N/A

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 13 - HKID Care: OVC

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 14 - HVCT Prevention: Counseling and Testing

Total Planned Funding for Program Budget Code: $460,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Overview

Targeting youth is the highest priority in the fight against AIDS in Angola. In an epidemic as vast as this one could be, the most

important strategy of all is to get to uninfected boys and girls before they start to have sex and teach them lifelong, safe behavior.

Youth, in particular girls, are not perpetrators of the epidemic but victims.

A few key findings from a Knowledge, Attitudes and Practices study (KAP) supported by the USG through Population Services

International (PSI) in collaboration with UNICEF shows that:

•43% of Angolan young people have had sex by the age of 15;

•nearly 70% of sexual activity amongst young people is unprotected;

•over one-third of boys and young men had slept with two or more partners in the previous three months, 90% are unable to name

all three principal ways of avoiding HIV;

•42% of youth are completely unconcerned or only a little worried about contracting HIV, only 35% of those who knew that

condoms are protective used one last time they had sex, compared with 19% of those who did not know;

•over one-third of respondents do not know where to buy condoms.

The need for widespread availability of voluntary counseling and testing sites is obvious. Without facilities to test their HIV status,

Angolans will not make necessary adjustments to their lives.

The National HIV/AIDS Strategic Plan for 2007-2010 calls for the rolling out of mobile CT units in all provinces and building the

capacity of health care workers to counsel and test for HIV. The USG supports this plan through providing technical assistance to

the National AIDS Institute (INLS) to fulfill its Global Fund to fight HIV/AIDS, Tuberculosis and Malaria (GFATM) objectives on the

provincial level. A challenge that remains is the quality of counseling and the follow-up after having tested positive. An opportunity

exists in the enhancement of both pre and post exposure counseling services at mobile clinics, and the USG is working with the

Provincial Health Department (DPS) in these areas and also on more follow up with clients through local NGOs.

Leveraging and Coordination

Currently the majority of CT services are within government health facilities. The USG, along with other donors, is discussing with

the INLS and the Ministry of Health (MoH) the need for different models of CT sites. It was clear from the XVII International

HIV/AIDS Conference in Mexico that, critical to the scaling up of counseling and testing is to have multiple CT models and sites,

mobile testing, Provider Initiated Testing and Counseling (PITC), and community based counseling and testing. The USG is

working on political commitment and enabling an environment which is conducive for policy change. Taking into account that HIV

testing and counseling services have gender dimensions, the USG is also working with the INLS on CT guidelines which point out

that disclosure can be problematic for women and that it is important to promote couples counseling and testing and to implement

strategies to increase male uptake of counseling and testing services.

The USG, in collaboration with UNICEF, is supporting the Ministry of Health and INLS to progressively establish CT in all

municipal health centers. Efforts are also being made to provide voluntary counseling and testing opportunities through outreach

services (mobile CT) to ensure the majority of the population has access to basic services.

Although the Angolan Armed Forces (FAA) coordinates on a regular basis with the Angolan institutions responsible for defining

and coordinating efforts to fight HIV (i.e., GFATM Country Coordinating Mechanism (CCM), the INLS, and the MoH), it acts

independently and with relative autonomy from these institutions. Historically, the political influence the FAA has possessed,

allowed it to define its needs and implement its programs without accountability to national health organizations. Currently, the

Military is a member on the CCM and attends the INLS partner meetings. They are beginning to work together with other parts of

the Government. To increase coordination among these actors, DOD's major implementing partner, Charles Drew University

(CDU), has promoted greater communication and coordination across Angola's institutions, while still respecting the FAA's

security concerns.

Current USG Support

The USG support for CT has focused primarily on creating an enabling environment for effective counseling and testing and

developing linkages with other services. The INLS strategic plan calls for scaling up of counseling and testing services. To

facilitate this, the USAID-funded Essential Health Services Program (EHSP) works with the Institute and provincial health

directorates in Luanda, Cunene, and Lunda Norte to extend CT services in 15 selected health facilities and is further expanding to

16 more VCT centers. Four principal activities support the scale-up:

•Training existing staff who will work as counselors in the facilities;

•Rehabilitating facilities on a small-scale to adapt infrastructure for counseling and testing activities;

•Furnishing and equipping the rehabilitated facilities to conduct counseling and testing;

•Facilitating within the INLS the procurement and logistics of test kits and other supplies required for counseling and testing.

The USG works to integrate CT services with other services within government health facilities to guarantee sustainability. The

INLS has taken the lead on CT and the USG provides supports by:

•Providing technical assistance to the INLS to fulfill its GFATM objectives on the provincial level;

•Continuing to support the south-south Initiative in the border regions to improve service delivery;

•With INLS and the Provincial Directorate of Health, encouraging and promoting task-shifting with inclusion of lay counselors

especially in areas where medical service is limited.

Through the DOD, the USG collaborates with the FAA to establish 3 CT centers and activities respectively in Luanda and

Lubango. The purpose of increasing the number of CT centers is to increase awareness in the population regarding HIV status,

prevent further transmission, expand surveillance data regarding the status of HIV infection in the country, and decrease stigma

surrounding HIV by normalizing the process of engaging in HIV screening. The areas selected for the second wave of CT

Centers include Cabinda, Huambo, Kuando Kubango and Lunda Sul, which were selected for their strategic location in the fight

against HIV. These activities are in line with national protocols to enhance the chances of success of both CT and anti retroviral

treatment (ART).

The program also supports a clinic data management system in collaboration with the Ministry of Health which provides

information on CT on a national level.

USG FY09 Support

In FY09, the USG will help update policy and guidelines to create a strengthened strategic direction for CT. There will also be an

effort to coordinate implementing partners at the provincial and district levels on a regular basis to address issues of logistics,

linkages and referrals, training, staffing, and share experiences with rolling out of new models or trainings.

In January 2009, an assessment of the EHSP will be conducted and recommendations may influence programming in this area.

The program will continue many of the FY08 activities but using technical assistance to give a more focused approach to

advocating the use of different models of CT and rolling it out at the community level while leverage from GoA and the GFATM is

sought for the rehabilitation cost.

In addition to continued activities, the USG will

•Promote the best practice of lay counselors conducting CT so that they are used in all types of settings to assist in CT activities

both in facility and home-based/outreach settings;

•Establish Standard Operating Procedures (SOP) for CT that include external quality assurance, lab quality assurance,

supervision of rapid tests, utilization of a CT register, M&E for CT to ensure consistency across all partners, and other standards

for provision of quality CT services (timers, training and re-training for counselors and nurses, etc.);

•Promote the best practice of incorporating people living with HIV/AIDS (PLWHAs) needs into prevention, CT, and care activities;

•Promote the integration of CT into the hospital system by the routine offering of CT or Provider Initiated Testing and Counseling

(PITC), vice co-location in most HC facilities;

•Develop a plan to begin viral load testing utilizing the current laboratory system;

USG wraparound activities will include:

•Collaboration with PMI in distributing bednets to HIV+ persons at voluntary counseling and testing (VCT) sites;

•Coordinate with water purification activities in VCT sites through the Certeza project financed by the water earmark aimed at

diminish water-born infections.

Targets

9.1 Number of service outlets providing counseling and testing according to national and international standards 45

9.3 Number of individuals trained in counseling and testing according to national and international standards 70

9.4 Number of individuals who received counseling and testing for HIV and received their test results (excluding TB) 50,000

Table 3.3.14:

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.16:

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18945

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18945 18945.08 HHS/Centers for US Centers for 8304 5857.08 $400,000

Disease Control & Disease Control

Prevention and Prevention

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $825,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Overview

Angola continues to make strides, even though it is still recovering from 40 years of civil strife and transitioning from emergency

health services to health development. Containing and reducing the current low-level prevalence of HIV/AIDS remains a priority

area in the collective effort to develop a robust health service infrastructure. Health Systems strengthening, including building local

capacity, is an essential component of the USG strategy in Angola across all health funded programs.

Developing this infrastructure calls for a policy framework and management systems to deliver quality services in national

prevention, treatment and care in a sustainable way. Accordingly, system strengthening is the Ministry of Health's (MoH) top

priority. The current health system has a large pool of basic health workers; however their technical capacity is low. The chief

policies and systems that need definition and upgrading are human resources, strategic information, planning and drug

management. A reliable information system will give the data needed for sound planning; appropriately trained personnel and

good drug management form the basis for delivering quality services effectively, resulting in a positive health impact.

Leveraging and Coordination

The USG coordinates its assistance with WHO, UNICEF, UNDP, the European Commission and the World Bank, all of which join

the USG as key members of national committees that help guide policy development and implementation. The USG

complements European Commission work to establish a new health management information system by strengthening health

information and planning systems at the municipal level. The USG is working closely with the UN to establish a Technical

Advisory Committee, which, together with other international agencies, will support the National AIDS Institute (INLS) as the in-

country coordinating body for HIV/AIDS. This proposed advisory committee will conduct assessments and provide

recommendations on protocols and guidelines the government plans to implement. The USG, German and British foreign

assistance agencies are members of the donor-led Global Implementation Support Team (GIST) to address Global Fund to fight

HIV/AIDS. Tuberculosis and Malaria (GFATM) program weaknesses and transparency concerns.

In policy and system strengthening, the USG supported Essential Health Services Project (EHSP) leverages resources and

creates synergies with other USAID projects in decentralization and civil society strengthening, the former working with local

governments and citizens and the latter working with non-governmental organizations (NGOs). These projects promote

leadership roles for women and people living with HIV/AIDS (PLWHA). The EHSP has been refined over recent months to focus

more tightly on the USG's priority areas of HIV/AIDS, malaria and family planning and is now under new leadership by a former

female Minister of Health from Latin America. This project is the vehicle for the clinical aspects of prevention of maternal to child

transmission (PMTCT) and voluntary counseling and testing (VCT), as well as almost all activities in health systems

strengthening.

Private sector enterprises, including multinational firms in the extractive industries, are additional sources for leveraging support

for the government of Angola (GoA), and under the leadership of the Ambassador, these opportunities will be expanded in the

FY09 program. The USG has engaged the private sector in becoming more involved in HIV/AIDS programs through the Angolan

Business Alliance. This partnership of companies is led at the moment by the Brazilian construction company, Odebrecht, who,

along with Coca-Cola and others, has a Global Development Alliance (GDA) agreement with USAID, to leverage those firms'

experience and energy for workforce HIV interventions and corporate social responsibility in general. This partnership, called

Comite Empresarial de Combate ao SIDA (CEC) will be used to engage other private sector partners (with a focus on oil sector

companies, such as Sonangol) to improve workforce policies, share experiences and act as a conduit of information between

those who have already developed strong in-house programs and those who wish to begin or strengthen their programs.

Current USG Support

In FY08, the USG provided support in the following areas:

Policy Making

•Standardized national HIV policies, procedures and protocols to reflect the latest scientific evidence and international consensus;

•Updated protocols and manuals on counseling and testing, PMTCT, blood safety and behavior change, with an aim toward

equalizing gender imbalances, training and supervision;

•Revised current policies that seek to reduce stigma and discrimination;

•Outlined policy benchmarks, including the expansion of categories of personnel that can perform rapid HIV testing; to scale up

PMTCT services; and strengthening of linkages between HIV and family planning services;

•Collaborated with EHSP, WHO and the MoH to support the completion of the National Health Account (NHA). This midterm

expenditure review of public health expenditure, household expenditure on health and health expenditure from donors has never

been done thoroughly in Angola. Together with the National Health Policy (currently in the approval process), and the National

Strategic Plan for HIV/AIDS, the NHA will be an indispensable planning instrument for all health actions. This funding will leverage

other USAID funding (President's Malaria Initiative (PMI) $100,000 and Population and Reproductive Health $100,000) and

complement other donor and government of Angola funding;

•Maintained representation with Angola Country Coordinating Mechanism.

Information

•Strengthened health management information systems to improve municipal-level planning that responds to concrete health

needs and ongoing municipal decentralization;

•Adapted the European Commission training model in budgeting and planning to the municipal level;

•Incorporated appropriate HIV/AIDS and tuberculosis reporting and analysis into the national information system;

Capacity-Building

•Trained personnel for voluntary counseling and testing centers, with an emphasis on women and youth- and men-friendliness

and prevention education;

•Trained health officials in epidemiological surveillance and in monitoring and evaluation of HIV/AIDS programs;

•Developed supervision tools to measure performance;

•Designed workforce training systems;

•At the request of the MoH , supported efforts to strengthen health care provider capacity to respond to the GoA roll-out of

antiretroviral (ARV) services, focused on provision of VCT and PMTCT within facilities in 3-7 Provinces in 2008 and 2009.

Drug Management

•Strengthened systems to forecast needs, procure drugs and ensure their timely and reliable supply throughout the health network

on provincial level;

•Upgraded integrated logistics systems and supply chains that encompass HIV/AIDS test kits, STI diagnostic materials, anti-

retrovirals, and drugs to fight opportunistic infections by complementing PMI funds, resulting in fewer stock-outs;

•Leveraged GDA support from private firms like Odebrecht, tapping their warehousing and distribution resources to facilitate flow

of condoms and prevention education to civil society (Business Coalition against AIDS, through GDA with Odebrecht).

Other

•Responding to a request from the Angolan government, assisted in the conceptualization and drafting of future HIV/AIDS

proposals for the GFATM;

•Provided technical assistance to enable the Ministry of Health to become the Principal Recipient for the GFATM Round 7 malaria

grant (USAID) and future rounds.

USG FY09 Support

The USG will continue to work with the entities supported in FY08 in areas outlined below. FY09 funds will support continuity of

services and training.

•Building on FY08 activities, the USG will continue to work with the INLS and MoH on the standardization of national HIV policies,

procedures and protocols. Where these policies and protocols have been finalized, the USG will support their roll out and

implementation;

•The USG will support the MoH to utilize the completed National Health Account (NHA) to better inform health sector planning and

expenditure;

•Expanding on FY08 successes, the USG will extend and focus support at the provincial level, assisting the Provincial Health

Deaprtments (DPS) in managing GFATM funding, strengthening of the health management information systems (HMIS), data

collection and use, and planning, forecasting and stock management. The USG will continue to work with PMI to improve the

management of the Essential Drug Program, especially around procurement and logistics of ARV's, test kits and drugs for

opportunistic infections, including TB drugs for DOTS. The USG will engage the PMI partner with expertise in supply chain and

logistics management to provide technical assistance in this area;

•At the request of the GoA, the USG will collaborate in the development of an Angolan Field Epidemiology and Laboratory

Training Program (FELTP) in conjunction with donors to respond to the need to improve workforce capacity. FELTP is a public

health training program designed to assist countries develop, set up, and implement public health strategies to improve and

strengthen their public health system and infrastructure. The laboratory component of the program aims to strengthen the linkage

between epidemiology and laboratory systems, primarily with the goal of using laboratory data to improve surveillance and

outbreak response. While in training, FELTP participants continue to provide in country services, working with the Ministry of

Health on relevant public health efforts specific to the host country. As laboratory systems continue to be strengthened and

supported in Angola, establishment of a FELTP is one mechanism to develop a trained Angolan workforce that can provide

sustained leadership and assistance to the Angolan Ministry of Health and the Public Health System as a whole. Based on needs

specific to Angola, the FELTP can be structured and integrated with a number of partners, including the Ministry of Health,

Universities and National Laboratories;

•As part of the cross border programming, the EHSP will assess an inventory of all available health services in the border region

with Namibia. The EHSP (in collaboration with DPS in Cunene and Kuando Kubango) will finance the exchange of experiences

and lessons learned between health workers of Angola and Namibia;

•Building on the success of the FY08 capacity building activities, the USG will continue to support training and mentorship in

organizational capacity, specifically in management, finance and monitoring and evaluation. Several civil society organizations

have taken up advocacy efforts on behalf of people living with HIV/AIDS under an umbrella granting mechanism which will expand

its CBO base in FY09. The USG team will promote more active and constructive involvement through the GFATM County

Coordinating Mechanism (CCM), where ministries and civil society are well represented. The capabilities of local civil society

organizations (CSOs) will be improved through training and technical assistance, and the establishment of a sub-grant fund to

support projects developed with municipal authorities. The EHSP will combine forces with the Municipal Development Program,

where possible, to foster increased community input into HIV/AIDS programming. The program will develop means for HIV/AIDS

staff at all levels, but particularly at the local level, to interface with members of their communities and to involve them in

decisions. Similarly, the Municipal Development Program will foster community input into municipal government's decision making

in the same provinces;

•The USG will buy into the USAID Regional Office for technical assistance in developing its HCD activities and leveraging the

Southern Africa Prevention Initiative.

Targets

14.1 Number of local organizations provided with technical assistance for HIV-related policy development 46

14.2 Number of local organizations provided with technical assistance for HIV-related institutional capacity building 93

14.3 Number of individuals trained in HIV-related policy development 150

14.4 Number of individuals trained in HIV-related institutional capacity building 400

14.5 Number of individuals trained in HIV-related stigma and discrimination reduction 400

14.6 Number of individuals trained in HIV-related community mobilization for prevention, care and/or treatment 250

Table 3.3.18:

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.18:

CDC staffing all costs

New/Continuing Activity: Continuing Activity

Continuing Activity: 19128

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

19128 19128.08 HHS/Centers for US Centers for 8304 5857.08 $518,000

Disease Control & Disease Control

Prevention and Prevention