Haiti FY 2006 Country Operational Plan (COP)


HAITI

Project Title: Haiti 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

-

500,000

500,000

-

-

500,000

-

500,000

HHS

1,000,000

25,710,841

26,710,841

-

-

26,710,841

4,094,119

30,804,960

Peace Corps

-

-

-

-

-

-

-

-

State

-

-

-

-

-

-

-

-

USAID

-

21,089,159

21,089,159

-

-

21,089,159

3,212,548

24,301,707

TOTAL Approved

1,000,000

47,300,000

48,300,000

-

-

48,300,000

7,306,667

55,606,667

*No new funds were approved for Haiti following February 2006.

HIV/AIDS Epidemic in Haiti:

Adult HIV Prevalence Rate: 3.8% [2.2-5.4%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 190,000 [120,000-270,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: N/A (UNAIDS 2006)

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

Haiti Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 30,100 2,800
End of FY 2005** 57,100 4,300
End of FY 2006*** 85,000 10,000
End of FY 2007*** 132,000 16,000

*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:

Haiti is the poorest nation in the Western Hemisphere and has the lowest gross domestic product per capita in the Caribbean with 1,860 USD per person. Seventy-five percent of its 8,530,000 people are living at or below the absolute poverty level according to the UNDP. Haiti has the highest HIV prevalence of any nation in the Latin America/Caribbean region. The 2003 antenatal care (ANC) survey showed a seroprevalence among pregnant women of 3.1%. HIV infection among tuberculosis (TB) patients is estimated to be at 40% while the TB incidence in Haiti is at 138/100,000. It is estimated that 30,000 Haitians are eligible for antiretroviral therapy (ART); approximately 4,300 persons are now receiving it through USG and the President�s Emergency Plan�s (EP) support. Currently, many barriers remain including limited public health services and weak clinical capacity for ARV therapy delivery. Most Haitians are unaware of their HIV serostatus and lack access to testing and other HIV/AIDS prevention, care, treatment and support services. Poverty and unemployment drive the sex industry as well as transactional sex. Several factors including poor socio-economic conditions, cultural and religious practices that encourage promiscuity, and lack of health infrastructure contribute to high levels of transmission. Knowledge about HIV/AIDS is fairly high, with 98% of men and 97% of women having heard about HIV/AIDS. Half of women and 71% of men living in urban areas believe that condom use is a very good way to prevent HIV, however, nationally, 38% of women and 19% of men think that nothing can be done to avoid infection. This lack of information is particularly pervasive in rural areas and among illiterate people (DHS 2000).

Recent political insecurity, although impeding full implementation of USG plans and imparting various delays, has not completely blocked roll out of services and scale up of activities. Contingency planning to continue the essential activities during times of political insecurity is being emphasized in FY 2006. Emergency Plan FY 2006 funds will be used to continue scale-up of treatment and care activities, building on capacity strengthening and training activities for the public health network, including public/private partnerships. Activities to reach groups particularly at risk including mobile men, men who have sex with men (MSM), commercial sex workers (CSW), non-formal sector workers, and men in uniform will be scaled up to address the higher HIV prevalence in these populations. A strong emphasis on AB/Youth will continue for youth in and out of school, continuing the policy of starting with pre-teens, and emphasizing secondary abstinence for teens and those in their early twenties.

Prevention: $11,311,457 as of August 2006 ($5,525,000 Field and $5,786,457 Central) (23.1% of prevention, care, and treatment budget)

HIV in Haiti is transmitted primarily through heterosexual contact, during birth, and through high risk populations including commercial sex workers, police, peacekeeping forces, and the MSM community which is mostly underground. Prevention activities in Haiti include: PMTCT, abstinence and be faithful (AB) programs, blood and injection safety, and other prevention (OP) activities. At the end of FY 2005, there were 56 PMTCT centers in Haiti. Of the 28,632 women who were tested from October 2004 to June 2005, 1,013 (3.5%) HIV positive women were identified. The FY 2006 funding support will focus on the 26 top performing sites (12 public and 14 private), which will network to the other 30 sites previously supported by PEPFAR.

The abstinence and be faithful program builds upon two years of achievements by the USG team that built capacity for effective long-term adolescent and youth HIV prevention programs by strengthening leadership, technical capacity, and the management capabilities of the Ministry of Health�s Prevention Technical Cluster and revitalizing the Behavior Change Communication (BCC) cluster. With FY 2006 funding, the USG will support AB programs that promote social norms supportive of healthy/safer sexual behaviors. This includes mobilizing community support to promote abstinence, mutual monogamy and partner reduction, and to address the sexual coercion and exploitation of young people.

Blood safety activities began with central funding and will continue through cooperative agreements with the Blood Safety Unit of the Ministry of Health and WHO/PAHO for provision of technical assistance. National guidelines have been developed, health care personnel trained, and new blood transfusion services opened with FY 2005 funding. Using FY 2006 funding, the blood safety program will continue to improve the monitoring of the national blood supply through the development of an electronic record system, continue to improve the laboratory screening of the blood supply, and continue to increase blood transfusion availability by promoting voluntary donations. Injection Safety activities are also under way through a centrally funded cooperative agreement. Waste management strategies and a post-exposure prophylaxis plan will also be developed and implemented. Continued effort will be placed on supplying disposable syringes to prevent re-use, and providing educational support and materials for safe waste and needle disposal at healthcare delivery sites.

FY 2006 funds will also be used for other prevention activities focusing on MARPS (most-at-risk-populations) including support of CSW clinics and an anonymous care center for MSMs. Activities will also target other high risk groups such as police and peacekeeping forces. Condom promotion and distribution will continue as a highly effective strategy to complement the other prevention interventions. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: JHPIEGO, Management Sciences for Health (MSH), Institute Haitien de Sant� Communautaire (INSHAC), Population Services International (PSI), Ministry of Health (MSPP), American Red Cross, World Vision International, Food for the Hungry, World Relief Corps, John snow International (JSI) and PACT.

Care: $11,434,488 as of August ($10,216,957 Field and $1,217,531 Central) (23.4% of prevention, care, and treatment budget)

Care activities in Haiti include palliative basic health care and support, TB/HIV, counseling and testing (CT), and support for orphans and vulnerable children (OVC). It is estimated that some 250,000 to 350,000 Haitians need palliative care. However, hospice and end-of-life care is currently rare. With FY 2006 monies, the USG plans to fund people living with HIV/AIDS (PLWHA) support groups, provide transport services and support a cadre of community health workers who will undertake a variety of activities including: accompanying people to appointments, promoting medication regimen adherence, and providing home-based psychosocial and other support. In addition, pain management at facilities and at their homes will be provided. Health care providers will receive technical training on clinical care of PLWHA as well as sensitivity training to reduce the stigma and discrimination that PLWHA endure in the health care system. In Haiti, 40% of TB patients are also infected with HIV. With FY 2006 resources, the USG plans to build upon an existing network of sites to strengthen TB/HIV integrated services to over 100 sites. The MSPP has hired a TB/HIV coordinator to reinforce coordination between HIV and TB activities. The national plan has a goal of providing routine counseling and testing at TB clinics as well as engaging in active TB case finding. USG will continue support of this national plan and by providing laboratory diagnostic kits (PPD) and clinical care for 20,000 HIV/TB patients.

Utilizing FY 2006 funding, the USG team will support innovative strategies to better target CT for MARP expanding on what was started in FY 2005 with CSW, police and truck drivers. The focus in FY 2006 will be on routine and provider driven counseling and testing in Antenatal Care (ANC), Labor and Delivery, and Infections Disease wards, including for those being treated for TB and sexually transmitted infections (STI). Emphasis will continue to be placed on developing linkages between Voluntary HIV/AIDS Counseling and Testing (VCT) sites and care and treatment services.

The USG team will continue supporting orphans and vulnerable Children (OVC), both in institutions/orphanages (where necessary) and communities/families. With FY 2006 funding, the goal will be to support interventions in all 10 departments, and to ensure that all interventions are well coordinated. OVC and potential foster parents will be identified through churches, local community organizations, and PLWA associations. Vulnerable children, those with at least one HIV infected parent or who are positive themselves, will be identified through linkages to VCT, PMTCT and ART sites, which will be refer them to ART car. Provision for education support for OVC will also continue. Based on a situational analysis of orphans and vulnerable children in Haiti, and taking into consideration the emphasis of the program priority focused on ART targets, the OVC component will be maintained at an essential level while a national strategy is developed in FY 2006. This strategy for the OVC component will have long-term benefits as the overall OVC component plan will ultimately be better defined. In August 2006, there was no change in the amount of funding allocated for care.

Principal Partners: Catholic Relief Services (CRS), Les Promoteurs de l'Objectif Zerosida (POZ), Partners in Health (PIH), MSPP, MSH, CARE, International Child Care (ICC), Academy for Education (AED), Population Services International (PSI), The Foundation for Reproductive Health and Family Education (FOSREF), Family Health International (FHI), and INSHAC.

Treatment: $26,209,002 as of August 2006 ($25,906,323 Field and $302,679 Central) (53.5% of prevention, care, and treatment budget)

Treatment activities in Haiti include the procurement and distribution of ART drugs and the improvement of laboratory infrastructure to support care and treatment. Since 2003, two NGO, Le Groupe Haitien d�Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) and PIH have been successfully implementing Highly Active Antiretroviral Therapy (HAART) in the country. With FY 2006 funds, the USG team in Haiti will extend HAART throughout the country through maintenance and reinforcement of the network of 29 ARV sites. International pediatric treatment guidelines for HIV pediatric treatment have been adopted in three pediatric hospitals. Human resource support, equipment, and materials have been and will continue to be provided to these sites. In an effort to improve and encourage effectiveness and high performance of ART sites, performance-based contracts have been established. Quality support, supervision, and clinical training for ART sites continue to be major components of the treatment activities. Currently, Haiti has a new national reference laboratory under construction, and a new national quality assurance and control (QA/QC) program is under development with expansion of external QA/QC to points of service. A greater emphasis on drug resistance testing is planned for FY 2006 funds; therefore, the USG will also continue providing support to improve the quality of laboratory services throughout the country. Current conditions of many public laboratories in Haiti are sub-optimal, reflecting the quality of lab services in Haiti. The USG team will continue to improve the quality of laboratory services in Haiti by improving the physical layout of laboratories that provided ARV services, providing a basic package of laboratory equipment needed for ARV services, and by improving knowledge of laboratory personnel by providing several training courses, among many other essential activities. In August 2006, there was no change in the amount of funding allocated for treatment. 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: CRS, GHESKIO, MSH, PIH, ITECH, MSPP, The Association of Public Health Laboratories (APHL), MSPP, Management and Resources for Health (MARCH), and the University of Maryland.

Other Costs: $ 6,651,720 as of August 2006

The cross-cutting activities in the current country operational plan include strategic information, policy analysis and systems strengthening, and management and staffing. Lack of trained personnel is a major barrier at all levels in the implementation of a national, comprehensive monitoring and evaluation system. With FY 2006 funds, the Plan will focus on reinforcement of the human resource capacity primarily in the field; strengthening of data collection and reporting; reinforcing data quality; strengthening the integration of the HIV/AIDS information system into the overall health information system; continuing field support for information technology infrastructure; and developing and implementing an electronic data management and reporting system for patients in clinical care. Policy activities will build on previous key institutional accomplishments within the MSPP, and will continue to expand the policy agenda toward the creation of a more widespread, national institutional capacity strategy. Specifically, this will be achieved by: (1) strengthening the existing steering mechanism established by the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM) (referred to as the �CCM�), to become the National Committee on HIV/AIDS, thereby accomplishing an objective of the �Three Ones�, by creating a unique coordinating body for HIV/AIDS activities; (2) developing, under the guidance of this committee, a new national strategic plan that will better capture the potential contributions of all sectors; and, (3) reinforcing the financial and grant management mechanisms established in FY 2005 on as wide a national scale as possible. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners for crosscutting activities include: Institut Haitian de l�Enfance (IHE), MEASURE, ITECH, Tulane University, National Alliance of State and Territorial AIDS Directors (NASTAD), MSPP, Policy Project, MSH, and the Futures Group International.

Other Donors, Global Fund Activities, Coordination Mechanisms:

Haiti has a number of other development partners that are working in the country on HIV/AIDS issues. While the USG is the largest donor program in Haiti, GFATM has approved a total of $66,905,477 for HIV/AIDS, $14,665,170 for TB, and $14,865,557 for Malaria for five years. In addition to the GFATM, other partners include: PAHO/WHO, UNICEF, UNFPA, UNDP, UNAIDS, CIDA, IDB, the Gates Foundation, the Clinton Foundation, and the Turner Foundation.

The CCM is chaired by the MSSP and is managed by a MSPP Coordinator for the GFATM and other internationally-supported HIV/AIDS programs. This person also currently serves as the Executive Secretary of the CCM. The CCM has representation from other ministries, USAID and CDC representing bilateral donors, the private sector, and multilateral organizations, but no formal executive committee. There is now an intermediary "facilitator" between the UCC (coordination and monitoring unit for HIV/AIDS) and the Minister and her cabinet, which will be supported by a Coordination Office with cross-cutting coordination and administrative responsibilities, including a strong Monitoring and Evaluation (M&E) Unit. The USG hopes to promote grants from the MSPP to other ministries on the CCM to engage them more fully in HIV/AIDS activities in their respective sectors. The MSPP will become the PI for the GFATM in 2006 under current plans.

Program Contact: Deputy Chief of Mission, Doug Griffiths and USAID, Population, Health and Nutrition Chief, Chris Barratt

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Haiti

August 2006 Operational Plan Main Page

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