New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $636,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

OVERVIEW

There is national consensus in Ghana that stigma/discrimination is the single most important obstacle to an effective HIV/AIDS

response. Research indicates that PLHA are systematically blamed for immoral behaviors and that Ghanaian culture extends this

blame to the entire family (GSCP 2006). Those who are known to be HIV-positive are often fired and/or evicted from their homes.

Police, judiciary and health workers are mentioned by PLHA as showing particularly stigmatizing and sometimes repressive

behaviors.

A critical shortcoming of Ghana's HIV/AIDS response is a lack of skilled personnel to coordinate and implement high-quality HIV

programs in a cohesive manner. While the national HIV program is increasingly decentralized, HIV-related education and training

of lower level authorities is limited. With more and more decision power in steering the HIV/AIDS response, these authorities as

well as district level NGOs need enhanced capacity to coordinate and implement programs.

To create a more conducive environment for the HIV/AIDS response, the USG has supported the Government of Ghana with the

development of a national stigma reduction campaign called "Who are you to blame?." The campaign aims to reduce stigmatizing

behaviors in the general population (measured through the DHS). The national anti-stigma campaign uses mass media at a

national level, reinforced by extensive community-level interpersonal communication activities through multiple channels including

teachers, NGOs and CBOs. The campaign launched early 2007.

Over 40 different civil society organizations are contributing to the campaign. Major achievements of the campaign since launch

include: training of strategically selected FBOs and NGOs in the newly developed stigma reduction curriculum in 27 districts and

buy-in from other development partners such JICA, GTZ, UNHCR, and UNFPA to directly fund and supervise the integration of

stigma reduction campaign messages into existing HIV programs funded by these development partners. These campaigns take

place in workplaces, refugee camps and traditional leaders programs.

KEY INTERVENTIONS

Other key interventions include activities to build technical and programmatic capacity in the 27 target districts to strengthen

decentralized HIV/AIDS programming. Moreover, the USG is preparing the next generation of civil society organizations to

effectively respond to the AIDS epidemic. Indigenous NGOs will be provided with technical and administrative skills to

successfully implement HIV/AIDS programming through direct USG assistance.

CURRENT USG SUPPORT

USG stigma reduction funding is spent on specific populations such as the police, judiciary and health workers, as well as on

PLHA groups in order to reduce self-stigma and learn to counteract discriminatory behavior. QHP has developed a cadre of

trainers who conduct the downstream training for health care providers in stigma reduction and improved infection prevention at

clinical facilities. In FY08, 25 ART sites received training in stigma reduction that involved almost 1,200 health workers including

both clinical and non-clinical (orderlies, environmental health staff, security, food services etc) staff. Non-clinical staff has a distinct

curriculum appropriate for their needs. The result of these trainings will be less stigmatizing behaviors and respect for human

rights in police stations, court rooms and hospitals.

The national stigma campaign is reinforced by a number of activities. DOD is preparing a video addressing stigma and

discrimination as part of their ongoing workplace HIV/AIDS program. The U.S. Ambassador and the USAID Director have

launched anti-stigma activities among the judiciary and the police through interaction with high-level decision makers (including

Leaders of the Police, the Justice Department, Supreme Court Justices and human rights lawyers). The final aim of the activity is

to develop anti-stigma codes of conduct within these services, and possibly establishing human rights focal points in police

stations.

SHARP provides district and national authorities with strategic information packages and strengthens the skills district level M&E

staff to monitor and supervise planned activities and strengthen coordination of the districts' response. In addition, it builds the

capacity of 14 NGO sub-grantees active in most-at-risk groups (MARP) interventions.

The national sex worker strategy is being developed by the GAC and the Ministry of Women and Children, with USAID technical

support that builds on USG experiences in Ghana with MARPS, including promoting FSW and MSM-friendly clinical services.

USG FY09 SUPPORT

The activities with the police, judiciary and prison service were delayed due to lengthy administrative approvals and acquisition

bottlenecks but will be fully implemented from 2009, continuing into calendar year 2010. These activities include training

representatives of the services nationwide, establishing codes of conduct and possibly establishing anti-stigma focal points in key

stations.

Peace Corps will continue its anti-stigma activities in the communities, while DOD will use its anti-stigma video for the Ghana

Armed Forces and use it in all 6 garrisons.

QHP objectives in 2009 include providing stigma reduction training for both literate health workers (mostly clinical staff) and non-

literate (non-clinical) staff in 15 new ART facilities.

Two new mechanisms will be put in place for health system strengthening. The first capacity building instrument will develop

several umbrella sub-granting mechanisms focusing on MSM and their sexual partners, FSW and their clients and non-paying

partners, and PLHA and their sexual partners. They will receive training mainly focusing on building capacities in financial and

human resource management, governance systems, and the effective use of strategic information in designing and implementing

HIV interventions targeting most-at-risk groups.

A second capacity building instrument will focus on the districts. Intense monitoring and supervision and technical assistance will

carefully guide the districts to increase their performance.

LEVERAGING AND COORDINATION

Other donors, lead by the Ghana AIDS Commission, will re-energize the anti-stigma activities within civil society organizations

using the curriculum developed by the USG implementers. Forty USG-trained organizations will be involved and major donors

such as JICA, UNFPA and GTZ that will support the roll out of the campaign at the grass-roots and workplace level, using the

materials of the national campaign.

EXPANSION OF PROGRAM WITH ADDITIONAL COMPACT FUNDING

USG activities will continue to focus where the need is greatest. It will expand its anti-stigma activities to the four districts with a

more generalized epidemic and it will intensify its campaign activities in the communities surrounding ART sites, largely by using

CBOs and FBOs that will be trained by the 40 USG trained NGOs.

A mass media component will be added and Peace Corps volunteers will receive special training in anti-stigma activities. DOD will

intensify its anti-stigma activities in the six garrisons. Nationwide PLHA groups will receive training to reduce self-stigmatization.

PRODUCTS AND OUTPUTS

* Code of conduct established for police, judiciary and prisons services for dealing with FSW and MSM

* Materials on rights of MSM and FSW developed and disseminated among target groups

* 1,200 Health staff trained in stigma reduction

* 5,000 military and civilians exposed to Armed Forces anti-stigma activities

* Improved performance of 15 District Assemblies, 3 umbrella NGOs and 50 NGO and PLHA support groups

* Capacity in organizational development increased in 280 individuals

* 500 individuals trained in community mobilizations for prevention, care and/or treatment

Table 3.3.18: