Zambian government launches new five-year AIDS strategy

The new National HIV and AIDS Strategic Framework (NASF, 2006-2010) was presented this week to a meeting of key government, UN and donor stakeholders and a few members of civil society organizations by the Zambian Minister of Health, Angela Cifire. In a country with an HIV prevalence rate ranging from 8% in Northern Province to 22% in the capital, Lusaka, where women are about 1.4 times more likely to be HIV-infected than men, and where and estimated 7.7% of young people aged 15-24 are thought to be living with HIV, the new strategy is vital and much welcomed.

The vision of the multi-sectoral response outlined in the new framework is a nation free from the threat of HIV. It aims for a "multisectoral response, coordinated by the National AIDS Council (NAC) that is committed to controlling HIV and AIDS by integrating the epidemic into the work of every partner and the development agenda."

The NAC has identified six key areas for intervention. According to the new framework, scaled-up actions will be rapid and responsive to the needs of the local communities. Within each key theme, the document describes the strategic objective, the rationale and challenges, as well as detailed strategies for achieving the targets. The six key areas are:

    * Intensifying prevention of HIV transmission;
    * Expanding treatment, care and support for people living with and affected by HIV;
    * Mitigating the socio-economic impact of HIV;
    * Strengthening the decentralized response by mainstreaming HIV;
    * Improving the capacity for monitoring by all partners;
    * Integrating advocacy and coordination of the multi-sectoral response.

The NASF includes a review of progress from 2002-2005 against current targets and indicators, as well as a summary of the political, economic, socio/cultural and technological factors that underpin the epidemic and the response.

Following the presentation, Dr Deji Popoola, Chairperson of the UN Theme Group on HIV and AIDS in Zambia, also outlined the workplan of the United Nations Country Team in Zambia (2007-2010). According to Dr Popoola, all UN organizations in Zambia will work from one workplan for the coming years. The workplan outlines the overall UN support to the national AIDS response and has strategically prioritized the tasks of the NASF, as they most closely align with the respective strengths of the 13 UN organizations present in the country.

Under the same six thematic areas outlined above, the UN Country Team expect the following outcomes as a result of their combined support:

    * An effective NAC that is able to achieve its mandate;
    * Increased access to an effective and comprehensive package of HIV prevention services, based on approaches that address the underlying drivers of the epidemic;
    * Increased access to treatment, care and support services;
    * Strengthened institutional capacity to mitigate the socio-economic impact for people infected and affected by HIV.

In support of these four outcomes, 16 corresponding outputs and 2007 results and activities are also defined. This adds up, at least on paper, to a coordinated, harmonized and carefully planned UN response to HIV in Zambia.

It was then the donors' turn to present their vision and commitments in support of the NASF. A presentation by the US government representative outlined the priority areas for support. They were unfortunately unable at this time to pledge specific financial commitments until they are approved by the US administration. The areas of support mentioned were: Public-private partnership, expanding coverage of programmes to prevent mother-to-child transmission of HIV (PMTCT) , more resources for antiretroviral (ARV) drug provision, greater focus on paediatric ARV formulations, increased support to orphans and other vulnerable children, support to the civil society response by assisting with organizational development, finance skills etc, and finally, direct funding to the NAC and line ministries on workplace policies. The US government also mentioned their intention to join the national 'Joint Financing Arrangement' (JFA) in 2007.

"We really appreciate increased direct support to the NAC - it will go a long way" said Sam Kapembwa of Zambia National AIDS Network (ZNAN).

On behalf of donors in the Joint Financing Arrangement (JFA), which currently includes the governments of Norway, Ireland, Sweden, the Netherlands and the United Kingdom, Beverly Warmington, Head of the UK Department for International Development in Zambia, also addressed the meeting. Instead of presenting a programme of work, she reinforced the principle of the JFA: To provide flexible and predictable funding to the NAC in order to enable it to undertake its fundamental role in coordinating the HIV response in Zambia ('One Coordinating Body'). She emphasized the need for more donors to join the JFA in support of NAC. In 2006 the total resources allocated to the NAC was approximately $4 million compared with the total Zambian HIV resources of $272 million for the same year. Acknowledging the US government's signal that they will join the JFA in their 2007 country plan, Dr Warmington urged others to join. A new JFA 'cycle' is due to commence this July.

Conspicuously absent from the roster of invited speakers was a representative of civil society or affected communities. There was no presentation on what civil society intends to achieve over the next five years. Rosemary Kumwenda, Assistant UN Resident Representative and HIV & Poverty Adviser, commented after the meeting "the voice of civil society is missing"

Paul Zulu, founder of Human Rights Foundation in Lusaka commented, "It is a good beginning - work has started and now we need to make sure it is implemented."

The Minister opened the floor for comments, but was met with a resounding silence all round - not one civil society representative felt able to speak up in the meeting.

While the NASF, the Joint UN Programme of Support and the donors had presented their strategic visions for the next five years, civil society's voice was missing. A key challenge will be to ensure that civil society is integrated and working alongside other key stakeholders as each has a key role to play. An essential step towards this would be to have a representative from civil society reporting as part of future HIV Partnership Forum meetings.

"Everything is in writing now. Money needs to be made available for organizations that are dealing with the drivers of the epidemic," commented Miriam Banda of the National Zambian Network of People Living with HIV/AIDS (NZP+). "We need to make sure there is a lot of emphasis on the socio-economic impact".

Ms Banda also remarked on the absence of emphasis on tuberculosis (TB) in the presentation of the plans.

"It is a big oversight. HIV and TB co-infection needs to be treated together".

In the NASF document, TB is mentioned in one paragraph under the theme of expanding treatment, care and support. In terms of strategies and outputs, it is combined with other sexually-transmitted infections and opportunistic infections (OI). In a country where up to 70% of TB patients are co-infected with HIV, and where more than 50% of people living with HIV will develop TB in their life time, TB has clearly not been emphasized enough and was completely absent from today's meeting.

The meeting ended with asense optimism. The detailed plans are now in place, the funding is apparently on the way - now the challenge turns to implementation and to engaging and supporting civil society to also play its role.

Further information:

    * National HIV and AIDS Strategic Framework 2006-2010
    * National HIV/AIDS/STI/TB Monitoring & Evaluation Plan 2006-2010
    * Joint United Nations Programme of Support on AIDS 2007-2010
    * Joint Financing Agreement Speech, 9 March 2006

[These documents will be made available shortly on the Partners Zambia eForum and website:]

Nadine Ferris France - HDN