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National AIDS Coordinating Agency (NACA)
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Strategic Information on HIV & AIDS
Overview

As the country scales up its HIV responses towards universal access to prevention, treatment, care and support, there has been an increasing recognition of the need to invest in strategic information to guide programme planning and to sustain national and international commitment and accountability.

Botswana has demonstrated commitment to international conventions and declarations on the HIV and AIDS epidemic such as UNGASS, Millennium Development Goals and the “Three Ones” Principle.  NACA and its partners take account of the changing dynamics of the epidemic and the socio-economic environment, the emerging HIV and AIDS treatment technologies, new relevant research findings and the lessons learnt from implementing national programmes. Research and surveillance data thus do provide the basis for the development of the next generation of programmes, while monitoring and evaluation are used as tools to guide the implementation of programmes and activities.  Efficient and effective resource mobilization, financial arrangements and coordination have been critical for Botswana in achieving the objectives of the national response.

The NACA Monitoring and Evaluation Division has the responsibility for the design, development and implementation of the overall monitoring plan of the National AIDS response. The BHRIMS is expected to collect and collate data from all sectors public and private, undertake data audits to check that primary data provided is accurately recorded and aggregated as outlined in reports submitted to them. To ensure a national and comprehensive monitoring system, NACA implements a monitoring and evaluation plan as part of the implementation of the NSF.
 
NACA and partners in the National Response produce information and disseminates it for the as a resource to support policy and strategy formulation as well as to provide directions for effective and efficient programme implementation at all levels of the response. Even though archiving, storage and information dissemination generally presents technical and administrative challenges, appropriate infrastructure and systems have been put in place to allow for such activities. The BHRIMS has now been transformed into an automated system to improve date capture, information flow and use. This is called the eBHRIMS and is described elsewhere on this site.

BHRIMS

    Guiding Principles of the BHRIMS

    The importance of consensus in improving effective use of HIV and IADS M&E data for action
    The advantages of simplicity of the system for easier understanding and sustainability of the system.
    Streamlining BHRIMS to standardized core indicators related and relevant to central, district and programme level shall be used to determine the information needs.
    Central coordination of BHRIMS in line with the national mandate of NACA as the national machinery empowered to develop a centralized system to collect, verify, enter and analyze M&E information for action.
    Institutional linkages and collaboration with all relevant partners that have comparative advantage in the generation of appropriate M&E information related to the national response.
     
Technical Work Group (TWG)

Terms of Reference

1. To provide technical guidance in the implementation of the BHRIMS concept
2. Provide Technical guidance on the BHRIMS policy, strategies and plan of action
3. Provide technical guidance in the Finalization of the National Core and Performance Indicators
4. Provide technical guidance in the development of Process indicators for Sectors and Districts
5. Provide technical guidance in the Harmonization and development of data collection tools and realistic pathways
6. Provide technical guidance in the development and implementation of capacity building plan on M&E for the country
7. Provide technical guidance in the utilization of generated M&E data in the country
 

Key M & E activities

National AIDS Council Quarterly Report

One of the key responsibilities of NACA is to track the performance of national HIV AND AIDS programmes on a regular basis. This requirement is accomplished through systematic tracking programme output indicators and targets as defined in the National Monitoring and Evaluation Framework. To this end, a quarterly report is produced for the National AIDS Council to gauge programme implementation. So far Botswana has been tracking the performance of the following national programmes and activities: HIV Counselling and Testing Voluntary counselling and testing – VCT: provided by several non-government service providers such as Tebelopele, Botswana Christian AIDS Intervention Programme (BOCAIP), Botswana Family Welfare Association (BOFWA), private health facilities and general practitioners Routine HIV testing conducted through government health facilities Prevention of Mother To Child Transmission (PMTCT) Anti-Retroviral Therapy programme - The MASA programme (ARV) Orphan care programme Community Home Based Care programme (CHBC) Condom Procurement & Distribution Deaths in the Public Service

Outcome Of Monitoring Evaluation

HIV AND AIDS Surveillance

Given the importance of HIV and AIDS surveillance in establishing the prevalence and trends in HIV as well as in providing useful information to inform programmes, policy and decision making, Botswana also conducts yearly HIV and AIDS surveillance among pregnant women aged 15-49 years. When this surveillance was first instituted in 1992, it focused on the collection of data to determine the magnitude and trends of the epidemic for resource mobilization and for policy development. However, as the epidemic matured, it became necessary to review the strategy to include additional behavioural data in order to understand the dynamics of the epidemic. The Second Generation Surveillance was thus introduced in 2001. The HIV prevalence among pregnant women aged 15-49 years has shown a flattening trend over the past decade as indicated in Figure 1.. Since 2002 the system has expanded in terms of number of ANC HIV sentinel surveillance sites, geographical coverage, and rural/urban representation. This helps to understand the dynamics of the epidemic in order to make sound decisions on how to respond.

Sentinel Surveillance data are collected:

  1. To provide information on the prevalence of HIV infection in sentinel populations in different geographic locations of Botswana.
  2. To monitor trends of HIV infection in these sentinel populations over time, and across sites.
  3. To use left over blood for Syphilis testing to determine HIV prevalence, incidence and the emergence of antiretroviral drug resistance (ART).
  4. To estimate the current number of HIV-infected persons in the general population 15-49 years.
  5. Provide information for program planning, monitoring and evaluation

 UNGASS Declaration of Commitment

Botswana is signatory to the United Nations General Assembly Special Session (UNGASS) hence the obligation to monitor the performance of an agreed set of core indicators. Every two years Botswana compiles a report that provides a picture of how the country is responding to the HIV and AIDS epidemic.

Figure 1: Adjusted HIV prevalence trends among pregnant women 2001 - 2007, Botswana Sentinel Surveillance

Research Coordination

NACA is entrusted with the coordination of HIV and AIDS research at national level. The objective being to facilitate development of a national research agenda which will determines priority setting when allocating resources for conducting research. Currently there is no approved national HIV and AIDS research agenda. However, different stakeholders are engaged in various researches to address determinants of the HIV and AIDS in the in the form sentinel surveillance and behavioural surveys. The most popular being the National Second Generation Sentinel surveillance supported by Ministry of health and National HIV and AIDS Surveys (BAIS) conducted every 3 years by Central Statistics Office (CSO) in collaboration with NACA.  Other development partners such as the collaboration between government of Botswana and USA (BOTUSA) and Harvard Institute are focusing on clinical research to address the National Response.

Aside from the Botswana AIDS Impact Survey III that Botswana is engaged with during 2008 through 2009 there is an assessment that seeks to establish knowledge of the key drivers of the HIV and AIDS epidemic – Know Your Epidemic: Know Your Response. This assessment is expected to be concluded in December 2008. NACA is further engaged in the development of a Monitoring and Evaluation Framework for HIV prevention interventions in Botswana. The proposed HIV prevention M&E framework is being developed as a further elaboration of the M&E chapter of the National Operational Plan for scaling up HIV prevention in Botswana. The Prevention Operational Plan and its M&E framework will be a key strategic orientation towards further strengthening the HIV Response Information Management System (BHRIMS) as recommended by the Mid Term Review of the National Strategic Framework.

Multiple and Concurrent Partnerships Campaign

Botswana, under the auspices of the National Prevention Technical Advisory Committee (TAC) developed the MCP programme to effect a meaningful and comprehensive prevention initiative.
 
The purpose of the national multiple concurrent partnerships (MCP) campaign plan is to fulfil the commitment under the “National Operational Plan for Scaling Up HIV Prevention in Botswana, 2008-2010” to a high-profile, national, multi-year behaviour change campaign specifically focussing on the acknowledged drivers of the epidemic, initially targeting multiple concurrent partnerships. High levels of multiple and concurrent sexual partnerships by men and women, with insufficient consistent, correct condom use, and combined with low levels of male circumcision, were identified as the key drivers of the HIV epidemic in the Southern Africa by an Expert Think Tank Meeting of the Southern African Development Community (SADC) in May 2006. The report of this meeting recognized the need to re-focus prevention efforts in the sub-region on these key drivers of HIV transmission
 
The rationale for a national campaign plan is to create common objectives, messages and resources that can be worked towards, communicated and leveraged in a genuinely national and multi-sectoral effort to address MCP and thus work towards the Vision 2016 of zero new infections. The campaign will carry the national HIV prevention branding currently being developed by NACA to demonstrate that it is an integral part of the country’s broader HIV prevention strategy.
 
The process of developing the campaign plan was, thus, a multi-sectoral one, involving national- and district-level policy-makers, managers and implementers from across the public sector and civil society. A full list of the partners involved in the development of the campaign plan can be found on the previous page.
 
What is MCP?
MCP describes situations in which an individual is engaged in sexual relationships with more than one person at the same time or over the same period of time. MCP contrasts with the pattern of sexual partnerships in which one sexual relationship ends before another begins and individuals are in only one sexual relationship at any one time; commonly described as ‘serial monogamy’.
 
It is important to draw a distinction between traditional polygamy, practiced within strict cultural parameters which actually serve to limit sexual networks to a man and his wives, and the multiple concurrent partnerships that are not culturally permitted and which result in the dense sexual networks that characterise today’s society.
 
The campaign addresses MCP in all its forms, but does have a strategic focus on young women and adult men. Messages address the key factors, some similar, some very different, that drive and motivate young women and adult men to engage in MCP. These include lack of knowledge about concurrency and HIV risk and related calculations that individuals make about the costs and benefits of having concurrent partners; consumerism; and gender, relationship, and peer-to-peer norms and values about sex and relationships. Another priority for the campaign has been the problem of inter-generational sex involving old men who use their status to have sex with vulnerable young girls, who feel pressured to consent.
 
The campaign combines approaches that create individual desire to adopt and maintain safe behaviours and those that create enabling environments for sustained behaviour change. Consumer-centred messaging have been developed to promote the relevant benefits of behaviour change and to shift the values and norms that shape target groups’ lives so that they feel supported to avoid having multiple concurrent partnerships rather than encouraged to do so. Throughout, messages will be developed and adapted with a view to the cultural dimensions of MCP.

  • MCP Documents
  • MCP and HIV Risks
  • Summary of the Campaign plan
  • How to get involved
  • PSI Report on MCP

 

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