“Community Action for Preventing HIV/AIDS”

JFPR 9006Cambodia, Laos and Vietnam

Japanese Fund for Poverty ReductionAsian Development Bank

This is a regional project for Cambodia, Vietnam and Laos.

In each country there is: An Executing Agency (EA) An national Implementing Agency (IA)

A few provinces are selected for implementation

Lao PDR

In Laos the project is implemented by the National Committee for the control of AIDS Bureau of the Ministry of Health (NCCA-B)

The Project is implemented in three Provinces: Khammouane, Oudomxay and Savannakhet

The Executing Agency is the Primary Health Care Expansion Project

Cambodia

In Cambodia the project is implemented by the National Centre for HIV/AIDS Dermatology and STD (NCHADS)

The Project is implemented in four Provinces: Battambang, Koh Kong, Prey Veng and Svey Rieng

The Executing Agency is the Ministry of Health

Vietnam

In Vietnam the project is implemented by the AIDS Division of the Ministry of Health

The Project is implemented in five Provinces: Dong Thap, An Giang, Kien Giang, Quang Tri and Lai Cau

The Executing Agency is the National Committee for Population and family Planning

What concepts underlie this Project? Low prevalence countries: to be cost-

effective, interventions need to be targeted to high risk situations

Assumption: link between mobility and vulnerability to HIV

Need for specific intervention strategies in each situation

Availability of in-country existing prevention packages, management structures and technical know-how.

Objectives:

to support a comprehensive set of HIV/AIDS prevention activities in situations of particular risk (“hot spots”)

to strengthen the capacity of national and local HIV authorities and selected NGOs to develop community-based prevention and care programmes.

Focus:

sites and areas that receive many transient, mobile populations or long-term migrants

large construction sites

source communities of migrants

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10

20

30

40

50

60

70

80

90

100

Commercial sex in last 12 months: various male groups, Cambodia, Laos, Vietnam

Bought sex Alw ays used condom

Elements of the Community-based Programme:

behaviour change communication (BCC)

social marketing of condoms (SMC)

management of sexually transmitted infection (STI).

a capacity-building element for developing models for Care.

Duration and Budget: Duration: 30 months; from June 2001 to

31 December 2003

Budget: 10 million US$ ($8 million JFPR Grant, $2 million contribution from the three Governments)

Source of funding: Japan Fund for Poverty Reduction (JFPR) through ADB

Country allocations from the grant Cambodia: $2.2 million

Lao PDR: $1.4 million

Vietnam: $3 million

Regional: $1.4 million

Allocations by category (in $'000)   

1.Revolving Credit Facilities 0 2.Civil Works 103 3.Equipment  313 4.Drugs and Supplies 419 5.Training, Workshops, Seminars 3,667 6.Consulting Services  2,582 7.Project Management  366 8.Other Project Inputs  0 9.Contingencies  550 TOTAL 8,000

Fund flow: Countries establish imprest accounts (usually in Ministries

of Finance/Economy) with initial withdrawals (advances) from ADB of $200,000 - $400,000

The imprest accounts are operated and audited by the EAs in accordance with ADB procedures

The IAs have sub-accounts and receive advances from the EA based on upon the work plans developed by the IAs

The IAs maintain their sub-accounts following specified procedures for the use of funds, reporting, auditing, etc

Provinces function as IAs and also have sub-accounts, operated in the same way

Statements of Expenditures (SOEs) by IAs are used to liquidate and replenish the advances.

Project activities are concentrated in six areas: Evidence-based programming Social marketing of condoms STI services IEC/BCC Models of Care Strengthening provincial capacity

1. Evidence-based programming: project activities in the three provinces are

based on careful and thorough assessments of risk situations; the nature and extent of risk involved, populations groups or behaviours involved, and the most effective ways to respond to them.

2. Social marketing of condoms: The Project supports the extension of

social marketing of condoms to the target populations in the three provinces

3. STI services

The project is strengthening STI services where managing STI will significantly reduce HIV transmission risk

4. IEC/BCC for Peer Education and Behaviour change:

The project supports carefully designed and targeted information, peer education and advocacy plans in each province, to ensure that all sections of society know about HIV and AIDS, know how to protect themselves, know how to live with people who have HIV or AIDS, and know how important protecting the community against HIV and AIDS is.

5. Models of comprehensive AIDS care: The project supports the development of

appropriate models of comprehensive care for PLWHA, linking testing and counseling services, institutional/clinical care, home and community care, and hospice care for terminal situations.

6. Strengthening the capacity of Provincial HIV/AIDS units: The key to effective implementation lies in a

shared responsibility between Provincial Health Departments (PHD) and the Provincial AIDS units, and central level (NCHADS, NCCA-B, AIDS Division). The central level develops overall strategy and guidelines for implementation of programme components; the provinces develop operational plans, based on these guidelines. Many other partners, such as other departments, NGOs and community organizations are also brought in for implementation.

The project is INNOVATIVE:

it makes large budgets available for implementation at provincial level

it uses established channels for fund flow it is based on national strategies it is relatively un-programmed: it is up to

the provinces to decide exactly what they want to do

it encourages partnerships

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

Cambodia Laos Vietnam Project

JFPR 9006: Budget allocation 2002

Central level Provincial level

This has BENEFITS:

Ownership: Ministries of Health clearly own the project

Flexibility: responds to real needs in real time

Efficiency: uses established channels and structures

But it also has RISKS:

strategies and plans need to be clearly established, reviewed and up-dated

planning, implementation and ACCOUNTABILITY capability must be ensured at provincial level

channels and structures must be flexible enough to cope with the innovative elements of the project

Present Status: Technically well-established: international &

local staff recruited; components based on identified operational strategies; implementation mechanisms in place; planning, monitoring and reporting systems functioning

But requires a significant and sustained increase in disbursements well above accustomed levels in ALL countries

So priority to support managerial and administrative capacity at both provincial and central level

Initial slow implementation at grass-root level will significantly accelerate in the rest of this year

Project Staff:

Regional Advisor: Peter Godwin STI Adviser: Dr Nigel O’Farrell BCC Adviser: Ken Swann

In-country staff (each country): Project Implementation Officer (PIO) Project accountant Local consultants for BCC and STI

13%

3%

8%

0%

2%

4%

6%

8%

10%

12%

14%

Cambodia Laos Vietnam

JFPR 9006 - % expenditure (of annual 02 budget)

THE ASIAN DEVELOPMENT BANK (ADB): FIGHTING POVERTY IN ASIA The Asian Development Bank (ADB) is working to

reduce poverty in Asia; and a part of this overall development strategy has been strengthening infrastructure for primary health care, and improving the quality of health services. Reducing the spread of HIV/AIDS within the context of health care systems is particularly important. Ill-health, whether caused by HIV and AIDS or not, is an important cause of poverty; and poverty is a major reason why health services, and particularly HIV-related prevention services, are underutilized.

Thank you

peter godwinRegional Adviser

Phnom PenhApril 2002