Swaziland – FY 2010 Approved Funding by Program Area, Agency and Funding Source*

Date: 2011 Description: FY 2010 Approved Funding by Program Area, Agency and Funding Source © PEPFAR

*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.

A Partnership Framework between the Governments of the Kingdom of Swaziland (GKoS) and the United States was signed in June 2009, and is available at http://www.pepfar.gov/frameworks/swaziland/index.htm. This agreement focuses on reducing new HIV infections, improving and decentralizing the quality of treatment and care, rapidly expanding male circumcision services, mitigating the impacts of HIV/AIDS on vulnerable children and their families, and strengthening human and institutional capacity. This five-year joint strategic agenda is supplemented by a PFIP that provides additional detail. The use of FY 2010 funding in Swaziland is guided by the strategic goals set forth in the Partnership Framework and PFIP. The PEPFAR team will continue to work in close collaboration with the GKOS in building a self-supporting Swaziland HIV/AIDS program.

PEPFAR will promote a combination prevention approach that includes a major scale-up of sexual prevention and male circumcision and a smaller, but significant focus on PMTCT and blood safety activities. The overall objective of the prevention program is to strengthen national leadership and local capacity for well-coordinated, sustained and effective prevention programs that are well linked from national to community level. In August 2010, the Ministry of Health, with the full endorsement of the King of Swaziland, will commence with an aggressive roll-out of accelerated male circumcision seeking to attain a high level of coverage in adult males thus averting signficiant new HIV infections.

PEPFAR seeks to encourage Swaziland’s efforts to increase coverage and improve the quality of comprehensive HIV care and treatment services. A focus of PEPFAR’s support plan is key investments to facilitate the country’s decentralization of services through infrastructural upgrades, and intensive support to health systems including laboratory management, human resource development and task shifting, SI, pharmaceutical supply chain, and creation of linkages between communities and health facilities.

The integration of HIV/TB services down to community level is key element of the national and PEPFAR strategy. PEPFAR will support greater access to basic lab services at primary care level and support a national lab sample transport system.

The necessary linkage of PEPFAR community-based care and treatment efforts with OVC programming is well understood and appreciated. Over the next five years, OVC programs will be brought to scale through the following goals: supporting a national process to establish quality service standards; contributing to the National Strategic Plan for Neighborhood Care points by supporting needed services for at least 10,000 children at 200 sites; contributing to the national child protection program by supporting training and piloting strategies for enhanced sustainability; and supporting community-level service delivery through several NGOs.

Over the next five years, PEPFAR important goals include HSS and emphasizing SI activities. The PEPFAR program is a principal contributor to human capacity, infrastructure and strategic planning needs of the national HIV/AIDS program. Ongoing and scaled-up system strengthening activities in FY 2010 include: building the capacity of local NGOs in organizational leadership and technical, financial and administrative management; strengthening MOH capacity in human resources management, recruitment and retention; and strengthening local coordination and monitoring of Global Fund activities by supporting the staffing of a new secretariat for the Country Coordinating Mechanism (CCM). SI activities planned for FY 2010 include: building the M&E capacity of MOH and local NGOs working on the HIV response; establishing internal PEPFAR data QA protocols; supporting development of the AIDS indicator survey; decentralizing the MOH Human Resource Information system to the four regions of Swaziland; and supporting an epidemiologist to work with the MOH.

The GoKS has MMC as an HIV prevention strategy. Swaziland’s male circumcision Accelerated Saturation Initiative (ASI) is an unprecedented effort to roll out medical male circumcision for HIV prevention to achieve rapid coverage at a national level. Additional FY 2010 GHCS-State funding for Swaziland will support voluntary medical male circumcision implementation and the Swaziland HIV Measurement Survey (SHIMS).

In early 2010, the Swaziland MoH collaborated with PEPFAR to outline a plan to accelerate the country's strategic goal of increasing the prevalence of circumcision of adult men aged 15 to 49 (more than 150,000 men currently are uncircumcised) within a one-year time frame. Because of the host-county support, size, location and the high rate of HIV in Swaziland, the accelerated MC plan offers an historic opportunity to: (1) make a significant impact in the country- potential to avert 88,000 new infections by 2025, reduce HIV incidence by 75 percent, identify 23,000 “new HIV positives” and save over $600 million in future care and treatment costs; and (2) evaluate the effectiveness of male circumcision within comprehensive HIV prevention, while creating a wealth of operational information to improve global prevention programming.

Funding will continue to support the initiative’s implementation, as the service delivery target group has been expanded to males aged 15-49 (approximately 150,000 uncircumcised). In addition, additional resources will support waste management, as the government facilities have limited capacity to deal with the medical wastes from this campaign. Medical waste management will be done in conjunction with the Government of the Kingdom of Swaziland in order to strengthen the health system.

Funding will be allocated to the Department of Health and Human Services Centers for Disease Control (HHS/CDC) for the evaluation component of ASI. Building local capacity - training, infrastructure upgrades, local hiring, research capacity - have been prioritized by the GoKS. SHIMS will provide a learning environment with the potential to leverage many additional public health science objectives.

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