Cote d'Ivoire FY 2007 Country Operational Plan (COP)


COTE D�IVOIRE

Project Title: Cote d�Ivoire FY 2007 Country Operational Plan (COP)

Budget Summary:

Field Programs Funding by Account  Central Programs Funding by Account  
   Notified as of March 2007 Notified as of June 2007 Notified as of November 2006   
Implementing Agency GAP GHAI Subtotal: Field Programs Funding GAP GHAI New Subtotal: Field Programs Funding GHAI Central Programs Total Dollars Allocated: Field & Central Funding
DOD 0 0 0 0 0 0 0 0
DOL 0 0 0 0 0 0 0 0
HHS 5,253,000 30,918,000 36,171,000 5,253,000 42,043,000 47,296,000 9,935,257 57,231,257
Peace Corps 0 0 0 0 0 0 0 0
State 0 30,000 30,000 0 30,000 30,000 0 30,000
USAID 0 12,510,000 12,510,000 0 26,635,000 26,635,000 517,761 27,152,761
TOTAL Approved 5,253,000 43,458,000 48,711,000 5,253,000 68,708,000 73,961,000 10,453,018 84,414,018

HIV/AIDS Epidemic in Cote d�Ivoire:
Estimated Population: 18,154,000*
HIV Prevalence rate*: 7.1%*
# of HIV infected: 750,000*
Estimated # of OVCs: 450,000*�
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
Prevalence is in adults only (15-49 years)
Orphans aged 0-17 due to AIDS

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

Cote d�Ivoire

Total # Individuals

Receiving Care and Support

Total # Individuals  

Receiving ART

Fiscal Year 2004*

27,100

4,500

Fiscal Year 2005**

33,800

11,100

Fiscal Year 2006***

65,200

27,600

Fiscal Year 2007****

131,000

47,500

Fiscal Year 2008****

205,000

60,000

*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
***Results. �Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007
****FY 2007 Country Operational Plan targets

Program Description:

Cote d�Ivoire continues to suffer from its deepest politico-military crisis since independence, split in two by a UN-controlled buffer zone. Even so, it remains a regional, economic, and migratory hub, bordered by Ghana, Guinea, Burkina Faso, Mali, Liberia, and the Atlantic Ocean. At least one-third of the population of 16.9 million consists of immigrants from the sub-region, and approximately half of the population lives in rural areas. Cote d�Ivoire has the highest national HIV prevalence in West Africa; both HIV-1 and HIV-2 viruses are prevalent. The 2005 AIDS Indicator Survey (AIS) has provided critical information about the country�s HIV/AIDS epidemic, permitting better targeting of prevention, care, and treatment efforts.

Within an overall adult HIV prevalence of 4.7%, the data describes a generalized epidemic marked by striking gender and geographic differences, early sexual debut, intergenerational and multiple concurrent sexual partnerships, weak knowledge about HIV transmission and prevention, and low condom use. In all age groups, females are far more likely than males to have HIV (overall 6.4% vs. 2.9%; among ages 20-24, 4.5% vs. 0.3%). Prevalence rates peak among women aged 30-34, at 14.9%, vs. 5.6% of men of the same age; male prevalence peaked among ages 40-44, at 7.0%, vs. 8.6% of women of that same age. Male prevalence may be mitigated by near-universal (96%) circumcision. Geographically, prevalence ranges from 1.7% in the Northwest to nearly 6% in the South and East and 6.1% in Abidjan. Populations at high risk for acquiring and transmitting HIV include sero-discordant couples, the uniformed services and ex-combatants, people in prostitution, economically vulnerable women and girls, truckers and mobile populations, sexually active youth, and orphans and vulnerable children (OVC). Tuberculosis (TB) is the leading cause of AIDS-related deaths; 47% of the 18,000 people newly diagnosed with TB each year are co-infected with HIV and in need of both HIV and TB treatment.

Additional Funding: In June 2007, an additional $19,000,000 was allocated to address HIV/TB co-infection, expand OVC programs, significantly increase support for ARV commodities and services, and strengthen prevention and SI activities. The additional funds will also support expansion of programs into North and West Cote d'Ivoire, following signing of a peace accord.

The following programmatic areas will be funded in fiscal year 2007 to mitigate the impact of the epidemic in Cote d�Ivoire:

Prevention: $16,570,508 ($13,150,975 Field and $3,419,533 Central) (23.3% of prevention, care, and treatment budget)

Primary HIV prevention priorities include behavior change to delay sexual debut and promote life skills with positive gender roles for in- and out-of-school children and youth; decreased cross-generational and coerced sexual relationships; the promotion of fidelity coupled with HIV testing within sexual partnerships; decreased hospital-related infection through blood safety; and risk reduction among high-risk populations. In fiscal year 2007, the Emergency Plan will reinforce and expand effective programs and introduce new interventions to reach both pervasive behaviors in the general population and specific subpopulations at greatest risk. Targeting of interventions will respond to available data, with continued concentration in the urban South (Abidjan, San Pedro) and prioritizing of other high-prevalence areas through local sub-grants and site selection for life-skills and sports programs for youth. Abstinence and Be Faithful (AB) components will target adult men and women and youth. Prevention efforts will include working with women and girls to emphasize linkages to prevention of mother-to-child transmission (PMTCT) and with men and boys to promote messages about gender equity and violence. All sexually active target populations reached will receive messages about the importance of counseling and testing. Based on lessons learned, available data, and the new National Strategic HIV/AIDS Plan 2006-2010, the Emergency Plan will focus on the following prevention priorities: locally appropriate responses to address major sources of new infections; expanded reach of behavior change communication (BCC) messages through mass-media and community-level outreach campaigns; support of local religious, professional, and other networks that influence community values; research to assess and refine prevention approaches; innovative strategies for promoting delay of sexual debut and partner reduction; and secondary HIV prevention for HIV-infected individuals and sero-discordant couples.

The Emergency Plan will continue the rapid integration of routine HIV testing in health-care facilities. While integrating PMTCT services in antenatal care, Emergency Plan partners will strengthen a family-centered approach that links PMTCT services with comprehensive treatment, care, and support, including psychosocial, nutritional, and family-planning support for HIV-infected pregnant women and their families.

Principal Partners: Agence Nationale d�Appui au Developpement Rural (ANADER), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), HOPE Worldwide (HW), Population Services International (PSI), John Snow International (JSI), Johns Hopkins University, Family Health International (FHI), CARE International, National Blood Transfusion Service/Ministry of Health and Public Hygiene, Social and Scientific Systems Inc., Alliance Nationale Contre le SIDA, ACONDA-VS, Ministry of National Education, Projet RETRO-CI, and Central Contraceptive Procurement (USAID).

Care: $21,499,508 ($21,188,280 Field and $311,228 Central) (30.3% of prevention, care and treatment budget)

In fiscal year 2007, the Emergency Plan will improve the quality and expand the geographic coverage of HIV counseling and testing (CT) services and of care and support services for persons living with HIV/AIDS (PLWHA) or affected by HIV/AIDS, including orphans and vulnerable children (OVC). The country program will ensure that all Emergency Plan-supported services meet quality standards, contribute to national priorities, and can be taken to scale feasibly with available and projected technical and financial resources. Expansion of routine CT at TB clinics and provision of other medical services (in-patient and out-patient) will be prioritized to identify people living with advanced HIV disease. Planning is underway for the integration of routine, provider-initiated CT and comprehensive care and treatment for both HIV and TB.

A family-centered approach to care will improve identification, household follow-up, and referral of HIV-infected or affected children. A continuum of care will link PLWHA with comprehensive community-based palliative care, which includes: cotrimoxazole prophylaxis, other preventive and supportive care, improved pain management and symptom control, management of TB and other co-infections, and peer counseling and support. The children of infected family members will be referred to appropriate OVC programs and services. The Emergency Plan will implement clinical care and hospice care programs which provide clinical monitoring, nutritional assessment and counseling, promotion of good personal and household hygiene, assessment and management of HIV-related psychosocial problems, end-of-life bereavement care, and succession planning and referrals for OVC. This approach explicitly prioritizes children, who may serve as entry points to care for adult family members in need of services. It also serves to release children from assuming the parental role, by providing palliative care for the adult caregivers.

The AIS estimated that 16% of children are OVC, including 8% who have lost father, mother, or both. The Emergency Plan will support the National OVC Program and partners in translating important policy achievements in 2005-2006 into high-quality, sustainable program services. An integrated and coordinated network model for linking OVC to other health, education, and social services will be replicated in other pilot sites, following the San Pedro pilot experience. Efforts will focus on promoting human and legal rights for OVC, and on improving the quality of OVC services through specialized training in monitoring and evaluation for sub-grantees and other activities. The Public-Private Partnership Technical Work Group will support the development of strategies for income-generating activities for adolescent girls and caregiver families to decrease their vulnerability and increase the sustainability of OVC care.

Principal Partners: Population Services International (PSI), JHPIEGO/Johns Hopkins University, HOPE Worldwide (HW), CARE International, Family Health International (FHI), Ministry of National Education, Ministry of Health, Agence Nationale d�Appui au Developpement Rural (ANADER), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), PSP one/Abt Associates, Projet RETRO-CI, Alliance Nationale Contre le SIDA, ACONDA-VS, and the Partnership for Supply Chain Management.

Treatment: $32,921,203 ($26,198,946 Field and $6,722,257 Central) (46.4% of prevention, care and treatment budget)

Cote d�Ivoire continues to succeed in scaling up comprehensive HIV treatment services nationwide, building on an eight-year history that began with the national Drug Access Initiative. Emergency Plan efforts focus on developing a system that provides a continuum of comprehensive care and treatment services, including antiretroviral (ARV) drug therapy, adherence support and monitoring, psychosocial support, palliative care, treatment of opportunistic and sexually transmitted infections, and care for HIV-affected families with prevention of further infections. The Emergency Plan will strengthen key systems that are critical for scale-up of high quality, sustainable treatment services: monitoring (including the emergence of ARV resistance) through a health management information system and targeted evaluations; pre-service and in-service training for health professionals; capacity building for decentralized health authorities; and the establishment of a laboratory network supported by the CDC/Projet RETRO-CI laboratory, which provides a majority of national HIV testing and monitoring. The Emergency Plan employs an innovative, family-centered approach to provide comprehensive, decentralized HIV treatment services. The clinical treatment package includes laboratory services, ARV-resistance testing, early infant diagnosis, targeted program evaluations, and data management.

The Emergency Plan will provide ongoing technical assistance and small grants to PLWHA and media organizations and networks to promote treatment literacy and uptake of counseling and testing, provide peer support, and work to reduce gender- and HIV-related stigma and discrimination.

Principal Partners: Agence Nationale d�Appui au Developpement Rural (ANADER), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), JHPIEGO/Johns Hopkins University, Population Services International (PSI), Association of Public Health Labs (APHL), University of California- San Francisco, the Partnership for Supply Chain Management Systems (SCMS), PSP one/Abt Associates, Family Health International (FHI), CARE International, Projet RETRO-CI, ACONDA-VS, and Alliance Nationale Contre le SIDA.

Other Costs: $13,422,799

Strategic Information. Strategic-information activities are a fundamental priority for the Emergency Plan program. The Emergency Plan will continue to work to fill critical information gaps and support coordination and planning with the Ministries of the Fight Against AIDS (MLS), Health, Education, and Family and Social Affairs (for OVC), as well as donors and key stakeholders to identify priorities, use comparative advantages, mobilize resources, and maximize their efficient use. Fiscal year 2007 support from the Emergency Plan and other development partners will support Cote d�Ivoire in building capacity in skilled human resources, informatics, and communications infrastructure and systems. These are required in the Ministries of Health and MLS for the development and implementation of appropriate surveillance and monitoring and evaluation (M&E) plans to improve use of data to guide interventions. Support will also be directed toward a unified M&E system to capture HIV-related information from CT, PMTCT, and treatment sites, to reinforce linkages among sites, and to facilitate effective use of data at different levels of the health system. Continued investment in telecommunications and informatics systems will be required to support M&E and will provide substantial secondary benefits, including improved networking, access to information, and distance-learning and telemedicine opportunities. The Emergency Plan will continue to support improved monitoring and evaluation of HIV interventions at the community level, the development of simple data-collection tools, and training in data collection and use by sub-grantees.

Principal Partners: Measure Evaluation/John Snow International, Ministry of the Fight Against AIDS, Family Health International (FHI), the Partnership for Supply Chain Management Systems (SCMS), Ministry of Health, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Projet RETRO-CI, ACONDA-VS, and Alliance Nationale Contre le SIDA.

Cross-cutting Activities. Cross-cutting activities will focus on human and organizational capacity; public-private partnerships and leveraging of additional resources; improved planning, coordination, and advocacy efforts; and addressing HIV- and gender-related stigma and discrimination. The Emergency Plan contributes to a policy forum led by the HIV committee of the Ministry of Economy and Finance, to define and implement strategies to promote public-private partnerships, HIV-in-the-workplace programs, and economic incentives that encourage greater private-sector investment in, and long-term sustainability of, HIV-related interventions and services. This work represents a logical continuation and reinforcement of activities supported by the Emergency Plan, large companies such as Unilever and Shell, and many other committees, donors, and partners.

Human and institutional capacities remain key issues constraining the scale-up of quality health services, including HIV/AIDS services. The Emergency Plan will work with the MOH to assess human-resource needs and availability in the public and private sectors and will support technical assistance and capacity transfer to the ministry. These activities will strengthen the managerial capacity of health managers and administrators at central, district, and community levels and allow nongovernmental organizations working in HIV/AIDS to enhance their work against stigma and discrimination.

Principal Partners: PSP one/Abt Associates, 20/20 Abt Associates, Ministry of Health, Family Health International (FHI), Ministry of National Education, AIDSTAR, CARE International, and Johns Hopkins University.

Other Donors, Global Fund Activities, and Coordination Mechanisms:

While the Emergency Plan is the largest donor active in the HIV/AIDS sector, other development partners include the Global Fund to Fight AIDS, TB and Malaria (with UNDP as principal beneficiary and an HIV project in the North through CARE International, 2006-2007), UN agencies (WHO, UNICEF, UNDP, UNFPA, UNAIDS, WFP), and, to a limited extent, other bilateral partners (the Belgian, Canadian, French, German, and Japanese development agencies). A large potential source of funding is the World Bank (which has proposed approximately $50 million over five years), but this funding continues to be delayed. The Emergency Plan Country Coordinator represents the USG on the Global Fund Country Coordinating Mechanism (CCM) and at most coordination forums, and the agency heads represent the USG at technical forums.

The CCM is a multi-sectoral, participatory forum that brings together 33 members of civil society, the public and private sectors, and multilateral and bilateral development partners. However, it requires reform and support in good-governance training, which the Emergency Plan will provide through country- and centrally-funded technical assistance in fiscal year 2007. The CCM complements the national system of HIV coordination committees stretching from the National HIV Council (headed annually by the president) to regional, district, and grass-roots village HIV/AIDS action committees, in addition to various sectoral and technical committees. The MLS� new National Strategic HIV/AIDS Plan (2006-2010) provides new forums for coordination that will improve overall communication and programming for HIV/AIDS activities. The UNAIDS theme group, with UNICEF as the chair, has expanded to include the USG. It provides a regular coordination forum, bringing multilateral and bilateral development partners together. Substantial efforts are being made to promote coordination and collaboration among in-country partners, the host government, and other key stakeholders.

Program Contact: Emergency Plan Country Coordinator, Jyoti Schlesinger

Time Frame: Fiscal year 2007 � fiscal year 2008

Approved Funding by Program Area: Cote d'Ivoire

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