Involvement of Ethiopian Parliament in HIV/AIDS Prevention, Care, and Treatment

This is a new activity linked with US Universities activities in COP 07. This activity is a cross-cutting and linked with other activities in care and treatment. The activity primarily address prevention and stigma reduction and will be linked closely with several outreach programs with interactive or interpersonal peer group elements, thus it will strengthen the overall country program.

The Federal Democratic Republic of Ethiopia has two Houses: the House of Peoples' Representatives and the House of the Federation.

The House of Peoples' Representatives is the highest governing body of the country. The House has legislative powers in all matters referred to by the constitution to federal jurisdiction. According to the constitution, the House has some 550 members who are accountable to the people who elected them. The 550 members are from both the ruling and opposition parties elected during May 2005 election that show high level involvements of the masses in the political process. Involving Parliamentarians as peoples' representatives in HIV/AIDS prevention, care, and treatment can have a major impact.

Parliamentarians can influence executive body to address HIV/AIDS issues in their respective political organizations and in the parliament process of oversight to the Executive Body (Ministries) and others and urge them to plan and implement programs by mainstreaming as part of their organizational duties and responsibilities.

Parliamentarians are not only advocates for their respective constituencies but also they address HIV prevention and promote care and treatment (counseling and testing, PMTCT, ART, STIs, positive living, etc.) while conducting their representational duties in their respective localities with their followers and influence national legislation and activities in Parliament including through mainstreaming HIV/AIDS in all legislation, making it regular agenda in Social Affairs Committee and at relevant Caucuses such as Women's Caucus and using other opportunities at governmental or non-governmental functions and with local Woreda and Kebele administrations to enhance their focus and attention to HIV/AIDS activities.

Being close to the people as their representatives, they are in a unique position to influence public opinion and confront the stigma surrounding HIV/AIDS. It has been learnt that there are individual initiatives from the members that they are highly involved with PLWHA associations. By virtue of the elevated positions of Parliamentarians, they can effectively mobilize, motivate, and encourage the masses in preventing new infections, promoting ART, PMTCT, VCT, STI and increase their uptake.

It is encouraging to note the increasing commitment in HIV/AIDS awareness, prevention, support and treatment with current parliamentarians which provides prime opportunity for this activity. These include the Speaker of the House who was the former Minister of Youth and Chair of the HIV/AIDS Management Board for the country and the First Lady who is Chair of the Social Affairs Committee and Women's Coalition on HIV/AIDS; both are very active in HIV/AIDS matters. While great progress has been made in the fight against HIV/AIDS, more effort is needed to ensure the development, funding and full implementation of strategies to combat it.

Parliamentarians need to speak out more openly and frequently about HIV/AIDS and how it can be prevented and legislate including HIV/AIDS Policy (has not been issued as of yet; rights of PLWHA).

As the parliament is a new one, it needs guidance and sensitization for their support to realize PEPFAR goals at large especially focusing on promotion of services to increase the uptake of services like VCT, ART, and PMTCT being role models and campaign in their locality during their vacation. This is also an opportunity to work on strengthening the network model.

Proposed new activities: (1)Training and orientations program for parliamentarians. This ensure that they have accurate and up to date knowledge about HIV/AIDS so that they act as advocates for

those infected and affected; (2)Adapt/develop a hand book for use in their guidance and advocacy. The handbook will also serve as reference material for the parliamentarians; (3)Strengthen HIV/AIDS committee in the parliament which is currently functioning under the Social affair Committee; (4)HIV/AIDS campaign during closing of the parliament and during their representational duties in their respective localities; (5)Serve as role models to the people they represent and in their respective Woredas for AB, CT, care, treatment and other HIV activities including through participation in public testing events; (6)Strengthen HIV/AIDS activity of the Parliament in general and Social Affairs and relevant Caucuses in particular; (7)Support outreach activities of Parliamentarian to their respective constituency to educate their communities on the prevention of HIV, community support to infected and affected families and play a role in stigma reduction; (8)Enhance the role of parliamentarians in the access to and promotion of care, support, and treatment services for infected and affected by HIV/AIDS; and (9)Advocate for and legislate rights-based and gender-sensitive non- discriminatory HIV/AIDS policies.

None provided.

Table 3.3.07:

PLUS UP: PEPFAR will channel funds to the Federal HIV/AIDS Prevention and Control Office (FHAPCO) to support the government's Millennium AIDS Campaign (MAC) which aims to counsel and test nearly five million clients by October 2008. In the first phase of MAC, 622, 000 people were tested. Review of MAC I revealed that uptake nearly doubled the planned targets in all regions. The campaign faced many constraints and problems, such as test kit shortages and lack of human resources; it did not target high risk populations for routine and diagnostic testing, it neglected children, and it suffered from poor linkages to care and treatment services. During the next two MAC phases, from Feb. 2007- Sept. 2008, the government plans to scale up HCT services in more than 1500 facilities, targets high risk populations, plans to expand and consolidate Provider Initiated HIV testing and Counseling and strengthen referral links from HCT to pre ART care. The fund will be used to strengthen the FHAPCO capacity to improve coordination and logistics management of the campaign .

PLUS UP FUNDING: In recent years, the HIV/AIDS program has expanded to a large number of sites and patients. The pace of acceleration has exerted great stress on the health system, especially in relation to human resources. Retention of trained staff in HIV/AIDS services is a serious issue affecting both expansion and quality of the program in general. Recently the country has embarked on a campaign to expand the program substantially to achieve highly ambitious targets. The human resource issue is a huge challenge as scale up builds momentum, and it needs to be addressed by multiple innovative approaches. One major factor in attrition is the extremely low remuneration in the government health sector. To support sites to retain trained staff, PEPFAR Ethiopia will support retention schemes including remuneration for weekends, holidays and after duty hours linked with HIV/AIDS program scale up. Other schemes might include scholarships for children of health workers located in more remote areas. The numbers to be trained and how they would be supported will be determined with each implementing partner. Other innovative ways of human resource retention are needed and should be adapted to regional/local situations. Thus plus up funds will support ART sites to retain trained staff and continue providing quality service while ensuring rapid program expansion. The Ministry of Health/HAPCO will implement these strategies in close collaboration with JHPIEGO and other implementing partners.

PEPFAR Ethiopia supports in-service and pre-service training to develop human capacity required for HIV/AIDS program. Training of trainers, clinical mentors and care providers is done at various venues and through ad hoc arrangements. A national training center with the capacity and set-up that will support standardized, comprehensive and practical HIV/AIDS training is a major gap in Ethiopia. As a result training in HIV/AIDS has largely been didactic and specific area focused, not providing the links among care, treatment and prevention services as well as the links between facility and community based services. Creating a national center with a primary goal of providing quality and comprehensive training is a priority of the Ministry of Health. ALERT hospital-health center-community network has designated for this purpose. ALERT has well established ART and care services that are well linked with community level services. ALERT has training facilities and is affiliated with Addis Ababa University. It is collocated and linked with an international center well prepared for operations research. It is well suited for HIV/AIDS training and technical support activities. ALERT requires expanding its training facility to strengthen the training in HIV/AIDS. PEPFAR Ethiopia will, along with other partners like the World Bank and GFATM, will support the plans to strengthen ALERT training capacity and will extensively use the ALERT Hospital HIV/AIDS services network to provide in-service and pre-service train to physicians, counseling nurses, pharmacy personnel, lab technologists, home based care volunteers and community counselors.

Table 3.3.11:

Support to the National Surveillance Systems

This is a continuing activity that was started 2002. This activity is linked with the Strengthening National HIV/AIDS/STI Surveillance Systems (5717) as well to all of the PEPFAR Ethiopia supported SI, prevention, treatment and care activities. Due to some ongoing changes in the organizational structure at the Ministry implementation of activities were slowed down, but has now picked up pace and the partner is on track with implementation. No funds from FY06 have so far been utilized, and thus the funding level has been kept flat lined.

Building the capacities of, the National HIV/AIDS Prevention and Control Office and RHB to enable them to extend their support to Zonal Health Departments (ZHD), Woreda Health Desks (WHD) and health facilities will directly benefit HIV/AIDS, TB/ HIV and STI surveillance programs. PEPFAR Ethiopia has been supporting NHAPCO for these activities over the last several years. In 2006, NHAPCO, with PEPFAR Ethiopia funding, extended its support to RHB's tals of selecting health facilities and staffs to be trained in the collection, compilation and reporting of surveillance data from HIV counseling and testing, TB/HIV and sexually transmitted infection treatment services. Communication between and among the NHAPCO, RHB, ZHD, WHD and health facilities was also enhanced. The capacity of RHB for providing supportive supervision to all the health facilities involved in surveillance activities was also strengthened. NHAPCO also provided support to RHB to conduct their annual surveillance planning and review meetings with their respective surveillance site staffs.

During FY07, PEPFAR Ethiopia plans to build upon the activities and lessons learned from the previous year. RHB, ZHD, WHD and health facilities will be supported through the NHAPCO in their preparations for the planning and the execution of the 2007 ANC based HIV surveillance and the other surveillance activities through the provision of technical guidance in the selection of staff for trainings, selection and preparation of sites, supportive supervision, and facilitation of inter-organizational communications. This activity complements the activities of PEPFAR Ethiopia described in COP ID 5717 through which PEPFAR Ethiopia will provide technical assistance to the NHAPCO.