The Ministry for the Fight Against AIDS (MLS) was created in 2001 to serve as the executive secretariat of

the National AIDS Council, the principal governmental policymaking and strategic-planning body for

HIV/AIDS in Cote d'Ivoire. The creation of the MLS was a key strategy in building effective national-level

coordination, as mandated in the National HIV/AIDS Strategic Plan. The mission of the MLS is to coordinate

a comprehensive and effective multi-sectoral and decentralized national response to HIV/AIDS, and the

ministry thus plays a central role in bringing together stakeholders to define national policy and strategies

for the care, treatment, and prevention of HIV/AIDS.

Since 2004, PEPFAR has provided assistance to the MLS to support the development of an information

technology infrastructure, the human capacity to utilize and maintain it, and the development and

implementation of a national monitoring and evaluation (M&E) system. Significant results of this

collaboration include:

• Creation, validation, and production of the 2006-2010 National HIV/AIDS Strategic Plan.

• Coordination of the 2005 National AIDS Indicator Survey (AIS).

• Creation and validation of the 2006-2010 National Monitoring and Evaluation Plan, which will guide

monitoring of all activities undertaken within the National Strategic Plan.

• Procurement of essential information technology infrastructure to strengthen M&E units at the central and

regional levels.

• Harmonization of community-level indicators.

• Creation of M&E training modules for the community level.

• Training of focal points on the utilization of M&E tools.

• Continued capacity building of the central-level M&E unit within the MLS.

• Evaluation of the 2006-2010 National Strategic Plan.

With FY08 funds, the MLS is supporting coordination and M&E of the national response to HIV/AIDS.

Behavior-change communication activities, an important component of the National Strategic Plan for which

the MLS received funding in previous years, are being executed in FY08 by other implementing partners

(ANADER, JHU/CCP, Care International, PSI, FHI, and others). The MLS is implementing the national

M&E plan and is building the capacity of M&E units of other ministries through:

• Identification of cross-sectoral M&E training needs of all institutions involved in HIV/AIDS data collection.

• Collaboration with other ministries, the private sector, and community partners to identify structures and

define mechanisms outside the MLS to collect HIV/AIDS data and send it to the central level.

• Elaboration, validation, and dissemination of the 2008 National HIV/AIDS Report.

• Implementation of a population-based survey in collaboration with the Ministry of Health (MOH) and Projet

Retro-CI.

• Strong performance in its role as the national, central source of HIV/AIDS information, including:

- Supporting the creation of a national data repository, in collaboration with other ministries, to store and

manage information. In this process, the MLS has contributed to the standardization of indicators and data-

collection tools and creation of a data confidentiality policy.

- Disseminating HIV/AIDS data/information through:

- Rehabilitation of a national HIV documentation center.

a. Production of information materials for dissemination

b. Organization of two information-dissemination workshops

c. Redesign of the MLS Web site, with particular focus on ease of use and the provision of up-to-date

national HIV/AIDS statistics, reports, and links to key international HIV/AIDS documents, guidelines, and

other data.

• Organization of four quarterly meetings of the national strategic information working group.

As highlighted in the process of creating the 2006-2010 National HIV/AIDS Strategic Plan, there is a notable

weakness in the central coordination of HIV/AIDS interventions throughout the country, as well as an

absence of a functional M&E system. The most important weakness of the routine system of information

management resides in the transmission of data from the peripheral level to the central one. In 2006, only

136 organizations out of 354 provided "non-health data" to the MLS M&E unit (DPSE). In the health sector,

223 of 2,631 health centers reported to the MOH M&E unit (DIPE). There is also a lack of coordination for

studies and investigations related to HIV conducted at national level. Sectoral databases are not integrated.

Human and material resources are insufficient. Supervision of M&E activities nationwide is irregular. These

weaknesses contribute to the MLS' difficulty in producing a regular consensual national report on the fight

against HIV/AIDS.

In FY09, the MLS will complete some activities initiated with FY08 funding, notably the installation of

databases in five regions and capacity building for sectoral and decentralized personnel involved in data

collection, along with supporting a socio-behavioral and prevalence survey.

The MLS will use FY09 funds to continue:

1. Development of partnerships to plan, coordinate, and manage the HIV M&E system in Cote d'Ivoire,

including revitalization of the national strategic information technical working group (TWG).

2. Development of national and sub-national HIV databases.

3. Supervision and data auditing by:

• Organizing four quarterly TWG meetings

• Integrating HIV-related databases of various ministries (Health; Family, Women, and Social Affairs;

Education, Interior, Defense)

• Reinforcing capacities of 40 data collection actors in key ministries and 19 regions of the country.

• Developing, validating, and disseminating a national 2009 report on the pandemic.

• Reinforcing capacities of the MLS M&E unit (DPSE) with annual Internet subscription and short-term

certified training.

• Using personal digital assistant (PDA) technology for routine data transmission from department level to

central level, with the support of SCMS

• Updating the MLS Web site with national HIV/AIDS statistics and reports

• Organizing an annual information workshop on HIV topics

• Rehabilitating five new regional HIV documentation centers

Activity Narrative: • Conducting an HIV/AIDS data quality audit

• Developing a national HIV/AIDS accounting study to quantify all 2009 expenditures on HIV/AIDS

• Finalize the DHS+ started with FY08 resources

• Supporting a socio-behavioral and prevalence survey among highly vulnerable populations as indicated

after a situational analysis (second-generation surveillance)

New/Continuing Activity: Continuing Activity

Continuing Activity: 15133

Continued Associated Activity Information

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

System ID System ID

15133 4555.08 HHS/Centers for Ministry of AIDS, 7055 5303.08 CoAg Ministry of $210,000

Disease Control & Côte d'Ivoire AIDS

Prevention #U62/CCU0243

13

10425 4555.07 HHS/Centers for Ministry of AIDS, 5303 5303.07 CoAg Ministry of $350,000

Disease Control & Côte d'Ivoire AIDS

Prevention #U62/CCU0243

13

4555 4555.06 HHS/Centers for Ministry of AIDS, 3377 78.06 Cooperative $250,000

Disease Control & Côte d'Ivoire Agreement with

Prevention Minisrty of AIDS

#U62/CCU0243

13

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $9,900,500

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Effective coordination, human resources, decentralization of services, workplace programs, and resource mobilization are key

challenges of the national multi-sector response to the HIV/AIDS epidemic in Cote d'Ivoire. The Ministry for the Fight Against

AIDS (MLS), in charge of overall coordination, is taking strong measures to improve its operational capacities, including the

creation of a National Technical Secretariat in charge of operational planning and coordination and of decentralized platforms for

technical support and data collection. The Ministry of Health (MOH), which leads the health-sector response (HIV testing, care,

treatment, drugs), is working to improve its planning, coordination, and monitoring and evaluation capacities, as well as to

strengthen its collaboration with other technical ministries whose contributions are critical for scaling up the national HIV/AIDS

response (Education (MEN), Family and Social Affairs (MFFAS) for OVC).

In FY08, PEFAR is providing funding to ministries and other partners to:

Strengthen Coordination and Implementation Capacity

The USG is helping to boost the government's planning, coordination, and policy-making capacities in support of the national

HIV/AIDS response, mainly by providing technical assistance to the Global Fund Country Coordinating Mechanism (CCM) and by

building the capacity of the MLS and MOH to plan and coordinate HIV/AIDS services at regional and district levels. The USG is

also helping to improve capacities of regional and district management and technical teams to plan, coordinate, and improve the

delivery of HIV/AIDS services, including integration of reproductive health and family planning in HIV services. Based on findings

from a 2007 service provision assessment, USG partners are assisting 19 health district teams to develop HIV/AIDS scale-up

plans to address specific local needs.

Build Human Capacity

An assessment of public-sector human resources for health (HRH) conducted in FY06 showed shortages and high attrition among

all cadres and identified gaps in critical skills sets. Following the development and validation of a national HRH strategy, the USG

is supporting the Ivoirian government's efforts to train and retain human resources needed for the delivery of quality HIV/AIDS

services. Efforts include matching of pre-service training with real-world skill needs; support for the reopening of nursing schools

in central and northern regions; continued development of pre-service and in-service training capacities through traditional

approaches (i.e. academic, on-site, etc.); and exploration of innovative ways to encourage and deliver continuing education using

information technology, print materials, and other accessible media.

Strengthen Management Capacities of the MOH Department of Human Resources (DRH)

The DRH, which is in charge of managing HRH for the HIV/AIDS response, is hampered by inadequate capacity to provide

sustained supervision and management of HR, weak HRH information systems, and limited infrastructure to perform day-to-day

HRH functions. PEPFAR is providing technical assistance to develop an action plan for strengthening the DRH's ability to

operationalize the HR Strategic Plan, including development of an information system capable of providing up-to-date HR data.

The Human Resource Information System (HRIS) will monitor human-resource needs to support the sustained delivery of quality

HIV/AIDS services to patients and keep track of all training activities.

Build Stronger Workplace Programs

Building on activities started in FY07, the USG is collaborating with other donors, UN System partners, and the Global Fund to

assist the MLS in strengthening collaboration platforms between the private and public sectors as a way to increase workplace

HIV initiatives. The USG is supporting MLS efforts to expand the number of sector HIV/AIDS committees that develop action plans

and implement workplace activities, including appropriate network linkages and referrals. The USG is also providing technical

support to the MLS to strengthen the coordination of workplace interventions, the documentation and dissemination of best

practices, the standardization of quality assurance (policy, norms, and procedures documents) and M&E tools, and the

implementation of regular participatory program reviews and supervision.

FY09 Priorities

With FY09 funding, PEPFAR will continue to support the government and civil society in their efforts to strengthen health systems

to maximize the impact of technical interventions. Key PEPFAR-funded activities will include:

1. Strengthening coordination of health and non-health sector interventions

PEPFAR will support government-wide efforts to improve data collection and information sharing to enable effective decision-

making and advocacy by stakeholders, including donors, international and bilateral partners, NGOs, and ministries. A training

program in health program management, M&E, and epidemiology will be developed in order to strengthen public capacity for

coordination and information management. The coordination role of the MLS will be reinforced at the central and regional levels

through improved planning and coordination capacities and tools. PEPFAR partners will also provide technical assistance to help

improve MLS coordination capacity and mobilize private-sector involvement in the HIV/AIDS response.

2. Supporting decentralization of the MOH

Since 2003, the Ivoirian government has pursued a policy of devolving responsibilities from the central government to local

government authorities. In this vein, management of health services became the responsibility of regional and local councils, with

MOH decentralized services maintaining responsibility for technical input. Implementing this approach has been a challenge

because of an inadequate understanding of roles and poor collaborative practices. As HIV services are scaled up, the capacity of

local and regional authorities to provide management and oversight of care and treatment programs will be essential.

PEPFAR will help address this challenge by supporting the decentralization unit of the MOH (SASED), which has developed a

three-pronged approach involving regional, district, and local health authorities. PEPFAR assistance in FY09 will include an

analysis of decentralization and the management of social services by decentralized entities; development of a collaboration

framework between the MOH and decentralized units; development of curricula to train MOH staff on the implications of

decentralization for priority health programs; and collaboration with 10 districts and two regions to develop costed health

development plans.

3. Reinforcing operational capacities of health districts

To prepare for scaling up HIV/AIDS services, the MOH has adopted a district approach for HIV interventions. In FY09, PEPFAR

will support the MOH in continuing this approach in order to strengthen the capacities of health districts as operational units for the

coordination and provision of comprehensive care and treatment activities. This coordination role of the health district includes

oversight of PEPFAR-funded interventions, to ensure that appropriate district officials are aware and involved in key strategic

choices and supervision of activities. Special emphasis will be placed on human resources, training, and planning.

Building on ongoing successes in the Abengourou health district in contributing to the rapid scale-up of ART, PMTCT, and CT

services, PEPFAR will help improve the operational capacity of 14 districts through increased participation of communities and

actors within the health care system. In the selected 14 districts, this approach will focus on improving the coordination of

HIV/AIDS services by the district health team, supporting refresher training for health care workers in HIV care, providing

laboratory equipment, ensuring the availability of consumables and lab reagents, donating vehicles (three per high-performing

district) for supervision, supporting the transportation of lab samples, conducting supervision visits and coaching of health care

workers, and reinforcing the management capacity of the district health team through national and international training courses.

4. Building human resources for health

In order to address the perpetual problem of insufficient health care personnel, which constitutes one of the major barriers to the

expansion of HIV care services, PEPFAR will provide financial and technical support to train 50 medical students in HIV, TB, and

malaria - the there major endemic diseases with the great morbidity and mortality - through theoretical coursework and a six-

month practicum in rural health care facilities; 50 social work students in pre- and post-test counseling, ART adherence education,

and psychosocial support for OVC; 25 pharmacy students in drug and lab-reagent supply-chain management and logistics; and

25 new midwives in PMTCT.

PEPFAR funding will also support the reinforcement of human and institutional capacity at the national health-care worker training

institute (INFAS) and medical school to increase the number of trained nurses, laboratory technicians, and physicians. PEPFAR

support will include salary payment to 35 instructors at INFAS, strengthening of the reference library at INFAS, a pilot incentive

scheme for health workers in hard-to-fill posts, and technical assistance to improve human-resources management.

To help the MOH manage human resources for health, PEPFAR provided funding in FY08 to establish a human resource

information system (HRIS). With FY09 funding, this system will be extended to three health districts and five health regions.

Support will include provision of basic information and communication technology infrastructure and training for users in the

development of information products and the use of data for workforce planning, budgeting, and performance management. The

record-archiving system at DRH will also be improved through minor rehabilitation, identification of storage space, and new IT

infrastructure and software.

5. Workplace programs

FY07 and FY08 activities will continue to support the MLS in strengthening collaboration platforms between the private and public

sectors as a way to increase workplace HIV initiatives. especially in the cocoa sector and among women's cooperatives involved

in food-crop production and marketing.

6. Building local capacity

Since FY07, the USG has supported a capacity-building initiative that awards performance-based funding to local organizations.

Given the success of this pilot experience led by EGPAF, which provides performance-based sub-grants to private and faith-

based health facilities, PEPFAR will support the extension of this approach to two health districts in FY09. These activities will be

implemented in close collaboration with the relevant ministries (MOH and MLS) and other partners. Results will be shared with

other health-sector partners with the expectation that this method could be scaled up nationally.

USG assistance will also support technical assistance for the integration of HIV and reproductive health/family-planning activities,

in collaboration with an organization of HIV-positive women and a family-planning association, within the limit of OGAC guidance.

PEPFAR funding will help provide technical assistance to several local organizations to help address cross-cutting organizational

(managerial, programmatic, financial, and accounting) challenges. In FY08, PEPFAR awarded funds to an AIDSTAR technical-

assistance partner to provide needed capacity-development assistance and training to help improve the performance and

competitiveness of local organizations. This effort will be pursued in FY09. Key beneficiaries of this assistance will include the

Alliance Nationale Contre le VIH/SIDA (a national umbrella NGO that manages sub-grants and provides technical assistance to

small community-based organizations) and several of its current or former subpartners.

7. Technical assistance to the CCM

PEPFAR funding will be used to build the capacity of the Global Fund Country Coordinating Mechanism in the areas of proposal

development, leadership and management, M&E, and resource mobilization. Strengthening the CCM in these areas will help

create a more stable, transparent, and efficiently run CCM, capable of winning Global Fund proposals and thus increasing funding

for HIV/AIDS in Cote d'Ivoire. One key innovation during FY09 will be the development and packaging of a virtual program on

CCM governance using a combination of CD-ROM, Web-based tools, and a facilitator guide for face-to-face trainings on

governance and transparency. This will give the CCM a reusable tool to train and orient new members to the CCM's

responsibilities and areas of accountability.

All USG-funded partners will report quarterly program results and other requested data to the PEPFAR strategic information team.

To help build and strengthen a unified national M&E system, all partners will participate in quarterly SI meetings and will

implement decisions taken during these meetings.

Table 3.3.18:

The Ministry for the Fight Against AIDS (MLS) was created in 2001 to serve as the executive secretariat of

the National AIDS Council, the principal governmental policy-making, strategic-planning, and coordination

body of the response to the HIV/AIDS pandemic in Côte d'Ivoire. Creation of the MLS was a key strategy in

building effective national-level coordination. The mission of the MLS is to coordinate a comprehensive and

effective multi-sector and decentralized national response to HIV/AIDS, and it thus plays a principal role in

bringing together stakeholders to define national policy and strategies for the care, treatment, and

prevention of HIV/AIDS in Côte d'Ivoire.

Since 2004, the USG has provided assistance to the MLS to support the development of an information

technology infrastructure and the human capacity to use and maintain it, the development and

implementation of a national monitoring and evaluation (M&E) system, and the development and

implementation of a national behavior change communication (BCC) strategy focused on abstinence and

fidelity. Significant results of this collaboration have been achieved, especially on a national level. The

creation, validation, production, and evaluation of the 2006-2010 National HIV/AIDS Strategic Plan were

completed. Subsequent successes have included coordination of the 2005 National AIDS Indicator Survey

(AIS); creation and validation of the 2006-2010 National Monitoring and Evaluation Plan, which will guide

monitoring of all activities undertaken within the National Strategic Plan; and procurement of essential

information technology infrastructure to strengthen M&E units at the central and regional levels. The

community level has seen significant advances with indicator harmonization, the creation of M&E training

modules, and the training of focal points on the utilization of M&E tools. Capacity building of the central-level

M&E unit within the MLS continues.

As was highlighted in the process of the creation of the 2006-2010 National HIV/AIDS Strategic Plan, there

is a notable weakness in the central coordination of HIV/AIDS interventions throughout the country. The

MLS is in the process of implementing a new organizational model, with a renewed focus on coordination as

opposed to actual delivery of HIV prevention, care, or treatment services and interventions. The USG is, in

turn, refocusing its efforts to build and reinforce the unique coordination role of the MLS to a) increase

communication among stakeholders, b) collect and disseminate essential HIV/AIDS data, and c) utilize this

data for effective national and international advocacy in the fight against HIV/AIDS in Côte d'Ivoire.

Policy and systems-strengthening activities with FY08 funding are focusing on building MLS capacities to

adequately fulfill its role as the key player in the national and sub-national coordination of all HIV/AIDS

activities. Activities are designed to increase information sharing and advocacy activities among

stakeholders, including donors, international and bilateral partners, NGOs, and ministries. These include:

• Organizing regular meetings of multilateral and bilateral donors to discuss new policy issues, challenges,

opportunities, etc. Meetings will bring together counterparts of similar levels of responsibility for

collaboration.

• Organizing regular meetings of implementing partners, including donors, foundations, United Nations

organizations, and NGOs, to discuss new policy issues, challenges, opportunities, etc.

• Organizing, in collaboration with other relevant ministries, quarterly meetings of technical working groups

(e.g. strategic information, gender and HIV, nutrition and HIV, CT, PMTCT, ABY, etc.) to facilitate the

sharing of best practices, the development of core competencies for training curricula, current research, and

challenges faced by the various governmental, NGO, and international partners involved in the fight against

HIV/AIDS.

• Identifying and procuring technical assistance to support the MLS in the areas of strategic information and

coordination.

• Organizing all obligatory meetings of governmental HIV/AIDS bodies, including the annual meeting of the

National Council for the Fight Against AIDS (CNLS) and the biannual Inter-Ministerial Committee for the

Fight Against AIDS (CIMLS).

• Mobilizing private-sector partners and resources for increased involvement in the fight against HIV/AIDS in

Côte d'Ivoire.

The institutional framework of the AIDS control M&E system is guided by the "three ones" principle of one

national M&E system. Effectively functioning M&E mechanisms may require changes in policy and/or

institutions. For example, few private companies implement HIV activities among staff and their relatives,

and few collect and/or provide data for the M&E system. The MLS will engage in advocacy needed to

increase the private sector's and civil society's involvement in the fight against HIV and capacity in M&E.

In addition, the MLS will work to produce and disseminate information related to the financing of HIV/AIDS

activities. The MLS' financial resource coordination department (DMRCF), which is involved in advocacy

and the development of financial tools, and the ministry's technical coordination office (STCO), which is in

charge of the follow-up of financial flows, must be reinforced. In order to reduce high turnover among MLS

staff, motivate the staff, and attract other civil servants to the MLS, the ministry will develop an international

training program in health program management, M&E, and epidemiology. This will serve to reinforce public

-sector capacities for coordination and M&E of the HIV epidemic in Côte d'Ivoire and help ensure

sustainability.

The MLS will use FY09 funds to reinforce its coordinating role and strengthen the national M&E system,

with a particular focus on building capacities and improving planning and coordination at the regional level.

The main activities will include:

• Reinforce operational capacities of the ministry's public sector, civil society/private sector, financial

resource coordination, and technical coordination departments (DSP, DSPSC, DMRCF, and STCO).

• Pursue advocacy activities directed at private-sector and public and community institutions

• Develop, validate, and distribute operational 2010 plans for regions and Abidjan, as well as a national

2010 action plan

• Train civil servants (long-term certified training for one person and short-term certified training for two

persons)

• Organize four regular meetings of multilateral and bilateral donors to discuss new policy issues,

challenges, and opportunities.

Activity Narrative: • Organize four regular meetings of implementing partners to discuss new policy issues, challenges, and

opportunities.

• Organize, in collaboration with other relevant ministries, quarterly meetings of technical working groups

involved in the fight against HIV/AIDS.

• Organize the annual meeting of the National Council for the Fight Against AIDS (CNLS) and the biannual

Inter-Ministerial Committee for the Fight Against AIDS (CIMLS).

• Organize annual coordination workshops with CRLS

• Perform two supervisions a year of CRLS

• Organize half-yearly coordination workshops with sectoral committees and annual supervision of sectoral

committees.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17062

Continued Associated Activity Information

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

System ID System ID

17062 17062.08 HHS/Centers for Ministry of AIDS, 7055 5303.08 CoAg Ministry of $400,000

Disease Control & Côte d'Ivoire AIDS

Prevention #U62/CCU0243

13

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: