Cote d'Ivoire FY 2006 Country Operational Plan (COP)


COTE D�IVOIRE

Project Title: Cote d�Ivoire FY 2006 Country Operational Plan (COP)

Budget Summary:

 
Field Programs Funding by Account
Central Programs Funding by Account
 
 
Notified as of May 2006
Current Notification August 2006
Current Notification August 2006
 
Implementing Agency

GAP

GHAI

Subtotal:
Field Programs Funding by Account

GHAI

GAP

New Subtotal: Field Programs Funding by Account

GHAI Central Programs

Total Dollars Allocated: Field & Central Funding

DOD

-

-

-

-

-

-

-

-

DOL

-

-

-

-

-

-

-

-

HHS

5,253,000

21,061,300

26,314,300

(1,380,000)

-

24,934,300

10,793,572

35,727,872

Peace Corps

-

-

-

-

-

-

-

-

State

-

-

-

-

-

-

-

-

USAID

-

9,075,700

9,075,700

1,380,000

-

10,455,700

424,611

10,880,311

TOTAL Approved

5,253,000

30,137,000

35,390,000

-

-

35,390,000

11,218,183

46,608,183

HIV/AIDS Epidemic in Cote d'Ivoire:

Adult HIV Prevalence Rate: 7.1% [4.3-9.7%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 750,000 [470,000-1,000,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 450,000 [280,000-630,000] (UNAIDS 2006)

Country Results and Projections to Achieve 2-7-10 Goals:

Cote d'Ivoire Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
FY 2004* 28,100 4,500
FY 2005** 33,800 11,100
FY 2006*** 64,172 23,517
FY 2007*** 93,054 47,500

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

Cote d'Ivoire continues to traverse its deepest politico-military crisis since independence and is divided by a United Nations-controlled buffer zone. Even so it remains a regional economic and migratory hub. Almost one-third of the population of 16.9 million is made up of immigrants from the sub-region, and approximately half of the population lives in rural areas. Cote d�Ivoire remains the country with the highest HIV prevalence in West Africa. A 19% decrease in life expectancy is predicted by 2005, along with an increase of 53% in the adult mortality rate due to HIV/AIDS. Drawing on data from before the crisis, the UN estimates that 750,000 [470,000-1,000,000] people are infected with HIV, with an adult prevalence rate of 7.1% [4.3-9.7%]. An estimated 310,000 children have lost one or both parents to AIDS.

Cote d�Ivoire has a severe, generalized HIV epidemic that is exacerbated by factors linked to the crisis. HIV is primarily transmitted by sexually active adolescents and adults and through vertical transmission to young children. Populations at high risk for acquiring and/or transmitting HIV include HIV-sero-discordant couples, the uniformed services and ex-combatants, commercial sex workers and economically vulnerable young women and girls, truckers and mobile populations, sexually active youth, and orphans and vulnerable children. Two-thirds of sexually active youth aged 15 to 19 reported not using a condom during their last sexual encounter. Most (98%) of the estimated 570,000 HIV-infected people do not know their HIV status. Tuberculosis (TB) continues to be the leading cause of AIDS deaths, with 47% of the annual 18,000 patients newly diagnosed with TB co-infected with HIV and in need of treatment for both.

Despite the crisis and isolated episodes of violence in the country, the USG interagency Emergency Plan team and implementing partners are working closely with the host government and this coordination is moving ahead the in-country programs with demonstrated positive results. FY 2006 funding will be used to mitigate the impact of the epidemic through sub-granting to community and faith-based organizations (CBO and FBO) to expand a decentralized multifaceted civil society response to the epidemic.

Prevention: $12,086,440 as of August 2006 ($7,786,024 Field and $4,300,416 Central) (30.5% of prevention, care, and treatment budget)

Using FY 2006 funds, HIV prevention activities will include supporting behavior change among children and youth to delay sexual debut and promote life skills with positive gender roles for in- and out-of-school youth; decreased cross-generational and coerced sexual relationships; promotion of fidelity coupled with HIV testing within sexual partnerships; decreased hospital-related infection through expanded blood-safety and injection-safety programs; and risk reduction among high-risk populations such as youth, the uniformed services, truckers and commercial sex workers through reduction of the number of sexual partners, consistent use of condoms and increased access to HIV testing and care services.

EP support of FY 2006 funds will complement UN and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) funds and assist the Ministry of Health (MOH) to increase the number of health facilities providing integrated prevention of mother-to-child HIV transmission (PMTCT) services to over 200 sites, with linkages to other family-based care and treatment services (expanding coverage from 2% to 20% over two years). The EP will support rural and the various faith-based communities to promote abstinence and fidelity and to sensitize against gender- and HIV-related discrimination within their communities. These activities will be implemented through new grants awarded in September 2005 and expanded under FY 2006 funding to sub-grants targeting civil-society partners. A proposed jointly managed Health and Human Services (HHS)-U.S. Agency for International Development (USAID) award envisions a national umbrella organization to provide sub-grants and capacity building. Existing interventions targeting the various uniformed services, ex-combatants, sex workers and other vulnerable populations will be expanded to extend scope and geographic coverage. Secondary HIV prevention among HIV-infected individuals and sero-discordant couples and identification of HIV-infected and HIV-affected family members are also priorities and provide opportunities to link prevention, care and treatment services.

In August 2006, an additional $240,000 was allocated for prevention activities because ICASS costs were substantially lower than originally estimated, thus freeing up more funds. The increased funds will go to PMTCT and AB activities. Of the additional funding, $120,000 will be used to increase the number of service outlets providing the minimum package of PMTCT services, as well as increasing the number of pregnant women who receive HIV counseling and testing for PMTCT, and increasing the number of pregnant women provided with a complete course of antiretroviral prophylaxis in a PMTCT setting. The remaining $120,000 will be used to strengthen the �Sports for Life� campaign, targeted predominantly on the 10-14 age group and complementing existing in and out of school activities in collaboration with the Ministry of Education, CARE International, and ANADER.

Principal Partners: Agence Nationale d�Appui au Developement Rural (ANADER), JHPIEGO/Johns Hopkins University, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), HOPE Worldwide (HW), Population Services International (PSI), John Snow International (JSI), Family Health International (FHI), CARE International, National Blood Transfusion Service/Ministry of Health and Population, Social and Scientific Systems Inc., International HIV/AIDS Alliance, Ministry of National Education, and Project RETRO-CI.

Care: $9,298,000 as of August 2006 ($9,102,490 Field and $195,510 Central) (23.4% of prevention, care, and treatment budget)

Using FY 2006 funding, the Emergency Plan will improve the quality and expand the geographic coverage of HIV counseling and testing (CT) services as well as care and support for orphans and vulnerable children (OVC) and people living with HIV/AIDS (PLWHA) or those affected by the disease. Current CT services in Cote d�Ivoire include innovative models but have poor geographic coverage, leaving 98% of the population unaware of their HIV status. The USG will help the MOH with FY 2006 funds to expand quality CT services to reach more than 75,880 people before March 2007 through two complementary strategies: expansion of integrated CT at public and other health services (including TB, sexually transmitted infections and family-planning services and hospitals) and, with matching resources from local government and/or other bodies, support for at least 25 sustainable youth- and couple-friendly CT services in community settings (with expanded access for rural and underserved populations, sex workers and the uniformed services facilitated by mobile and targeted services).

The USG will promote the identification of people with advanced HIV disease in urgent need of treatment (including 47% of 18,000 TB cases and more than 50% of 37,000 University Hospital in-patients). They will also build on existing models in Cote d�Ivoire for leveraging of funds to promote sustainability and local ownership. Improved quality will also be a focus, with improved training and supervision tools incorporating couple counseling and expanding human capacity. Coverage of OVC and home-based and palliative care services in the community will be expanded through community follow-up of all HIV-positive individuals identified through CT and care services. New sub-grants schemes coupled with technical and management assistance targeting faith- and community-based organizations will promote expanded service delivery. The USG will explicitly target underserved rural and crisis-afflicted areas. Implementation of national policy and guidelines for palliative care, community care and OVC care will also assist scale-up of quality standardized services. OVC, PLWHA and other beneficiaries will be supported to become effective advocates for required legal and policy reform. The EP will support a pilot regional project to promote and evaluate a network of linked social and health services and community-based services to inform the national roll-out model. The EP will complement HIV and TB funds from the GFATM and assist the MOH to integrate HIV and TB services with the expansion of CT and comprehensive HIV services at all TB sites (to reach 18,000 TB patients annually) and incorporation of TB screening and referral at all CT services. There is no change in the amount of funding allocated for care as of this operational plan.

Principal Partners: PSI, JHPIEGO/Johns Hopkins University, HOPE Worldwide, International HIV/AIDS Alliance, CARE International, FHI, MOH, Ministry of National Education, ANADER, EGPAF, PSP One/Abt Associates, Project RETRO-CI.

Treatment: $18,305,243 as of August 2006 ($11,582,986 Field and $6,722,257 Central) (46.1% of prevention, care, and treatment budget)

The USG has played an integral role in expanding comprehensive HIV treatment in Cote d�Ivoire since the debut in 1998 of the national pilot drug access initiative. With EP support, a six-fold increase in the number of persons receiving treatment has been registered, with exponential growth slowed only by availability of drugs and resources. With FY 2006 funds, the Emergency Plan will continue to support the national roll-out plan and complement GFATM programs in promotion of universal access to treatment. The EP will also continue to strengthen key systems that are critical for scale-up of quality sustainable treatment services, including HIV commodities management coordinated by the national public pharmacy; monitoring through the health management information system and targeted evaluations, including of the emergence of antiretroviral resistance; in-service and pre-service training for health professionals; capacity building for decentralized health authorities; and the establishment of a laboratory network to provide decentralized HIV services supported by the CDC/Project RETRO-CI laboratory which has provided the majority of national HIV testing and monitoring.

Currently, the USG is rapidly expanding service delivery through public, faith-based and private facilities, with technical assistance to promote family care and ensure links to relevant prevention, care and support services. The EP will complement GFATM TB funds to integrate HIV diagnostic and treatment services at all TB care centers and link patients to ongoing HIV services. With FY 2006 funds, the new twinning partnership will help establish national training for adult and pediatric referral centers of excellence at tertiary facilities, with integrated counseling and testing and HIV services throughout.

The USG will provide ongoing technical and financial support through small grants to PLWHA and media networks/organizations to promote treatment literacy and uptake of counseling and testing and to provide peer support and sensitize against gender- and HIV-related stigma and discrimination. Overall efforts will contribute to development of a system that can provide a continuum of comprehensive care and treatment services, including antiretroviral drug therapy, psychosocial support, treatment of opportunistic infections and care for HIV-affected families, including prevention of further infections.

In the May 2006 notification an additional $2,000,000 was allocated for treatment activities. These funds will provide ART treatment for an additional 12,000 persons per month and add 10 ARV service sites to the treatment program.

In August 2006, and addition $840,000 was allocated for treatment activities because ICASS costs were substantially lower than originally estimated, thus freeing up funds. The funds will be used to provide additional ARTs and care to support national treatment scale up. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: ANADER, EGPAF, JHPIEGO/Johns Hopkins University, International HIV/AIDS Alliance, HOPE Worldwide, PSI, Association of Public Health Laboratories (APHL), University of California- San Francisco, Supply Chain Management Systems (SCMS), PSP one/Abt Associates, Family Health International (FHI), CARE International, and Projet RETRO-CI.

Other Costs: $6,918,500 as of August 2006

Strategic information activities will continue to fill critical information gaps and support coordination and planning with the key Ministries of AIDS, Health, Education and Social Affairs (orphans and vulnerable children) as well as donors and key stakeholders to identify priorities, use comparative advantages, mobilize resources and maximize their efficient use. FY 2006 funding will support the completion of human resources and facilities evaluations, collect monitoring data to direct program efforts and measure program results, and conduct targeted evaluations. The integration of HIV indicators into the national health management information system will be completed in FY 2006 as well.

Along with other major development partners, the USG will support the ongoing capacity building (critical skilled human resources, informatics and communications infrastructure and systems) required at the key Ministries of Health and AIDS to plan, develop and implement appropriate surveillance and monitoring and evaluation (M&E) plans to improve use of data to guide interventions. Support will also be directed toward a common system to capture HIV-related information from CT, PMTCT and treatment to reinforce linkages among sites and effective use of data at different levels of the health system. The USG will also support improved monitoring and evaluation of HIV interventions at the community level and the development of simple data collection tools, as well as training in data collection and use by sub-grantee recipients.

Using FY 2006 funding, cross-cutting activities will focus on human and organizational capacity; public-private sector partnerships and leveraging of additional resources; improved planning, coordination and advocacy efforts; and addressing HIV- and gender-related stigma and discrimination. The USG will work with other partners to complete the evaluation of human-capacity needs, which allow for the development of a national strategy to address human-capacity constraints, including a comprehensive training plan.

A national linking organization will be established to provide support for small- to medium-capacity community- and faith-based organizations to develop their management, planning and overall capacities while strengthening the civil-society response to HIV/AIDS in Cote d�Ivoire. These new activities will also allow non-governmental organizations (NGO) working in HIV/AIDS to enhance their work in fighting stigma and discrimination. The USG will provide support to key private and public sector organizations to document and share their best practices to fight HIV/AIDS in the workplace and promote innovative public-private partnerships designed to leverage additional human and financial resources. In addition, FY 2006 support will assist the Ministries of Health and Education to establish HIV-in-the-workplace programs for their large and socially influential staff.

In August 2006, $1,080,000 was reprogrammed from other costs because the actual ICASS costs were substantially lower than originally estimated. Of this amount, $240,000 was reprogrammed to the prevention program area to PMTCT and AB activities, and $840,000 was reprogrammed to ARV drugs activities.

Principal Partners: PSP One/Abt Associates, Management Sciences for Health (MSH), MOH, FHI, Ministry of National Education, Measure Evaluation/John Snow International, Measure/MACRO, National Institute of Statistics, Ministry of AIDS, International HIV/AIDS Alliance, Supply Chain Management Systems (The Partnership), EGPAF, and Projet RETRO-CI.

Administrative funds will support program management costs to implement and manage the Emergency Plan. HHS and USAID personnel, travel, management and logistics support in country will be included in these costs. USAID will recruit a USAID focal point to manage USAID-funded projects as part of the joint interagency team.

Other Donors, Global Fund Activities, Coordination Mechanisms:

While the USG is the largest donor, other development partners active in the HIV/AIDS sector include the GFATM ($27 million HIV project continuation 2006-2008 and $2 million TB project 2005-2006 with United Nations Development Programme (UNDP) as principal beneficiary and an HIV project in the North with CARE International 2006-2007), the UN Organizations (WHO, UNICEF, UNDP, UNFPA, UNAIDS, WFP, UNHCR, etc.) and to a limited extent other bilateral partners (the Belgian, Canadian, French, German and Japanese Cooperation). A large potential source of funding is the World Bank-MAP (proposed to be on the order of $50 million USD over five years), which continues to be delayed. USG agencies coordinate in country through the USG Emergency Plan coordinating committee chaired by the US Ambassador. HHS represents the USG on the GFATM Country Coordinating Mechanism (CCM) and at most technical forums. The CCM is a strong multi-sectoral participatory forum that brings together 33 members of civil society, public and private sectors, and multilateral and bilateral development partners. This complements the national system of HIV coordination committees stretching from the national HIV council (headed by the President annually) through the regional, district and grass-roots village HIV/AIDS action committee, in addition to various sectoral and technical committees. The Ministry of AIDS leads a committee that meets quarterly to improve planning and coordination and includes civil-society representatives, bilateral and multilateral partners, and the Ministries of Health and Finance. The UNAIDS theme group also proposes to expand to include bilateral partners with 2005 chair UNICEF to provide a regular coordination forum bringing multilateral and bilateral development partners together. Substantial efforts are made to promote coordination and collaboration among in-country partners and the host government and other key stakeholders.

Program Contact: Deputy Chief of Mission, Vicente Valle and CDC Chief of Party, Monica Nolan

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Cote d'Ivoire

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