Goal and objectives:The overall goal of the Reproductive and Child Health Alliance or RACHA, as it is called in Cambodia, is to contribute to the achievement of Cambodias Millennium Development Goals by 2015 focusing on improving maternal, newborn, and child health and reducing the prevalence and impact of HIV. RACHA intends to promote linkages between maternal, newborn, and child health services and HIV prevention, care and treatment services.

Geographic coverage and target populations:RACHA undertakes HIV/AIDS activities in eight areas of four provinces covering 955 people living with HIV, 400 orphans and vulnerable children, and 6,000 pregnant women.

Strategies for maximizing cost efficiency and sustainability:RACHA integrates HIV/AIDS and tuberculosis education and referrals into existing maternal, newborn, and child health services including reproductive health, family planning, and antenatal care. RACHA strengthens community structures, including home-based care and self-support groups, to respond to the needs of people living with HIV and orphans and vulnerable children, and to establish a self-sustaining, cost-efficient service-delivery infrastructure. RACHA is retraining home-based care team leaders expand their roles as community-care facilitators, able to lead self-support groups independently in their communities. The facilitators will be focal points to represent the interests of beneficiary groups in the community and health service delivery settings, and will promote a sense of ownership among self-support groups.

Monitoring and evaluation:RACHA will monitor progress, reporting twice a year on PEPFAR indicators for the prevention of mother-to-child transmission, HIV testing and counseling, tuberculosis and HIV, and home-based care.

Target Population:People living with HIV.

Interventions:RACHA supports home-based care and self-support groups as primary support units in the community to provide quality care and support for adults living with HIV/AIDS in 12 health centers in two operational districts in Koh Kong province. Twelve home-based care teams support 555 adults living with HIV. RACHA will continue to strengthen the 32 self-support groups and the linkage to health services.

Intervention:RACHA provides quality care and support for 555 adults living with HIV via activities implemented through home-based care and self-support groups and in 12 health centers in two areas in Koh Kong province. RACHA is now developing new ways to decrease beneficiary dependency without compromising quality of life or survival. In FY 2012, activities will focus on building the capacity of home-based care teams, providing training at least once a year on roles and responsibilities, facilitation skills, counseling skills, antiretroviral therapy compliance and adherence, HIV prevention for HIV infected and affected individuals, service referrals, and family planning. RACHA promotes savings groups, income generation activities, and micro-enterprise development through community-support groups, and will engage in local advocacy to will increase government and local commune support for integration of HIV/AIDS care activities into annual area health plans and Commune Investment Plans.

RACHA will develop specific tools to measure the progress of its transitional plan. These include phase-in and phase-out assessment tools for food and social support; a self-assessment tool for support groups; and a home-based care performance appraisal tool. RACHA will conduct semi-annual monitoring with people living with HIV and orphans and vulnerable children to assess their living status including their food security, household-income capacity, and access to health care.

Target population:Orphans and vulnerable children and their caregivers.

Interventions:RACHA specifically targets the most vulnerable children living in families with HIV, those who have lost one or both parents or are living with foster-care givers. Activities for orphans and vulnerable children are integrated with the adult care programs, working through the same community mechanisms and structures, such as home-based care teams and self-support groups. The program works in the same geographical areas as RACHAs adult care activities to reach 400 orphans and vulnerable children. In FY 2012, specific targets include: 10 orphans and vulnerable children clubs and 10 orphans and vulnerable children caregiver self-support groups are established and functional; 50 families with orphans and vulnerable children are supported to run income-generating activities; 200 orphans and vulnerable children are receiving school materials; and 90 percent of targeted school-aged orphans and vulnerable children are registered for and attending school.

RACHA promotes coordination of care at all levels in providing comprehensive support for orphans and vulnerable children. At the household level, it will train and strengthen primary caregivers on income generating skills as well as in provision of physical and psychosocial care and support. At the community level, RACHA will support caregiver self-support groups to establish savings groups and micro-enterprises, and to improve their access to microfinance schemes. Orphans and vulnerable children clubs will hold regular monthly meetings to give children the chance to play together and socialize, pursue child-led initiatives and monitor school attendance for their peers. The monitoring tools utilized in the adult care program will also measure orphans and vulnerable children indicators. RACHA will link targeted orphans and vulnerable children to its broader child health and nutrition program.

Target population:Target populations include tuberculosis patients and people living with HIV.

Interventions:RACHA will expand coverage and use of HIV testing and counseling services in accordance with the national plan of the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Infections. At HIV testing and counseling sites, RACHA will support the improvement of facilities for counseling and educational activities and will intensify the delivery of integrated services that address tuberculosis and HIV. RACHA will foster collaborative efforts and strengthen the networks with partners in providing care, support, and treatment to beneficiaries. Most importantly, RACHA will strengthen the coordination role between provincial maternal and child health staff, tuberculosis clinic staff, and health area staff to ensure they understand and communicate with each other. In FY 2012, RACHA targets will include: renovation of two additional HIV testing sites; provision of HIV testing and counseling to 28,000 individuals (50 percent of these being female); 80 percent of tuberculosis patients are screened with HIV counseling and testing services; and training of 14 health center staff in HIV testing and counseling according to national and international standards.

Target populations:Sexually active youth and adults.

Interventions:RACHA will promote safer sexual behaviors through the integration of HIV prevention education into community-based maternal, newborn, and child health interventions. In FY 2012, RACHA will reach 350,000 persons with integrated education messages on HIV, reproductive health and family planning, antenatal care, and tuberculosis. These prevention activities will be carried out in 255 health centers within 10 areas in five provinces.

RACHA will carry out these activities through a network of community-based volunteers including Village Health Support Groups, older women living in religious communities, traditional birth attendants, and village shopkeepers (who are best positioned to reach people in rural areas, especially men and women of reproductive age, in ways that are culturally acceptable). RACHA will promote behavior change and service utilization through community-based approaches such as comedy for health shows, community-based distribution agents, and outreach activities. Volunteer networks will reach rural populations on a relatively large scale to promote behavior change to increase peoples understanding of HIV, reproductive health and family planning, antenatal care, and tuberculosis, and their demand for HIV testing and counseling, prevention of mother-to-child transmission, and other relevant services.

Target populations:Sexually active youth and adults.

Interventions:The number of HIV testing and counseling sites nationally has increased from only 12 sites in 2000 to almost 250 by the end of 2010. However, due to poor transport links and substantial travel costs, some areas still do not have access to services. Since HIV testing and counseling is a critical entry point to HIV prevention, care and treatment services, RACHA will provide technical, logistical and financial assistance to further expand access to HIV testing and counseling services among pregnant women and other at-risk populations. In FY 2012, RACHA targets will include: renovation of two additional HIV testing sites; provision of HIV testing and counseling to 28,000 individuals (50 percent female); 80 percent of tuberculosis patients are screened with HIV counseling and testing services; and training of 14 health center staff in HIV testing and counseling according to national and international standards.

RACHA will expand coverage and use of HIV testing and counseling services in accordance with the national plan of the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Infections. RACHA will pursue the improvement of facilities for HIV counseling and educational activities. It will intensify the delivery of HIV testing and counseling services with integrated messages on family planning and will support quality assurance in line with national guidelines. It will foster collaborative efforts and strengthen the networks with partners in providing care, support, and treatment to beneficiaries. Most importantly, RACHA will strengthen the coordination role between provincial maternal and child health staff, and health area staff to ensure they understand and communicate with each other.

Target populations:Sexually active youth and adults.

Interventions:RACHA will promote safer sexual behaviors through the integration of HIV prevention education into community-based maternal, newborn, and child health interventions. In FY 2012, RACHA will reach 350,000 persons with integrated education messages on HIV, reproductive health and family planning, antenatal care, and tuberculosis. These prevention activities will be carried out in 255 health centers of 10 areas in five provinces.

RACHA will carry out these activities through a network of community-based volunteers including Village Health Support Groups, older women living in religious communities, traditional birth attendants, and village shopkeepers (who are best positioned to reach people in rural areas, especially men and women of reproductive age, in ways that are culturally acceptable). RACHA will promote behavior change and service utilization through community-based approaches such as comedy for health shows, community-based distribution agents, and outreach activities. Volunteer networks will reach rural populations on a relatively large scale to promote behavior change to increase peoples understanding of HIV, reproductive health and family planning, antenatal care, and tuberculosis, and their demand for condoms, HIV testing and counseling, prevention of mother-to-child transmission, and other relevant services.

Target populations:Target populations include pregnant women and infants.

Interventions:In FY 2012, RACHA will provide technical, financial, and logistical support to facilitate access to HIV testing and counseling and other prevention of mother-to-child transmission services in 127 health centers in eight areas of four target provinces. These activities will achieve the following targets: 6,000 pregnant women with known HIV status (this includes women who were tested for HIV and received their results); 40 HIV-positive pregnant women receiving antiretroviral therapy to reduce the risk of mother to child transmission; 36 infants born to HIV-positive women received an HIV test within 12 months of birth; and 36 infants born to HIV-positive pregnant women initiated cotrimoxazole prophylaxis within two months of birth.

RACHAs activities address service needs that are not supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other sources of funding. Activities will include: referral support; blood transfers between health centers and to satellite HIV testing and counseling sites; follow-up of mothers and exposed infants; community education through existing maternal, newborn, and child health channels; training and supervision to service providers; and regular coordination meetings. RACHA will be involved actively in the national technical working groups on HIV testing and counseling and prevention of mother-to-child transmission, and will support continuous quality improvement systems at all levels. At the community level, RACHA will promote male involvement in HIV and maternal, newborn, and child health services, including positive prevention activities among people living with HIV. RACHA will promote family-planning informed choice and dual use of condoms and other family planning methods for at-risk and HIV-infected individuals.