Yaoundé Rapid Assessment of HIV 11 to15 September Prevention in Cameroon 2017 Inter-agency expert team Madiarra Coulibaly (Alliance Cote d’Ivoire) Dagmar Hanisch (UNFPA Zimbabwe) Clémence Bare (ONUSIDA, BR-AOC) Abdelkader Bacha (UNICEF , BR-AOC)
Context • New infections continue, with insufficient changes in incidence (and stagnation among key populations and young people) • For every 2 people initiated on ART, 5 new infections occur. • Resources allocated for prevention are declining with the growing focus on treatment prevention needs to be strengthened through political and financial mobilisation at all levels • Global Coalition for Prevention to be lanced in October 2017 – Cameroon is part of the selected priority countries • At country level: a complimentary process to others such as NSP, GF Concept Note, Start free, stay free, AIDS free…
Aim of the Rapid Assessment Support/strengthen the national prevention response through a systematic evaluation of the (primary) prevention pillars* and their management at country level. *5 pillars selected at the global level, to be adapted to the country context (see pillars in the plan)
Objectives • Engage in dialogue with main stakeholders on the national HIV (primary) prevention strategy, management and coordination of the response, capacities, and implementation • Identify gaps and bottlenecks • Strengthen national prevention strategies, especially in strategic documents, e.g. NSP, GF Concept Note, etc • Generating recommendations for addressing gaps in the medium term, as well as needs for technical assistance and resource mobilisation
Rapid Assessment Team • Regional HIV prevention experts with proven expertise in programmes as well as strategic analysis (3 UN agencies, International AIDS Alliance) • Local team – UNAIDS country office, UN Joint Team on AIDS, and resource persons from government and civil society
Methodology • Combination of desk review, key informant interviews, and focus group discussions • Participatory process, flexible, and adapted to country needs and analyses (NSP, CN, CoP etc) • Inclusive dialogue • Checklist used as guide, adapted to the context • Meetings with key prevention actors, including visits to service delivery sites
Limitations • The standard protocol includes two ‘light’ phases: evaluation and national consultation • Process was shortened in Cameroon to one stage only, with short evaluation of 3 days and 1.5 days of national consultation to create a road map • Meetings were somewhat limited in the diversity of partners: some key populations (FSW), pharmacy dept, CCM, and private sector could not be visited
• 2016 Prevalence 15-49 ys 3,8% [3,1% - 4,5%] Estimated number PLHIV 2016- 560 000, women 356 925, • Country men 203 793 Estimated number of new infections (2016) 32 000 of which approx. • Profile 20 000 among women and among adolescents 12 509 (all sexes) Number of HIV+ adolescents (10-19 ans): Girls 25 446, Boys14 598 • Number of young (15-24 ans) PLHIV Girls 56 011, Boys 20 536 • Annual AIDS-related deaths 29 000 • 600000 Key Populations Average Prevalence / City Prevalence 500000 123460 73060 400000 202858 175158 Bamenda : 32,8% 560000 300000 380540 Douala : 30,6% Female Sex workers 200000 (75,5%) 24,3% Bertoua : 24,3% 205382 175420 100000 (45,3%) Yaoundé : 23,3% 29962 (7,3%) Kribi : 15% 0 Men having sex Yaoundé : 45,1% with men (MSM) Douala : 25,7% 20,6% Bertoua : 9,2% Kribi : 5,9% Bamenda : 3,9%
Notre plan Analysis of planning and systems for HIV prevention 1. National HIV Prevention Strategy 2. Results framework and targets 3. HIV prevention coordination structures / systems 4. Management and financing capacities for HIV prevention
Notre plan (suite) Analysis of HIV Prevention Programmes in Cameroon 5. Implementation • Cross-cutting aspects of prevention implementation • Condom promotion & distribution • Key Populations • HIV prevention among girls and young women (and their partners) in a context of high prevalence and vulnerability • Pre-Exposure Prophylaxis (PrEP)
Main Results Findings & Recommendations
Part 1- Analysis of HIV Prevention Planning & Systems 1. National strategic framework for HIV prevention 2. Results framework and targets 3. Prevention architecture & systems 4. Management and financing capacities for HIV prevention
1. National Strategic Framework
1. National Strategic Framework (1) Findings • Recently developed National AIDS Strategic Plan 2018-2022 contains significant combination prevention component • Standalone documents for specific prevention areas exist (Youth & adolescents, gender & HIV, PMTCT , HIV communication strategy, Education sector HIV strategy, condom programming … ) • There are sector strategies targeting young women (MINJEC, MINESUP , MINPROFF , MINAS, MINEDUB/MINESEC, MINDEFENSE … ).
1. National Strategic Framework (2) Recommendations • Develop a two year operational plan with a prevention component addressing the gaps in primary prevention identified in the respective pillars of this evaluation • Strengthen the “locations / populations” angle in the operational plan, using the ‘cities & HIV’ approach in the 14 selected cities, including youth and key populations • Some sector strategies need updating in view of the new NSP and the findings of this assessment
1. National Strategic Framework (3) Technical Assistance • Development of operational plan / roadmap • Implementation of the cities approach • Support to partners for updating of sector strategies
2. Results Framework and Targets
2. Results Framework and Targets (1) Findings: • Prevention results chain is well articulated in terms of results and measurable indicators for the major pillars of HIV prevention • NSP impact level target for prevention (reduction in new infections) is set at 60% for 2022, below the Fast Track recommendation which envisages a reduction in new infections by 75% in 2020 compared to 2010 • There are currently no district level targets, including for the high-priority districts
2. Results Framework and Targets (2) Recommendations: • Analyse and build consensus on impact level targets for reduction of new infections in light of the Fast Track recommendation – to be discussed • Develop a Prevention Acceleration Roadmap/two year operational plan with targets and indicators at central and decentralised levels • Strengthen data collection by integrating community data and standardise service packages across geographical areas and funders Technical Assistance • For development of road map/operational plan with disaggregated results framework and operational follow-up systems
3. Prevention Architecture - Governance & coordination
3. Prevention Architecture - Governance & coordination (1) Findings: • There is leadership of the HIV response, but with a need to strengthen the prevention aspect • The multisectoral response is coordinated by GTC/NAC, located within the MOH • The health sector response to HIV prevention remains insufficient, as well as intra-ministerial coordination and creation of synergies between different directorates • Other sectors (Social Affairs, Youth & Training, Education, Defense…) are motivated with interesting perspectives but limited impact due to a lack of real coordination and financing, according to discussions
3. Prevention Architecture - Governance & coordination (2) Findings – cont. • There is no steering committee or specific technical working group for HIV prevention • Actual private sector engagement is limited or has little visibility although there are attempts to reinvigorate PPP in HIV prevention • There is no partnership forum which is able to address issues of HIV prevention • There are thematic working groups in different areas of HIV prevention but they lack an overall vision and fail to create synergies
3. Prevention Architecture - Governance & coordination (3) Recommendations : • Establish a ‘light’ specific multi-sectoral working group for HIV prevention which includes all key government sectors, civil society, private sector and key partners, with TOR and clear deliverables • Establish a HIV partnership forum • Develop a roadmap for HIV prevention activities to be presented in Geneva (launch of the coalition) • Carry out a situational analysis of the institutional framework of the HIV response with support from UNAIDS, with the aim of optimising the existing structures and improving performance
3. Prevention Architecture - Governance & coordination (4) Technical Assistance: • Setup of national partnership forum including UNJT • Consultations on analysis of the institutional framework • National dialogue and advocacy with stakeholders for implementation of recommendations from the institutional framework analysis • To organise a forum with the private sector around HIV prevention
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