South Africa FY 2006 Country Operational Plan (COP)


SOUTH AFRICA

Project Title: South Africa 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

0

1,000,000

1,000,000

0

0

1,000,000

0

1,000,000

DOL

0

0

0

0

0

0

0

0

HHS

4,818,000

71,952,281

76,770,281

0

0

76,770,281

20,523,587

97,293,866

Peace Corps

0

372,819

372,819

0

0

372,819

0

372,819

State

0

865,000

865,000

0

0

865,000

0

865,000

USAID

0

117,362,900

117,362,900

0

0

117,362,900

4,644,843

122,007,743

TOTAL Approved

4,818,000

191,553,000

196,371,000

0

0

196,371,000

25,168,430

221,539,430

HIV/AIDS Epidemic in South Africa:

HIV prevalence among pregnant women: 18.8% [16.8-20.7%] (UNAIDS, 2006)
Estimated Number of HIV-Infected People: 5.5 million 4,900,000-6,100,000] (UNAIDS, 2006)
Estimated Number of AIDS Orphans: 1.2 million [970,000-1,400,000] (UNAIDS, 2006)

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

South Africa Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 599,900 12,200
End of FY 2005** 548,200 93,000
End of FY 2006*** 672,911 150,000
End of FY 2007*** 891,799 265,000

*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:

Over the past decade, South Africa has transformed itself into an egalitarian democracy, aggressively addressing social and economic challenges and the racial inequalities of its apartheid past. In spite of a high per capita GDP ($3,480), 40% of South Africans live in poverty. In the first decade of democracy, adult HIV prevalence has risen from less than 3% to an estimated 18.8% [16.8-20.7%]. With 5.5 million citizens infected with HIV, South Africa has more infected adults and children than any other country in the world. South Africa�s HIV epidemic is generalized and maturing, characterized by: (1) high levels of prevalence and asymptomatic HIV infections; (2) an infection rate that may be beginning to plateau but is still extremely high; (3) high infection rates among sexually active young people, and other vulnerable and high-risk populations (mobile populations, sex workers and their clients, and uniformed services), and newborns; (4) vulnerability of women and girls; and (5) important regional variations with antenatal seroprevalence rates ranging from 15.4% to 40.7% in the nine provinces.

Although 75% of people living with HIV/AIDS (PLWHA) are asymptomatic, South Africa is witnessing increased levels of immunodeficiency and HIV-associated morbidity, frequently manifested by tuberculosis (TB), pneumonia and wasting. The cure rate for TB is low (56.7% in 2003), and treatment interruption rates remain high (12.4%) heightening concern for development of Multi-Drug Resistant TB. AIDS-associated mortality is high (370,000 AIDS deaths in 2003) with large increases in HIV mortality among young adults and children (40% of under-five mortality is associated with HIV in 2000). As mortality increases, so too will AIDS orphans, already numbering upwards of 1.1 million.

Using FY 2006 funding, the USG Emergency Plan program in South Africa will provide support to public, private and NGO sector HIV activities at the national, provincial and local levels through a broad-based network of over 80 prime partners and more than 200 sub-partners. Emergency Plan funding will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $36,342,280 as of August 2006 ($29,970,750 Field and $6,371,530 Central) (18.6% of prevention, care, and treatment budget)

Prevention activities in South Africa include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness programs, community-based communications programs, blood and injection safety, and other prevention initiatives.

As of July 2005, there were 3,064 PMTCT sites in South Africa with services available at all hospitals and more than 70% of clinics. It is anticipated that universal coverage will be reached in the next 12-month period. The Emergency Plan will support: (1) the expansion and strengthening of the South African PMTCT program by improving service quality, building the capacity of professional and lay health care workers, and by developing effective logistic and information systems; (2) programs that create increased awareness and demand for quality PMTCT service delivery at the community level; and (3) increased integration of PMTCT with other related HIV and primary health care services. Using FY 2006 funds, 95,900 pregnant women will receive PMTCT services through direct Emergency Plan support. USG agencies will support primary prevention with special emphasis on abstinence and faithfulness activities that are implemented through school, community, and faith-based life-skills education programs. Through both community-based and large-scale non governmental (NGO) and faith based organizations (FBO) programs, the Emergency Plan will support youth and young people to delay sexual debut and practice abstinence, faithfulness and responsible decision-making. In addition, USG agencies will assist the Department of Health to increase the availability and use of condoms by high-risk groups. Other prevention initiatives focus on behavior change and other communication efforts, safe medical practices and blood supply, and HIV prevention education for military personnel, women surviving on transactional sex, prison inmates and correctional officers, mobile populations, traditional healers, teachers, and trade unionists in all nine provinces of South Africa.

In the May 2006 notification, an additional $6,076,373 was allocated for prevention activities. The additional funds will support PMTCT activities, Abstinence and Be Faithful Programs, other behavior change programs, and medical injection safety programs. Plus-up funding will enable 9,200 additional women to receive HIV counseling and testing for PMTCT and an additional 1,694 pregnant women will be provided with a complete course of antiretroviral prophylaxis in a PMTCT setting. The number of health workers trained in the provision of PMTCT services according to national and international standards will increase by 105 individuals as a result of plus-up funding. The funds will support community outreach with abstinence and faithfulness messages to an additional 2.3 million people and over 10,000 people will be trained to promote HIV/AIDS prevention programs. Funding will provide for the training of 92 individuals in medical injection safety. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: USG South Africa partners with over 40 agencies in the prevention program area. South African Government partners include the National Departments of Health (NDOH), Correctional Services, Education, Justice, and Defense. International partners include Africare, Salvation Army World Services, Population Council, EngenderHealth, Johns Hopkins University, Hope Worldwide, John Snow Inc., Academy for Educational Development, Family Health International, American Center for International Labor Solidarity, International Training and Education Center on HIV, University Research Corporation, Harvard School of Public Health, the Population Council, Fresh Ministries, and the Elizabeth Glaser Pediatric AIDS Foundation. Local South African partners include Health Systems Trust, Human Science Research Council, Soul City, Wits Health Consortium, University of Western Cape, Centre for HIV/AIDS Networking, Comprecare, Living Hope Community Center, Nelson Mandela Children�s Fund, and the Nelson Mandela School of Medicine, and the University of KwaZulu-Natal.

Care: $64,266,105 as of August 2006 ($62,851,352 Field and $1,414,753 Central) (32.9% of prevention, care, and treatment budget)

Care activities in South Africa include basic palliative care and support, TB/HIV, support for orphans and vulnerable children (OVC), and counseling and testing (CT). With 6.29 million HIV-positive individuals, the clinical and palliative care needs of patients suffering from AIDS places a severe strain on health services. Accordingly, the Emergency Plan supports programs to increase the availability and quality of palliative care services, including providing training, technical and financial assistance to NGO, FBO and community-based and home-based care programs, hospice and palliative care organizations as well as public sector health facilities. Using FY 2006 funds, Emergency Plan-supported care programs will directly reach over 400,000 HIV-positive individuals in need of care and will provide palliative care training for at least 14,000 professional and lay caregivers.

South Africa has one of the highest estimated TB infection rates in the world with 55% of TB patients HIV-positive. With FY 2006 funding, USG agencies will support implementation of best practices to maximize integration of HIV/TB prevention, diagnosis, treatment and management programs, and to increase the effectiveness of referral networks between TB and HIV services.

Care and support of OVC is a key component to mitigate the impact of the epidemic in South Africa, where an estimated 1.1 million children have lost at least one parent to HIV and AIDS. USG care and support of OVC in South Africa will provide financial and technical assistance to OVC programs focusing on mobilizing community- and faith-based organizations to improve the number and quality of services provided for OVC. These programs encompass the entire care and support continuum, including psychosocial and nutritional support, maximizing OVC access to South African Government benefits, and strengthening OVC support through referrals for health care, support groups and training. With FY 2006 funding these programs will provide comprehensive services to at least 200,000 OVC and more limited services to an additional 110,000 OVC by the end of September 2007.

Expanding the availability, access and quality of CT services is a critical component of the USG AIDS program in South Africa. Emergency Plan CT activities support NDOH efforts to expand current CT sites and services. Using FY 2006 funds, the USG will continue to provide CT training for over 11,000 health staff and counselors in all nine provinces as well as training for NGO, trade unions, and employers. All USG CT activities are intentionally linked to clinical care and support and/or treatment activities to assure that individuals testing positive have access to needed services. At least three USG programs have mobile CT programs targeting high-risk populations, underserved communities and men. With the assistance of FY 2006 Emergency Plan funding, USG-supported counseling and testing activities will result in 620,000 individuals knowing their HIV status by September 2007.

In the May 2006 notification, an additional $10,217,997 was allocated for care activities. The additional funds will expand efforts to strengthen the capacity of local HIV/AIDS organizations to provide palliative care and OVC activities, support HIV testing for TB patients and support CT. The number of individuals provided with general HIV-related palliative care will increase by 122,000. Training will be provided for an additional 1,604 individuals in palliative care and 4,000 providers caring for OVC. An additional 25,000 OVC will be served with this funding. In August 2006, there was no change in the amount of funding allocated for care.

Principal Partners: USG South Africa partners with nearly 50 individual agencies in the care and support areas. South African Government partners include the National Departments of Health, Correctional Services, Social Development, Provincial and Local Government and Defense, and the National Health Laboratory Service. International partners include Africare, Catholic Relief Services, Salvation Army World Services, Humana People to People, Population Council, EngenderHealth, Johns Hopkins University, JHPIEGO, Hope Worldwide, John Snow Inc., Family Health International, American Center for International Labor Solidarity, Columbia University, Harvard University, Population Services International, and the Elizabeth Glaser Pediatric AIDS Foundation. Local South African partners include Right to Care, Hospice and Palliative Care Association of South Africa, Africa Center for Health and Population Studies, Wits Health Consortium, Medical Research Council, South African National Council of Child and Family Welfare, Broadreach Health Care, Aurum Health Research, Comprecare, Starfish, Nurturing Orphans for AIDS and Humanity (NOAH), HIVCARE, Living Hope Community Center, Nelson Mandela Children�s Fund, Tshikululu Social Investments, and the Nelson Mandela School of Medicine.

Treatment: $94,855,097 as of August 2006 ($77,472,950 Field and $17,382,147 Central) (48.5% of prevention, care, and treatment budget)

In 2003, the South African Government took the historic step of developing a comprehensive plan to implement a nationwide antiretroviral (ARV) treatment program. This plan has provided an ideal opportunity for the USG to contribute to the South African Government target of universal access to ARV services by 2009. Based on best practices and expertise in the private and public sectors, the USG program will strengthen comprehensive care for HIV-infected people by: (1) scaling-up existing effective programs; (2) initiating new treatment programs; (3) providing direct treatment services; (4) increasing the capacity of the National and Provincial Departments of Health to develop, manage and evaluate AIDS treatment programs, including the training of health workers, enhancing the quality of treatment services, and strengthening the management of ARV-related pharmaceuticals; and (5) increasing demand for, acceptance of, and compliance with ARV treatment through treatment literacy campaigns and community mobilization. USG agencies will provide direct support for 20 ARV treatment programs operating in at least 500 service outlets in the public, private and NGO sectors and comprehensive, high quality ARV treatment services to over 145,000 by September 2007. In addition, the USG has set a goal that ten percent of the individuals on treatment will be HIV-positive children by September 2007. Because the South African Government is committed to purchasing all ARV drugs required for all public sector treatment sites, the USG will be purchasing a limited amount of ARV for its NGO and private sector programs. Building local human capacity is a key feature of the USG�s treatment program, and the USG will support training in ARV therapy for at least 18,000 service providers in FY 2006.

In the May 2006 notification, an additional $18,781,000 was allocated for treatment activities. The additional funds will support a significant expansion of ARV treatment programs and will allow USG/South Africa to expand Emergency Plan programs into underserved geographic areas, to increase HIV-TB linked services, and to support additional pharmacists at AIDS treatment sites � all of which are program objectives supported by the South African Government. An additional 71 service outlets will be able to provide antiretroviral therapy, and an additional 25,727 individuals will receive antiretroviral therapy as a result of this funding. The total number of health workers trained to deliver antiretroviral therapy (ART) services will increase by over 1,200 individuals. 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: USG South Africa partners with 30 individual agencies in the treatment program areas. South African government partners include the National Departments of Health, Correctional Services, and Defense, and the National Institute for Communicable Diseases. International partners include American Center for International Labor Solidarity, Africare, Catholic Relief Services, Population Council, Absolute Return for Kids (ARK), John Snow Inc., Johns Hopkins University and JHPIEGO, Columbia University, Elizabeth Glaser Pediatric AIDS Foundation, Management Sciences for Health, University Research Corporation, American Center for International labor Solidarity, and the International Training and Education Center on HIV (I-TECH). Local South African partners include Foundation for Professional Development, Africa Center for Health and Population, Soul City, Right to Care, Wits Health Consortium, Broadreach Health Care, Medical Research Council of South Africa, Aurum Health Research, HIVCARE, and the University of KwaZulu-Natal.

Other Costs: $26,075,948 as of August 2006

The USG will assist NDOH to design and implement an integrated monitoring and evaluation (M&E) system. To facilitate the management of the Emergency Plan monitoring and reporting process, the USG is implementing a single consolidated data warehouse center that serves as the focal point for all Emergency Plan data collected by the partners. Through collaboration and assistance to the South African Government and strengthening of implementing partners� strategic information systems, the USG will also support specific targeted evaluations to improve prevention, care and treatment programs, to identify potential new interventions, and to document best practices. The USG will also assist the Department of Social Development in strengthening their M&E system to identify and track OVC.

As of February 2006, the total pending budget for South Africa was $37,530,900. In April 2006, an additional $2,455,530 was allocated for strategic information, policy analysis and systems-strengthening activities and management and staffing activities. The additional funds will support technical assistance, training, travel, evaluation activities and the expansion of the development of a health human resources plan. An additional 125 individuals will be trained in strategic information. The number of HIV-positive individuals trained in HIV-related policy development, HIV-related institutional capacity building, HIV-related stigma and discrimination reduction, and HIV-related community mobilization for prevention, care and/or treatment will increase by 160.

Management and Staffing costs will support the program and technical assistance required to implement and manage Emergency Plan activities. The United States Agency for International Development, Department of Health and Human Services, The United States Peace Corps, and Department of Defense personnel, travel, management, and logistics support in country are included in these costs. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners: USG South Africa partners with 20 individual agencies in strategic information, targeted evaluation and management and staffing program areas. South African government partners include the National Departments of Health, Correctional Services, Social Development, and Defense, the South African National Blood Service, and the National Institute for Communicable Diseases. International partners include Population Council, JHPIEGO, Academy for Educational Development, Harvard University, University of North Carolina, and the National Alliance of State and Territorial AIDS Directors. Local South African partners include Human Science Research Council, Medical Research Council of South Africa, University of Pretoria, University of KwaZulu-Natal, and Wits Health Consortium.

Other Donors, Global Fund Activities, Coordination Mechanisms:

The United States is the largest bilateral donor to South Africa�s health sector, having provided a total of over $158 million in support in FY 2005, the majority of which is for HIV/AIDS prevention, care and treatment. The USG is one of nearly 20 bilateral and multilateral donors providing technical and financial assistance in support of South Africa�s HIV and Sexually Transmitted Infections (STI) Strategic and Comprehensive Plans. In addition to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), other major donors include the European Union, the United Kingdom, Belgium, Netherlands, Australia, France, Sweden and Germany. GFATM has entered into agreements for three grants from South Africa, totaling $65 million over two years for AIDS and TB programs. These grants provide funding to expand treatment services in the Western Cape, to provide a broad package of HIV prevention, treatment and care activities in KwaZulu-Natal, and to support a youth focused prevention campaign. The primary HIV/AIDS coordinating body is the South African National AIDS Council (SANAC). In addition to working with SANAC, the USG meets regularly with key officials of individual Ministries (Health, Social Development, Treasury, Defense, Education, Justice, Provincial and Local Government and Correctional Services) to ensure that USG assistance complements and supports the South African Government�s plans for prevention, care and treatment.

Program Contact: Deputy Chief of Mission, Donald Teitelbaum and Health Attach� F. Gray Handley

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: South Africa

August 2006 Operational Plan Main Page

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