The HIV/AIDS component of the Angola Essential Health Services Program (EHSP) started implementation in October 2007. The purpose of the HIV/AIDS activity is to prevent HIV/AIDS transmission in Angola by improving the national and provincial capacity to address the HIV/AIDS epidemic, and to increase access to quality VCT and PMTCT services including follow-up for HIV-positive individuals. The HIV/AIDS component was initially started in the three provinces of Luanda, Lunda Norte and Cunene. In the next year, program activities expanded to four new provinces: Cabinda, Kuando Kubango, Lunda Sul, and Huambo to work in a total of 7 provinces. In COP 10, EHSP plans to expand and work in a total of 8 provinces, prioritizing those with the highest HIV prevalence and include the above mentioned plus Uige, as well as all along the transport corridor between Luanda and Cunene.

Overall objectives of the EHSP include:

1. Improved capacity of the health system in targeted provinces to plan, budget, and deliver quality health care and services.

2. Increased individual and civil society knowledge and practice of positive health behaviors related to HIV/AIDS.

3. Increased individual and civil society demand for and participation in improving quality and health services.

Overall in FY 09, EHSP reached the majority of their targets in the areas of PMTCT, VCT and sexual prevention.

¬

A major achievement of the EHSP 2007 was the establishment of 30% of all new PMTCT sites within the country. EHSP aimed In FY09 to have a total of 16 PMTCT sites, but far surpassed themselves with the creation of a total of 30 new PMTCT service outlets providing the minimum package of PMTCT services according to national and international standards. Specific results include 26,197 pregnant women counseled and tested despite the challenge of enduring a several month stock out on tests kits at the provincial (DPS) level. Additionally, they surpassed their goal of number of pregnant women who were provided with a complete course of ARV Prophylaxis in a PMTCT setting. Numbers of health care workers trained also surpassed expectations. EHSP's successes were greatly enhanced by a strong working relationship between EHSP and the INLS and DPS teams.

A major achievement in FY 09 in CT was that 23,684 individuals received counseling and testing. EHSP supported a total of 23 VCT service outlets in FY09 of which 8 new VCTs providing counseling and testing for HIV according to national and international standards. Numbers of counselors trained surpassed their targets with 30 trainees.

In FY 09 EHSP, trained 48 trained individuals in institutional capacity building and trained 848 (target 200) in both HIV related stigma and discrimination reduction and HIV-related community mobilization for prevention, care and/or treatment.

In FY 09, a total of 54,505 people were reached with sexual prevention abstinence and being faithful messages, while 17,993 with other prevention messages. Prevention messages covering messages of AB and C were delivered through schools, churches and public places such as markets and relied mostly on the cascade methodology. EHSP project trained and worked with community health agents and community leaders to deliver these prevention activities.

In COP 10, EHSP plans to continue to scale-up VCT services to work in a total of 8 provinces; prioritizing provinces with the highest HIV prevalence. Additionally, the transport corridor between Luanda and Cunene province is a critical area of focus.

In COP 10, EHSP will increase CT in reproductive health services at the municipal level. EHSP will support the increase of CT, with expansion to both new centers and mobile clinics, in key geographic regions. EHSP will establish new VCT service sites if possible together with PMTCT by rehabilitating existing health centers with GoA, USG and GFATM funds and integrating services at government health facilities.

Specific activities include the provision of equipment and small scale refurbishment for counseling and testing services; training in Counseling and Testing including lay counselors; increased provision of supportive supervision and in-service training.

EHSP will continue to provide support to MOH in the decentralization process by providing technical assistance in the areas of finance and planning, national health accounts, and gap analysis. EHSP will work to expand quality control system at municipal and provincial levels to strengthen supervision of health staff and community health workers. Additionally, EHSP will support the MOH to develop capacity of existing health care workers (doctors, nurses, nurse-midwives, medical assistants, laboratory technologists; pharmacy technicians) work on upgrading the clinical, leadership, management, planning, supervision, information systems, quality improvement of services, and stigma reduction skills of health care workers via in-service training at provincial and municipal levels. Collaboration with the MOH will also include support to develop a policy and plan for task shifting to nurses, auxiliaries and community health workers; the establishment of a policy for community health workers to guarantee appropriate follow up to diagnosis (both positive and negative), care and support, and treatment (adherence), and assistance in formulating a strategy to reinforce the referral system.

Some specific activities will include: the provision of technical assistance to train health personnel for PMTCT/VCT; support and management of the mobile clinic; updating national guidelines for CT policies, development of Standard Operating Procedures (SOP); an emphasis the quality of counseling; follow-up for HIV+ in treatment adherence; training of lay-counselors training; improvements of M&E for CT and the follow-up of PMTCT at the provincial level; as well as training and support to permanent staff in every of the 8 provinces to strengthen M&E and supervision.

EHSP will scale-up community mobilization and communication activities using the successful implementation of community agents training, the link between the health services and the CHW and through capacity building of CSOs and local NGOs and church groups in prevention, care, stigma and discrimination reduction. Prevention activities, conducted mostly through community agents put an emphasis on understanding risk reduction and promoting key behavior change messages, in line with the overall National behavior change messages and campaigns. The capacity of community agents will continue to be built through training, supportive supervision, management and technical assistance, in close collaboration with the DSH and the Provincial government. Technical assistance in provision of quality AB prevention programming will be provided by EHSP.

EHSP will scale-up community mobilization and communication activities using the successful implementation of community agents training, the link between the health services and the CHW and through capacity building of CSOs and local NGOs and church groups in prevention, care, stigma and discrimination reduction. Prevention activities, conducted mostly through community agents put an emphasis on understanding risk reduction and promoting key behavior change messages, in line with the overall, National behavior change messages and campaigns. The capacity of community agents will continue to be built through training, supportive supervision, management and technical assistance, in close collaboration with the DSH and the Provincial government. Technical assistance in provision of quality other prevention programming, including STI prevention and treatment and condom promotion and distribution will be provided by EHSP.

In COP 10, EHSP plans to continue to scale-up PMTCT services to work in a total of 8 provinces; prioritizing provinces with the highest HIV prevalence. The aim is to achieve 100% coverage of ANC facilities in both Luanda and Cunene province as well as the transport corridor between the cities in the upcoming two years.

Specific activities will include the on-going collaboration with GRA, USG and GFATM in order to establish new PMTCT sites by rehabilitating existing ANC centers. These sites will be integrated into existing services at government health facilities and will utilize personnel and funds from GRA, USG and GFATM. Plans are to increase CT coverage in prenatal services, and CT and PMTCT at delivery and post partum, at both the provincial and municipal levels. The EHSP will also strengthen integration and articulation with Maternal -Infant Services and Family Planning at municipal level, as well as increase the provision of reproductive health/family planning services at PMTCT sites. Activities will also include training of health staff in integrated PMTC and Family Planning services and M&E.

Increased emphasis will be placed on quality monitoring and follow-up of HIV positive pregnant women and exposed newborn, increased supervision and in-service training; and strengthened south to south cooperation.

An internal evaluation of the PMTCT package will be implemented to define future scale-up