PEPFAR VIETNAM'S STRATEGIC INFORMATION ACTIVITY

UNCLAS SECTION 01 OF 03 HANOI 000094 SIPDIS SIPDIS STATE FOR OGAC (AMBASSADOR DYBUL, JHOLLOWAY, KMARCONI) HHS/OSSI/DSI PASS TO HHS/OGHA (WSTIEGER, LVALDEZ, CHICKEY, MWYNNE) AND NIH/FIC (RGLASS) AND SAMHSA (CWESTLY) USAID FOR ANE (CJENNINGS, MWARD) AND GH (KYAMASHITA, KHILL) BANGKOK FOR USAID/RDM/A (OCARDUNER, CBOWES) CDC FOR COGH (SBLOUNT),CCID (MCOHEN),and GAP (DBIRX, RJSIMONDS) E.O. 12958: N/A TAGS: PGOV PROP SOCI TBIO EAID SNAR KHIV VM SUBJECT: PEPFAR VIETNAM'S STRATEGIC INFORMATION ACTIVITY REF: HANOI 1082 (2007) ¶1. (U) Summary. The President's Emergency Plan for AIDS Relief (PEPFAR) plays an important role in U.S.-Vietnam relations and is the single largest vehicle for U.S. bilateral assistance. As in the 14 other PEPFAR nations, information collection and analysis play an important role in promoting AIDS prevention efforts here. Our strategic information (SI) challenges, however, are unlike those in other PEPFAR nations due to differences in the nature of the epidemic and the government environment in Vietnam. In this message, we seek to outline the distinctive problems we face here and our approaches to addressing them. In particular, we document how we are reacting to deficiencies in Vietnam's health establishment through capacity building at the Ministry of Health (MOH) and other national institutions, which we see as essential for programmatic success. To better focus efforts, and to help build a common OGAC-Mission Vietnam vision for the SI activity, we request headquarters technical support from the OGAC Strategic Information (SI) Team Leader and the Vietnam SI advisor. End Summary. ¶3. (U) "Strategic information," or SI, empowers policy makers to both "know the epidemic" and "know the results" from on-going efforts. SI is critical in the process of developing efficient planning of evidence-based implementation approaches and in optimizing the use of resources. SI is tied to the systems that produce it. In health, an SI system is a networked, integrated set of processes to manage information and assist in strategic decision making. It supports and shapes the strategy of an organization, often leading to innovation in the way the organization conducts its work, the creation of new opportunities, and the development of services. SI in Vietnam -------------- 4.(U) Intravenous drug use largely drives Vietnam's HIV epidemic, a situation very different than that in the other 14 PEPFAR nations. Accordingly, efforts in Vietnam have focused on implementing a customized SI program focusing on prevention. The in-country PEPFAR team worked with the Office of Global AIDS Coordinator (OGAC) SI technical working groups and OGAC assigned technical advisors to develop the Vietnam-specific SI strategy. Focused on training, data use, and information exchange, SI efforts to date have promoted the use of models and tools to increase the availability of accurate and relevant information forms the basis of planning, implementation, monitoring, evaluation, and management of HIV programs. The in-country SI Team provides direct technical assistance to the GVN, national technical working groups (TWGs),and program implementers for program monitoring and evaluation, health information systems, surveillance and surveys, and human capacity development (HCD). Through national MOH-led TWGs, the team develops training, guidelines, and implementation plans for national SI activities. USG technical staff and funded partners review and analyze data for each PEPFAR program area to assess and improve the quality of information collected during service delivery. Finally, team members strengthen HCD by formalizing partnerships among national training institutions and MOH to develop curricula and applied learning opportunities to build a qualified public health workforce. ¶5. (U) Last summer, Mission Vietnam's Front Office undertook a detailed review and analysis of "strategic challenges" facing the PEPFAR program in Vietnam (reftel). Their conclusions highlighted the need to build capacity in the broader health sector and to improve sustainability of donor supported programs. To maintain health sector improvements and buttress PEPFAR success, they determined that Vietnam must improve its capacity to manage and use information to evaluate and improve program performance. Though PEPFAR information activities have contributed to continued GVN progress in developing timely and complete information, Mission leadership determined that refocusing on-going activities in SI will allow Vietnam and the PEPFAR program to shift their primary focus from providing "emergency relief" to building long-term Vietnamese capacity to sustain its fight against HIV/AIDS. Therefore, as designed and implemented, PEPFAR Vietnam's SI strategy is tailored to promote the creation of a set of standardized methods and tools, staff trained in data use, and an integrated information system centered in the Ministry of Health (MOH),and including data from all HIV program activities regardless of funding source or implementer. Resources HANOI 00000094 002 OF 003 -------------- ¶6. (U) In line with OGAC guidance, approximately 6.6 percent of the total COP FY 2008 budget is directly devoted to the SI program area, supported by a nine-person in-country team, five of which were newly approved in the FY2008 COP. Currently, the PEPFAR team has filled five positions and is recruiting for the other four. Additionally, funding and support from other program areas assists the development of SI through information collection as part of normal service delivery operations and by providing expert program-specific input to data collection and use plans. Accomplishments -------------- ¶7. (U) Consistent with the SI mission and strategy, SI-supported national TWGs, in close cooperation with PEFPAR partners, such as MOH, UNAIDS, World Health Organization (WHO),World Bank (WB), Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM),have developed a framework to begin monitoring and evaluation, established a sentinel surveillance system, conducted special surveys including the Integrated Biological and Behavioral Surveillance (IBBS) and AIDS Indicator Survey, and strengthened components of various health information systems. These TWGs plan to conduct another round of IBBS and national activities aimed at estimating the size of most-at-risk populations. Surveillance and survey activities are being targeted on these populations with behavioral and population size estimation data prioritized Information systems have been developed and are being piloted for routine service delivery of HIV care, treatment, and prevention. Current Challenges -------------- ¶8. (U) PEPFAR SI efforts do not lack financing or USG human resources. However, the inability of central authorities to implement and manage infrastructure and human capacity, coordinate national programs through the MOH, or deploy SI tools most relevant to Vietnam hamper overall HIV prevention efforts. Because all PEPFAR HIV programs in Vietnam are implemented through the GVN, this lack of capacity affects PEPFAR's ability to obtain quality information on supported programs. While reporting systems already exist and PEPFAR technical staff members continue to work with their GVN counterparts to improve data quality and use, the capacity to collect and report quality data remains extremely limited. ¶9. (U) Vietnam's increasingly decentralized approach to health sector reform further complicates SI efforts. The GVN needs to upgrade systems infrastructure while hiring and training its own staff on relevant SI activities. The current (poorly designed) reporting system is too cumbersome. In particular, capacity and appropriate systems are lacking to 1) review and revise across programs and funding streams; 2) further develop and standardized tools for collection and dissemination to ensure a nationally centralized source of information on all HIV program activities; 3) maintain, organize and systematize existing data to improve data quality and completeness; 4) continue to prioritize surveillance and population size estimation to improve reliability for the hard-to-reach and most at risk populations, which form the focus of the current epidemic; and, 5)develop, organize and conduct, in coordination with domestic and foreign experts, trainings and workshops to promote the strategic use of information derived from the above programs. The Way Forward -------------- ¶9. (U) The establishment of national TWGs and associated cooperative frameworks provides a mechanism through which to build a functional system. TWGs must target field level (i.e., provincial or district) involvement and use customized approaches that work at facility and community levels. One important goal is to institute the use of nationally standardized forms, combined with a capable and affordable software development private sector, which will allow Vietnam to establish nationally standardized and integrated information systems centered and coordinated by in the MOH. Comment: Forging A Common USG Strategy -------------- ¶10. (U) Recent discussion of Vietnam's FY2008 COP review has revealed concerns within OGAC regarding the strategy and focus of HANOI 00000094 003 OF 003 the SI activity of PEPFAR in Vietnam. From the Mission Vietnam perspective, some of these concerns might be attributed to the stark differences in the epidemic and government environment we face here compared to those in other PEPFAR nations. Regardless of their origin, Mission Vietnam and its PEPFAR team is committed to eliminating misunderstandings and forging a common understanding as we move forward together. With that goal in mind, we request continued technical support from the OGAC SI team with a concerted focus on SI-specific technical experts in national strategies for size estimation, surveillance systems, and information systems. In addition, the PEPFAR Team requests that the OGAC SI Technical Work Group leader and the Vietnam SI advisor visit Vietnam to assist team Vietnam to finalize a concrete strategy to address the data issues unique to Vietnam. MICHALAK