National Strategic Plan on HIV/AIDS 2011–2015

Objectives

Sierra Leone’s National HIV/AIDS Strategic Plan II for 2011-2015 is a multisectoral, results-based framework intended to advance universal access to HIV prevention, treatment, care and support, contribute to the Millennium Development Goal of halting and reversing HIV, and address the epidemic’s social and economic effects. Its overarching result is zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2015.[1][2][3]

• Strengthen coordination, decentralised response, resource mobilisation and management across national and sub-national structures.[3]
• Protect rights and reduce stigma, discrimination, gender inequality and legal vulnerabilities affecting people living with HIV, women, children, young people and marginalised groups.[3][4]
• Reduce HIV incidence by 50% by 2015 through sexual, biomedical and mother-to-child-transmission prevention.[5][6]
• Expand prevention among female sex workers and clients, men who have sex with men, injecting drug users, fisherfolk, transporters, uniformed personnel, prisoners, miners, cross-border traders, young people, women and the general population.[3]
• Improve treatment coverage, continuity and quality, including antiretroviral therapy, paediatric HIV care, tuberculosis and HIV collaboration, laboratory services and management of opportunistic infections.[7][8]
• Improve care, support, social protection, economic empowerment and protection for people living with HIV, affected households, and orphans and vulnerable children.[9][10]
• Strengthen research, surveillance, monitoring, evaluation, data quality and knowledge management to support evidence-based planning and programme improvement.[11][12]

The framework sets impact-level results covering effective national and decentralised coordination, application of rights-protecting laws and policies, lower HIV incidence, reduced HIV-related morbidity and mortality, equal opportunities for people infected and affected by HIV, and stronger research, monitoring and evaluation systems.[13]Key targets include HIV prevalence of 0.5% among people aged 15-24 years, 90% retention on antiretroviral treatment at 12 months, and a 50% reduction in reported rights violations addressed under relevant laws and policies by 2015.[13]

Implementation

Implementation uses a decentralised, community-based and multisectoral model led by the National HIV/AIDS Secretariat, with the National AIDS Council providing high-level policy direction and coordination. Delivery combines public-health services with community action, rights-based programming, targeted prevention, integration with existing health services, and partnerships among government, civil society, people living with HIV, the private sector, faith-based organisations, development partners and United Nations agencies.[14][15][16]

• Coordinate the response through the National HIV/AIDS Secretariat, National AIDS Control Programme, District AIDS Committees, planned Chiefdom AIDS Committees, ministries, local councils, coordinating networks and technical working groups.[17][18]
• Strengthen District AIDS Committees to develop local plans, mobilise resources, coordinate implementers and monitor district programmes, recognising that many committees were reported to be non-functional or weakly positioned.[17]
• Use existing ministry systems and personnel to mainstream HIV activities into sector mandates, including health, education, fisheries, labour, social welfare, defence and local government.[19]
• Deliver HIV counselling and testing through health facilities and stand-alone civil-society or faith-based centres, while expanding youth-friendly services, prevention of mother-to-child transmission and services for key populations.[20]
• Integrate HIV counselling and testing, prevention of mother-to-child transmission, antiretroviral therapy, tuberculosis services, sexual and reproductive health services and laboratory support within decentralised care pathways.[8][18]
• Use peer educators, trained people living with HIV, community-based organisations, caregivers, health workers, traditional and faith leaders, media and workplace networks to support prevention, care, advocacy and demand creation.[21][15]
• Build capacity through needs assessments, technical-assistance plans, training, task-shifting, improved logistics, procurement systems, laboratory strengthening and health-information systems.[22][23]

The 2011-2012 Operational Plan was designed to translate the strategic framework into quarterly activities across six thematic areas, identify lead entities according to comparative advantage, and support stakeholders to align their own evidence-based operational plans.[18]Planning was informed by the 2010 Know Your Epidemic, Know Your Response study, review of the preceding strategy, desk review, field data collection, incidence modelling, results-based management training and consultations with government, civil society, people living with HIV, private-sector organisations, district bodies, technical partners and donors.[2][24]

Monitoring arrangements include a national monitoring and evaluation framework, routine programme data collection, harmonised data tools, District Health Information System use, supervisory visits, technical working groups and periodic reviews.[25]Joint mid-term and final reviews were scheduled for 2013 and 2015, supplemented by antenatal-clinic surveillance, integrated biological and behavioural surveillance, demographic and health surveys and sexual-behavioural surveys.[26]The plan also seeks to integrate HIV data systems with health management information systems, improve reporting by implementing partners and establish district-level monitoring and evaluation technical working groups.[11]

Costing used a resource-needs model, estimating five-year resource requirements of US dollars 322 million, with US dollars 106 million in assured financing and a resource-mobilisation requirement of approximately US dollars 216 million.[27]A later financing assessment identified an overall five-year resource gap of US dollars 215.8 million and substantial reliance on external support, particularly the Global Fund.[28]The approach therefore includes donor coordination, domestic budget mainstreaming, private-sector engagement, resource tracking, pooled or joint financing options and strengthened financial management, auditing and expenditure monitoring.[29][30]

Monitoring & Evaluation

The plan establishes research, monitoring and evaluation as one of six thematic areas and seeks to strengthen systems at national and sub-national levels to support evidence-based planning, implementation and continuous improvement of the HIV response.[3][11]Its results framework links impact and outcome targets to indicators, while a comprehensive monitoring and evaluation plan is intended to provide more detailed output measures.[13][26]

• Monitor implementation against targets for National Strategic Plan delivery, HIV incidence, rights violations, antiretroviral treatment retention, service access, commodity stock-outs, prevention coverage, care and support, and poverty among people living with HIV.[13][23][31][8][10]
• Strengthen routine data collection for prevention of mother-to-child transmission, HIV counselling and testing, antiretroviral therapy, sexually transmitted infections, condom distribution, orphan and vulnerable child services, home-based care and nutritional support through harmonised national tools and the District Health Information System.[25]
• Integrate HIV monitoring and evaluation with Health Management Information Systems, harmonise data-collection forms, link HIV/AIDS databases, improve implementing-partner reporting and expand stakeholder information sharing.[11][32]
• Build capacity by appointing monitoring and evaluation officers, establishing district and regional technical working groups, undertaking capacity assessments, training staff and conducting joint supervisory visits and data-quality checks.[33][11][34][35]
• Conduct surveillance and research through antenatal clinic surveillance, integrated biological and behavioural surveillance, demographic and health surveys, sexual-behavioural surveys, sero-prevalence studies and studies among populations at higher risk.[26][12]
• Review performance through periodic programme reviews, joint supervisory visits, a mid-term review in 2013 and a final review in 2015; monitor National HIV/AIDS Secretariat performance contracts quarterly through the Office of the President.[26]

Selected 2015 monitoring targets include 75% implementation of the plan, 90% retention on antiretroviral treatment at 12 months, 100% annual reporting by District AIDS Committees to the National HIV/AIDS Secretariat, 80% of district and chiefdom committees with designated monitoring and evaluation officers, nine regions with functional monitoring systems, 10 HIV/AIDS-related studies and three annual dissemination forums.[13][32]The material nevertheless identifies weaknesses in district capacity, irregular coordination meetings, late reporting and incomplete data for key populations; reporting timetables and independent accountability arrangements are not consistently specified.[25][33][22]

Costing & Financing

The five-year National Strategic Plan was costed using a resource-need model, with estimated intervention requirements of USS 322 million, assured financing of USS 106 million and an indicative resource-mobilisation requirement of USS 216 million.[27]A more precise five-year resource gap is reported as US dollars 215.8 million, reflecting substantial unmet financing needs over 2011-2015.[28]

• Mobilise additional domestic and external resources, diversify donor support, explore pooled or joint financing, mainstream HIV and AIDS into public budgets and strengthen resource tracking.[29][22][36]
• Increase government contributions to HIV and AIDS spending from 3% in 2009 to targets of 10% in 2013 and 15% in 2015; a separate objective seeks government HIV financing of at least 2% of gross domestic product by 2015.[23][36]
• Strengthen financial management through computerised systems, accounting controls, internal audit, statutory audits, implementing-agency reporting and National AIDS Spending Assessments that distinguish commitments from disbursements.[30]
• Address heavy external dependence: development partners provided over 80% of health-sector funding, while Global Fund support represented 95% of HIV and AIDS funding in 2010.[37][28]
• Consider dedicated health taxes on alcohol, tobacco and mobile phones to increase domestic resources, while pursuing the national target of allocating at least 15% of the national budget to health.[28]

For 2011, assured resources were US dollars 17.8 million and the additional requirement was US dollars 4.8 million; additional requirements then rose from US dollars 17.3 million in 2012 to US dollars 93.9 million in 2015.[28]The source identifies technical and financial assistance from the World Bank, United Nations agencies, the Global Fund, KfW, the United States Government, the European Union and other partners, but does not provide detailed thematic budgets, unit costs or expenditure profiles.[38][16][18]