SAG-USG Joint 5-Year Partnership Framework (PF) and Partnership Framework

Implementation Plan (PFIP)2012/13 – 2016/17

KwaZulu Natal SAG PEPFAR All Partners’ Meeting

28 November 2011

Key Questions for PEPFAR

• Where were we?

• Where are we?

• What has changed?

• Where are we going?

Where were we?South Africa

• Scale of SA HIV epidemic huge

• Consequences of SA HIV epidemic staggering (morbidity, mortality, orphans, stigma)

• AIDS Denialism slowed effective response

• Tools to respond limited: ART, palliative care, VCT, AB(C)

PEPFAR

PEPFAR started as an Emergency Plan

Put as many people on ART as quickly as possible

Rapidly scale-up of programs

Rapid and substantial increase in funding 2004 – 08

Principles of the South Africa PEPFAR Program

Core Principle

Interagency Cooperation in a single program

1. Partner with South African Government

2. Support the South African National Strategic Plan

3. Fewer partners, but work with more indigenous organizations

4. Build on demonstrated success

5. Develop local capacity

6. Plan for sustainability

South African Government Partnerships

• Supporting the South African Government is a Core Principle of PEPFAR in South Africa– Department of Health– Department of Correctional Services– South African National Defence Force

(including Military Health Services) – Department of Social Development– Department of Education– Provincial Departments of Health

PEPFAR Operations in SA

U.S. President's Emergency Plan for AIDS Relief:

Office of International Health, PEPFAR Secretariat, South

Africa

Office of the Global AIDS Coordinator (OGAC),

Washington DC

U.S. Agency for

International Development

(USAID)

Ambassador’s Community

Grants Program

U.S. Department of Defense

Centers for Disease

Control and Prevention

(CDC)

Coordination, Collaboration, Support of PEPFAR Implementing Agencies

Peace Corps

South Africa PEPFAR Funding

148 prime implementing partners (contractors

and grantees)

and

more than 650 sub-partners

working throughout

the nine provinces

USAID and CDC PEPFAR PROGRAM

Unintended Consequences

• Weak coordination of scale-up

• Duplication and gaps in coverage

• Duplication/innovation – HMIS systems, training curricula, training, …

• Systems Parallel to SAG response created

• SAG Ownership of PEPFAR not enough, although aligned

• Decision-making processes not shared

What has Changed?

• Huge achievements in South Africa

• Political mandate to strengthen the National HIV Response

• Vibrant visionary leadership in health

• Roll out of new strategies to increase access and control HIV

• Expanding portfolio of prevention interventions

Achievements

• About 1.7 million South African on ART

• Mother-to-Child- Transmission decreased to 3.5%

• HIV Incidence decreased 25% between 2001 and 2009

PEPFAR Reauthorization

• Moving from Emergency to Sustainabilityo Strengthen SA leadership in PEPFAR SA program

activitieso Transition progressively PEPFAR operations from direct

service delivery to technical assistance and capacity building

o Expand prevention

• Partnership Framework (PF) and PFIPo Sets new course for changeo Change in doing business

What is the PF?

The PF is a 5-year joint strategic framework for cooperation between the US and SA governments, and other partners to combat HIV/AIDS and TB in South Africa.

Key themes in the PF?Efficiency

Sustainability

Stage 1: Partnership Framework (PF)

1. Establish collaborative

relationship

2. Negotiate overarching 5-year

goals of PF and commitments

of each party

3. Synthesize agreements into a

concise signed document

PF signed December 14, 2010

Stage 2: Partnership Framework Implementation

Plan (PFIP)

Develop an Implementation Plan that

Includes specific strategies to

achieve 5 year Goals and Objectives

in the PF

Framework Stages

Focus of the PFPurposeTo improve the effectiveness, efficiency and sustainability of the South African national HIV and TB response.

Guiding Principleso South African Leadershipo Alignmento Sustainabilityo Innovation & Responsivenesso Mutual Accountabilityo Multi-Sectoral Engagement & Participationo Gender Sensitivityo Financial Commitments & Transparency

PF Goals

o Prevent new HIV & TB infections

o Increase life expectancy and improve the quality of life for people living with and affected by HIV & TB

o Strengthen the effectiveness of the HIV & TB response

The goals of the PF are based on SA priorities:

Goal 1 Objectives

o Expand biomedical and behavioral prevention interventions that address the various drivers of the epidemics

oReduce vulnerability to HIV & TB infection, especially focusing on the needs of infants, girls and women

oIncrease the number of persons who know their HIV & TB status and link them to appropriate services

Prevent new HIV & TB infections

Goal 2 ObjectivesIncrease life expectancy and improve the quality of life for people living with and affected by HIV & TB

o Expand integrated treatment, care, and support services

oDecrease infant, child, and maternal mortality due to HIV&AIDS and TB

oMitigate the impact of HIV & AIDS and TB on individuals , families and communities, especially OVC

Goal 3 ObjectivesStrengthen the effectiveness of the HIV & TB response

o Strengthen and improve access to institutions and services, especially primary institutions

oStrengthen the use of quality epidemiological and program information to inform planning, policy and decision making

oImprove planning and management of human resources to meet the changing needs of the epidemic

oImprove health care and prevention financing

Governance & Management Structure

High-level Steering Committee o Strategic directiono Governance

Management-level Committeeo Management o Coordination

Key Elements o Joint oversight of PF and its implementationo Annual evaluation and reviewo Annual adjustments as needed

Where do we need to go?PFIP Development

Treatment and Care to transition to the SAG

• Integrate with the NSP 2012 - 2016

• Adopt and follow SAG priorities

• Integrate with the PHC and District Health System model

• Work with SAG to determine how NGOs can best contribute to this plan

Where are we going?PFIP Development

• Limit the amount of overlap to be efficient and effective

• Drive down the cost of service

• While strengthening the overall health system

• Prevention is the key to sustainability

• At all times ensure that care and treatment of patients is ensured

PFIP Development

• Bilateral PF Steering Committee includes Office of Deputy President, NDOH, DSD, DOE, DPSA and Treasury

• Align with the National Strategic Plan for HIV & Aids, STIs and TB (2012-2016)

• Work with provinces and districts

• Consultations

PFIP Development

• Provincial Consultations– Input on provincial and district needs early– Discussion of proposed PFIP– Discuss how NGOs can best contribute to this

plan in provinces and districts

• PFIP will address national program with room for provincial and district “tailoring” of activities/effort

Transition, Technical Assistance, and Capacity Building

• Progressively transition delivery of services to SA DOH staff

• “Transfer” staff from PEPFAR NGOs to DOH

• Train new health care workers

• Train existing DOH staff to enhance skills

• Provide technical expertise for a period of time to transfer skills, build a system, etc.

Partnership

• Change is difficult

• Partnership and teamwork make things happen

• Together we have a chance to really make a difference

Thank You