Dear Missing the Target Team,
Many thanks for your email of 17 October addressed to Dr Piot, and for the opportunity to contribute your report on the crucial treatment issue.
You asked a number of overarching questions as well as some that are more specific. We have attempted to group and answer these questions, moving from the present to the longer term vision and the link with health systems development. In view of the comprehensive response provided by Dr Kevin De Cock of WHO, the leading UNAIDS Cosponsor on health, I would like to respond in more detail to those issues that relate directly to the work of UNAIDS. I hope that these parts taken together will give you a satisfactory answer to your concerns.
1. Status of country setting targets.
As you know following a resolution of the General Assembly in December 2005, UNAIDS facilitated country and regional consultations this year, aimed at defining key obstacles towards universal access for prevention, treatment, care and support. The Political Declaration that emanated from the High Level Meeting of the General Assembly in June 2006 asked countries to develop ambitious targets for universal access. Supporting countries to implement this request has been a major focus of our work in the last six months, building on the momentum created by the “3 by 5” initiative. UNAIDS with its partners has developed and disseminated both technical and operational guidance on “Setting National Targets for Moving towards Universal Access” and UNAIDS is in the process of developing further detailed guidance to empower civil society organizations in assisting the scaling up process.
By the end of October 2006, 84 countries had provided target data on the outcome indicators, proposed in the UNAIDS guidance paper. Of these, 76 countries have set treatment targets. The treatment targets are for the most part ambitious, with many countries aiming to double or triple their treatment coverage, based on the late 2005 baseline. Achieving these targets will clearly depend on the financial and human resources available at country level however, and UNAIDS will continue to advocate for additional resources, in line with its estimated resource needs for an expanded response to AIDS in low- and middle income countries. In addition, UNAIDS will maintain its support to countries to ‘make the money work’, as well as accessing additional funds. Several countries for example, supported by UNAIDS, have succeeded in bridging their funding gap through the Global Fund round 6.
Summaries of the process and of the targets that have been set will shortly be made available at the UNAIDS website. A region by region analysis is already being posted on the website, depicting progress being made in target setting, and challenges encountered as well as the participation of civil society to date. Individual country examples are also being provided per region where available. Since the process of targets revision, finalization and inclusion in national planning processes is ongoing, a more complete picture of the targets set to date will be available at the end of the year. Ultimately and where available, links to the (updated) national strategic plans will also be provided.
2. Status of implementing the Global Task Team (GTT) recommendations
Status of Implementing the Global Task Team (GTT) Recommendations
The GTT recommendations cover a broad number of follow-up actions by different agencies and stakeholders. Providing a concise response to the question about the status of implementing the GTT recommendations is therefore not straightforward due to the comprehensive scope of the recommendations. On several recommendations there have been good progress - for others progress have been slower. Some main areas are:
Joint UN Teams on AIDS
To date, at least 44 UN Theme Groups on HIV/AIDS have established joint UN teams on AIDS, and at least 19 more teams are expected to be in place by the end of the year (see Figure 1). Within this context, a number of joint teams have adapted the UNAIDS Technical Support Division of Labour to the specific country context. By December 2006, it is expected that a significant number of joint teams will have completed development of joint programmes of support. About 50% of the UN country Teams have agreed upon an accountability mechanism that provides clear definition of accountability lines and mechanisms for enforcing them, thereby providing a greater commitment of UN agencies.
GIST (Global Problem-solving and Implementation Support Team)
The Joint Global Problem Solving and Implementation Support Team (GIST) has undertaken joint rapid analysis of major implementation bottlenecks to Global Fund grants in more than 15 countries, and has facilitated action to unblock these bottlenecks in nine countries and one region. GIST members meet monthly to plan GIST actions. For each country that requests GIST assistance, a “lead agency” is designated to coordinate actions and regular reporting. Specific GIST actions have included the provision of governance-related support, as well as technical and management support, with the close involvement of UNAIDS Regional Support Teams, UN Country Teams and HIV/AIDS Theme Groups, and other country-level, regional and international partners. Decisions regarding responsibilities for the provision of technical support are taken within the overall framework of the UNAIDS Technical Support Division of Labour.
In June 2006, the Programme Coordinating Board called for “the involvement of other development partners, such as bilaterals and NGOs, where necessary,” in the GIST. The first GIST meeting with extended participation—including the United Kingdom, the United States, Germany (GTZ) and two representatives from civil society—is expected to be held on 10 November 2006 in Geneva.
World Bank and Global Fund coordination
The Global Fund and World Bank commissioned a study on the AIDS Programmes of their organizations focusing on their comparative advantages, areas of overlap and complementarities. Among the many recommendations of the study are:
AIDS Strategic and Action Planning
Under the leadership of the World Bank, the AIDS Strategic and Action Planning service has undertaken a number of country-based activities in the last quarter of the year, organizing peer reviews in three countries, providing technical support and beginning the process of capacity building. A review of existing national strategic plans has been implemented as well as the prioritization and costing of new strategies in four countries. More comprehensive support has been provided to some eight countries in the form of assistance in the development of roadmaps and the preparation of the national AIDS strategy. The World Bank has been working on the development of a Self Assessment tool to allow countries to develop more prioritized, evidence-driven and efficient national strategic plans, currently being used by eight countries in the review of their National plans. AIDS Strategic and Action Planning operations are done in consultation with the UNAIDS Secretariat, other partners, and Technical Support Facilities.
Country Harmonization and Alignment Tool
Global Task Team Recommendation 4.1 called for UNAIDS to develop a scorecard-style accountability tool. The purpose of the tool is to assist National AIDS Coordinating Authorities - in collaboration with international partner agencies - to assess 1) the participation and degree of engagement of country-based partners in the national response, and 2) the degree of harmonization and alignment among international partners.
This recommendation has materialized in the form of a Country Harmonization and Alignment Tool. The Country Harmonization and Alignment Tool will primarily be used by national AIDS authorities to gauge the level of internal and external partner adherence to the “Three Ones” principles and international partners’ adherence to commitments made at Monterey, Rome and Paris, and through the GTT process. The tool fits logically in the context of a Joint AIDS Programme Review to help address the problem of un-harmonized practice at country level, but can be used separately. In its function as a “barometer” of the current status of harmonization, and alignment at country level and identifying where real or perceived blockages lie, it will serve as an advocacy tool for strengthening accountability, focusing dialogue and driving progress. The tool is being piloted in Botswana, Democratic Republic of Congo, Mozambique, Nigeria, Somalia, Zambia, Brazil, Guyana and Indonesia.
For further details and analysis on the Global Task Team implementation please see the PCB report available at:http://data.unaids.org/pub/Report/2006/PCB_18_06_6_en.pdf
Global Task Team Independent Assessment
You may also want to know that in June 2006 the UNAIDS Programme Coordinating Board recommended that there should be an independent assessment of GTT implementation at country level. This is likely to report to the June 2007 Board meeting. The PCB NGO representative for Europe has been involved in the development of this assessment, which has been organized around the following themes:
1. Technical support provided by the UN system and international partners to national AIDS responses;
2. Harmonization and alignment of international development partners to rationalise and simplify the management of development funding
3. What specific progress should we look for in six months?
Though countries committed themselves to set targets by the end of 2006, many countries are still awaiting formal endorsement by the national authorities of the targets, while other low prevalence countries have only just begun the target setting process. In addition, the necessary alignment and integration of target setting to national planning processes means that a number of countries will continue with this process during the course of 2007. During this time, UNAIDS will provide ongoing support to countries to:
i.) Complete their target setting process, including consensus building for joint action;
ii.) Develop and cost robust national action plans, to strengthen harmonization and alignment of partners’ efforts, in support of a scaled up national response;
iii.) Continue support to the development one national monitoring and evaluation system, in order to allow monitoring of progress towards universal access;
iv.) Strengthen civil society engagement, particularly people living with HIV in the entire scaling up process, from planning to implementation,
What specific progress should we look for in one year?
In the next year I expect that the obstacles countries have identified to scaling up treatment programmes are being addressed in partnership with other stakeholders at the country, regional and global level. Sustainable access to affordable medicines, diagnostics and commodities will be one of the first issues to focus on, linked to the need for more sustainable and predictable financing, including access to funding for national and grassroots-level civil society organizations. At the country level, we will continue support the strengthening of networks of civil organizations and people living with HIV through the Joint UN Team, to enable their active engagement in planning and the decentralized implementation of the national response.
The UNAIDS Secretariat and its Cosponsors will work harder with partners at country level to integrate collaborative HIV-TB activities into UN programmes. In this regard, we are delighted that WHO, as the lead agency on health issues under the UN division of labour, is establishing as part of its HIV/AIDS department a new unit on Health Systems Strengthening. UNAIDS is further taking an active role in current discussions on scaling up health systems, being taken forward by WHO and the World Bank. We are all very aware of the need to strengthen coordination, with a clear focus upon country outcomes and we are developing proposals to strengthen these processes so to improve harmonisation of policy among of the different agencies. We hope to see tangible progress in this area through 2007. Alongside this we are currently developing a longer term four year strategic framework that will guide the collective UN effort and encourage us to develop more sustainable responses that can address systemic constraints.
At country level the UNAIDS Country Coordinators and Officers are strongly encouraged to work closely together with WHO and other relevant agencies to ensure focused input for optimum results. We see the formation of single HIV programmes and single teams as an important step in developing health systems responses to AIDS.
The challenge for countries will be to maintain the momentum of the Universal Access and to ensure an exceptional response to AIDS. This needs a longer term vision for AIDS, which encompasses both prevention and treatment, and advocacy to push for sustainable financing strategies.
So I agree with your point that we need a new vision and I hope we can actively involve you and other civil society groups on developing this vision. I know that UNAIDS Staff members are looking forward to the opportunity to meet and discuss thee issues further with the ITPC delegation during the visit you have planned for early 2007.
Michel Sidibe
________________________________
Michel Sidibe
Director
Department of Country and Regional Support
UNAIDS
1211 Geneva 27
Switzerland
Tel. (41) 22 791 3392/4759