CIVIL SOCIETY FUND
Strengthening civil society for improved HIV/AIDS and OVC service delivery in Uganda
RFA # 11-001: Reduction Of New HIV Infections Through Enhanced
Community Engagement In Combination HIV Prevention
Pre-bidders workshops ; 12th October 2011
WORKSHOP OBJECTIVES
• Orient potential applicants on the RFA 11-001 requirements
• Share the national HIV Prevention Strategy;
• Orient stakeholders about combination HIV Prevention and
its package in the context of Uganda;
• Discuss approaches for supporting convergence of partners
and joint planning and partnerships frameworks for the 6
districts;
EXPECTED WORKSHOP OUTPUTS
• Improved understanding the RFA 11-001 requirements to
enable them write appropriate concept papers/proposals
• Improved understanding of the national HIV Prevention
Strategy, and combination HIV Prevention including its
package in the context of Uganda;
• Orient stakeholders on the design and methodology for
the Combination HIV Prevention pilot program;
• Suggested approaches for supporting convergence of
partners and joint planning and partnerships frameworks
for the 6 districts;
3


UGANDA NATIONAL HIV PREVENTION STRATEGY
..Expanding and doing HIV prevention better ….
BACKGROUND
• Uganda’s HIV epidemic is mature, and generalised
• Recent evidence shows that the epidemic has evolved – risk
factors and drivers as well as population groups most affected
have changed in recent years
• Although various HIV Prevention Interventions have piloted /
implemented for 25 yrs, Uganda still has a run away epidemic
Over 124,000 new HIV Infections in 2009
New Infections exceeding AIDS deaths by about X2
New Infections exceed annual ART enrolment by X3
• HIV prevention is one of the priorities of the NDP (2010 -15)
TRENDS IN HIV PREVALENCE
About 731,000 potential new infection over next five years if status quo
is maintained. Of these about 112,000 would be among children
HETEROGENEITY OF HIV BURDEN
• Very High HIV Prevalence
– Sex Workers, Partners of Sex workers, Individuals with history of
same sex. Fishing communities
• Average HIV Prevalence
– Antenatal women, Boda boda cyclists, Plantation workers
• Relatively low HIV Prevalence
– University Students
• Majority of new infections sexually transmitted
– 37% multiple partnerships
– HIV discordant monogamous
– Sex work and networks
– Majority of sexual transmission among individuals over 25 years
• MTCT about 20-25% infections
• Negligible blood borne infections
SOCIAL/STRUCTURAL DRIVERS OF HIV
• Socio-cultural drivers
– Harmful cultural beliefs/practices e.g. polygamy, widow
inheritance, courtship rape, rites of passage,
• Gender Norms
– SGBV, multiple partnerships among men, Permissiveness
among women, Masculinity among men
• Socio-Economic
– Poverty/wealth, Dependency , mobility
• Human rights violations especially for women/girls
– access to justice- weak enforcement of existing laws
• Inequities in access to health services
• Stigma and Discrimination
WHY NEW HIV INFECTIONS REMAIN HIGH....
Current HIV
Prevention
not always
aligned to
epidemic
drivers:
Relevant sexual behaviours. i.e. multiple concurrent
partnerships, transactional sex, etc
Low coverage of male circumcision
Socio-cultural and gender norms often neglected
Coverage of Over 60% of adults never tested for HIV
key HIV
prevention
Over 40% of antenatal mothers no access to PMTCT
services still
sub-optimal
Almost three-quarters of adult men not circumcised
to make
public health
Over half of risky sex not protected with condoms
impact
Quality of HIV prevention services not optimal
CONSIDERATIONS IN THE NEW STRATEGY
• Aligning HIV prevention efforts to drivers of the HIV/AIDS
epidemic
• Target population groups with the highest risk of new
infections
• Central theme of the new strategy is Combination HIV
prevention approaches using proven interventions
– Minimum HIV prevention packages for the general
population and specific groups brought to critical
coverage
• Alignment to NDP NSP, HSSIP – i.e. the strategy to
implement the HIV prevention component in these
frameworks / strategic plans


THE NATIONAL HIV PREVENTION STRATEGY
MISSION & VISION
Mission
The strategy is to serve as a resource to stakeholders to
strengthen planning, implementation, coordination, and
monitoring of HIV prevention programmes to significantly
reduce new infections
Vision
“Uganda where new HIV infections are rare, and where
everyone regardless of age, gender, ethnicity or socioeconomic status has uninterrupted access to high quality and
effective HIV prevention services free from stigma and
discrimination”.
MISSION
Mission
The strategy is to serve as a resource to stakeholders to
strengthen planning, implementation, coordination, and
monitoring of HIV prevention programmes to significantly
reduce new infections
Vision
“Uganda where new HIV infections are rare, and where
everyone regardless of age, gender, ethnicity or socioeconomic status has uninterrupted access to high quality and
effective HIV prevention services free from stigma and
discrimination”.
GOAL
• To reduce new HIV
infections by 30%
based on the baseline
of 2009 which would
result in 40%
reduction of the
projected number of
new HIV infections in
2015, in line with the
targets in the NDP
• To reduce MTCT Rate
reduced from 29% to
less than 10% by 2015
New Infections - Reduced
New Infections - Status Quo
IR - Status Quo
IR Reduced
180,000
2
160,000
1.8
140,000
1.6
120,000
1.4
40
%
30%
100,000
1.2
1
80,000
0.8
60,000
0.6
40,000
0.4
20,000
0.2
0
0
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
•40% Reduction in new infections based on
projected 2015 levels
•Equivalent to 30% reduction based on 2009
estimates of new infections
•IR declines from 0.74 to 0.46 /100PYs
•178,930 New HIV Infections averted
2015
OUTCOMES BY 2015
New HIV Infections Reduced by 30% from 2009 levels
(i.e. 40% of projected new infections in2015)
Increased
coverage,
and
utilization of
HIV
prevention
services
Increased
adoption of
safer sexual
behaviors
and reduced
risky
behaviors
A
strengthened
& sustainable
enabling
environment
that mitigates
underlying
factors that
drive the HIV
epidemic
Achieving a
more
coordinated
HIV
prevention
response at
all levels
Strengthened
information
systems for
HIV
prevention
PRIORITIES FOR HIV PREVENTION
• To adequately address the key drivers
 Scale up priority HIV prevention services i.e. PMTCT,
HCT, SMC, ART for HIV Prevention and Condom use
 Reduce "unsafe sex" i.e. multiple and concurrent
partnerships, early debut, cross generational ,
transactional and, casual sex
 Make "unsafe sex" safer through condom promotion
and increased male circumcision.
 Reduce gender/socio-cultural/structural constructs
that facilitate sexual transmission of HIV
 Improved Coordination and M&E for HIV Prevention
PRIORITY POPULATION GROUPS
• General Population with a strategic shift to adults, married
and previously married individuals, wealthy and working
adults
• Residents of high prevalence / high risk locations e.g. urban
residents, high HIV prevalence regions, transport corridors,
boarder crossings, fish landing sites etc
• Most-at-risk population groups, especially sex workers and
their partners, long-distance truckers, fish-mongers, men in
military service,
• Vulnerable population groups e.g. victims of rape and
sexual violence, non-infected partners of individuals in HIV
sero-discordant relationships, widows, etc
• PLHIV
MINIMUM PACKAGE OF SERVICES FOR GENERAL
POPULATION
Core Components:
• PMTCT
• Male circumcision
• HIV counseling and testing
• Antiretroviral Therapy
• Condom promotion
• BCC integrated into existing structures (religious institutions, work
places, school, etc) focusing on multiple partnerships etc
Complimentary Components:
• IEC Messages and social norms reinforced through mass media
• STI screening and treatment
• Blood Transfusion Safety and Infection Control
• Supporting policy and advocacy
MINIMUM PACKAGE OF SERVICES FOR MARPs
•
•
•
•
•
•
•
•
•
•
Community-based peer education and outreach
Risk reduction counseling (peer, outreach or in clinic settings)
Condom promotion and distribution
HIV counseling and testing
STI screening and treatment
Family planning and SRH services
Post Exposure Prophylaxis
HIV care and treatment
Access to health/social services
Structural issues (community mobilization initiatives and policy
level initiatives, including those which address stigma and
discrimination)
IMPLEMENTATION STRATEGY
• Combination HIV Prevention
– Referral linkages, Integration of services, Health Systems
Strengthening
• Realignment of funding priorities
– Increased domestic and external resources, Fund HIV
Prevention as a key and cross-cutting component of the NDP
• Improved Coordination
– Multisectoral response, Health sector, Line Ministries, LGs
• Monitoring and Evaluation
– Results-based, Strengthening of M&E systems, Alignment of
M&E systems, Improved reporting and surveillance, systems
– Impact evaluation, Resource tracking, Improved information
management and sharing


INTRODUCTION TO RFA 11-001
INTRODUCTION TO RFA 11-001
• HIV/AIDS epidemic in Uganda , goal and purpose
• The HIV Prevention Strategy
• Combination HIV Prevention with emphasis on behavioural
and structural interventions
• The community engagement concept
• Eligible CSOs CBOs; cultural/religious institutions; NGOs;
networks and NNGOs.
• principal recipients must have district presence of 3 years
consortiums.
• 6 focus districts
• UGX 26 billion in a period of 36 months.
OBJECTIVES OF THE RFA
• The objectives for this RFA mirror those stipulated in the
National Prevention Strategy. These include:
• To empower individuals and communities to effectively
demand for quality HIV/AIDS services and to demand for
inclusive delivery of these services.
• To increase adoption of safer sexual behaviors/practices
• To create a sustainable enabling environment that mitigates
the underlying socio-cultural, gender based and other
structural drivers of the HIV epidemic
• To achieve a well coordinated HIV prevention response
EXPECTED OUTCOMES OF THE RFA
Higher Level Outcomes
• Increased demand for and utilization of HIV prevention and
care services in the targeted districts
• Increased adoption of safer sexual behaviors /practices and
reduced risky behavior among targeted men and women
• Improved community perception of the benefits of
sustained behavior change.
• Well coordinated HIV prevention efforts at national, district
and community level.
24
EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes
• Increased proportion of adults who have ever received HCT
and know at least two benefits of testing.
• Increased proportion of infected mothers and the exposed
infants accessing a minimum package of PMTCT
• Reduced recent multiple concurrent partners among men
and women in the targeted communities
• Increased average age for marriage or sexual debut for
individuals especially youth in the targeted communities
• Increased proportion of risky sexual acts/encounters that
are consistently protected by condoms
EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes (cont..)
• Increased percentage of women who make decisions about
their sexual and reproductive health rights independently
or jointly with their partners
• Reduction of percentage of women who experience sexual
violence
• Improved involvement of men in community based HIV
prevention interventions
• Functional referral mechanisms/systems among the
community and facility HIV/AIDS services
THE 4 KNOWS
• Know Your Epidemic
– Analysis of data on prevalence and incidence to prioritize
populations and geographic areas that are most at risk for HIV.
• Know Your Context
– Data to contextualize the epidemic. Ensure cultural relevance.
• Know Your Response
– Tracking the epidemiological alignment, scope, coverage and
effectiveness of prevention efforts.
• Know Your Costs
– Knowing what is spent, and what the output for investment is;
prioritizing interventions based on cost-effectiveness.


COMBINATION HIV PREVENTION
COMBINATION HIV PREVENTION
The National HIV Prevention Strategy for Uganda calls for a
strategic shift towards Combination HIV Prevention
Definition (UNAIDS )
“The strategic, simultaneous use of different classes of
prevention activities (biomedical, behavioral, social/
structural) that operates on multiple levels (individual,
community, societal), to respond to the specific needs of
particular audiences and modes of HIV transmission, and to
make efficient use of resources through prioritizing,
partnership, and engagement of affected communities.”
BIOMEDICAL
•
•
•
•
•
ART treatment for eligible patients and PreP
Safe Male Circumcision
PMTCT
Home-based HIV Testing
HIV Testing (routine/opt-out) linked to ART and behavioral
change programs TLC
• Family planning
• STI-screening and treatment of MARPs & PLHIV
• Safe syringes
BEHAVIORAL
• Condom Use Promotion Programs
• Peer education HIV prevention programs addressing
condom use, concurrency, age-mixing and transactional sex
targeting high risk groups
• Couple counseling
• Disclosure promotion programs
• Delay sexual onset
• Adherence to ART support programs
• Positives Counseling Programs
• Positive Health Dignity and Prevention (PHDP)
• Abstinence and Faithfulness programs
31
SOCIAL/STRUCTURAL
• Micro credit programs to support women’s economic
situation
• Creating Demand for HIV Prevention Services Programs
• GBV prevention programs
• Conditional Cash Transfers
• Women Empowerment Programs
• PLHIV programs addressing stigma
• Addressing widow inheritance
• Human Rights and Empowerment Interventions for Sex
Workers, IDU’s
• Easing access to care for Sex Workers, IDU’s
BENEFITS OF THE RIGHT COMBINATION
• Several HIV interventions have a proven, but partial efficacy
• In combination a synergy effect can occur between
different interventions, which increases the effectiveness of
all of the interventions when delivered together.
• According to the local epidemiology we will have a tailor
made HIV prevention program for the area
• The tailor made approach adds effectiveness, high risk
individuals and groups are targeted first to avert most new
HIV infections
• Tailor made combined intervention taking place at the
same time in the same place to a defined standard are
know to be more effective.


COMMUNITY ENGAGEMENT
COMMUNITY ENGAGEMENT DEFINITION
Community engagement is the process of working collaboratively
with and through groups of people affiliated by geographic
proximity, special interest, or similar situations to address issues
affecting the well-being of those people.(adapted from Fawcett et
al, 1995)
Different levels at which one engages with people:* Inform
* Consult
* Involve
* Collaborate
* Empower
N.B: Different situations require the use of different levels of
engagement
COMMUNITY ENGAGEMENT PRINCIPLES
• Empowering the people to make decisions, raise question
& problems and be part of the solution
• The rules of engagement between the target beneficiaries
and the supporting agency need to be clarified
• Should be participatory (need awareness before this can be
acted upon)
• Should include both men and women
• Focus on the power dynamics (women empowerment)
• Community ownership
• Accountability
BENEFITS OF COMMUNITY ENGAGEMENT
of engaging the community:• the development of sustained, community-focused and led
interventions
• Use of explicit methodologies that engage people in
discussion and collective action on the factors that
influence risk and vulnerability to HIV in their particular
communities.
• The development and/or strengthening of strategic
partnerships and coalitions that help mobilize resources
and influence systems, change relationships and serve as
catalysts for changing policies, programs and practices.
AREA OF FOCUS AND SUGGESTED INTERVENTIONS
•
•
•
•
Innovative interventions in the following:Communication for social and individual behavior change
Gender norms and harmful social cultural practices
Coordination, collaboration, strategic partnerships
networks and referrals
• Cross cutting issues
• Engage with district and any other relevant
• Capacity building interventions for communities and
selected duty bearers.
NOTES
• Consortiums -leverage resources and avoid duplication of
efforts.
• Procurement restrictions
• Niche/comparative advantage
• Coverage of target populations


Building Strategic Partnerships, Linkages and Referrals
– The role of the various stakeholders in the district
Strategies for strengthening partnership, linkages & referrals
•
•
•
•
Establishing terms and conditions of partnership
Ensuring clarity of roles of all partners
Ensuring regular meetings of the partners
Ensuring transparency and accountability in the
partnerships
• Strengthening forums for partnership development
• Strengthening the capacity of service providers to manage
referrals

OVERVIEW OF THE M&E SECTION

OVERVIEW OF THE M&E SECTION
The M&E section has three main components;
1.
2.
3.
4.
The M&E Matrix
The M&E Narrative
The M&E Resources
The CSF M&E System
THE M&E MATRIX
Builds on the log frame and provides the following details:
1. Overall Objective – what your project intends to contribute to.
2. Outcome-desired change/ result that your project aims to
achieve
3. Outputs - immediate results of project activities
4. Performance indicators (within prevention strategy framework)
and respective baselines and targets
5. Means of Verification (MOV) - Data sources
6. Frequency of data collection for each indicator
7. Responsible person /entity for data collection for each indicator
8. Frequency of data analysis and use for each indicator
9. Responsible person /entity for data analysis for each indicator
THE NARRATIVE SECTION
Explain precisely the how, what, who, when and where
regarding;
• Data collection
• Data storage
• Data analysis, reporting and utilization
• Other monitoring processes
• Data quality assurance
• M&E capacity building
• Monitoring external, uncontrollable factors
M&E RESOURCES
Provide a sufficient M&E budget (10 – 15% of the total
project budget) cater for:– Full-time M&E personnel to carry out M&E functions
– Equipment for data capture, storage, processing and
reporting e.g. computers, internet
– Short-term M&E resources e.g. consultants, data
entrants
– M&E activities including data collection, analysis,
storage, reporting, review meetings, trainings,
assessments, tools production, field monitoring visits
and the like.
The CSF M&E System
• Data collection tools: CSF has standardized data collection
tools fro capturing HCT, HIV prevention, PMTCT, that are
used by all the sub grantees. The sub grantees will
therefore be required to adopt the available data collection
tools.
• Reporting formats: CSF has standardized reporting formats
for quarterly, semi annual and annual reports. All sub
grantees are supposed to abide by the reporting timelines
• An online database: CSF has an online database for
capturing sub grantee data and all are required to enter
their data in this database.
• Indicators: CSF has standardized indicators that all sub
grantees are required report against.
TARGET AND DENOMINATOR TABLE
CATEGORY (CSW, PHA, Fisher folk etc)
District
Sub county
Parish
Age
(Years)
10-14
15-24
≥25
Target
Female
Denominator
Male
Target
Denominator
Total
Target Denominator
EXPECTED OUTCOMES OF THE RFA
Higher Level Outcomes
• Increased demand for and utilization of HIV prevention and
care services in the targeted districts
• Increased adoption of safer sexual behaviors /practices and
reduced risky behavior among targeted men and women
• Improved community perception of the benefits of
sustained behavior change.
• Well coordinated HIV prevention efforts at national, district
and community level.
49
EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes
• Increased proportion of adults who have ever received HCT
and know at least two benefits of testing.
• Increased proportion of infected mothers and the exposed
infants accessing a minimum package of PMTCT
• Reduced recent multiple concurrent partners among men
and women in the targeted communities
• Increased average age for marriage or sexual debut for
individuals especially youth in the targeted communities
• Increased proportion of risky sexual acts/encounters that
are consistently protected by condoms
50
EXPECTED OUTCOMES OF THE RFA
Lower Level Outcomes (cont..)
• Increased percentage of women who make decisions about
their sexual and reproductive health rights independently
or jointly with their partners
• Reduction of percentage of women who experience sexual
violence
• Improved involvement of men in community based HIV
prevention interventions
• Functional referral mechanisms/systems among the
community and facility HIV/AIDS services
51
THANK YOU
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FINAL Pre-bidders ppp