Building upon the strong national health infrastructure, the Government of Botswana (GOB) has initiated and sustained a multilevel, multi-sector response to HIV/AIDS.

The National HIV/AIDS response is embodied in the National Strategic Framework and involves several governmental bodies. These include the Ministry of Health (MOH), the Ministry of State President (which houses the National AIDS Coordinating Agency), Ministry of Local Government (MLG) and Ministry of Education (MOE).

Major Activities: The GOB supports national programs for prevention, care and treatment including behavior change communication, HIV-testing services, Prevention of Mother to Child Transmission services, Orphans & Vulnerable Children, opportunistic infections, sexually transmitted diseases, ARV treatment and services. The GOB supports surveillance, blood safety, and monitoring and evaluation (M&E) programs. Linkages between PMTCT and Family planning are also emphasized. The GHI principles of capacity building through training, mentorship and support are also incorporated in these projects. Funding in FY 2012 will be given to the implementation of activities in the laboratory strategic plan identified as priorities by PEPFAR for system strengthening. GOB through the MLG and NACA will also be working on initiatives geared at building the capacity of OVC service providers, particularly community service organizations (CSO) to improve service delivery as well as empowering families and communities to offer OVC care at community levels. Scaling up of e-registers, lay counselor training, palliative care and injection safety activities will also be carried out during FY2012 using pipeline funds.

The Care and Support program provides care and support services to people infected and affected by HIV/AIDS. The program encompasses a broad array of clinical, psychological, social, spiritual, and preventive care for adults. It includes palliative care, care for the caregivers, cervical cancer prevention, care and support for refugees, sexually transmitted infections, safe motherhood, opportunistic infections management, and community-based care.

The programs strategic goal is to scale up care and support services to adults with an emphasis on improving the coverage and the quality of care and support services through strengthening managerial and technical assistance as well as strengthening long-term capacity for comprehensive service delivery.

This includes building the capacity of both the government primary health care systems and civil society organizations. Currently the health care sector provides care and support both in institutions and at the community level. The care and support program ensures provision of integrated services to infected and affected individuals. The integrated services include psychological support services, HIV counseling and testing, pre-HAART monitoring, cotrimoxazole prophylaxis, sexually transmitted infections screening and treatment, cervical cancer screening and treatment, sexual and reproductive health, referrals and follow-up, and palliative care.

Support for the OVC program will focus on the following; 1) strengthening the coordination of OVC service providers at national, district and community levels as a matter of priority. Particular reference will be to build the capacity of the newly established District Child Protection Committees for operational efficiency as well as to facilitate for and to manage joint effort on OVC, care and support. This is expected to minimize waste emanating from duplication of services to the same clientele; 2) activities geared at empowering civil society organizations as well as families and communities to offer comprehensive, quality and sustainable care and support interventions to OVC in their localities. Emphasis will be on community responses to enhance ownership, not just over dependence on government driven OVC interventions through welfare support. Activities will include training communities to be able to identify OVC at risk and provide assistance as well as referral to and link them with available service providers in their areas; 3) economic strengthening to most vulnerable families as a means to enhance their graduation from social welfare systems is a critical area of focus. In FY12, such families with be targeted with interventions to facilitate for their exit from welfare through economic empowerment initiatives in line with the Botswana drive to eradicate poverty. This will include activities geared towards food security in partnership with the Ministry of Agriculture These initiatives will also target families of and OVC under institutional care to prepare them for re-integration with the rest of the world; 4) enhancement of alternative care for OVC, particularly through adoption and foster care. Adoption Act of 1952 is in the process of being reviewed as it is no longer coherent with the current challenges. Foster care program needs to be resuscitated. The country has few over flowing OVC institutional care facilities whose maintenance is very costly as proven by recent studies, therefore adoption and foster care are healthier and affordable alternatives. Support will cover the review of the Adoption Act as well as Foster care interventions; 5) improvement of M&E systems through database development and piloting in 2012. Stakeholders and users will be trained and there will be a mid-year pilot review. All of these efforts will be supported by the design and production of appropriate IEC materials and publications for maximum reach and timely responses; 6) improving coverage of malnourished children as well as strengthen institutional capacity in other districts; 7) training of health workers, NGOs and community-based organizations caring for OVCs in order to improve care of OVCs and referrals of malnourished children; 8) a bench marking trip to Malawi to learn how the Positive Deviance/ Hearth approach is implemented to empower communities to address childhood malnutrition; and 8) procuring therapeutic supplementary food used for treatment of acute malnutrition in children.

TB/HIV FY 2012 funds will support collaborative activities designed to integrate clinical management, treatment and strategic information for both the Botswana National TB Program (BNTP) and the Department of HIV/AIDS Prevention and Control (DHAPC). Specifically, the budget provides salary support for all of the existing program personnel who are positioned within the DHAPC. Funds for laptops are needed for use by officers as they travel to districts on support visits as well as during trainings. Other related equipment is needed for day to day office operations.

As part of a new TB/HIV integrated approach, revision of current isoniazid preventive therapy (IPT) policy and clinical guidelines will require printing, training seminars, and improved clinical monitoring. Information, education and communication (IEC) materials will also be developed. Twice yearly meetings of TB coordinators provide for monitoring and evaluation of TB/HIV activities by the central level staff as well as mentoring of the district staff. Patient and heath care worker education will also be emphasized. Improved TB/HIV collaborative activities will need proper documentation to demonstrate best practices. This will be achieved through the development of the TB/HIV collaborative website, which in turn will allow routine program monitoring to be shared across sites and districts. Results from operational research will be shared in local and international scientific meetings, hence the budget for international travel for BNTP and DHAPC staff.

The Care and Support program provides care and support services to children infected and affected by HIV/AIDS. The program encompasses a broad array of clinical, psychological, social, spiritual, and preventive care. Infant and child mortality in Botswana continues to be dramatically affected by the HIV epidemic, and HIV continues to contribute to an alarmingly high proportion of deaths of children younger than five years old, more than 50% by some estimates. Child mortality for younger than five years old is high at 120 per 1,000. Reasons for this high infant and child mortality are unclear and may relate to intrauterine HIV infection, HIV drug exposure, formula use, or other factors related to the HIV epidemic.

The programs strategic goal is to scale up care and support services to children and adolescents with an emphasis on improving the coverage and the quality of care and support services through strengthening managerial and technical assistance as well as strengthening long-term capacity for comprehensive service delivery.

This includes building the capacity of both the government primary health care systems and civil society organizations. Currently the health care sector provides care and support both in institutions and at the community level. The care and support program ensures provision of integrated services to infected and affected individuals. The integrated services include psychological support services, HIV counseling and testing, pre-HAART monitoring, cotrimoxazole prophylaxis, referrals and follow-up, and palliative Care.

The MASA Expert patient project supported by PEPFAR at the national level has been established to identify and refer children who need testing to health facilities; follow-up on children from PMTCT and under 5 clinics who need care and refer them to the point of service sites for anti-retroviral therapy (ART); and provide psychosocial support and appropriate referrals as needed.

Since FY 2006, PEPFAR has supported improvement of laboratory infrastructure and quality assurance in the country. To date three public health laboratories have been accredited by the South African National Accreditation System (SANAS) to the ISO 15189 Standard. A Laboratory Information System has been piloted at four sites and is now being rolled out to ten additional laboratories. The Laboratory Service has developed a 5-year National Laboratory Strategic Plan (2009 2014) that spells out the objectives and activities that the ministry wants to engage in to improve laboratories in the country. Funding in FY 2012 will be given to the implementation of activities in the laboratory strategic plan identified as priorities by PEPFAR for system strengthening . FY 2012 funding will continue supporting the laboratory services in the following areas :

1. In the MOH, we will a) support salaries of staff at the National TB Reference Laboratory and Nyangabgwe Hospital Laboratory; b) continue the implementation of the Strengthening Laboratory Management Towards Accreditation (SLMTA) training package by conducting support visits to laboratories; c) support the National Quality Assurance scheme through procurement of External Quality Assurance panels and strengthening of accredited laboratories and those enrolled in the accreditation process; d) improve laboratory space to meet the ISO standard; e) roll out the new rapid HIV test training manual and implement the post marketing of rapid diagnostic test strategy developed by CDC in Botswana.

2. Botswana Bureau of Standards (BOBS) will continue working with four district laboratories to get them accredited. Four new laboratories will be added to BOBS portfolio this fiscal year to take them through the whole Quality Management System (QMS) process. Funding will also be used to enroll ten laboratories through the Strengthening Laboratory Management Towards Accreditation (SLMTA) process. BOBS will continue to train MOH personnel in the Understanding of ISO 15189:2007, documentation, and auditing. Funding will also support calibration of equipment at the chosen laboratories.

3. Funding will be used to support the University of Botswana Medical Laboratory Science Department to support training of laboratory scientists. Two lecturers will be trained in problem based learning and flow cytometry. Ffunding will be used to support training of clinical lab preceptors at different clinical laboratories where students do their internships to strengthen the clinical laboratory experiential learning of the students. Funding will also be used to develop Continuing Medical Education in the fields of biostatistics and method validation.

Ministry of Health: DHAPC/NHL: PEPFAR supported HIV sentinel surveillance among pregnant women at antenatal clinics (ANC sentinel surveillance) in collaboration with the Division of HIV/AIDS Prevention and Care since 2006. A 2011 PEPFAR funded study showed that the HIV prevalence data are comparable when using ANC sentinel surveillance or PMTCT program registers. COP12 funding will be used to strengthen routine surveillance using PMTCT clinic data that will be obtained by scanning PMTCT registers and routine HIV testing registers. In future years, these data will be captured using electronic registers at hospitals and clinics. PEPFAR support will also be used to support the development of a routine specimen collection and testing system at the National Health Laboratory to replace ANC surveillance ($280,000).

DHPDME : The objectives of Leadership Capacity Building at Department of Health Policy Development, Monitoring and Evaluation (DHPDME) are to strengthen the national network of M&E officers in health districts, improve accuracy and timeliness of national morbidity and mortality statistics, develop and implement national data quality assurance standards and tools, promote operations research using existing program data, and support the use of the existing District Health Information System (DHIS) for national reporting of all health indicators. The Department is new but has a broad mandate to coordinate health data reporting and use and to harmonize health information systems across the Ministry of Health. ($500,000)

Ministry of Education: PEPFAR will continue to support the biannual Botswana Youth Risk Behavioral Surveillance Survey (BYRBSS) with the Ministry of Education and Skills Development. The BYRBSS collects data on both HIV and non-HIV related risk factors among students aged 10-19 years enrolled in Botswana school. Increased funding will be used to introduce biomarker collection and voluntary HIV counseling and testing for students and staff. ($500,000)

NACA: PEPFAR funding will be used to expand the scope of the 2012 Botswana AIDS Impact Survey (BAIS). The activities include revising the survey questions, supporting and expanding laboratory testing (incidence and resistance), ensuring return of rapid HIV test results and post-test counseling to participants, and electronic data capture of survey responses using hand held computers or digital tablets. ($1,000,000 pipeline)

PEPFAR will continue to support the Advanced M&E training project to design and implement a masters level curriculum for monitoring and evaluation as part of the epidemiology/statistics curriculum at the new School of Public Health at the University of Botswana. The target for this program includes physicians and nurses in preservice training and the existing cadre of 48 information management officers (IMOs) in the districts that were trained and deployed by PEPFAR support during the last four years. ($100,000). Since 2007, PEPFAR has supported Basic M&E training for HIV program officers through the Institute of Development Management (IDM) in Botswana. In COP11, there were 119 students who successfully completed the training. NACA will assume responsibility for the program after COP12. ($100,000)

MLG: PEPFAR will support one position at the Ministry of Local Government to coordinate the 24 recently absorbed M&E Officers at the District AIDS Coordinator Offices. This position will be absorbed in 2013. ($35,000)

In April 2010, Botswana- Ministry of Health (MOH) underwent a major transformation where Primary Health Care relocated to MOH; this was not properly implemented and resulted in unclear organizational structures and systems in District Health Management Teams operations. This also affected the corporate functions because some of the functions have been decentralized to DHMT. The country spends a considerable amount of resources on health but effective funds allocation and use is questionable, this is related to weak health financing systems, weak public health expenditure reviews and lack of regular health sector costing. Quality Management Systems is lacking, which contribute negatively to the health outcomes. There is inadequate skilled health workforce and high staff turnover in the Public Health Sector; this is linked to unfair and poor management practices. The Government of Botswana receives PEPFAR funds and it is imperative to have well established financial management systems that will ensure proper maintenance of expenditure tracking and internal audits. The COP 12 funds will assist MOH to embark on the process of decentralizing functions and building capacity of the DHMT to deliver effective and efficient services to their communities through, a three year implementation plan for Integrated Health Service Plan, re-organization of health care delivery by strengthening DHMT within purview of MOH and re-organization of health delivery model by recommended levels of health care focusing on the EHSP. The funds will support initiation of reforms in health financing. The other support will be capacity building activities of the staff. DHMT will be trained on District Health Systems and MOH will be capacitated to manage change. PEPFAR will continue supporting the government in management of funds by engaging a consultant to assist in internal audits and paying the salary of an Administrative Officer.

The funds will be used to review Human Resources for Health management structures, establish Health Leadership Management Program and train Public Healthcare system leaders. Review of transfer policy will be funded to develop clear deployment and transfer guidelines. The funding will also include support of assessment of the workload for general administration and develop the staffing norms. There will also be support of salaries of faculty at University of Botswana and Health Training Institutions that are responsible for production of new Allied Health Care workers (Pharmacy and Laboratory). Quality Management Systems will be improved by strengthening Botswana Health Inspectorate (BHI). The focus will be on strategy development and implementation, development of Health Inspectorate public education resources, strengthening of HI to acquire membership for International Society for Quality in Health. Quality management trainings will also be offered that will include HealthQual training. The funds will continue supporting the salary of Community Capacity Enhancement Program Coordinator to strengthen capacity of Botswana Government and Community Based Organization to use Community Conversation to enhance delivery of HIV prevention interventions.

OHSS is linked to other functional areas and there is coordination of quality health services and training of new health care workers. Other public health programs benefit from the HIV funding support. PEPFAR works with other donors such ACHAP in leveraging of funds for HIV and TB.

In an effort to streamline Safe Male Circumcision (SMC) service delivery, the MOH will achieve the following six objectives in COP12: 1) Human resources- six doctors will continue to be supported through PEPFAR. In addition, three nursing positions have been converted to two program officers to support the SMC unit at MOH to support SMC service delivery and demand creation coordination at MOH; 2) Demand creation- Targeting in-and-out of school youth as well as the community at large in the 16 high volume districts. We also plan to continue using multi media mass media channels for demand creation; 3) Supplies- Procurement of SMC supplies for integrated service delivery sites; procurement of Early Infant Male Circumcision (EIMC) devices and general supplies; 4) Training- Targeted training and mentorship of SMC dedicated teams; the trainer of trainer (TOT) model will be used at integrated SMC sites; training of relevant health care providers on EIMC site preparation and piloting of EIMC; 5) Printing The adult SMC training curriculum is being revised in quarter 4 (FY 2011/12); printing of developed EIMC curriculum; 6) Early Infant Male Circumcision (EIMC)- While adult SMC is a priority, we plan to initiate implementation of the EIMC for sustainability of the programme. Coordination of the national SMC program continues to be supported by PEPFAR, including technical working group meetings, trainings, and dissemination of information and procedures.

The World Health Organization (WHO) estimates that about 5% of new HIV infections in developing and transitional countries are attributable to unsafe blood and unsafe injection practices and occupational exposure (WHO, 2008). Transfusion of unsafe blood remains the highest mode through which HIV and other infections can be transmitted if access to safe and adequate blood supply is limited. A situational analysis of the National Blood Transfusion Service conducted by Safe Blood for Africa Foundation in 2002 revealed that the service was collecting only 30% of units of blood required annually and the HIV prevalence in donated blood was standing at 9% with a total discard rate due to transfusion transmissible infections (HIV, Hepatitis B, Hepatitis C and syphilis) of 15%. The implementation of Blood Safety and Youth HIV prevention program with the funding of African Comprehensive HIV AIDS Partnership (ACHAP)from 2003 to 2005 and PEPFAR from 2004 to date provided infrastructure development, acquisition of additional equipment, hiring of staff, and technical assistance from Safe Blood for Africa Foundation. PEPFAR support of the GOB goal of improving the provision of a safe and adequate blood supply has yielded remarkable success through Blood Center construction and renovation, equipment procurement, policy and guidelines, and personnel provision. HIV and other transfusion transmissible infections (TTI) in discarded donated blood has dropped dramatically from 9.9% in 2004 to 2.5% in 2010. In addition, the supply of safe blood has increased from 13,000 donated units in 2004 to 20,000 units in 2010. The vision of the Blood Safety program is to fully graduate the PEPFAR-supported personnel positions by 2013, and improve blood supply adequacy by integrating blood donation activities with other HIV prevention programs. In 2012, PEPFAR and the Government Of Botswana (GOB) will engage in a process to implement a sustainability plan with the aim of reducing reliance of the Blood Safety program on external financial and technical resources. Key aspects of the graduation plan will include: ending PEPFAR funded positions by 2013, purchasing the last batch of critical equipment, strengthening hospital transfusion committees and sub-contracting Pledge 25 Club for donor recruitment. In addition, accreditation of NBTS to ensure continued quality, strengthening M&E and data management systems and integrating blood safety with other programs such as HIV counseling and testing and voluntary safe male circumcision.

The Botswana CDC Injection Safety Project (BCISP) is aimed at preventing medical transmission of HIV and bloodborne infection (viral hepatitis) in the Botswana healthcare settings. The project contributes towards the Botswana Partnership Framework of reducing new HIV infections by 50%.

The project has since 2011 scaled-up to all 29 health districts, starting with training of trainers, development and implementation of healthcare worker safety programs such as Hepatitis B guidelines and resuscitating the development of the Infection Prevention and Control policy and the associated monitoring and evaluation strategies, training staff on healthcare waste management. The activities will be implemented utilizing existing structures, in particular the District Health Management teams (DHMTs) and the key staff led by the national injection safety coordinator based at MoH headquarters employed with PEPFAR support. The main objective of the project is to strengthen the health system through the development of the national Infection Prevention and Control (IPC) Policy. The policy will guide the institutionalization and sustainability of the project interventions beyond the life project funded by the US Government. During this planning period the other measures aimed at strengthening of institutional resources such as training of Infection Prevention & Control Coordinators, continuous support of training through training of trainers (TOTs), implementation of injection safety guidelines, service norms and standards, promoting utilization and accessibility of post exposure prophylaxis of HIV and hepatitis B, as well as provision of hepatitis B vaccination. The project will promote the sustained strategy by having project staff within MoH and the district management teams to lead implementation of the project. The project will continue the integration and promoting of safety concepts into the teaching curricula of Institute of Health Science. The MOH will utilize the project in the implementation of a health information system database that will be used to capture monthly data on occupational injuries, post exposure prophylaxis (PEP) usage, hepatitis B vaccination coverage to promote evidence based decision making as a benchmark and implementation improvement. Measure of progress towards targets will be reviewed every quarter and through continuous supervisory monitoring of the project interventions. Monitoring will be combined with technical assistance from JSI which will be aimed at improving quality assurance and services.During COP12, PEPFAR will fund three positions at MOH in the Division of Environmental and Occupational Health, implementation of the Infection Prevention and Control policy and project monitoring in all the 29 health districts.

Ministry of Education and Skills Development implements a curriculum based life skills project, called "Living," targeting learners from primary level to junior 6-13, secondary level 13-16, senior secondary 17-18 years. The project comprises of reproducing life skills curriculum, learners worksheets, Teachers guides, and a monitoring plan. Topics are divided into target age groups such that Primary school materials focuses on abstinence and delayed sexual debut, while Junior and Senior Secondary School curricula include male and female adolescents who are sexually active. In addition to the Life skills Curricula, the Ministry of Education runs a Television program in which 25 out-off-school youth will participate to dialogue with 25 secondary school Peer Educators who will be trained as mentors for the 10 regions. They will mentor both learners and teachers with skills that help them to reduce the risk of HIV key drivers such as Multiple Concurrent Partnerships; Adolescent and Intergenerational Sex; Alcohol and Drug Abuse; Stigma and Discrimination and Gender-based Violence and Sexual Abuse. This project targets both boys and girls equally. Peer Education is a joint effort between MOE and Education Development Center (EDC) another CDC partner. $15,000 for AB

Through PEPFAR support, the Counseling and Testing Program of MOH provides coordination, monitoring; technical support and guidance to all HIV testing and counseling (HTC) service providers nationwide, with the goal of expanding access to quality services. Although the program targets the general population, specific targeted groups for COP 12 comprise men, couples, youth and other groups in hard to reach areas including high risk groups. In order to expand accessibility of HTC services; support Safe Male Circumcision (SMC) scale up and increase proportion of people who know tale their HIV status, COP 12 funds will largely support building capacity and providing support to Health Care workers (HCW) to provide HTC services. Activities supported will include the training of HCW at integrated SMC sites to provide Routine HIV Testing (RHT); Couple HIV Counseling and Testing, and the roll out of the Counselor Supervision program. The Counselor Supervision Program will be rolled out in both government and civil society settings.COP 12 funds will also support the consolidation of ongoing activities. In this regard, quality assurance and Monitoring and Evaluation activities will be prioritized. Activities will include HCW support and mentoring visits; dissemination and operationalization of HTC guidelines and standards; dissemination of HTC registers; orientation of HCW on the new HTC registers and the development of User manuals for the register. Funds will also be used to support a single position at the counseling and testing unit to strengthen their capacity to implement activities and provide technical oversight to the national HTC program. This will also build their capacity to take over implementation and monitoring of the RHT improvement project that University Research Company (URC) is currently implementing once URC cooperative agreement expires in 2013. Following the evaluation of alternative rapid HIV test kits, the national rapid test algorithm changed slightly in 2010 with the addition of a new rapid HIV test kit. COP 12 funds will therefore support the retraining of providers on the new algorithm. Additional activities that will be supported include the strengthening and integration of Positive Health Dignity and Prevention (PHDP) services in HTC programs such as the provision of ongoing supportive counseling to PLWHIV. Funds will also support training of providers in 32 Infectious Disease Control Centres (IDCCs) to implement the minimum package of PHDP services onsite where HIV care and treatment services are regularly provided.

NACA: The project aims to support the Government of Botswana National AIDS Coordinating Agency (NACA) in the development and implementation of a strategic and multi-faceted HIV prevention communications campaign that links behavior change with prevention services. NACA will provide coordination and leadership and build capacity of national organizations and local authorities. NACA will partner with Population Services International (PSI) to implement the campaign in selected districts. The project will use strategies such as mass media communication, key stakeholder sensitization, media advocacy and community-based interventions that aim to change societal norms and individual behaviors. Key activities that will be funded are training of program coordinators and health care workers at national and district level, design, develop and produce Information Education and Communication (IEC)/ Behavior Change Communication (BCC) materials, conduct advocacy workshops with community leadership in the districts, coordinate the implementation of interpersonal communication, work within workplace establishments and other small group interventions in selected districts, establish a National Clearing House project that will review and approve all IEC/BCC materials as well as linking the campaigns to Botswana HIV Response Management Information Systems (BHRIMS).

The Ministry of Education and Skills Development will conduct two day training workshop in for four new senior secondary schools reaching approximately 200 teachers aged 2260 per school. These teachers will use teacher guides and life skills curriculum to reach learners aged 6-18 years old. The project will also be introduced in Teacher Training Colleges, so that they do not only know about Life Skills when they are in classes. Another component of this project is to Link up Schools to the Tebelopele Voluntary Counseling and Testing Centers to allow for both teachers and student to test for HIV.

Ministry of Health: PHDP With the Positive Health Dignity and Prevention (PHDP) strategic and implementation plans developed with previous COP funds, prior year pipeline funds will largely support the roll out of the implementation plan. Activities supported will include capacity building efforts in different sectors through training of providers; review of policies and guidelines; implementation of the minimum PDHP package; mentoring and support visits; development of counseling protocols; educational materials; piloting implementation of PHDP activities in six districts; and a position of a coordinator to drive implementation of PHDP interventions.

Civil Society Organizations (CSO) will be supported to work closely with government health facilities to strengthen referral linkages and provision of post -test support services. Sites will be strengthened to put systems in place to ensure that HIV positive people are linked to the National ARV program; regularly screened for STI as part of prevention; provided with ongoing support including family planning counseling; provided with condoms and referral for cervical cancer screening for HIV positive women.

The activities under this cooperative agreement include building the capacity of the MOH to address all issues pertaining to the prevention of mother to child transmission of HIV (PMTCT). Although the Botswana PMTCT program has done relatively well in terms of preventing vertical transmission, other aspects of the program are still lagging behind. In particular, rates of unintended pregnancies in HIV infected women remain high and adoption of safe infant feeding practices remains problematic. Strengthening of these other prongs of PMTCT will ensure greater HIV- free survival of children and improved health outcomes for infected women. CDC support to the Ministry of Health for PMTCT related activities for COP2012 will be directed at the PMTCT, Sexual Reproductive Health (SRH) and Infant Nutrition Units.

The Infant Nutrition Program continues to promote and support optimal infant and young child feeding (IYCF) practices. IYCF practices in Botswana remain unsatisfactory and more efforts are needed to build capacity of health personnel to strengthen child growth monitoring and promotion (CGMP) and nutritional surveillance. This will include, in part, development and dissemination of appropriate IEC materials such as the CGMP training manual for health workers and other educational materials on complementary feeding.

Health workers (HW) will also need mentoring on the management of acute, severe malnutrition that continues to be a challenge in the country. PEPFAR support in FY 2012 will focus on training of HW on community based management of acute malnutrition (CMAM), development and reviewing training materials to align them with the WHO guidelines and procurement of CMAM and inpatient therapeutic products. HW will also be trained on the Baby-Mother Friendly Hospital Initiative Counseling Course focused on improving infant feeding practices in the context of HIV/AIDS.

Funding for the PMTCT unit will focus on training HW on updated PMTCT guidelines. Botswana is currently scaling up to provide triple prophylaxis (Option B of the new WHO guidelines) for all its pregnant HIV infected women. Update trainings are an essential element as through them, the PMTCT program is able to not only inform HW on the latest information, but also to keep contact with health providers, share experiences, discuss implementation challenges and successes and together map a way forward for improving the quality of PMTCT program.

The SRH needs of HIV infected people have remained neglected since the onset of the epidemic. In order to better address this gap, SRH and HIV services need to be better integrated, and HW need to be empowered to be able to tackle the SRH needs of PLWHA. PEPFAR support for the SRH Unit will go towards revision and printing of the Family Planning procedures manual, register and client card. Some funding will also go towards update trainings of HW on family planning issues with a renewed focus on the HIV infected population. The unit is also in the process of recruiting one SRH Training coordinator whose mandate will be to coordinate trainings at the district level and build capacity in the MOH. This position is funded in FY2012.

These areas of support are in keeping with PEPFARs strategies to improve the effectiveness of PMTCT and related programs. Linkages between PMTCT and Family planning are also emphasized. The GHI principles of capacity building through training, mentorship and support are also incorporated in these projects.

Central Medical Stores is the Government of Botswana's procurement and distribution organisation for health sector commodities. CMS' goal is to support the HIV/AIDS programme by ensuring that commodities are available at all times for prevention, diagnosis and treatment activities. MOH ARV clinic upgrade activities. Botswana, a country with a population of more than 1.8 million people, is one of the countries with the highest HIV prevalence in the world.

ARV therapy was introduced in the country in 2002 and since then more than 32 hospitals and 200 clinics and health posts are now dispensing ARVs.

According to July report, more than 70,000 patients out of 140,000 were on ARV treatment in the clinics and health posts. This shows that with time more patients will be accessing treatment in facilities close to their homes.

According to NDP 9, Ministry of Health is planning to roll out ARV services to all clinics in the country which are more than 286. This is expected to ease movement of patients from one place to the other in search of services as integrated approach to provision of care is being envisaged.

Context

There has been an increase in number of people who are accessing ARV services in the clinics. This is going according to MOH plan of decongesting the hospitals and while strengthening provision of ART services in the clinics.

On economic terms, more people are expected to access treatment in their areas hence reducing the cost incurred when seeking services in areas far from their villages. Again it is expected that there will be a reduction in patients who are defaulting as services will be close to these patients and clinics will be able to follow them.

Clinics upgrade is important as it allows patients to source ARV services from facilities in their areas. Ministry of Health is currently working on relieving hospitals from running IDCCs and this has put a strain on the current clinics and health posts. It is therefore important that these facilities are strengthened, increase working space and also have nurses who can be able to prescribe and dispense. Networking of facilities will improve communication and flow of data from and between facilities and thus improve on the type of data that is generated.

The Ministry of Health (MOH) subcontracts with Airborne Lifeline to transport HIV/AIDS specialists from Princess Marina Hospital in Gaborone and Nyangagbwe Referral Hospital in Francistown to remote sites in Botswana on a scheduled basis. During site visits medical professionals, mainly from Baylor and the University of Pennsylvania, treat patients (approximately 450 per month) and train other health care providers. Airborne Lifeline also transports anti-retroviral (ARV) drugs, medical equipment, and other commodities to these remote clinics in a secure and timely manner. Laboratory specimens such as CD4 samples can be transported back to central laboratories on the return flights.

Airborne Lifeline began flight operations in Botswana in May 2007 and received its first PEPFAR grant in April 2008. Airborne Lifeline currently flies to nine sites: Hukuntsi, Tsabong, Ghanzi, Gumare, Kasane, Maun, Saronga, Kang, and Shakawe.

Given the proposed FY 2012 reduction of 40% in Airbornes PEPFAR funding, the MOH will be consulted as to whether to eliminate service to certain locations, utilize smaller/slower aircraft, or eliminate cargo shipments.