08.P0205 MLG - Prevention in Districts

The Ministry of Local Government (MLG), Primary Health Care Department, is in charge of the District

Multisectoral AIDS Committees (DMSAC), which are the primary planning bodies for a range of HIV-related

interventions on the district level. The DMSACs develop comprehensive HIV/AIDS plans each year, yet

those plans often go under-funded. This activity provides additional funds to the DMSAC in 5 districts

selected by the Ministry for PEPFAR prevention assistance, to carry out additional prevention activities.

The activities range widely by district and have included in the past: basic education and local IEC, support

for local civil society groups' initiatives such as theater, small scale campaigns, peer outreach in select

settings, programs for school-age youth, and training for pastors and PLWHA in primary prevention. The

funding and activities supported by PEPFAR are a portion of the total managed by the Districts; they also

receive funding from the GOB to support these comprehensive plans.

In 2007, the funds assisted districts to apply certain prevention outreach and implementation strategies that

they thought were good for their district. These funds complimented those made available through the GOB.

By the third quarter of 2007, half of all activities focused on youth and couples had been completed. Nearly

all activities directed towards males, as well as those targeting community leaders, traditional healers, and

businesses were completed. Across the 5 districts, approximately 7,000 people have been reached through

various means and 25 people trained to provide prevention programs. The districts also benefited from

technical support from a US NGO the National Alliance for State and Territorial AIDS Directors (NASTAD).

In 2008, the five districts will focus their efforts further, to support more strategic and higher quality

prevention interventions. NASTAD will assist them with this process. The specific target groups and

interventions will be determined in coming months.

Complementing this activity are: 1) a small grants program for some of the local civil society groups working

in these five districts, and 2) technical support from NASTAD to the 5 target districts to strengthen the

planning and utilization of both the PEPFAR-provided funds and those provided to the districts by the GOB.

Together, these three activities will increase the total amount of assistance and funding for prevention

activities in those districts, through two critical directions: the DMSAC and local planning and monitoring

bodies and the civil society groups that conduct a large share of the prevention-related implementation on

the local level.

The funding for this activity is from both the AB program area and the C/OP program area. The District

comprehensive plans that the District staff develop usually include activities for a range of target groups and

issues, including some that belong under AB (e.g. school abstinence pageants) and some that belong under

C/OP (sex worker outreach, establishing condom distribution sites).

08.P0505 Ministry of Local Government - Prevention in Districts

The Ministry of Local Government (MLG), Primary Health Care Department, is in charge of the District

Multisectoral AIDS Committees (DMSAC), which are the primary planning bodies for a range of HIV-related

interventions on the district level. The DMSAC develop comprehensive HIV/AIDS plans each year, yet

those plans often go under-funded. This activity provides funds to the DMSAC in 5 districts selected by the

Ministry for PEPFAR prevention assistance, to carry out additional prevention activities.

The activities range widely by district and have included in the past: basic education and local IEC, support

for local civil society groups' initiatives such as theater, small scale campaigns, peer outreach in select

settings, programs for school-age youth, and training for pastors and PLWHA in primary prevention. The

funding and activities supported by PEPFAR are a portion of the total managed by the Districts; they also

receive funding from GOB to support these Comprehensive Plans.

In 2007, the funds assisted districts to apply certain prevention outreach and implementation strategies that

they thought were good for their district. These funds complimented those made available through the GOB.

By the third quarter of 2007, half of all activities focused on youth and couples had been completed. Nearly

all activities directed towards males, as well as those targeting community leaders, traditional healers, and

businesses were completed. Across the 5 districts, approximately 7,000 people have been reached and 25

people trained to provide prevention programs. The districts also benefited from technical support from a

US NGO, the National Alliance for State and Territorial AIDS Directors (NASTAD).

In 2008, the 5 districts will focus their efforts further, to support more strategic and higher quality prevention

interventions. NASTAD will assist them with this process. The specific target groups and interventions will

be determined in coming months.

Complementing this activity are 1) a small grants program for some of the local civil society groups working

in these five districts, and 2) technical support from NASTAD to the 5 target districts to strengthen the

planning and utilization of both the PEPFAR-provided funds and those provided to the districts by the GOB.

Together, these three activities will increase the total amount of assistance and funding for prevention

activities in those districts, through two critical directions: the DMSAC and local planning and monitoring

bodies and the civil society groups that conduct a large share of the prevention-related implementation on

the local level.

The funding for this activity is from both the AB program area and the C/OP program area. The District

Comprehensive Plans that the District staff develop usually include activities for a range of target groups

and issues, including some that belong under AB (e.g. school abstinence pageants) and some that belong

under C/OP (sex worker outreach, establishing condom distribution sites).

08.C0806 Ministry of Local Government - OVC Support

2007 accomplishments

MLG's DSS continues to build on its work to date. Through 2007 emphasis was placed on the development

of guidelines, policy, M&E framework, training manuals, upgrading the OVC registration and data

management systems. DSS focused on addressing capacity building issues at the Child Welfare Division at

the national level.

2008 plans

DSS intends scale up interventions and will continue strengthen capacity at the national and district level to

effectively support, monitor and coordinate the implementation of OVC programs. DSS will specifically focus

on strengthening linkages with key implementing partners such as BOCAIP and Marang Child Care

Network, addressing issues of quality and service delivery to OVC.

Through BOCAIP, DSS will strengthen and monitor the quality of services provided to OVC and promote

referrals among partners and improved reporting of results. BOCAIP will work closely with CBO/NGO/FBOs

to support comprehensive care to OVC for both protection and welfare of children affected and infected by

HIV and AIDS. Training on guidelines and regulations related to services delivery as well as tracking the

use of existing tools is integral to this support. DSS working closely with BOCAIP will ensure that at

community level there is monitoring in the delivery of the food basket to OVC. To further enhance the

quality of service at family level BOCAIP will provide guidance to service providers on child participation and

involvement.

With Marang, DSS will work in training, advocacy and coordination of NGO/CBO/ FBO's and Social

Workers at national and district level. Under advocacy, Marang will disseminate relevant legislation affecting

orphans and vulnerable children to different stakeholders. Emphasis will be placed on issues of vigilance to

child abuse, incest, detrimental cultural practices, inheritance and will writing to protect children's rights as

well as working with the media on reporting issues of OVC.

DSS will continue to strengthen its coordinating structures both at the national and district level to ensure

comprehensive and effective delivery of services for orphans and vulnerable children. Marang, as the only

OVC umbrella network in the country with a coordination mandate, will collaborate with DSS and other

relevant government departments to ensure effective coordination and quality of services to OVC. Marang

will collaborate with DSS and other stakeholders in promoting and strengthening coordination committees

such as the District Child Welfare Committees and Village Child welfare committees. Marang will

collaborate with government in establishing CCCFs among its partner organizations. The CCCF will serve

as the "watch dogs" for OVC services at the community level. DSS will also collaborate with Marang in

holding National OVC forums. This will be an annual event bringing all NGOs/CBOs/FBOs and other

relevant stakeholders to share best practices and lessons learned in OVC programming.

Marang will facilitate improved monitoring of OVC services by supporting DSS in disseminating the OVC

data collection tools for reporting. Marang will take a lead role in coordinating and monitoring the activities

of community based organizations to ensure application of these tools.

By strengthening the policy implementation environment, Botswana can achieve greater impact in terms of

averting new infections, care for OVC, and meeting the treatment and care needs of people living with or

affected by HIV. OVC advocacy initiatives will be a key concern in the regions, such as child participation,

birth registration, education, inheritance, access to services and child abuse. Marang will contribute to the

reduction of stigma through advocacy. Outreach at key community events and special venues. These

activities will be done in conjunction with the Department of Social Services, UNICEF and Marang

members.

The DSS will continue to take a lead role in ensuring that there is capacity to implement OVC programs and

that they are adequately monitored and evaluated using the National M&E Framework for orphans and

vulnerable children. DSS will facilitate and ensure that there is documentation of best practices and lessons

learned from the overall PEPFAR supported OVC program.

08.T1110: MLG - ARV Support

To improve access to ARVs in line with the goal of "Universal Access" the MASA program focuses on

improving access to ARVs by expanding all the components of ART services to the satellite clinics, having

in the operation linkages between treatment and prevention and optimizing workload distribution and

service provision as key strategy. A critical element of this will include developing a full ART service

provision to the clinic level. In so doing, not only will access to the program be improved, but also other

critical related programs will be linked to MASA program and hence ensure the much needed service to

clients and patients. These programs are; Maternal and Child Health (MCH), Prevention of Mother to Child

Transmission (PMTCT) of HIV, TB, Sexually Transmitted Infections (STI), Palliative Care and Home Based

Care (HBC).

MLG has already rolled out ARVs to 30 facilities and is planning to rollout ARV to 50 facilities this year

2007/2008 to a cumulative of 80 facilities and to 128 in financial year 2008/2009. The national projection of

patients who will be on ART by the end of 2008, 2009 and 2010 is 92,500, 110,000 and 125,000

respectively.

Currently there are 14 facilities that are dispensing drugs on site and 19 on outreach.

To date, Eleven (11) drug storerooms were strengthened and or upgraded to be able to store ARV drugs.

Nine (9) of these facilities are dispensing on site and one on outreach.

In COP 6 the post of a public health specialist was filled and drug storerooms for 33 more facilities were

upgraded. 300 nurses were trained in drug management and dispensing to provide these services at the

sites. 34 facilities were targeted for strengthening of the drugs storerooms and increasing the working

space.

2008 plans

MLG will continue training nurses on dispensing ARVs to increase capacity. To ensure that facilities always

have nurses who can dispense, this training will increase the number of nurses who have been trained on

dispensing to 500. There will be 3 sessions of trainings for nurses on drugs dispensing.

The MLG will use funds to renovate one old building and convert it into district/regional ARV drugs

warehouse where drugs from Central Medical Stores will be stored before being distributed to the facilities.

Having district drug warehouses in all districts will improve the supply chain management to ensure that

drugs are always in stock, there is proper drugs management system in place, proper accounting of drugs

in the districts, there is safety of the drugs and ultimately their distribution resulting in improved access.

Pharmacists will manage these district/regional warehouses. Support and training for the pharmacists will

come from SCMS.

MLG's Department of Primary Health Care has the responsibility of coordinating the ARV rollout to the

clinics. MLG will hire 2 Regional ARV Coordinators for the northern and southern parts of the country

funded by PEPFAR. The 2 Regional ARV Coordinators will be responsible for monitoring the projects

implementation through frequent visits to the districts facilities where rollout will be implemented. They will

closely supervise the strengthening of the infrastructure, monitoring of the funds in the districts by making

sure that accounts are in order and payments are made speedily. With the increase in number of health

facilities that are dispensing from 30 to 80 to 128 in 2006/2007, 2007/2008 and 2008/2009 respectively, the

two coordinators will closely oversee the whole process of the rollout, give necessary assistance to the

districts and through the national coordinator make provisions for the needs that might arise. The two (2)

regional coordinators will work hand in hand with the District HIV/AIDS Coordinators (DAC) to increases the

uptake of MASA program in the health facilities. The 2 coordinators will be hired as project posts and will be

taken over by GOB after 3 years.

The Public Health Specialist, who is in place, will direct the overall coordination of the rollout of ARV to the

clinics in collaboration with the Ministry of Health. He will also provide guidance to the District Health Teams

on issues of rollout of ARV to the clinics; where applicable facilitate training to personnel of Local Authorities

on ARV rollout and provide technical support to DHTs on ARV program.

08.X1307: MLG - Support for monitoring & evaluation in districts

In an effort to continue building its capacity to provide strategic information on HIV prevention and care and

to improve HIV/AIDS and other health data quality MLG's Department of Public Health Care and Services,

formerly the AIDS Coordination Unit, requests financial support for the salary of two Senior M&E officers at

headquarters in Gaborone and for 44 Information Management officers (IMOs) placed in the districts (DHT

and DAC).

The overall objective of these activities is to increase MLG's M&E capacity to monitor the HIV response at

the district and central levels. This will be translated into improving the national level M&E coordination,

district reporting, strengthening and streamlining of data flow systems, and supporting overall efforts to

improve the quality of HIV care.

IMOs.

Twenty of these positions will be at the DAC Offices working with NACA and 24 positions will be with the

DHTs. The recruitment process is about to complete and these officers are expected to be on board by

September 2008. Technical assistance in mentoring these officers will be provided by I-TECH. The later will

work closely with MLG in providing job orientation, mentoring and supervision, technical assistance and

administrative support as well as developing the plan to integrate these new staff members into government

service over time.

Senior M&E officers.

The staff has been hired and is currently posted at the MLG headquarters. Together with the head of the

head M&E Unit in the Department of Public Health Care and Services, they will supervise and support the

IMOs placed at the DHTs and DACs. These officers will work hand in hand with the I-TECH mentors to

acquire necessary skills in supporting the IMOs at both DACs and DHTs. They will ensure the quality of

data from the districts and the timeliness of reports to the central level.

08-X1403: MLG - Community Capacity Enhancement Program

As part of the multi-sectoral response to HIV in Botswana, Government seeks to empower Batswana to

actively participate in HIV prevention and care in their own lives and their communities. To address this

objective, MLG with technical support from the United Nations Development Program (UNDP), has adopted

a participatory methodology for engaging communities in the fight against HIV/AIDS that has shown to be

effective in the African context. In 2004, five districts were selected to begin implementation of the

Community Capacity Enhancement Program (CCEP) using the "community conversations" method. This

methodology seeks to build on the capacity of individuals and communities to facilitate local responses to

HIV/AIDS in the areas prevention, care, treatment and support, stigma reduction and addressing gender

inequities. Specifically, the program is designed to explore community perspectives concerning how to live

with, and respect, PLWHAs and their involvement in community responses to the epidemic; strengthen the

capacity of individuals and organizations to facilitate local community responses to HIV/AIDS that integrate

care with prevention, keeping in mind other priority concerns such as coping strategies, orphans and

vulnerable children, health and development, etc.; sustain local action by increasing the capacity to care,

change and find hope within and among individuals, families and the community; strengthen individual and

organizational reflection on their approach and ways of working with communities and; facilitate the transfer

of lessons learned and change among individuals, from organization to organization and from community to

community.

This program uses trained volunteer facilitators to engage their own communities in a process to discuss

and identify local HIV-related issues and community solutions. Fifteen (15) national United Nations

Volunteers (UNVs) are in place in the districts to lead and facilitate this program. A program officer, housed

at MLG and supported by PEPFAR, is responsible for overall implementation.

In 2007, the stigma reduction component of the program is being intensified with technical assistance from

NASTAD. This element will specifically address HIV/AIDS stigma, support to PLWHAs and treatment

adherence in conversations and community-initiated action plans.

To date, the UNDP CCEP Facilitator Training Manual has been adapted to the Botswana context, trainers

have been trained in 24 of the 27 districts, community facilitators have been trained in 11 districts and

community conversations are ongoing in 11 communities.

2007 Achievements:

Trained 28 trainers in 8 districts; trained 39 facilitators in 2 districts; hired CCEP project officer/manager for

headquarters.

2008 Plans:

Achieve national coverage by training 20 trainers from four remaining target districts; train 24 facilitators in

four remaining districts; train 95 additional facilitators in other districts.