIV in the national and its pandemic poses to people in Swaziland, BSRCS own response on HIV and AIDS. is proposing to accelerate and scale up its HIV and AIDS response through implementing a new BSRCS experience in working at community five year Integrated HIV and AIDS programme level using community-based volunteers is its 2006-2010. The HIV and AIDS programme is comparative advantage in implementing a part of the Southern Africa Regional HIV and programme of this nature. Thus, the National AIDS programme, and the five year appeal Society will scale up its best practice of number (MAA63003) was launched on 1 integrating community home-based care November 2006 which is a component of the (CHBC), use of volunteers and community International Federation Global HIV and AIDS leaders in the implementation of this new Alliance. The International Federation is Integrated HIV and AIDS Programme. scaling-up its response to HIV and is committed The Integrated HIV and AIDS programme seeks to reducing vulnerability to HIV and its impact CHF 21,861,156 towards a total budget of through: CHF 23,085,831 for the five year Preventing further infections; implementation period (2006 2010) 2

Baphalali Swaziland Red Cross Society: Integrated HIV and AIDS Programme 2006-2010 1.0. Background The Kingdom of Swaziland has an estimated population of 1,032,000 with a population growth rate of 0.2%. Of the total population, 53% are women and 47% are men. The 1997 census found that a total of 66% of de facto household heads were women and 5.4% were aged below 20 years. The majority of the Swazi population (over 77%) resides in the rural areas and practices subsistence farming. According to the Human Development Index, Swaziland is rated at 147. About two thirds (69%) of the Swazi population live below the poverty line defined as E128.60 (about USD22.00) per month in spite of a high per capita income of USD1,350 (Budget speech by the Minister of Finance, 2005). The economy has weakened considerably in recent years, with unemployment rate being estimated at 22% and this has been compounded by the HIV and AIDS pandemic and a series of droughts that have hit the country since 2002. 1.1. HIV and AIDS situation Swaziland has the highest HIV prevalence among pregnant women attending antenatal care clinics worldwide and the pandemic has not yet shown any signs of abating. HIV prevalence rates among pregnant women attending antenatal clinics rose exponentially in the 1990s from 3.9% in 1993 to 26.1% in 1996; and then 31.6% in 1998 and 38.6% in 2002. In 2003/4, HIV prevalence among all pregnant women attending antenatal clinics was 42.2%; 44,5% in urban areas and 40,3% in rural areas (Ministry of Health and Social Welfare (MoHSW 9 th Round National Sero surveillance report, March 2005). These statistics simply shows that two out of every five pregnant women are HIV infected. Young pregnant women aged 15-24 years have a high HIV prevalence of 39.4%, indicating high levels of HIV incidence (new infections). According to Joint United Nations Programme on AIDS (UNAIDS) estimates, 220,000 Swazis were living with HIV as at the end of 2005. The impact of the pandemic is becoming evident as the pandemic matures. This is manifested by the increasing numbers of orphans due to AIDS, overcrowding in the health facilities, worsening food shortages and declining household income levels. Currently, there are 63,000 OVC in the country and the number is projected to reach 120,000 by 2010. Patients with HIV related illnesses occupy 50% of the beds on the medical wards. Table 1 - Statistics on HIV and AIDS as at the end of 2005 in Swaziland Number of people living with HIV 220,000 Adult (aged 15-49 years) HIV prevalence rate 33% Adults aged 15 years and over living with HIV 210,000 Women aged 15 years and over living with HIV 120,000 Children aged 0-14 years living with HIV 15,000 Deaths to AIDS (children and adults) 16,000 Orphans (0-17 years) due to AIDS 63,000 Source: UNAIDS 2006 Report on the global AIDS pandemic 1.2. Determinants of the pandemic HIV transmission in Swaziland is mainly heterosexual and is fuelled by poverty, high mobility, gender inequalities and gender based violence, food insecurity and high prevalence of high-risk behaviours. Poverty, hardship and gender inequality, especially with regard to economic opportunities, increases the 3

likelihood of particularly poor women being forced into either sex work or transactional sex or intergenerational sex as a survival strategy. According to the behavioural surveillance survey (BSS) conducted by The Family Life Association (FLAS) in collaboration with MoHSW and Family Health International in 2002, female youth (both in and out of school) tended to have sex with older sexual partners than themselves as compared to males who were having sex with sexual partners of similar age. The rules governing sexual relationships differ for women and men, with men having most of the power. The Swazi society expects women to be subordinate and submissive; allows men to have multiple sexual partners and polygamy, which exposes women to HIV infection (National Emergency Response Council on HIV and AIDS (NERCHA), April 2004). The people of Swaziland are extremely mobile both within the country and across borders. Swaziland is a small country with good infrastructure, which makes it easy for urban dwellers to maintain contact with their rural homesteads and cross into South Africa. Traditionally, a significant number of single men go to South Africa to work in the mines. This separation from their spouses puts both the men and women at risk of engaging in higher-risk sex. In Swaziland, domestic violence is seen as a cultural phenomena rather than a criminal activity. Gender based violence is usually accompanied by the use of physical or psychological coercion, which is socially tolerated including sexual violence and rape in marriage. Rape is more likely to result in tears, which facilitate HIV transmission if the male partner is infected. Swaziland like some other five countries in southern Africa has been facing food crisis in the past years as a result of a series of droughts and also due to the impact of HIV and AIDS on the agricultural sector. The combination of hunger and HIV is lethal; the convergence of the two calamities sharply increases people, in particular women and children vulnerability to HIV infection and disease. 1.3. The Impact of the pandemic A study on mortality conducted from 1994-1999 using bereavement notices in The times of Swaziland revealed a marked increasing trend in deaths among people aged 26-40 years from 1995-1999, with most of the deaths largely being attributed to HIV and AIDS (NERCHA, What is driving the pandemic? 2003) The crude death rate has increased, as a result of AIDS mortality, from 9.9 to 22.7 deaths per 1,000 populations and is projected to reach 30.2 deaths per 1,000 populations by 2010. The projected population size in 2015 is estimated at 1.58 million; about 41% lower than it would have been in the absence of AIDS (World Bank 2001). Life expectancy in Swaziland has declined from 65 years in 1991 to 38 years in 2002. It is projected that if current trends in HIV infection persist, life expectancy in Swaziland will fall below 30 years by the year 2010. The OVC is projected to increase to over 120,000 (approximately 15% of the population) by 2010 (Stanecki, 2001). In 2003, the UNAIDS country report showed that there were 15,000 households headed by orphans. While AIDS affects all socio-economic groups, severity of poverty increases among the poorest people as they lose the productive members of their households. The limited resources are diverted to cover health care of a family member who is chronically ill, and funeral expenses. The increase in expenditures, especially on heath care drags poor households further into poverty, with resounding implications not only to the family but to the household as a whole. There are an increasing number of patients suffering from opportunistic infections, as the pandemic progresses and matures. About 50% of the hospital beds are estimated to be occupied by patients with HIV and AIDS related conditions. The pandemic is resulting in overcrowding in hospital wards ((MoHSW National Surveillance report, 2004). In the education sector, it is projected that there will be an increase in children not enrolled in primary school from 3.5% in 1999 to 30% by 2015. The quality of education may also decline due to increased deaths among teachers. The ratio of teachers to students has shifted from 1:35 in 1997 to 1:52 in 2000 4

(Ministry of Education, 1999). An AIDS impact assessment study on the public sector in 2003, identified HIV and AIDS as the major cause of high mortality in the public sector (NERCHA, What is driving the pandemic? 2003) AIDS is worsening the chronic food shortages in a country that has experienced successive severe droughts, since 2002. The pandemic has led to reduction in the agricultural output. Data presented at the Global Development Network Conference, 2005 in Dakar, Senegal attributed a reduction of 34% of the farm are under cultivation, 54% in maize production and 30% in cattle to HIV and AIDS pandemic. 1.4. National HIV and AIDS response The Kingdom of Swaziland is implementing a multi-sectoral National HIV response involving government ministries, non-governmental organizations; faith based organization s (FBOs), the private sector, bilateral and multilateral agencies and associations of PLHIV. This response is being coordinated by the NERCHA, which is under the prime minister s office. The major programme areas in the National Strategic Plan (NSP) are; prevention, care and support and impact mitigation. In November 2004 the NSP was reviewed and the main priorities for the next strategic plan were identified. The fight against HIV and AIDS is also considered one of the priorities for the government as attested by its inclusion in the Government Policy (Transformation Policy Statement SPEED - 2004). Swaziland has developed various guidelines and protocols in the areas of HBC, voluntary counselling and testing (VCT), clinical guidelines and management of opportunistic infections, including ART and PPTCT. By the end of 2004, it was estimated that about 7,000 people were on ART. The target set for the end of 2005, as part of World Health Organisation s 3 by 5 initiative, was 16,000 but the estimated number of PLHIV in need for ART was 32,000. In addition, PPTCT and VCT services have gradually been expanded. The CHBC programme has been further strengthened, the access to care and support, supplies have greatly improved by the introduction of Inkhundla-based supply containers. Reproductive health has received renewed attention with further strengthening of the capacity of health care providers through training, to manage sexually transmitted infections (STIs) at health facilities. Swaziland has a draft national action plan on OVC developed in 2003 to assist in the implementation of activities for orphans and other children made vulnerable by HIV and AIDS. Food security is being reinforced, by facilitating the establishment of backyard gardens, and promoting rainwater harvesting. 2.0. Baphalali Swaziland Red Cross Society: Track Record and Lessons Learned After the adoption of the Strategy 2010 at the Federation General Assembly in 1999, the International Federation Africa team developed an African Red Cross and Red Crescent Health Initiative (ARCHI 2010) to implement ten public health priorities on the Africa continent aiming at reducing the mortality by 5% in 2010. All African National Societies including Malawi signed the Ouagadougou Declaration during the 5 th Pan African Conference in September 2000 engaging all societies to focus on health and care issues, particularly HIV and AIDS, food security and volunteer management. Four years later in September 2004, at the 6 th Pan African Conference, African Red Cross Societies reiterated this commitment and priorities in the Algiers Plan of Action. In 2005, the International Federation adopted its new programme for the Federation of Future including a New Operating Model, and enhanced Membership Services and Global Alliances. In line with the Ouagadougou Declaration and also in response to the government s multi-sectoral approach to HIV, and the United Nations Millennium Development Goals 1, BSRCS intensified its HIV and AIDS response. BSRCS is currently running an integrated HIV and AIDS programme, focusing on 1 Millennium Development Goals The UN Millennium Goals charter states that by the year 2015, all 191 United Nations Member States have pledged to meet eight goals, thus, eradication of extreme poverty and hunger; achievement of universal primary education; promotion of gender equality and empowerment of women; reduction of child mortality; improvement of maternal health; combating HIV and AIDS, malaria and other diseases; ensuring environmental sustainability; development of a global partnership for development. 5

HIV prevention, care and support for PLHIV, raising treatment literacy on ART, support to OVC and interventions to reduce stigma and discrimination. The HIV prevention activities include; peer education among in school youth, prison staff and prison inmates, provision of information, education and communication (IEC) through electronic and print media, mobilising and sensitising communities about VCT, PPTCT and ART services, mobilization of the general public about HIV and AIDS, using the media, interpersonal approach and through drama and sports. The National Society has also integrated HIV and AIDS into food security, water and sanitation and its other core programmes. By Mid June 2005, BSRCS was providing HBC to 3,500 PLHIV, material support, educational assistance to 6,000 OVC facilitating the operations of five support groups of PLHIV. Others areas being addressed include tuberculosis (TB) and malaria control and HIV and AIDS workplace programmes for infected and affected staff and volunteers working with the National Society. 2.1. Comparative advantages of Baphalali Swaziland Red Cross Society BSRCS carries out the bulk of their activities through the use of trained community-based volunteers nation-wide. It is able to capitalize on its community knowledge, trust, and established infrastructure to mobilize an extensive network of divisions and volunteers into social action both for short-term disasters and for long-term community health as it is an integral and permanent part of the communities in which it works The other comparative advantages include-: its ability to integrate HIV and AIDS into the other pressing needs of the communities, especially food security, water and sanitation, having partnerships with various stakeholders and development of partners including the government, international development partners and its experience in handling emergencies. 2.2. Lessons learned BSRCS has registered various lessons learned, while implementing HIV and AIDS activities as follows: Mobile services are needed to cater for the communities living far from the health clinics; Need to continue advocating for treatment literacy about ARVs; Maintenance and strengthening of the current HIV and AIDS activities, as well as scaling up to cover more communities and more geographical areas, especially the scaling up of home based care to all Red Cross branches; Improvement in human resources and financial management systems, including management and retention of volunteers; Implementation of HIV and AIDS prevention through peer education among youth and inmates; Carrying out prevention and anti-stigma campaigns in communities; Integration of HIV and AIDS into other core programmes of the National Society is feasible and it works; Building on strategic alliance in the implementation of HIV and AIDS programmes at community levels to increase output; Conduct operational research to inform and guide operations of the Red Cross in terms of services deliveries in areas of OVC, PLHIV and other core business of Red Cross. Maintain dialogue with the communities about HIV and AIDS issues. 2.3. Challenges Understaffing in the referral health facilities makes it difficult to actively involve the nurses and clinicians to supervise and make follow up of HBC volunteers. Inadequate facilities for management of opportunistic infections, including drugs at the referral health centres. This is frustrating to both the HBC volunteers who refer and the patients who are referred. Poor documentation and information sharing of best practices with regard to monitoring of events that promotes community dialogue on HIV and AIDS. A lot was done but not adequately captured. There is need to have website for all National Society to post their products. VCT has been promoted in all project areas. There is now a dilemma of failing to meet the expectations of HBC clients who have gone for VCT and are HIV positive, and would like to go for ARVs but cannot access them. 6

Transport constraints in projects, which have operated with aged vehicles. Maintenance of old vehicles is costly and has implications on the budget programme of the society. Difficult to manage project information in projects that have operated without computers or with continued computer problems. Establishment of computer network division is critical. Delays in allocation of funding from development partners mostly during the first three months of the year negatively affected project implementation progress. The budget had emphasized more on HBC activities hence it was difficult to fully develop the prevention and orphan care component. Sustaining the supply of HBC kits which are expensive and require frequent replenishing has been a major challenge in HBC. Food insecurity continues to be a pressing concern in many of the households involved in the program. There is a need to explore food security activities that are appropriate for households with minimum labour constraints and chronically ill members. This should be implemented with close collaboration with the food security team. 2.4. Recommendations Based on the lessons learnt and challenges, the following recommendations have been identified for the implementation of the new integrated HIV and AIDS programme: BSRCS will lobby government and other partners to expand ART services including capacity building of the operational health workers. BSRCS should ensure information sharing and documentation best practices under the new HIV and AIDS programme. BRSCS should be supported to improve transport and communication in its project areas, and office equipment where needed. BSRCS should ensure that HIV prevention is a major component in its response in addition to the care, treatment and support, and anti-stigma and discrimination interventions. BSRCS shall continue humanitarian issues such food security in its HIV and AIDS programmes. 3.0. The New HIV and AIDS Programme 2006-2010 BSRCS strategic HIV and AIDS programme 2006-2010 is part of the Southern Africa Regional HIV and AIDS Programme, which is a component of the International Federation Global HIV and AIDS Alliance. The activities under this programme will support the Swaziland s national HIV and AIDS policies and programmes and will be in line with the established principles of the International Red Cross and Red Crescent Movement. Specific scope of the activities in the programme has been developed based on the National Strategic Plan and harmonized with tasks agreed under the international assistance arrangements in Malawi including UNAIDS, and other United Nations (UN) agencies, non-governmental organizations (NGOs) and civil society groups, and donors. The purpose of the HIV and AIDS Programme 2006-2010 is to reduce vulnerability to HIV and its impact in Malawi through achieving the following outputs: HIV infections are prevented; Care, treatment, and support are expanded; Stigma and discrimination associated with HIV and AIDS are reduced. These will be bolstered by a fourth output: The national society s capacity is strengthened to enable more effective, expanded, direct outreach to served communities. The new Integrated HIV and AIDS programme 2006 to 2010 will target to reach the following populations with HIV and AIDS interventions by 2010-: 200,000 youth throughout the country (in all its 59 branches) reached with Together We Can approach through peers in 30 youth peer education sites; 7

300,000 women and men from the general adult population, who are in the child bearing aged (15-49 years); 22,000 PLHIV (clients who know their HIV Status in all the 59 branches of the National Society) 30,000 OVC in all branches; 5,000 correctional services community (staff, their families and inmates) from 14 correctional services and other mobile populations e.g. uniformed forces and long distance truck drivers. OUTPUT 1: HIV infections are prevented among 505,000 people in the project sites by 2010. Strategy 1: Promote safer sexual behaviours among general population (men, women and youth) and high-risk groups using culturally and sensitive IEC on HIV and AIDS through peer education and mass media approaches. Conducting two community discussions per year in 80 branches (both current and foreseeable). Developing and distributing IEC 300,000 brochures, one digital versatile decoder with best practices of the National Society in HIV prevention. Mobilizing and sensitizing communities using interpersonal communication and mass media both print and electronic, theatre, radio slots in Swati Channel. Training peer educators (600 youth, 150 prison inmates, 150 prison staff, military, 150 long distance truck drivers by 2010). Supporting peer education for the various target populations identified above throughout the five years. Facilitating youth dialogue (debate, writing, role play, drama, prize-giving) and organize exchange visits for 80 Youth Branch Members to facilitate behaviour change in branches. Establishing 16 youth groups per year. Conducting training for ten youth instructors. Training 16 donor clubs per year in life skills so that young people can donate less contaminated blood by 2010. Mobilizing and sensitizing 91,000 teachers and parents on Youth Empowerment Assertive Response (YEAR). Scheduling parents/youth meetings to give feedback on the project and branch development (two annually) and provide awards to young girls and boys (15-21 years) for those who took the oath not to indulge themselves in sexual intercourse until marriage. Developing partnerships and support recreational sports among the youth. Strategy 2: Improve condom promotion, provision and distribution in all project sites Selecting, recruiting and training 150 male and female condom distributors. Identifying and setting up 28 condom outlets in each community of 1,350 sexually active people. Conducting sensitization community seminars on correct and consistent use of condoms. Strategy 3: Promote increased uptake of VCT and PMTCT and ART services among the general population, youth and high-risk groups using community mobilisation and peer-to peer education approaches. Conducting training for 16 chiefs per year by 2010 on VCT. Providing VCT mobile testing in all Red Cross clinics. Procuring blood testing equipment and supplies including transport for shipping blood samples for VCT to the national referral laboratory. Conducting training and refresher courses for counsellors in seven VCT centres. Mobilizing communities for VCT committees in 80 chiefdoms. 8

Strategy 4: Encourage greater uptake of PMTCT and ART services through community mobilisation. Conducting 12 community outreach visits per site per month. Mobilising and sensitizing community leaders and chiefs about PPTCT and ART services. Educating communities on PPTCT through drama. Distributing IEC materials on PPTCT to community members and women in the communities. Training six midwives on PMTCT per year. Screening pregnant women who come for primary health care services for HIV after counselling, and provide 2,160 positive pregnant women with Nevirapine at the local clinics within the 80 communities by 2010. Supplying food packs to mothers (PPTCT clients) with HIV. Output 2: Care, treatment and support services are expanded and reached 22,000 PLHIV and 30,000 OVC by 2010. Strategy 1: Provide care, treatment and support through home based care. Providing ART to patients in needs at Sigombeni and Mahwalala. Conducting training for 660 care facilitators by 2010 Providing 660 HBC kits to care facilitators and replenishing them every month with the necessary medications. Supplying 22,000 HBC clients and patients on ART (those in dire need) with 63,600 blankets over a five-year period, starting in 2006. Procuring and distributing food packs for 22,o00 clients (those in dire need) quarterly over a fiveyear period. (e.g. Food packs contains: mealie-meal, beans, oil and fish) Conducting training of 32 support groups members per year on support formation and positive development. Strategy 2: Establish systems to improve food security and nutrition measures for households affected by HIV and AIDS, and water and sanitation Conducting training for 3,500 PLHIV in 80 communities on small and medium enterprises (Bee- Hive Keeping) Conducting refresher-training course for 3,500 PLHIV once a year through 2010. Educating PLHIV and affected households on food security and nutrition. Establishing and supporting 16 small medium enterprises (SME) for PLHIV support groups each year through the five years. Conducting workshop for 16 branch youth members on SME focusing non-labour intensive projects such as beehive keeping. Procuring 16 bee-hive boxes each year and supply them to the youth. Establishing communal gardens as income generating projects. Installing 915 hand-pumps on boreholes for every 250 community members and establish committees to look after the pumps. Educating 80 communities to keep home surroundings safe and clean (domestic and excreta safe disposal) and on the control vector and water borne diseases. Distributing 50,000 insecticide treated nets to PLHIV and OVC in dire need. Strategy 3: Provision of material assistance including educational and psychosocial support to OVC Providing material, educational and psycho-social support to 30,000 OVC by 2010. 9

Training National Society staff, HBC and OVC facilitators and other volunteers in various OVC needs, rights and other related issues. Sensitizing and hold meetings with community leaders, OVC committees, school heads, local authorities and other partners (government, donors, private sector etc) to solicit support for OVC. Output 3: Stigma and discrimination associated with HIV and AIDS reduced Strategy 1: Intensify awareness on the rights of PLHIV, children, OVC and women in the area of HIV and AIDS Conducting community mobilization and sensitization to educate them on the rights of women, children, OVC, PLHIV and anti-stigma and discrimination practices. Conducting a workshop for 80 chiefs to educate them on anti-stigma and discrimination practices, as well as the rights of PLHIV, OVC, women and children. Hiring a consultant to prepare an anti-stigma and discrimination advocacy strategy for the National Society by 2007. Conducting four workshops for staff and stakeholders to adapt the BSRCS anti-stigma and discrimination advocacy strategy by 2007. Output 4: Capacity strengthened to enable more effective, expanded, direct outreach to served communities Strategy 1: Strengthen staff and volunteer management systems Reviewing and implementing volunteer management policies including their incentives. Reviewing staff salaries to match the market prices. Conducting three orientation workshops for 90 staff members on the HIV and AIDS Workplace Policy. Organizing staff and volunteer social gatherings at least once a year. Ensuring all staff is covered by medical aid scheme. Strategy 2: Strengthen the capacity of staff and volunteers to plan, implement, monitor and evaluate HIV activities and programmes Training staff and volunteers in project planning, implementation, monitoring, evaluation and reporting. Developing checklists, monitoring tools and reporting formats for the various levels. Supporting supervision visits at the various levels. Strategy 3: Provide logistical and administrative support to the National Society for effective running of the HIV and AIDS programme Providing administrative and office supplies, transport. Establishing, equipping and maintaining project offices. Strategy 4: improve information sharing and knowledge management Supporting supervision and monitoring of activities. 10

Conducting of operational research. Documenting best practices and support information sharing through intra and inter-country exchange visits and meetings. Strategy 5: Resource mobilization and develop strategic partnerships and alliances with relevant organizations Conducting fundraising activities. Developing marketing materials and work plans at national, provincial and branch levels. Developing and forging relevant and effective strategic partnerships with key stakeholders. 4.0. Implementation and Management The programme will be implemented by BSRCS, as part of an operational alliance on HIV and AIDS in Swaziland with support of the International Federation of Red Cross and Red Crescent Societies. Both technical and financial support are anticipated from the Federation, Swiss and Finnish Red Cross Societies, United Nations International Children Emergency Fund (UNICEF), United National Development Programme (UNDP) World Food Programme (WFP), NERCHA, European Commission Humanitarian Office (ECHO) and Swaziland Charitable organization, which are currently funding and or collaborating with the BSRCS in HIV and AIDS interventions. The secretary general will have overall responsibility for the management and coordination of the programme. The national HIV and AIDS programme manager will be responsible for the day-to-day management, coordination and monitoring of the programme. The administrative assistant/secretary in the national HIV and AIDS unit will manage the administrative issues including organising the duties of the drivers. Due to the scale of the planned programme, an OVC programme officer at the national level will be recruited to assist the national programme manager with the implementation, supervision, monitoring and evaluation of the activities related to OVC support. Furthermore, training and advocacy officer will also be recruited to oversee and provide technical input into the implementation of the workplace programmes. The accountant at the national level will manage the programme finances. S/He will link up with the finance officers from the funding partners in securing the funds from them committed to the programme. The accountant will work closely with the national HIV and AIDS coordinator. The project officers will be responsible for overseeing the implementation of the activities within their respective project areas. The expansion of the HIV programmes, however, necessitates more logistical input especially towards transport. The national programme manager will continue to attend the meetings organised by the NERCHA and other relevant government ministries and non-governmental organization s (NGOs). S/He through the head of the department will organize programme review meetings with all the project officers to review progress, share experiences from the field and make plans. Once in a while, other stakeholders will be invited to these meetings to share their experiences with the Red Cross. Sometimes, these meetings will be used to orient or train project officers on various HIV and AIDS programme issues. At the district level coordination will be done through the existing Red Cross district executive committees and the regional health management teams. At community level, coordination will be done through the Red Cross branch committees, HBC and support group committees that already exist and other community development committees. The financial management of the project will be transparent and ethical, and it will be the ultimate responsibility of the office of the secretary general, through the health and care manager and the head of finance and administration. The established financial accounting and external auditing systems currently in use by BSRCS will be utilized to manage the programme funds. The National Society will produce 11

monthly financial statements and financial reports. BSRCS appointed auditors will audit the programme s accounts. 5.0. Monitoring, Evaluation and Reporting Monitoring and evaluation (M and E) of this programme will be very crucial to gather accurate information that will guide planning, implementation, assessment of the performance and impact of the programme. The National Society will develop M & E system that will ensure feedback into the programme. Feasible and simple process indicators have been developed and are in the logframe to assess the implementation and outcomes of the programme. Data for assessing some of the outcome and the impact indicators will be generated from surveys such as HIV sentinel surveillance surveys and Demographic and health surveys (DHS) conducted by other partners. Key recipients under this programme will be trained on M and E of the programme, indicators, use of data collection and reporting formats. BSRCS will develop simple data collection and reporting formats for the various levels. A client, OVC and programme activity database for each project area will be developed and confidentially maintained. All databases will then be compiled, collated and consolidated into a quarterly report at provincial level. The provincial coordinators will be responsible for compiling, making the quarterly reports on the projects under their respective provinces. At national level, the national HIV and AIDS coordinator together with staff in his/her unit will compile, collate analyse and make national quarterly and annual programme reports. At the community level, volunteers will produce monthly reports and hold monthly debriefing meetings with their supervisors. The volunteers will also produce monthly reports and hold debriefing meetings with the Provincial coordinators. The national HIV and AIDS programme manager will give a feedback to the provincial coordinators who will in turn provide the same to the volunteers and the community. All national and annual programme progress reports will be distributed to the partners and the Federation Secretariat. There will be three project reviews; the baseline assessment/review in each of the project areas, midterm output review and towards the end of the project. These reviews will be conducted internally by BSRCS, as evaluation tools to measure progress of implementation and any issues related to implementation of the programme. Participatory methods will be used in the reviews. There will be an external evaluation using participatory method, at mid term i.e. after the first two years to measure progress towards the set objectives, and then plan the next project phase accordingly. A final evaluation will be conducted at the end of the five-year period. To complement data from programme M and E, operational research will be conducted to provide information for consolidating and improving service delivery and the operations of the National Society. 6.0. Important Assumptions and Risks The successful implementation of this Integrated HIV and AIDS programme assumes that: The strategic and implementing partners, including the communities will remain committed to HIV and AIDS programming; Communities will be receptive of the interventions; There will be adequate resources: especially financial resources for implementation of all the planned interventions; Its funding partners for its core programmes will support the integration of HIV and AIDS into these other programmes; Other partners of the BSRCS will collect data on the outcome and impact indicators. It is assumed that this data will measure the programme s achievement of the goals set, towards the reduction in the spread of HIV, and alleviating the suffering of the vulnerable populations: 12

The government will address the challenges of inadequate staffing and poor infrastructure, which have a bearing on the provision of VCT, PPTCT and ART; There are no obvious risks perceived at this stage that will affect the implementation of the programme. 7.0. Programme Budget The estimated budget for this Integrated HIV and AIDS programme 2006 to 2010 is CHF 23,085,831. The programme is currently 5.3% covered and is therefore seeking CHF 21,861,156 to support implementation, needs of the National Society and the Federation Secretariat s programme support cost. Summary Budget for 2006-2010 Activity 2006 2007 2008 2009 2010 TOTAL Prevention activities 175,871 177,888 218,677 240,545 264,599 1,077,580 Care Support And Treatment Reducing stigma and discrimination 660,274 806,588 3,032,953 4,090,993 5,007,351 13,598,159 114,738 116,612 128,273 141,100 155,210 655,933 Institutional strengthening 596,080 1,040,057 1,332,533 1,455,428 1,615,766 6,039,864 Federation secretariat support 124,088 171,750 378,003 475,513 564,941 1,714,295 Grand Total In CHF 1,671,051 2,312,895 5,090,439 6,403,579 7,607,867 23,085,831 Committed funding 1,224,675 Funding Gap in CHF 21,861,156 % Gap 94.70% 13

Contact information For further information related to this programme please contact: In Swaziland: Sibongile Hlope, Secretary General, Baphalali Swaziland Red Cross Society, Mbabane; Email: sibongile@redcross.og.sz; Phone +268.404 25.32; Fax +268 404 61.08 In Zimbabwe: Françoise Le Goff, Head of Southern Africa Regional Delegation, Harare; Email: francoise.legoff@ifrc.org; Phone +263.4.70.61.55, +263.4.72.03.15; Fax +263.4.70.87.84 In Geneva: John Roche, Federation Regional Officer for Southern Africa, Africa Dept., Geneva; Email:: john.roche@ifrc.org; Phone +41.22.730.44.40, Fax +41.22.733.03.95 For information on the International Federation Global HIV and AIDS Alliance contact: In Geneva: Dr Mukesh Kapila, Special Representative of the Secretary General for HIV and AIDS; Email: mukesh.kapila@ifrc.org; Phone +41.22.73.43.41, Fax +41.22.733.03.95 Annex Logical Framework 14

Baphalali Swaziland Red Cross Society: Integrated HIV and AIDS Programme 2006-2010 Appendix 1: Logframe Baphalali Swaziland Red Cross Society HIV and AIDS Programme 2006-2010 Logframe Narrative Summary (NS) Goal: To reduce vulnerability to HIV and its impact in Southern Africa Purpose: To reduce vulnerability to HIV and its impact in Swaziland Outputs 1. HIV infections are prevented among 505,000 people in project sites by 2010. 2. Care, treatment, and support services are expanded and reached 22,000 and 30,000 OVC by 2010. Objectively Verifiable Indicators (OVI) Declining HIV prevalence rates for the general population Declining HIV prevalence rates among pregnant women aged 15-24 years Survival and improved quality of life Reduced incidence of HIV among target population (505,000) Percentage of pregnant women aged 15-24 years who are HIV positive. Survival and improved quality of life for 22,000 PLHIV and 30,000 OVC Objectively Verifiable Indicators (OVI) 1.1 Percentage of women and men aged 15-24 years who correctly identify ways to prevent HIV infection 1.2 Percentage of women and men aged 15-24 years reporting use of a condom at last sex with a nonregular partner casual sex. 1.3 Delayed sexual debut among youths in target population 2.1 100% PLHIV receive care, treatment and support by 2010 2.2 90% of PLHIV on ART from Government health facilities are adequately supported with Means of Verification (MOV) UNAIDS Global HIV and AIDS pandemic reports National DHS Population surveys Programme review and assessment reports Means of Verification (MOV) Population surveys National demographic health surveys Health facility reports National Society Reports Interviews with target groups Programme reports Health facility records Key informant Interviews Important Assumptions Sufficient national budgetary allocations, and international donor assistance resources provided, and access to targeted populations achieved Important Assumptions Willingness of target population to modify their cultural beliefs about sexual behaviour Availability of donor support to implement the programme. Willingness of governments to support expansion of care treatment and support 15

3. Stigma and discrimination associated with HIV and AIDS are reduced. 4. Capacity of BSRCS is strengthened to enable more effective, expanded, direct outreach to served communities. adherence, treatment literacy and preparedness 2.3 22,000 households affected by HIV receive food assistance (quarterly) and involved in livelihood approaches 2.4 100% of OVC receive material, psychosocial, and educational support annually 3.1 80% of households and communities expressing accepting attitudes towards PLHIV 3.2 100% of employers in the impact area not discriminating employees due to HIV 3.3. Increased uptake of VCT, PPTCT, ART, TB and STIs services in the impact area by 2010. 4.1 80% staff and volunteers recruited and retained in the programme throughout the period. 4.2 Volunteer management and Human Resources policies developed, reviewed and implemented 4.3 Timely, quality and accurate reports are produced as required 4.4 100% staff and volunteers trained in planning, reporting, monitoring and evaluation 4.5 100% of project offices are provided with administrative support, equipment and infrastructure. 4.6 Information sharing, operation research, documentation conducted. 4.7 Number. policies produced and implemented volunteer and staff Focus group discussions Interviews with key informants Household and community surveys Focus group discussions DHS Records of the Health facilities, VCT centres and employers. Programme reports Reviews and evaluations Interviews with staff and volunteers interventions. Availability of programme resources to implement the activities. Willingness and commitment by government institutions and stakeholders including communities to reduce stigma and discrimination National society integrity and dignity issues may hamper implementation. Willingness of NS management to culture of work to fit into 21 st century approaches to management. 16

Output 1 Conducting two community discussions per year in 80 branches (both current and foreseeable). Developing and distributing IEC 300,000 brochures, one digital versatile decoder with best practices of the National Society in HIV prevention. Mobilizing and sensitizing communities using interpersonal communication and mass media both print and electronic, theatre, radio slots in Swati Channel. Training peer educators (600 youth, 150 prison inmates, 150 prison staff, military, 150 long distance truck drivers by 2010). Supporting peer education for the various target populations identified above throughout the five years. Facilitating youth dialogue (debate, writing, role play, and drama, prize-giving) and organize exchange visits for 80 youth branch members to facilitate behaviour change in branches. Establishing 16 youth groups per year. Conducting training for ten youth instructors. Training 16 donor clubs per year in life skills so that young people can donate less contaminated blood by 2010. Mobilizing and sensitizing 91,000 teachers and parents on Youth Empowerment Assertive Response (YEAR). Scheduling parents youth meetings to give feedback on the project and branch development (two annually) and provide awards to young girls and boys (15-21 years) for those who took the oath not to indulge themselves in sexual intercourse until marriage. Developing partnerships and support recreational sports among the youth. 4.8 Resource mobilization conducted and strategic partnerships and alliances established. Objectively Verifiable Indicators (OVI) Number of baseline surveys conducted IEC materials developed and distributed and the number of people who have received materials Number of peer educators trained Number of mass media campaigns conducted Number of people attending VCT and receiving PPTCT and ART services Number of youth groups established Number of VCT centres established and operational Total budget: CHF 1,077,580 Sources of information Programme quarterly reports, reviews and evaluation Focus group discussions Interviews and observations Health facility records Assessment reports Activity to output Willingness of the local governments to support the implementation of the projects at local level Availability of qualified staff at district and provincial level to manage the projects Availability of volunteers who are willing to participate in the programme. 17

Selecting, recruiting and training 150 male and female condom distributors. Identifying and setting up 28 condom outlets in each community of 1,350 sexually active people. Conducting sensitization community seminars on correct and consistent use of condoms. Conducting training for 16 chiefs per year by 2010 on VCT. Providing VCT mobile testing in all Red Cross clinics. Procuring blood testing equipment and supplies including transport for shipping blood samples for VCT to the national Referral laboratory. Conducting training and refresher courses for counsellors in seven VCT centres. Mobilizing communities for VCT committees in 80 chiefdoms. Conducting 12 community outreach visits per site per month. Mobilising and sensitizing community leaders and chiefs about PPTCT and ART services. Educating communities on PPTCT through drama. Distributing IEC materials on PPTCT to community members and women in the communities. Training six midwives on PPTCT. Screening pregnant women who come for primary health care services for HIV after counselling, and provide 2,160 positive pregnant women with Nevirapine at the local clinics within the 80 communities by 2010. Supplying food packs to mothers (PPTCT clients) with HIV. Output 2 Providing ART to patients in need at Sigombeni and Mahwalala. Conducting training for 660 care facilitators by 2010 Providing 660 HBC Kits to care facilitators and replenish them every month with the necessary medications. HBC materials procured and distributed Number of volunteers trained on ART training package Number of family members trained Number of support groups established per province 18 Programme reports Training reports Assessment and situation analysis reports

Supplying 22,000 HBC clients and patients on ART (those in dire need) with 63,600 blankets over a fiveyear period, starting in 2006. Procuring and distribute food packs for 22,000 clients (those in dire need) quarterly over a five-year period. (E.g. Food packs contains: mealie-meal, beans, oil and fish). Conducting training of 32 support groups members per year on support formation and positive development. Conducting training for 3,500 PLHIV in 80 Communities on small and medium enterprises (Bee- Hive Keeping). Conducting refresher-training course for 3,500 PLHIV once a year through 2010. Educating PLHIV and affected households on food security and nutrition. Establishing and supporting 16 small medium enterprises (SME) for PLHIV support groups each year through the five years. Conducting workshop for 16 branch youth members on SME focusing non-labour intensive projects such as beehive keeping. Procuring 16 bee-hive boxes each year and supply them to the youth. Establishing communal gardens as income generating projects. Installing 915 hand pumps for every 250 community members and establish committees to look after the pumps. Educating 80 communities to keep home surroundings safe and clean (domestic and excreta safe disposal) and on the control vector and water borne diseases. Distributing 50,000 insecticide treated nets to PLHIV and OVC in dire need of them. Providing material, educational and psycho-social support to 30,000 OVC by 2010. Training staff, HBC and OVC facilitators and other volunteers in various OVC needs, rights and other Number of coaches trained Number of food security and nutrition assessments conducted Number of volunteers trained on food security, livelihoods Number of gardens established Number of OVC receiving support Number of situational analysis conducted Total budget CHF 13,598,159 19