ដឹកនាំការឆ្លើយតបនឹងជាំងឺឆេដស៏ឆៅប្បឆេសកម្ពុជា Managing HIV and AIDS Response in Cambodia National AIDS Authority, 26 December 2013 Dr Phalla Tia , Vice Chair of NAA ចំណុចគន្លឹះននបទបង្ហាញ 1 Introduction 2 Result Based Management (RBM) 3 Update HIV and AIDS Response in Cambodia 4 5 Global, regional and country commitments for HIV and AIDS response Lessons learned from the HIV and AIDS Response in 2012-2013 6 Managing HIV and AIDS response in 2014-2015 7 Conclusions Suggestions for recommendations Introduction What is the value added of the National AIDS Authority ? សារគ្នលេះឹ ៩ 9 Key messages of Leadership Forum បុស្នតគ្រួ ឆោយឆសាក សាត យមានគានឆយើង ម្ួយចាំននួ ានសាំោនតលង់លក់ឆៅឆលើចងកូត But unfortunately, some of us have fallen asleep at the wheel Khun Mechai Viravaidya President of PDA 1. ពប្ងឹងម្គ្គឆុ េេសភាពនិងការប្គ្ប់ប្គ្ង (Leadership and Management) 2. វិនិឆោគ្ឆោយភាពវវឆ្លលត (SMART Investment ( low cost , high impact )) 3. េិនននយ័ គ្ឺជាេាំណាច ( Data is power) 4. រូបេនកឆនេះឆ យើ គ្ឺជាេនកដឹកនាំ ( You are the leader) 5. 6. សូម្េុកស គ្ម្ន៏ជាសនលូ វនការឆ្លយើ តប ( Community as the center of the response) ឈប់ឆ្វដើ ចូ ពីម្នុ ឆេៀត។ប្តវូ ឆ្វតាើ ម្របកគ្ាំឆ ើញថ្មIី nnovations ( Not business as usual ; Move with the innovation) 7. 8. ជាំរុញការស្សវងរកករណីថ្បមី ឆងកនើ ចាំននួ េនកឆប្បប្ើ ាស់ឧសថ្ប្បឆ្លាំងឆម្ឆោគ្ឆេដស៏នងិ ឆ្វឆើ ោយគាត់បនតការពាាលជាប់ជាប្បចាំ ( Accelerating case detection, maximizing ARV using , retain ARV users) ឆតត តឆលើប្បជាជនចាំណុចនិងេីតាាំងយុេសា ធ ប្សត ( Be focus on KAPs and geographic area 9. លុបបាំាត់ការឆរើសឆេើងនិងមាក់ងាយ (E liminate S&D ) Are we on the right track? If yes how ? Is a dashboard necessary? Introduction II- Management I- Financial III- Program WHO ( WHAT GROUP) IS MAKING DECISION? Doing the right thing : Leadership Doing thing right : Management Key Phases of RBM Strategic Planning Performance Measurement Performance Management UNICEF • Formulating SMART results • Setting targets • Selecting indicators • Monitoring performance data • Reviewing & reporting performance • Evaluation and Lessons • Using performance information for managing Definitions Impact Positive and negative, primary and secondary long-term effects produced by a development intervention, directly or indirectly, intended or unintended. Outcome The likely or achieved short-term and medium-term effects of an intervention’s outputs. Output The products and services which result from the completion of activities within a development intervention. Types of Change Impact Changes in the lives of people Outcome Institutional Change: values, ethic, rules, laws – associated with to institutional performance, access.. Behavioural change: knowledge, skills, practices (individual level) Output Operational Change: provision of goods and services Definitions Impact: Human Change Outcome: Institutional & Behavioural Change Outputs: Products & Services Skills & Abilities Positive and negative, primary and secondary long-term effects produced by a HIV infections reduced development intervention, directly or indirectly, intended or unintended. The likely or achieved short-term and medium-term effects ofresponse an intervention’s An effective national is delivered outputs. The products and services which result from the National AIDS Commission has the capacity to operate completion of activities within a development effectively and guide the national response intervention. Results-Chain Inputs Activities Outputs Outcomes Indicators Assumptions/Risks Impact A Typology for RBM Results Like… Focus Impact HIV incidence reduced Human! Outcome Response brought to scale Institutional/ Outcome Leadership empowered Output Skills of NAC strengthened Activity Train 250 district AIDS officers Behavioural Institutional/ Behavioural Operational/ skills, abilities, products & services @ Timeframe 5-10 yrs 5 yrs 5 yrs <3 yrs <1 yr Why RBM? It provides a coherent framework for strategic planning and management based on learning and accountability. បចចុបបននភាពវនការោលោលជាំងឺឆេដស៏ឆៅកម្ពុជា ចាំនួនេនកផ្េុកឆម្ឆោគ្ឆេដស៏ 76,000នក់ ចាំនួនប្សតីផ្េុកឆម្ឆោគ្ឆេដស៏ 39,000នក់ ករណី្លងឆម្ឆោគ្ឆេដស៏ថ្មី 1,400នក់ ចាំនួនប្សតីមានវផ្េឆ េះេេួលការពាាលឆដើម្បីបងាករការចាំឡងឆម្ឆោគ្ឆេ ដស៏ឆៅកូន 1,058នក់ េនកជាំងឺឆេដស៏ោយុឆលើស១៥ឆ្លនាំស្ដលប្តូវេេួលថ្នាំARV 54,000នក់ េនកជាំងឺឆេដស៏ោយុឆលើស១៥ឆ្លនាំស្ដលានេេួលថ្នាំARV 44,318នក់ ប្គ្ួសារស្ដលរងឆបេះ ល់ឆោយជាំងឺឆេដស៏ស្ដលេេួលឆសបៀង ករណីសាលប់ឆោយជាំងឺឆេដស៏ 0?ប្គ្ួសារ 2,700នក់ កុមារកាំប្ ឆោយឆម្ឆោគ្ឆេដស៏ 28,500 បចចុបបននភាពវនការោលោលជាំងឺឆេដស៏ឆៅកម្ពុជា ចាំនួនេនកផ្េុកឆម្ឆោគ្ឆេដស៏ 76,000នក់ ចាំនួនប្សតីផ្េុកឆម្ឆោគ្ឆេដស៏ 39,000នក់ ករណី្លងឆម្ឆោគ្ឆេដស៏ថ្មី 0នក់ ចាំនួនប្សតីមានវផ្េឆ េះេេួលការពាាលឆដើម្បីបងាករការចាំឡងឆម្ឆោគ្ឆេ ដស៏ឆៅកូន 1,104នក់ េនកជាំងឺឆេដស៏ោយុឆលើស១៥ឆ្លនាំស្ដលប្តូវេេួលថ្នាំARV 54,000នក់ េនកជាំងឺឆេដស៏ោយុឆលើស១៥ឆ្លនាំស្ដលានេេួលថ្នាំARV 44,318នក់ ប្គ្ួសារស្ដលរងឆបេះ ល់ឆោយជាំងឺឆេដស៏ស្ដលេេួលឆសបៀង ករណីសាលប់ឆោយជាំងឺឆេដស៏ 20,000ប្គ្ួសារ 0នក់ Cambodian migrants working in Thailand Total registration of Cambodian Migrants to Thailand : 235,521+ 112,275 (2011, MOPH Thailand ) HIV prevalence: 2.15% ( 2010 MOPH Thailand) ឆសចកតីឆបតជាាចិតតថ្នក់ពិភពឆោកនិងថ្នក់តាំបន់ កនុងការឆ្លើយតបនឹងឆម្ឆោគ្ឆេដស៏/ជាំងឺឆេដស៏ Global and Regional Commitments on HIV and AIDS វថ្ងផ្ុតកាំណត់សាំោប់ ឆសចកតីសាំឆរចឆលខ៦៦/១០របស់ប្កុម្ប្បឹកាឆសដឋកិចចជនិងសងគម្វនេងគការស ប្បជាជាតិកនុងតាំបន់ោសុីនិងាសុី វីកវន(ESCAP) ឆគាលឆៅស សវតសរបស់េងគការស ប្បជាជាតិ ឆគាលឆៅស សវតសេី៦បញ្ឈប់ការោលោលជម្ងឹឆេ ដស៏ឆៅឆ្លនាំ២០១៥និងឆផ្តើម្ឆ្វើឆោយជាំងឹឆេដស៏ថ្យ ចុេះ ២០០១ការប្បកាសឆសចកតីសាំឆរចចិតតរបស់េងគការ ស ប្បជាជាតិឆលើការងារឆេដស៏: វិបតតិសកលសកម្មភាពសកល ឆសចកតីសាំឆរចឆលខ៦៧/៩របស់(UNESCAP) ២០០៦ការប្បកាសឆសចកតីសាំឆរច ឆគាលនឆោាយរបស់េងគការស ប្បជាជាតិ ២០១១ឆសចកតីប្បកាសឆគាលនឆោាយវនេងគការស ប្បជាជាតិឆលើការងារឆេដស៏:បឆងកើនកមាលាំងឆយើងឆដើម្បីលុប បាំាត់ឆម្ឆោគ្ឆេដស៏និងជាំងឹឆេដស៏ ២០១១ឆសចកតីឆគាលនឆោាយវនASEAN:ឆ្វឆើ ោយ ០ការ្លងឆម្ឆោគ្ឆេដស៏ថ្មី០ការឆរើសឆេើងនិង០សាល ប់ស្ដលប ណាតលពីជាំងឹឆេដស៏ ឆគាលឆៅស សវតសរបស់េងគការស ប្បជាជាតិ ឆគាលឆៅនិងការឆបតជាាចិតតលុបបាំាត់វន ឆសចកតីឆគាលនឆោាយវនេងគការស ប្បជាជាតិ សាំឆរចឆគាលឆៅបីសូនយ ០្លងថ្មី ០សាល ប់០ឆរើសឆេើង ដល់ឆ្លនាំ២០១៥/២០២០ 2011 United Nations General Assembly Political Declaration on HIV/AIDS: Targets and elimination commitments សាំឆរចឆគាលឆៅបីសូនយ ០្លងថ្មី ០សាល ប់០ឆរើសឆេើង ដល់ឆ្លនាំ២០១៥/២០២០ 2011 United Nations General Assembly Political Declaration on HIV/AIDS: Targets and elimination commitments Lessons learned from HIV and AIDS Response in 2012-2013 Cambodian Context for HIV and AIDS Response 70 1.8 1.7 1.7 1.6 60 1.6 1.5 55 54 1.5 1.4 1.3 50 HIV epidemic and Funding 1.3 46 1.2 58 1.6 55 1.4 48 47 1.2 40 1 1 1 35 0.9 0.9 30 0.8 26 0.6 20 19 0.3 10 0.3 0.5 0.1 0.1 1 3 3.5 5 5 5 6 7 8 8 500 MUSD 0.8 0.7 0.6 0.4 8.5 10 0.2 0 0 1 2 3 4 Decades 1991-2000 Strategic Plan STP MTP NSP0 9 10 11 12 13 14 15 16 17 18 19 20 21 Funding in MUSD NSPI Decades 2010-2020 Decades 2000-2010 HIV prevalence among adult NSPIII NSPII 05-06 NASAI Costing modalities 1. Results? 1.1 1.1 Resource Need Model(RNM) 07-08 09-10 11-12 NASAII NASAIV NASAIII Long Run Cost (LRC) NSPIV Cambodian Context for HIV and AIDS Response Paris Declaration on Aid effectiveness ឆសចកតីប្បកាសេីប្កុងារើសសតីពីប្បសិេធភាពជាំនួយ Accra Agenda for Action Busan HL Forum on aid effectiveness GDJ TWG/JMI Partnership & country ownership PBA 70 1.8 1.7 1.7 1.6 60 1.6 1.5 55 54 1.5 1.4 1.3 50 HIV epidemic and Funding 1.3 46 1.2 58 1.6 55 1.4 48 47 1.2 40 1 1 1 35 0.9 0.9 30 0.8 26 0.6 20 19 0.3 10 0.3 0.5 0.1 0.1 1 3 3.5 5 5 5 6 7 8 8 500 MUSD 0.8 0.7 0.6 0.2 0 1 2 3 4 Decades 1991-2000 STP MTP NSP0 9 10 11 12 13 14 15 16 17 18 19 20 21 Funding in MUSD NSPI Decades 2010-2020 Decades 2000-2010 HIV prevalence among adult NSPIII NSPII 05-06 NASAI Costing modalities Results? Effectiveness? Efficiency? Sustainability ? 0.4 8.5 10 0 Strategic Plan 1. 2. 3. 4. 1.1 1.1 Resource Need Model(RNM) 07-08 09-10 11-12 NASAII NASAIV NASAIII Long Run Cost (LRC) NSPIV Investment Framework (IF) េភិប្កម្ប្គ្ប់ប្គ្ងេូទាំងកម្មវ្ិ ី Program Based Approach ១កម្ម វត្ថុន ៃះភិក្កម្ក្រប់ក្រង ទូ ទង ាំ កម្ម វ ិធី 1Consensus on objectives of PBA ៨ការសិកា ិងសាំរបសាំរ ួល 8 Learning and adaptation ២ក្កបខណ្ឌគោល គោបាយ ទូ លាំទូលាយ 2 Comprehensive Policy Framework ៧ការគលើកកាំពស់សម្ថ ភាពប គចច កគទស 7 Capacity Development component ៣គោលគៅរ ួម្ោា 3 Common Goals ៦ការឯកភាពគលើរចនាសម្ព ័ ិងការបបងបចកភារកិចជ 6 Agreed institutional arragements and responsibilities Source : www.cdc-crdb.gov.kh ៤ក្កបខណ្ឌគរៀបចាំការគក្បើ ក្បាសថវ ិកាទូ លាំទូលាយ 4 Comprehensive Resource Framework ៥ភាពជានៃរូ ិងរចនាសម្ព ័ ធ សាំរាប់គធវ ើការស ទ នា 5 Partnership and dialogue structures JMI- Joint Monitoring Indicators 2012-2013) of GDJ TWG on HIV and AIDS Cambodia’s 2015 HIV Prevention, Treatment and Impact Mitigation Targets are achieved through cost effective and efficient programme-based approaches Key Events in 2013 • United Nations – – • • • • GFATM • • • • • • National Stakeholder Consultation for the Mid-term Review of the Progress towards the Targets of the 2011 UN Political Declaration on HIV/AIDS June 2013 ( HLM) 10 Indicators for Three Zero GARPR : UNGASS NSP III ( Review ) ….NSPIV GDJ TWG on HIV and AIDS – ( 2012 -2013 JMI ) – Partnership Development Strategies (GDJ TWG Retreat in Siem Reap) 12-13 Nov 2013 – National HIV Health Sector Program Review in Cambodia 29 April – 10 May 2013 HIV-Sensitive Social Protection for Impact Mitigation in Asia and the Pacific ICAAP11 ( 16-22 November 2013) • SSF Reprogramming August 2013 Gender Review OIG Report / Recovery NFM Application for 2016-2018 New Term of CCM GFATM SSF Phase 2 ( signing in 2Jan 2014) Incentives Scheme and Proposed Incentives ( December 2013 ) NAA • • • • Investment framework for effective response to HIV and AIDS New Structure of the National AIDS Authority ( 27September and 18 November 2013) Policy Board Meeting ( 28 November 2013) 7 Points policy directives ( 17 December 2013) How these activities are initiated ? How those activities are coordinated? Domestic vs. External Sources (millions of USD) • Spending from external sources was reduced by 20% from 2010 to 2012 • NASA III didn’t include 2.5m$ p.a. of salaries paid by RGC HIV/AIDS Spending by Financing Sources, (millions of USD) HIV/AIDS Spending by Financing Sources, (% of total) HIV/AIDS Spending by ASC (millions of USD) and Number of ART Patients Budget allocation WHO ( WHAT GROUP) IS MAKING DECISION? Proposal Development Committee ( Round Based Application) Budget allocation Monitoring HIV and AIDS Response CCC LFA CCC Oversight PR ( SR, SSR) GDJTWG on HIV and AIDS URC Monitoring Flagship Program យនតការប្គ្ប់ប្គ្ងម្ូលនិ្សិ កល GF Board GFATM Management GF Secretariat 1. 2. OIG Audit Investigation Portfolio Manager Guiding documents 1. Governance Manual 2. PD Manual 3. Conflict of interest Policy CCC CCC Ex Com CCC OC GDJTWG on HIV and AIDS LFA WG AIDS PR WG TB PR PDC WG Ma WG HSS PR PR Guiding documents 1. 2. 3. 4. 5. 6. Program Grant Agreement HR Manual Finance Manual Procurement Guidelines SR Management Guidelines M&E Guidelines PR Coordinating Group SR SR SR SR SSR SSR SSR SSR GDJTWG on Health MOH ការប្បៀបប ៀបមួយ A dashboard is needed 1. Financial 2. Management 3. Program បុគ្គលិករដឋេះ២០០០នក់ បុគ្គលិកសងគម្សុីវិលេះ៤០០០នក់ ប្បជាជនឆគាលឆៅេះ១០០០០០នក់ II- Management I- Financial III- Program WHO ( WHAT GROUP) IS MAKING DECISION? Grant Dashboard (GFATM) II- Management 1. Where are the drugs? 2. Are sub-recipients receiving resources and technical assistance as schedule? I- Financial Where is the money? Recommendations Actions III- Program 1. Are activities implemented as planned ? 2. Do the results match the performance goals ? Injecting plus sex work Sharper Boosted epidemiologic COPCT al targeting: Response reaching those at highest risk Injecting DUs Male/TG sex workers MSM ‘pleasure circuit’ Non injecting DU EW ‘Massage’ KTV Beer promoters ... Casino workers Current Trends in Health Financing Health Financing Indicators In 2008 Total Health expenditure (THE) ( US$ M) 564 General government Health expenditure ( GGHE) ( US$ M) 105 External expenditure on health ( US$ M) 111 Total health expenditure per capita 41 Total health expenditure as % of GDP 5.5 General government Health expenditure ( GGHE) as % of THE 19 External expenditure on health as % of THE 19.7 Out of pocket expenditure on health as of % of THE Total HIV and AIDS expenditure ( US$M) Total HIV and AIDS expenditure as % of THE Government HIV and AIDS expenditure as % of GGHE Source : Health Financing report 2012, MoH , NASA IV, 2013 in 2012 763 187 117 52 5.4 24.5 15.3 61.5 51.8 9.2 60.2 50.9 6.7 5 3 Health Sector Review • Urgent need to prepare a resource needs and mobilisation plan for sustained funding for essential HIV and AIDS services until 2020 – Sustain donor funding at adequate levels , increase domestic funding through diverse mechanisms as part of gradual integration of the HIV Program in broader Health system – In the shift towards more domestic funding, continuum of key prevention,care and treatment program needs to be mainted – Increase value for money to allocate resources to the most effective programs and improve service delivery and management efficiencies • Agreement on mechanism to increase domestic funding as a contribution of supply ( e.g. ARVs, Condoms) and demand side ( e.g. inclusions of ART, STI services in socal health protection schemes) financing under the new health financing policy Next steps in the coming two years • Expand and use evidence at central and provincial levels for priority settings and to inform the multi-year plan, systematically evaltuate program – Ongoing/ complete NASA IV, budgeting for GF HIV/SSF grant phase 2 costing ,Cambodia 3.0 – To be developed effectiveness and efficiency assessment , unit costs and resources need estimates • Develop a multi-Year resources needs and mobliisation plan to advocate and work with development partners, MOH, MOEF, other non health Ministreis, and other programs • Engage with MOH to contribute to the development and implmentation of Cambodia Healht strategic Plan from 2016 onwards and Cambodia Health Financing Policy Are we on a secure road “Getting to Zero ?” AIDS Spending Category Asia and Pacific and Cambodia 100% 90% 8% 7% 26% 32% 11% 80% 12% 70% 10% 9% 60% 50% 24% 7% 30% 28% 27% 27% Cambodia 2011 Cambodia 2012 40% 30% 20% 43% 10% 0% Asia and Pacific (2007) Policy and enabling Environment Program Management and Administration Orphans and Vulnerable Children Care and Treatment Prevention Managing HIV and AIDS Response in 2014-2015 Is there any innovative structure to replace it ? Cambodia’s 2015 HIV Prevention, Treatment and Impact Mitigation Targets are achieved through cost effective and efficient programme-based approaches CAM-H-NCHADS Phase 2 2014 2015 YEAR 1 YEAR 2 Summary budget by cost category Human Resources Technical and Management Assistance Training Health Products and Health Equipment Pharmaceutical Products (Medicines) Procurement and Supply Management Costs (PSM) Infrastructure and Other Equipment Communication Materials Monitoring and Evaluation (M&E) Living Support to Clients/Target Population Planning and Administration Overheads Other TOTAL TOTAL % 21% 3% 6% 11% 23% 5,534,823 6,312,397 11,847,220 788,125 725,718 1,513,843 1,696,646 1,784,304 3,480,950 3,294,693 3,253,082 6,547,775 6,508,240 6,511,840 13,020,081 1,262,288 1,370,572 2,632,860 458,145 293,733 751,878 254,666 152,626 407,293 2,346,086 2,774,916 5,121,002 3,606,408 4,170,604 7,777,011 1,201,376 1,081,246 2,282,622 1,028,943 1,233,256 2,262,199 - 27,980,441 - - 23,578,249 57,644,735 5% 1% 1% 9% 13% 4% 4% 0% CAM- HIV- SSF Phase II CHEC 0% CPN+ CRS 2% 2% FI HACC 0% 1% AHF 3% KHANA 19% NCHADS 58% NAA 7% NMHCH 3% NPH RHAC 0% 2% WOMEN 2% SHCHC 1% Estimated Resources for 2014 100% 90% 80% 1 3 1 4 Private ( Nat/ Intl) 70% Intl NGO 60% 50% 31 UN 40% GFATM 30% 20% 10% 0% Multi (-GF/Uns) Bilateral 6 6 1 RGC Cambodia : Keys actions on GA Resolution 65/277 Key actions Target 1 Target 2 Target 3 Target 4 Target 5 Target 6 Target 7 Target 8 Target 10 Responsible Coordination: NCHADS Contributors: key NGOs, UNICEF, WHO, UNAIDS, US-CDC, MARPs. Coordination: NCHADS Contributors: key NGOs, UNICEF, WHO, UNAIDS, CDC, MARPs. Coordination: NAA/MoI Revise PCPI training and monitoring tools to ensure effective implementation and monitoring of the initiative. Contributors: KHANA, FHI360, HACC, UNAIDS. Review the Boosted CoPCT SOP and adapt its services to the immediate and evolving needs of MARPs, especially Coordination: NCHADS those who face multiple risks. Contributors: key NGOs, UNICEF, WHO, UNAIDS, US-CDC, MARPs. Finalize and approve the NSP policy and SOP reflecting clear institutional leadership in overseeing and managing Coordination: National Mental Health Programme (Ministry of Health)/NACD the NSP and related programmes. Contributors: NACD, WHO, UNAIDS, HAARP, KHANA, Mith Samlanh, Korsang, FHI360. Coordination: National Mental Health Programme (Ministry of Health) Accelerate transition of the NSP licensing authority from NACD to the Ministry of Health. Contributors: NACD, WHO, UNAIDS, HAARP, KHANA, Mith Samlanh, Korsang, FHI360. Coordination: NCHADS Implement CPITC initiatives among PWUD and PWID. Contributors: WHO, UNAIDS, KHANA, Mith Samlanh, Korsang, FHI360. Advocate for better cross border coordination between Thailand and Cambodia on the issue of CoPTC for Migrant Coordination: NCHADS /NAA Workers Contributors : ASEAN ATFOA, JUNIMA/ UNDP Operationalize the recommendations of the recent Health Sector HIV Programme Review and conduct necessary Coordination: NMCHC and consistent follow-up. Contributors: NCHADS, key implementing NGOs, WHO/JUTH, CDC, CHAI Coordination: NMCHC Conduct implementation research for new services and approaches to test for efficiency and effectiveness, prioritizing the most important target groups. Contributors: NCHADS, key implementing NGOs, UNICEF Integrate PMTCT into national health system and funding mechanisms to ensure the sustainability of PMTCT (see Coordination: MOH Target 10). Contributors: NCHADS, NMCHC, key implementing NGOs, UNICEF/JUTH Operationalize the recommendations of the recent Health Sector HIV Programme Review and conduct necessary Coordination: NMCHC and consistent follow-up. Contributors: NCHADS, key implementing NGOs, WHO/JUTH, CDC, CHAI Coordination: NMCHC Conduct implementation research for new services and approaches to test for efficiency and effectiveness, prioritizing the most important target groups. Contributors: NCHADS, key implementing NGOs, UNICEF Integrate PMTCT into national health system and funding mechanisms to ensure the sustainability of PMTCT (see Coordination: MOH Target 10). Contributors: NCHADS, NMCHC, key implementing NGOs, UNICEF/JUTH Operationalize the recommendations of the recent Health Sector HIV Programme Review and conduct necessary Coordination: NCHADS and consistent follow-up. Contributors: CENAT, NMCHC, key implementing NGOs, WHO/JUTH, US-CDC, CHAI. Coordination: NCHADS Conduct implementation research for new services and approaches to test for efficiency and effectiveness, prioritizing the most important target groups. Contributors: NCHADS, key implementing NGOs, UNICEF Integrate care and treatment into national health system and funding mechanisms to ensure the sustainability of Coordination: MOH these services (see Target 10). Contributors: NCHADS, key implementing NGOs, WHO/JUTH, CHAI Coordination: NAA Identification and costing of key program interventions of NSP III/IV by using the Investment Framework Contributors: key ministries, implementing NGOs, UNs and Development Partners Coordination: NAA Develop a five year resource mobilisation plan to guide funding applications with the RGC as well as external donors. Contributors: key ministries, implementing NGOs, UNs and Development Partners Coordination: NAA, as part of the NSP III mid-term review (MRT) Assessment of current HIV funding governance mechanisms and recommendations for gradual harmonisation/integration within national systems Contributors: NCHADS, relevant departments in MoH, MoP, MEF and other ministries, UNAIDS, WHO, US-CDC, GiZ Coordinator: NAA Use the governance and accountability structure to mobilize resource from funding agencies including GFATM Contributors: NCHADS (Costed health sector response to HIV/AIDS, key implementing NGOs, UN and other development partners Comprehensive HIV-related gender (including GBV) review of national response to HIV Coordination: NAA in collaboration with MOWA, UN agencies and CSOs Develop clear strategy and indicators on GBV and HIV Coordination: NAA in collaboration with MoWA, UN agencies and CSOs Development of an evidence informed Action Plan on GBV and HIV (consistent with NSP III mid-term review Lead: MoWA in collaboration with NAA, NCHADS, with inputs from development partners and CSOs (MRT)recommendations and NAPVAW) Coordination: NAA National review of Law and Policy barrier for the AIDS response (as per Cambodia’s commitment to the ESCAP) Contribution: key ministries, civil society, UNAIDS/UNDP Coordination for Law enforcement bodies: NAA in collaboration with MOI and relevant development partners and communities Legal literacy among Law enforcement bodies and the PLHIV and MARPs communities Coordination for communities: CPN+ in collaboration with networks of MARPs with support from NGOs working on Legal and human rights, government and relevant development partners and UN agencies Coordination: NAA and MOI Implementation of action on PCPI with a clear monitoring system established Contribution: UNAIDS/ relevant development partners and NGOs Conduct MTR of NSP III (including the issues on governance and accountability framework for country response to Coordination: NAA HIV and AIDS). Contributors: UNs/Development partners, CRDB/CDC, MARPs Network, CSOs and key ministries Review and update when needed recommendations of the ‘Review of SP for Incorporating HIV Sensitivity’ report Coordination: NAA and identify key actions to implement them Contributors: CARD, key ministries, implementing NGOs, UNDP/JUTH Coordination: NAA, possibly as part of the NSP III mid-term review Address remaining information gaps on HIV specific SP services e.g. service coverage and gaps, unit and total costs Contributors: CARD, key non-health ministries, implementing NGOs, UNAIDS/JUTH Raise the understanding and share experience on the Boosted CoPCT SOP for MARPs at the national and subnational levels. Conduct mapping exercise to identify and locate MARPs at higher risk and services delivery points for a better planning and delivery of services. Coordination: NAA Ensure planning and resource mobilization for continued essential SP services for HIV affected households while pursuing opportunities for gradual integration of management and service delivery mechanisms Contributors: CARD, key non-health ministries, implementing NGOs, UNAIDS/JUTH Timeline Q4 2013 Q3 2013 Q3 2013 Q3 2014 Ongoing process Q3 2013 Q3 2013 Q1 2014 Starting Q3 2013 Starting Q3 2013 On-going process Starting Q3 2013 Starting Q3 2013 On-going process Starting Q3 2013 Starting Q3 2013 On-going process Q3-4 2013 Q1 2014 Q3-4 2013 Starting Q1 2014 Q3-4 2013 Q2 2014 Q1 2014 Q3-4 2013 Q4 2013 Q3-4 2013 Q2-Q3 2013 Q2 2013 Q3-4 2014 Q3-4 2013 for HIV/SSF grant Annual RGC budgeting periods 2015 for new GF grant GDJTWG on HIV and AIDS What is the line of accountability? GDJTWG on Health 100% GFATM 90% 1 3 1 4 Technical Advisory Board 80% Private ( Nat/ Intl) 70% Intl NGO 60% 50% 31 Multi (GF/Uns) UN GFATM 40% FLAGSHIP Bilateral 30% RGC 20% 6 10% 6 United Nations 0% 1 GDJTWG on HIV and AIDS 100% 90% 1 3 1 4 80% 70% Intl NGO 60% 50% 31 Multi (GF/Un s) 40% 30% 20% 10% Privat e( Nat/ Intl) 6 6 0% 1 UN Continuum of Prevention , Care treatment and support Impact Mitigation Enabling Environment and HR Leadership and Development synergies GDJTWG on HIV and AIDS Continuum of Prevention , Care treatment and support Impact Mitigation Enabling Environment and HR Leadership and Development synergies Conclusions and Recommendations Strengthening coordinating structure 100% 90% 1 3 1 4 80% Private ( Nat/ Intl) Intl NGO 70% 60% 50% 31 UN 40% 30% 20% Multi (GF/Uns) GFATM 6 10% 6 Bilateral សាំឆរចឆគាលឆៅបីសូនយ ០្លងថ្មី០សាល ប់០ឆរើសឆេើង GDJTWG on HIV and AIDS Continuum of Prevention , Care treatment and support Impact Mitigation Enabling Environment and HR Leadership and Development synergies 0% 1 I- Financial II- Management III- Program យនតការប្គ្ប់ប្គ្ងម្ូលនិ្សិ កល GF Board GFATM Management GF Secretariat 1. 2. OIG Audit Investigation Portfolio Manager Guiding documents 1. Governance Manual 2. PD Manual 3. Conflict of interest Policy CCC CCC Ex Com CCC OC GDJTWG on HIV and AIDS LFA WG AIDS WG TB PR PR PDC WG Ma WG HSS PR PR Guiding documents 1. 2. 3. 4. 5. 6. Program Grant Agreement HR Manual Finance Manual Procurement Guidelines SR Management Guidelines M&E Guidelines PR Coordinating Group SR SR SR SR SSR SSR SSR SSR GDJTWG on Health MOH 7 Point Policy Directives • 1. The National AIDS Authority should continue coordination with relevant ministries and institutions as well as with development partners and civil society organizations to promote and encourage the 100% use of condom for the sake of safe sex, a mean of preventing the transmission of sexual disease and HIV virus. • • 2. Incorporate the fight against AIDS and mother health-care as additional points in the Village-Commune Safety policy of the Ministry of Interior. • • 3. The National AIDS Authority, the Ministry of Health, along with relevant ministries and institutions, the development partners, and the civil society organizations should coordinate in mapping out localities identifying the number of PLHIV and MARPs --including entertainment workers, men having sex with men, orphans and vulnerable children, and PLHIV who migrate-as well as the number and locations of establishments providing continuum of prevention and HIV and AIDS treatment and related services. 7 Point Policy Directives • • • • • • 4. The National AIDS Authority should take measures to reactivate AIDS-fighting Committees at capital, provincial, districts, communes, and sangkats. The Ministry of Health should advice Provincial Health Department to closely coordinate with Provincial AIDS Committee/ Secretariat for HIV and AIDS response. Every Provincial AIDS Committee/ Secretariat should strengthen partnership with civil society organizations operating in respective province to enhance effectiveness of the response. 5. The National AIDS Authority, the National Authority for Combating Drugs, the Ministry of Interior, the Ministry of Health, and relevant ministries and institutions should coordinate for creating an enabling environment for MARPs, including entertainment service girls, men having sex with men, and injecting drug users, to have access to comprehensive HIV and AIDS treatment services. 6. The National AIDS Authority should coordinate with the Ministry of Education, Youths, and Sports, youth organizations, and relevant institutions to broaden education for male and female young people to equip them with an accurate understanding of the danger of HIV and AIDS and to inform them on comprehensive preventive options. 7 Point Policy Directives • 7. The National AIDS Authority has leading roles in coordinating and monitoring the implementation of the work on HIV/AIDS as mentioned in the National Strategic Development Plan 2014-2018 in conformity with the guidance provided by the Royal Government of Cambodia through the Cambodia Rehabilitation and Development Committee of the Cambodia Development Council. The National AIDS Authority has leading roles on aid effectiveness and bears the responsibility for a nationwide HIV and AIDS response. Relevant ministries, Phnom Penh and Provincial AIDS Committees should coordinate to develop respective HIV and AIDS action plan for optimizing the use of funding received from all sources in order to achieve tangible, effective, and efficient results and move forward in ensuring sustainability of the response. Mobilizing resources for 2016-2018 1. Use existing guiding principles , SOP and guidelines/directives , commitments ( PBA, RBF, ..) 2. NSPIV Development 3. Application of NFM NSPIII Review NSPIV Submission for GFATM by using NFM 2016-2018 Investment Framework in Cambodia ប្ាសាេភិមានោកាស 1 2 3 4 ប្គ្ប់ប្គ្ងឆដើម្បីលេធផ្ល (Managing for results) ភាពឆ្វើជាមាចស់ Ownership ( Partner countries ) វដគ្ូឆរៀបចាំ រឆបៀបវារ:ការងារ (Partners set agenda) តាំរឹម្រឆបៀបវារ: ការងាររួម្គាន ជាម្ួយ វដគ្ូ Alignment ( Donors-Partners) (Aligning with partners’ agenda) ភាពតាំរឹម្ សុខុដុម្នីយកម្ម Harmonization ( Donors-Donors) Phimeanakas ឆរៀបចាំឆោយមាន ការឯកភាពរួម្គាន ( Establishing common arrangements) ឆប្បើប្ាស់ប្បព័នធរបស់វដគ្ូ( Using partners’ system សាំរួលបេោឋ នឆោយងាយ ( Simplifying procedures) ស្ចកចយព័ត៌មាន ( Sharing information Robust country dialogue is the foundation(NFM) HIV, TB and malaria programs incl. health staff and Health system planners People living with HIV, TB patients, people who have had malaria Country Dialogue with diverse group of stakeholders to identify priorities to put in the Concept Note Women's organizations Domestic human rights experts Men who have sex with men (MSM) and transgender people Migrants, refugees, internally displaced people, ethnic minorities, forest fringe workers People who inject drugs Key Affected Populations: national networks Sex workers Youth GDJTWG on HIV and AIDS function regularly 100% Continuum of Prevention , Care treatment and support 90% 1 3 1 4 80% Intl NGO 70% 60% Impact Mitigation 50% 31 Enabling Environment and HR 30% 20% GFATM 6 10% 6 0% Sub-TWG on HIV and AIDS function regularly Multi (GF/Uns) UN 40% Leadership and Development synergies Private ( Nat/ Intl) 1 Bilateral Key Events in 2014-2015 • United Nations – – • • • GFATM • • • • • • National Stakeholder Consultation for Continuum of of the Progress the Mid-term Review towards the Targets Prevention , of the 2011 UN Political Declaration on HIV/AIDS June Care 2013 ( HLM) 10 Indicators for Three treatment Zero and support GARPR : UNGASS NSP III ( Review ) ….NSPIV GDJ TWG on HIV and AIDS – ( 2012 -2013 JMI ) – Partnership Development Strategies (GDJ TWG Retreat in Enabling Siem Reap) 12-13 Nov 2013 Environment – National HIV Health Sector and HRReview in Cambodia 29 Program April – 10 May 2013 HIV-Sensitive Social Protection for Impact Mitigation in Asia and the Pacific • SSF Reprogramming August 2013 ImpactReview Gender OIG Report / Recovery Mitigation NFM Application for 2016-2018 New Term of CCM GFATM SSF Phase 2 ( signing in 2Jan 2014) Incentives Scheme and Proposed Incentives ( December 2013 ) NAA • • • • Investment framework for effective response to HIV and AIDS Leadership New Structure of the National AIDS and Authority ( 27September and 18 Development November 2013) synergies Policy Board Meeting ( 28 November 2013) 7 Points policy directives ( 17 December 2013) NCHADS