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MINISTRY OF FIGHT AGAINST AIDS IVORY COAST REPUBLIC Union – Di
scipline – Work
FOLLOW- UP ON THE UNDERTAKING DECLARATION ON VIH/AIDS (UNGASS)
IVORY COAST NATIONAL REPORT, 2006
TECHNICAL AND FINANCIAL SUPPORT FOR UNAIDS
CONSULTANTS : M. GUELLA Michel ; Economist, Planner M. KONAN K. Clovis, MBA; Économist for health
DECEMBER 2005
2
SUMMARY TITLE PAGE Letters and acronyms 2List of visited organisations 4Introduction 5
Chapter I- Glance on the status 7Chapter II : General view of AIDS epidemiology 12Chapter III : National fight against AIDS epidemics 17
Chapter IV : Main obstacles found and necessary action to reach the targets/aims of UNGASS 27
Chapter V : Necessary support by partners in development in the country 29
Chapter VI : Follow-up – estimation frame, 30
APPENDICES 43
Appendix 1 : Questions on the index evaluation combining national policies
Appendix 2 : Process of consulting/preparing the national report for monitoring the follow-up of the undertaking declaration on VIH/AIDS
Appendix 3 : Form of follow-up and evaluation
LETTERS ANDACRONYMS
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AIMAS Ivory Association of social marketing ARV Antiretroviral AZT Zidovudine CDI Consumer of injected drugs CDV Advice and voluntary tracing CGECI Ivory Coast Confederation of Companies CHR Regional hospital centre CHU University hospital centre CILAD MinisterialComity for fight against drugs CNPI Regional Council of Ivory MDs CPN Pre birth advice CNTS National Centre for blood transfusion, CTV Advice and voluntary treatment DAAF Management of Administration and Financial affairs DGBF General Management of the budget and finances DSRP Strategic document for reducing poverty ENSEA Statistics and applied Economy National College ESC Enquiry for monitoring behaviours IST Infection transmissible sexually HG General Hospital MEMEF State Ministry, Ministry for Economy and Finance MEMSP State Ministry, Ministry for Health and Population MSSSH Ministry of Social Security, Solidarity and Handicapped MEN National Education Ministry MICS Multiple Indicator Cluster Survey MLS Ministry for Fight against AIDS MST Sickness sexually transmissible OEV Orphan and weak child OMS World Health Organisation
ONG Non-Governmental Organisation
ONUSIDA UN common programme against VIH/AIDS
PEPFAR President Emergency ¨Plan against AIDS
PMI Mother anc child protection
PNLS National programme for fighting against AIDS
PNLT National programme for fighting against Tuberculosis
PNPEC National programme for looking after people living with VIH/AIDS PNOEV National programme for looking after Orphans and weak children PTME Prévention de la Transmission Mère-Enfant RETRO-CI Retrovirus on Ivory Coast SIDA Syndrom AIDS TME Transmission from mother to child
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TUB Tuberculosis UGFM Management unit for the world funds UNFPA UN Funds for population UNGASS Specail session of UN General Assembly for VIH/AIDS UNICEF UN programme for childhood VIH Immunodeficiency human virus.
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LIST OF VISITED ORGANISATIONS Government Ministry, Economy and Finance Ministry - General Management for Budget and Finance
Government Ministry for health and population - Management for administration and finance - National Programme for looking after persons living with VIH/AIDS - National Centre for Blood Transfusion - Management of Computers, planning and evaluation
Ministry for Social Security, Solidarity and Handicapped persons - National Programme for taking charge of Orphans and weak children
Ministry of National Education - Management for Mutuals and Social Matters in Schools - Teaching management for High Schools and Colleges - Management for pedagogy and continuous training
Ministry of fight against AIDS - Management of Administration and Finance - Management for planning, programming and follow-up - Management for Social Mobilising Ministry for Youth and Civic Service CGECI (Ivory Coast General Confederation of Companies) ENSEA ( National School for Statistics and Applied Economy) INS ( Statistics National Institute) AIMAS (Ivory coast agency for Social Marketing ) UNFPA (UN Programme for population) UNICEF (UN programme for children). OMS (World Health Organisation) ONUSIDA (UN common programme on VIH/AIDS) PEPFAR (Plan d’urgence du président pour l’aide à AIDS) CDC project RETROCI PNUD (UN programme on developing) FONDS MONDIAL (Management Unit for the Word Funds in the Ivory Coast) WORLD BANK
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INTRODUCTION
The VIH/AIDS a modern time disease, that exceeds the public health, has become a problem for the development, even safety. Faced with this threat, the world states who met in 2000 to discuss the aim of development (millenary summit) decided as an aim for the development to fight against VIH/AIDS, Paludism and other sicknesses (aim 6). And in a specific way for this, the target is to have stopped and started to reverse the present tendency of the epidemic of VIH/AIDS between now and 2015 (aim 7). Africa, grouping 75% of the 36.1 million persons who had VIH in 2001 did a meeting of the economical commission for Africa concerning VIH/AIDS in April 2001 at Abuja (Nigeria). This time, the African heads of state undertook to give 15% of their yearly budget to improve the health sector and fight against the epidemic of VIH/AIDS
On top of all these decisions,189 Members of UN adopted in June 2001, in a special session, The Undertaking Declaration concerning VIH/AIDS and the international community has decided on common aims to slow down the spreading of VIH/AIDS
Faced with the requirement to install a multisector action on all fronts, The Declaration supports national, regional and global answers to stop new infections with VIH, enlarge access to cares and soften the effects
Aware of the need to install a multi sectors action on all fronts, the Declaration is supporting national, regional and global answers, to stop new infections with VIH, and enlarge the access to cares and soften the effects of epidemics.
This Declaration confirms that the spreading of VIH/AIDS is a real obstacle to realising
the millenary aims. This requires therefore urgent actions, arranged and supported at national level ( developing multi sector and decentralised strategies), regional (support to subn-regional and regional initiatives) and global (helping a narrower cooperation between UN organisations and the international organisations which take part in the fight against VIH/AIDS
In order to follow the progress made in agreed engagements and allow the publishing of a yearly activity report by the Secretary General of the United Nations, a series of basic indicators has been worked out. The reports thus produced by member countries allow the identification of obstacles found and propose actions in order to identify the problems found and to accelerate the realising of this declaration’s aims
The basic indicators have been put into four classes, every one having to be filled in, with precise periods. These classes are:
o Indicators of actions and national undertakings
o Indicator of knnw-how and national behaviour
o Indicators of the national effect;
o Indicators of global actions and undertakings
The unit of follow up and evaluation, of UN AIDS has fixed some clear definitions for each indicator and mechanics for collecting regular information.
In order to improve on the quality of data, the national Indicators have been refined and selected according to the country having concentrated epidemics and country with a general epidemics such as Ivory Coast.. The number of special Indicators has gone from 13 to 17.
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The next document worked out by the Ministry for Fighting against AIDS is the third Ivory Coast National report, having signed the Declaration
It includes the five following parts : :
1- A glance on the status
2- General view of the AIDS epidemics
3- National reply to the AIDS epidemics
4- Main obstacles found and necessary actions to reach the aims of UNGASS
5- Necessary support by partners of development
6- Frame of follow up and evaluation
1/ STATUS
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The epidemics of VIH/AIDS has become, over 20 years a real problem for the development of nearly all the African countries. It concerns the most active age slice (15-49 years) and affects all the sectors of socio-economics activity. The size oif the damage. Caused by the VIH/AIDS on the Ivory Coast Development is such that the pandemia with a foresight of 7%, (UN AIDS,2004) has become a national urgency 570,000 persons still live with VIH in the Ivory Coast, 530,000 of these being adults (15-49) and 40,000 being children (0-14 years); monitoring on women in Ivory Coast towns made in 2004 shows that 8.3% are infected with VIH. This study shows a point with women 25-29 and a younger age, the average age on the first sexual contact of 16.2 years (over half the pregnant women started sex between 15 and 17 years ) However the enquiry on behaviour (ESC) made by the National School of Statistics and Applied Economy (ENSEA) in 2004 shows good signs. This enquiry shows that 82.6% of youngsters between 15 ti 24 year know exactly how to prevent. Sexual transmission of VIH as compared with 40.5% in 2004. With the results of the enquiry on AIDS indicators (EIS) and the study concerning the predispositin being done, we hope to have more precise data on VIH/AIDS epidémiology in Ivory Coast in 2006.. Sales of preservative have gone from about 37 million in 2006 to over 40 millions in 2005. With this status, the national response since the announcement of the first AIDS caes in 1985, has been bu installing instances and structures: - National commission for fight against AIDS in 1987;
- Natinal programme of fight against AIDS, ISI and Tuberculosis (PNLS/IST/TUB) in 1992;
- Ministry connected with the Prime Minister looking after the fight against
AIDS, 24 January 2001; - Ministry for fight against AIDS since 13 March 2003.
The type and fast evolution of the epidemics called for a strengthening of the structural and institutional bases of the fight. This is what shows from the response made by the main actors when making a strategy plan in 2002-2004 This analysis points out a reply mainly limited in medicine, with a low participation of the economy sectors even if the civil society has taken part. The government has thus insisted in marking its will to organise and drive a national response taking into account the sanitary factors and all the effects of VIH.
The strategic plan of 2002-2004 has identified several weak groups needing priority action. They are the youth, the women, the moving populations, the sex professionals, the police and the fighters, the orphans and vulnerable children. (OEV) Thus, in spite of the military-political crisis situation, in place since September 2002, the political and institutional undertaking of fight against AIDS has become stronger with the installation of various organs and structures for a better coordination of the fight, in a multi sector and decentralised look:these organs are
o The National Council for fighting against AIDS (CNLS), presided by the Chief of State, with as the Technical Secretary, the Ministry for fight against AIDS. This council is acting as a political and strategic advisor.
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o The Inter Ministry Counil for fighting against AIDS (CIMLS) presided by the Prime Minister, coordinating the government action against AIDS.
o The multiparty and partnership commission, presided by the Minister of fight against AIDS, being a frame for exchanging with the partners in fight against AIDS
Beside these central organs, we have decentralised and sector organs that are::
The regional commissions for fight against AIDS (CRLS), presided by the regional Prefects in 13 regions out of 19 in the country The Departmental Commissions for fight against AIDS (CDLS) presided by Departnental Prefects ( in 34 out of 50)
o The town commissions for fight against AIDS, presided by Sub-Prefects (in 52 towns out of 135)
oo Sector commissions for fight against AIDS, presided by Ministers of Ministerial
Departments (34 out of 41)
The village commissions for fight against AIDS, presided by Village Chiefs
Several other operational technical structures were created and standard and political documents worked out.. There is the National Programme for taking charge of Orphans and other children made fragile by VIH/AIDS (PNOEV) (covered by the Health, Social Security and Handicapped Ministry (MSSSSID). Thjs programme looks after coordination of OEV. Documents on standards and process for infections sexually transmissible (IST) stopping transmission from mother to child (PTME), Advice and voluntary tracing (CDV), social mobilizing, taking charge of OEV, National Programme for taking charge of people living with VIH (PVVIH)(PNPEC) is created at the Health and Population Ministry to coordinate the taking charge. The civil society has not remained outside this undertaking. The networks which are the non-governmental Collective (ONG) for fight against AIDS in Ivory Coast (COSCD) and the Ivory PVVIH Network (RIP+) have further structured with an increase in the number of members. About 700 ONG registered with the Management for Social Mobilizing (DMS) in, the Ministry for fight against AIDS. Such organisations, supported by International ONGs play and still play a great role in the offers where has been watched a run down of the sanitary system. The local groups have undertaken a fight against VIHAIDS, by being allied with Mayors to fight against VIJ/AIDS and the Union of towns in Ivory Coast (UVICOCI). The private sector has taken a lead in this fight against this pandemia to which it is strongly attached. About a hundred companies have today cells for fighting against AIDS.A few years ago, there was only 10. Coalitions are getting into place, the largest being within the Ivory Coast Federation of Companies. This national undertaking is supported by various technical and financial partners, among which the American Government through PEPFAR, UN AIDS and its co-partners, the Belgian, Italian, Canadian, Japanese, French, etc. co-operations and the ONG international. Those various supports have allowed the Ivory Coast to increase its intervention possibilities by strengthening prevention, but also by allowing a greater number of sick persons to access treatment. Thus, the antiretroviral treatment (ARV)has gone from about 30000 FCFA per month to 5000 FCFA per quarter (including the biological evaluation), which allowed to pass from 2105 persons in treatment in June 2003 to 17404 persons in November 2005.. The extra effort made by the Ivory Coast Country by fixing since the 1st December 2005 the treatment cost ARV at 1000 FCFA (about US$2) per month including the biological evaluation, which will allow having 39000 persons under treatment at the end of 2005.
Next to this national undertaking, there are sub-regional initiatives such as the Project
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ct to make the future safer, the Project of the “Mano River
us of epidemic, referring to basic indicators of UN GASS, in short in the
asic Indicators from UNGASS Indicators Sources
CORRIDOR (connecting the axis Abidjan-Lagos) the Project RAILS LINK (The railway axis Abidjan-Ouagadougou) the ProjeUnion,” and the Ivry Coast, etc. The Ivory Coast, a country with generalised epidemic, has in this report filled in 17 indicators as well as the statfollowing table. Table 1 : Résumé of B
Values
Actions and national undertakings
L Funds engaged by the Government to fight 6 987 795 658 FCEA MLS/MEMSP against VIH/AIDS from 2003 to 2005 MEMEF/
2. Composite index of nationa 0 l policies 7.87 / 1
National programmes in 2005
3.Percentage of schools where masters were formed to teaching in relation to VIH/AIDS, based in psycho-social abilities, and acquired during the last school year
38,43% MEN/DMOSS/DELC
3’: Extra indicator : Percentage of écoles primary and secondary schools within which teaching concerned with VIH/AIDS is given based on psycho-social abilities.
100% MEN
4. Percentage of large companies having installed policies and programmes to fight against VIH/AIDS in the place of work
66,66% CGECI ; enquiry on site
5. Percentage of persons suffering fro IST and received in health centres, for which the diagnosis was correct, and who are treated nnd advised thoroughly
?
6. Percentage of pregnant women infected by VIH who receive a complete antiretroviral to reduce the risk of TME.
4.36% RETROCI/UGFM
MEMSP/PNPEC,INS, RGPH 98/
7. Percentage of persons for which the VIH infection is advanced and who receive an association of antiretroviraux
22,08% MEMSP/PNPEC
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7’: Extra indicator : percentage of health centres who are able to give cares to persons living with VIH/AIDS
NPR -
8. Percentage of children made orphan and other fragile children living in homes having an outside free aid.
NPR
9. Percentage of transfusion blood units having been the object of VIH finding out 100% MEMSP/CNTS
Knowledge and behaviour in 2005
10. Percentage of people aged 15 to 24 years who have together an exact knowledge on the way to avoid sexual transmission, of VIH and who don’t accept the main false ideas concerning the virus transmission
82,62% ESC, ENSEA 2004
11. Percentage of youngsters having had sexual contacts before the age of 15 years. 14,06% ESC, ENSEA
2004
11’: Extra indicator Average age for the first sexual connection: 16,5 ESC, ENSEA
2004
12. Percentage of youth aged between 15 and 24 having had sexual connection outside their marriage with an irregular partner over the last 12 months
61,01% ESC, ENSEA 2004
13. Percentage de youngsters aged between 15 and 24 who know how to use a preservative when having a sexual contact with an occasional partner
69,66% ESC, ENSEA 2004
14. Rate of present schooling between orphan children and non-orphan children NPR -
14’ Extra indicator : Percentage of children under 15 who are orphans. 7,2% INS, RGPH98,
Prospects 2005
Impact in 2005
12
15. Percentage of youngsters aged 15 to 24 who are infected by VIH 6,2% DIPE/MEMSP
16. Percentage of adults and children infected by VIH still alive under antiretroviral. treatment 12 months after the start.
87,28% MEMSP/PNPEC
17. Percentage of babies infected by VIH, born from mothers themselves infected by the virus. 25%
MEMSP/PNPEC/RETROCI
II. OVERALL VIEW OF AIDS EPIDEMY
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A general view on the VIH/AIDS epidemy . in Ivory Coast will consist in presenting the VIH/AIDS status based on the data of the monitoring of pregnant women (according toWHO recommendations for countries with a general epidemy) and the UN AIDS 2005 report
In Ivory Coast, the system of monitoring :VIH/AIDS was installed formally in 1987 by the National Programme of FIGHT against AIDS, Sexually transmissible sicknesses and Tuberculosis (PNLS/MST/TUB) under the Public Health Ministry and with collaboration of project RETRO-CL. This monitoring has two main activities:
- Monitoring VIH through a monitoring network among pregnant women - Notifying AIDS cases
The epidemiological monitoring of VIH/AIDS is a continuous collect, analysing and data distributing process concerning the diffusion and spreading of VIH/AIDS in the population. It is an essential tool in working out, planning, starting, follow-up and evaluation of actions to fight against this epidemics.
The sero-monitoring of VIH in pregnant women is a yearly enquiry that initially was made in towns in 10 sanitary region capitals. From year 2001, this enquiry was extended to country areas with adding 14 country sites selected in 4 sanitary areas. However, in 2004, country areas were not able to be included in the enquiry because of the political crisis in the Ivory Coast.. Contrary to previous years, the number of town sites increased in the 2004 enquiry.
The UN AIDS report in 2005 shows that out of the 40.3 million people living with VIH in the world, Africa below Sahara has 25.8 million, of which 3.2 millions are new and 2.4 million deaths are caused by AIDS.
In the Ivory Coast, the value in the sexually active population of 15-49 is of about 7% at the end of 2004 according to the UN AIDS report (Curve 1). Further, according to the same report,, about 570,000 people live with VIH in Ivory Coast, of which 530,000 are adults (15-49) and 40,000 are children (0-14) (Curve 2).These figures, higher than in 2001 (6.7%) are a sign that epidemics progresses.
CURVE 1 : Glance on VIH/AIDS epidemics evolution in Ivory Coast in the active population.
6,5
6,6
6,7
6,8
6,9
7
Taux chez les 15 - 49
Taux chez les 15 - 49 6,7 7
fin 2001 fin 2003
S
ource: Report UNAIDS 2004
Curve 2 : Evolution of the case number of VIH positive in Ivory Coast depending on population parts
0
100 000
200 000
300 000
400 000
500 000
600 000
fin 2001 510 000 480 000 38 000fin 2003 570 000 530 000 40 000
Adultes et enfants Adultes (15-49) Enfants (0-14)
Source : Report UNAIDS 2004
In 2004, the infection by VIH for pregnant women in Ivory Coast in town sites was 8.3% This is shared in an homogeneous way in the south half of Ivory Coast. However the VIH levels are relatively low in the North. The VIH pregnant women value was 8.25%, with ends of 4.9% at motherhood in the regional hospital centre (CHR) in Bondoukou and 15.5% in the General Hospital (HG) in Abobo North. It is necessary to note that VIH infection continues to be generalised in all regions who participated to the monitoring enquiry based on the WHO definition and the UN AIDS definition of the epidemics levels.
The presence of VIH increases with age and reaches a summit in men of 25-29 years. This has gone from 4.1% in 15-19 years to 12.7% in 25-29 years, and remained stable after 30 years at about 10%. The distribution of the sero-prevalence according to the geographical area and age is shown on the map and the curve hereunder
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FSAS: 7.7%
Korhogo
Bouaké
Abengourou
DaloaMan
AbidjanSan Pedro
Odienné
Bondoukou
Yamoussoukro
6.8% 6.6%
8.2% 8.3%
8.9%
8.8%
5.6% 4.9%
10.0% : 15.5% HGA
FSK: 9.3%
15
Source : RETRO-CI PROJECT MONITORING 2004 Curve 2 : VIH Presence (%) in pregnant women in towns according to age in 2004.
% VIH Positifs
0
4.1
VIH postifs
16
Age-groups (in years)
Sources: Retro-CI project, sentinel surveillance 2004 It should be remembered that in 2004, despite the socio-political crisis in Ivory Coast, it was possible to carry out the annual sentinel surveillance survey of HIV and syphilis among pregnant women. The results of the survey constitute at present the first information available on the scale of HIV infection throughout the country in the post-crisis context, pending the results of the survey on AIDS indicators being carried out at the moment. Although the data is limited to the population of pregnant women in urban areas, it provides useful information on the epidemic's tendencies in the population, making it possible to direct activities involving prevention and taking care of others.
The following key information transpires from analysis of the data for 2004, and should be taken into account in devising intervention activities:
- The population of pregnant women is substantially younger. More than half were aged between 15 and 24. The proportion is particularly high among pregnant women registered with sites in the former besieged areas, particularly at the Belleville mother-and-child protection centre (PMI) in Bouaké, the PMI in Man and the PMI in Odienné, where more than a quarter were aged between 15 and 19.
Most of the population covered by the survey were of Ivory Coast nationality and had had no schooling. However, it was the pregnant women recorded in the PMIs in Odienné, Bouaké and Korhogo who had the highest proportion of lack of schooling, with rates as high as 72.2% at the PMI in Odienné.
8
12.7
11
8.3
10.3
0
2
4
6
8
10
12
14
16
10-14 15-19 20-24 25-29 30-34 35-39 40+
n=741
n=435 n=87
n=218 n=995
n=882
n=36
- On the whole, pregnant women are late in coming to the health establishments for their
first antenatal examination. More than half attend their first antenatal examination during the second third of their pregnancy.
- The average age at the time of having sex for the first time is 16.2 years. More than half the pregnant women were aged between 15 and 17 when they first had sex. This figure is slightly lower at the maternity unit at the regional hospital in Man and at the Bardot PMI in San Pedro, where the age was 15.6 and 15.9 years respectively.
- Overall, the occasional prevalence of HIV among pregnant women in urban areas in 2004 was 8.3%. The median prevalence of HIV was 8.25%, with extremes of 4.9% at the maternity unit of the regional hospital in Bondoukou and 15.55% at the general hospital in Abobo Nord.
- On the whole, pregnant women in the government-controlled area seem to be more infected by HIV (9.1%) than those in the former besieged area (6.8%), although the difference between the two areas is not significant. Nevertheless, pregnant women in the 15-19 years age-group in these former besieged areas are significantly more infected by HIV (6.3%).
- Overall there is a non-significant drop in HIV prevalence from 2002 to 2004 at all the sites, except the regional hospital in Bondoukou where the drop is significant, falling from 11% to 4.9%.
Graph 3 below compares prevalence in the various regions in 2002 and 2004. It should be noted that the data for 2004 does not include rural sites.
0
2
4
6
8
10
12
Prev
alen
ce
BOU
AKE
KOR
HO
GO
YAM
OU
SSO
UKR
O
DAL
OA
MAN
SAN
-PED
RO
OD
IEN
NE
ABID
JAN
BON
DO
UKO
U
ABEN
GO
UR
OU
TOTA
L R
CI
Region
Graph 3: Comparison of sentinel surveillance by region in 2002 and 2004
rate ofprevalence(%)(2002)
rate ofprevalence(%)(2004)
jjj
17
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III/ NATIONAL RESPONSE TO THE AIDS EPIDEMIC
3.1- Action and commitment at the national level
3.1.1. Amount of national funding committed by the government to combating HIV/AIDS
The amount of national funding committed by the Ivory Coast government to combating HIV/AIDS in 2005 is three billion, two hundred and seventy-two million, two hundred and thirty-three thousand, two hundred CFA francs (XOF 3 272 233 200), of which almost one-third is earmarked for the purchase of ARVs.
This amount could be less than the actual sum as it does not include activities to combat AIDS carried out by a host of health structures active in the field. This could be included in a more in-depth study directed at setting up national accounts for the efforts to combat AIDS.
Nevertheless, by comparing this amount with the amount for 2003 (XOF 1 051 709 458), a substantial increase is clearly visible.
The data includes the operating and investment costs borne by the Ivory Coast State in combating AIDS. It also includes the cost of training workers, the payroll for civil servants and contracted staff in the structures responsible for combating AIDS, and the budget allocated to the purchase of ARVs. It should be emphasised that the amount does not cover the State's contribution to the running of screening centres, the prevention of MTCT, and the provision of benefits to people suffering from AIDS.
The breakdown of this funding by expenditure heading is as follows:
Table 2: Breakdown by expenditure heading of the national funding allocated to combating AIDS.
19
A-EXPENDITURE CONNECTED WITH HIV/AIDS AMOUNT
Payroll of civil servants in Ministry combating AIDS (MLS) 221 167 000
Cost of contracted staff 11 512 000
Running of MLS structures 855 978 200
Sub-total A 1 088 657 200
B-DIRECT HEALTH EXPENSES
Purchases for testing 32 963 000
Management of ARV medicines 900 000 000
Purchases of medical products 12 500 000
Awareness campaigns 135 681 000
Sub-total B 1 081 144 000
C-EXPENSES CONNECTED WITH HEALTH
Combating AIDS 227 000 000
Institutional support 183 264 000
PNPEC (benefits scheme) 92 800 000
PNLT (TB scheme) 70 914 000
Training and technical staff 155 854 000
National fund for combating AIDS 100 000 000
Transfer to not-for-profit institutions 3 500 000
Running of the CCM (coordination committee) 57 000 000
Sub-total C 890 332 000
D-EXPENSES NOT CONNECTED WITH HEALTH
National programme of care for orphans and vulnerable children 36 100 000
Transfer to NGOs 20 000 000
Assistance and support for the destitute 5 500 000
Focal points at Ministries 102 500 000
Survey on AIDS indicators 48 000 000
Sub-total D 212 100 000
GRAND TOTAL 3 272 233 200 S
ource: DGBF/MEMEF; DAAF/MEMSP/MLS
Graph 4: Breakdown by expenditure heading of national funding allocated to combating AIDS
A-EXPENDITURE CONNECTED
WITH HIV/AIDS35%
B-DIRECT EXPENDITURE
ON HEALTH34%
C-EXPENDITURE CONNECTED WITH HEALTH
24%
D-EXPENDITURE
NOT CONNECTED WITH HEALTH
7%
A-EXPENDITURE CONNECTED WITHHIV/AIDSB-DIRECT EXPENDITURE ON HEALTH
C-EXPENDITURE CONNECTED WITHHEALTHD-EXPENDITURE NOT CONNECTEDWITH HEALTH
Sources: DGBF/MEMEF; DAAF/MEMSP/MLS Graph 5: Evolution of national funding allocated to combating AIDS in 2003 and 2005
0
500 000 000
1 000 000 000
1 500 000 000
2 000 000 000
2 500 000 000
3 000 000 000
3 500 000 000
2003 2004 2005
Amount (XOF)
Sources: DGBF/MEMEF; DAAF/MEMSP/MLS
From 2003 to 2005, the aggregate national funding allocated to combating AIDS amounted to six billion, nine hundred and fifty-seven million, seven hundred and ninety-five thousand, six hundred and fifty-eight CFA francs (XOF 6 957 795 658).
20
Government action is supported by development partners. The information gathered from the various institutions and national agencies (list not exhaustive) active in the Ivory Coast makes it possible to estimate expenditure in 2005 at approximately 56 million US dollars, ie slightly more than 30 billion CFA francs (1 US$ = 550 CFA francs). These figures are under-estimated and nee
21
d to be determined more exactly in the context of a study reviewing
Contribution made by partners in combating AIDS in the Ivory Coast in 2005
Amount in 2005 (USD)
expenditure on combating AIDS. The table below shows the contribution of each partner tocombating AIDS.
Table 3*:
Partners
UNFPA 1 047 000
World Bank 158 600
UNDP 129 459
Global Fund 10 284 000
UNAIDS 220 000
WHO 381 000
UNOIC 276 926 **
Belgian technical cooperation 455 000
GTZ (German technical cooperation) 77 522
UNESCO/Japan 200 000
French cooperation
(Priority Solidarity Fund)
275 000
PEPFAR 42 410 390 ***
TOTAL 55 914 897* this list is not exhaustive; only those partners who replied in time are included in the table ** this contribution, mainly comprising running expenses and office fittings for the UNOIC HIV/AIDS Unit office, covers the period from June 2004 to July 2005 *** this amount does not include the contributions granted directly by the central level for action in the Ivory Coast
National Composite Policy Index (NCPI)
The national composite policy index produces the figure of 7.87 out of 10 with 8 for part A and 7.75 for part B. The table below shows the breakdown of this indicator by section. It should be noted that human rights represent the weakest link in the chain.
Table 4: Breakdown of the national composite policy index
Score out of 10 Part A 8 I Strategic plan 7 II Political support 8 III Prevention 9 IV Care and support 8 V Monitoring and evaluation 8 Part B 7.75 I Human rights 6 II Participation of civil society 8 III Prevention 9 IV Care and support 8 Composite index 7.87
Graph 6: National composite policy index
0
1
2
3
4
5
6
7
8
9
10
Part A Part B Composite index
Série1
22
3.2. National programmes
23
3.2.1. Percentage of schools with teachers who have been trained in life-skills-based
HIV/AIDS education and who taught it during the last academic year The percentage of schools with teachers who have been trained in life-skills-based HIV/AIDS education and who taught it during the last academic year is 38.43%. The information gathered from the Ministry of Education (MEN) and teachers' unions indicate that by 2005 at least 15456 teachers in 2608 primary and secondary schools have been trained in life skills and awareness of HIV/AIDS. It should be said that "civic and moral education" is taught in all schools; it emphasises the acquisition of life skills, including behaviour to adopt regarding HIV/AIDS. The HIV/AIDS element was introduced in syllabuses for civic and moral education with support from UNFPA. Most schools have health clubs that are run by teachers and pupils with awareness guides for those in charge. These health clubs, which deal mainly with HIV/AIDS, were set up with support from UNFPA and boosted by further support from UNESCO in 2004. 3.2.2. Percentage of large enterprises/companies that have HIV/AIDS workplace
policies and programmes This report covers the 25 largest enterprises in the private sector by number of employees (source: CGECI) and five ministries (transport, employment, tourism, education and health) following the 2006 version of the UNGASS guidelines on the construction of core indicators. Fifteen (15) of the 25 private-sector enterprises surveyed have a full programme for combating HIV/AIDS covering the areas referred to in the guidelines. The five ministries surveyed provide all the services covered except for medicines in connection with HIV/AIDS.
The percentage of large enterprises/companies that have set up HIV/AIDS workplace policies and programmes is 66.66%, compared with 43.33% in 2003 (2004 UNGASS report).
The figure is rising because of the efforts made in the employment sector to intensify prevention with support from many institutional and technical partners (MLS, CGECI, PEPFAR, FHI, Global Fund, etc).
3.2.3. Percentage of patients with STIs at health-care facilities who are appropriately
diagnosed, treated and counselled No precise figure can be put to this indicator as its stands. However, it should be noted that STIs are diagnosed in the Ivory Coast according to the syndromic approach and the treatment is included in primary health care, but no survey has been carried out on the quality of these services.
3.2.4. Percentage of HIV-infected pregnant women receiving a complete course of
antiretroviral prophylaxis to reduce the risk of MTCT
24
The percentage of HIV-infected pregnant women receiving a complete course of antiretroviral prophylaxis to reduce the risk of MTCT is estimated at 4.36%, compared with 0.98% in 2003 (UNGASS 2004 report).
The sentinel surveillance carried out among pregnant women in 2004 in urban areas produced a figure for prevalence of 8.3%; the number of HIV-infected pregnant women in the country in the course of the previous 12 months was 54 365 (RASS/MEMSP). The percentage of infected pregnant women receiving treatment has increased because the treatment has been free of charge for women and children since the second half of 2004. The increase in the number of MTCT prevention centres and the inclusion of prevention of MTCT in the minimum package of activities are additional factors in the increase of this percentage. 3.2.5. Percentage of people with advanced HIV infection receiving antiretroviral
combination therapy The percentage of people with advanced HIV infection receiving antiretroviral combination therapy is 22.08%. The figure for people receiving ARV treatment increased from 2 473 in 2003 (1.96%) (2004 UNGASS report) to approximately 17 404 at the end of November 2005. This significant increase is partly due to the reduction in the cost of ARV treatment and the substantial financial contribution made by the State and partners, and partly to intense social mobilisation. It should be noted that the number of people receiving treatment also includes people in the private sector. 3.2.6. Percentage of orphans and vulnerable children whose households received free
basic external support in care for the child No figure can be given for the percentage of orphans and vulnerable children whose households received free basic external support in care for the child. However, the information obtained from the national programme for taking care of orphans and vulnerable children and various partners working with orphans and vulnerable children indicates that approximately 8000 orphans and vulnerable children received school support, food, nutritional support, medical assistance, etc. 3.2.7. Percentage of transfused blood units screened for HIV The public sector alone, through the national blood transfusion centre (CNTS) is responsible for producing and distributing safe blood in the Ivory Coast. 100% of the units of blood transfused are systematically screened.
3.3. Knowledge and behaviour
25
3.3.1. Percentage of young people aged 15-24 who both correctly identify ways of
preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission
3.3.2. The most recent behavioural survey was commissioned by the Ministry for Youth and
Civic Service and carried out by ENSEA in 2004 with technical and financial support from UNFPA. This survey covered three towns (Bondoukou, Bouaflé and Toumodi). Of 1940 young people aged 15-24 questioned, 82.62% (84.19% among young men and 81.50% among young women) both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission. A similar study carried out in 2002 by ENSEA in two places indicated that 40.5% of young people aged 15-24 years both correctly identified the two main ways of preventing transmission and could identify three misconceptions about HIV transmission. (Target: 90% by 2005; 95% by 2010)
3.3.3. Percentage of young women and men who had had sex before the age of 15
The 2004 behavioural survey indicates that 14.06% of young people declared that they had had sex before the age of 15 - 13.30% of young men and 14.54% of young women. This percentage was 27% in 2002, compared with 29% in 1998 (ENSEA, behavioural surveys, 2002 and 1998). This indicates that young people are increasingly delaying their first sexual encounters. This could be due to the positive effect of the intensification of prevention among young people in the Ivory Coast.
3.3.4. Percentage of young women and men aged 15-24 who have had sex with a non-
marital, non-cohabiting partner in the last 12 months The data from the 2004 behavioural survey indicates that 61.01% of young people declared that they had had sex with a non-regular partner within the last 12 months - 57.94% of young men and 64.25% of young women.
3.3.5. Percentage of young people aged 15-24 reporting the use of a condom during
sexual intercourse with a non-regular sexual partner The data from the 2004 behavioural survey indicates that 69.66% of young people aged 15-24 reported the use of a condom during sexual intercourse with a non-regular sexual partner - 75.69% of young men and 63.90% of young women. This percentage has improved considerably compared with the figures from the 2002 behavioural survey, which were 53.91% - 45.9% of young women and 62.5% of young men.
Graph 7: Percentage of young people aged 15-24 reporting the use of a condom during sexual intercourse with a non-regular sexual partner, in 2002 and in 2004
62,50%
45,90%
53,91%
75,69%
63,90%
69,66%
0,00%
10,00%
20,00%
30,00%
40,00%
50,00%
60,00%
70,00%
80,00%
young men young women Total
20022004
Sources: ENSEA
behavioural surveys, 2002 and 2004
3.3.6. Ratio of current school attendance among orphans to that among non-orphans No figure can be given for this ratio as the questionnaire for the Ministry of Education's schools survey does not take this indicator into account. However, the additional indicator on the percentage of orphaned children under 15 is estimated at 7.25% according to the updated general population and housing census (INS, RGPH 98, forecasts for 2005). 3.4- Impact 3.4.1- Percentage of young women and men aged 15-24 who are HIV-infected The percentage of young women and men aged 15-24 who are HIV-infected is estimated at 6.2% on the basis of sentinel surveillance of pregnant women in 2004. (Target: 25% reduction by 2005 in those countries most affected, and 25% reduction worldwide by 2010) 3.4.2- Percentage of adults and children with HIV still alive 12 months after initiation of antiretroviral therapy The percentage of adults and children with HIV still alive 12 months after initiation of ARV therapy is estimated at 87.28% - 85.09% for men and 88.60% for women. This high figure confirms once again the importance of ARV treatment in lowering AIDS mortality. 3.4.3- Percentage of infants born to HIV-infected mothers who are infected
26
The percentage of infants born to HIV-infected mothers who are infected is estimated at 25% according to the method for calculation indicated in the UNGASS guidelines. This rate is the same as the rate of MTCT with no treatment, which takes us far away from the target to be reached by 2005, which is to reduce the figure by 20%. The figure was 24.87% in the 2004 report.
27
(Target: 20% reduction by 2005, and a 50% reduction by 2010)
IV. MAIN OBSTACLES ENCOUNTERED AND ACTION NECESSARY FOR ACHIEVING THE UNGASS GOALS/ OBJECTIVES
28
4.1- Main obstacles The main obstacles encountering in achieving the UNGASS objectives fall into three categories: - the military and political crisis; - the flow of financial resources; - the ineffectual coordination of activities to combat the pandemic. 4.1.1- The military and political crisis The Declaration indicates clearly that prevention must be the foundation of joint action. To do this, specific objectives have been drawn up on this point, including reducing by 25% the incidence of HIV among young people in the 15-24 age-group by 2005, stepping up the fight against HIV/AIDS in the employment sector, ensuring wider access to counselling and voluntary screening (CVS) services, supplying uncontaminated blood products, reducing by 20% by 2005 the proportion of infants infected by HIV, etc. The military and political crisis affecting the Ivory Coast since 19 September 2002 has resulted in the country being split in two and activities to combat AIDS being stopped in the north and west of the country, many cases of physical and sexual violence, a reduction in schooling, the reduction of even termination of prevention and programmes for taking care of people living with HIV in this part of the country in the past three years, etc. There is a risk that this situation will compromise achieving the objectives referred to above. As regards care and treatment, which are essential features of effective action, the Declaration provides for the reinforcement of health care systems, particularly by ensuring access to affordable treatment and community follow-up by people living with HIV. Unfortunately, the deterioration of the health system as a result of the crisis, the absence or shortage of qualified health personnel, the difficulties patients have in travelling, etc all prevent the implementation of large-scale continuous activities in these areas. As regards orphans and vulnerable children, the Declaration recommends implementing strategies by 2005 with a view to ensuring a favourable environment. With the absence of activities for taking care of orphans and vulnerable children, more particularly the absence of schooling for the past three years in the north and west of the country, and the absence of support structures for this category, achievement of this objective is compromised. 4.1.2- Financial flows Because of the Ivory Coast's failure to clear its national debt, the World Bank suspended payments in its favour, thereby delaying signature of the donation agreement that is part of the multi-sectoral scheme for combating AIDS (PMLS). This substantially reduces the financial resources the Ivory Coast should have had available, and represents a deficit that prevents implementation of the decentralisation activities. Moreover, because of the crisis situation, most of the partners provide their contributions mainly in the form of emergency action that does not always take account of all the aspects of the fight against AIDS. As the financial flows are not properly controlled, their allocation cannot be prioritised satisfactorily.
4.1.3- The ineffectual coordination of efforts to combat AIDS
29
The better to coordinate the fight against AIDS, the Ivory Coast Government has set up a large number of coordination bodies that are finding it difficult to function effectively. These include:
- the national council for combating AIDS (CNLS) was set up in 2004 but is yet to meet;
- the strategic framework for combating AIDS, currently under review, has not represented the single reference framework for action by the technical and financial partners; some partners actually carry out activities on their own, even outside the national action framework;
- the ineffectiveness of the monitoring and evaluation framework; as part of the MAP project, a monitoring and evaluation plan was drawn up but needs to be updated and validated in order to serve as the single reference framework for all the partners for monitoring and evaluation of the indicators for their support programmes;
- the weakness of coordination among civil society organisations, and the weakness of the involvement of academic institutions;
- the lack of annual action plans on the basis of which the partners could programme their action to operate in synergy and complementarily;
- the lack of a coordinated plan for scaling-up ARV treatment, and particularly universal access to prevention, treatment and care; the process of drawing up a document on universal access is in hand and will serve as a reference for accelerating access to these packages of services for everyone who needs it by 2010;
- apart from a few sectoral committees, most of the decentralised and sectoral committees are not functional;
- the existence of a resources coordination committee that has no functional connections with the CNLS;
- decentralised committees have not yet been set up in the former besieged areas, because of the crisis.
Other difficulties in drawing up the UNGASS report
Note should also be taken of various problems concerning the drawing up of this report rather than achievement of the UNGASS objectives covered in previous chapters. The main problem has been the difficulty in collecting indicator data as the information is difficult to discern or gives rise to confusion. An example of this is Indicator 12 – the percentage of young people aged 15-24 who have had sex with a non-marital, non-cohabiting sexual partner in the last 12 months. Inasmuch as the official marriageable age is 15, it would be more appropriate to replace "non-marital" by "non-regular". 4.2 Action to be carried out The action that must be carried out in order to achieve the UNGASS objectives includes, inter alia: - restoration of the health system throughout the country;
- intensification of the prevention of HIV/AIDS by emphasising the new types of behaviour that have emerged as a result of the crisis (rape, more widespread prostitution, etc) and encourage the transmission of HIV/AIDS;
30
-
- nation, particularly the national council for
sensual coordination.
To be a lebetter-coor
-
d complementarity.
providing technical and financial support to promote more involvement on the part of the private sector
o organise and coordinate its efforts and make them effective, the Ivory Coast adopted a evaluation in 2003. This will be updated in a
drawing up the national strategic
.1 General objective of the framework
- the continuous mobilisation of financial resources through the reinforcement of coordination with a view to pooling the efforts of the State and the technical and financial partners and carrying out a study to analyse financial flows;
- in the context of this continuous mobilisation of financial resources, arrangements will be made to re-open discussions on the MAP project document and facilitate the signature of the donation agreement for starting up the programme to combat AIDS;
devising and finalising the new strategic framework for combating AIDS over the period 2006-2010 and the various consecutive annual action plans to serve as platforms for action to be carried out jointly by the partners. This activity will be carried out in a participative, inclusive manner by all the players/beneficiaries involved in combating HIV/AIDS and incorporated into civil society, particularly among the associations of people living with HIV/AIDS, so that the framework and its action plans may serve as a reference for everyone;
reviewing the main bodies for national coordicombating AIDS and the national committee for coordinating resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria by establishing functional links for effective con
V. SUPPORT NECESSARY FROM THE COUNTRY'S DEVELOPMENT PARTNERS
b to achieve the UNGASS goals/objectives in the Ivory Coast Republic, more and dinated support is needed from the country's partners.
Bilateral and multilateral partners are active in the fields of prevention and the provision of overall care, coordination and management, and monitoring and evaluation for the humanitarian organisations, and in the development of action to combat HIV/AIDS, but there is no coordination for their support which would promote synergy anTechnical and financial support is necessary for devising and implementing the national strategic plan for the period 2006-2010. This plan will include a national system for monitoring and evaluation with standard indicators that will be adopted by all the partners.
- Their support is also needed for organising a round-table discussion on mobilising resources and re-opening discussions on signature of the donation agreement concerning the MAP scheme, focusing on the effective decentralisation of action to combat HIV/AIDS and the coordination of the parties involved.
- The State and the partners must also step up advocacy,
and civil society in the fight against AIDS. VI. FRAMEWORK FOR MONITORING AND EVALUATION Tnational framework for monitoring and articipative manner and validated as part of the process for p
plan. 5
To develop a single syst
31
em of monitoring and evaluation included at every stage in the effort co
plemented about efforts to intensify prevention
socio-economic impact of
activities in the public and private sectors and in civil society
- research activities
Sou
to mbat HIV/AIDS.
5.2 Specific objectives - to measure the performance of the programmes being im- to inform the national and international communities
and the provision of care - to inform the population about programmes for reducing the
HIV/AIDS 5.3 Elements in the monitoring and evaluation system -- epidemiological and behavioural surveillance
- financial management - indicators connected with partners and the main Declarations Outline for coordination of monitoring and evaluation
partners
rces: MLS, DPSSE
5.4The
List of indicators national indicators used are as follows:
5.4.1 Prevention
peripheral structures
NGOs
other MINISTRIES
regional committees departmental
committees
MONITORING AND EVALUATION UNITMinistry for combating AIDS
reference group on monitoring / evaluation
peripheral level
intermediate level
central level
DIPE MEMSP
villagetees
commit
peripheral structures CS
municipal committees
peripheral structures OBC/OAC
32
ld)
2. Nu e3. Nu e4. Nu e5. Nu e. Number of people reached through IEC/CCC by:
s promoting abstinence
use tion
5.4.2 Reinforc capacity
1. Number of training sessions organised to reinforce capacity ded
. Number of organisations for which training has been provided eople trained:
• men
5.4.3 Treatment
ganisation (by
STItreated in STI care centres supported by
cording to international standards iving support from the organisation
ent for STIs by a care
5.4
Ho ndividuals trained to provide home-based care
es e activities
receiving support from the
received palliative care
ide psychosocial support
1. n care of regarding nutrition
1. Number of condoms distributed (free of charge/ somb r of condom distribution centres created mb r of educational kits developed mb r of educational kits distributed mb r of IEC/CCC sessions organised
6• community programme• community programmes promoting fidelity • community programmes promoting condom• community programmes promoting other means of preven
ement of
2. Number of cases of technical support provi34. Number of p
• women 5. Number of people trained and supervised
ARV
Number of people infected by HIV receiving suppo1. rt from the orgender and age group)
s
1. Number of individuals diagnosed and/or the organisation ac
2. Number of STI care centres rece3. Number of individuals referred for diagnosis and/or treatm
centre supported by the organisation
.4 Care and support
me-based care1. Number of i2. Number of homes served by home-based care programm3. Number of individuals concerned by home-based car4. Number of structures offering home-based care and
organisation
Palliative care 1. Number of people trained to provide palliative care 2. Number of persons having
Psychosocial support 1. Number of people trained to prov2. Number of persons receiving psychosocial support
Nutritional care Number of persons take
33
2.
Orp1. Num he community (by
and vulnerable children taken out of school or having had no schooling receiving assistance with finding employment
support in compiling ents
er)
activities carried out ocacy activities
5.4.6
carried out by the community
by the
ble children
ntified by the community ken care of by the community
rphans and vulnerable
ing (CVS)
Number of food kits distributed
hans and vulnerable children ber of orphans and vulnerable children taken care of by t
gender and age-group) • Number of people trained to take care of orphans and vulnerable children • Number of orphans and vulnerable children referred for free medical care • Number of orphans
• Number of orphans and vulnerable children on school/back at school 2. Number of training courses held on taking care of orphans and vulnerable children 3. Number of orphans and vulnerable children receiving legaladministrative docum
AGR 1. Number of people trained in AGR (by gender) 2. Number of people receiving support for an AGR (by gend
5.4.5 dvocacy 1- Number of advocacy A
2- Number of people reached by adv3- Number of organisations involved in advocacy activities Community activities
Awareness of HIV/AIDS 1- Number of awareness sessions2- Number of educational kits developed by the communities 3- Number of education workers trained in HIV/AIDS by the community 4- Number of people made aware of HIV/AIDS by the community NB: Breakdown by gender and age
Prevention of MTCT
1- Number of awareness sessions carried out by the community 2- Number of pregnant women made aware of the prevention of MTCT community 3- Number of community leaders trained in the prevention of MTCT
Interventions orphans and vulnera1- Number of orphans and vulnerable children ide2- Number of orphans and vulnerable children ta3- Number of community leaders trained in taking care of ochildren NB: Breakdown by gender and age
Counselling and voluntary screen1- Number of people trained in promoting CVS 2- Number of awareness sessions carried out by the community 3- Number of people reached by awareness sessions on CVS NB: Breakdown by gender and age
Care and support
34
ation and treatment eatment carried out by the community
d out by the community rted by the community
Field: Reinforcement of capacity
. Number of organisations trained f people trained:
women
Field: ment
y gender
or treated in STI health-care centres international standards
2. Number of STI health-care centres receiving support from the organisation 3. Nu rred eatment by a health-care centr isatio
MTCT PREVENTION INDICAT
1- Number of people trained in educ2- Number of education sessions on tr3- Number of educational kits distributed 4- Number of people reached by education sessions carrie5- Number of people living with HIV suppoNB: Breakdown by gender and age
1. Num ining sessions held to reinforce capacity 2. Quantity of technical support provided
ber of tra
34. Number o
men
5. Number of persons trained and supervised
Treat ARV 1. Number of HIV-infected people receiving support from the organisation (band age) STIs 1. Number of individuals diagnosed and/supported by the organisation according to
mber of individuals refee supported by the organ
for STI diagnosis and/or trn
ORS
Order no. Selected indicators Method of calculation
Number of pregnant women tested 1 ant
first Proportion of pregnwomen tested for HIV Number of pregnant women attending their
antenatal consultation Number of pregnant women who have received the result 2
Proportion of pregnant women tested who have received the result Number of pregnant women tested
Number of pregnant women who are HIV+ 3 Proportion of pregnant women who are HIV+ Number of pregnant women tested
Number of pregnant women who have receivHIV+ result
ed an 4
Proportion of pregnant women tested who have received an HIV+ result Number of pregnant women who are HIV+
Number of pregnant women who are HIV1+ 5 Proportion of pregnant women who are HIV1+ Number of pregnant women who are HIV+
Number of pregnant women who are HIV2+ 6 Proportion of pregnant women who are HIV2+ Number of pregnant women who are HIV+
35
Order no. Selected indicators Method of calculation
Number of pregnant women who are HIV1+ and HIV2+ 7 IV1+ and
Proportion of pregnant women who are HHIV2+ Number of HIV+ pregnant women
Number of ARV doses (mother) distributed
8
Proportion of HIV+ pregnant women who have received an ARV dose for themselves
Number of pregnant women who are HIV+
Number of ARV doses (child) distributed 9
Proportion of HIV+ pregnant women who have received an ARV dose for their child Number of pregnant women who are HIV+
Number of HIV+ mothers practising replacement feeding at the first postnatal consultation 10
Proportion de HIV+ mothershaving given birth practising replacement feeding a
t the first postnatal consultation
Number of HIV+ mothers having given birth and attending the first postnatal contact Number of children born to HIV+ mothers found to be HIV+ on screening after 15 months 11
Proportion of children born to HIV+ mothers found to be HIV+ after 15 months Number of children born to HIV+ mothers screened
after 15 months
36
INDICATORS FOR TAKING CHARGE OF HIV/AIDS METHOD OF CALCULATION – SOURCE of DATA
MONITORING OF PATIENTS WITHOUT ARV No. Title of indicator Method of calculation Source of data 1 Number of patients according
to HIV type total Create register
or add variable 2 Number of HIV+ patients
monitored per month (old and new)
total Register to be created
3 Number of patients according to stage of evolution at first contact (CDC 1993)
total Create register or add variable
4 Number of new cases of opportunistic infections classified under AIDS
total Register Consultation or admission form
5 Number of patients under preventive CTX (old and new)
total Register and form
6 Number of consultations per month
total Register and form
7 Number of health establishments with capacity and conditions to provide a high level of taking charge, including ARV
analysis Report on programme
MONITORING OF PATIENTS ON ARV TREATMENT No. Title of indicator Method of calculation Source of data8 Number of patients eligible for
ARV treatment per month (new + old)
total Register and file
9 Number of HIV+ patients not on ARV who have died
total Register file
Number of HIV+ patients on ARV who have died
total Register file
10 Number of patients on ARV per month (old + new)
total File or prescription book
11 Number of health staff trained in prescribing and dispensing ARV
total Report on programme
37
ARV No. Title of indicator Method of calculation Source of data12 Number of patients supplied with
ARV each month for a year (1st and 2nd line)
total Pharmacist's register
13 Quantities of ARV molecules ordered / received / dispensed / outdated per month
total Pharmacist's register
14 Number of days of being out of stock of ARV per month, for each molecule
total Pharmacist's register
HIV / TB No. Title of indicator Method of calculation Source of
data N: Number of TB patients who are HIV+
File card register, file
15 % of HIV+ patients suffering from TB
D: Number of TB sufferers tested File card register, file
N: Number of HIV+ patients on ARV suffering from ARV
File card register, file
16 % of HIV+ patients on ARV suffering from TB
D: Number of TB sufferers who are HIV+
File card register, file
N: Number of HIV+ patients on ARV receiving treatment for TB
Register 17 % of HIV+ patients on ARV receiving treatment for TB
D: Number of HIV+ patients on ARV Register
38
HIV/AIDS PREVENTION INDICATORS METHOD FOR CALCULATION - SOURCES OF DATA
AWARENESS AND COMMUNITY MOBILISATION
No. Title of indicator Method for calculation
SOURCES
01
Number of audiovisual programmes on combating HIV/AIDS broadcast per month
N: count of broadcasts
Activity report / survey report
Number of HIV/AIDS prevention brochures/leaflets/posters produced
N: number of HIV/AIDS prevention brochures/leaflets/posters produced
Activity report/ survey report
03
Number of HIV/AIDS prevention brochures/leaflets/posters circulated
N: number of HIV/AIDS prevention brochures/leaflets/posters circulated
Activity report/ survey report
N: number of districts with operational NGOs/OBC/ trade unions 04
Percentage of districts with operational NGOs/OBC/trade unions D: total number of districts
Survey report
05 Number of enterprises with an operational committee for combating HIV/AIDS
N: Count of enterprises (≥ 50 employees)
CNPI report Report by directorate of Directorate of occupation medicine
06 Number of prevention campaigns directed at the military and para-military
N: Count
Activity and survey reports by DSSA, para-military organisations, police force, Customs, NGOs and other associations
39
07
Number of prevention campaigns directed at orphans and vulnerable children
N: Count
Activity report by MSSSH ,Min. for women, the family and children
08 Number of prevention campaigns directed at young people
N: Count
Activity report by NGOs, OBC, Ministry of Education (DESAC),Ministry for Youth, Ministry for Sport and Leisure
09 Number of prevention campaigns directed at sex workers
N: Count
Activity reports by NGOs, projects (Retro-CI, PPP, PSI)
10 Number of prevention campaigns directed at migrants and lorry drivers
N: Count Activity reports by NGOs, corridor project, PSAMAO
11 Number of prevention campaigns directed at prisoners
N: Count Activity report by NGOs in prison environment
PROMOTION OF CONDOM USE
40
12 Number of condoms sold/distributed per year N: Count
Activity reports of AIMAS, NGOs, AIDS committees in enterprises; private pharmacies
N: number of young people aged 15-24 who always use a condom 13
Percentage of young people aged 15-24 who always use a condom D: Total number of
young people aged 15-24
Survey reports
N: number of young unmarried people aged 15-24 who have never had sexual intercourse 14
Percentage of young unmarried people aged 15-24 who have never had sexual intercourse D: number of young
people aged 15-24 in the survey
Survey reports
15 Number of villages with at least one point of sale of condoms
N: Count
Activity report / Survey report and pharmaceutical stores
TRANSFUSION SAFETY
N: Number of pouches of blood transfused in the last 12 months tested for HIV according to national or WHO guidelines
Survey report Activity report
16
% of pouches of blood transfused in the last 12 months tested for HIV according to national guidelines D: Total number of pouches of
blood transfused – tested and not tested – in the last 12 months
41
TAKING CHARGE OF STIs
17 Number of district health service personnel trained in syndromic taking charge of STIs
N: Count
Activity reports from health districts
18 Number of health structures not out of stock of STI kits N: Count
Activity reports from health districts
INJECTION SAFETY
19 Number of structures with a health waste management system
N: Count
Survey reports
20 Number of health personnel training in means of preventing BEAs
N: Count
Activity reports
21 Number of BEAs recorded by health personnel per month
N: Count
Activity reports
TRAINING
22
Number of persons in NGOs/ OBC / enterprises/ trade unions/CNPI / and other partners trained in the prevention of STIs /HIV/AIDS
N: Count
Activity reports
42
Counselling and voluntary screening (CVS)
23 Number of functional CVS sites
N: Count
Activity reports
24 Number of CVS sites not out of stock of screening kits
N: Count
Activity reports
25 Number of clients counselled
N: Count
Activity reports
N: number of clients screened positive
26 Percentage of clients screened positive
D: total number of clients screened
Activity reports
N: number of clients having collected the screening result
27 Percentage of clients having collected the screening result
D: total number of clients screened
Activity reports
43
APPENDICES
APPENDIX 1: Consultation/preparation process for the National Report on monitoring the follow-up to the Declaration of Commitment on HIV/AIDS (methodology)
APPENDIX 2: Questionnaire on the national composite policy index
APPENDIX 3: National return forms for the indicators on programmes, knowledge, behaviour and impact
