ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

HPI will work with traditional faith-based organizations (FBOs) such as the Zion Christian Church and

AMOS to develop and broadcast abstinence and being faithful messages in COP 2009.

ACTIVITY 1. National House of Traditional Leaders (NHTL)

In addition to activities described in 2008, HPI will assist the NHTL in finalizing its sector plan, which will be

presented to the South African National AIDS Council. HPI will also assist the NHTL to develop a national

plan for implementation throughout seven provinces of South Africa. HPI will focus on human and

institutional capacity building activities to newly constituted district and local houses of traditional leaders

(TLs) to expand, improve and implement HIV prevention activities. HPI aim to improve governance,

accountability, and leadership, to widen partnerships and resources for HIV prevention within TL structures.

HPI envisages that there will be increased community participation in HIV prevention activities.

ACTIVITY 2. Zion Christian Church

HPI will assist the National Council of the Zion Christian Church (ZCC) to develop a national HIV prevention

strategy and an implementation plan to be carried out in all the affiliated churches. HPI will also support the

provincial churches of the ZCC by developing and implementing AB prevention messages into the church

activities. Thirty participants will be reached in each provincial workshop. HPI will encourage the ZCC to

promote prevention messages, such as the reduction of concurrent sexual partners, delayed sexual debut

for young people, being faithful to one sexual partner, the role of gender and gender-based violence, and

prevention for positive individuals. This activity will reduce stigma and discrimination towards people living

with HIV. Approximately 270 people will benefit from this activity. Each of the 270 participants will then

conduct various activities at the church level to reach other members of the church and the community with

AB prevention messages. Participants will develop action plans to disseminate AB prevention messages

and conduct outreach within the church communities. HPI will follow up with support and supervision to a

subset of those who participated in this activity to assess (1) the degree to which participants were able to

implement their action plans; (2) the challenges and opportunities participants encounter in their community;

and (3) to reinforce skills learned in the provincial implementation program to build a sustainable cadre of

HIV Prevention Champions. Participants will be comprised of faith-based HIV committee leaders, members

of the broader church community. IEC materials will follow the guidelines of the National Department of

Health and the leadership of the church.

ACTIVITY 3: Digital Storytelling

HPI will engage Sonke Gender Justice and the Center for Digital Storytelling to develop HIV prevention

messages and stories for TLs and farm workers. Men and women affected by violence and HIV and AIDS

will share their stories through an intensive, participatory workshop process, and will bring people together

to speak out in digital format. HPI hopes to deepen existing conversations about gender norms and the HIV

epidemic by highlighting every-day voices of courage, survival, and action. Some stories are raw

testimonials about survival; others challenge damaging myths, and misperceptions among men about their

sexuality and offer practical steps and interventions. This activity will also focus on restoring healthy

relationships between men and women in order to make a distinctive contribution towards HIV prevention.

The stories will be distributed across South Africa, and will be used to educate local communities, training

community, civic leaders, FBOs and TLs, and to promote sustained community action. This will be in

keeping with the "Silence Speaks" methodology, which adapts principles from popular education, art

therapy, trauma recovery and group process to ensure opportunities for personal and collective

transformation.

ACTIVITY 4: AMOS

Amos is a nonprofit organization registered with the Health and Welfare Seta. AMOS's strength lies in its

unique position and influence among the farming communities and its ability to engage with marginalized

farming populations in South Africa. It has a 15-year track record of working with farm owners and workers

in addressing the challenges posed by HIV. HPI will work with AMOS to implement an HIV prevention

program targeting farm workers and owners. The farm workers are particularly hard to reach, highly mobile

and live in isolated areas in the Northern Cape, Mpumalanga and KwaZulu-Natal. This effective prevention

program will address life skills, accurate HIV prevention information and social mobilization of the farming

community to counter gender injustice and stigma and discrimination.

---------

SUMMARY

HPI TO1 is follow-on to the POLICY Project funded by USAID. HPI TO1 will support the implementation of

policies and programs to integrate gender, stigma and discrimination into HIV prevention programs. The

project will work with faith-based organizations (FBOs), traditional leaders (TLs), and community-based

organizations (CBOs) to develop and implement Abstinence and Be faithful (AB) prevention messages and

programs. HPI TO1 will assist FBOs and CBOs to systematically identify program gaps and barriers to

uptake or dissemination. Activities will focus on improving knowledge about HIV, behavior change to reduce

risk, community mobilization and participation in HIV prevention programs.

Over the years, HPI TO1 has worked with the FBOs and TLs as a key target group. The organization aims

to respond to the needs of the groups in prevention. These needs have evolved variously from the need to

sensitize the leadership and membership on the necessity of including a prevention focus in their programs,

to helping groups set up prevention programs for their diocese and communities. Currently, HPI TO1is

targeting behavior change and emphasizing what needs to happen at the personal level. HPI TO1 will be

utililizing approaches that influence individual behavior as it relates to HIV prevention, using proven

Activity Narrative: approaches that reinforce person-to-person influences and decision making, and which will ultimately lead

to behavior change at the personal level.

Emphasis areas are training in AB, with special focus on behavior change; community mobilization and

participation; gender which will address male norms and behaviors, reduce gender-based violence and

coercion; and human capacity building for partners at the national, provincial and community levels.

Capacity building aims to identify and address the operational barriers that impede the expansion of HIV

programs. The target population is adolescents, adults, people living with HIV, and religious leaders.

BACKGROUND

HPI TO1 empowers new partners to participate in the policy making process. The initiative helps

organizations translate policies, strategic plans, and operational guidelines into effective programs and

services. The project will work with FBOs, TLs, and CBOs to develop and implement AB prevention

messages and programs and to assist these organizations in systematically identifying program gaps and

barriers to uptake or dissemination. HPI TO1 will continue to build and strengthen the capacity of

organizations and institutions across all sectors to design, implement, and evaluate comprehensive HIV

prevention, care, and support programs and policies. Project assistance focuses on improving multi-sectoral

capacity and involvement in the country's national HIV and AIDS program by assisting different role players

in developing and implementing effective advocacy strategies for HIV and AIDS; facilitating effective

planning for HIV and AIDS programs; increasing the information used for policy and program development;

and strengthening collaboration between government and civil society organizations (CSOs) and institutions

working in HIV and AIDS. The activities proposed under HPI TO1 will (1) focus on the devolution of capacity

building and training in AB programs to district level for TLs and to FBOs; (2) provide technical assistance to

TLs and faith-leaders to ensure their training skills are used and appropriate prevention messages are being

disseminated in communities; and (3) build the capacity of traditional and faith leaders to identify barriers to

uptake or expansion of prevention programs. In this period HPI TO1 will also work in partnership with the

South African National AIDS Council (SANAC) and the National House of Traditional Leaders. HPI TO1 will

partner with SANAC to provide direct technical assistance to TL structures in South Africa.

Traditional Leaders: It is estimated that over 16 million people live in the rural areas that are under the

jurisdiction of TLs. These TLs command respect and have significant influence on the day-to-day running of

many rural/ peri-urban communities. They are also key players in the governance structures of South Africa,

particularly at the local level, and are therefore well placed to mobilize communities to access and use

services. In 2001, a partnership between the National Department of Health (NDOH) and the Nelson

Mandela Foundation (NMF) supported the formation of the National TLs' HIV and AIDS Forum and the

development of a national strategy by TLs to address the challenges of HIV and AIDS. Previously, the

activities in this program area focused mostly on Traditional Leaders at the provincial level and were

implemented in partnership with a small non statutory Traditional Leaders forum. In this period HPI TO1 will

be implementing this activity in support of the National House of Traditional Leaders. This is the biggest

body of Traditional Leaders in South Africa and is also a statutory body represented in the national

parliament and the South African National AIDS Council. The National House of Traditional Leaders is key

in assisting HPI reach as many Traditional Leaders in their various forms, kings, indunas, chiefs, traditional

councilors and will be implemented at the district level. Further in this period HPI will be implementing

activities in the Northern Cape which did not receive any interventions previously.

Faith-Based Organizations: South Africa is a multi-faith country. FBOs are rooted in the community and are

in a strong position to mobilize communities to address the challenge of HIV and AIDS. They can promote

prevention strategies, mobilize communities against stigma and discrimination, and provide community-

based care and support to people infected or affected by HIV and AIDS. The capacity of many FBOs to

develop appropriate training materials or to design and implement effective programs varies considerably.

In the previous interventions HPI TO1 worked with FBO's such as the National Baptist Church of Southern

Africa, the Southern African Catholic Bishops Conference and the Church of the Provinces of Southern

Africa. In this period HPI will be working with the mostly Africa traditional faiths such as the Zion Christian

Church and Shembe.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1. Traditional Leaders

HPI TO1 will conduct six provincial, three-day training workshops; each workshop will host 40 participants.

Each of 240 people trained will then conduct at least five activities to reach community members with A/B

messages within one year of receiving the training. These workshops will be focusing on encouraging TLs

to promote prevention messages in particular, the reduction of concurrent sexual partners being faithful to

one sexual partner, especially in older youth and adults engaged in sexual relationships, abstinence or

delaying sexual debut for young people aged 10-14 before they start engage in sexual activity, the role of

gender and gender based violence in prevention and prevention for positive individuals. This activity will be

implemented in KwaZulu-Natal, Eastern Cape, Mpumalanga, Free State, Limpopo, North West and

Northern Cape provinces. The training will focus on the design, planning, and dissemination of successful

AB prevention messages and will include strategies to reduce community level stigma and discrimination

and raise awareness of the impact of gender-based violence on women's access to prevention programs

including discussion of issues of the role of men in society. HPI TO1 will look at individual behavior and how

to reinforce positive behaviors in the community. We will look at addressing both individual and larger

community issues that are barriers to behavior change. Trainees who are TLs will include AB prevention

messages into one TL's council meetings once a month. As more TL's take the lead in addressing HIV and

AIDS, this would have more impact in behavior change of men in their different constituencies, because

most Traditional Leaders are men. The training materials used throughout this activity will be developed by

HPI TO1. HPI TO1 will follow up with a subset of trainees to (1) assess the activities carried out; (2) identify

the challenges and opportunities TLs are experiencing in disseminating AB messages; and (3) provide

technical assistance to the TLs to strengthen their skills in order to address implementation challenges.

Activity Narrative: ACTIVITY 2. Faith-Based Organizations

HPI TO1 will facilitate nine provincial workshops on integrating AB messages into the church activities of a

selected church group. Thirty participants will be reached in each provincial workshop. These workshops

will focus on encouraging FBOs to promote prevention messages, such as the reduction of concurrent

sexual partners, the delay of sexual debut for young people, being faithful to one sexual partner, the role of

gender and gender-based violence against women and girl children in prevention and prevention for

positive individuals. A total of 315 people will be trained. Each of the 315 people trained will then conduct at

least one activity to reach community members with A/B messages within one year of receiving the training.

Trainees will develop action plans to disseminate AB prevention messages and conduct prevention

outreach activities within the church communities. HPI TO1 will follow up with a subset of those who

participated in training to assess: (1) the degree to which participants were able to implement their action

plans; (2) the challenges and opportunities trainees encounter in their community; and (3) to reinforce skills

learned in the provincial training workshops in order to build a sustainable cadre of trainers. The trainees for

FBOs will be comprised of faith-based HIV and AIDS committee members and other members of the

broader church community. Technical assistance will be included in the training curriculum.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15073

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15073 3014.08 U.S. Agency for Health Policy 7034 466.08 HPI $944,750

International Initiative

Development

7602 3014.07 U.S. Agency for The Futures 4484 466.07 HPI $1,200,000

International Group

Development International

3014 3014.06 U.S. Agency for The Futures 2670 466.06 Policy Project $900,000

International Group

Development International

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $38,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

NO FY 2009 FUNDING IS REQUESTED FOR THIS ACTIVITY:

This activity was approved in the FY 2008 COP, is funded with FY 2008 PEPFAR funds, and is included

here to provide complete information for reviewers. No FY 2009 funding is requested for this activity.

PEPFAR OP funds were allocated for Health Policy Initiative (HPI) to provide training to strengthen the

capacity and collaboration of National Department of Health (NDOH), and civil society groups in their work

with men to ensure implementation of the National Reproductive Guidelines for Men; work closely with

JHPIEGO and the NDOH to jointly develop prevention messaging for traditional leaders, traditional healers

and traditional surgeons that can be incorporated into existing traditional male circumcision activities; and

work with these groups to build capacity in the delivery of appropriate, accurate prevention messaging in the

context of male circumcision. The circumcision activities of HPI will be completed according to schedule in

2008 and will also be funded in COP 2009. Other OP activities will not be funded as this is not a strong area

for HPI. Therefore there is no need to continue funding this activity with FY 2009 COP funds.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15074

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15074 6427.08 U.S. Agency for Health Policy 7034 466.08 HPI $388,000

International Initiative

Development

7606 6427.07 U.S. Agency for The Futures 4484 466.07 HPI $100,000

International Group

Development International

6427 6427.06 U.S. Agency for The Futures 2670 466.06 Policy Project $300,000

International Group

Development International

Table 3.3.03:

SUMMARY AND BACKGROUND:

Prevention must be greatly prioritized in the response to AIDS and efforts are being made to find new

prevention technologies to bolster the package of already known effective prevention methods. Male

circumcision (MC) is one of these new potential methods. With two decades of observational studies there

are studies that suggest a link between male circumcision and increased protection against HIV

transmission, and a number of studies indicating high levels of potential acceptability. Three randomized

control trials on male circumcision were undertaken in Orange Farm, near Johannesburg in South Africa,

Rakai, Uganda and Kisumu, Kenya. These results support findings published in 2005 from the South Africa

Orange Farm Trial, sponsored by the French National Agency for Research on AIDS, which demonstrated

that male circumcision provided at least a 60% reduction in HIV infection among men who were

circumcised. The study of 3,274 men was stopped at the interim analysis stage due to compelling evidence

that men in the intervention arm were 61 per cent less likely to have become infected with HIV.

The investigators concluded that male circumcision does provide a significant degree of protection. Given

the limited impact of other HIV prevention methods across the region, these findings led to considerable

excitement about the potential for male circumcision to significantly reduce new infections. Dynamic

simulation models indicate that roll-out of male circumcision would lead to dramatic reductions in HIV

infection rates and associated mortality over time.

At the same time, concern was raised about whether publicity about the results might lead to "disinhibition",

with men misinterpreting the results and reaching the conclusion that the increased protection offered by

circumcision allowed for more risky sexual behavior-especially less consistent condom use and more

concurrent partners.

In March 2007, the WHO and UNAIDS jointly issued a set of recommendations on male circumcision which

included guidance on how best to integrate male circumcision into other HIV services. The relevant section

reads: "Male circumcision should never replace other known methods of HIV prevention and should always

be considered as part of a comprehensive HIV prevention package, which includes: promoting delay in the

onset of sexual relations, abstinence from penetrative sex and reduction in the number of sexual partners;

providing and promoting correct and consistent use of male and female condoms; providing HIV testing and

counseling services; and providing services for the treatment of sexually transmitted infections."

ACTIVTIES AND EXPECTED RESULTS:

With the collaboration between Health Policy Initiative (HPI), Sonke Gender Justice Network (SGJ) and

Jhpiego, a program will be developed that will be looking into health education on MC and associated

interventions that will help men better understand the effect of MC education on the fight against HIV.

However there has to be an understanding that MC cannot be implemented as a stand-alone program, but

rather be incorporated into broader reproductive health programs. This initiative will draw on innovative

promising and best practices as indicated by the research that has been done around MC. In addition,

substantial numbers of males are circumcised for cultural reasons. Male circumcision has strong cultural

importance in certain communities and it frequently forms part of religious and cultural practices surrounding

birth or transition of boys to manhood.

Broad community engagement is required to introduce or expand access to safe male circumcision

services. This also serves as a means of communicating accurate information about the intervention,

notably that male circumcision provides only partial protection against the risk of acquiring HIV. The role of

civil society organizations in addressing the challenges and opportunities of preventive MC is crucial.

All the sectors should be well informed about MC activities and research undertaken. The collaboration

between the three partners, namely HPI, Sonke Gender Justice Network and Jhpiego will look at the

following strategies in dealing with MC as a strategy that can contribute in the reduction of the spread of

HIV.

ACTIVITY 1: Development of IEC materials on MC

Situational Analysis: to gather and/or use existing data on MC available in the country and analyze

information related to the target groups such as traditional and faith-based leaders involved in the program

and prioritizing key issues. This will be done through site visits, individual and group interviews.

In this initiative HPI plans to collaborate in partnership with partners that also have expertise and long

history of working with men; Sonke Gender Justice and Jhpiego as well as the National Department of

Health's Women's Health Directorate, the Gender Desk and the HIV/AIDS, STI and TB Directorate to

develop information, education communication materials for the MC mobilization program following the

recommendations in WHO guidelines.

In developing these materials, messages will be carefully tailored, culturally sensitive, draw on local

language and symbols, and be appropriate to the particular level of development and understanding of the

population groups for which the messages are designed. For effectiveness to prevent men developing a

false sense of security and engaging in high-risk sexual behaviors and also to address gender stereotypes

messages will be tailored for men and women. Culturally sensitive and appropriate material will be

developed and also made for initiation schools for areas where these institutions exist, to minimize stigma

associated with circumcision status.

ACTIVITY 2: Social mobilization activities

There are a wide range of socio-cultural issues to consider in the context of introducing or expanding the

availability of male circumcision services. These issues differ according to circumcision history and practice

in different communities; hence it is crucial that the MC activity be looked at in context of the geographical

Activity Narrative: area, beliefs, norms etc. MC activities should also act as an opportunity to address the reproductive health

needs of men, and such activities actively counsel and promote safer and responsible sexual behavior.

HPI and Sonke Gender Justice will facilitate workshops targeting organizations, local structures and

institutions that are dealing with MC and men's reproductive health. Men's imbizo (gatherings) will be used

to facilitate community dialogues that will encourage men to talk about MC. HPI will also encourage the use

of available guidelines on MC and facilitate compliance to them. HPI will also focus on providing a

supportive supervision system to government to create an enabling environment for the implementation and

monitoring of educational MC activities and their compliance to available policies. Practical, cost-effective

and sustainable methods will be used to reach out to men in all nine provinces. In the discussions that HPI

and other partners will facilitate, they will ensure that policy makers and program developers are involved

and that this is done in consultation with civil society members, local stakeholders, different population

groups and other critical decision makers.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.07:

NO FY 2009 FUNDING IS REQUESTED FOR THIS ACTIVITY:

This activity was approved in the FY 2008 COP, is funded with FY 2008 PEPFAR funds, and is included

here to provide complete information for reviewers. No FY 2009 funding is requested for this activity.

PEPFAR home-based care funds were allocated to Health Policy Initiative (HPI) to develop capacity of

PLHIV organizations in South Africa to equip them with skills to mobilize and advocate for essential care

and treatment support services, knowledge and awareness of essential prevention and basic preventative

care interventions and the importance of mobilizing and referring for essential HIV and AIDS PMTCT, ART,

OI management (including TB), family planning and CT services for its members and their families. The

HBHC activities of HPI will be completed according to schedule in 2008 but will not be funded in COP 2009.

It is felt that HPI has built enough capacity in this area and the National Department of Health now has to

take this forward. Therefore there is no need to continue funding this activity with FY 2009 COP funds.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15075

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15075 3015.08 U.S. Agency for Health Policy 7034 466.08 HPI $291,000

International Initiative

Development

7603 3015.07 U.S. Agency for The Futures 4484 466.07 HPI $275,000

International Group

Development International

3015 3015.06 U.S. Agency for The Futures 2670 466.06 Policy Project $100,000

International Group

Development International

Table 3.3.08:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

BACKGROUND:

To ensure the HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP) is successfully

implemented in all sectors and at all levels, costing and tracking government expenditure is key in the

implementation and success of the NSP. With limited skills and capacity in costing identified in HIV and

AIDS activities within all government departments, more departments are in need of capacity and skills in

costing to ensuring appropriate resource allocation; therefore the increase in activities.

Due to the specific needs from the South African government for technical assistance in strategic

information, the GOALS model will not be applicable to the South African context and to address the

technical gaps in planning, reporting and tracking HIV and AIDS interventions, the Health Policy Initiative

(HPI) will develop tailor-made models and capacity building activities. This will support evidence-based

program planning and the overall success of the NSP.

ACTIVITY 1: National Department of Health (NDOH) HIV and AIDS, Comprehensive Care, Support and

Treatment Sub Directorate Costing

HPI will continue to work with NDOH HIV and AIDS, Comprehensive Care, Support and Treatment Sub

Directorate (CCMT) focusing on capacity building programs for costing of HIV and AIDS care and treatment

interventions at the provincial level. The programs will also include costing for TB and sexually transmitted

infections (STI). The objective of this activity will expand in scope by developing a tailor-made costing model

for the HIV and AIDS, Comprehensive Care, Support and Treatment Managers. This model will standardize

and guide a benchmarked approach within all provinces in ensuring effective resource needs required for

HIV and AIDS care and treatment in their specific province. This will impact greatly on producing more

realistic budgets and will ensure adequate funding. Consensus will have to be reached on the use of a

single costing model for all provinces to ensure accurate and provincial specific budgets. The workshop

program will be initiated to capacitate DOH staff with the aim to create provincial-level budgets which are

based on clear and realistic assumptions about resource needs in the area of care and treatment. Available

data on unit cost relating to treatment programs specific to South Africa, needs to be collated for the use in

the development of a costing model.

HPI in collaboration with Futures Institute will develop the model for the NDOH. The tools will be piloted

through a consultative workshop, drawing participants from selected provinces, and later implementation to

all nine provinces. The tools will focus on costing national and provincial response to treatment, care and

management as well as ensure capacity to provide adequate budget justification and explanations to

executive management.

CCMT program managers will be trained on the model, and followed-up on the application of the model

within NDOH and PDOH. To strengthen the above costing activity and ensure that there is enough evidence

to proof human capacity development in costing for program managers within NDOH and PDOH in

HIV/AIDS, HPI will carry out a rigorous monitoring activity to measure the impact, successes and results of

the application of the model within all the NDOH and PDOH.

ACTIVITY 2: Department of Public Service and Administration (DPSA) Costing

HPI will continue workshops at provincial-level departmental staff in the use of the DPSA Costing Model to

support the implementation of the model nationally. However, the focus in provinces will be monitored to

ensure proper and effective use of the model to design improved budgets for HIV and AIDS workplace

interventions in the public sector. The aim of the monitoring process is to ensure successful institutional

capacity implementation as well as social capital within the departments. The experiences of the provincial

departments in the use of the DPSA costing model will be captured and fed into the finalization of the

guideline for the costing model. Any significant data that will improve on the quality of this model will be

used for updating the model. An online version of the DPSA costing model will be designed to ensure that

government departments are able to access the latest version of the model as well as updated costing

through the internet.

While the application of the model is monitored, lessons from this process will be utilized to finalize a

national costing curriculum. This curriculum will be integrated into public servant training courses within the

South African Management and Development Training Institute (SAMDI) and other universities in the

country. The curriculum will illustrate how costing can be used to address questions of efficiency, equity and

sustainability of HIV and AIDS activities for which program managers are responsible for.

ACTIVITY 3: National Department of Transport

The National Transport Sector Council (NTSC) on HIVand AIDS requested technical assistance from HPI in

the development of the sector's monitoring and evaluation (M&E) plan to complete the NDOT strategic plan.

HPI in partnership with ILO provided technical assistance through a consultative platform to develop the

transport sectors' M&E plan. HPI will continue supporting the NDOT and the NTSC to build their capacity to

implement a standardized M&E framework. This will be done through sector workshops, collaborative,

consultative and informed dialogue between member organizations of the council as well as support of the

implementation of the HIV and AIDS M&E system to all member organizations.

-------------------------

SUMMARY

The Health Policy Initiative (HPI) will carry out capacity building activities and provide technical support to

ensure improved national and provincial level financial planning and effective resource allocation for HIV

Activity Narrative: and AIDS. The target populations are host county government workers at national and provincial levels, with

a specific focus on AIDS Control Program staff; and the emphasis area for this activity is other strategic

information (SI) activities, to include healthcare financing and local organization capacity development.

BACKGROUND

HPI has significant expertise in providing assistance to governments and donors in planning and allocating

future resources to manage national HIV and AIDS programs. This is an ongoing activity in South Africa,

first initiated in 2001 with the collaboration of the National Department of Health (NDOH) and several other

government departments. Since 2004, the activities were funded by PEPFAR and included provision of

technical assistance and training for staff at the Health Financing and Economics Unit (HFEU) of the NDOH

in applying the GOALS model. The GOALS model is a computer model designed to support HIV and AIDS

planning by linking expenditure on specific program interventions to coverage of the population in need and

to program goals, such as infections averted and deaths averted. HPI will continue to support the NDOH in

preparing resource allocation and human capacity building plans to implement the NDOH's HIV & AIDS and

STI Strategic Plan for South Africa, 2007-2011 (NSP) effectively. HPI has made it a priority to strengthen

the capacity of provincial governments to cost their Provincial Strategic Plans and to align it with the NSP.

HPI will provide technical assistance to all nine provinces and use information from the COP or other

sources to identify gaps in budget allocations and providing information on what set of interventions can

most effectively contribute to achieving the South Africa prevention and treatment targets.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Resource Allocation

In this phase, financial staff from the NDOH HIV and AIDS, Comprehensive Care, Support and Treatment

Unit, will form part of the national training team to roll this intervention out further to the provinces. Training

and technical assistance will be provided to national trainers to conduct national and provincial training for

technical working group members on resource allocation, the use of data for decision making to prepare for

HIV and AIDS human capacity needs, programming and financing of the NSP. Financial staff from the HIV

and AIDS Care and Support Unit will also be trained to use the GOALS model and to teach staff at the

provincial level on the use of the GOALS resource model to design programs, and to allocate financial and

human resources. HPI staff will follow-up throughout the year with the HIV and AIDS, Care and Support

trainers to provide additional capacity building.

This activity will contribute substantially towards meeting the vision outlined in the USG Five-Year Strategy

for South Africa. It will contribute to reaching the goal of averting 7 million infections through improved

planning and resource allocation.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15076

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15076 3017.08 U.S. Agency for Health Policy 7034 466.08 HPI $121,250

International Initiative

Development

7605 3017.07 U.S. Agency for The Futures 4484 466.07 HPI $125,000

International Group

Development International

3017 3017.06 U.S. Agency for The Futures 2670 466.06 Policy Project $150,000

International Group

Development International

Emphasis Areas

Health-related Wraparound Programs

* TB

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,715

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The activity that has been changed is the support to the Crossroads Helping Hand Project. The project has

been closed due to the fact that HPI supports the National Baptist Church of Southern Africa, the mother

body of the Helping Hand Project. Further support has also been extended to the Nelson Mandela High

School in Crossroads, Cape Town where the Helping Hand Project is housed.

No capacity building will be provided by HPI to any tuberculosis (TB) NGOs since no activities have been

approved for TB services and organizations for 2009. The TB modules in the diploma program in HIV/AIDS

Management in the Workplace and AIDS and Development in Society address the importance of TB/HIV

integration and focus on identifying TB and HIV co-infected individuals in the workplace. TB and the

emerging M/XDR-TB epidemic represent a major challenge to HIV care and treatment programs and

therefore the activities will remain as part of the HIV and AIDS policy development course material for 2009.

------------------------

SUMMARY:

Health Policy Initiative Task Order 1 (HPI TO1) provides an enabling policy environment as a foundation on

which to build quality, sustainable HIV programs and services. The HIV epidemic in South Africa (SA)

cannot be addressed by the health sector alone-it requires a strong, coordinated multisectoral response

from workplaces, faith-based groups, and civil society organizations to ease the burden on the health

system. They also have critical role to play in reducing stigma and discrimination (SD) against people living

with HIV (PLHIV) which is essential for encouraging counseling and testing, disclosure, and antiretroviral

(ARV) treatment. Multisectoral engagement, including involvement of PLHIV and other vulnerable groups, is

critical to ensure that: needs of those most affected are met; community leaders break the silence; stigma

that hinders HIV prevention and treatment is eliminated; and resources for implementation are mobilized

across all sectors.

In response, HPI proposes three activities that will strengthen HIV policies and programs of public and

private sector workplaces; reduce SD; and build HIV-related institutional capacity of civil society groups. HPI

will provide technical assistance to partners to build capacity to analyze and use data to enhance evidence-

based decision-making, and to identify and address operational barriers to effective HIV and AIDS

programs. HPI will also assist organizations in translating policies, strategic plans, and operational

guidelines into effective programs and services.

BACKGROUND:

The National HIV, AIDS and STI Strategic Plan for SA, 2007-2011 highlights "World of Work" as an

important sector for future management of HIV and AIDS in SA. Workplace policies in public sector and

National Operational Plan for Comprehensive HIV and AIDS Management, Treatment Care and Support

have been developed to support implementation of HIV and AIDS strategies. Adequacy of existing

structures should be assessed, and capacity to develop and implement public and private sector HIV and

AIDS programs should be strengthened. Workplace policies need to be developed and implemented in both

private and public sector, with special focus on encouraging acceptance of HIV-infected employees and

promoting open discussion of HIV and AIDS and non-discrimination.

IN FY 2007, HPI TO1 developed "Managing HIV and AIDS in the Workplace: A Guide for Government

Departments" as a guide in implementing the Minimum Standards on HIV and AIDS. Use of this guide

within the Department of Public Service and Administration (DPSA) has mostly been done at national and

provincial levels for managers leading and developing HIV and AIDS programs. HPI TO1 has launched

several HIV and AIDS Management Programs for senior managers and executive leaders in 2007 with key

tertiary institutions (TIs). Primary objective of the leadership training programs is to secure commitment by

leaders in South Africa to actively and openly address HIV in their business environments.

For many years women have been suffered from discrimination. Gender inequality hinders social and

economic development and is a critical element of the transformation agenda in SA. HPI TO1 will

strengthen capacity of women by conducting a leadership course for women to capacitate and mobilize

them in leadership to play vital role to ensure accountability and gender sensitive responses that will

increase reach of HIV and AIDS programs run by them.

Evidence from programs in South Africa suggests that people still fear testing for HIV and treatment. In

partnership with HPI TO1, Center for the Study of AIDS (CSA) has implemented the Siyam'kela Project,,

focusing on HIV-related stigma. To date, the project has been successful in developing conceptual and

theoretical tools to understand and mitigate stigma for government and civil society to inform the mitigation

efforts, build capacity, design advocacy messages and materials, and offer training and technical assistance

(TA) around stigma.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: HIV and AIDS Workplace Programs

A. Program Managers and Graduate Students. HPI TO1 has worked closely with University of Stellenbosch

to design training modules and facilitate training sessions as part of its diploma course on HIV program

management and the workplace. As a follow-up to this activity, HPI will identify graduates of the program

who have become HIV policy champions in their workplaces. HPI will provide capacity building and TA to

these policy champions to strengthen development and implementation of HIV workplace policies and

programs in their respective workplaces. In addition, HPI will assess the impact of the overall diploma

course. HPI will identify a sample of 50 graduates to explore extent to which they are engaged in HIV

workplace policies, dialogue, advocacy, and program implementation.

B. Executive Business Leaders. HPI TO1 will build leadership capacity of key business personnel to

Activity Narrative: strategically and effectively respond to HIV in their work environments. Training participants will include

senior managers and executives, from both public and private sectors, who enroll for Masters in Business

Administration (MBA) and Executive Leadership courses through six TIs. These institutions will assist in

educating key role players and their contribution is in the form of integrating the HIV & AIDS workplace

module to the MBA and Executive courses. HPI expects to initiate, strengthen and improve more

appropriate workplace programming in the private sector.

C. Women Program Managers. HPI TO1 seeks to strengthen technical expertise, leadership abilities, and

program management skills of women working to prevent spread and mitigate effects of HIV. This responds

to need for greater and more meaningful involvement of women in designing and guiding HIV and AIDS

programs. Through their current programs, the national departments for Gender will help select women to

participate in the program who are from civil society, religious, and government bodies and are involved in

or manage HIV programs. Women's leadership courses will help improve focus, ensure accountability, and

increase reach of HIV programs by incorporating strategies that are gender sensitive.

D. DPSA and Government Departments. In partnership with DPSA, HPI TO1 will assist 30 departments to

plan, develop, implement, and maintain HIV workplace policies and programs within human rights and

gender framework. DPSA has mandate of instituting, strengthening, and upholding effective and efficient

human resource practices in all government departments in nine provinces. Heads of Departments will

oversee development and implementation of HIV workplace policies and programs. Heads of Departments

follow the "Managing HIV and AIDS in the Workplace: A Guide for Government Departments," which

provides guidance on Minimum Standards on HIV and AIDS. HPI will work with DPSA to develop and

improve existing guides and monitoring tools to strengthen HIV & AIDS programs in public sector

workplace.

ACTIVITY 2: Stigma Mitigation

SD has had a negative impact on HIV prevention in SA and has affected efforts to improve care and support

for PLHIV. This has been exacerbated by lack of concepts and theoretical tools to understand and measure

SD and their impact. Through ongoing implementation of Siyam'kela Project, capacity building for PLHIV

organizations and families was done to advocate for stigma mitigation. With FY 2008 funds, the activities

will focus on providing training to PLHIV organizations and their members at provincial levels on SD

mitigation using the National Stigma Framework (NSF). Training will take place in all nine provinces of SA

and through NDOH's HIV, AIDS, STI and TB directorate - Care and Support Unit; selection will take place to

ensure departmental representation of all provinces. Representatives of PLHIV networks in different

provinces will be included. Training and subsequent follow up will focus on implementation of NSF and

sector plans to reduce HIV-related stigma. Through NDOH sector plans resources have been allocated for

M&E of activities related to SD in provincial health departments. HPI TO1 will work with 405 representatives

from NGOs, PLHIV groups and provincial health departments. HPI TO1 will provide TA to the HIV, AIDS,

STI and TB directorate - Care and Support Unit to ensure implementation of their stigma plans. Evaluation

will be conducted to report on progress and implementation of NSF.

ACTIVITY 3: Civil Society Organizational and Institutional Capacity Development

The SA Government's AIDS Action Plan spearheaded a national capacity-building process for the interfaith

sector, in collaboration with POLICY Project which resulted in establishment of an interfaith program, FBOs

in HIV/AIDS Partnership (FOHAP), in 2002. As a continuation of assistance started in 2007, HPI TO1 will

provide institutional capacity building to two national FBOs, the National Baptist Church of Southern Africa

in Crossroads and an African traditional FBO such as the Zion Christian Church or the Shembe, as well as

three NGOs in three provinces which have been identified by the NDOH as key outlets in high prevalence

areas for support to strengthen their capacity to: 1) develop strategic plans for program implementation; 2)

provide institutional capacity building by facilitating governance and organizational development workshops

to respond to the need for designing and implementing HIV prevention programs; and 3) build capacity of

TB organizations to enable them to integrate HIV activities into their work. HPI TO1 is engaged with the

three organizations providing TB outreach under the palliative care section. These activities will result in

stronger TB/HIV technical programming and operations for the organization. HPI TO1 will provide

institutional capacity building to 5 organizations and 180 staff for COP FY 2008.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15077

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15077 3016.08 U.S. Agency for Health Policy 7034 466.08 HPI $1,455,000

International Initiative

Development

3016 3016.06 U.S. Agency for The Futures 2670 466.06 Policy Project $750,000

International Group

Development International

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Reducing violence and coercion

Health-related Wraparound Programs

* TB

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $186,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: