LESOTHO RED CROSS SOCIETY. INTEGRATED HIV and AIDS PROGRAMME

Transcription

1 LESOTHO RED CROSS SOCIETY INTEGRATED HIV and AIDS PROGRAMME November 2006

2 Executive summary In response to the government call to scale up the fight against HIV and AIDS, Lesotho Red Cross Society (LRCS) has expanded its integrated community home-based Care (ICHBC) programme from four districts to seven, using mainly trained community volunteers. Through the ICHBC programme, the National Society is providing holistic care and support to chronically ill patients and orphans and other children (OVC). Currently the LRCS has identified and registered 3,261 ICHBC clients; 51 of them are on antiretroviral (ARVs); and 2,597 OVC of which 1,253 are being provided with educational support. Over 2,200 ICHBC clients and 1,400 OVC are being provided with food support, and 625 OVC are engaged in income generating activities (IGAs) through support groups. LRCS is planning to scale up its response under the new Integrated HIV and AIDS Programme The HIV and AIDS programme is part of the Southern Africa Regional HIV and AIDS programme which is a component of the International Federation Global HIV and AIDS Alliance. The Southern Africa: Regional HIV and AIDS Programme Appeal number (MAA63003) was launched on 1 November The International Federation is scaling-up its response to HIV and is committed to reducing vulnerability to HIV and its impact through: Preventing further infections; Expanding care, treatment, and support; Reducing stigma and discrimination. In order to achieve these three outputs, the LRCS capacity will be strengthened to enable more effective, expanded, direct outreach to communities served. The new programme will target one million people with HIV prevention interventions, 7,200 PLHIV and 10,200 OVC by LRCS will consolidate existing and forge new partnerships in scaling up its response. The Integrated HIV and AIDS programme seeks CHF 38,172,648 towards a total budget of CHF 40,733,471 for the five-year implementation period ( ) 2

3 1. Background Lesotho has an estimated population of 2.2 million of which 52% are women. Women-headed households accounted for 25% of all the households in Fifty-six percent of the population lives on less than USD 2 a day. The Human Development Index for Lesotho is 149. According to the Lesotho Demographic Health Survey, men are more likely to be illiterate (no formal education) than women (17% versus 2%). Lesotho s economy is heavily reliant on agriculture. However, like most of the southern Africa countries has experienced a series of droughts in the past few years. This coupled with the HIV and AIDS pandemic, has led to acute shortages of food in the country. Historically Lesotho s main export was its labour to the gold mines of the Republic of South Africa. Due to the drastic decline of the labour demand of miners in South Africa, a number of the Basotho men have returned home; thus increasing the unemployment rate HIV and AIDS situation Lesotho has the second highest HIV prevalence rates in the Sub-Sahara region and the HIV and AIDS pandemic has not yet shown any signs of abating (WHO/AFRO 2005 update, Dec 2005). HIV prevalence among pregnant women attending antenatal clinics rose exponentially in the 1990s from 2.2% in 1991 to 21.3% in In 2003/4, HIV prevalence among pregnant women attending antenatal clinics was 28.4%. In Lesotho, like most of the southern Africa countries, HIV prevalence rates in urban areas are close to those in the rural areas. In , HIV prevalence among Antenatal Clinic attendees in rural areas was 27.6%, while that in the urban areas was 31%. The Demographic and Health Survey (DHS) showed that more women than men were HIV infected. HIV prevalence among women aged years was 19.3% as compared to 6.3% among men of the same age. Table 1: Statistics on HIV and AIDS as at the end of 2005 in Lesotho Number of people living with HIV. 270,000 Adult (aged years) HIV prevalence rate. 23.3% Adults aged 15 years and over living with HIV. 210,200 Women aged 15 years and over living with HIV. 110,200 Children aged 0-14 years living with HIV. 18,000 Deaths to AIDS (children and adults). 23,000 Orphans (0-17 years) due to AIDS 97,000 Percentage of women (15-24 years) who had sex with a casual partner in the last 12 months. 43.3% Percentage of men (15-24 years) who had sex with a casual partner in the last 12 months. 89.5% Percentage of women aged years reporting use of a condom at last sex with a nonregular 50.0% partner casual sex. Percentage of men aged years reporting use of a condom at last sex with a non-regular 48.0% partner casual sex. Source: UNAIDS 2006 Report on the global AIDS pandemic The DHS found that young women aged years had an HIV prevalence of 26.5% as compared to 15% among men of the same age. At the end of 2005, 270,000 people were estimated to be living with HIV of which more than half were women (table 1). The HIV and AIDS pandemic is one of the leading causes of mortality among both children and adults. The public health sector is overwhelmed, with more than half of the hospital beds occupied by patients with HIV and AIDS related illnesses. The number of orphans is on the rise and has already overstretched the traditional coping mechanisms that have usually looked after orphans. His Majesty King Letsie III declared HIV and AIDS a national disaster and this marked the beginning of concerted efforts towards the fight against the pandemic. 3

4 1.2. Determinants of the pandemic There are multiple factors driving the pandemic in the country. These factors include-; poverty, high mobility, food insecurity, socio-cultural practices and gender inequalities, (especially disempowerment of women and girl child). There is need to ensure that HIV prevention and control strategies take into account the growing linkages between AIDS and these factors that put people at a greater risk to HIV infection. Some cultural practices such as widow inheritance, polygamy, cultural mistresses, scarification rituals and clan head shaving using one blade that is not sterilised are believed to be significantly contributing to the transmission of HIV infection. Poverty forces, especially women and young girls into commercial and intergenerational sex. A behavioural surveillance survey conducted in 2001 in the country among the youth aged years, found that female youth who were sexually active, were having sexual partners who were much older than them as compared to male youth who reported having partners of the same age. Typically, girls in cross-generational relationships have limited power to resist pressures to unsafe sexual practices and due to the relatively high prevalence of HIV; these older men may already be infected with HIV. The same survey found that the majority of the sex workers in Lesotho were young women, with a median age of 23 years. Poverty is also a major underlying cause for migration of the Basotho from rural to urban areas in Lesotho. The separation of male and female spouses has implications on the spread of HIV infection. Migration leads to escalation in engagement of high-risk behaviours including sex work, and multiple sexual relationships. More than half (54%) of these migrant women surveyed in Maseru and 48% from Leribe reported having had sex with a non-married, non-cohabiting sexual partner casual sex in the past 12 months. Basotho men who have historically sought employment in the mines in South Africa are returning home. This phenomenon is playing a significant role in the dynamics of HIV transmission in the country. More than 54% and 46% of the miners surveyed in Maseru and Leribe in 2001 reported having sex with a sex worker in the last 12 months. Gender inequalities are playing a major role in feminizing the pandemic in Lesotho. Gender inequalities are a result of society and cultural attitudes, beliefs as well as practices. In Lesotho, like most countries in the region, the rules governing sexual relationships differ for women and men, with men having the upper hand. Due to these gender inequalities, women find it difficult to negotiate for safer sex even if they know that they are putting themselves at risk. Young girls are forced into early marriages against their will. In Lesotho, domestic violence is seen as a cultural rather than a criminal activity (Action-aid International Africa, SIPAA, in June 2005). In the era of HIV and AIDS, young girls have proven to be more vulnerable to rape and defilement, which is a form of gender-based violence. There is a wide spread misconception about HIV and AIDS in Lesotho; that an infected man having sex with a virgin will cure AIDS. The abrasions caused by forced vaginal sex penetration facilitate entry of the virus, a fact that is especially worse for adolescent girls. Moreover, condoms are rarely used in these situations The impact of the AIDS pandemic The HIV and AIDS pandemic is reversing the developmental gains of the past decades, including hard won increases in child survival and life expectancy. The DHS indicated an upward trend in early childhood mortality overtime. Infant mortality rates increased from 75 deaths per 1,000 live births in the five to nine year period preceding the survey ( ) to 91 deaths per 1,000 live births during the Similarly, an increase has been observed with the children aged less than five years. Mortality increased from 90 deaths to 113 deaths per 1,000 live births over the same period. Life expectancy has declined from 58.6 years in 1996 to 39 years for men in The number OVC is on the increase, and at the end of 2005, there was an estimate of 97,000 orphans due to AIDS in the country. The majority of the orphans are left under the custody of grandparents who have limited resources and skills to cater for their welfare. According to the Ministry of Health and Social Welfare (MoHSW), 30% of the orphans were out of school in The World Bank estimates that by 2015, the national GDP will be reduced by one third as a result of HIV and AIDS (Government poverty reduction strategy paper 2004). The AIDS pandemic is resulting in premature deaths or early retirement on medical grounds of the most productive age group. On the other 4

5 hand, family members have to care for the sick; and this means less time to work on the farms and land being cultivated. In addition, people who have succumbed to AIDS and are chronically ill are unable to be productive in their gardens. AIDS affected households also appear to suffer severe poverty than the nonaffected households (UNAIDS Global Report July 2004). The impact is more severe, if the sick family member or the one who dies is the sole breadwinner. With increasing numbers of people succumbing to AIDS and opportunistic infections such as tuberculosis (TB), the public health sector is increasingly getting overwhelmed. According to the MoHSW, about 50% of the hospital in-patients and 25% of the outpatients had HIV and AIDS related illnesses in This situation makes home-based care programmes highly relevant. Countries with high HIV and AIDS prevalence such as Lesotho are experiencing high numbers of people with TB (World Health Organisation (WHO) October 2003). Lesotho falls in the group of countries where 50 out of 100,000 adults are infected with both TB and HIV (WHO October 2003). The HIV and AIDS pandemic is worsening the chronic food shortages in the country, arising from successive severe droughts. The pandemic impact arises as a result of HIV and AIDS affected households losing farm labour and switching to less labour intensive non-cash crops, thus reducing cash income that would be used to buy food. This situation increases the vulnerability of populations to HIV infection, especially women and OVC, who may be forced into sex work or transactional sex as a means of survival National HIV and AIDS response There are various key stakeholders involved in the national and HIV response in the country. These include the government, United Nations Agencies, bilateral and multilateral donors, non-governmental organizations, (NGOs) faith-based organizations (FBO), embassies and international organizations as well as networks and associations of PLHIV. Lesotho has developed and implemented a number of plans on HIV and AIDS. Currently, it is implementing the fifth plan covering period ; which is multi-sectoral in approach. The Lesotho AIDS programme coordinating authority (LAPCA) under the office of the prime minister is charged with the overall coordination of the national HIV and AIDS response. Each government ministry sets aside 2% of its recurrent budget to finance HIV and AIDS activities. The government has adopted a new Southern Africa Development Community (SADC) strategic framework and programme of action One of the key elements of the framework is the Know your status campaign which was launched in March The campaign involves door-to-door voluntary counselling and testing (VCT). Lesotho is the first country in southern Africa to offer such type of service. In 2005, a paediatric anti-retroviral therapy (ART) centre of excellence in the country was opened. The centre has developed guidelines and procedures for treatment of children with anti-retroviral (ARVs). In addition to the National HIV and AIDS Policy, the government has developed a number of other policies and these include-; The Sexual Offences Act (2003), Poverty Reduction Strategy Paper and Lesotho Vision 2020, Youth Policy (1999), Gender Policy (2002), Adolescent Health Policy (2003) and Social Welfare Policy (2003). A Child and Gender Protection Unit was established in Lesotho Police Service, to address gender-based violence. The MoHSW has developed guidelines on clinical management of HIV and AIDS, home-based care (HBC) and prevention of parent-tochild (PPTCT) including infant and child feeding. An OVC strategy is still in draft form. 2.0 Lesotho Red Cross Society: Track Record and Lessons Learned After the adoption of the Strategy 2010 at the Federation General Assembly in 1999, the International Federation Africa team developed an African Red Cross and Red Crescent Health Initiative (ARCHI 2010) to implement ten public health priorities on the Africa continent aiming at reducing the mortality by 5% in All African National Societies including Malawi signed the Ouagadougou Declaration during the 5 th Pan African Conference in September 2000 engaging all societies to focus on health and care issues, particularly HIV and AIDS, food security and volunteer management. Four years later in September 2004, at the 6 th Pan African Conference, African Red Cross Societies reiterated this commitment and priorities in the Algiers Plan of Action. 5

6 In response to the government call to scale up the fight against HIV and AIDS and also its commitment to the Ouagadougou declaration, LRCS has expanded its ICHB programme from four districts to seven, using mainly trained community volunteers. Through the ICHBC programme, the National Society is providing holistic care and support to chronically ill patients and OVC. LRCS has identified and registered 3,261 ICHBC clients, 51 of them are on ART and 2,597 OVC of which 1,253 are being provided with educational support. Over 2,200 HBC clients and 1,400 OVC are being provided with food support, and 625 OVC have IGAs. The HIV prevention activities are integrated into the ICHB programme. Staff and volunteers use community meetings, drama, cultural day events and debates in primary and high schools, to sensitize people on HIV and AIDS and also to advocate against stigma and discrimination. Communities are also mobilized and sensitized on VCT and PPTCT. The staff and volunteers also distribute information, educational and communication (IEC) materials to the communities. LRCS has developed strong referral systems, with local health services to provide follow up and monitoring of support to clients on ART, TB direct observation treatment strategy (DOTS). LRCS has organized a number of workshops and events in collaboration with the network for PLWHIV (LENEPWAH) aimed at reducing AIDS related stigma and discrimination Comparative advantages of Lesotho Red Cross Society LRCS has significantly scaled up community-based HIV and AIDS interventions in the last three to five years. This has been possible because of its comparative advantage to manage a large base of communitybased volunteers. The National Society has experience in mobilizing and working in partnerships with government, NGOs, CBOs and FBOs, multilateral and bilateral agencies, including UN agencies to meet community needs Impact of the HIV and AIDS programme Discussions with the beneficiaries of the ICHBC reveal that the LRCS has contributed to increasing awareness about HIV and AIDS among the general population. Additionally, LRCS has contributed to improving the lives of PLHIV and OVC through provision of care and support. These achievements, however, need to be scientifically ascertained by carrying out well-designed research and surveys. About 112 households have established nutritional backyard gardens, eight poultry projects and seven piglet-rearing projects. The OVC advocacy campaign has reached 80,000 people through Mo-Africa Radio, Radio Lesotho, Public Eye newspaper, Lentsoe la Basotho and Lesotho Television. A total of 1,600 OVC received educational support, in the form of school fees while 400 OVC received material support, which enabled them to go to school in winter. A number of parents were sensitized on preparing wills and as a result, 82 of these parents wrote wills. In many villages within the project areas, people have taken the initiative of registering OVC Lessons learned The lessons learned from implementation of an integrated HIV and AIDS programme include-: The pandemic is more serious in poor communities, where food is difficult to secure. The dynamism of the pandemic is complex, requiring flexibility and adaptation to new challenges. Communities are able to deal with their own problems given the appropriate capacity and skillssuch as Teacher-to-child-to-parent HIV and AIDS prevention and community-based micro projects (CBMP) for OVC and support groups. Commitment and passion for work has helped staff members accomplish their objectives. Need for increase in understanding and competency regarding HIV and AIDS among the general membership at branch and divisional level. Need to define and implement human resource and other policies more clearly. The ART roll out brings a new paradigm to traditional Red Cross interventions of HBC, OVC and prevention, with the opportunity for LRCS to work more on positive prevention Challenges LRCS encountered a number of challenges which include: Increased resources are required to strengthen volunteer management; 6

7 Working with communities on HIV and AIDS needs a collaborated and collective approach to avoid confusing the community on the identity of the National Society; A clear strategy on reduction of stigma and discrimination is needed; Need to market the National Society for increased influence and acceptability at all levels is paramount for effective programme implementation and effectiveness; Mobilizing resources to assist in strengthening the capacity of LRCS for increased effective coordination and management is critical for sustainability; Increased integration of programme activities is required to ensure a more holistic and effective response Recommendations LRCS will consolidate and scale up the integrated approach to HIV and AIDS under the new programme, which has been observed to provide a more holistic and effective response. LRCS will mobilise more resources under the new HIV and AIDS programme to enable an effective scaling up of the interventions. LRCS will review its policies on volunteer management including incentives to increase the retention rates of staff and volunteers. LRCS will continue to ensure community participation in its activities; to increase ownership and acceptability of the interventions. 3.0 The new HIV and AIDS programme This new Integrated HIV and AIDS Programme is part of the Southern Africa regional HIV and AIDS programme, which is a component of the International Federation Global HIV and AIDS Alliance. The activities under this programme will support the country s national HIV and AIDS policies and programmes and will be in line with the Fundamental Principles of the International Federation Red Cross and Red Crescent Specific scope of the activities in the programme has been developed based on the national strategic plan and harmonized with tasks agreed under the international assistance arrangements in Lesotho including United Nations Joint Programme on HIV and AIDS (UNAIDS), and other UN agencies, NGOs and civil society groups, and donors. The purpose of the HIV and AIDS Programme is to reduce vulnerability to HIV and its impact in Lesotho through achieving the following outputs: HIV infections are prevented Care, treatment, and support are expanded Stigma and discrimination associated with HIV and AIDS are reduced. These will be bolstered by a fourth output: The National Society s capacity is strengthened to enable more effective, expanded, direct outreach to served communities. The programme will reach one million people (youth, women and men) with HIV prevention interventions, and provide care and support to 7,200 PLHIV and 10,200 OVC in all the districts of Lesotho by Output 1: HIV infections are prevented Strategy 1: Promote culturally sensitive information, education and communication (IEC) on HIV and AIDS for sexual behaviour change among the general population and high-risk populations one million people. Conducting a Knowledge, Attitude, Behaviour and Practice (KABP) baseline and end of programme surveys. 7

8 Mobilizing and educate communities (general population and youth) on HIV and AIDS, sexually transmitted infection (STIs), TB, common illness, gender and other related social issues. Recruiting and training 1,000 ICHBC volunteers on HIV prevention issues; and 400 peer educators Recruiting, train and support 300 drama groups. Disseminating information on HIV and AIDS, STIs, TB and other health issues through songs, poetry, role plays and IEC materials to one million people. Conducting mass media campaigns at national, district and community level. Conducting life skills, sexual reproductive health and first aid training for prevention volunteers. Establishing and maintaining 200 youth anti-aids clubs in all districts. Designing and producing cultural sensitive IEC materials in collaboration with partners. Integrating HIV and AIDS activities such as information on HIV and AIDS, condom distribution into malaria, TB, immunization programmes, food security and other programmes. Mapping peer education programmes in the country and assessing unmet needs. Conducting two national level stakeholders trainings on HIV prevention, knowledge and skills. Conducting ten district level stakeholders trainings on HIV prevention, knowledge and skills. Strategy 2: Improve condom promotion, provision and distribution in 180 LRCS sentinel posts Training volunteers on condom distribution, practices and establish condom distribution networks and outlets Procuring and distributing 30 million male condoms and five million female condoms per annum. Conducting sensitization community seminars on correct and consistent use of condoms. Strategy 3: Promote increased uptake of VCT, PPTCT and ART services among the general population, youth and high-risk groups using peer-to peer information and community mobilization by 2010 Mobilizing and sensitizing communities to utilize VCT, PPTCT and ART services including sexual reproductive health, STIs, TB control services and related health services. Develop and support drama, radio, television programmes and educational materials informing people about VCT, PPTCT, ART and other related health services. Networking and collaborating with relevant ministries and stakeholders to identify services for ICHBC beneficiaries such as VCT and PPTCT. Implementing and maintaining confidential referral system. Output 2: Care, treatment and support services expanded. Strategy 1: Provide care, treatment and support for 7,200 PLHIV by 2010 Conducting baseline and end of programme surveys to assess care, treatment and support services to PLHIV Mobilizing and educate 7,200 PLHIV and 10,200 OVC on ART and TB treatment; as well as on the other common health issues. Recruiting, and train 1,050 active staff and volunteers in ICHBC activities including HIV and AIDS, basic gender issues and Memory 1 work. 1 Memory Box - is one of the Red Cross initiatives to help mothers and fathers, powerless in the face of death due to HIV and AIDS, to communicate with their children by making a treasure chest of information such as family, photographs, letters, stories and history. The memory box also serves as an important vehicle in the AIDS education battle, by allowing people to talk openly about the disease 8

9 Procuring, developing and translating the ICHBC training manual based on Federation toolkits and MoHSW for training for trainers (ToT), ICHBC facilitators. Conducting home visits and provide psycho-social support to PLHIV and palliative care Procuring HBC materials (1,000 HBC kits, uniforms, boot bags, bicycles, etc). Establishing and maintaining support groups for PLHIV by 2010 Assisting ICHBC clients in writing wills and succession planning. Providing medical and funeral support to ICHBC facilitators. Establishing and maintaining 33 support groups for ICHBC facilitators. Supporting and developing of branch committees to coordinate ICHBC activities. Strategy 2: Establish systems to improve food security and nutrition measures for 7,200 households affected by HIV and AIDS Training PLHIV affected households in management skills and support them to establishing IGAs and horticultural projects. Providing food supplements and supporting most vulnerable clients and OVC. Establishing partnerships and networking with agencies involved in promoting food security and nutrition (for example World Food Programme (WFP) and MoHSW). Supporting food production and storage: Distributing fast maturing and drought resistant seeds. Developing partnerships with organizations with best practices on IGAs/self help projects. Strategy 3: Provision of material assistance including school materials and psychosocial support to 10,200 OVC by 2010 Conducting OVC situation analysis, identifying and registering the most vulnerable OVC in all project areas by Providing educational, material and psychosocial support for OVC. Implementing memory work, establishing youth clubs and involving OVC in writing wills and leisure activities including sports. Establishing and maintaining support groups for OVC. Ensuring access to paediatric ART and literacy for OVC including other health care services Providing shelter support for special cases. Establishing and maintaining skills development programmes with OVC that is horticulture projects and IGAs. Sensitizing and holding meetings with community leaders, OVC committees, school heads, local authorities and other partners (government, donors and private sector among others) to solicit support for OVC. Training OVC peer educators and supporting them to conduct home visits and counselling of OVC, and psychosocial support. Establishing and regularly update provincial and national database on OVC. Output 3: Stigma and discrimination associated with HIV and AIDS reduced Strategy 1: Intensify awareness on the rights of PLHIV, children, OVC and women in the area of HIV and AIDS. Lobbying government for developing and implementing of relevant policies for PLHIV, OVC. Designing, producing and distributing IEC materials on anti-stigma and discrimination and rights of children, OVC and women in collaboration with the Lesotho network of PLHIV. Holding divisional competitions (drama and songs among others) on best practices of addressing stigma and discrimination issues. 9

10 Developing procedures of referrals for issues of stigma and discrimination within and outside the LRCS. Integrating anti-stigma and discrimination advocacy messages commemoration days such as World Aids Day. Holding one national anti-stigma and discrimination campaign held per year. Identifying, train and support 50 Ambassadors of Hope. Adapting the Federation regional advocacy strategy and National OVC strategy. Strategy 2: Incorporate HIV and AIDS concerns with the human resource management policy in the National Society. Reviewing Human Resources Management Policy regarding HIV and AIDS issues. Finalizing LRCS Workplace Policy and roll out HIV and AIDS work place programmes at the various levels of the National Society. Evaluating HIV and AIDS workplace policy implementation. Output 4: Capacity strengthened to enable more effective, expanded, direct outreach to served communities Strategy 1: Strengthen staff and volunteer management systems Conducting periodic review of staff needs and volunteers. Reviewing and implement volunteer management policies. Reviewing the allowances paid to volunteers and paying the incentives regularly as well as the salaries of the staff. Strategy 2: Strengthen the capacity of staff and volunteers to plan, implement, monitor and evaluate HIV and AIDS activities and programmes Developing and printing training manuals for training staff and volunteers in planning as well as budgeting, communication skills, advocacy skills, monitoring and evaluation, project management, proposal writing and operational research methods. Training staff and volunteers in planning and budgeting, communication skills, advocacy skills, monitoring and evaluation, project management, proposal writing and operational research methods. Strategy 3: Provide logistical and administrative support to the National Society for effective running of the HIV and AIDS programme Activity Establishing, equipping and maintaining project offices. Strategy 4: improve information sharing and knowledge management Conducting operational research. Facilitating information sharing through meetings, distribution of newsletter and progress report. Documenting best practices. Supervising and monitoring regularly the implementation of HIV and AIDS activities in all the project sites. Establishing HIV and AIDS databases at various levels. 10

11 Strategy 5: Develop resource mobilization, strategic partnerships and alliances with relevant organizations Conducting fundraising activities. Developing marketing materials and work plans at national, provincial and branch levels. Developing and implementing relevant and effective strategic partnerships with key stakeholders. 4.0 Implementation and Management The programme will be implemented by LRCS, as part of an operational alliance on HIV and AIDS in Lesotho with support of the Federation Secretariat. It is anticipated that LSRC will continue to work with its current partners under this new programme, which include the British, German, Norwegian and Swedish Red Cross Societies, the National Olympic Committee and Ministry of Information, Lesotho Network of NGOs, MoHSW, National AIDS Commission (LAPCA), Population Services International, UNICEF, UNAIDS, WFP, Global Fund, LENEPWA and British government s Department for International Development (DFID). The LRCS also anticipates forging partnerships with care International, Christian Health Association of Lesotho, Lesotho Planned Parenthood association and the private Sector Coalition against AIDS in Lesotho. The secretary general will have overall responsibility for the management and coordination of the programme. She/He will also be responsible for linking the National Society on policy issues with the MoHSW, other local partners, sister national societies and the Federation Secretariat.. An action plan is being put in place for the implementation of the recently concluded human resource review. The national HIV and AIDS programme manager will be the focal person responsible for managing this programme. The office of the National HIV and AIDS programme manager will have an administrative programme, assistant/secretary to arrange the administrative issues of the programme. The national prevention officer and the OVC officer will be recruited to support the national programme manager. The district HIV and AIDS project officers will be managing the programme at the district level. The expansion of the programme will necessitate recruitment of assistant project officers and accounts assistants. These will be recruited as and when they are required. The expansion of the programme will also require extra logistical support especially transport. The financial and auditing guidelines and procedures being used by LRCS on its current various projects will be followed and used under the new HIV and AIDS Integrated programme. The overall responsibility of financial management will be with the office of the secretary general, through the head of finance. All financial regulations and procedures will be adapted to ensure compliance with the donor and national legal requirements, while still ensuring proper management and control. An accountant designated for the programme will carry out financial accounting. The national HIV and AIDS programme manager working in conjunction with the accountant will keep track of the flow of funds for the activities. The programme already has an accountant at national level. She/He is the one who will be responsible for management of program finances. The officer will link up with finance officers from the development partners, funding the project. The programme will also use the transport and logistics officer for all project procurements and distributions. The National Society will produce monthly financial statements and reports. Reputable external auditors will annually audit these reports. Financial reports from the projects in the districts will be scrutinized at the national level and advances will be made to the projects on a quarterly basis. Quarterly financial reports will be submitted to the donors, together with the narrative reports. 5.0 Monitoring, Evaluation and Reporting Arrangements Monitoring and evaluation (M and E) of this programme will be very crucial to gather accurate information that will guide planning, implementation, assessment of the performance and impact of the programme. LRCS will develop M and E system that will ensure feedback into the programme. Feasible and simple process indicators have been developed and are in the log frame to assess the implementation and outcomes 11

12 of the programme. Data for assessing some of the outcome and the impact indicators will be generated from surveys such as HIV sentinel surveillance surveys and DHS conducted by other partners. Key staff under this programme will be trained on M & E of the programme, indicators, use of data collection and reporting formats. LRCS will develop simple data collection and reporting formats for the various levels. Database for programme activity for each project area will be developed and confidentially maintained. It will then be compiled, collated and consolidated into a quarterly report at provincial level. The divisional and District managers will be responsible for compiling, making the quarterly reports on the projects under their respective areas. At national level, the national HIV and AIDS programme manager and staff will compile, collate analyse and make national quarterly and annual programme reports. At the community level, volunteers will produce monthly reports and hold monthly debriefing meetings with their supervisors. The latter will also produce monthly reports and hold debriefing meetings with the divisional and district officers. The national HIV and AIDS programme manager will give feedback to the district officers who will in turn provide the same to the volunteers and the community. All national and annual programme progress reports will be distributed to the partners and the Federation regional office. There will be three project reviews; the baseline assessment and review in each of the project areas, midterm output review and towards the end of the project. These reviews will be conducted internally by LRCS, as evaluation tools to measure progress of implementation and any issues related to implementation of the programme. Participatory methods will be used in the reviews. There will be an external evaluation using participatory method, at mid-term that is after the first two years to measure progress towards the set objectives, and then plan the next project phase accordingly. A final evaluation will be conducted at the end of the five-year period. To complement data from programme monitoring and evaluation, operational research will be conducted to provide information for consolidating and improving service delivery and the operations of the National Society Important Assumptions and Risks The successful implementation of this programme will depend on a number of factors. LRCS assumes that; It will mobilize adequate financial resources to implement all the planned activities; All the partners it intends to work with will remain or be committed to HIV and AIDS; Communities will be committed to fight against HIV and AIDS and receptive to the interventions; The government and other partners will listen to the voices of the people living with HIV and AIDS and those affected by HIV and AIDS. This will enhance the involvement of PLHIV in the response and hopefully and will contribute to the reduction of stigma and discrimination; Partners responsible for conducting surveys to generate data to calculate impact and some outcome indicators will carry them out; At the moment there are no visible risks to the programme. 7.0 Programme Budget The estimated budget for this Integrated HIV and AIDS programme is CHF 40,733,471. The programme is currently 6,29% covered and is therefore seeking CHF 38,172,648 to support implementation, the needs of the National Society and the Federation Secretariat s programme support cost. Summary Budget for Activity TOTAL PREVENTION ACTIVITIES CARE SUPPORT AND TREATMENT 52, , , , , , ,712 3,353,585 5,535,569 7,276,677 8,742,115 25,375,658 12

13 REDUCING STIGMA AND DISCRIMINATION INSTITUTIONAL STRENGTHENING FEDERATION SECRETARIAT SUPPORT 93, , , , ,749 1,420, , ,853 1,060,431 6,093,212 1,886,119 10,247,829 77, , ,955 1,111, ,317 3,024,762 Total in CHF 1,048,427 5,095,816 7,567,661 14,964,634 12,056,933 40,733,471 COMMITTED FUNDING 2,560,823 FUNDING GAP IN CHF 38,172,648 % GAP 93.71% Contact information For further information related to this programme please contact: In Lesotho: Thabelo Ramatlapeng, Secretary General, Lesotho Red Cross Society, Maseru; redcross@redcross.org.ls; Phone ; Fax In Zimbabwe: Françoise Le Goff, Head of Southern Africa Regional Delegation, Harare; francoise.legoff@ifrc.org; Phone , ; Fax In Geneva: John Roche, Federation Regional Officer for Southern Africa, Africa Dept.,; john.roche@ifrc.org; Phone , Fax For information on the International Federation Global HIV and AIDS Alliance contact: In Geneva: Dr Mukesh Kapila, Special Representative of the Secretary General for HIV and AIDS; mukesh.kapila@ifrc.org; Phone , Fax

14 Appendix 1: Logframe Narrative summary (NS) Goal: To reduce vulnerability to HIV and its impact in Southern Africa. Purpose: To reduce vulnerability to HIV and its impact in Lesotho. Outputs 1. HIV infections are prevented. Lesotho Red Cross Society HIV and AIDS Programme Objectively verifiable indicators (OVI) Declining HIV prevalence rates for the general population. Declining HIV prevalence rates among pregnant women aged years Survival and improved quality of life Reduced incidence of HIV among target population (one million). Percentage of pregnant women aged years who are HIV positive. Survival and Improved quality of life for 7,200 and 10,200 OVC Objectively verifiable indicators (OVI) 1.1 Percentage of women and men aged years who correctly identify ways to prevent HIV infection 1.2 Percentage of women and men aged years reporting use of a condom at last sex with a non-regular partner casual sex. 1.3 Delayed sexual debut among youths in target population. Means of verification (MOV) UNAIDS Global HIV and AIDS pandemic reports. National DHS. Population surveys. Programme review and assessment reports. Antenatal clinic HIV surveillance. Means of verification (MOV) Population surveys. National demographic health surveys. Health facility reports. National Society reports. Interviews with target groups. Important assumptions Sufficient national budgetary allocations, and international donor assistance resources provided, and access to targeted populations achieved. Important assumptions Willingness of target population to modify their cultural beliefs about sexual behaviour. Availability of donor support to implement the programme. 2. Care, treatment, and support expanded % PLHIV receive care, treatment and support by % of PLHIV on ART from Government health facilities are adequately supported with adherence, treatment literacy and preparedness ,200 households affected by HIV receive food assistance and involved Programme reports. Health facility records. Key informant Interviews Focus group discussions. Willingness of governments to support expansion of care treatment and support interventions. Availability of programme resources

15 3. Stigma and discrimination associated with HIV and AIDS are reduced. 4. Capacity of LRCS is strengthened to enable more effective, expanded, direct outreach to served communities. in livelihood approaches % of OVC receive material, psychosocial, and educational support annually % of households and communities expressing positive attitudes towards PLPHIV % of employers in the impact area not discriminating employees Living with HIV 3.3. Uptake of VCT, PPTCT, ART, TB and STIs services in the impact area is increased to 80% by % staff and volunteers recruited and retained in the programme throughout the period. 4.2 Volunteer management and human resources policies developed, reviewed and implemented 4.3 Timely, quality and accurate reports are produced as required % staff and volunteers trained in planning, reporting, monitoring and evaluation % of project offices are provided with administrative support, equipment and infrastructure. 4.6 Number of Information sharing meetings, operation research and documentation conducted. 4.7 Number of policies produced and implemented Volunteer and human resource 4.8 Resource mobilization conducted and strategic partnerships and alliances established. Interviews with key informants Household and community surveys Focus group discussions Demographic and Health Survey Records of the health facilities, VCT centres and employers. Programme reports Reviews and evaluations Interviews with staff and volunteers to implement the activities. Willingness and commitment by government institutions and stakeholders including communities to reduce stigma and discrimination. National Society integrity and dignity issues may hamper implementation. Willingness of National Society management to culture of work to fit into 21 st century approaches to management. 2

16 Objectively verifiable indicators (OVI) Sources of information Activity to output Output 1 Conducting baseline and end of programme Knowledge, Attitude, Behaviour and Practice (KABP) surveys. Mobilizing and educating communities on HIV, STIs, TB, common illnesses, gender and other related issues through role plays, poetry, and IEC materials. Recruiting and training 800 peer educators and 300 drama groups. Mapping peer education activities in the country to determine needs. Designing, producing and distributing culturally sensitive IEC materials. Conducting two national and ten district level stakeholder s trainings on HIV prevention, knowledge and skills annually. Conducting mass media campaigns. Conducting life skills, sexual reproductive health and first aid training for prevention volunteers. Training volunteers on condom promotion and distribution and establish 80 outlets. Mobilizing and sensitizing communities on the use of VCT, PPTCT and ART services. Developing and supporting drama, television programmes and educational materials informing people about VCT, PPTCT, ART and other related services. Implementing and maintaining confidential referral system. Output 2 Conducting baseline and end of programme surveys to assess care, treatment and support services to PLHIV. Mobilizing and educating 7,200 PLHIV and 10,200 OVC on ART and TB treatment as well as on other common health issues. Number of baseline surveys conducted. Number of IEC materials developed and distributed and the number of people who have received materials Number of peer educators trained. Number of mass media campaigns conducted. Number of people attending VCT and receiving PPTCT and ART services. Number of VCT centres established and operational. Total budget: CHF 664,306 HBC materials procured and distributed. Number of volunteers trained on ART training package. Number of PLHIV and OVC mobilized and sensitized on TB, ART Programme quarterly reports, reviews and evaluation. Focus group discussions. Interviews and observations. Health facility records. Assessment reports. Programme reports. Training reports. Assessment and situation analysis reports. Willingness of the local governments to support the implementation of the projects at local level. Availability of qualified staff at district and provincial level to manage the projects. Availability of volunteers who are willing to participate in the programme. 3

17 Procuring HBC materials (1,000 HBC kits, uniforms, boots, bags, bicycles etc) per quarter Conducting home visits three times a week and four hours per day. Revising the HBC manual. Establishing support groups for PLHIV Recruiting and training 1,050 staff volunteers in ICHBC activities including HIV, basic gender and memory work and on ART training package. Training PLHIV affected households in management skills and support them to establish IGAs and horticultural projects and psychological. Needs. Providing food supplements and supporting the most vulnerable clients and OVC; establishing partnerships and networking with agencies involved in promoting food security and nutrition (such as WFP and MoHSW). Conducting OVC situation analysis, identify and register the most vulnerable OVC in all project areas by Providing educational, material and psychosocial support to OVC. Output 3 Lobbying government for development and implementation of relevant policies for PLHIV, OVC. Designing, producing and distributing IEC materials on anti-stigma and discrimination and rights of children, OVC and women in collaboration with the Lesotho network of PLHIV. Holding divisional competitions (drama and songs among others) on best practices of addressing stigma and discrimination issues. Integrating anti-stigma and discrimination advocacy messages commemoration days e.g. World Aids Day. Holding one national anti-stigma and discrimination campaign per year. Identifying, training and supporting 50 Ambassadors of Hope. and other common health issues. Number of family members trained. Number of support groups established per project area. Number of coaches trained. Number of volunteers and households trained on food security, livelihoods. Number of gardens established. Number of clients and OVC receiving support. Number of situational analysis conducted. Total budget: CHF25,375,658 IEC materials developed and distributed. Number of anti-stigma campaigns conducted. Number of volunteers trained on the rights of PLWHIV and children Number of NS policies developed and implemented. Referral systems in place. Work place police in developed. Total budget: CHF1,420,916 4 Programme reports. Household surveys. Interviews. Availability of policies.

18 Adapting the Federation regional advocacy strategy and National OVC strategy. Designing, producing and distributing IEC materials anti-stigma campaign materials, Reviewing human resources management policy regarding HIV and AIDS issues within the National Society Finalising LRCS workplace policy and roll out HIV and AIDS work place programmes at the various levels of the National Red Cross Society. Evaluating HIV and AIDS Workplace Policy implementation. Output 4 Strengthening staff and volunteer management systems by conducting periodic reviews of staff and volunteer needs. Developing and printing training manuals for training staff and volunteers in planning and budgeting, communication skills, advocacy skills, monitoring and evaluation, project management, proposal writing operational research methods. Training staff and volunteers in planning and budgeting, communication skills, advocacy skills, M & E, project management, proposal writing operational research methods. Establishing, equipping and maintaining project offices. Conducting operational research, information sharing and document best practices. Supervising and monitoring regularly the implementation of HIV and AIDS activities in all the project sites. Establishing HIV and AIDS databases at various levels. Conducting resource mobilization activities and develop strategic partnerships with relevant organizations. Number of staff and volunteers retained Number of staff and volunteers trained on planning, reporting and M & E Number of offices equipped Funds raised Partnerships developed and MOU Operation research protocols and reports Total budget: CHF 1,196,101 Other costs related to capital, transport and storage, personnel and administration amount to: CHF 9,051,728 Federation Secretariat Support Cost CHF 3,024,762 National Society volunteer data base and Human Resources reports Availability of MoU with partners and donor agreements 5