ACTIVITY DESCRIPTION: This is an integrated project mandated to create an enabling environment for HIV/AIDS at the national level. We plan to support the Federal Ministry of Health (FMOH) to implement activities under the national health sector plan for HIV/AIDS. We will provide Technical Assistance (TA) to the Food and Drugs Department of FMOH to review the National Drug Policy. ENHANSE will support the finalization of the National Laboratory Policy to guide the improvement of laboratory services and support FMOH's efforts in disseminating the national palliative care guidelines, the Integrated Management of Adolescent and Adulthood Illnesses guidelines and the Blood Safety policy. The Government of Nigeria (GoN) will be supported to organize national and zonal dissemination stakeholder usage workshops for national survey reports, such as the National AIDS and Reproductive Health Survey, Behavior Sentinel Survey, and the National ANC Sero-sentinel HIV/AIDS Survey. TA will be extended to the national prevention working group, OVC working group, TB/HIV working group, and other national working groups to perform their quality assurance and coordinating roles. ENHANSE will work with the FMOH, MMIS project and other relevant agencies to develop a waste management policy. Support will be provided to the FMOH towards the development of a home-based care manual. To address manpower challenges, about 15 long-term consultants will be hired to provide technical support to the ART/PMTCT programs, M&E, Palliative Care, and program management to improve the quality of implementation and reporting, including several SI staff for NASCP. We will support the Global Fund (GF) Country Coordinating Mechanism (CCM) through TA for proposal development, coordination of the funds' application process and for implementation of activities. Four principal recipients will be supported in areas of capacity building and M&E. To ensure that the national HIV/AIDS Policy conforms to current global and national realities, NACA is reviewing the national HIV/AIDS policy. ENHANSE will support this review especially as it relates to support for non-laboratorians conducting testing, and non-clinicians providing adherence counseling, palliative care, and psychosocial support. We will also ensure that training of all states on the Nigerian National Response Information Management System continues and that the means for nationwide implementation exist. We will support the passage of bills on NACA agency, stigma and discrimination and the workplace. ENHANSE will support NACA to develop the National Priority Plan for HIV/AIDS that derives from the national strategic framework, to highlight key activities which must be achieved in two years to boost coordinating functions and ensure better allocation, management of resources and engagement with all partners. We will work towards the completion of the National OVC Action Plan. Media activities will be supported via continued training and exposure of 30 journalists to policy makers and those affected by the disease. The National Human Rights Commission will be assisted to develop guidelines for mainstreaming human rights into HIV/AIDS programming. TA will be available to at least 4 CSOs and 4 public sector partners on policy development, and advocacy. TA will be provided to the Supreme Council for Islamic Affairs to develop its HIV/AIDS Policy and to the Interfaith Coalition to finalize its HIV/AIDS Care and Support Guidelines. ENHANSE will serve as the platform of USG implementing partners' dialogue for greater harmonization of activities via 2 workshops and exchange of information using the USAIDIT newsletter. We will provide logistic and other support to the GON to participate meaningfully during USG TA visits. It is expected that the policy and guidelines developed, and the work of the individuals trained, will have a significant impact on PLWHAS. The policies and guidelines will help facilitate improved delivery of high quality and harmonized clinical and laboratory services. Issues related to greater ownership and support for PEPFAR in Nigeria will be facilitated via enhanced opportunities for dialogue and consensus building leading to greater sustainability.

Targets

Target Target Value Not Applicable Number of local organizations provided with technical assistance for 4  strategic information activities Number of individuals trained in strategic information (includes 30  M&E, surveillance, and/or HMIS)

Target Populations: Community-based organizations Country coordinating mechanisms Faith-based organizations National AIDS control program staff Policy makers Host country government workers

Key Legislative Issues Gender

Increasing gender equity in HIV/AIDS programs

Wrap Arounds Education Coverage Areas: National

Table 3.3.14: Program Planning Overview Program Area: Other/Policy Analysis and System Strengthening Budget Code: OHPS Program Area Code: 14 Total Planned Funding for Program Area: $ 7,115,000.00

Program Area Context:

Engendering bold leadership, achieving sustainability and human capacity development and strengthening coordination and collaboration are three policy/system strengthening interventions in the USG/Nigeria Five Year Plan. In COP 07, USG Nigeria will continue to COP06 activities while working in collaboration with the Government of Nigeria (GoN), the Global Fund, the World Bank and other partners to focus specifically on sustainability. Two new partners will contribute to the other policy and systems strengthening program area in COP 07—one of which is an indigenous organization.

In COP 06, USG Nigeria advanced the HIV/AIDS policy agenda in Nigeria. Activities included working with the Federal Ministry of Health (FMOH) to inaugurate a laboratory working group to develop and implement a national laboratory policy. The national laboratory policy will be finalized in COP07. Contributions were also made in 2006 to finalize counseling and testing guidelines to ensure unfettered access to counseling and testing nationwide. A cost plan for the implementation of the Armed Forces HIV/AIDS Policy Guidelines was also developed.

Human resources strengthening under COP06 resulted in technical support for HIV advocacy in the workplace being provided to the Nigeria Employers Consultative Association (NECA). USG Nigeria worked with NECA to build the capacity of peer health educators from the private sector. This work focused on preventing and managing HIV/AIDS in the workplace. Training was provided to human resource officers, managers and administrative staff from large, medium and small businesses as well as to national labor unions. As a result of the COP06 Local Compensation Technical Assistance team visit, recommendations were made to reduce support to staff costs and to harmonize IP compensation plans in the same facility or in a similar facility in the same geographical area. USG/Nigeria will continue to implement these recommendations in COP07.

Under COP 07, USG Nigeria will continue to support many of the policies and guidelines that were initiated in COP06. Contributions provided to the development of the National Strategic Framework in COP06 will be built upon in COP07 through its dissemination and implementation. An outcome will include the development of user friendly guides of the framework for use by State Action Committees on AIDS (SACA) and other NGOs and FBOs.

Technical assistance will continue to be provided to the GoN and other stakeholders in COP07 to strengthen their capacity to plan, manage and implement HIV programs. For example, support will be provided to National Action Committee on AIDS (NACA) for the National Priority Plan for HIV/AIDS which will ensure better allocation and management of resources. An anticipated outcome is the passage of the NACA agency bill in COP07 that will move NACA from an office under the Presidency and establish as an Agency within the Federal government, ensuring sustainability after upcoming elections. USG Nigeria will work with the Supreme Council for Islamic Affairs to develop its HIV/AIDS policy. and The development of guidelines for dissemination of the National Drug Policy as well as its actual dissemination will be carried out. Support will also be provided to the Nigerian Ministry of Defense (NMOD) in developing, implementing and reviewing policies on reduction of incidence and prevalence of HIV/AIDS in military communities and in strengthening its systems. Finally, the newly established National Prevention Working Group will be supported and strengthened.

In February 2004, the FMOH acknowledged a number of weaknesses in procurement, distribution and monitoring of centrally procured medicines and other health program related commodities. This weakness has hindered expansion of ART services by the GON. It is therefore imperative that logistics management systems for test kits, ARV drugs and other commodities related to HIV/AIDS diagnosis and care are established, scaled up, and institutionalized in Nigeria.

Systems strengthening activities under COP07 will include strengthening the GON's logistics management

system in 30 ART centers including the provision of training for logistics system operators. USG/Nigeria will build institutional capacity for logistics management in four GON agencies (NASCP, FDS, DPRS, and NACA) and improve the enabling environment for a well functioning, sustainable logistics system. It is anticipated that the Heart to Heart (H2H) brand will become the national HIV counseling and testing logo due to USG/Nigeria support for a nationwide campaign in COP07.

USG Nigeria COP07 goals for other policy and systems strengthening include targets in policy development, institutional capacity building, community mobilization, and discrimination reduction. COP 07 targets exceed COP 06 targets for all indicators except for the number of individuals trained in HIV policy development. USG Nigeria feels strongly that a core group of individuals have been trained in HIV policy development and that the planned training levels will be adequate to support USG policy goals.

Program areas beyond policy and systems strengthening will be supported under COP07. ARV Services, for example, will be affected as USG Nigeria works to ensure continuous availability of ARV drugs to treatment sites through training, monitoring and effective use of logistics management information. Counseling and testing will be enhanced as USG Nigeria increases efforts to reduce stigma and discrimination and improves the logistics system to ensure availability of test kits.

USG Nigeria will engage women's groups within the FBO leadership to ensure they are equitably represented in all training and leadership. Particular support will be provided to the eager, but under-resourced Ministry of Women's Affairs. Local military communities will be mobilized to address male norms and behaviors regarding cross-generational and transactional sex and support for the development of military policy to prevent sexual violence and coercion. CBOs will be strengthened in their efforts to reduce the stigma associated with HIV status and to reduce discrimination faced by those with HIV or AIDS.

Activities to strengthen human capacity in COP06 resulted in a set of recommendations on the implementation of incentive and retention schemes for scale up of HIV services. Over the next year, USG Nigeria will continue to implement these recommendations. Similarly, in COP06 USG Nigeria performed an assessment of the GON human resources information system. In COP 07, USG Nigeria will continue to support GON in responding to the results of the survey. COP07 activities in this regard will also include strengthening the management function of the FMOH by improving their ability to review key policies such as the Food and Drug Policy.

USG Nigeria worked closely with the Global Fund during COP06 and will continue these efforts under COP07. As part of multi-stakeholder support for the reconstitution of a new CCM in Nigeria, USG Nigeria strengthened the management structure by helping the Interim CCM finalize the selection process of new CCM members based on clearly defined constituencies and selection procedures. Ongoing capacity-building for the CCM, as well as for the principle recipients of the award, is included in COP07.

As policy development and systems strengthening cuts across all program areas, there are many members of the interagency technical teams that support these efforts. In addition to supporting all of the National working groups and task teams, the USG technical team also gives guidance to our Enabling Environment partners in assisting them to advance the more technical aspects of our policy portfolio.

Program Area Target: Number of local organizations provided with technical assistance for 11 HIV-related policy development Number of local organizations provided with technical assistance for 61 HIV-related institutional capacity building Number of individuals trained in HIV-related policy development 232 Number of individuals trained in HIV-related institutional capacity building 496 Number of individuals trained in HIV-related stigma and discrimination 1,272 reduction Number of individuals trained in HIV-related community mobilization for 168 prevention, care and/or treatment

Table 3.3.14:

ACTIVITY DESCRIPTION This activity relates to Palliative Care (3.3.06), Lab (3.3.12), TB/HIV (3.3.07), OVC (3.3.08) and Blood Safety (3.3.03) activities.

This is an integrated project mandated to create an enabling environment for HIV/AIDS activities at the national level. We plan to support the Federal Ministry of Health (FMOH) to implement activities under the national health sector plan for HIV/AIDS. We will provide Technical Assistance (TA) to the Food and Drugs Department of FMOH to review the National Drug Policy. ENHANSE will support the finalization of the National Laboratory Policy to guide the improvement of laboratory services and support FMOH's efforts in disseminating the national palliative care guidelines, the Integrated Management of Adolescent and Adulthood Illnesses guidelines and the Blood Safety policy. The Government of Nigeria (GoN) will be supported to organize national and zonal dissemination stakeholder usage workshops for national survey reports such as National AIDS and Reproductive Health Survey, Behavior Sentinel Survey, and the National ANC Sero-sentinel HIV/AIDS Survey. TA will be extended to the national prevention working group, OVC working group, TB/HIV working group, and other national working groups to perform their quality assurance and coordinating roles. ENHANSE will work with the FMOH, MMIS project and other relevant agencies to develop a waste management policy. Support will be provided to the FMOH towards the development of a home-based care manual. To address manpower challenges, about 10 long-term consultants will be hired to provide technical support to the ART/PMTCT programs, M&E, Palliative Care, and program management to improve the quality of implementation and reporting. We will support the Global Fund (GF) Country Coordinating Mechanism (CCM) through TA for proposal development, coordination of the funds' application process and for implementation of activities.

Four principal recipients will be supported in areas of capacity building, and M&E. To ensure that the national HIV/AIDS Policy conforms to current global and national realities, NACA is reviewing the national HIV/AIDS policy. ENHANSE will support this review especially as it relates to support for non-laboratorians conducting testing, and non-clinicians providing adherence counseling, palliative care, and psychosocial support. We will also ensure that training of all states on the Nigerian National Response Information Management System continues and that the means for nationwide implementation exist. We will support the passage of bills on NACA agency, stigma and discrimination and the workplace. ENHANSE will support NACA to develop the National Priority Plan for HIV/AIDS that derives from the national strategic framework, to highlight key activities which must be achieved in two years to boost coordinating functions and ensure better allocation, management of resources and engagement with all partners. We will work towards the completion of the National OVC Action Plan. Media activities will be supported via continued training and exposure of 30 journalists to policy makers and those affected by the disease. The National Human Rights Commission will be assisted to develop guidelines for mainstreaming human rights into HIV/AIDS programming. TA will be available to at least 4 CSOs and 4 public sector partners on policy development, and advocacy. TA will be provided to the Supreme Council for Islamic Affairs to develop its HIV/AIDS Policy and to the Interfaith Coalition to finalize its HIV/AIDS Care and Support Guidelines. ENHANSE will serve as the platform for USG implementing partners' dialogue for greater harmonization of activities via 2 workshops and exchange of information using the USAIDIT newsletter. We will provide logistic and other support to the GON to participate meaningfully during USG TA visits.

CONTRIBUTIONS It is expected that the policy and guidelines developed, and the work of the individuals trained, will have a significant impact on PLWHAS. The policies and guidelines will help facilitate improved delivery of high quality and harmonized clinical and laboratory services. Issues related to greater ownership and support for PEPFAR in Nigeria will be facilitated via enhanced opportunities for dialogue and consensus building leading to greater sustainability.

LINKS This activity is linked to initiatives in other areas of the ENHANSE mandate that cover

reproductive health and population activities, child survival and education. Specifically, this activity links to palliative care, lab, TB/HIV and blood safety. In addition, it links to the integration of HIV/AIDS into family planning and vice versa via new guidelines being developed. It is also linked to initiatives with the uniformed services, national management of TB, as well as programs addressing OVC.

TARGET POPULATIONS The activity focuses largely on national level public and private sector institutions, especially those playing a significant role in addressing HIV/AIDS prevention, treatment and care such as NACA and NASCP/FMOH. ENHANSE's interventions also target the CCM with activities to strengthen its capacity for the funds' application processes while also creating the avenue for international partner agencies to work collaboratively and to leverage resources for HIV/AIDS programming. In addition, this activity targets media organizations from the print and electronic media as well as the national legislature and political parties. The activity also targets the leadership of Faith-based Organizations as well as national networks of those living with the virus or associated with them.

LEGISLATIVE ISSUES This activity will increase legislative engagement with HIV/AIDS related issues especially those addressing institutionalization of the current structures leading the national response. In addition, this activity will be addressing specific legislation related to the workplace and HIV/AIDS, as well as the larger context of HIV/AIDS stigma and discrimination. This activity will also address issues of gender and women's legal rights, education and democracy. For example, this activity will also target cross-cutting legislature such as the domestication of Convention for the Eradication of Domestic violence Against Women (CEDAW), the Child Rights Act, or those addressing intellectual property rights especially as it relates to the use of generic drugs and products for public health purposes. The conduct of a legislative audit as it relates to HIV/AIDS will be addressed.

EMPHASIS AREAS This activity's major emphasis is on policy development and utilization. Minor emphasis areas include training, strategic information/M&E and linkages with other sectors.