This implementing mechanism is unchanged from last year. Reproductive and Child Health Alliance (RACHA)

Overall Goals and HIV-Specific Objectives

RACHA provides a broad range of reproductive and child health activities in rural communities of Cambodia. Its comprehensive goal is to contribute to the achievement of Cambodia's Millennium Development Goals by 2015, with specific interim targets for 2013 of reducing maternal and under-5 mortality by 25%; increasing modern contraceptive prevalence to at least 33%; reducing TB prevalence by 20%; and reducing HIV prevalence in the sexually active population by 10%. With support from PEPFAR, RACHA intends to contribute to this last objective by expanding its HIV program to include home based care (HBC) for people living with HIV/AIDS (PLWHA), TB/HIV patients, and services for orphans and vulnerable children (OVC).

The FY 2010 PEPFAR funding will support continued activities in the areas of prevention of mother to child transmission (PMTCT) and voluntary confidential counseling and testing (VCCT) interventions, including capacity building and services strengthening, referral and linkages, and awareness raising in the community. New activities for FY10 include care for PLWHA by promoting Most at Risk Populations (MARPS) -friendly HIV services and providing a minimum package of Prevention with PLHIV (PwP) interventions; routine HIV testing and counseling for TB patients, and support for OVC. RACHA's other sexual prevention activities for FY10 will integrate a peer-education HIV component into couple/gender relationship strengthening, comedies for health performances for community awareness and behavior change, a Community Based Service (CBS) program through village shops sellers and a joint advocacy campaign.

Target Populations

RACHA will take on an existing group of 919 PLWHA and 716 OVC who were previously served by an organization no longer receiving USAID funds. It has targeted 1,150 PLWHA, entertainment and commercial sex workers (CSW), and TB patients in the five ODs where it supports CDOTS; 5040 pregnant women, their partners and newborns for PMTCT activities; and 17,800 men and women for VCCT services.

Geographic Coverage

RACHA's Adult Care and OVC projects cover two Operational Districts (OD) in Koh Kong province. Currently, RACHA supports HIV testing for all TB patients in five ODs located in Pursat and Siem Reap provinces. RACHA will expand this program to cover seven ODs in FY10. RACHA supports four PMTCT and seven VCCT sites in Siem Reap, Pursat, and Phnom Penh and intends to cover nine health facilities for VCCT in the next fiscal year.

Making the Most of HIV Resources

RACHA integrates STI/HIV/AIDS and Family Planning (FP) into its Reproductive Health (RH) activities. It has the ability to scale up its program at a lower cost through its participatory approach. RACHA provides inter-institutional coordination among international organizations (IOs) and local NGOs and with agencies such as UNICEF, UNFPA, etc. RACHA also collaborates with the Ministry of Health (MoH) and its agencies/departments, commune councils and religious leaders.

The adult care and OVC programs will continue to receive support from the Global Fund to cover the treatment of PLWHA and Mondul Mith Chouy Mith (MMM) activity until 2010. The HIV funds will support capacity building and strengthening of health providers. RACHA will also undertake fund raising activities locally and implement a credit-for-health program in the area to generate income from the community to support the PLWHA

Cross-cutting Areas

RACHA's health related wraparound programs include RH, FP, maternal, newborn and child health (MNCH) and TB. RACHA supports cross-cutting activities in the areas of gender, human resources for health, economic strengthening, mobile populations, and renovation. It ensures involvement of males in reproductive health programs to reduce sexually risky behavior and HIV/STD transmission both for themselves and for their female and male sexual partners. It provides training and strengthening of PMTCT counselors, lab technicians and other staff on PMTCT and VCCT to more than 400 health care workers, community volunteers and local comedians. Plans for FY10 include renovating existing clinics to improve on-site testing access.

Enhancing Sustainability

RACHA, as a strong partner of the MoH, will continue to provide TA and establish partnerships and referral systems at the local, OD and PHD levels. In FY10 RACHA will: collaborate closely with the community, religious leaders, social welfare institutions, NGO, CBO, and self-help groups; ensure the PLWHA self-help group network is institutionalized in the community; strengthen the role of the family as primary caregiver; mobilize and sensitize the community about HIV/AIDS; integrate the program activities into the Commune Integrated Plan (CIP) for cost contribution; ensure coordination of program teams with community representatives to address any limitations in policy and administration; and mobilize Village Health Support Groups (VHSGs) to strengthen the community network at the grassroots level.

M&E

RACHA will conduct proper M&E of PEPFAR old and next generation indicators for PMTCT, OVC, TB/HIV, and HBC. It will ensure that the six elements of minimum Prevention with Positives package are provided to PLHIV at last visit. Baseline surveys when necessary will be conducted. Semi-annual evaluation will be conducted along with the SAR for USAID. A mid-term correlation study will measure the extent to which the activities have reached the target group and the magnitude of these programs' effect on beneficiaries' wellbeing. RACHA's Central Reporting System (RCRS) and Health Information System (HIS) will be upgraded for easy monitoring of data from the community.

This is a new activity. HIV care and support services

RACHA's HBC and support activities aim to provide comprehensive and compassionate care for PLWHA and a minimum package of PwP interventions. Specifically, RACHA will promote coverage and utilization of VCCT and PMTCT services; refer for OI/ART and CD4 count; support monitoring and supervision of HBC teams by Provincial AIDS Offices (PAO) and OI/ART physicians; provide family planning counseling; and access to condoms and other contraceptives. RACHA will provide continuous behavioral counseling to reduce risky behaviors; begin livelihood skills training for PLWHA; and provide refresher training to village caregivers on home based palliative care.

Coverage area and target population

RACHA's HBC project covers the Koh Kong province and provides a minimum one care service to 1,150 PLHA including entertainment workers and CSW, pregnant and lactating women and other PLWHA eligible adults. RACHA has targeted 650 PHLA to receive a minimum package of PwP intervention.

Client retention and referrals

RACHA will pay for transportation of blood specimens of pregnant women for HIV testing and fund PLWHA travel to ART facilities. It will provide adequate training and supervision as well as physical, social and psychological support to caregivers and volunteers for HBC. It will promote greater involvement of PLWHA in peer counseling and formation of support groups and acknowledge of their special contribution to the program. RACHA promotes a savings fund program to help improve the economic status of PLWHA and works to strengthen self help groups. RACHA hopes to use its well-managed HBC program to also improve clinical management, including TB diagnosis and adherence to treatment.

Linkages

RACHA will further integrate HIV/MCH/FP programs for HBC and will establish a referral system at all levels. It will collaborate closely with the community, faith-based organizations, social welfare institutions, NGOs, and CBOs. It will establish linkages with Cambodian People Living with HIV/AIDS Network (CPN+) to institutionalize self-help groups in the community.

Monitoring and evaluation

RACHA will monitor the quality of care and services along with the indicators and targets: 650 PLHA reached with a minimum package of PwP intervention; 420 adults provided with a minimum of one care service.

This is a new activity. Geographic coverage and target population:

RACHA's OVC project covers the two Operational Districts (ODs) of Koh Kong province. This new project was handed over by CARE International. Currently, there are 716 OVC, 80 percent of whom are covered by HBC groups.

Priority action:

RACHA's priority action is to promote coordination of care at all levels in order to meet the needs of OVC in their catchment area. As a successor of CARE, it will continue to provide economic, nutritional, educational and psychosocial support to the most vulnerable of children. In the area of child protection, RACHA will support child birth registration and protection from child labor, trafficking and sexual exploitation. To this end, RACHA will advance advocacy to create a supportive environment for all children. It will adopt CARE's income generating program and skills training for youth.

Community support and coordination:

RACHA will strengthen family and community support and coordination. It will involve and link with government agencies, POs, NGOs, schools, Pagodas, clinics/health facilities, commune councils and the local community to provide comprehensive support for OVC. It will train and strengthen the family as primary caregivers (including village and religious leaders) on physical and psychosocial care for PLWHA. It will coordinate with other NGOs for support of travel costs of OVCs to HCs for ARV, and provide training to caregivers in HIV prevention, HBC and OVC care. It will coordinate with Provincial Department of Fine Arts to train OVCs as performers for the comedy for health.

M&E considerations:

1. Counting the number of eligible children provided with a minimum of one care service disaggregated by sex and age. For FY 2010-2011, RACHA has targeted 730 OVC.

2. Counting the number of eligible children who received food and/or other nutritional services. RACHA has targeted 249 OVC.

Lessons Learned and challenges:

RACHA has considered the lessons learned and challenges shared by CARE as a springboard for its new HBC and OVC project. It will carry on the best practices of CARE and will work with the community holistically to strengthen collaboration and linkages with various stakeholders.

This activity is unchanged from last year.

This activity is unchanged from last year.

This activity is unchanged from last year.

This is a new activity.

Alignment of activities with national policy:

RACHA's TB/HIV activities will be undertaken parallel to the Ministry of Health's continuum of care strategy. Following the national policies for TB and HIV, RACHA will focus on increasing TB treatment access through VCCT centers and increasing access to and use of VCCT services by general TB patients.

Coordination across partners:

RACHA will strengthen its collaboration and referral of HIV testing and counseling of TB patients; strengthen collaboration to introduce antiretroviral therapy (ART) to patients who meet the ART eligibility criteria; collaborate with health institutions for timely referral and treatment of TB clients; and ensure HIV care and support at home-based care sites. RACHA will also assist CENAT/MoH in conducting surveillance of HIV prevalence among tuberculosis patients.

Human Resource Capacity and Sustainability:

RACHA links traditional healers to increase the TB detection rate and regular and/or proper TB treatment. It will support the implementation of MoH TB-HIV screening in the health center and/or nearby VCCT centers within RACHA-focus ODs. It will strengthen the VHSGs to support CDOTS implementation. It will provide training to medical personnel, health workers, and community workers on TB-HIV, educate volunteers and family members on preventive measures against TB, and facilitate administration of DOTS.

Monitoring and Evaluation:

M&E will focus on the number and percentage of all registered TB patients who were referred to VCCT and tested for HIV and the number of people who will be trained in TB-HIV.

Accomplishments:

In the five ODs where RACHA supports CDOTS and HIV testing, 1,873 TB patients have registered for treatment and 897 have volunteered to receive an HIV test. Case data shows that 48% of TB patients received VCCT in a six month period (23 cases were found HIV-positive and 4 positive cases were referred to receive ARV). RACHA will expand TB-HIV program coverage to seven ODs in FY 10 and expects more TB patients to utilize VCCT services. Linking TB with HIV services will increase TB case-finding and reduce treatment delay. VCCT services could be an entry point to TB screening to reduce TB morbidity and HIV associated mortality.