Uganda FY 2006 Country Operational Plan (COP)


UGANDA

Project Title: Uganda 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

1,486,400

1,486,400

0

0

1,486,400

0

1,486,400

DOL

0

0

0

0

0

0

0

0

HHS

8,040,000

60,879,488

68,919,488

0

0

68,919,488

8,741,115

77,660,603

Peace Corps

0

728,300

728,300

0

0

728,300

0

728,300

State

0

915,734

915,734

0

0

915,734

0

915,734

USAID

0

80,990,078

80,990,078

0

0

80,990,078

8,094,346

89,084,424

TOTAL Approved

8,040,000

145,000,000

153,040,000

0

0

153,040,000

16,835,461

169,875,461

HIV/AIDS Epidemic in Uganda:

Adult HIV Prevalence Rate: 6.7% [5.7-7.6%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 1 million [850,000-1,200,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 1 million [870,000-1,300,000] (UNAIDS 2006)

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

Uganda Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 252,500 33,000
End of FY 2005** 371,200 67,500
End of FY 2006*** 343,087 90,000
End of FY 2007*** 457,019 120,000

*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:

According to performance data collected in mid-2005, the President�s Emergency Plan in Uganda is ahead in achieving treatment, care and support targets. Nonetheless, the USG team proposes new improvements to the Emergency Plan to stem the tide of the epidemic. The country operational plan for FY 2006 has devoted greater resources to prevention activities, care for orphans, pediatric AIDS and antiretroviral therapy. The reach of the Emergency Plan will be intensified among underserved populations, including people displaced by an 18-year insurgency in northern Uganda.

The Emergency Plan in Uganda has changed strategically to focus resources where the most recent data has revealed specific areas and behaviors requiring increased attention. For example, results from a national sero-prevalence survey show a national prevalence of 6.7% [5.7-7.6%], noticeably higher than the earlier UNAIDS data. Prevalence varies widely across regions in Uganda. The conflict areas in the Northern Districts, the North Central District and the capital city of Kampala, are particularly hard hit, with prevalence rates of approximately 9.2%. Other recently available country data demonstrates that a high proportion of men report multiple concurrent sexual relationships, a significant number of couples are discordant, and an unsettlingly high number of HIV positive couples experience unplanned pregnancies. As such, the USG believes that to effectively lower HIV incidence, the Emergency Plan in Uganda must reinforce its efforts in prevention for HIV positive individuals and couples, improve access to family planning among HIV positive couples, and spearhead a national effort to address the gender and sexual norms that condone multiple concurrent sexual relationships for men.

The Emergency Plan will also continue to support palliative care programs and provide comprehensive support including: treatment for opportunistic infections and tuberculosis (TB), septrin prophylaxis, safe water, long-lasting insecticide-treated nets, psychosocial support, pain management and other interventions. With FY 2006 funding, the program will reach over 350,000 people including over 150,000 orphans.

The Emergency Plan will continue to expand access to antiretroviral therapy (ART) programs to reach 70,000 individuals in 2006 and meet our FY 2008 target. The program in 2006 will focus on ensuring quality, adherence, and laboratory monitoring and increasing access in underserved areas. Additionally, increased numbers of infants will receive care and treatment.

Prevention: $28,751,391 as of August 2006 ($21,158,108 Field and $7,593,283 Central) (19.2% of prevention, care, and treatment budget)

The Emergency Plan will continue to support prevention programs for youth, adults and high-risk populations. The Ugandan President�s Initiative for AIDS Strategy Communication for Youth (PIASCY), reaches five and a half million primary and secondary school students with HIV prevention messages focused on abstinence and faithfulness. With FY 2006 funding, the USG will assist the Ministry of Education to roll out this program and greatly expand the number of secondary and technical institutions benefiting from it. The PIASCY program will also allow over 45,000 teachers to improve their skills in guidance counseling. To complement this institutional approach, the USG is supporting numerous civil society and faith based organizations that work at the community level to reach out of school youth through peer education and through other communication initiatives including drama and radio programming. The USG will also continue to support national campaigns that elevate the debate about young people�s vulnerability and the importance of adult support. This comprehensive approach will reach approximately nine million in and out of school youth, teachers, young married couples and the larger community with AB messages.

With FY 2006 funding, the Emergency Plan will intensify its focus on men and couples to promote faithfulness, couples testing and mutual disclosure. National campaigns focusing on faithfulness, testing and normative behavior change for men will create a social environment that supports prevention programming. Prevention activities for HIV positive individuals such as individual risk assessment, condom provision, sexually transmitted infection (STI) diagnosis and treatment, and family planning with linkages to prevention of mother-to-child transmission (PMTCT) programming will be further integrated into HIV/AIDS care programming. Over 150,000 women will be reached through PMTCT in over 200 sites. Prevention approaches will continue to focus on the most at risk populations, particularly uniformed service members, truckers, fishermen, and prostitutes, who continue to fuel the epidemic in Uganda. Innovative approaches will be expanded to include these groups and vulnerable groups in conflict areas and currently underserved areas. These approaches will reach an estimated 2,380,000 individuals who are most at risk.

The basic infrastructure for blood and injection safety exists. In FY 2005, guidelines for blood and injection safety were revised, and infrastructure for safe blood transfusion services was improved, to reduce the need for, and practice of, unnecessary blood transfusions. An expanded blood safety team will collect 175,000 units of blood, counsel and test donors for HIV, and refer them to care and treatment if appropriate.

In May 2006, an additional $132,900 was allocated for prevention activities. The additional funds will support Abstinence, Be Faithful, and other prevention programs, and training for prevention activities. Together with previously allocated funds, these funds will enable prevention programs promoting abstinence and/or being faithful to reach 3,000 people, and 20 individuals will receive training to provide these programs. Funding will also support training for 50 individuals to provide prevention messages beyond abstinence and/or being faithful, and 2,000 additional individuals will be reached through these programs. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: AIDS Information Center, Care International, AIDSRelief Consortium/Catholic Relief Services, Creative Associates, Elizabeth Glazer Pediatric AIDS Foundation, International Rescue Committee, International Youth Foundation, Inter-Religious Council of Uganda, Johns Hopkins University, John Snow International, Ministry of Education and Sports, Ministry of Gender, Ministry of Health (MOH), PATH, Protecting Families Against AIDS, The AIDS Support Organization, Samaritan�s Purse, Uganda Blood Transfusion Service, and World Vision International

Care: $57,261,152 as of August 2006 ($54,283,649 Field and $2,977,503 Central) (38.3% of prevention, care, and treatment budget)

With FY 2006 funds, the Emergency Plan will continue to expand access to quality palliative care for people living with HIV/AIDS (PLWHA) and their families through public sector facilities, nongovernmental, community and faith based organizations (NGO, CBO and FBO) and other community networks. Over 360,000 individuals, including over 150,000 OVC, will receive palliative care services in 950 service outlets. The Emergency Plan will focus on integrating elements of preventive care, including the use of daily cortrimoxazole, long lasting insecticide-treated nets, safe water, appropriate nutrition, and psychosocial support, into existing HIV/AIDS care services. In addition, pain management and symptom control, end-of-life care and bereavement support to families and their caregivers will be emphasized as critical elements of palliative care. Routine tuberculosis (TB) screening, treatment, and prevention, will be integrated with HIV counseling and testing. Similarly, HIV counseling and testing (CT) will be integrated as a routine service within all TB treatment sites.

The Emergency Plan will also strengthen capacity of indigenous organizations and networks to deliver comprehensive palliative care, to integrate prevention and, as required, to link directly to service referral for ART. Community based organizations including FBO, NGO, and religious leaders will be trained to serve as indigenous sources of ongoing psychosocial support in communities.

The USG will intensify efforts to enable individuals to learn their HIV status and be linked to care and treatment immediately. The Emergency Plan will target couples, family members and children of HIV positive individuals and other high-risk groups, including a focus in high-prevalence regions. The Emergency Plan will expand CT coverage through various approaches including facility-based services, mobile outreaches to rural populations and integrating TB-testing as a routine component of clinical care. FY 2006 funding will support routine CT in prenatal clinics, in-patient and out-patient wards of regional and district hospitals, and selected health centers; a total of 571,417 people will receive quality counseling and testing services overall.

There are over two million orphans or vulnerable children (OVC) affected by HIV in Uganda, with an estimated 900,000 orphaned as a direct result of HIV. FY 2006 funds will expand access to care and support services for orphans and caretaker families through civil society and networks of FBO. The Emergency Plan will continue building the leadership capacity of the Ministry of Gender, Labor and Social Development as the lead agency to effectively coordinate and guide the national response to the crisis. In FY 2006, This Ministry will administer a $10 million grant program for OVC support to be implemented by indigenous groups.

In May 2006, an additional $2,080,920 was allocated for care activities. The funds will expand efforts to strengthen the capacity of local HIV/AIDS organizations to provide palliative care and OVC activities and support training to test for HIV in TB patients. The number of individuals provided with general HIV-related palliative care will increase by 200. Training will be provided for an additional 910 individuals in TB/HIV related palliative care and 725 providers in caring for OVC. OVC programs will serve an additional 5,380 OVC. In August 2006, there was no change in the amount of funding allocated for care.

Principal Partners: Africare, African medical and Research Foundation, AIDS Information Center, AIDSRelief Consortium/Catholic Relief Services, ACDI/VOCA, AVSI, Baylor University/Pediatric Infectious Disease Clinic, CARE USA, Christian AID, Creative Associates International, Hospice Uganda Africa, Integrated Community Based Initiatives, International Rescue Committee, Johns Hopkins University, Kumi District Director of Health Services, Makerere University Facility of Medicine, Makerere University Institute of Public Health, MOH, Mildmay International, National Medical Stores, Research Triangle Institute, Inter-Religious Council of Uganda, Opportunity International, Plan Uganda, Population Services International, Reach-Out Mbuya, Salvation Army, and the AIDS Support Organization

Treatment: $63,586,510 as of August 2006 ($57,321,835 Field and $6,264,675 Central) (42.5% of prevention, care, and treatment budget)

Treatment activities in Uganda include support to provide antiretroviral (ARV) drugs, ARV services, logistics and laboratory services. With FY 2006 funding, the Emergency Plan will expand ART to 70,000 Ugandans through over 60 service delivery points in the public, non-governmental and faith based sectors with a significant number of Ugandan partners. Services are widely distributed in urban and rural settings, in the conflict-affected North, and in post-conflict areas in the West. The Emergency Plan will expand support for ART to poor and rural populations, women and children and high-prevalence areas.

The USG will continue to support facility-based, outreach-based, and home-based provision of ART services, which have contributed to the rapid scale-up of ART in Uganda. The Emergency Plan supported ART programs provide comprehensive HIV/AIDS care and treatment services and many additionally provide �wrap-around� services. With FY 2006 funds, the Emergency Plan will intensify the integration of HIV prevention into ART and basic care programs.

Maintaining an adequate supply of essential drug and laboratory commodities in the public sector continues to be a challenge in Uganda. These commodities include drugs to treat opportunistic infections (including TB), HIV test kits, condoms and laboratory reagents. The USG will continue to strengthen national logistics and commodity supply systems to ensure full supply of ARV drugs and related HIV commodities. Building on the successful establishment of a laboratory credit line in 2004, the Emergency Plan will continue to provide HIV test kits and lab reagents to national and NGO partners. The USG will support the MOH to train national partners in drug logistics. FY 2006 funding will allow the USG to work with the Government of Uganda, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and development partners to ensure a full supply of all critical HIV commodities.

The USG will also expand access to a full complement of needed HIV laboratory testing for all HIV positive individuals in the care network including CD4 monitoring, viral load, and early infant diagnosis. Nationally, the USG is leading an effort for a national laboratory network that will improve laboratory services in rural health facilities, develop regional centers of excellence for advanced HIV tests, provide quality assurance and resistance monitoring, and ensure there are trained providers in all USG supported sites.

FY 2006 funds will be used by the Emergency Plan to scale up a national ART quality assurance program, to improve quality of clinical care service delivery, and to monitor patient outcomes to improve adherence. The USG will continue to build capacity by training clinicians, counselors, and laboratory staff and will provide technical assistance to develop national policies, guidelines, and materials. Networks of people living with HIV will liaise with health facilities as part of a continuum of care to support adherence to care and treatment. The USG will also support widespread campaigns to improve understanding and use of antiretroviral treatment for providers, clients, and the general population.

In May 2006, an additional $7,568,880 was allocated for treatment activities. These funds will purchase additional ARV drugs, provide new training opportunities and improve laboratory infrastructure and operations. Through these additional funds, 365 individuals will be trained in the provision of lab-related activities and 75 will be trained to deliver ART services. These funds will provide ART for 5,000 more individuals and to build capacity in one more laboratory for HIV diagnostic testing. 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: African Medical and Research Foundation, AIDS-Relief Consortium/Catholic Relief Services, Baylor University/Pediatric Infectious Disease Clinic, Elizabeth Glazer Pediatric AIDS Foundation, Emerging Markets, Inter-Religious Council of Uganda, Home Based AIDS Care Project, Makerere University Institute of Public Health, Joint Clinical Research Center, Makerere University Facility of Medicine, Mildmay Center, MOH, National Medical Stores, Reach-Out Mbuya, The AIDS Support Organization, and University Research Corporation.

Other Costs: $20,276,408 as of August 2006

With FY 2006 funds, the USG will continue to strengthen national monitoring and evaluation systems for HIV, at both the national and district levels. Working collaboratively with the Government of Uganda, civil society, and development partners, USG will support strategic planning and leadership within the Uganda AIDS Commission, and will improve mainstreaming of HIV through other sectors (such as water, agriculture, public service). The USG will also provide technical assistance for policy development within the MOH, with a focus on the development of a National Laboratory Policy and a Laboratory Quality Assurance System for rapid HIV testing in the country. In addition, the USG will continue focusing on the health management and logistics management information system within the MOH, as well as the information systems in Ministries of Education and Gender that deliver HIV services. Through a new mechanism, USG will aid indigenous organizations human resources management, administration, financial management, strategic planning and monitoring. The Emergency Plan will conduct population-based surveys, and support policy-level analyses to ensure that Uganda�s HIV/AIDS response is guided by up-to-date information.

In May 2006, an additional $921,300 was allocated for strategic information, policy analysis and systems-strengthening, and management and staffing activities. The additional funds will support technical assistance and training. An additional 50 individuals will be trained in HIV-related policy development and 50 will be trained in HIV-related institutional capacity building. In addition, 180 individuals will be trained in HIV-related community mobilization. The number of HIV service outlets/programs provided with technical assistance related to policy and/or capacity building will increase by twenty. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners: John Snow International, Social and Scientific Systems, New York AIDS Institute, MOH, Macro International, Makerere University Institute of Public Health, Medical Research Council, The AIDS Support Organization, and the University of California San Francisco.

Other Donors, Global Fund Activities, Coordination Mechanism:

The USG actively engages in coordination, planning and monitoring through both Government of Uganda and development partner coordination groups. The Uganda AIDS Commission is the overall coordinating body for HIV/AIDS and meets monthly as a national partnership committee of public and private representatives. The Commission acts as Secretariat to the Emergency Plan Advisory Committee chaired by the former Prime Minister and comprised of 19 national representatives from public sector, faith based and private sector and people living with AIDS. The Advisory Committee meets quarterly to advise the USG team on program direction. The Commission also leads a national behavior change communication committee and M&E committee in which the USG participates. The USAID currently chairs the AIDS Development Partners and Education Funding Partners Group and the USG is represented in the AIDS, Health and OVC groups. The MOH implements a �sector wide approach� and hosts monthly Health Policy Advisory Committee meetings to which all groups working in the public health sector must participate, as well as technical committees for: ART, counseling and testing, TB/HIV integration, laboratory services, PMTCT, and training. GFATM Secretariat recently lifted a suspension on grants to Uganda and the Ministry of Finance is in process of redesigning the institutional arrangements. The USG will actively participate to ensure full synchronization with the Emergency Plan.

Program Contact: Deputy Chief of Mission, William Fitzgerald and Emergency Plan Coordinator, Premila Bartlett

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Uganda

August 2006 Operational Plan Main Page

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