Htc programme


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Htc programme

  1. 1. Coordination complexity archetypes – South Africa (province) 1 Includes provider-initiated VCT SOURCE: South Africa HIV/ AIDS stakeholder interviews Medium High Low Extreme Intervention type (primary) <ul><ul><li>Clinical </li></ul></ul><ul><ul><li>Clinical </li></ul></ul><ul><ul><li>Clinical/ Behavioural </li></ul></ul><ul><ul><li>Behavioural </li></ul></ul>Number of funders <ul><ul><li>0-2 </li></ul></ul><ul><ul><li>3-5 </li></ul></ul><ul><ul><li>>10 </li></ul></ul><ul><ul><li>3-5 </li></ul></ul>Number of implementers <ul><ul><li>1 </li></ul></ul><ul><ul><li>2-10 </li></ul></ul><ul><ul><li>11-25 </li></ul></ul><ul><ul><li>>25 </li></ul></ul>Examples of programs in archetype <ul><ul><li>N/A </li></ul></ul><ul><ul><li>N/A </li></ul></ul><ul><ul><li>PMTCT </li></ul></ul><ul><ul><li>ART </li></ul></ul><ul><ul><li>HCT </li></ul></ul><ul><ul><li>MMC </li></ul></ul><ul><ul><li>OVC </li></ul></ul><ul><ul><li>BCC </li></ul></ul>
  2. 2. The HCT programme has medium to high complexity (1/2) Low Medium High Extreme Funders <ul><ul><li>NDoH funds majority of testing programmes, with Global Fund and PEPFAR the main international donors providing funding for testing </li></ul></ul><ul><ul><li>Private sector contribution is small (and largely unknown) </li></ul></ul><ul><ul><li>Funding is largely vertical (i.e., provincial governments fund facility-based testing, with limited government tenders to CSOs/ NGOs; international donors tend to fund national/ provincial NGOs, who provide technical assistance/ mobile testing within the districts) </li></ul></ul>Implementers <ul><ul><li>At a provincial level, majority of testing is still done within government health facilities </li></ul></ul><ul><ul><li>Each district will have 5-10 NGOs/ CSOs providing technical assistance (in the form of training/ secondments) as well as non-facility based services (e.g., mobile units, door-to-door testing etc.) </li></ul></ul><ul><ul><li>The private sector will offer facilities as well as testing services </li></ul></ul>Size <ul><ul><li>Programme aims to test 15 million people by June 2011, with the private sector expected to contribute 2 million tests </li></ul></ul><ul><ul><li>In 2010 ~ 5 million tests were conducted but no unique identifier to understand where multiple tests on one individual were conducted </li></ul></ul><ul><ul><li>Facility-based testing is largely vertical, with limited coordination required (single, clinical delivery stream based in NDoh facilities) </li></ul></ul><ul><ul><ul><li>Lay counsellors do the majority of pre- and post- testing, with nurses still doing the majority of the tests (slowly starting to shift this lay counsellors) </li></ul></ul></ul><ul><ul><li>Non-facility absed testing is performed by multiple, small CSO’s/ NGO partners </li></ul></ul>Capabilities required SOURCE: South Africa HIV/AIDS response stake holder interviews PRELIMINARY
  3. 3. The HCT programme has medium to high complexity (2/2) SOURCE: South Africa HIV/AIDS response stakeholder interviews 1 HIV/ AIDS, TB and STD director ILLUSTRATIVE HCT lead Provincial National District HCT lead SANAC Prevention Task Team HCT lead Implementers District AIDS council MoH => DG=> HIV Director Directorate for Prevention Premier=>MEC=> Head of department District HAST Director Provincial Nerve Centre Provincial HAST 1 director National Nerve Centre District Nerve Centre Provincial AIDS council National & provincial HCT leads meet quarterly to exchange ideas & information NGOs NGOs NGOs Gvt clinics/ hospitals NGOs NGOs NGOs NGOs (TA/ mobile CT/direct support), Private sector (testing) NGOs NGOs NGOs National NGOs NGOs NGOs NGOs Prevention/ CT leads NGOs NGOs NGOs International donors NGOs NGOs NGOs Prevention/ CT leads NGOs NGOs NGOs National NGOs NGOs NGOs NGOs Prevention/ CT leads NGOs NGOs NGOs Local Nerve Centres
  4. 4. The multi-sector HCT campaign is coordinated by Nerve Centres SOURCE: South Africa HIV/AIDS response stakeholder interviews ILLUSTRATIVE Provincial National Local Implementers SANAC Government (DoH, DSD, DoE) Private sector Civil society Donors <ul><ul><li>Nerve centres have been able to drive implementation of the HCT campaign down to local level </li></ul></ul><ul><ul><li>The nerve centres ability to collect and evaluate data has been limited, and currently the status of the campaign is uncertain </li></ul></ul>Hospital Nerve Centres coordinate local implementers National Nerve Centre updates PDoHs weekly Led by NDoH and SANAC heads, meets weekly National Nerve Center PDoH Hospital Nerve Centers NGOs NGOs NGOs Partners NGOs NGOs NGOs Private sector NGOs NGOs NGOs District facilities
  5. 5. In April 2010, South Africa launched an ambitious campaign to test 15 million South Africans within 13 months % <ul><li>Campaign objectives </li></ul><ul><ul><li>To increase health-seeking behaviour </li></ul></ul><ul><ul><li>To encourage SAs to know their status </li></ul></ul><ul><ul><li>To equip those who are HIV-negative to remain that way </li></ul></ul><ul><ul><li>To create a quick and easy way to access wellness and treatment services </li></ul></ul>Progress against target <ul><ul><li>The Government launched its HIV Counselling and Testing Campaign (HCT) on 15 April 2010 </li></ul></ul><ul><ul><li>The target is to have 15 million South Africans tested for HIV by June 2011; Private sector expected to test 2 million </li></ul></ul><ul><ul><li>To achieve this, all people attending a public healthcare facility would be offered an HIV test, regardless of whether they have symptoms of the disease or not </li></ul></ul><ul><ul><li>Mobile HCT testing centres have also been set up to visit informal settlements and rural areas </li></ul></ul>Persons Tested Persons Counselled Target 15 69% SOURCE: Health-e-news, SANAC, Department of Health, Press Search “ This is the most ambitious HIV testing campaign in the world.” - Mark Heywood, SANAC deputy director Number of participants at Dec 2010 Millions
  6. 6. Programme statistics <ul><ul><li>There is uncertainty regarding the validity of the recorded numbers </li></ul></ul><ul><ul><li>Some believe especially the HCT campaign results may be higher than currently documented as private sector and NGO contributions have not been systematically incorporated </li></ul></ul>Outcomes of the HCT campaign, 2010-2011 Coverage of the HCT programme, 2004-2009 Persons Tested Persons Counselled Target 15 69% SOURCE: Department of Health, ASSA North West 72 Free State Gauteng MP Eastern cape Kwa Zulu Natal Northern Cape Limpopo Western Cape PRELIMINARY Number of participants at Dec 2010 Millions Cumulative HIV Testing Uptake by Province 2004-2009, % of target tested
  7. 7. Key programme players and roles SOURCE: South Africa HIV/AIDS response stakeholder interviews PRELIMINARY Donors and providers of technical assistance <ul><ul><li>PEPFAR & Global Fund provide funding to NGOs for HCT (training, and mobile testing) </li></ul></ul><ul><ul><li>Limited involvement at provincial level </li></ul></ul><ul><ul><li>NGOs offer some TA at district level </li></ul></ul><ul><ul><li>NGOs/ CSOs technical assistance (e.g., training) and mobile testing </li></ul></ul><ul><ul><li>All partners monitor & report to donors (and are required to supply data to district gvt) </li></ul></ul><ul><ul><li>Conduct ad-hoc independent evaluation </li></ul></ul><ul><ul><li>PEPFAR, UNAIDS, EU Donor group provide technical assistance </li></ul></ul>Civil society organisations <ul><ul><li>N/A </li></ul></ul><ul><ul><li>N/A </li></ul></ul><ul><ul><li>Lay counsellors provide majority of pre-/post-test counselling </li></ul></ul><ul><ul><li>Monitor achievements and gaps </li></ul></ul><ul><ul><li>Wrote the civil society declaration </li></ul></ul><ul><ul><li>Input into and challenge policies/ strategies </li></ul></ul><ul><ul><li>DoH allocates resources across provinces </li></ul></ul><ul><ul><li>Donors provide HCT funding budget to DoH </li></ul></ul><ul><ul><li>Target set centrally and disaggregated to district level </li></ul></ul><ul><ul><li>Provincial DoH develop operational plans </li></ul></ul><ul><ul><li>SANAC Secretariat to manage HCT database </li></ul></ul>Government <ul><ul><li>HSRC – annual household survey </li></ul></ul><ul><ul><li>Department of Health/ SANAC lead the development of strategy/ policy </li></ul></ul><ul><ul><li>Majority of testing in government health facilities, led by lay counsellors and nurses </li></ul></ul>Private sector <ul><ul><li>Limited contribution beyond funding employee testing </li></ul></ul><ul><ul><li>Limited involvement </li></ul></ul><ul><ul><li>Providing some facilities and testing services </li></ul></ul><ul><ul><li>Expected to conduct 2 mil tests for HCT campaign </li></ul></ul><ul><ul><li>SABCHOA collects standard template a portion of the PS to feed into DHIS </li></ul></ul><ul><ul><li>Limited involvement </li></ul></ul><ul><ul><li>Limited involvement </li></ul></ul>Strategy/ Policy Resource allocation/ mobilization Planning Implemen- tation Monitoring & reporting Evaluation
  8. 8. Landscape of programme execution SOURCE: South Africa HIV/AIDS response stakeholder interviews <ul><ul><li>No comprehensive, reliable incidence data </li></ul></ul><ul><ul><li>Incidence is not measured in the household survey, although it could easily be incorporated </li></ul></ul><ul><ul><li>Monitoring and reporting is challenging – measuring ‘tests’ not people tested </li></ul></ul><ul><ul><li>Need electronic card system (unique identifier) - in SA have the basic infrastructure in place to roll this out </li></ul></ul><ul><ul><li>Data collection in relation to campaign has been relatively good. However, baseline data quality remains very poor </li></ul></ul><ul><ul><li>Baseline planning very poor: very few targets set at a district/ local level </li></ul></ul><ul><ul><li>Planning in relation to the campaign has been excellent – very detailed disaggregated targets/ milestones </li></ul></ul><ul><ul><li>Illustrates that pressure from senior leaders/ real performance management around achieving clear targets within a certain timeframe can drive good planning </li></ul></ul><ul><ul><li>Mix of government and donor funding (tbd) </li></ul></ul><ul><ul><li>Government has very little visibility into what donors are funding/ what NGOs/ CSOs and the private sector are doing in terms of service delivery </li></ul></ul><ul><ul><li>National strategy is good – ‘almost too much consultation´ </li></ul></ul><ul><ul><li>Problem lies in operationalising the national strategy </li></ul></ul><ul><ul><li>In April 2010, South Africa launched an ambitious campaign to test 15 million South Africans within 13 months </li></ul></ul><ul><ul><li>Being monitored by SANAC (HCT Campaign nerve centre) & implemented by DoH </li></ul></ul><ul><ul><li>Lay counsellors do majority of facility-based counselling (KZN only province where they are incorporated into health system) </li></ul></ul><ul><ul><li>Lay counsellors starting to test as well (task-shifting) - concerns around quality control </li></ul></ul><ul><ul><li>Disjointed implementation, with no standardized training/ testing model </li></ul></ul><ul><ul><li>NGOs/ CSOs lead on non-facility based testing </li></ul></ul>PRELIMINARY Strategy/ Policy Resource allocation/ mobilization Planning Implementation Monitoring & reporting Evaluation