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OVERVIEW OF THE HIV/AIDS SITUATION IN GHANA AND GHANA’S NATIONAL RESPONSE (GHANA MULTI-COUNTRY HIV/AIDS PROGRAM [MAP] PR

OVERVIEW OF THE HIV/AIDS SITUATION IN GHANA AND GHANA’S NATIONAL RESPONSE (GHANA MULTI-COUNTRY HIV/AIDS PROGRAM [MAP] PRESENTATION BY PROF SAKYI AWUKU AMOA DIRECTOR-GENERAL, GHANA AIDS COMMISSION AT THE WORLD BANK OFFICES IN WASHINGTON DC, ON 17 TH MAY 2005. KEY FEATURES OF HIV/AIDS IN GHANA.

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OVERVIEW OF THE HIV/AIDS SITUATION IN GHANA AND GHANA’S NATIONAL RESPONSE (GHANA MULTI-COUNTRY HIV/AIDS PROGRAM [MAP] PR

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  1. OVERVIEW OF THE HIV/AIDS SITUATION IN GHANA AND GHANA’S NATIONAL RESPONSE (GHANA MULTI-COUNTRY HIV/AIDS PROGRAM [MAP] PRESENTATION BY PROF SAKYI AWUKU AMOA DIRECTOR-GENERAL, GHANA AIDS COMMISSION AT THE WORLD BANK OFFICES IN WASHINGTON DC, ON 17TH MAY 2005

  2. KEY FEATURES OF HIV/AIDS IN GHANA • HIV/AIDS epidemic appeared in Ghana in March 1986 • Ghana has remained comparatively a low prevalence rate country • Ghana adult prevalence rate was 3.4% (2002), 3.6% (2003), 3.1% (2004) • According to surveillance report infection rate has gone up by 50% within the last 2 years • Majority of infections (nearly 90%) are within the age group 15-49 yrs • 63% of infected people are women and girls • Six cities have prevalence rates above 5% • Infection rate among age group 25-29 is 4.5%

  3. THE NATIONAL RESPONSE • The National response initially was managed as a disease rather than a developmental issue, and was directed by Ministry of Health • The earlier response led to the establishment of: - National Advisory Commission on AIDS in 1985 - National AIDS Control Programme in 1987 • Later the complex nature of the epidemic:- i. Led to the establishment of Ghana AIDS Commission in 2000 ii. Adoption of a multi-sectoral approach iii. Development of a National Strategic Framework to guide the National Response iv. Adoption of MAP • MAP I comes to an end in 2005 and preparations are currently underway to implement MAP II in 2006

  4. THE NATIONAL STRATEGIC FRAMEWORK I (2001-2005) a. Objectives • The Strategic Framework I had four key objectives - To reduce the current prevalence rate by 30% by 2005 - To create an enabling environment for PLWHAs - To improve service delivery and mitigate the impact on individuals and the general society - To establish multi-sectoral & multi-disciplinary institutional framework for coordination

  5. b. INTERVENTION AREASof NSF I • National Response Focuses on • Prevention of New Transmission • Support and care for PLWHAs • Creating an enabling environment • Decentralized implementation structures • Research, Monitoring and Evaluation

  6. ADOPTION OF MAP I • MAP utilizes multi-sectoral approach • Involving: • Community Based Organizations • Non Governmental Organizations • Faith Based Organization • Private Sector Organizations • District Assemblies (138) • Line Ministries, Departments and Agencies

  7. EFFECTIVENESS AND FUNDING UNDER MAP I • MAP became effective on 8th May 2002 with seed amount of US $25 Million from IDA credit for establishment of the GARFUND. • DFID provided support with £20 Million for capacity building • Disbursement of funds started on 25th June 2002

  8. PROJECT COMPONENTS The GARFUND provides funds for sub-projects under 4 component as follows:- $ • Component I: Prevention and Care Services-18.9m • Component II: Strengthening Public/Private- 2.4m Institutions for HIV/AIDS Control • Component III: Knowledge Management - 1.0m • Component IV: Project Management - 2.7m $25.0m

  9. ACHIEVEMENTS UNDER MAP I • MAP project has been very successful in Ghana • GARFUND has also significantly strengthened the breadth and depth of the national response • Through MAP, Ghana has achieved near universal awareness yet low level of appreciation of personal risk.

  10. INDICATORS OF PROGRESS THROUGH GARFUND (MAP SUPPORT On the whole 27 indicators were used to monitor the MAP activities. The following are some of the impact and outcomes. 1. Education in Schools • Indicator: Percentage of schools with teachers trained in life-skills based HIV/AIDS education and who taught it during the last academic year - 4383 teachers trained in life-skilled based HIV/AIDS education. - 5370 teachers taught HIV & AIDS Education in the 2002- 2003 academic year. • Reducing Mother to Child Transmission - PMTCT services started in 2003 at two sites. Since then, more sites have been established across the country, bringing the total number of sites to 85. - The mother/baby pair on Nevirapine is 436.

  11. 3. Promoting VCT Indicator: Number of centres that have at least one staff trained as a councilor providing specialized HIV counselling and testing services free or at affordable rates. VCT was started in 2003 and stand-alone sites for that year were 4. This number has increased to a total of 90 sites located in various parts of the country. • Providing Home-Based Care Indicator: Number of NGOs receiving financial support from GAC providing home-based care and support services to people living with HIV/AIDS. Home based care and support includes any or all of the following-counselling, food, clothing, nutritional supplementation, palliative care, treatment, other psychosocial and material assistance. In 2002 4 NGOs funded and in 2003 19 NGOs received support.

  12. Providing OVC Care • Indicator: Number of NGOs receiving financial assistance for giving care and support to OVC. Care and support includes food, school fees, counselling, nutritional supplementation etc to OVC. 2002, 8 NGOs were supported and in 2003, 55 NGOs were supported. • National Level-Sectoral Response • Indicator: Percentrage of sector ministries with HIV & AIDS work plans and budgets approved and funded by GAC and being implemented. 31% of sector ministries had HIV & AIDS work plans in place. By 2003 42% of Ghanaian sector ministries have HIV & AIDS work plans in place with corresponding budgets.

  13. District Response Initiative • Indicator: The percentage of districts with HIV/AIDS work plans and budgets approved and funded by GAC. To assess progress toward a decentralized response, the Ghana AIDS Commission has been tracking and reviewing district work plans and budgets. In 2002, one year after the launch of the national strategy, none of the district had HIV & AIDS plans work plans in place. By 2003, the GAC has approved and funded work plans and budgets for all 110 districts. • Community Level Response • Indicator: The Percentage of donor funds awarded to CBOs. The first call of the GARFUND, in 2002, distributed about one-fifth of the funds (20.6%) to community based organizations. In 2003, this percentage increased to 39.0%.

  14. 7. Indicator: Number of regional and district focal persons trained on M & E. By 2002, 90 districts and all 10 regions has a focal person trained in M & E and by 2003, all 10 regions and 110 districts did. In 2005, 28 new districts were created and the focal person are yet to be trained.

  15. COMPONENT I: PREVENTION AND CARE SERVICES • Some excellent results under this component are: - Awareness creation which is nearly 100% among the population • Currently through MAP over 3000 CBOs, NGOs, MDAs, Private Sector and academic institutions are being funded. • Preventive behaviours being promoted by the implementing entities in • High risk groups • Mother to child transmission • Transmission through blood and blood products • Prevention and advocacy work • VCT activities • Support and care services • Workplace interventions • CSW programmes • Income generation activities • Nutritional supplements

  16. - Care for orphans and Vulnerable Children (GAC is supporting 22 organizations with funding totalling over $500,000 to provide care to benefit over 3000 orphans e.g. provision of school fees, uniform, meals, health care. • The challenge is how to sustain this initiatives • People living with HIV/AIDS being supported through the Network Associations • Ghana considers age group 5-12 as window of hope leading to implementation of programmes for school aged children. MAP has supported youth peer educations communication programme in schools. • HIV/AIDS programmes are now mainstreamed in school curricula. Prevention is cheaper than treatment • Progress made in reaching out to the private sector

  17. Substantial progress made in the area of - STI management is mainstreamed into health care services - Training of technicians for safe blood supply - Clinical services for PLWHAs and Commercial Sex Workers have been mainstreamed in the provision of health services. - Effective mass media campaign in place • Effective use of television, radio, print media, outdooring advertising for HIV & AIDS education achieved because of MAP. - Introduction of ARV • Since December 2003 about 2000 patients put on it • As at March 2005, total disbursement under the component totalled US $18.7 million

  18. COMPONENT 2: STRENGTHENING OF PUBLIC AND PRIVATE INSTITUTIONS • Component 2 has empowered the local structures and districts in the fight against HIV/AIDS through financial and decision making authority and support for district AIDS committees, their roles, how they oversee programmes sustainability, M&E. • It has strengthened capacity at local levels for the fight against HIV/AIDS and increased competency and monitoring skills. District Response Initiative making the necessary impact. • Beneficiary Organizations (CBOs, NGOs, etc) trained in financial management, proposal writing, project management, monitoring and evaluation and technical knowledge on HIV/AIDS

  19. MAP has succeeded in getting 19 MDAs to prepare their sector plans for intervention activities. • Technical manuals prepared for capacity building activities of District Assemblies M & E staff • For sustainability District and Regional AIDS Committees have been put in place for supervision, monitoring and evaluation

  20. COMPONENT 3-KNOWLEDGE MANAGEMENT • As of March 30, 2005 funds disbursed under this component amounted to $445,766. Achievements under this component are:- • National HIV & AIDS policy developed • National workplace policy developed • OVC policy and guidelines development completed • HIV/AIDS Education for teachers (implementation of first phase of $4.5 million programme is underway)-GNAT being funded to educate teachers • Curriculum developed for teachers education • Teaching of HIV/AIDS mainstreamed in schools • Development of National integrated IEC/BCC strategy-draft policy document completed • National Research Conference was organized in February 2004 with the aim to encourage evidence based researches

  21. RESEARCH ACTIVITIES • Evidence based researches being undertaken include: • A study on the status of Orphans and Vulnerable Children (OVC). Results have led to the development of operational guidelines for effective programming of OVC. (GAC/UNDP) • A study on the Queenmothers Association of Manya Krobo in relation to orphan care. The Queenmothers Association supports 600 orphans and a further 400 in the neighbouring Yilo Krobo district. GAC/UNICEF • Schistosomiasis and HIV/AIDS in the lower Volta Basin study initiated by the University of Ghana being undertaken in the communities along the Volta Lake to assess risk of genital schistosomiasis to HIV infection and its spread.

  22. The Nutritional Intervention Project being implemented by Kumasi Centre for Collaborative Research (KCCR) of School of Medical Science to assess impact of nutritional interventions on HIV progression. It involves 100 PLWHA. • The University of Ghana Medical School, Korle-Bu is undertaking the Prevalence of HIV, Hepatitis B (HBV), Hepatitis C (HCV) infections, Tuberculosis and Syphilis among Prisoners in Accra and Nsawam - Integrating Home-Based Care into the Community Health and Family Planning Services of Ghana Health Service being undertaken by Navorongo Health Research Centre in the Kassena Nankana District of the Northern Region.

  23. - The Noguchi Memorial Institute for Medical Research commenced Microbicides Clinical Trials to assess the level of effectiveness of SAVVY (microbicides product) in preventing male-to-female vaginal HIV transmission among women at high risk in Accra and Kumasi. - The Department of Social Work of the University of Ghana is studying the Identification of Factors Affecting Variations in HIV Prevalence and Trends at Sentinel Surveillance Sites throughout the country. The study involves 2550 communities nationwide with 5100 respondents.

  24. COMPONENT 4 – PROJECT MANAGEMENT • Under this component a total of $1 million has been disbursed. Achievements include - Beefing up the capacity of the Secretariat - Joint Review of National Response completed - Strengthening capacity of district structures for national response-RAC, DAC, DRMT. - Monitoring and Evaluation of GARFUND put in place - Project management is a best practice. With only 10 professional staff GAC has successfully managed such a complex programme. • Stringent financial requirements have been established to monitor use of funds. The following mechanisms are utilized • Guidelines for disbursement • Financial reporting arrangements

  25. Decentralized marginalized system have been established e.g. District Assemblies responsible for supervision of CBO activities. • Monitoring and Evaluation Focal Persons (138) • Field Investigations • Operational Manuals • Ex-post audit of sub-projects • Development of National M/E plan with 28 indicators on NSF I thematic areas

  26. OTHER GENERAL ACHIEVEMENTS • Increased level of commitment of individuals to take responsibility for their health e.g. VCT is on the increase • improved community mobilization and leadership e.g. Traditional leadership for initiatives-Manya Krobo Queenmothers programmes • MAP has brought development partners and stakeholders together at all levels • MAP brought the Christian and Muslim Churches together on a compassion campaign to support PLWHAs

  27. CHALLENGES OF MAP • Scaling up and reporting quickly • Coordination of National Response • Monitoring the intervention activities of large number of sub-projects • Ensuring that funds reach quickly and efficiently the intended beneficiaries and are properly utilized • Building public confidence that CBOs/NGOs are capable of implementing appropriate intervention programmes • Establishing framework of implementation that is transparent and equitable • Achieving high levels of behaviour change in the youth group

  28. Getting the local banks to ensure fast transfer of funds to beneficiaries • Handling inappropriate demands for projects that do not quality for the MAP • Getting the public sector organizations (MDAs) to provide counterpart funding for the GARFUND • Promotion of Condoms use against cultural and religious values

  29. Upscaling advocacy work to address stigmatization and socio-cultural practices • Dealing with different perceptions of the general public with regard to how to manage the national response • How to upscale anti-retroviral drugs for treatment and care - Issue of Cost - Training of Physicians - Sustainability of making the drugs available • Upscaling VCT, PMTCT programmes, support for OVCs • Improving the coordination of the national response

  30. KNOWLEDGE ABOUT THE EPIDEMIC IN GHANA The DHS conducted in 2003 has given us enough information about the epidemic in Ghana. We know that: • Ghana is relatively a low prevalence country • Infection in women is nearly 3%, while it is 2% for men • Women are nearly three and half times as likely to be HIV positive as men • Higher risk sexual behaviour is common among young people • The peak prevalence among women is at age 35-39 • AIDS awareness is very high in Ghana; behaviour change is low • Usage of condoms is low. Only one-third of women and half of men interviewed used a condom at the last higher-risk sex • There is a relatively high acceptance of PLWHA in Ghana

  31. WAY FORWARD In order to address the pandemic in the next 5 years preparatory work towards MAP II are underway: • Developing a follow-up project-Multisectoral HIV/AIDS Project (MSHAP) that will strengthen CSOs to undertake activities and to ensure a more rapid multisectoral scaling up of HIV/AIDS activities throughout the country • Development of National Strategic Framework II 2006-2010

  32. CONCLUSION With the current national HIV prevalence rate of 3.1% our ability to reduce it or maintain the same level will largely depend on • the extent of knowledge of the populace of factors that promote the spread of the epidemic and the conduct of effective and well coordinated research into those factors • the development Partners (particularly the World Bank) willingness to continue to contribute to funding of the National Response

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