BUILDING THE PRESIDENT'S EMERGENCY PLAN FOR AIDS

UNCLAS GABORONE 000405 SIPDIS STATE FOR S/GAC, AF/S, EAP, WHA AND OES; DEPARTMENT PLEASE PASS TO PEACE CORPS WASHINGTON; DEPT ALSO FOR AID; HHS FOR WSTEIGER E.O. 12958: N/A TAGS: KHIV SOCI TBIO EAID KPAO BC HIV AIDS SUBJECT: BUILDING THE PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF IN BOTSWANA REFS: A) STATE 28801; (B) 04 BOTSWANA 1572; (C) 04 BOTSWANA 1170 AND PREVIOUS ¶1. Summary: Botswana is one of 15 focus countries assisted by the President's Emergency Plan for AIDS Relief. In FY- 2004, the U.S. Mission in Botswana expended more than $18 million for Emergency Plan HIV/AIDS prevention, treatment, and care. More than $35 million has been programmed in FY- ¶2005. From August through October 2004, a USG interagency team engaged in a broadly participatory process with the Government of Botswana (including the Country Coordinating Mechanism of the Global Fund),civil society, the United Nations, and other partners to prepare a Five-Year Emergency Plan Strategic Plan and a FY-2005 Emergency Plan Country Operational Plan. Both plans were reviewed and approved in Washington, with the exception of two small projects that were reprogrammed. This report describes the process utilized, which was described by local partners and UN staff in Botswana and Geneva as a best practice. End summary. ¶2. The USG has been working hand-in-hand with local partners in Botswana on HIV/AIDS and tuberculosis since ¶1995. However, in 2000 the HIV/AIDS program began to rapidly scale up with the advent of the DHHS/CDC Global AIDS Program. Further significant increases occurred in 2003 with the commencement of the President's Initiative for PMTCT. In FY-2004, USG HIV/AIDS funding in Botswana doubled under the Emergency Plan to more than $20 million, and nearly doubled again to about $40 million in FY-2005. ¶3. In developing the FY-2004 Country Operational Plan (COP) -- the first year of the five-year Emergency Plan -- the U.S. Mission Emergency Plan team (comprised of State, DHHS/CDC, the USAID Regional Program, Peace Corps and the DOD Office of Defense Cooperation) formed an advisory Steering Committee, chaired by the Coordinator of Botswana's National AIDS Coordinating Agency (NACA) (which is charged by the Office of the President with coordinating all national HIV/AIDS interventions). The Steering Committee included the Ministries of Education, Finance & Development Planning (which oversees all international development assistance),Health, and Local Government (which oversees palliative care and assistance to orphans),along with UNAIDS, UNDP, UNFPA, UNICEF, and WHO. The Steering Committee endorsed the FY-2004 COP, which was approved in full by the Office of the Global AIDS Coordinator. ¶4. In 2004, the preparation of the Emergency Plan Five-Year Strategic Plan and the substantial increase in funds available for the FY-2005 Emergency Plan COP provided the U.S. Mission with the opportunity to undertake a more extensive participatory strategic planning process. The Steering Committee was brought under the purview of the HIV/AIDS Subcommittee of the Country Coordinating Mechanism (CCM) of the Global Fund in order to ensure broad participation and coordination with other HIV/AIDS response initiatives. The Steering Committee was also further expanded to include the Ministry of Labor and Home Affairs (which oversees AIDS in the workplace and youth issues). An all-day CCM workshop, led by the CCM Chair (the Secretary for Economic Affairs in the Ministry of Finance and Development Planning),was held on August 26, 2004 to initiate the Botswana Emergency Plan planning process. Participants included the U.S. Mission (led by the DCM, visiting Emergency Plan Core Team members, representatives from six relevant Ministries, five UN agencies and key civil society organizations, and the African Comprehensive HIV/AIDS Partnership (ACHAP - the Gates and Merck Foundations). ¶5. The CCM endorsed the formation of five Technical Working Groups (TWGs): 1) behavior change communication for prevention, youth, and gender issues; 2) care and treatment (including PMTCT, blood safety, injection safety, ARVs, laboratory strengthening, sexually transmitted infections, palliative care, tuberculosis and other opportunistic infections); 3) HIV counseling and testing; 4) orphans and vulnerable children; and 5) strategic information and capacity building (including monitoring and evaluation, human capacity development, informatics, policy analysis, and system strengthening including program management training). Each TWG was composed of technical experts drawn from the Government of Botswana, the U.S. Mission, the UN, and civil society. ¶6. The USG Mission became the secretariat for all TWGs, providing technical, administrative and logistical support. This proved to be important in maintaining the momentum of the effort and relieving other partners, particularly government officials, of the cumbersome burden of such matters. Participants were only asked to express their ideas, not to manage the process. ¶7. Guided by the Botswana HIV/AIDS National Strategic Framework (2003-2009) and National Operational Plan (2003- 2009),nearly 100 TWG participants spent many hours in August, September, and October 2004 providing input for the Five-Year Strategy and FY-2005 COP, often meeting on a weekly basis. A senior technical USG representative provided linkage to each group, and a U.S. consultant with skills in participatory program planning provided day-to-day coordination and edited the input from the groups. On October 13, the Steering Committee endorsed both documents. The CCM Chair added his endorsement on October 22, clearing the way for final approval by the Ambassador and submission to Global AIDS Coordinator Randall Tobias by the October 29 deadline. Both plans were reviewed and fully approved in Washington, with the exception of two small projects (representing less than half of one percent of the total budget) that were reprogrammed. ¶8. As a reference for interested posts, the Terms of Reference for the Steering Committee and TWGs are included in paras 13 and 14. The Emergency Plan Process in Botswana - A Success Story -------------- -------------- ¶9. The U.S. Mission is very pleased with how well the consultative process engaged key HIV/AIDS intervention partners in the nation, building on Botswana's outstanding political will and leadership -- most notably that of President Festus G. Mogae. Our five-year strategy and FY- 2005 COP not only reflect widespread consensus on Botswana's most critical needs for HIV/AIDS intervention, they have also been formally adopted by the Government of Botswana and other key institutions, paving the way for rapid and effective project implementation. Employing the already existing Global Fund Country Coordination Mechanism (CCM) and utilizing multi-agency TWGs has ensured that there is no duplication of effort among key partners, has allowed a broad range of technical experts and decision-makers to be instrumental in developing the Emergency Plan, has assured that the objectives of Botswana's national strategic framework are recognized and fully incorporated, and has contributed to the overall sustainability of the many new and existing initiatives under the Emergency Plan. ¶10. It is worth noting the importance of the Mission's seamless internal USG interagency process, led by the Ambassador, which enabled the USG in Botswana to always be on the same page and speak with one voice. Team Botswana (State Department, DHHS/CDC, USAID, Peace Corps and DOD/ODC) truly left their uniforms at the door and collaborated to create a unified Five-Year Strategy and FY-2005 COP. The DCM, as the interagency head of the Emergency Plan process, routinely gathered Team Botswana together to resolve questions and issues that arose. ¶11. It is also important to single out the work of civil society organizations. Their involvement in the Emergency Plan process is a key to success as they are in the forefront of identifying and responding to the challenges and issues of implementing HIV/AIDS intervention at the community level. ¶12. Comment: The U.S. Mission feels the process involved has been well worth the effort. Commenting on the process employed in putting together the Emergency Plan, the Botswana WHO Representative commented: "This is a best practice for being inclusive. We commend the management style of the Emergency Plan team in Botswana. Indeed they are a team to emulate." During the Ambassador and CDC Director's recent visit to Geneva, UNAIDS Deputy Director Michele Sidibe commented, "Botswana represents a model that other countries should emulate in fighting the HIV/AIDS pandemic." We trust this description of how we built the Emergency Plan in Botswana will provide ideas for other focus countries and for other USG HIV/AIDS intervention programs in the future. ¶13. Terms of Reference - Steering Committee -------------- In order to maximize the benefit from and coordinate the implementation of PEPFAR, a Steering Committee with representation from the Government of Botswana, relevant UN agencies, and the U.S. Embassy country team, including the BOTUSA Project, was constituted in 2003. With the need to develop a five-year strategic plan and plan for the doubling of funding available in FY-2005, this steering committee is being reactivated with these terms of reference. Composition of Steering Committee: -- The Permanent Secretaries, or their representatives, from five Ministries from the Government of Botswana (Education, Finance & Development Planning, Health, Labor and Home Affairs, & Local Government). -- National AIDS Coordinating Agency (NACA) -- The Agency Heads, or their representatives, from five United Nations Agencies (UNAIDS, UNDP, UNFPA, UNICEF and WHO) -- U.S. Mission (State Department, DHHS/CDC (BOTUSA), USAID/RCSA). Goal of Steering Committee: To guide the U.S. Mission in developing a PEPFAR program that most effectively combats the HIV/AIDS epidemic in Botswana through the Government of Botswana's 2003-2009 HIV/AIDS Response National Strategic Framework and National Operational Plan and the U.S. Government's PEPFAR objectives. Specific Objectives: -- To provide policy guidance, advise on, review, and approve a five-year PEPFAR Botswana Strategic Plan - 2004- 2008, and an FY-2005 Country Operational Plan (COP),which will be drafted by five Technical Working Groups (TWGs). The TWGs are being formed working under the auspices of the Botswana Global Fund Country Coordinating Mechanism (CCM). -- Critical policy guidance is needed on: (a) Distribution of funding by priority area - prevention, treatment, and care and support, and (b) Distribution of funding by partner type - Government of Botswana funding, international contractor, university, international NGO, UN agency, local NGO, etc. -- To provide oversight as needed at the policy level for future needs in planning, implementation, monitoring, and evaluation of PEPFAR Botswana. Steering Committee Operations: -- The Chairperson of the Steering Committee will be the NACA Coordinator or her designee. -- The TWGs will report to the Steering Committee, which in turn will report to the Chairman of the CCM. -- The CCM will provide the above-named documents to U.S. Ambassador to Botswana Joseph Huggins for his approval and submission to Ambassador Randall Tobias, U.S. Global AIDS Coordinator. -- The U.S. Embassy country team will provide administrative and technical support to the Steering Committee. ¶14. Terms of Reference - TWGs -------------- A steering committee with representation from the Government of Botswana, relevant UN agencies, and the U.S. Embassy country team, including the BOTUSA Project, was constituted in 2003 to maximize the benefit from and coordinate the implementation of PEPFAR. With the need to develop a five- year strategy and plan for the doubling of funding available in FY-2005, PEPFAR technical working groups (TWGs) are being formed working under the auspices of the Botswana Global Fund Country Coordinating Mechanism (CCM). Technical Working Groups: There will be a total of five TWGs in the following areas: -- Behavior Change Communication for Prevention, Youth, and Gender (BCC) -- Care and Treatment, including PMTCT, blood safety, injection safety, ARVs, sexually transmitted infections, palliative care, tuberculosis and other opportunistic infections (Care) -- HIV Counseling and Testing (HCT) -- Orphans and Vulnerable Children (OVC) -- Strategic Information and Capacity Building, including monitoring and evaluation, human capacity development, laboratory infrastructure, informatics, policy analysis, and system strengthening including program management training (SI/CB) Composition: Each TWG will have a chairperson, a secretary, and members drawn from the Government of Botswana, the UN, the U.S. Embassy country team, and civil society. Reporting: The TWGs will report to the PEPFAR Steering Committee, which reports to the Chairperson of the CCM, representing the Permanent Secretary of the Ministry of Finance and Development Planning. Purpose: The TWGs will have the following objectives: -- To provide technical input into the PEPFAR Botswana five- year strategic plan using the guidelines provided by the U.S. Office of the Global AIDS Coordinator. -- To provide technical input into the PEPFAR Botswana FY- 2005 Country Operation Plan using the template provided by the U.S. Office of the Global AIDS Coordinator. -- To provide technical input as requested by the PEPFAR Steering Committee for future needs in planning, implementation, monitoring, and evaluation of PEPFAR Botswana. Rationale: Working through TWGs under the PEPFAR Steering Committee in the CCM will help ensure that PEPFAR Botswana is effective; coordinated with initiatives of the Government of Botswana, the UN, other development partners, and civil society; and aligned with the Botswana 2003-2009 HIV/AIDS Response National Strategic Framework and National Operational Plan. Support: The U.S. Embassy country team will serve as the secretariat to the TWGs providing administrative and SIPDIS technical support. HUGGINS NNNN